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Natriuretic Peptide Testing for Pulmonary Arterial Hypertension: Clinical Effectiveness, Cost-Effectiveness, and Guidelines Natriuretic Peptide Testing for Pulmonary Arterial Hypertension: Clinical Effectiveness, Cost-Effectiveness, and Guidelines | CADTH.ca Find the information you need Natriuretic Peptide Testing for Pulmonary Arterial Hypertension: Clinical Effectiveness, Cost-Effectiveness, and Guidelines Natriuretic Peptide Testing for Pulmonary Arterial Hypertension: Clinical (...) Effectiveness, Cost-Effectiveness, and Guidelines Last updated: July 24, 2019 Project Number: RB1358-000 Product Line: Research Type: Devices and Systems Report Type: Summary of Abstracts Result type: Report Question What is the clinical utility of natriuretic peptide testing for prognosis or guiding therapy for pulmonary arterial hypertension? What is the cost-effectiveness of natriuretic peptide testing for prognosis or guiding therapy for pulmonary arterial hypertension? What are the guidelines
). It is aimed at teams of health professionals who refer patients to specialists for a Transjugular intrahepatic portosystemic stent-shunt (TIPSS). This patient summary aims to summarise the key recommendations. TIPSS is a non-surgical treatment for patients with liver disease and higher than normal pressures in the liver and surrounding blood vessels (known as portal hypertension), in particular the portal vein and hepatic veins. It involves a specialist (doctor) known as an interventional radiologist (...) is performed within 72h of an acute variceal bleed in a stable patient who has stopped bleeding. There is conflicting data on whether it is effective, and which patients stand to benefit from this option. b. In patients with long standing kidney disease. c. In a very rare condition called idiopathic non-cirrhotic portal hypertension where there is disease in the small blood vessels in the liver. d. TIPSS as a preventative therapy in patients with portal hypertension being considered for surgery outside
hypertension Pulmonary hypertension (PH) is a serious condition of the pulmonary blood vessels characterized by increased pulmonary arterial pressure (PAP) and is often associated with progressive right ventricular (RV) failure and a high risk of death. PH is increasingly recognized as an important cause of dyspnea and exercise limitation in many patients. As per the current World Health Organization (WHO) PH classification updated at the Sixth World Symposium on Pulmonary Hypertension held in 2018 in Nice (...) with previous pulmonary embolism. Thromb Res. 2009;124(3):256–258. 10. Gary T, Starz I, Belaj K, et al. Hyperlipidemia is associated with a higher pulmonary artery systolic pressure in patients after pul- monary embolism. Thromb Res. 2012;129(1):86–88. 11. Giuliani L, Piccinino C, D’Armini MA, et al. Prevalence of undiag- nosed chronic thromboembolic pulmonary hypertension after pul- monary embolism. Blood Coagul Fibrinolysis. 2014;25(7):649–653. 12. Gu erin L, Couturaud F, Parent F, et al. Prevalence
Prostanoids and their analogues for the treatment of pulmonary hypertension in neonates. Persistent pulmonary hypertension of the newborn (PPHN) is a disease entity that describes a physiology in which there is persistence of increased pulmonary arterial pressure. PPHN is characterised by failure to adapt to a functional postnatal circulation with a fall in pulmonary vascular resistance. PPHN is responsible for impairment in oxygenation and significant neonatal mortality and morbidity
Oral antihypertensive regimens (nifedipine retard, labetalol, and methyldopa) for management of severe hypertension in pregnancy: an open-label, randomised controlled trial. Hypertension is the most common medical disorder in pregnancy, complicating one in ten pregnancies. Treatment of severely increased bloodpressure is widely recommended to reduce the risk for maternal complications. Regimens for the acute treatment of severe hypertension typically include intravenous medications. Although (...) stillborn. No birth had more than one adverse event.All oral antihypertensives reduced bloodpressure to the reference range in most women. As single drugs, nifedipine retard use resulted in a greater frequency of primary outcome attainment than labetalol or methyldopa use. All three oral drugs-methyldopa, nifedipine, and labetalol-are viable initial options for treating severe hypertension in low-resource settings.PREEMPT (University of British Columbia, Vancouver, BC, Canada; grantee of Bill & Melinda
2019LancetControlled trial quality: predicted high
Calcium supplementation commencing before or early in pregnancy, for preventing hypertensivedisorders of pregnancy. The hypertensivedisorders of pregnancy include pre-eclampsia, gestational hypertension, chronic hypertension, and undefined hypertension. Pre-eclampsia is considerably more prevalent in low-income than in high-income countries. One possible explanation for this discrepancy is dietary differences, particularly calcium deficiency. Calcium supplementation in the second half (...) to be inadequate. This is an update of a review first published in 2017.To determine the effect of calcium supplementation, given before or early in pregnancy and for at least the first half of pregnancy, on pre-eclampsia and other hypertensivedisorders, maternal morbidity and mortality, and fetal and neonatal outcomes.We searched the Cochrane Pregnancy and Childbirth Trials Register (31 July 2018), PubMed (13 July 2018), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP; 31
Patiromer versus placebo to enable spironolactone use in patients with resistant hypertension and chronic kidney disease (AMBER): a phase 2, randomised, double-blind, placebo-controlled trial. Spironolactone is effective at reducing bloodpressure in patients with uncontrolled resistant hypertension. However, the use of spironolactone in patients with chronic kidney disease can be restricted by hyperkalaemia. We evaluated use of the potassium binder patiromer to allow more persistent use (...) eligibility criteria at the final screening visit were stratified by local serum potassium measurement (4·3 to <4·7 mmol/L vs 4·7 to 5·1 mmol/L) and history of diabetes. Participants were randomly assigned (1:1) with an interactive web response system to receive either placebo or patiromer (8·4 g once daily), in addition to open-label spironolactone (starting at 25 mg once daily) and their baseline bloodpressure medications. Participants, the study team that administered treatments and measured blood
people with isolated systolic hypertension (systolic bloodpressure 160 mmHg or more) the same treatment as people with both raised systolic and diastolic bloodpressure.   1.4.28 Offer antihypertensive drug treatment to women of childbearing potential with diagnosed hypertension in line with the recommendations in this guideline. For women considering pregnancy or who are pregnant or breastfeeding, manage hypertension in line with the recommendations on management of pregnancy (...) is it for? 4 Recommendations 5 1.1 Measuring bloodpressure 5 1.2 Diagnosing hypertension 6 1.3 Assessing cardiovascular risk and target organ damage 8 1.4 Treating and monitoring hypertension 9 1.5 Identifying who to refer for same-day specialist review 17 T erms used in this guideline 18 Recommendations for research 21 Key recommendations for research 21 Rationale and impact 23 Diagnosing hypertension 23 Relaxation therapies 24 Starting antihypertensive drug treatment 25 Monitoring treatment and blood
Morbidity of Persistent Pulmonary Hypertension of the Newborn in the First Year of Life To assess postdischarge mortality and morbidity in infants diagnosed with different etiologies and severities of persistent pulmonary hypertension of the newborn (PPHN), and to identify risk factors for these adverse clinical outcomes.This was a population-based study using an administrative dataset linking birth and death certificates, hospital discharge and readmissions records from 2005 to 2012
patients aged 18-75 with hypertension and text messaging capabilities who were seen at least twice in the prior 12 months with at least two out-of-range bloodpressure (BP) measurements, including the most recent visit.Patients were randomized in a 1:2:2 ratio to receive (1) usual care, (2) electronic pill bottles for medication adherence monitoring (pill bottle), and (3) bidirectional text messaging for medication adherence monitoring (bidirectional text).Change in systolic BP during the final 4-month (...) with electronic pill bottles nor bidirectional text messaging about medication adherence improved bloodpressure control. Adherence to prescribed medications was not improved enough to affect BP control or it was not the primary driver of poor control.clinicaltrials.gov (NCT02778542).
Risk assessment in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension Current pulmonary hypertension treatment guidelines recommend use of a risk stratification model encompassing a range of parameters, allowing patients to be categorised as low, intermediate or high risk. Three abbreviated versions of this risk stratification model were previously evaluated in patients with pulmonary arterial hypertension (PAH) in the French, Swedish and COMPERA registries. Our (...) objective was to investigate the three abbreviated risk stratification methods for patients with mostly prevalent PAH and chronic thromboembolic pulmonary hypertension (CTEPH), in patients from the PATENT-1/2 and CHEST-1/2 studies of riociguat.Risk was assessed at baseline and at follow-up in PATENT-1 and CHEST-1. Survival and clinical worsening-free survival were assessed in patients in each risk group/strata.With all three methods, riociguat improved risk group/strata in patients with PAH after 12
. PICO Question Population: Patients presenting to the emergency department (ED) with severely elevatedBP and no signs or symptoms concerning for end-organ damage Intervention: Laboratory testing, electrocardiogram (ECG), chest x-ray, rapid reduction bloodpressure, initiation of antihypertensive agents upon discharge Comparison: Outpatient referral for evaluation and initiation of antihypertensive therapy Outcome: Sroke, MI, renal failure, dialysis, death Search Strategy PudMed was searched (...) 170,340 visits (1820 per million adult ED visits overall) to 496,894 visits (4610 per million), with hypertensive emergency representing just over a third of these visits. The risks of hypertension, both treated and untreated, include long-term and acute damage to various organs. found that in a cohort of predominantly African-American patients presenting to the ED with asymptomatic elevatedbloodpressure, the prevalence of subclinical hypertensive heart disease is very high (90.7%; 95% CI 85.2
-significant in all models. The results were similar when alternative functional forms were used to estimate the impact and the bandwidths around the intervention threshold were changed. The results did not vary by demographic and social subgroups.Community based hypertension screening and encouraging people with raisedbloodpressure to seek care and adopt bloodpressure lowering behaviour changes could have important long term impact on systolic bloodpressure at the population level. This approach could (...) Impact of community based screening for hypertension on bloodpressure after two years: regression discontinuity analysis in a national cohort of older adults in China. To estimate the causal impact of community based bloodpressure screening on subsequent bloodpressure levels among older adults in China.Regression discontinuity analysis using data from a national cohort study.2011-12 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey, a national cohort of older adults
Genetic Variants Influencing Plasma Renin Activity in Hypertensive Patients From the PEAR Study (Pharmacogenomic Evaluation of Antihypertensive Responses). Plasma renin is an important regulator of bloodpressure (BP). Plasma renin activity (PRA) has been shown to correlate with variability in BP response to antihypertensive agents. We conducted a genome-wide association study to identify single-nucleotide polymorphisms (SNPs) associated with baseline PRA using data from the PEAR study (...) (Pharmacogenomic Evaluation of Antihypertensive Responses).Multiple linear regression analysis was performed in 461 whites and 297 blacks using an additive model, adjusting for age, sex, and ancestry-specific principal components. Top SNPs were prioritized by testing the expected direction of association for BP response to atenolol and hydrochlorothiazide. Top regions from the BP response prioritization were tested for functional evidence through differences in gene expression by genotype using RNA sequencing
Pharmacotherapy for hypertension in adults 60 years or older. This is the second substantive update of this review. It was originally published in 1998 and was previously updated in 2009. Elevatedbloodpressure (known as 'hypertension') increases with age - most rapidly over age 60. Systolic hypertension is more strongly associated with cardiovascular disease than is diastolic hypertension, and it occurs more commonly in older people. It is important to know the benefits and harms (...) for adult patients (≥ 60 years old) with hypertension defined as bloodpressure greater than 140/90 mmHg.Outcomes assessed were all-cause mortality; cardiovascular morbidity and mortality; cerebrovascular morbidity and mortality; coronary heart disease morbidity and mortality; and withdrawal due to adverse effects. We modified the definition of cardiovascular mortality and morbidity to exclude transient ischaemic attacks when possible.This update includes one additional trial (MRC-TMH 1985). Sixteen
Six-Month Results of Treatment-Blinded Medication Titration for Hypertension Control Following Randomization to Endovascular Ultrasound Renal Denervation or a Sham Procedure in the RADIANCE-HTN SOLO Trial The multicenter, international, randomized, blinded, sham-controlled RADIANCE-HTN SOLO trial demonstrated a 6.3 mmHg greater reduction in daytime ambulatory systolic bloodpressure (BP) at 2 months by endovascular ultrasound renal denervation (RDN) compared with a sham procedure among patients (...) not treated with antihypertensive medications. We report 6-month results following the addition of a recommended standardized stepped-care antihypertensive treatment (SSAHT) to the randomized endovascular procedure under continued blinding to initial treatment.Patients with a daytime ambulatory BP greater ≥135/85 mmHg and <170/105 mmHg after a 4-week discontinuation of up to 2 antihypertensive medications and a suitable renal artery anatomy, were randomized to RDN (n=74) or sham (n=72). Patients were
Hypertension. Recent guidelines on diagnosis and management of highbloodpressure (BP) include substantial changes and several new concepts compared with previous guidelines. These are reviewed and their clinical implications are discussed in this article. The goal is to provide a practical reference to assist clinicians with up-to-date management of patients with highBP. Important issues include new diagnostic thresholds, out-of-office BP monitoring, intensified treatment goals (...) , and a different approach to resistant hypertension. Finally, differences among guidelines, the persistent controversies that have led to them, and their implications for clinical practice are discussed.
Antihyperglycemic and BloodPressure Effects of Empagliflozin in Black Patients With Type 2 Diabetes Mellitus and Hypertension Empagliflozin, a sodium-glucose cotransporter 2 inhibitor indicated for type 2 diabetes mellitus (T2DM), can lower bloodpressure (BP) and reduce cardiovascular mortality in patients with T2DM and preexisting cardiovascular disease. Its effects in blacks have been understudied.In this 24-week study, 150 blacks with T2DM and hypertension had glycohemoglobin (primary end (...) to -3.04; P=0.0025], respectively). Diastolic BP was also reduced.In blacks with T2DM, empagliflozin reduced glycohemoglobin, body weight, and BP. The effect of empagliflozin on BP increased from 12 to 24 weeks, suggesting a full antihypertensive effect takes ≥6 months to be fully realized. At week 24, the placebo-subtracted BP effect was similar to standard antihypertensive monotherapies, suggesting that empagliflozin may be beneficial for this high-risk population.URL: https://www.clinicaltrials.gov