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Alissa A Frame, Richard David Wainford
The prevalence of hypertension rises with age to approximately two out of three adults over the age of 60 in the United States. Although the mechanisms underlying age-related hypertension are incompletely understood, sodium homeostasis is critical to the long-term regulation of blood pressure and there is strong evidence that aging is associated with alterations in renal sodium handling. This mini-review focuses on recent advancements in our understanding of the vascular, neurohumoral, and renal mechanisms that influence sodium homeostasis and promote age-related hypertension...
February 14, 2018: American Journal of Physiology. Renal Physiology
Tengis S Pavlov, Alexander Staruschenko
Salt-sensitive hypertension is associated with renal and vascular dysfunctions, which lead to impaired fluid excretion, increased cardiac output, and total peripheral resistance. It is commonly accepted that increased renal sodium handling and plasma volume expansion are necessary factors for the development of salt-induced hypertension. The epithelial sodium channel (ENaC) is a trimeric ion channel expressed in the distal nephron that plays a critical role in the regulation of sodium reabsorption in both normal and pathological conditions...
August 1, 2017: American Journal of Physiology. Renal Physiology
Bernard C Rossier
The amiloride-sensitive epithelial sodium channel (ENaC) constitutes the rate-limiting step for sodium reabsorption in epithelial cells that line the distal part of the renal tubule, the distal colon, the duct of several exocrine glands, and the lung. The activity of this channel is regulated by aldosterone and hormones involved in the maintenance of sodium balance, blood volume and blood pressure. In this review, we discuss recent advances in our understanding of ENaC function and regulation relevant to the control of sodium balance and blood pressure...
April 2014: Current Opinion in Pharmacology
Mahdi Salih, Ivan Gautschi, Miguel X van Bemmelen, Michael Di Benedetto, Alice S Brooks, Dorien Lugtenberg, Laurent Schild, Ewout J Hoorn
Liddle syndrome is an autosomal dominant form of hypokalemic hypertension due to mutations in the β- or γ-subunit of the epithelial sodium channel (ENaC). Here, we describe a family with Liddle syndrome due to a mutation in αENaC. The proband was referred because of resistant hypokalemic hypertension, suppressed renin and aldosterone, and no mutations in the genes encoding β- or γENaC. Exome sequencing revealed a heterozygous, nonconservative T>C single-nucleotide mutation in αENaC that substituted Cys479 with Arg (C479R)...
November 2017: Journal of the American Society of Nephrology: JASN
Leo F Buckley, Dave L Dixon, George F Wohlford, Dayanjan S Wijesinghe, William L Baker, Benjamin W Van Tassell
OBJECTIVE: We sought to determine the effect of intensive blood pressure (BP) control on cardiovascular outcomes in participants with type 2 diabetes mellitus (T2DM) and additional risk factors for cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS: This study was a post hoc, multivariate, subgroup analysis of ACCORD-BP (Action to Control Cardiovascular Risk in Diabetes Blood Pressure) participants. Participants were eligible for the analysis if they were in the standard glucose control arm of ACCORD-BP and also had the additional CVD risk factors required for SPRINT (Systolic Blood Pressure Intervention Trial) eligibility...
December 2017: Diabetes Care
Paul E Drawz, Joachim H Ix
Hypertension is the leading chronic disease risk factor in the world and is especially important in patients with CKD, nearly 90% of whom have hypertension. Recently, in the Systolic BP Intervention Trial (SPRINT), intensive lowering of clinic systolic BP to a target <120 mm Hg, compared with a standard BP target of <140 mm Hg, reduced risk for cardiovascular disease and all-cause mortality. However, because BP was measured unobserved using an automated device, some investigators have questioned the ability to translate SPRINT results into routine clinical practice, in which measurement of BP is typically less standardized...
February 2018: Journal of the American Society of Nephrology: JASN
Raymond R Townsend, Tara I Chang, Debbie L Cohen, William C Cushman, Gregory W Evans, Stephen P Glasser, William E Haley, Christine Olney, Suzanne Oparil, Rita Del Pinto, Roberto Pisoni, Addison A Taylor, Kausik Umanath, Jackson T Wright, Joseph Yeboah
Orthostatic changes in systolic blood pressure (SBP) impact cardiovascular outcomes. In this study, we aimed to determine the pattern of orthostatic systolic pressure changes in participants enrolled in the SBP Intervention Trial (SPRINT) at their baseline visit before randomization and sought to understand clinical factors predictive of these changes. Of the 9323 participants enrolled in SPRINT, 8662 had complete data for these analyses. The SBP after 1 minute of standing was subtracted from the mean value of the three preceding seated SBP values...
November 2016: Journal of the American Society of Hypertension: JASH
Michael V Rocco, Kaycee M Sink, Laura C Lovato, Dawn F Wolfgram, Thomas B Wiegmann, Barry M Wall, Kausik Umanath, Frederic Rahbari-Oskoui, Anna C Porter, Roberto Pisoni, Cora E Lewis, Julia B Lewis, James P Lash, Lois A Katz, Amret T Hawfield, William E Haley, Barry I Freedman, Jamie P Dwyer, Paul E Drawz, Mirela Dobre, Alfred K Cheung, Ruth C Campbell, Udayan Bhatt, Srinivasan Beddhu, Paul L Kimmel, David M Reboussin, Glenn M Chertow
BACKGROUND: Treating to a lower blood pressure (BP) may increase acute kidney injury (AKI) events. STUDY DESIGN: Data for AKI resulting in or during hospitalization or emergency department visits were collected as part of the serious adverse events reporting process of the Systolic Blood Pressure Intervention Trial (SPRINT). SETTING & PARTICIPANTS: 9,361 participants 50 years or older with 1 or more risk factors for cardiovascular disease...
November 18, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Daniel E Weiner, Sarah A Gaussoin, John Nord, Alexander P Auchus, Gordon J Chelune, Michel Chonchol, Laura Coker, William E Haley, Anthony A Killeen, Paul L Kimmel, Alan J Lerner, Suzanne Oparil, Mohammad G Saklayen, Yelena M Slinin, Clinton B Wright, Jeff D Williamson, Manjula Kurella Tamura
BACKGROUND: Chronic kidney disease is common and is associated with cardiovascular disease, cerebrovascular disease, and cognitive function, although the nature of this relationship remains uncertain. STUDY DESIGN: Cross-sectional cohort using baseline data from the Systolic Blood Pressure Intervention Trial (SPRINT). SETTING & PARTICIPANTS: Participants in SPRINT, a randomized clinical trial of blood pressure targets in older community-dwelling adults with cardiovascular disease, chronic kidney disease, or high cardiovascular disease risk and without diabetes or known stroke, who underwent detailed neurocognitive testing in the cognition substudy, SPRINT-Memory and Cognition in Decreased Hypertension (SPRINT-MIND)...
September 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Elsayed Z Soliman, Walter T Ambrosius, William C Cushman, Zhu-Ming Zhang, Jeffrey T Bates, Javier A Neyra, Thaddeus Y Carson, Leonardo Tamariz, Lama Ghazi, Monique E Cho, Brian P Shapiro, Jiang He, Lawrence J Fine, Cora E Lewis
BACKGROUND: It is currently unknown whether intensive blood pressure (BP) lowering beyond that recommended would lead to more lowering of the risk of left ventricular hypertrophy (LVH) in patients with hypertension and whether reducing the risk of LVH explains the reported cardiovascular disease (CVD) benefits of intensive BP lowering in this population. METHODS: This analysis included 8164 participants (mean age, 67.9 years; 35.3% women; 31.2% blacks) with hypertension but no diabetes mellitus from the SPRINT trial (Systolic Blood Pressure Intervention Trial): 4086 randomly assigned to intensive BP lowering (target SBP <120 mm Hg) and 4078 assigned to standard BP lowering (target SBP <140 mm Hg)...
August 1, 2017: Circulation
Katrina M Mirabito Colafella, Kate M Denton
Although intrinsic mechanisms that regulate arterial blood pressure (BP) are similar in men and women, marked variations exist at the molecular, cellular and tissue levels. These physiological disparities between the sexes likely contribute to differences in disease onset, susceptibility, prevalence and treatment responses. Key systems that are important in the development of hypertension and cardiovascular disease (CVD), including the sympathetic nervous system, the renin-angiotensin-aldosterone system and the immune system, are differentially activated in males and females...
January 30, 2018: Nature Reviews. Nephrology
Wanpen Vongpatanasin
Resistant hypertension-uncontrolled hypertension with 3 or more antihypertensive agents-is increasingly common in clinical practice. Clinicians should exclude pseudoresistant hypertension, which results from nonadherence to medications or from elevated blood pressure related to the white coat syndrome. In patients with truly resistant hypertension, thiazide diuretics, particularly chlorthalidone, should be considered as one of the initial agents. The other 2 agents should include calcium channel blockers and angiotensin-converting enzyme inhibitors for cardiovascular protection...
June 4, 2014: JAMA: the Journal of the American Medical Association
Alexander A Leung, Dennis J Orton, Alex Chin, Hossein Sadrzadeh, Gregory A Kline
Direct renin concentration is replacing plasma renin activity in many laboratories for the investigation of primary aldosteronism, which may have a significant impact on the resulting aldosterone:renin ratios. We sought to develop a population-based approach to establishing an aldosterone:renin ratio cutoff when transitioning between assays. A population-based study was performed in Calgary, Alberta, Canada of 4301 individuals who received testing from January 2012 to November 2015. In 2014, direct renin concentration replaced plasma renin activity in routine testing...
March 2017: Hypertension
Gian Paolo Rossi, Teresa Maria Seccia, Gaetana Palumbo, Anna Belfiore, Giampaolo Bernini, Graziella Caridi, Giovambattista Desideri, Bruno Fabris, Claudio Ferri, Gilberta Giacchetti, Claudio Letizia, Mauro Maccario, Francesca Mallamaci, Massimo Mannelli, Anna Patalano, Damiano Rizzoni, Ermanno Rossi, Achille Cesare Pessina, Franco Mantero
The plasma aldosterone concentration:renin ratio (ARR) is widely used for the screening of primary aldosteronism, but its reproducibility is unknown. We, therefore, investigated the within-patient reproducibility of the ARR in a prospective multicenter study of consecutive hypertensive patients referred to specialized centers for hypertension in Italy. After the patients were carefully prepared from the pharmacological standpoint, the ARR was determined at baseline in 1136 patients and repeated after, on average, 4 weeks in the patients who had initially an ARR > or =40 and in 1 of every 4 of those with an ARR <40...
January 2010: Hypertension
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
2016-09-08 02:04:49
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