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Latest & greatest articles for hypertension
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Mecobalamin and early functional outcomes of ischemic stroke patients with H-type hypertension. To analyze the effect of mecobalamin on the early-functional outcomes of patients with ischemic stroke and H-type hypertension.From October of 2014 to October of 2016, 224 cases of ischemic stroke and H-type hypertension were selected. The patients were randomly divided into treatment control groups, with 112 patients in each group. The control group was treated with the conventional therapy
intracranial pressure, and instituting a low-sodium weight-reduction diet plus acetazolamide when indicated. Therapy can be given to reverse and prevent loss of vision. Definition Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a disorder of increased intracranial pressure that occurs mainly in overweight women of childbearing years, often in the setting of weight gain. Wall M. Idiopathic intracranial hypertension. Neurol Clin. 2010;28:593-617. http://www.ncbi.nlm.nih.gov (...) Idiopathic intracranial hypertension Idiopathic intracranial hypertension - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Idiopathic intracranial hypertension Last reviewed: February 2019 Last updated: October 2018 Summary The most popular hypothesis is that idiopathic intracranial hypertension (IIH) is a syndrome of reduced cerebrospinal fluid absorption. Clinical features include headaches, pulse-synchronous
a longitudinal cohort study of 30 239 participants as not having hypertension at baseline (2003-2007) and participating in a follow-up visit 9.4 years (median) later.There were 12 clinical and social factors, including score for the Southern diet (range, -4.5 to 8.2; higher values reflect higher level of adherence to the dietary pattern), including higher fried and related food intake.Incident hypertension (systolic bloodpressure ≥140 mm Hg, diastolic bloodpressure ≥90 mm Hg, or use of antihypertensive (...) Association of Clinical and Social Factors With Excess Hypertension Risk in Black Compared With White US Adults. The high prevalence of hypertension among the US black population is a major contributor to disparities in life expectancy; however, the causes for higher incidence of hypertension among black adults are unknown.To evaluate potential factors associated with higher risk of incident hypertension among black adults.Prospective cohort study of black and white adults selected from
of hypertension-related complications continues to be paramount, and to depend more on the extent of bloodpressure (BP) lowering than on choice of any specific drug class as first-line therapy for those patients without comorbid conditions which compel a specific drug class choice (such as diabetes mellitus, cardiac disease or renal disease) . Therefore, in the choice of antihypertensive drugs, consideration of BP control effectiveness supersedes consideration of ‘pleiotropic’ effects of the five major (...) . Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991;265:3255-64. Forette F, Seux ML, Staessen J, Thij L, Birkenhager WH, Babarskeine MR, et al. Prevention of dementia in the SYST-EUR trial. Lancet 1998;352:1347-51. Joffres MR, Hamet P, Rabkin SW, Gelskey D, Hogan K, Fodor G. Prevalence, control and awareness of highbloodpressure among Canadian adults. CMAJ
measurement of BP], and Supplemental Table S2 [Recommended Technique for Automated Office BP]). Patient selection for intensive management is recommended and caution should be taken in certain high-risk groups (Table 4; Grade B). In 2016, a new recommendation to consider intensive BP control targeting an SBP ≤ 120 mm Hg in selected high-risk patients. This recommendation is based primarily upon the Systolic BloodPressure Intervention Trial (SPRINT) . SPRINT was a randomized controlled trial that enrolled (...) encounters, monitoring, and medication usage. Individuals who received intensive treatment in SPRINT were followed monthly until target BP levels were achieved. On average, they were prescribed 2.7 antihypertensive agents, compared with 1.8 agents in the standard control group. Table 4. Generalizability of intensive bloodpressure-lowering: cautions and contraindications eGFR, estimated glomerular filtration rate; SBP, systolic bloodpressure. Limited or no evidence Heart failure (ejection fraction < 35
). The mean BP throughout the study period was 0.9/0.6 mm Hg lower in patients treated with telmisartan than in those treated with ramipril. Adjustment for this small difference in bloodpressure did not affect materially results for the primary outcome (RR, 1.02; 95%CI, 0.95 to 1.10). Total mortality (RR, 0.99; 95%CI, 0.91 to 1.07) and the composite of cardiovascular death, MI or stroke (RR 0.98; 95%CI, 0.90 to 1.07) were similar. Two additional trials compared ARBs with placebo in high-risk patients (...) Cardiovascular events through Combination therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial: A hypertensive population at high cardiovascular risk. Blood Press 2007;16:13-9. Messerli FH, Mancia G, Conti CR, et al. Dogma disputed: can aggressively lowering bloodpressure in hypertensive patients with CAD be dangerous? Ann Intern Med 2006;144:884-93. Bangalore S, Messerli FH, Wun CC, et al. J-curve revisited: an analysis of bloodpressure and cardiovascular events in the Treating to New
evaluation of all hypertensive patients is not recommended (Grade D). Left ventricular hypertrophy is common among patients with hypertension, with an estimated prevalence of more than 20% depending on the measure used, and is an important independent risk factor for cardiovascular complications . Bloodpressure reduction reduces cardiovascular morbidity and morbidity in patients with documented left ventricular hypertrophy . Left ventricular mass measurement by transthoracic 2D echocardiography (...) Diagnosis & Assessment of Hypertension - Role of Echocardiography IX. Role of Echocardiography | Hypertension Canada Guidelines Subgroup Members: George Honos, MD Central Review Committee: Stella S. Daskalopoulou, MD MSc DIC PhD (Chair); Kaberi Dasgupta, MD MSc; Kelly B. Zarnke, MD MSc; Kara Nerenberg, MD, MSc; Alexander A. Leung, MD MPH; Kevin C. Harris, MD MHSc; Kerry McBrien, MD MPH; Sonia Butalia, BSc MD MSc; Meranda Nakhla, MD MSc Co-Chairs: Doreen M. Rabi, MD MSc, Stella S. Daskalopoulou
-week randomized controlled trials to compare once daily AZL-M 40 mg, AZL-M 80 mg, OLM 40 mg, and placebo. The second analysis included 1,020 patients from a 12-week randomized controlled trial to compare once daily AZL-M/CLD 40/25 mg, AZL-M/CLD 80/25 mg, and OLM/HCTZ 40/25 mg. Efficacy end points were 24-hour mean ambulatory and clinic systolic and diastolic bloodpressure (SPB/DBP) and the percentage of patients achieving clinic SBP/DBP targets. Treatment with AZL-M 80 mg lowered mean clinic SBP (...) Comparison of Effectiveness of Azilsartan Medoxomil and Olmesartan in Blacks Versus Whites With Systemic Hypertension Two post hoc analyses in self-identified black and white patients with hypertension evaluated the angiotensin II receptor blocker azilsartan medoxomil (AZL-M) and the fixed-dose combination of AZL-M with chlorthalidone (AZL-M/CLD) versus the ARB olmesartan (OLM) and the OLM fixed-dose combination with hydrochlorothiazide (OLM/HCTZ). One analysis pooled 1,610 patients from two 6
Cardiovascular risk model performance in women with and without hypertensivedisorders of pregnancy Compare the predictive performance of Framingham Risk Score (FRS), Pooled Cohort Equations (PCEs) and Systematic COronary Risk Evaluation (SCORE) model between women with and without a history of hypertensivedisorders of pregnancy (hHDP) and determine the effects of recalibration and refitting on predictive performance.We included 29 751 women, 6302 with hHDP and 17 369 without. We assessed
according to baseline resistant hypertension status, using Action to Control Cardiovascular Risk in Diabetes (ACCORD) and Systolic BloodPressure Intervention Trial (SPRINT) patient-level data. Patients were categorized as having baseline apparent resistant hypertension (bloodpressure ≥130/80 mm Hg while using 3 antihypertensive drugs or use of ≥4 drugs regardless of bloodpressure) or non-resistant hypertension (all others). Cox regression was used to assess effects of treatment assignment, resistant (...) Optimal Systolic BloodPressure Target in Apparent Resistant and Non-Resistant Hypertension: A Pooled Analysis of Patient-Level Data from Sprint and ACCORD Prior studies suggest benefits of bloodpressure lowering on cardiovascular risk may be attenuated in patients with resistant hypertension compared with the general hypertensive population, but prospective data are lacking.We assessed intensive (<120 mm Hg) versus standard (<140 mm Hg) systolic bloodpressure targets on adverse outcome risk
practice was encouraged for another 6 months. The primary outcome was bloodpressure. Secondary outcomes were fasting blood sugar, glycated haemoglobin, total cholesterol, triglycerides, high- and low-density lipoprotein, body mass index, waist circumference, aerobic endurance, perceived stress, quality of life and exercise self-efficacy. Data were collected at baseline, post-intervention at 3 months and follow-up assessments at 6 and 9 months. Generalised estimating equation models were used (...) to compare the changes in outcomes over time between groups.At baseline, the participants had an average bloodpressure = 141/81 and average body mass index = 26; 58% were diabetics, 61% presented with dyslipidemia and 11% were smokers. No significant difference was noted between groups. Tai Chi significantly lowered bloodpressure (systolic -13.33 mmHg; diastolic -6.45 mmHg), fasting blood sugar (-0.72 mmol/L), glycated haemoglobin (-0.39%) and perceived stress (-3.22 score) and improved perceived
-linear fashion with increased BP . Further, numerous trials show antihypertensive therapy reduces relative risk of cardiovascular events by approximately 25% to 30%, irrespective of pre-treatment BP, (at least for diastolic BPs in excess of 90 mm Hg) — of course, Early trials generally enrolled patients with diastolic bloodpressures in excess of 90 mm Hg and later trials enrolled patients with elevated systolic bloodpressure (often greater than 160 mmHg) . Recommendations for hypertension (...) with elevated diastolic bloodpressure. The Hypertension Detection and Follow-up Program (HDFP), a 5-year pragmatic randomized trial comparing an intensive antihypertensive treatment program with usual care, is a notable example. This trial reported a statistically significant 17% reduction in total mortality in the overall trial . Mortality was also reduced (5.9% with active treatment vs. 7.4% for usual care; P < 0.01) in the subgroup of 7825 patients with DBP levels between 90 and 104 mm Hg . Relative
and associations with target organ damage (TOD) in high-risk youth. METHODS: Participants (10–18 years old) undergoing an evaluation of the cardiovascular effects of obesity and type 2 diabetes mellitus in youth were studied. Bloodpressure was categorized according to the 2 guidelines as normal, elevated, and hypertension (stages 1 and 2). Measures of TOD (carotid artery intima-media thickness, pulse wave velocity, left ventricular mass, and diastolic function) were obtained. Associations between blood (...) of the Revised AAP Pediatric Hypertension Guidelines Michael Khoury , Philip R. Khoury , Lawrence M. Dolan , Thomas R. Kimball , Elaine M. Urbina Abstract BACKGROUND AND OBJECTIVES: New pediatric hypertension definitions were recently published in a clinical practice guideline (CPG). We evaluated the impact of the CPG, compared with the previous guideline ("Fourth Report on the Diagnosis, Evaluation, and Treatment of HighBloodPressure in Children and Adolescents"), on the prevalence of hypertension
be performed only done after biochemical confirmation of disease. v. Definitive treatment is with surgical resection. Preoperative planning is recommended for bloodpressure control and volume expansion: α-blockade should be started 10-14 days preoperatively. Typical options include oral phenoxybenzamine (a long-acting, non-selective, irreversible α-blocker), prazosin, or doxazosin. Other anti-hypertensives may be added as necessary but diuretics should be avoided if possible. Oral β-blockers may (...) ) should be collected as follows: In the morning after the patient has been ambulatory (sitting, standing, or walking) for at least 2 hours. Patients should be seated for 5-15 minutes prior to the blood draw. Hypokalemia should be corrected and sodium intake should be liberalized. Agents that markedly affect the results of testing (aldosterone antagonists, potassium sparing and wasting diuretics) should be withdrawn at least 4-6 weeks prior. If the results are not diagnostic, and if hypertension can
AND MANAGEMENT OF HIGHBP IN CHILDREN Abstract Systemic hypertension is a major cause of morbidity and mortality in adulthood. Highbloodpressure (HBP) and repeated measures of HBP, hypertension (HTN), begin in youth. Knowledge of how best to diagnose, manage, and treat systemic HTN in children and adolescents is important for primary and subspecialty care providers. OBJECTIVES: To provide a technical summary of the methodology used to generate the 2017 “Clinical Practice Guideline for Screening (...) with specific chronic diseases, such as chronic kidney disease (CKD), also have an increased prevalence of elevatedBP and HTN. According to the Chronic Kidney Disease (CKD) in Children study, 37% of youth with CKD had elevated systolic bloodpressure (SBP) or diastolic bloodpressure (DBP) (>90th percentile), and 14% are hypertensive (based on repeated BP assessment), with either a SBP and/or DBP greater than or equal to the 95th percentile. – Stated Objective of the AAP Regarding the Preparation
physician guideline adherence and also led to greater reductions in patients’ BP . Findings from this trial support involvement of pharmacists in assisting physicians with BP management and are consistent with a growing literature supporting effectiveness of pharmacists in improving BP control. Utilizing electronic medication compliance aids (Grade D) This is primarily based upon expert consensus. References Chockalingam A, Bacher M, Campbell N, et al. Adherence to management of highbloodpressure (...) : recommendations of the Canadian Coalition for HighBloodPressure Prevention and Control. Can J Public Health 1998;89(Suppl 2):15-6. Fodor JG, Cutler H, Irvine J, et al. Adherence to non-pharmacological therapy for hypertension: problems and solutions. Can J Public Health 1998;89(Suppl 2):112-5. Schroeder K, Fahey T, Ebrahim S. How can we improve adherence to bloodpressure- lowering medication in ambulatory care? Systematic review of randomized controlled trials. Arch Intern Med 2004;164:722-32. Feldman RD
Med 2005;142:342-51. Peterson JC, Adler S, Burkart JM, et al. Bloodpressure control, proteinuria, and the progression of renal disease. The Modification of Diet in Renal Disease Study. Ann Intern Med 1995;123:754-62. Wright JT Jr, Bakris G, Greene T, et al. Effect of bloodpressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA 2002;288:2421-31. Norris K, Bourgoigne J, Gassman J, et al. Cardiovascular outcomes (...) disease , target BP is <140/90 mmHg (Grade B). For patients with hypertension and proteinuric chronic kidney disease (urinary protein >500 mg per 24 hours or albumin to creatinine ratio >30 mg/mmol), initial therapy should be an ACE inhibitor (Grade A) or an ARB if there is intolerance to ACE inhibitors (Grade B). Thiazide/thiazide-like diuretics are recommended as additive antihypertensive therapy (Grade D). For patients with chronic kidney disease and volume overload, loop diuretics
% or at least 60% and evidence of hemodynamic pressure gradients . In addition, these patients had either hypertension not controlled with two or more drugs or declining renal function. All subjects had their cardiovascular risk factors (bloodpressure [BP], lipids, glycemic control, and antiplatelet therapy) managed systematically according to a protocol, with 460 patients assigned randomly to stenting of stenotic renal arteries. The primary composite outcome included cardiovascular or renal death (...) management and limitation of the use of renal revascularization procedures. In particular, it is recommended that hypertensive patients with RAS be managed with good BP control to appropriate targets, a high dose of a high-potency statin for lipid management, good glycemic control, and appropriate antiplatelet therapy. Management should also include adoption of health behaviours appropriate to risk profile. The National Institutes of Health-funded CORAL trial enrolled 947 patients with RAS of at least 80
such as hydralazine or minoxidil should not be used. Left ventricular hypertrophy (LVH) is commonly associated with hypertension and is a strong risk factor (independent of bloodpressure [BP]) for stroke, myocardial infarction (MI), congestive heart failure and other cardiovascular events . The Losartan Intervention For Endpoint reduction in hypertension (LIFE) trial enrolled 9193 patients with hypertension who had LVH, and was designed to establish whether selective blocking of angiotensin II improved LVH (...) drugs. In summary, while antihypertensive therapy improves left ventricular mass and reduces cardiovascular morbidity and mortality in patients with LVH, no one anti-hypertensive class is superior to all others. Most major classes of antihypertensive agents (except direct arterial vasodilators, such as hydralazine or minoxidil) have been shown to cause LVH regression, but not always to the same degree in relation to the amount of BP lowering achieved. Therefore, antihypertensive treatment should
with significant elevations in bloodpressure. Caution, however, should be exercised in patients in whom a substantial fall in BP is more likely to occur or is more poorly tolerated (e.g., the elderly and patients with autonomic neuropathy). Regarding systolic BP targets, two major meta-analyses have examined the relative benefits and risks of achieving lower SBP in patients with diabetes mellitus and hypertension. The Bangalore et al. meta-analysis included trials comparing achieved SBP levels of < 135 mm Hg (...) complications (e.g., retinopathy and nephropathy), as well as macrovascular complications in patients with hypertension, who have diabetes mellitus. The association between BP level (systolic and diastolic) and cardiovascular risk is continuous and graded in patients with diabetes mellitus. Treatment of hypertension appears to confer greater benefits in people with diabetes than in age-matched people with hypertension, who do not have diabetes , and the benefits of aggressive bloodpressure lowering may