Latest & greatest articles for hypertension

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Top results for hypertension

41. Hypertension in pregnancy: Scenario: Proteinuria and no hypertension after 20 weeks' gestation

+] protein on dipstick testing and no other symptoms of pre-eclampsia, follow-up and reassess in 1 week: Advise the woman to seek immediate medical attention if she develops symptoms of in the intervening period. Dipstick the urine and measure the blood pressure. Use albumin:creatinine ratio or protein:creatinine ratio to quantify persistent ([1+] on dipstick) proteinuria. Seek specialist obstetric advice if proteinuria is significant (protein:creatinine ratio of at least 30 mg/mmol (...) care setting by a healthcare professional who is trained in the management of hypertensive disorders [ ]. Expert opinion within the earlier Pre-eclampsia Community Guideline (PRECOG) [ ] states that proteinuria may be the first clinical indication of pre-eclampsia. The recommendation to arrange secondary care assessment for women with [2+] proteinuria is largely based on PRECOG guidelines that all women over 20 weeks' gestation with [2+] proteinuria or more on dipstick testing should be referred

2020 NICE Clinical Knowledge Summaries

42. Hypertension in pregnancy: Scenario: Postpartum follow-up for hypertensive disorders in pregnancy

for up to 2 weeks after transfer to community, care until treatment is no longer required and there is no hypertension. If blood pressure falls below 140/90 mmHg — a reduction in treatment can be considered. If blood pressure falls below 130/80 mmHg — treatment can be reduced. If antihypertensive treatment is required in the postnatal period: Be aware that methyldopa taken during pregnancy should ideally be stopped within 2 days of birth as it may increase the risk of depression. For women who (...) and management [ ]. How should I follow up a woman with chronic hypertension postpartum? Note: antihypertensive treatment in the postnatal period will usually be initiated by a specialist before the woman is discharged from hospital. Further monitoring and management may take place in primary care under the terms of a shared-care arrangement. Measure blood pressure (this will usually be done by the community midwife after hospital discharge): Daily for the first 2 days postnatally. At least once between days

2020 NICE Clinical Knowledge Summaries

43. Hypertension in pregnancy: Scenario: Pre-eclampsia

or flashing before the eyes. Severe pain just below the ribs. Vomiting. Sudden swelling of the face, hands or feet. Arrange emergency secondary care assessment for any woman in whom pre-eclampsia is suspected. Advise women with severe hypertension (blood pressure of 160/110 mmHg or more) then they will be offered hospital admission for ongoing monitoring of their condition and of their baby's wellbeing. Women with less severe hypertension may be offered admission depending upon whether there are clinical (...) practice for women who are at high risk of pre-eclampsia to be referred to a consultant obstetrician. Testing for proteinuria and monitoring blood pressure The recommendation to test for proteinuria and measure blood pressure at each antenatal check is based on expert opinion in the NICE guideline Antenatal care for uncomplicated pregnancies [ ]. Emergency assessment The advice to arrange emergency secondary care assessment for any women in whom pre-eclampsia is suspected is based on advice from NICE

2020 NICE Clinical Knowledge Summaries

44. Hypertension in pregnancy: Scenario: New hypertension after 20 weeks' gestation

' gestation? Arrange secondary care assessment by a healthcare professional trained in the management of hypertensive disorders of pregnancy for all women with new onset of hypertension (over 140 mmHg systolic or over 90 mmHg diastolic) after 20 weeks of pregnancy. Be aware of the signs and symptoms of, and risk factors for . Advise women with new onset severe hypertension (blood pressure of 160/110 mmHg or more) that they are likely to be admitted to hospital for ongoing monitoring of their condition (...) with gestational hypertension/pre-eclampsia should be offered an integrated package of care that may include hospital admission, initiation of pharmacotherapy, regular measurement of blood pressure, testing for proteinuria, relevant blood tests, placental growth factor (PlGF)-based testing (to help rule out pre-eclampsia), and assessment of fetal wellbeing. Admission to hospital if blood pressure is 160/110 mmHg or greater is recommended. © .

2020 NICE Clinical Knowledge Summaries

45. Hypertension in pregnancy: Nifedipine

with caution include: Other antihypertensives — nifedipine may increase their blood pressure-lowering effect. Betablockers — deterioration of heart failure has been observed in isolated cases. Digoxin — may lead to reduced digoxin clearance. The person should therefore be monitored for symptoms of digoxin toxicity such as confusion, nausea, anorexia, or disturbance of colour vision. If digoxin toxicity is suspected, measure serum digoxin levels and seek specialist advice if necessary. Cytochrome P450 (...) (within 4 weeks) of myocardial infarction. Nifedipine should be used with caution in people with: Severe hypotension (systolic blood pressure less than 90 mm Hg). Hepatic impairment. Poor cardiac reserve. Diabetes mellitus — may require adjustment of diabetes treatment as nifedipine can affect blood sugar. [ ; ] Adverse effects Adverse effects of nifedipine include: Neurological — headache, migraine, paraesthesia, tremor, asthenia, vertigo, visual disturbance. Cardiac — vasodilation, hypotension

2020 NICE Clinical Knowledge Summaries

46. Hypertension in pregnancy: Methyldopa

the antihypertensive effect of methyldopa. Iron — may decrease the bioavailability of methyldopa reducing its effect on blood pressure control. [ ; ] Dosing information Start with a dose of 250 mg 2–3 times a day. If required and tolerated, increase the dose gradually at intervals of at least 2 days. Maximum dose is 3 g daily. [ ] © . (...) Hypertension in pregnancy: Methyldopa Methyldopa | Prescribing information | Hypertension in pregnancy | CKS | NICE Search CKS… Menu Methyldopa Hypertension in pregnancy: Methyldopa Last revised in October 2019 Methyldopa Contraindications and cautions Methyldopa is not specifically licensed for the treatment of hypertension in pregnancy. However, the manufacturer states that methyldopa can be used during pregnancy if there is no safer alternative available. Methyldopa should not be prescribed

2020 NICE Clinical Knowledge Summaries

47. Hypertension in pregnancy: Scenario: Chronic hypertension, or new hypertension before 20 weeks' gestation

— consider continuing existing treatment if necessary. Advise the woman that the limited evidence available has not shown an increased risk of congenital malformation with such treatments. Be aware that pregnant women previously diagnosed with chronic hypertension may exhibit blood pressure within the normal range due to the physiological drop in blood pressure that occurs in early pregnancy. Continued antihypertensive treatment is not necessary if: Sustained systolic blood pressure is less than 110 mmHg (...) . For more information, including recommended doses, see the relevant sections in . If a woman with chronic hypertension is not already taking antihypentensive treatment, while she is waiting to see a specialist, offer drug treatment if there is: Sustained systolic blood pressure of 140 mmHg or higher, or Sustained diastolic blood pressure of 90 mmHg or higher. Target blood pressure following antihypertensive treatment in pregnancy is 135/85 mmHg. Ensure that aspirin 75—150 mg daily is prescribed from 12

2020 NICE Clinical Knowledge Summaries

48. Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers

to the coronavirus causing SARS, the COVID-19 virus binds to a specific enzyme called ACE2 to infect cells, and ACE2 levels are increased following treatment with ACE-i and ARBs. Because of the social media-related amplification, patients taking these drugs for their high blood pressure and their doctors have become increasingly concerned, and, in some cases, have stopped taking their ACE-I or ARB medications. This speculation about the safety of ACE-i or ARB treatment in relation to COVID-19 does not have (...) Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser. Did you

2020 European Society of Cardiology

49. Impact of Moderate Aerobic Training on Physical Capacities of Hypertensive Obese Elderly. Full Text available with Trip Pro

Impact of Moderate Aerobic Training on Physical Capacities of Hypertensive Obese Elderly. The association of old age and chronic conditions, such as hypertension and obesity, can lead to larger decreases in the physical capacities of elderly, compared with their healthy counterparts. Physical exercise has been demonstrated to be efficient in postponing this phenomenon, mainly strength training. However, little is known about the effect of aerobic training on this condition. The aim of this work (...) was to investigate the impact of 12 weeks of moderate-intensity aerobic training on the physical capacities of hypertensive obese older women. Aerobic power, lower limb muscle power, upper limb muscle strength, endurance, and flexibility of 19 hypertensive obese elders were evaluated. Afterward, patients were blindly randomized into control group (CG) and exercise group (EG). EG underwent three sessions/week of 60 min of moderate-intensity aerobic training, during 12 weeks. EG showed increases in VO2max compared

2019 Gerontology & geriatric medicine Controlled trial quality: uncertain

50. Hydrochlorothiazide and Squamous Cell Skin Cancer: Remember when hypertension was easy?

Hydrochlorothiazide and Squamous Cell Skin Cancer: Remember when hypertension was easy? 1 Tools for Practice is proudly sponsored by the Alberta College of Family Physicians (ACFP). ACFP is a provincial, professional voluntary organization, representing more than 4,800 family physicians, family medicine residents, and medical students in Alberta. Established over sixty years ago, the ACFP strives for excellence in family practice through advocacy, continuing medical education and primary care (...) research. www.acfp.ca November 25, 2019 (en français) Hydrochlorothiazide and Squamous Cell Skin Cancer: Remember when hypertension was easy? Clinical Question: Does hydrochlorothiazide increase the risk of squamous cell carcinoma (SCC) of the skin? Bottom Line: Observational data suggest an association between hydrochlorothiazide and the risk of SCC. Causation has not been proven. Risk appears to consistently increase with dose and duration (example: 5 years of use increases risk 3-4 times). Baseline

2019 Tools for Practice

51. Therapy for Pulmonary Arterial Hypertension in Adults: Update of the CHEST Guideline and Expert Panel Report

-disordered breathing: ACCP evidence-based clinical practice guidelines. Chest. 2004; 126 : 72S-77S McLaughlin V.V. Presberg K.W. Doyle R.L. et al. Prognosis of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest. 2004; 126 : 78S-92S Taichman D.B. Ornelas J. Chung L. et al. Pharmacologic therapy for pulmonary arterial hypertension in adults: CHEST guideline and expert panel report. Chest. 2014; 146 : 449-475 Diekember R.L. Ireland B.K. Merz L.R. Development (...) Therapy for Pulmonary Arterial Hypertension in Adults: Update of the CHEST Guideline and Expert Panel Report Therapy for Pulmonary Arterial Hypertension in Adults - CHEST Go search , P565-586, March 01, 2019 Powered By Mendeley Share on Therapy for Pulmonary Arterial Hypertension in Adults Update of the CHEST Guideline and Expert Panel Report James R. Klinger Affiliations Brown University, Providence, RI C. Gregory Elliott Affiliations Intermountain Healthcare and the University of Utah School

2019 American College of Chest Physicians

52. 2019 AHA/ACC Clinical Performance and Quality Measures for Adults With High Blood Pressure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures Full Text available with Trip Pro

health insurers. In particular, the widespread use of the 2017 Hypertension Clinical Practice Guidelines classification scheme will also help to guide decision-making about when to prescribe antihypertensive medications in accordance with its current recommendations for the ACC/AHA stages of HBP (ie, stage 2, stage 1, and elevated blood pressure [BP]), as outlined in . Table 3. Guideline Recommendation for BP-Lowering Medications: ACC/AHA COR/LOE ASCVD Risk Stage 2 High BP (≥140 mm Hg) Stage 1 High (...) about intensity of BP lowering and choice of antihypertensive drugs (COR: 2a, LOE: C-EO). ACC indicates American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; COR, Class of Recommendation; and LOE, Level of Evidence. In the 2017 Hypertension Clinical Practice Guidelines, the authors emphasized the critical importance of measuring atherosclerotic cardiovascular disease (ASCVD) risk for all patients with HBP, regardless

2019 American Heart Association

53. Updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension Full Text available with Trip Pro

S8 online), or cardiomyopathy with elevated left ventricular end-diastolic filling pressures. AVT, acute vasoreactivity testing; ASD, atrial septal defect; CHD, congenital heart disease; iNO, inhaled nitric oxide; PAH, pulmonary arterial hypertension; PDA, patent ductus arteriosus; PH, pulmonary hypertension; PHVD, pulmonary hypertensive vascular disease; pre-OP, preoperatively; PVR, pulmonary vascular resistance; PVRi, pulmonary vascular resistance index; Qp, pulmonary blood flow; Qs, systemic (...) : , , , , , , , , Pulmonary hypertension (PH) and associated pulmonary vascular disease (PVD) are characterized by pulmonary vascular remodeling leading to elevated pulmonary arterial pressure and, over time, right ventricular (RV) dysfunction, underfilling/compression of the left ventricle, and terminal heart failure. x 1 Humbert, M, Guignabert, C, Bonnet, S et al. Pathology and pathobiology of pulmonary hypertension: State of the art and research perspectives. Eur Respir J . 2019 ; 53 , x 2 Vonk Noordegraaf, A, Chin

2019 International Society for Heart and Lung Transplantation

54. Cardiopulmonary exercise testing in a combined screening approach to individuate pulmonary arterial hypertension in systemic sclerosis Full Text available with Trip Pro

Cardiopulmonary exercise testing in a combined screening approach to individuate pulmonary arterial hypertension in systemic sclerosis The DETECT algorithm has been developed to identify SSc patients at risk for pulmonary arterial hypertension (PAH) yielding high sensitivity but low specificity, and positive predictive value. We tested whether cardiopulmonary exercise testing (CPET) could improve the performance of the DETECT screening strategy.Consecutive SSc patients over a 30-month period (...) were screened with the DETECT algorithm and positive subjects were referred for CPET before the execution of right-heart catheterization. The predictive performance of CPET on top of DETECT was evaluated and internally validated via bootstrap replicates.Out of 314 patients, 96 satisfied the DETECT application criteria and 54 were positive. PAH was ascertained in 17 (31.5%) and pre-capillary pulmonary hypertension in 23 (42.6%) patients. Within CPET variables, the slope of the minute ventilation

2019 EvidenceUpdates

55. In patients taking a beta blocker for uncomplicated hypertension, what is the best way to taper it off?

therapy, there is an upregulation of receptors, which can lead to an adrenergic surge if BBs are abruptly stopped. This is particularly seen with short-acting BBs. So, how do we prevent an adrenergic surge and appropriately taper? We don’t really know, as there haven’t been many studies. One study from back in 1982 compared a propranolol taper over 6 to 9 days versus over 2 weeks and found no difference in blood pressure. Beta-adrenergic receptors have half-lives of 1.5 days, so tapering with halved (...) In patients taking a beta blocker for uncomplicated hypertension, what is the best way to taper it off? Chiefs’ Inquiry Corner 11/4/19 – Clinical Correlations Search Chiefs’ Inquiry Corner 11/4/19 November 4, 2019 2 min read Beta blockers (BBs) have fallen out of favor as first-line, or even second-line, treatment options for hypertension. And as patients’ medical regimens gradually drop BBs, concerns may arise about the rebound phenomenon we learn in medical school. With chronic beta blocker

2019 Clinical Correlations

56. Therapeutic-induced hypertension in patients with noncardioembolic acute stroke (Abstract)

group, phenylephrine was administered intravenously to increase systolic blood pressure (SBP) up to 200 mm Hg. The primary efficacy endpoint was early neurologic improvement (reduction in NIH Stroke Scale [NIHSS] score of ≥2 points during the first 7 days). The secondary efficacy endpoint was a modified Rankin Scale score of 0 to 2 at 90 days. Safety outcomes included symptomatic intracranial hemorrhage/edema, myocardial infarction, and death.In the modified intention-to-treat analyses, 76 and 77 (...) Therapeutic-induced hypertension in patients with noncardioembolic acute stroke To evaluate the safety and efficacy of induced hypertension in patients with acute ischemic stroke.In this multicenter randomized clinical trial, patients with acute noncardioembolic ischemic stroke within 24 hours of onset who were ineligible for revascularization therapy and those with progressive stroke during hospitalization were randomly assigned (1:1) to the control and intervention groups. In the intervention

2019 EvidenceUpdates

57. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial Full Text available with Trip Pro

) to ingest the entire daily dose of ≥1 hypertension medications at bedtime (n = 9552) or all of them upon awakening (n = 9532). At inclusion and at every scheduled clinic visit (at least annually) throughout follow-up, ambulatory blood pressure (ABP) monitoring was performed for 48 h. During the 6.3-year median patient follow-up, 1752 participants experienced the primary CVD outcome (CVD death, myocardial infarction, coronary revascularization, heart failure, or stroke). Patients of the bedtime, compared (...) with the upon-waking, treatment-time regimen showed significantly lower hazard ratio-adjusted for significant influential characteristics of age, sex, type 2 diabetes, chronic kidney disease, smoking, HDL cholesterol, asleep systolic blood pressure (BP) mean, sleep-time relative systolic BP decline, and previous CVD event-of the primary CVD outcome [0.55 (95% CI 0.50-0.61), P < 0.001] and each of its single components (P < 0.001 in all cases), i.e. CVD death [0.44 (0.34-0.56)], myocardial infarction [0.66

2019 EvidenceUpdates

58. Causal association between periodontitis and hypertension: evidence from Mendelian randomization and a randomized controlled trial of non-surgical periodontal therapy Full Text available with Trip Pro

performed a two-sample Mendelian randomization analysis in the ∼750 000 UK-Biobank/International Consortium of Blood Pressure-Genome-Wide Association Studies participants using single nucleotide polymorphisms (SNPs) in SIGLEC5, DEFA1A3, MTND1P5, and LOC107984137 loci GWAS-linked to periodontitis, to ascertain their effect on blood pressure (BP) estimates. This demonstrated a significant relationship between periodontitis-linked SNPs and BP phenotypes. We then performed a randomized intervention trial (...) on the effects of treatment of periodontitis on BP. One hundred and one hypertensive patients with moderate/severe periodontitis were randomized to intensive periodontal treatment (IPT; sub- and supragingival scaling/chlorhexidine; n = 50) or control periodontal treatment (CPT; supragingival scaling; n = 51) with mean ambulatory 24-h (ABPM) systolic BP (SBP) as primary outcome. Intensive periodontal treatment improved periodontal status at 2 months, compared to CPT. This was accompanied by a substantial

2019 EvidenceUpdates

59. Endothelin receptor antagonists for pulmonary arterial hypertension

Endothelin receptor antagonists for pulmonary arterial hypertension '); } else { document.write(' '); } ACE | Endothelin receptor antagonists for treating pulmonary arterial hypertension Search > > Endothelin receptor antagonists for treating pulmonary arterial hypertension - Endothelin receptor antagonists for treating pulmonary arterial hypertension Published on 2 September 2019 Guidance Recommendations The Ministry of Health's Drug Advisory Committee has recommended: Ambrisentan 5 mg and 10 (...) mg tablets for treating adults with a confirmed diagnosis of WHO Functional Class II or III pulmonary arterial hypertension (PAH) who have one of the following PAH aetiologies: Idiopathic PAH; Heritable or familial PAH; PAH associated with connective tissue disease; Anorexigen-induced PAH; or PAH associated with HIV infection. Subsidy status Ambrisentan 5 mg and 10 mg tablets are recommended for inclusion on the Medication Assistance Fund (MAF) for the abovementioned indication. MAF assistance

2019 Appropriate Care Guides, Agency for Care Effectiveness (Singapore)

60. A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4): a cluster-randomised controlled trial. (Abstract)

A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4): a cluster-randomised controlled trial. Hypertension is the leading cause of cardiovascular disease globally. Despite proven benefits, hypertension control is poor. We hypothesised that a comprehensive approach to lowering blood pressure and other risk factors, informed by detailed analysis of local barriers, would be superior to usual care in individuals with poorly controlled or newly diagnosed (...) % (95% CI -7·11 to -2·44, p<0·0001). There was an absolute 11·45 mm Hg (95% CI -14·94 to -7·97) greater reduction in systolic blood pressure, and a 0·41 mmol/L (95% CI -0·60 to -0·23) reduction in LDL with the intervention group (both p<0·0001). Change in blood pressure control status (<140 mm Hg) was 69% in the intervention group versus 30% in the control group (p<0·0001). There were no safety concerns with the intervention.A comprehensive model of care led by NPHWs, involving primary care

2019 Lancet