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David M Reboussin, Norrina B Allen, Michael E Griswold, Eliseo Guallar, Yuling Hong, Daniel T Lackland, Edgar Pete R Miller, Tamar Polonsky, Angela M Thompson-Paul, Suma Vupputuri
OBJECTIVE: To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? METHODS: Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question...
November 7, 2017: Journal of the American College of Cardiology
Hélène Beaussier, Pierre Boutouyrie, Guillaume Bobrie, Michael Frank, Stéphane Laurent, François Coudoré, Michel Azizi
OBJECTIVES: We assessed the influence of medication adherence on blood pressure (BP) control and target organ damage in a pre-specified analysis of a published trial comparing sequential nephron blockade (SNB) or sequential renin-angiotensin system blockade (SRASB) in patients with resistant hypertension. METHODS: Patients were randomized to SNB (n = 82) or SRASB (n = 82) and studied at baseline and after 12 weeks. BP was measured by ambulatory blood pressure monitoring...
December 2015: Journal of Hypertension
Anil K Bidani, Karen A Griffin
Substantial evidence indicates that the adverse effects of hypertension on the kidney depend on the degree to which systemic blood pressure elevations are transmitted to the renal microvasculature. Such blood pressure transmission and consequent susceptibility to hypertensive renal damage is markedly exacerbated in states characterized by preglomerular vasodilation and an impairment of the normally protective renal autoregulatory mechanisms, e.g. diabetes or chronic renal disease. Moreover, this pathophysiology gives rise to the prediction that prevention of hypertension-induced barotrauma will require blood pressure to be reduced well into the normotensive range in such patients, as is being recognized in the currently recommended blood pressure goals...
January 2002: Current Opinion in Nephrology and Hypertension
Ramón C Hermida, Diana E Ayala, Artemio Mojón, José R Fernández
Time of ingestion of hypertension medications can affect circadian patterns of BP, but whether this translates into an effect on clinical outcomes is unknown. Here, in an open-label trial, we randomly assigned 661 patients with CKD either to take all prescribed hypertension medications upon awakening or to take at least one of them at bedtime. We measured 48-hour ambulatory BP at baseline and 3 months after any adjustment in treatment or, at the least, annually. After a median follow-up of 5.4 years, patients who took at least one BP-lowering medication at bedtime had an adjusted risk for total cardiovascular events (a composite of death, myocardial infarction, angina pectoris, revascularization, heart failure, arterial occlusion of lower extremities, occlusion of the retinal artery, and stroke) that was approximately one-third that of patients who took all medications upon awakening (adjusted HR 0...
December 2011: Journal of the American Society of Nephrology: JASN
Luca De Nicola, Francis B Gabbai, Rajiv Agarwal, Paolo Chiodini, Silvio Borrelli, Vincenzo Bellizzi, Felice Nappi, Giuseppe Conte, Roberto Minutolo
OBJECTIVES: This study sought to evaluate in chronic kidney disease (CKD) prevalence and prognosis of true resistant hypertension (RH) (i.e., confirmed by ambulatory blood pressure [ABP] monitoring). BACKGROUND: In CKD, uncontrolled hypertension is a major risk factor, but no study has properly investigated the role of RH. METHODS: We prospectively studied 436 hypertensive CKD patients under nephrology care. Four groups were constituted by combining 24-h ABP with diagnosis of RH (office blood pressure ≥130/80 mm Hg, despite adherence to ≥3 full-dose antihypertensive drugs including a diuretic agent or ≥4 drugs): control (ABP <125/75 mm Hg without RH); pseudoresistance (ABP <125/75 mm Hg with RH); sustained hypertension (ABP ≥125/75 mm Hg without RH); and true resistance (ABP ≥125/75 mm Hg with RH)...
June 18, 2013: Journal of the American College of Cardiology
Sudhir Unni, Kellee White, Michael Goodman, Xiangyang Ye, Panagiotis Mavros, Lori D Bash, Diana Brixner
BACKGROUND: Hypertension is a major risk factor in the progression of chronic kidney disease (CKD). Although hypertension is more prevalent and treated more often among CKD patients, it is less likely to be controlled. Current guidelines recommend the use of multiple antihypertensive agents to achieve optimal blood pressure (BP) control. However, BP control attained by number and type of antihypertensive therapy according to CKD stage has not been examined thoroughly. STUDY DESIGN: Cross-sectional analysis of an electronic medical record (EMR) database...
June 2015: American Journal of Hypertension
Eoin O'Brien, Eamon Dolan, Neil Atkins
No abstract text is available yet for this article.
June 2015: Journal of Clinical Hypertension
Stephen C Textor, Michael M McKusick
PURPOSE OF REVIEW: Atherosclerotic renovascular disease remains highly prevalent and presents an array of clinical syndromes. Recent prospective trials have dampened enthusiasm for revascularization generally, but clinicians recognize the need to identify patients likely to benefit from vascular intervention. RECENT FINDINGS: This article highlights the inflammatory nature of vascular occlusive disease and the limits of the kidney to adapt to reduced blood flow...
March 2016: Current Opinion in Nephrology and Hypertension
J Radermacher, A Chavan, J Bleck, A Vitzthum, B Stoess, M J Gebel, M Galanski, K M Koch, H Haller
BACKGROUND: Prospectively identifying patients whose renal function or blood pressure will improve after the correction of renal-artery stenosis has not been possible. We evaluated whether a high level of resistance to flow in the segmental arteries of both kidneys (indicated by resistance-index values of at least 80) can be used prospectively to select appropriate patients for treatment. METHODS: We evaluated 5950 patients with hypertension for renal-artery stenosis using color Doppler ultrasonography, and we measured the resistance index ([1 - end-diastolic velocity divided by maximal systolic velocity] x 100)...
February 8, 2001: New England Journal of Medicine
Heinrich Wieneke, Thomas Friedrich Michael Konorza, Holger Eggebrecht, Christoph Kurt Naber, Sebastian Philipp, Thomas Philipp, Andreas Kribben, Raimund Erbel
Renal artery stenosis (RAS) is both a common and progressive disease and its prevalence in patients > 65 years is 6.8%. In patients with known or suspected atherosclerosis undergoing coronary angiography, a frequency of even 11-23% is reported in the literature. Despite this high prevalence, there is an ongoing discussion about the indications for revascularization and it is currently unclear, whether renal artery revascularization reduces adverse cardiovascular and renal events. Nevertheless, the number of interventions for RAS is rising steadily, although up to 40% of patients do not profit from this intervention...
May 15, 2009: Medizinische Klinik
K Kario, G L Bakris, D Bhatt
OBJECTIVE: To study the impact of catheter-based renal artery denervation (RDN) on change in morning and night systolic BP (SBP) defined by ambulatory BP measurements (ABPM) 6 months post-randomization. DESIGN AND METHOD: SYMPLICITY HTN-3 and SYMPLICITY HTN-Japan are prospective, randomized, controlled trials of RDN for treatment of resistant hypertension. However, SYMPLICITY HTN-3 included a blinded, sham control and HTN-Japan control patients were not blinded and continued medical management alone...
June 2015: Journal of Hypertension
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
Giacomo Pucci, Maria Giovanna Ranalli, Francesca Battista, Giuseppe Schillaci
β-Blockers are less effective than other antihypertensive drug classes in reducing central systolic blood pressure (cSBP) as compared with peripheral SBP (pSBP). Whether this effect is less pronounced with vasodilating β-blockers (VBB) when compared with nonvasodilating β-blockers (NVBB) remains unsettled. We conducted a systematic review and meta-analysis of randomized trials exploring the effects of β-blockers on both pSBP and cSBP in hypertension. We selected 20 studies, for a total of 32 treatment arms (n=21 for NVBB, n=11 for VBB) and 1263 participants (n=962 for NVBB, n=301 for VBB)...
February 2016: Hypertension
Rajiv Agarwal
Left ventricular (LV) hypertrophy is an established cardiovascular risk factor, yet little is known about its trajectory in people with chronic kidney disease. The goal of this prospective research study was to describe the trajectory of LV mass index, its relationship with blood pressure (BP), and specifically to compare the relationship of BP measured in the clinic and 24-hour ambulatory BP monitoring with LV mass index. Among 274 veterans with chronic kidney disease followed for over ≤ 4 years, the rate of growth of log LV mass index was inversely related to baseline LV mass index; it was rapid in the first 2 years, and plateaued subsequently...
April 2016: Hypertension
Frederik Persson, Julia B Lewis, Edmund J Lewis, Peter Rossing, Norman K Hollenberg, Parving Hans-Henrik
INTRODUCTION: Aldosterone blockade reduces albuminuria in diabetic patients with chronic kidney disease (CKD), and improves prognosis in chronic heart failure. This study assessed the effects of direct renin inhibition with aliskiren in combination with losartan and optimal antihypertensive therapy on urinary aldosterone, plasma renin activity (PRA) and plasma renin concentration (PRC). MATERIALS AND METHODS: In the AVOID study, 599 patients with type 2 diabetes, hypertension and nephropathy received 6 months aliskiren (150 mg force titrated to 300 mg once daily after 3 months) or placebo added to losartan 100 mg and optimal antihypertensive therapy...
March 2012: Journal of the Renin-angiotensin-aldosterone System: JRAAS
Hans-Henrik Parving, Frederik Persson, Julia B Lewis, Edmund J Lewis, Norman K Hollenberg
BACKGROUND: Diabetic nephropathy is the leading cause of end-stage renal disease in developed countries. We evaluated the renoprotective effects of dual blockade of the renin-angiotensin-aldosterone system by adding treatment with aliskiren, an oral direct renin inhibitor, to treatment with the maximal recommended dose of losartan (100 mg daily) and optimal antihypertensive therapy in patients who had hypertension and type 2 diabetes with nephropathy. METHODS: We enrolled 599 patients in this multinational, randomized, double-blind study...
June 5, 2008: New England Journal of Medicine
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
Carolyn H Still, Keith C Ferdinand, Gbenga Ogedegbe, Jackson T Wright
UNLABELLED: Hypertension is the most commonly diagnosed condition in persons aged 60 and older and is the single most important risk factor for cardiovascular disease (ischemic heart disease, heart failure, and stroke), kidney disease, and dementia. More than half of individuals with hypertension in the United States are aged 60 and older. Hypertension disproportionately affects African Americans, with all age groups, including elderly adults, having a higher burden of hypertension-related complications than other U...
October 2015: Journal of the American Geriatrics Society
Walter T Ambrosius, Kaycee M Sink, Capri G Foy, Dan R Berlowitz, Alfred K Cheung, William C Cushman, Lawrence J Fine, David C Goff, Karen C Johnson, Anthony A Killeen, Cora E Lewis, Suzanne Oparil, David M Reboussin, Michael V Rocco, Joni K Snyder, Jeff D Williamson, Jackson T Wright, Paul K Whelton
BACKGROUND: High blood pressure is an important public health concern because it is highly prevalent and a risk factor for adverse health outcomes, including coronary heart disease, stroke, decompensated heart failure, chronic kidney disease, and decline in cognitive function. Observational studies show a progressive increase in risk associated with blood pressure above 115/75 mm Hg. Prior research has shown that reducing elevated systolic blood pressure lowers the risk of subsequent clinical complications from cardiovascular disease...
October 2014: Clinical Trials: Journal of the Society for Clinical Trials
Giuseppe Mancia
The Eighth Joint National Committee (JNC 8) guidelines on hypertension have generated great interest among physicians. These guidelines differ from those published in 2003 (the JNC 7) - in the document format, blood-pressure cut-off values, and recommendations for antihypertensive drug use. The JNC 8 have some limitations that could affect clinical practice.
April 2014: Nature Reviews. Cardiology
2015-11-18 20:11:16
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