Assessing healthcare professional knowledge, attitudes, and practices on hypertension management. Announcing a new World Hypertension League resource.

Science.gov (United States)

Campbell, Norm R C; Dashdorj, Naranjargal; Baatarsuren, Uurtsaikh; Myanganbayar, Maral; Dashtseren, Myagmartseren; Unurjargal, Tsolmon; Zhang, Xin-Hua; Veiga, Eugenia Velludo; Beheiry, Hind Mamoun; Mohan, Sailesh; Almustafa, Bader; Niebylski, Mark; Lackland, Daniel

2017-09-01

To assist hypertension control programs and specifically the development of training and education programs on hypertension for healthcare professionals, the World Hypertension League has developed a resource to assess knowledge, attitudes, and practices on hypertension management. The resource assesses: (1) the importance of hypertension as a clinical and public health risk; (2) education in national or international hypertension recommendations; (3) lifestyle causes of hypertension; (4) measurement of blood pressure, screening, and diagnosis of hypertension; (5) lifestyle therapy counseling; (6) cardiovascular risk assessment; (7) antihypertensive drug therapy; and (8) adherence to therapy. In addition, the resource assesses the attitudes and practices of healthcare professionals for task sharing/shifting, use of care algorithms, and use of registries with performance reporting functions. The resource is designed to help support the Global Hearts Alliance to provide standardized and enhanced hypertension control globally. ©2017 Wiley Periodicals, Inc.

Management of hypertension in the elderly.

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Pimenta, Eduardo; Oparil, Suzanne

2012-03-13

Hypertension is the most-prevalent modifiable risk factor for cardiovascular morbidity and mortality worldwide. Hypertension is highly prevalent among older adults (≥65 years), and aging of the population will substantially increase the prevalence of this condition. Age-related endothelial dysfunction and increased arterial stiffness contribute to the increased prevalence of hypertension, particularly systolic hypertension, among the elderly. The incidence of some forms of secondary hypertension also increases with age, mainly owing to the use of drugs (especially NSAIDs that have pressor effects) and the presence of chronic kidney disease, obstructive sleep apnea, and renal artery stenosis. Guidelines differ in thresholds and goals for antihypertensive drug therapy in the elderly because of a paucity of high-level evidence from randomized controlled trials and inconsistencies in the definition of 'elderly'. Medical treatment of hypertension reduces cardiovascular morbidity and mortality in the elderly, and all guidelines recommend lifestyle modifications and medical treatment for elderly patients whose blood pressure exceeds prescribed thresholds and who are at moderate or high cardiovascular disease risk. In the absence of comorbidities, which constitute 'compelling indications' for the use of specific antihypertensive drugs or drug classes, no clear evidence exists to support recommendations for the use of particular antihypertensive-drug classes in older adults.

Hypertension og hjernen

DEFF Research Database (Denmark)

Christensen, Hanne; Strandgaard, Svend

2009-01-01

Hypertension is a major and modifiable risk factor of stroke and dementia. Hypertension causes remodelling of the cerebral resistance vessels, impairing their tolerance to very low blood pressure. In primary prevention of stroke, the effect of beta-blockers is inferior to other classes...... of antihypertensives. In secondary prevention of stroke, ACE-inhibitors and angiotensin blockers may be recommended as first choice drugs. Lowering of the blood pressure is, however, more important than the choice of drug. Udgivelsesdato: 2009-Jun-8...

Misleading guidelines for the diagnosis and management of hypertension

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Flávio Danni Fuchs

2014-10-01

Full Text Available International guidelines for the diagnosis and management of hypertension were recently released [1,2]. A historical trend of lowering the blood pressure (BP thresholds to diagnose hypertension in high risk individuals was unexpectedly reversed. BP targets for the treatment were modified accordingly. Therefore some individuals who were hypertensive before are now normotensive. Other guidelines still recommend the previous diagnostic limits and goals of treatment [3-5], resulting that an individual may be hypertensive in some countries and normotensive in others. The guidelines are more homogeneous in the recommendations for treatment, particularly in regard to the liberal options of drugs to starting the treatment. Unfortunately, in my view, this liberal view includes drugs without unbiased evidences of effectiveness, such as Angiotensin Receptor Blockers (ARB. In this point of view, I discuss the reasons and misconceptions in the establishment of diagnostic thresholds and the shortcomings in the recommendations of antihypertensive drugs.

TREATMENT OF HYPERTENSION IN PREGNANCY: GUIDELINES AND CLINICAL EXPERIENCE

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O. V. Gaisenok

2014-01-01

Full Text Available Topical issues of the treatment of hypertension in pregnancy are presented. Examples from clinical practice are discussed as well as possible medical treatment of hypertension in pregnant women taking into account actual recommendations.

Lifestyle Modifications to Prevent and Control Hypertension.

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Samadian, Fariba; Dalili, Nooshin; Jamalian, Ali

2016-09-01

Hypertension is the most important, modifiable risk factor for cardiovascular disease and mortality. High salt intake may predispose children to develop hypertension later. A modest reduction in population salt intake worldwide would result in a major improvement in public health. Regarding smoking as another risk factor, there are various strategies that can be used to promote smoking cessation. Physicians are in an excellent position to help their patients stop smoking. Targeted weight loss interventions in population subgroups might be more effective for the prevention of hypertension than a general-population approach. A diet rich in high-potassium fruit and vegetables is strongly recommended. Fresh products are best; normal potassium content is reduced when foods are canned or frozen. Calcium supplementation reduces blood pressure in hypertensive individuals during chronic nitric oxide synthase inhibition and high calcium diet enhances vasorelaxation in nitric oxide-deficient hypertension. Magnesium should be considered by anyone seeking to prevent or treat high blood pressure. The foundation for a healthy blood pressure consists of a healthy diet, adequate exercise, stress reduction, and sufficient amounts of potassium and magnesium, but further investigations are required before making definitive therapeutic recommendations on magnesium use. Alcohol usage is a more frequent contributor to hypertension than is generally appreciated. For hypertensive patients in whom stress appears to be an important issue, stress management should be considered as an intervention. Individualized cognitive behavioral interventions are more likely to be effective than single-component interventions.

Echocardiography in hypertension: a call for standardization from the Working Group on Heart and Hypertension of the Italian Society of Hypertension.

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Cuspidi, Cesare; Muiesan, Maria Lorenza; De Luca, Nicola; Salvetti, Massimo; Agabiti-Rosei, Enrico; Schillaci, Giuseppe

2014-03-01

The variety of clinical information provided by the echocardiogram (i.e. assessment of left ventricular (LV) structure and geometry, systolic/diastolic function, left atrial and aortic size) in addition to its superior sensitivity for LV hypertrophy detection compared to electrocardiogram are strong arguments supporting the paramount importance of this technique in the assessment of hypertensive heart disease. A number of limitations of the echocardiographic technique, however, including lack of standardized/quantitative procedures, impair its diagnostic accuracy and cost-effectiveness. The aim of these recommendations is to provide a document on the minimum acceptable requirements for the clinical practice of echocardiography in the hypertensive setting and thus to improve the quality of this fundamental tool in the cardiovascular risk stratification of hypertensive patients.

Hypertension criterion for stroke prevention--to strengthen the principle of individualization in guidelines.

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Chen, Yicong; Chen, Xinran; Dang, Ge; Zhao, Yuhui; Ouyang, Fubing; Su, Zhenpei; Zeng, Jinsheng

2015-03-01

The diagnosis of hypertension, as recommended by most guidelines, is determined by systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. A threshold-based definition of hypertension, however, ignores sex and age, pathophysiology, and disparities in patient-specific conditions. Moreover, the harmful effects of hypertension-induced target organ damage cannot be ignored. Although the principle of individualization for hypertension management is recommended, especially for stroke prevention, how to practice it in a clinical setting has not been clearly elaborated. Therefore, we put forward a proposal for individualized hypertension management incorporating target organ damage, the main harmful effect of hypertension. We propose that hypertension should be diagnosed when an individual's blood pressure exceeds some difference from their own baseline in young adulthood, accompanied by any hypertension-induced target organ damage, confirmed by various detection methods. Application of this proposal to stroke prevention will hopefully strengthen the principle of individualized hypertension management. ©2015 Wiley Periodicals, Inc.

Farmakologisk behandling af mild ukompliceret hypertension i almen praksis

DEFF Research Database (Denmark)

Paulsen, Maja Skov; Christensen, Bo; Søndergaard, Jens

2013-01-01

pressure 90-99 mmHg; no diabetes or cardiovascular disease) did not reduce mortality or morbidity. The evidence for pharmacotherapy in patients having mild/uncomplicated hypertension is weak. However, current Danish guidelines have taken this into consideration in their recommendations of pharmacotherapy......Hypertension is an important risk factor for cardiovascular disease. In Denmark, patients with hypertension are primarily managed in primary care. A recent Cochrane review concluded that pharmacotherapy of patients with mild hypertension (systolic blood pressure 140-159 mmHg; diastolic blood...... to patients with mild/uncomplicated hypertension....

Diagnostic status of hypertension on the adherence to the Dietary Approaches to Stop Hypertension (DASH diet

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Hyun Kim, PhD

2016-12-01

Full Text Available The Dietary Approaches to Stop Hypertension (DASH diet is a widely recommended diet for individuals with hypertension. Adherence to the DASH diet has been shown to be effective for controlling hypertension, but it is unclear whether a hypertension diagnosis has an impact on adherence to the diet and nutrient intake. This study examined the association between hypertension diagnosis and the DASH nutrient intake using the multivariate linear regression method. The sample was composed of individuals with hypertension in the National Health and Nutrition Examination Survey (NHANES from 2007 to 2012. The outcome was the DASH accordance score (0 to 9 points, which measures the intake of nine nutrients compared to target amounts. Study findings indicate that a diagnostic status of hypertension was associated with increased consumption of sodium, saturated fat, total fat, and protein. Adherence to the DASH diet was more likely to be associated with health conditions such as obesity and heart diseases and lifestyle behaviors such as current smoking status and physical activity. Individuals diagnosed with hypertension showed less adherence to the DASH diet than those not diagnosed with hypertension, so a diagnosis of hypertension did not seem to provide an incentive to engage in healthy dietary behavior. Overall, regardless of diagnostic status, individuals with hypertension did not seem to follow the DASH guidelines.

[Power training for patients with arterial hypertension].

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Weisser, B; Richter, H; Siewers, M

2006-11-23

Nowadays, not only endurance training but also power training is recommended for patients with hypertension. In appropriately doses programs (no forced respiration), a number of studies have documented a blood pressure lowering effect. In the elderly hypertensive in particular, positive effects of power training that go beyond the simple lowering of elevated blood pressure may be expected.

Physical Activity and the Prevention of Hypertension

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Diaz, Keith M.; Shimbo, Daichi

2013-01-01

As the worldwide prevalence of hypertension continues to increase, the primary prevention of hypertension has become an important global public health initiative. Physical activity is commonly recommended as an important lifestyle modification that may aid in the prevention of hypertension. Recent epidemiologic evidence has demonstrated a consistent, temporal, and dose-dependent relationship between physical activity and the development of hypertension. Experimental evidence from interventional studies have further confirmed a relationship between physical activity and hypertension as the favorable effects of exercise on blood pressure reduction have been well characterized in recent years. Despite the available evidence strongly supporting a role for physical activity in the prevention of hypertension, many unanswered questions regarding the protective benefits of physical activity in high-risk individuals, the factors that may moderate the relationship between physical activity and hypertension, and the optimal prescription for hypertension prevention remain. We review the most recent evidence for the role of physical activity in the prevention of hypertension and discuss recent studies that have sought to address these unanswered questions. PMID:24052212

The prevalence of resistant arterial hypertension and secondary causes in a cohort of hypertensive patients: a single center experience

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Luigi Petramala

2017-11-01

Full Text Available The prevalence of resistant hypertension (RHT still remains unknown. Aim of the study was to investigate in a large cohort of hypertensive patients the prevalence of RHT, and to identify in these patients the secondary forms of arterial hypertension (SH. We enrolled a series of 3685 consecutive hypertensive patients. All patients underwent complete physical examination, laboratory tests, screening for SH. Ambulatory blood pressure monitoring (ABPM was performed to exclude white-coat hypertension. Further, we investigated for any obstructive sleep apnea syndrome (OSA. Only 232 (5.8% hypertensive patients fulfilled criteria for RHT. 91 (39% had a SH; 56 (61% hypertensive patients had a primary aldosteronism, 22 (24% had OSA, 7 (7.7% had a hypercortisolism, and 5 (5.5% had a renovascular hypertension (RVH. Only one patient had adrenal pheochromocytoma. An accurate definition and investigation into RHT is needed. We recommend ABPM to all patients at diagnosis. Finally, all patients must be screened for SH, such as adrenal hypertension, OSA and RVH, especially those who are apparently resistant to polypharmacological treatment.

[Hypertension in females].

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Cífková, Renata

2015-05-01

Hypertension is the most common cardiovascular disorder affecting more males in younger age groups; in the age group of 45-64, it is equally frequent in both genders, it is more common in elderly females. Blood pressure increases more in females around the menopause. Use of hormonal replacement therapy is not associated with an BP increase but, because of increased risk of coronary events, stroke, and thromboembolic events, HRT is not re-commended in CVD prevention. There is a similar decrease in BP by antihypertensive drugs in both genders as well as benefit from antihypertensive treatment. Women report about a double rate of adverse events of antihypertensive drugs. Oral contraception use is associated with a mild BP increase in most women and development of overt hypertension in about 5 %. Pre-eclampsia is associated with increased risk of developing CVD later in life (more frequent development of hypertension, myocardial infarction, and stroke).

Prevalence of Hypertension and Association of Obesity with Hypertension in School Ggoing Children of Surat City, Western India

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Salvi S. Shah

2013-08-01

Full Text Available Purpose: The association of obesity with hypertension has been recognized for the decades which are the important risk factors for the cardiovascular disease. So the purpose of the present study was to determine association of obesity with hypertension in school going children of Surat. Methodology: School going children aged between 12-18 years, of five schools in Surat were selected for the study. Height and weight were measured and BMI was calculated. Blood pressure measurements were taken as per recommendation of American heart society and family history of hypertension has also been assessed. Hypertension was considered if blood pressure is more than 95th percentile according to the update of task force report and Obesity was diagnosed by BMI for age. Results: Of 682 children, 8.94% were obese and 20.09% were hypertensive. Conclusion: Obesity is strongly associated with hypertension in children and both together may risk factors for later coronary disease.

Pulmonary hypertension CT imaging

International Nuclear Information System (INIS)

Nedevska, A.

2013-01-01

Full text: The right heart catheterization is the gold standard in the diagnosis and determines the severity of pulmonary hypertension. The significant technical progress of noninvasive diagnostic imaging methods significantly improves the pixel density and spatial resolution in the study of cardiovascular structures, thus changes their role and place in the overall diagnostic plan. Learning points: What is the etiology, clinical manifestation and general pathophysiological disorders in pulmonary hypertension. What are the established diagnostic methods in the diagnosis and follow-up of patients with pulmonary hypertension. What is the recommended protocol for CT scanning for patients with clinically suspected or documented pulmonary hypertension. What are the important diagnostic findings in CT scan of a patient with pulmonary hypertension. Discussion: The prospect of instantaneous complex - anatomical and functional cardiopulmonary and vascular diagnostics seems extremely attractive. The contrast enhanced multislice computed (CT ) and magnetic resonance imaging are very suitable methods for imaging the structures of the right heart, with the possibility of obtaining multiple projections and three-dimensional imaging reconstructions . There are specific morphological features that, if carefully analyzed, provide diagnostic information. Thus, it is possible to avoid or at least reduce the frequency of use of invasive diagnostic cardiac catheterization in patients with pulmonary hypertension. Conclusion: This review focuses on the use of contrast-enhanced CT for comprehensive evaluation of patients with pulmonary hypertension and presents the observed characteristic changes in the chest, lung parenchyma , the structures of the right half of the heart and pulmonary vessels

[Pregnancy in pulmonary arterial hypertension patients].

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Rosengarten, Dror; Kramer, Mordechai R

2013-09-01

Pulmonary arterial hypertension (PAH) is a disorder defined by elevated mean pulmonary arterial pressure. PAH can be idiopathic or associated with a variety of medical conditions such as scleroderma, congenital heart disease, left heart failure, lung disease or chronic pulmonary thromboembolism. This progressive disease can cause severe right heart failure and death. Normal physiologic changes that occur during pregnancy may produce fatal consequences in PAH patients. Current guidelines recommend that pregnancy be avoided or terminated early in women with PAH. During the past decade, new advanced therapies for PAH have emerged gathering reports of successful pregnancies in patients with pulmonary hypertension. Substantial risk still exists and current recommendations have not changed. Nevertheless, in selected cases, if a patient insists on continuing the pregnancy, being fully aware of the risks involved, an intensive treatment approach should be implemented in experienced centers. This is necessary in order to control pulmonary hypertension during pregnancy and reduce the risk so as to improve outcomes. This review will focus on the pathophysiology of PAH in pregnancy and appropriate management during pregnancy, delivery and the post-partum period.

The International Society of Hypertension and World Hypertension League call on governments, nongovernmental organizations and the food industry to work to reduce dietary sodium.

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Campbell, Norman R C; Lackland, Daniel T; Chockalingam, Arun; Lisheng, Liu; Harrap, Stephen B; Touyz, Rhian M; Burrell, Louise M; Ramírez, Agustín J; Schmieder, Roland E; Schutte, Aletta E; Prabhakaran, Dorairaj; Schiffrin, Ernesto L

2014-02-01

The International Society of Hypertension and the World Hypertension League have developed a policy statement calling for reducing dietary salt. The policy supports the WHO and the United Nations recommendations, which are based on a comprehensive and up-to-date review of relevant research. The policy statement calls for broad societal action to reduce dietary salt, thus reducing blood pressure and preventing hypertension and its related burden of cardiovascular disease. The hypertension organizations and experts need to become more engaged in the efforts to prevent hypertension and to advocate strongly to have dietary salt reduction policies implemented. The statement is being circulated to national hypertension organizations and to international nongovernmental health organizations for consideration of endorsement. Member organizations of the International Society of Hypertension and the World Hypertension League are urged to support this effort.

Is there a standard for surgical therapy of hepatocellular carcinoma in healthy and cirrhotic liver? A comparison of eight guidelines.

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Manzini, Giulia; Henne-Bruns, Doris; Porzsolt, Franz; Kremer, Michael

2017-01-01

Liver resection (LR) and transplantation are the most reliable treatments for hepatocellular carcinoma (HCC). Aim was to compare different guidelines regarding indication for resection and transplantation because of HCC with and without underlying cirrhosis. We compared the following guidelines published after 1 January 2010: American (American Association for the Study of Liver Diseases (AASLD)), Spanish (Sociedad Espanola de Oncologia Medica (SEOM)), European (European Association for the study of liver-European Organization for Research and Treatment of Cancer (EASL-EORTC) and European Society for Medical Oncology-European Society of Digestive Oncology (ESMO-ESDO)), Asian (Asian Pacific Association for the Study of Liver (APASL)), Japanese (Japan Society of Hepatology (JSH)), Italian (Associazione Italiana Oncologia Medica (AIOM)) and German (S3) guidelines. All guidelines recommend resection as therapy of choice in healthy liver. Guidelines based on the Barcelona Clinic Liver Cancer staging system recommend resection for single HCCguidelines recommend LR for patients with Child-Pugh A/B with HCC without tumour size restriction; APASL guidelines in general exclude patients with Child-Pugh A from transplantation. In patients with Child-Pugh B, transplantation is the second-line therapy, if resection is not possible for patients within Milan criteria. German and Italian guidelines recommend transplantation for all patients within Milan criteria. Whereas resection is the standard therapy of HCC in healthy liver, a standard regarding the indication for LR and transplantation for HCC in cirrhotic liver does not exist, although nearly all guidelines claim to be evidence based. Surprisingly, despite European guidelines, Germany and Italy use their own national guidelines which partially differ from the European. Possible solutions of the problems are discussed.

Expert Consensus on the Treatment of Hypertension with Chinese Patent Medicines

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Li Ying Wang

2013-01-01

Full Text Available Objectives. This study was aimed to determine the therapeutic principle and identify Chinese Patent Medicine (CPM with corresponding indications for hypertension treatment. Methods. Three rounds of Delphi survey were mailed among 40 cardiovascular integrative medicine specialists. Items with agreement of more than 80% respondents were included in the consensus. Results. According to majority of the panelists, CPM is suitable for most hypertensive patients and should be used according to traditional Chinese medicine pattern classification. CPM could be used alone for grade 1 hypertension and could be used in combination with Western biomedicine (WM for both grade 2 and grade 3 hypertension. It is recommended that less than two CPMs are used simultaneously. For the treatment of grade 2 and 3 hypertension, CPM and WM should be taken separately. Recommended CPMs included Tianma Gouteng granule, Qiju Dihuang capsule, Jinkui Shenqi pill, Yinxingye tablet, Niuhuang Jiangya pill and Banxia Tianma pill. The indications of 4 CPMs were specified with symptoms related to TCM pattern classification by the experts. Conclusions. An expert consensus on CMP application was formed for the treatment of hypertension in the form of integrative medicine. A flow of IM hypertension management was proposed based on the results of the survey.

ACR Appropriateness Criteria® Suspected Pulmonary Hypertension.

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Sirajuddin, Arlene; Donnelly, Edwin F; Crabtree, Traves P; Henry, Travis S; Iannettoni, Mark D; Johnson, Geoffrey B; Kazerooni, Ella A; Maldonado, Fabien; Olsen, Kathryn M; Wu, Carol C; Mohammed, Tan-Lucien; Kanne, Jeffrey P

2017-05-01

Pulmonary hypertension may be idiopathic or related to a large variety of diseases. Various imaging examinations that may be helpful in diagnosing and determining the etiology of pulmonary hypertension are discussed. Imaging examinations that may aid in the diagnosis of pulmonary hypertension include chest radiography, ultrasound echocardiography, ventilation/perfusion scans, CT, MRI, right heart catheterization, pulmonary angiography, and fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

[Chronic hypertension and pregnancy].

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Lecarpentier, Edouard; Tsatsaris, Vassili

2012-09-01

Hypertensive disorders in pregnancy are a leading cause of maternal and perinatal mortality and morbidity. The management of patients with chronic hypertension requires a multidisciplinary approach prior to conception, during pregnancy and post-partum. In the preconception period, fetotoxic agents should be discontinued. It is also essential to undertake a full cardiovascular examination which may, in some cases, question the possibility of pregnancy. During pregnancy, blood pressure should be monitored and controlled, but not necessarily returned to a normal value. Low blood pressure levels could indeed lead to placental hypoperfusion and fetal growth restriction. Close clinical, biological and ultrasound monitoring is recommended, even postpartum, since those patients are at higher risk for preeclampsia.

Australian association for exercise and sports science position statement on exercise and hypertension.

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Sharman, James E; Stowasser, Michael

2009-03-01

Hypertension (high blood pressure; BP) is a leading contributor to premature death and disability from cardiovascular disease. Lifestyle modification that includes regular physical activity is often recommended to patients with hypertension as one of the first line treatments for lowering BP, as well as improving overall risk for cardiovascular events. It is recognised that allied health care professionals play an important role in helping patients to achieve BP control by influencing and reinforcing appropriate lifestyle behavior. The minimum amount of exercise that is recommended in patients with hypertension comprises a mix of moderate to vigorous aerobic (endurance) activity (up to 5 days/week) in addition to resistance (strength) training (on 2 or more non-consecutive days/week). However, due to the dose-response relationship between physical activity and health, exercise levels performed beyond the minimum recommendations are expected to confer additional health benefits. Vigorous exercise training is generally safe and well tolerated by most people, including those with hypertension, although some special considerations are required and these are discussed in this review.

Left-sided portal hypertension revisited

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Antonio Manenti

2016-12-01

Conclusions: In every case of left-sided portal hypertension, upper digestive endoscopy and close follow-up are recommended. Besides, computed tomography can demonstrate particular conditions directly favoring gastroesophageal varices, and aid in selection of the appropriate therapeutic decisions. [Arch Clin Exp Surg 2016; 5(4.000: 211-215

Achievement of recommended glucose and blood pressure targets in patients with type 2 diabetes and hypertension in clinical practice – study rationale and protocol of DIALOGUE

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Gitt Anselm K

2012-12-01

Full Text Available Abstract Background Patients with type 2 diabetes have 2–4 times greater risk for cardiovascular morbidity and mortality than those without, and this is even further aggravated if they also suffer from hypertension. Unfortunately, less than one third of hypertensive diabetic patients meet blood pressure targets, and more than half fail to achieve target HbA1c values. Thus, appropriate blood pressure and glucose control are of utmost importance. Since treatment sometimes fails in clinical practice while clinical trials generally suggest good efficacy, data from daily clinical practice, especially with regard to the use of newly developed anti-diabetic and anti-hypertensive compounds in unselected patient populations, are essential. The DIALOGUE registry aims to close this important gap by evaluating different treatment approaches in hypertensive type 2 diabetic patients with respect to their effectiveness and tolerability and their impact on outcomes. In addition, DIALOGUE is the first registry to determine treatment success based on the new individualized treatment targets recommended by the ADA and the EASD. Methods DIALOGUE is a prospective observational German multicentre registry and will enrol 10,000 patients with both diabetes and hypertension in up to 700 sites. After a baseline visit, further documentations are scheduled at 6, 12 and 24 months. There are two co-primary objectives referring to the most recent guidelines for the treatment of diabetes and hypertension: 1 individual HbA1c goal achievement with respect to anti-diabetic pharmacotherapy and 2 individual blood pressure goal achievement with different antihypertensive treatments. Among the secondary objectives the rate of major cardio-vascular and cerebro-vascular events (MACCE and the rate of hospitalizations are the most important. Conclusion The registry will be able to gain insights into the reasons for the obvious gap between the demonstrated efficacy and safety of anti

Cardiovascular magnetic resonance in pulmonary hypertension

Science.gov (United States)

2012-01-01

Pulmonary hypertension represents a group of conditions characterized by higher than normal pulmonary artery pressures. Despite improved treatments, outcomes in many instances remain poor. In recent years, there has been growing interest in the use of Cardiovascular Magnetic Resonance (CMR) in patients with pulmonary hypertension. This technique offers certain advantages over other imaging modalities since it is well suited to the assessment of the right ventricle and the proximal pulmonary arteries. Reflecting the relatively sparse evidence supporting its use, CMR is not routinely recommended for patients with pulmonary hypertension. However, it is particularly useful in patient with pulmonary arterial hypertension associated with congenital heart disease. Furthermore, it has proven informative in a number of ways; illustrating how right ventricular remodeling is favorably reversed by drug therapies and providing explicit confirmation of the importance of the right ventricle to clinical outcome. This review will discuss these aspects and practical considerations before speculating on future applications. PMID:22257586

Recognition and Management of Resistant Hypertension.

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Braam, Branko; Taler, Sandra J; Rahman, Mahboob; Fillaus, Jennifer A; Greco, Barbara A; Forman, John P; Reisin, Efrain; Cohen, Debbie L; Saklayen, Mohammad G; Hedayati, S Susan

2017-03-07

Despite improvements in hypertension awareness and treatment, 30%-60% of hypertensive patients do not achieve BP targets and subsequently remain at risk for target organ damage. This therapeutic gap is particularly important to nephrologists, who frequently encounter treatment-resistant hypertension in patients with CKD. Data are limited on how best to treat patients with CKD and resistant hypertension, because patients with CKD have historically been excluded from hypertension treatment trials. First, we propose a consistent definition of resistant hypertension as BP levels confirmed by both in-office and out-of-office measurements that exceed appropriate targets while the patient is receiving treatment with at least three antihypertensive medications, including a diuretic, at dosages optimized to provide maximum benefit in the absence of intolerable side effects. Second, we recommend that each patient undergo a standardized, stepwise evaluation to assess adherence to dietary and lifestyle modifications and antihypertensive medications to identify and reduce barriers and discontinue use of substances that may exacerbate hypertension. Patients in whom there is high clinical suspicion should be evaluated for potential secondary causes of hypertension. Evidence-based management of resistant hypertension is discussed with special considerations of the differences in approach to patients with and without CKD, including the specific roles of diuretics and mineralocorticoid receptor antagonists and the current place of emerging therapies, such as renal denervation and baroreceptor stimulation. We endorse use of such a systematic approach to improve recognition and care for this vulnerable patient group that is at high risk for future kidney and cardiovascular events. Copyright © 2017 by the American Society of Nephrology.

Diagnosis of secondary hypertension: an age-based approach.

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Viera, Anthony J; Neutze, Dana M

2010-12-15

Secondary hypertension is a type of hypertension with an underlying, potentially correctable cause. A secondary etiology may be suggested by symptoms (e.g., flushing and sweating suggestive of pheochromocytoma), examina- tion findings (e.g., a renal bruit suggestive of renal artery stenosis), or laboratory abnormalities (e.g., hypokalemia suggestive of aldosteronism). Secondary hypertension also should be considered in patients with resistant hyper- tension, and early or late onset of hypertension. The prevalence of secondary hypertension and the most common etiologies vary by age group. Approximately 5 to 10 percent of adults with hypertension have a secondary cause. In young adults, particu- larly women, renal artery stenosis caused by fibromuscular dyspla- sia is one of the most common secondary etiologies. Fibromuscular dysplasia can be detected by abdominal magnetic resonance imag- ing or computed tomography. These same imaging modalities can be used to detect atherosclerotic renal artery stenosis, a major cause of secondary hypertension in older adults. In middle-aged adults, aldosteronism is the most common secondary cause of hyperten- sion, and the recommended initial diagnostic test is an aldosterone/ renin ratio. Up to 85 percent of children with hypertension have an identifiable cause, most often renal parenchymal disease. Therefore, all children with confirmed hypertension should have an evaluation for an underlying etiology that includes renal ultrasonography.

Dutch guideline for the management of hypertensive crisis -- 2010 revision.

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van den Born, B J H; Beutler, J J; Gaillard, C A J M; de Gooijer, A; van den Meiracker, A H; Kroon, A A

2011-05-01

Hypertensive crises are divided into hypertensive urgencies and emergencies. Together they form a heterogeneous group of acute hypertensive disorders depending on the presence or type of target organs involved. Despite better treatment options for hypertension, hypertensive crisis and its associated complications remain relatively common. In the Netherlands the number of patients starting renal replacement therapy because of 'malignant hypertension' has increased in the past two decades. In 2003, the first Dutch guideline on hypertensive crisis was released to allow a standardised evidence-based approach for patients presenting with a hypertensive crisis. In this paper we give an overview of the current management of hypertensive crisis and discuss several important changes incorporated in the 2010 revision. These changes include a modification in terminology replacing 'malignant hypertension' with 'hypertensive crisis with retinopathy and reclassification of hypertensive crisis with retinopathy under hypertensive emergencies instead of urgencies. With regard to the treatment of hypertensive emergencies, nicardipine instead of nitroprusside or labetalol is favoured for the management of perioperative hypertension, whereas labetalol has become the drug of choice for the treatment of hypertension associated with pre-eclampsia. For the treatment of hypertensive urgencies, oral administration of nifedipine retard instead of captopril is recommended as first-line therapy. In addition, a section on the management of hypertensive emergencies according to the type of target organ involved has been added. Efforts to increase the awareness and treatment of hypertension in the population at large may lower the incidence of hypertensive crisis and its complications.

Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in Cardiac Critical Care Pulmonary Hypertension.

Science.gov (United States)

Kim, John S; McSweeney, Julia; Lee, Joanne; Ivy, Dunbar

2016-03-01

To review the pharmacologic treatment options for pulmonary arterial hypertension in the cardiac intensive care setting and summarize the most-recent literature supporting these therapies. Literature search for prospective studies, retrospective analyses, and case reports evaluating the safety and efficacy of pulmonary arterial hypertension therapies. Mechanisms of action and pharmacokinetics, treatment recommendations, safety considerations, and outcomes for specific medical therapies. Specific targeted therapies developed for the treatment of adult patients with pulmonary arterial hypertension have been applied for the benefit of children with pulmonary arterial hypertension. With the exception of inhaled nitric oxide, there are no pulmonary arterial hypertension medications approved for children in the United States by the Food and Drug Administration. Unfortunately, data on treatment strategies in children with pulmonary arterial hypertension are limited by the small number of randomized controlled clinical trials evaluating the safety and efficacy of specific treatments. The treatment options for pulmonary arterial hypertension in children focus on endothelial-based pathways. Calcium channel blockers are recommended for use in a very small, select group of children who are responsive to vasoreactivity testing at cardiac catheterization. Phosphodiesterase type 5 inhibitor therapy is the most-commonly recommended oral treatment option in children with pulmonary arterial hypertension. Prostacyclins provide adjunctive therapy for the treatment of pulmonary arterial hypertension as infusions (IV and subcutaneous) and inhalation agents. Inhaled nitric oxide is the first-line vasodilator therapy in persistent pulmonary hypertension of the newborn and is commonly used in the treatment of pulmonary arterial hypertension in the ICU. Endothelin receptor antagonists have been shown to improve exercise tolerance and survival in adult patients with pulmonary arterial

Etiopathogenetic Mechanisms of Pulmonary Hypertension in Sleep-Related Breathing Disorders

Directory of Open Access Journals (Sweden)

Ayodeji Adegunsoye

2012-01-01

Full Text Available Obstructive sleep apnea syndrome is a common disorder with significant health consequences and is on the rise in consonance with the obesity pandemic. In view of the association between sleep-disordered breathing and pulmonary hypertension as depicted by multiple studies, current clinical practice guidelines categorize obstructive sleep apnea as a risk factor for pulmonary hypertension and recommend an assessment for sleep disordered breathing in evaluating patients with pulmonary hypertension. The dysregulatory mechanisms associated with hypoxemic episodes observed in sleep related breathing disorders contribute to the onset of pulmonary hypertension and identification of these potentially treatable factors might help in the reduction of overall cardiovascular mortality.

Impact of Hypertension on Cognitive Function

Science.gov (United States)

Iadecola, Costantino; Yaffe, Kristine; Biller, José; Bratzke, Lisa C.; Faraci, Frank M.; Gorelick, Philip B.; Gulati, Martha; Kamel, Hooman; Knopman, David S.; Launer, Lenore J.; Saczynski, Jane S.; Seshadri, Sudha; Zeki Al Hazzouri, Adina

2017-01-01

Background Age-related dementia, most commonly caused by Alzheimer disease or cerebrovascular factors (vascular dementia), is a major public health threat. Chronic arterial hypertension is a well-established risk factor for both types of dementia, but the link between hypertension and its treatment and cognition remains poorly understood. In this scientific statement, a multidisciplinary team of experts examines the impact of hypertension on cognition to assess the state of the knowledge, to identify gaps, and to provide future directions. Methods Authors with relevant expertise were selected to contribute to this statement in accordance with the American Heart Association conflict-of-interest management policy. Panel members were assigned topics relevant to their areas of expertise, reviewed the literature, and summarized the available data. Results Hypertension disrupts the structure and function of cerebral blood vessels, leads to ischemic damage of white matter regions critical for cognitive function, and may promote Alzheimer pathology. There is strong evidence of a deleterious influence of midlife hypertension on late-life cognitive function, but the cognitive impact of late-life hypertension is less clear. Observational studies demonstrated a cumulative effect of hypertension on cerebrovascular damage, but evidence from clinical trials that antihypertensive treatment improves cognition is not conclusive. Conclusions After carefully reviewing the literature, the group concluded that there were insufficient data to make evidence-based recommendations. However, judicious treatment of hypertension, taking into account goals of care and individual characteristics (eg, age and comorbidities), seems justified to safeguard vascular health and, as a consequence, brain health. PMID:27977393

Hypertensive patients perception of their illness: A qualitative study ...

African Journals Online (AJOL)

PROMOTING ACCESS TO AFRICAN RESEARCH ... treatment and lifestyle changes recommendations in a primary care setting. ... Conclusion - Hypertensive patients need information during their encounter with health care providers on ...

Management of Hypertension in Patients with Chronic Kidney Disease in Asia.

Science.gov (United States)

Huang, Qi-Fang; Hoshide, Satoshi; Cheng, Hao-Min; Park, Sungha; Park, Chang-Gyu; Chen, Chen-Huan; Kario, Kazuomi; Wang, Ji-Guang

2016-01-01

Hypertension is both a cause and consequence of chronic kidney disease (CKD). According to the Chinese national survey in 2007-2010, the prevalence of CKD was much higher in hypertensive patients (18.9%, n=16,691) than in the overall population sample (10.8%, n=47,204). CKD in hypertension confers risks to the kidneys as well as other organs. Probably because of high dietary salt intake, Asian hypertensive patients with CKD show high prevalence of non-dipping and reversed dipping blood pressure pattern, and may have even higher risks of cardiovascular disease. Therefore, out-of-office blood pressure evaluation and comprehensive cardiovascular evaluations are required. Most of current hypertension guidelines recommend intensive antihypertensive treatment in hypertensive patients with CKD. This is probably of particular relevance for cardiovascular prevention in Asia, because stroke, as a major complication of hypertension in Asia, is more closely related to blood pressure than coronary events. Intensive blood pressure control to 130/80 mmHg is often required to prevent CKD progression and cardiovascular complications. The inhibitors of the renin-angiotensin system (RAS) are recommended as the first line antihypertensive medications in patients with a glomerular filtration rate higher than 30 ml/min/1.73 m², which may more efficaciously prevent end-stage renal disease and cardiovascular events. Nonetheless, combination therapy of RAS inhibitors with other classes of antihypertensive drugs, such as calcium-channel blockers, diuretics, etc, is required to control blood pressure to the target. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Pulmonary hypertension in children

Science.gov (United States)

Al Dabbagh, Maha; Banjar, Hanna; Galal, Nasser; Kouatli, Amjad; Kandil, Hammam; Chehab, May

2014-01-01

Pulmonary hypertension (PH) is relatively uncommon in children. Pulmonary arterial hypertension (PAH) in pediatric comprises a wide spectrum of diseases, from a transient neonatal condition to a progressive disease associated with morbidity and mortality. Most common PAH in pediatric are idiopathic (IPAH) or PAH associated with congenital heart disease (PAH-CHD), while other associated conditions, such as connective tissue disease (CTD), are less common in pediatrics. Despite better understanding of PH and the availability of new medications during recent decades; the diagnosis, investigation and choice of therapy remain a challenge in children, as evidence-based recommendations depend mainly on adult studies. In this review, we provide a detailed discussion about the distinctive features of PAH in pediatric, mainly emphacysing on classification and diagnostic algorithm. PMID:25076989

Public awareness hypertension: findings of a kidney day

International Nuclear Information System (INIS)

Khan, R.M.A.; Saeed, T.; Awan, S.R.; Ahmad, M.

2008-01-01

To determine the frequency of hypertension, its associated life style factors and to explore the level of awareness about hypertension among adult populace attending the kidney day and to formulate the strategies to improve the awareness. A total of one hundred participants were interviewed. The structured questionnaire was filled at the spot to obtain socio demographic information after taking verbal informed consent. Height, weight, pulse, blood pressure were recorded. A total of one hundred participants were interviewed. Overall frequency of hypertension in the study population was twenty five percent (25%). The prevalence of hypertension increased with increasing age and body mass index. Only thirty five percent (35%) could define hypertension and this awareness was significantly associated with educational level. Lack of physical activity, card playing and televisionization was observed in sixty percent of participants while thirty three percent were overweight. Fifty nine percent were using additional salt while seventy percent were having meals and snacks outside. High frequency of hypertension, obesity, lack of physical activity, unhealthy nutrition, and faulty dietary habits was observed in the study population. Emphasis on health education and use of electronic and print media is recommended to improve the public awareness about the risk factors and consequences of hypertension like stroke, heart attack, kidney failure etc. (author)

Assessment of pulmonary hypertension by CT and MR imaging

International Nuclear Information System (INIS)

Ley, Sebastian; Kreitner, Karl-Friedrich; Heussel, Claus P.; Fink, Christian; Kauczor, Hans-Ulrich; Borst, Mathias M.

2004-01-01

In the recent World Health Organization (WHO) classification the group of pulmonary arterial hypertension (PH) comprises the classic primary pulmonary hypertension and several conditions with definite or very high risk factors to develop pulmonary arterial hypertension. Therapeutic advances drive the need for a comprehensive pre-therapeutic evaluation for optimal treatment. Furthermore, follow-up examinations need to be performed to monitor changes in disease status and response to therapy. Up to now, the diagnostic imaging work-up of PH comprises mainly echocardiography, invasive right heart catheterization and ventilation/perfusion scintigraphy. Due to technical advances helical computed tomography (CT) and magnetic resonance imaging (MRI) became more important in the evaluation and for differential diagnosis of pulmonary arterial hypertension. Both modalities are reviewed and recommendations for clinical use are given. (orig.)

Hypertension Prevalence, Cardiac Complications, and Antihypertensive Medication Use in Children.

Science.gov (United States)

Dobson, Craig P; Eide, Matilda; Nylund, Cade M

2015-07-01

To determine the prevalence of hypertension diagnosis in children of US military members and quantify echocardiography evaluations, cardiac complications, and antihypertensive prescriptions in the post-2004 guideline era. Using billing data from military health insurance (TRICARE) enrollees, hypertension cases were defined as 2 or more visits with a primary or unspecified hypertension diagnosis during any calendar year or 1 such visit if with a cardiologist or nephrologist. During 2006-2011, the database contained an average 1.3 million subjects aged 2-18 years per year. A total of 16 322 met the definition of hypertension (2.6/1000). The incidence of hypertension increased by 17% between 2006 and 2011 (from 2.3/1000 to 2.7/1000; P Hypertension was more common in adolescents aged 12-18 years than in younger children (5.4/1000 vs 0.9/1000). Among patients with hypertension, 5585 (34%) underwent echocardiography. The frequency of annual echocardiograms increased from 22.7% to 27.7% (P hypertension, 6353 (38.9%) received an antihypertensive medication. The prevalence of hypertension in children has increased. Compliance with national guidelines is poor. Of pediatric patients with hypertension who receive an echocardiogram, 1 in 12 had identified cardiac complications, supporting the current recommendations for echocardiography in children with hypertension. Less than one-half of children with hypertension are treated with medication. Published by Elsevier Inc.

Substandard care in maternal mortality due to hypertensive disease in pregnancy in the Netherlands

NARCIS (Netherlands)

Schutte, J. M.; Schuitemaker, N. W. E.; van Roosmalen, J.; Steegers, E. A. P.

Objective To review the standard of care in cases of maternal mortality due to hypertensive diseases in pregnancy and to make recommendations for its improvement. Design Care given to women with hypertensive disease in pregnancy was audited and substandard care factors identified. Setting

Secondary prevention of stroke in Saskatchewan, Canada: hypertension control.

Science.gov (United States)

Bartsch, Janelle Ann; Teare, Gary F; Neufeld, Anne; Hudema, Nedeene; Muhajarine, Nazeem

2013-10-01

In the province of Saskatchewan, Canada, stroke is the third leading cause of death as well as the major cause of adult disability. Once a person suffers a stroke or transient ischemic attack (TIA), they are at high risk for having a secondary stroke. Hypertension (elevated blood pressure) is the single most important modifiable risk factor for both first and recurrent stroke, and is thus an important risk factor to be controlled. According to the Canadian Stroke Strategy (CSS) Best Practice Recommendations, blood pressure lowering treatment should be initiated before discharge from hospital for all stroke/TIA patients. The purpose of this study was to examine the quality of medically driven secondary stroke prevention care in Saskatchewan as applied to hypertension control. The objectives of the study were to: (1) develop methodology and calculate a secondary stroke process of care measure using available data in Saskatchewan, based on an appropriate hypertension therapy indicator recommendation from the CSS Performance Measurement Manual; (2) examine variation in secondary stroke prevention hypertensive care among the Saskatchewan Regional Health Authorities; and (3) investigate factors associated with receiving evidence-based hypertensive secondary stroke prevention. This multi-year cross-sectional study was an analysis of deidentified health data derived from linkage of administrative health data. A select indicator from the CSS Performance Measurement Manual that measures adherence to a CSS Best Practice Guidelines concerning use of antihypertensive medications for secondary stroke prevention was calculated. Logistic regression was used to quantify the association of patient demographic and socioeconomic characteristics and geographic location of care with receipt of guideline-recommended hypertensive secondary stroke prevention. The target population was all Saskatchewan residents who were hospitalized in Saskatchewan for a stroke or TIA between April 1, 2001

Obesity and Hypertension amongst Traders in Ijebu Ode, Nigeria

African Journals Online (AJOL)

Dr Olaleye

Keywords: Obesity, hypertension, market men and women, Nigeria. INTRODUCTION ... Physical inactivity has been identified as a major cause of excessive body ... with mean daily energy intake far higher than recommended levels (Afolabi et.

Essential hypertension vs. secondary hypertension among children.

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Gupta-Malhotra, Monesha; Banker, Ashish; Shete, Sanjay; Hashmi, Syed Sharukh; Tyson, John E; Barratt, Michelle S; Hecht, Jacqueline T; Milewicz, Diane M; Boerwinkle, Eric

2015-01-01

The aim was to determine the proportions and correlates of essential hypertension among children in a tertiary pediatric hypertension clinic. We evaluated 423 consecutive children and collected demographic and clinical history by retrospective chart review. We identified 275 (65%) hypertensive children (blood pressure >95th percentile per the "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents") from 423 children referred to the clinic for history of elevated blood pressure. The remainder of the patients had normotension (11%), white coat hypertension (11%), prehypertension (10%), and pending diagnosis (3%). Among the 275 hypertensive children, 43% (n = 119; boys = 56%; median age = 12 years; range = 3-17 years) had essential hypertension and 57% (n = 156; boys = 66%; median age = 9 years; range = 0.08-19 years) had secondary hypertension. When compared with those with secondary hypertension, those with essential hypertension had a significantly older age at diagnosis (P = 0.0002), stronger family history of hypertension (94% vs. 68%; P secondary hypertension. The phenotype of essential hypertension can present as early as 3 years of age and is the predominant form of hypertension in children after age of 6 years. Among children with hypertension, those with essential hypertension present at an older age, have a stronger family history of hypertension, and have lower prevalence of preterm birth. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Pregnancy in pulmonary arterial hypertension

Directory of Open Access Journals (Sweden)

Karen M. Olsson

2016-12-01

Full Text Available Despite advanced therapies, maternal mortality in women with pulmonary arterial hypertension (PAH remains high in pregnancy and is especially high during the post-partum period. However, recent data indicates that morbidity and mortality during pregnancy and after birth have improved for PAH patients. The current European Society of Cardiology/European Respiratory Society guidelines recommend that women with PAH should not become pregnant. Therefore, the risks associated with pregnancy must be emphasised and counselling offered to women at the time of PAH diagnosis and to women with PAH who become pregnant. Early termination should be discussed. Women who choose to continue with their pregnancy should be treated at specialised pulmonary hypertension centres with experience in managing PAH during and after pregnancy.

Pregnancy in pulmonary arterial hypertension.

Science.gov (United States)

Olsson, Karen M; Channick, Richard

2016-12-01

Despite advanced therapies, maternal mortality in women with pulmonary arterial hypertension (PAH) remains high in pregnancy and is especially high during the post-partum period. However, recent data indicates that morbidity and mortality during pregnancy and after birth have improved for PAH patients. The current European Society of Cardiology/European Respiratory Society guidelines recommend that women with PAH should not become pregnant. Therefore, the risks associated with pregnancy must be emphasised and counselling offered to women at the time of PAH diagnosis and to women with PAH who become pregnant. Early termination should be discussed. Women who choose to continue with their pregnancy should be treated at specialised pulmonary hypertension centres with experience in managing PAH during and after pregnancy. Copyright ©ERS 2016.

[Arterial hypertension due to altitude].

Science.gov (United States)

Domej, Wolfgang; Trapp, Michael; Miggitsch, Eva Maria; Krakher, Tiziana; Riedlbauer, Rita; Roher, Peter; Schwaberger, Günther

2008-01-01

The behavior of blood pressure under hypoxic conditions depends on individual factors, altitude and duration of stay at altitude. While most humans are normotensive at higher altitudes, a few will react with moderate hypertension or hypotension. Excessive elevation of arterial blood pressure is not even to be expected below 4,000 m. Rather, several weeks' stay at higher altitude will decrease systolic and diastolic blood pressure at rest as well as during physical exertion. A high-altitude treatment for rehabilitation purposes at moderate altitude may be recommended for patients with cardio-circulatory disorders. Improvements can last several months even after returning to accustomed altitudes. Furthermore, endurance-trained hypertensive patients with pharmacologically controlled arterial blood pressure might be able to participate in mountain treks without additional health risk.

Refractory versus resistant hypertension: Novel distinctive phenotypes

Science.gov (United States)

Dudenbostel, Tanja; Siddiqui, Mohammed; Gharpure, Nitin; Calhoun, David A.

2017-01-01

Resistant hypertension (RHTN) is relatively common with an estimated prevalence of 10-20% of treated hypertensive patients. It is defined as blood pressure (BP) >140/90 mmHg treated with ≥3 antihypertensive medications, including a diuretic, if tolerated. Refractory hypertension is a novel phenotype of severe antihypertensive treatment failure. The proposed definition for refractory hypertension, i.e. BP >140/90 mmHg with use of ≥5 different antihypertensive medications, including a diuretic and a mineralocorticoid receptor antagonist (MRA) has been applied inconsistently. In comparison to RHTN, refractory hypertension seems to be less prevalent than RHTN. This review focuses on current knowledge about this novel phenotype compared with RHTN including definition, prevalence, mechanisms, characteristics and comorbidities, including cardiovascular risk. In patients with RHTN excess fluid retention is thought to be a common mechanism for the development of RHTN. Recently, evidence has emerged suggesting that refractory hypertension may be more of neurogenic etiology due to increased sympathetic activity as opposed to excess fluid retention. Treatment recommendations for RHTN are generally based on use and intensification of diuretic therapy, especially with the combination of a long-acting thiazide-like diuretic and an MRA. Based on findings from available studies, such an approach does not seem to be a successful strategy to control BP in patients with refractory hypertension and effective sympathetic inhibition in such patients, either with medications and/or device based approaches may be needed. PMID:29034321

Hypertension Subtypes among Hypertensive Patients in Ibadan

Directory of Open Access Journals (Sweden)

Abiodun M. Adeoye

2014-01-01

Full Text Available Background. Certain hypertension subtypes have been shown to increase the risk for cardiovascular morbidity and mortality and may be related to specific underlying genetic determinants. Inappropriate characterization of subtypes of hypertension makes efforts at elucidating the genetic contributions to the etiology of hypertension largely vapid. We report the hypertension subtypes among patients with hypertension from South-Western Nigeria. Methods. A total of 1858 subjects comprising 76% female, hypertensive, aged 18 and above were recruited into the study from two centers in Ibadan, Nigeria. Hypertension was identified using JNCVII definition and was further grouped into four subtypes: controlled hypertension (CH, isolated systolic hypertension (ISH, isolated diastolic hypertension (IDH, and systolic-diastolic hypertension (SDH. Results. Systolic-diastolic hypertension was the most prevalent. Whereas SDH (77.6% versus 73.5% and IDH (4.9% versus 4.7% were more prevalent among females, ISH (10.1% versus 6.2% was higher among males (P=0.048. Female subjects were more obese (P<0.0001 and SDH was prevalent among the obese group. Conclusion. Gender and obesity significantly influenced the distribution of the hypertension subtypes. Characterization of hypertension by subtypes in genetic association studies could lead to identification of previously unknown genetic variants involved in the etiology of hypertension. Large-scale studies among various ethnic groups may be needed to confirm these observations.

[Ambulatory blood pressure monitoring for hypertension diagnosis?

Science.gov (United States)

Gijón Conde, T; Banegas, J R

2017-01-01

The early and accurate diagnosis of hypertension is essential given its importance in the development of cardiovascular disease. The boundaries between normal blood pressure (BP) and hypertension are arbitrary and based on the benefits of treating exceeding those of not treating. Conventional BP measurement at the clinic only offers information of a particular time and presents multiple biases dependent on inherent variability of BP and measurement technique itself. Multiple studies have demonstrated the prognosis superiority in the development of cardiovascular disease of ambulatory blood pressure monitoring (ABPM), allows detection of white coat hypertension, avoiding overdiagnosis and overtreatment, and the detection of patients with masked hypertension who are at risk of underdetection and undertreatment. ABPM also assess nightime BP and circadian variability, providing additional prognostic value. ABPM is recognized in the diagnosis of hypertension in 2011 British NICE Guidelines, very argued at the 2013 European Society of Hypertension guidelines, and recommended in the US Preventive Services Task Force in 2015, 2016 Canadian Guidelines and the 2016 Spanish Program of Preventive Activities and Health Promotion (PAPPS). Its generalization is likely to be only a matter of time. Copyright © 2017 Sociedad Española de Hipertension-Liga Española para la Lucha de la Hipertensión Arterial (SEH-LELHA). Publicado por Elsevier España, S.L.U. All rights reserved.

Secondary arterial hypertension: when, who, and how to screen?

Science.gov (United States)

Rimoldi, Stefano F; Scherrer, Urs; Messerli, Franz H

2014-05-14

Secondary hypertension refers to arterial hypertension due to an identifiable cause and affects ∼5-10% of the general hypertensive population. Because secondary forms are rare and work up is time-consuming and expensive, only patients with clinical suspicion should be screened. In recent years, some new aspects gained importance regarding this screening. In particular, increasing evidence suggests that 24 h ambulatory blood pressure (BP) monitoring plays a central role in the work up of patients with suspected secondary hypertension. Moreover, obstructive sleep apnoea has been identified as one of the most frequent causes. Finally, the introduction of catheter-based renal denervation for the treatment of patients with resistant hypertension has dramatically increased the interest and the number of patients evaluated for renal artery stenosis. We review the clinical clues of the most common causes of secondary hypertension. Specific recommendations are given as to evaluation and treatment of various forms of secondary hypertension. Despite appropriate therapy or even removal of the secondary cause, BP rarely ever returns to normal with long-term follow-up. Such residue hypertension indicates either that some patients with secondary hypertension also have concomitant essential hypertension or that irreversible vascular remodelling has taken place. Thus, in patients with potentially reversible causes of hypertension, early detection and treatment are important to minimize/prevent irreversible changes in the vasculature and target organs. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013. For permissions please email: journals.permissions@oup.com.

Blood pressure and LDL-cholesterol targets for prevention of recurrent strokes and cognitive decline in the hypertensive patient: design of the European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment randomized trial.

Science.gov (United States)

Zanchetti, Alberto; Liu, Lisheng; Mancia, Giuseppe; Parati, Gianfranco; Grassi, Guido; Stramba-Badiale, Marco; Silani, Vincenzo; Bilo, Grzegorz; Corrao, Giovanni; Zambon, Antonella; Scotti, Lorenza; Zhang, Xinhua; Wang, HayYan; Zhang, Yuqing; Zhang, Xuezhong; Guan, Ting Rui; Berge, Eivind; Redon, Josep; Narkiewicz, Krzysztof; Dominiczak, Anna; Nilsson, Peter; Viigimaa, Margus; Laurent, Stéphane; Agabiti-Rosei, Enrico; Wu, Zhaosu; Zhu, Dingliang; Rodicio, José Luis; Ruilope, Luis Miguel; Martell-Claros, Nieves; Pinto, Fernando; Schmieder, Roland E; Burnier, Michel; Banach, Maciej; Cifkova, Renata; Farsang, Csaba; Konradi, Alexandra; Lazareva, Irina; Sirenko, Yuriy; Dorobantu, Maria; Postadzhiyan, Arman; Accetto, Rok; Jelakovic, Bojan; Lovic, Dragan; Manolis, Athanasios J; Stylianou, Philippos; Erdine, Serap; Dicker, Dror; Wei, Gangzhi; Xu, Chengbin; Xie, Hengge; Coca, Antonio; O'Brien, John; Ford, Gary

2014-09-01

The SBP values to be achieved by antihypertensive therapy in order to maximize reduction of cardiovascular outcomes are unknown; neither is it clear whether in patients with a previous cardiovascular event, the optimal values are lower than in the low-to-moderate risk hypertensive patients, or a more cautious blood pressure (BP) reduction should be obtained. Because of the uncertainty whether 'the lower the better' or the 'J-curve' hypothesis is correct, the European Society of Hypertension and the Chinese Hypertension League have promoted a randomized trial comparing antihypertensive treatment strategies aiming at three different SBP targets in hypertensive patients with a recent stroke or transient ischaemic attack. As the optimal level of low-density lipoprotein cholesterol (LDL-C) level is also unknown in these patients, LDL-C-lowering has been included in the design. The European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment trial is a prospective multinational, randomized trial with a 3 × 2 factorial design comparing: three different SBP targets (1, hypertension and a stroke or transient ischaemic attack 1-6 months before randomization. Antihypertensive and statin treatments will be initiated or modified using suitable registered agents chosen by the investigators, in order to maintain patients within the randomized SBP and LDL-C windows. All patients will be followed up every 3 months for BP and every 6 months for LDL-C. Ambulatory BP will be measured yearly. Primary outcome is time to stroke (fatal and non-fatal). Important secondary outcomes are: time to first major cardiovascular event; cognitive decline (Montreal Cognitive Assessment) and dementia. All major outcomes will be adjudicated by committees blind to randomized allocation. A Data and Safety Monitoring Board has open access to data and can recommend trial interruption for safety. It has been calculated that 925 patients would reach the primary

Computer-assisted static/dynamic renal imaging: a screening test for renovascular hypertension

International Nuclear Information System (INIS)

Keim, H.J.; Johnson, P.M.; Vaughan, E.D. Jr.; Beg, K.; Follett, D.A.; Freeman, L.M.; Laragh, J.H.

1979-01-01

Computer-assisted static/dynamic renal imaging with [ 197 Hg] chlormerodrin and [/sup 99m/Tc] pertechnetate was evaluated prospectively as a screening test for renovascular hypertension. Results are reported for 51 patients: 33 with benign essential hypertension and 18 with renovascular hypertension, and for 21 normal controls. All patients underwent renal arteriography. Patients with significant obesity, renal insufficiency, or renoparenchymal disease were excluded from this study. Independent visual analyses of renal gamma images and time-activity transit curves identified 17 of the 18 patients with renovascular hypertension; one study was equivocal. There were five equivocal and three false-positive results in the essential hypertension and normal control groups. The sensitivity of the method was 94% and the specificity 85%. Since the prevalence of the renovascular subset of hypertension is approximately 5%, the predictive value is only 25%. Inclusion of computer-generated data did not improve this result. Accordingly, this method is not recommended as a primary screening test for renovascular hypertension

Pulmonary hypertension and echocardiogram parameters in obstructive sleep apnea.

Science.gov (United States)

Wong, H T; Chee, K H; Chong, A W

2017-06-01

Obstructive sleep apnea (OSA) is a growing health hazard in the United States and worldwide. OSA is now recognized as a disorder with systemic manifestations and its association with obesity and adverse cardiovascular consequences. There is increasing evidence that OSA may be associated with systemic hypertension and an increased incidence of stroke, heart failure, myocardial infarction, and arrhythmias. Less information is available about the association between OSA and pulmonary hypertension (PH). We therefore conduct this study to look at the prevalence of the pulmonary hypertension in obstructive sleep apnea patient and to identify risk factors leading to pulmonary hypertension among OSA patient. We studied and analyzed all OSA patient confirmed by polysomnograph in the year 2015. Twenty-five patients with OSA were included in this study with prevalence of pulmonary hypertension of 16%. Univariate analysis of various factors revealed a statistically significant association between having the lowest SpO 2 of pulmonary hypertension (p = 0.016). There were no statistically significant associations between age, gender, smoking status, hypertension, body mass index (BMI), or apnea-hypopnea index (AHI) with occurrence of pulmonary hypertension. AHI is not a good predictor for pulmonary hypertension. The real value of using AHI to predict the health risk of OSA is doubtful. We recommend routine echocardiogram among OSA patient. The objective information in the echocardiogram provides evidence for counseling of patient with disease of OSA and hence hopefully can improve compliance of patient to treatment especially usage of CPAP.

Obesity and Hypertension, Heart Failure, and Coronary Heart Disease—Risk Factor, Paradox, and Recommendations for Weight Loss

OpenAIRE

Artham, Surya M.; Lavie, Carl J.; Milani, Richard V.; Ventura, Hector O.

2009-01-01

Obesity prevalence has reached epidemic proportions and is independently associated with numerous cardiovascular disease (CVD) risk factors, including diabetes mellitus, hypertension, dyslipidemia, cancers, sleep apnea, and other major CVDs. Obesity has significant negative impact on CVD, including hypertension, coronary heart disease, heart failure, and arrhythmias via its maladaptive effects on individual CVD risk factors and cardiac structure and function. Despite this negative association...

[Expert consensus statement on interventional renal sympathetic denervation for hypertension treatment].

Science.gov (United States)

Mahfoud, F; Vonend, O; Bruck, H; Clasen, W; Eckert, S; Frye, B; Haller, H; Hausberg, M; Hoppe, U C; Hoyer, J; Hahn, K; Keller, T; Krämer, B K; Kreutz, R; Potthoff, S A; Reinecke, H; Schmieder, R; Schwenger, V; Kintscher, U; Böhm, M; Rump, L C

2011-11-01

This commentary summarizes the expert consensus and recommendations of the working group 'Herz und Niere' of the German Society of Cardiology (DGK), the German Society of Nephrology (DGfN) and the German Hypertension League (DHL) on renal denervation for antihypertensive treatment. Renal denervation is a new, interventional approach to selectively denervate renal afferent and efferent sympathetic fibers. Renal denervation has been demonstrated to reduce office systolic and diastolic blood pressure in patients with resistant hypertension, defined as systolic office blood pressure ≥ 160 mm Hg and ≥ 150 mm Hg in patients with diabetes type 2, which should currently be used as blood pressure thresholds for undergoing the procedure. Exclusion of secondary hypertension causes and optimized antihypertensive drug treatment is mandatory in every patient with resistant hypertension. In order to exclude pseudoresistance, 24-hour blood pressure measurements should be performed. Preserved renal function was an inclusion criterion in the Symplicity studies, therefore, renal denervation should be only considered in patients with a glomerular filtration rate > 45 ml/min. Adequate centre qualification in both, treatment of hypertension and interventional expertise are essential to ensure correct patient selection and procedural safety. Long-term follow-up after renal denervation and participation in the German Renal Denervation (GREAT) Registry are recommended to assess safety and efficacy after renal denervation over time. © Georg Thieme Verlag KG Stuttgart · New York.

[Secondary hypertension].

Science.gov (United States)

Yoshida, Yuichi; Shibata, Hirotaka

2015-11-01

Hypertension is a common disease and a crucial predisposing factor of cardiovascular diseases. Approximately 10% of hypertensive patients are secondary hypertension, a pathogenetic factor of which can be identified. Secondary hypertension consists of endocrine, renal, and other diseases. Primary aldosteronism, Cushing's syndrome, pheochromocytoma, hyperthyroidism, and hypothyroidism result in endocrine hypertension. Renal parenchymal hypertension and renovascular hypertension result in renal hypertension. Other diseases such as obstructive sleep apnea syndrome are also very prevalent in secondary hypertension. It is very crucial to find and treat secondary hypertension at earlier stages since most secondary hypertension is curable or can be dramatically improved by specific treatment. One should keep in mind that screening of secondary hypertension should be done at least once in a daily clinical practice.

Resistance Training in Spontaneously Hypertensive Rats with Severe Hypertension

Directory of Open Access Journals (Sweden)

Rodrigo Vanerson Passos Neves

2016-01-01

Full Text Available Abstract Background: Resistance training (RT has been recommended as a non-pharmacological treatment for moderate hypertension. In spite of the important role of exercise intensity on training prescription, there is still no data regarding the effects of RT intensity on severe hypertension (SH. Objective: This study examined the effects of two RT protocols (vertical ladder climbing, performed at different overloads of maximal weight carried (MWC, on blood pressure (BP and muscle strength of spontaneously hypertensive rats (SHR with SH. Methods: Fifteen male SHR ENT#091;206 ± 10 mmHg of systolic BP (SBPENT#093; and five Wistar Kyoto rats (WKY; 119 ± 10 mmHg of SBP were divided into 4 groups: sedentary (SED-WKY and SHR (SED-SHR; RT1-SHR training relative to body weight (~40% of MWC; and RT2-SHR training relative to MWC test (~70% of MWC. Systolic BP and heart rate (HR were measured weekly using the tail-cuff method. The progression of muscle strength was determined once every fifteen days. The RT consisted of 3 weekly sessions on non-consecutive days for 12-weeks. Results: Both RT protocols prevented the increase in SBP (delta - 5 and -7 mmHg, respectively; p > 0.05, whereas SBP of the SED-SHR group increased by 19 mmHg (p 0.05. Conclusions: Our data indicated that both RT protocols were effective in preventing chronic elevation of SBP in SH. Additionally, a higher RT overload induced a greater increase in muscle strength.

Management of arterial hypertension in patients with acute stroke.

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Adeoye, Opeolu; Jauch, Edward C

2006-11-01

Management of arterial hypertension in the hyperacute period immediately after stroke ictus remains controversial. Extremes of blood pressure (BP) are associated with poor outcomes in all stroke subtypes. Severely hypertensive patients likely benefit from modest BP reductions, but aggressive BP reduction may worsen outcome. Although little evidence is currently available to definitively establish guideline recommendations for optimal BP goals at stroke presentation, recently published research is shedding some light on how to approach management of BP after stroke. Antihypertensive treatment should probably be deferred in ischemic stroke patients except in cases of severe hypertension or when thrombolytic therapy is warranted and the patient's BP is above acceptable levels. Hypertensive hemorrhagic stroke patients may benefit from modest BP reductions. Relative hypotension causing regional hypoperfusion is an increasingly understood concept immediately following ischemic or hemorrhagic stroke, emphasizing the need for careful titration of appropriate medications to minimize fluctuations in BP for treated patients. Ongoing trials will improve our current knowledge regarding BP management after ischemic and hemorrhagic stroke.

Hypertension Subtypes among Hypertensive Patients in Ibadan

OpenAIRE

Abiodun M. Adeoye; Adewole Adebiyi; Bamidele O. Tayo; Babatunde L. Salako; Adesola Ogunniyi; Richard S. Cooper

2014-01-01

Background. Certain hypertension subtypes have been shown to increase the risk for cardiovascular morbidity and mortality and may be related to specific underlying genetic determinants. Inappropriate characterization of subtypes of hypertension makes efforts at elucidating the genetic contributions to the etiology of hypertension largely vapid. We report the hypertension subtypes among patients with hypertension from South-Western Nigeria. Methods. A total of 1858 subjects comprising 76% fema...

Ocular Hypertension

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... Español Eye Health / Eye Health A-Z Ocular Hypertension Sections What Is Ocular Hypertension? Ocular Hypertension Causes ... Hypertension Diagnosis Ocular Hypertension Treatment What Is Ocular Hypertension? Leer en Español: ¿Qué es la hipertensión ocular? ...

Evaluation and management of pediatric hypertensive crises: hypertensive urgency and hypertensive emergencies

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Patel NH

2012-11-01

Full Text Available Nirali H Patel,1 Sarah K Romero,2 David C Kaelber31Division of Emergency Medicine, Akron Children's Hospital, Akron, OH, USA; 2Division of Emergency Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA; 3Departments of Information Services, Internal Medicine, Pediatrics, and Epidemiology and Biostatistics, The Center for Clinical Informatics Research and Education, The MetroHealth System and School of Medicine, Case Western Reserve University, Cleveland OH, USAAbstract: Hypertension (HTN in the pediatric population is estimated to have a world-wide prevalence of 2%-5%. As with adults, pediatric patients with HTN can present with hypertensive crises include hypertensive urgency and hypertensive emergencies. However, pediatric blood pressure problems have a greater chance of being from secondary causes of HTN, as opposed to primary HTN, than in adults. Thorough evaluation of a child with a hypertensive emergency includes accurate blood pressure readings, complete and focused symptom history, and appropriate past medical, surgical, and family history. Physical exam should include height, weight, four-limb blood pressures, a general overall examination and especially detailed cardiovascular and neurological examinations, including fundoscopic examination. Initial work-up should typically include electrocardiography, chest X-ray, serum chemistries, complete blood count, and urinalysis. Initial management of hypertensive emergencies generally includes the use of intravenous or oral antihypertensive medications, as well as appropriate, typically outpatient, follow-up. Emergency department goals for hypertensive crises are to (1 safely lower blood pressure, and (2 treat/minimize acute end organ damage, while (3 identifying underlying etiology. Intravenous antihypertensive medications are the treatment modality of choice for hypertensive emergencies with the goal of reducing systolic blood pressure by 25% of the original value over an 8

["Consumption of restricted foods" in Mexican hypertensive patients].

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Piña López, Julio Alfonso; Moral de la Rubia, José; Ybarra Sagarduy, José Luis; Camacho Mata, Dacia Yurima; Masud-Yunes Zárraga, José Luis

2017-10-27

Strict adherence to personal health recommendations is necessary to improve the clinical control of arterial hypertension. To identify predictors of the behavior to avoid the "consumption of restricted foods" in a sample of hypertensive patients from Tamaulipas, Mexico. Participants were 183 patients with arterial hypertension diagnosis, who completed two self-administered questionnaires and different questions regarding adherence and self-care behaviors. A trajectory analysis was used for the interpretation of data. Less tolerance to frustration, a major affective social support and a lower body mass index were behavior predictors to avoid the consumption of restricted foods (pBS= 0.294, χ2/gl= 1.417, GFI = 0.993, AGFI = 0.965, NFI = 0.934, IFI = 0.980 y SRMR = 0.040), explaining approximately 20% of the variance in the study behavior. The study of adherence and self-care behaviors demands to identify what and how some personal and interpersonal variables are influencing in their daily practice, which can contribute to improve the interdisciplinary interventions programs in clinical and communitarian settings for attending patients living with arterial hypertension.

[Exercise in arterial hypertension].

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Predel, Hans-Georg; Schramm, Thomas

2006-09-01

Regular endurance training has established itself as a major therapeutic principle in the specter of nonpharmacological measures in arterial hypertension. An initial medical check as well as an adequate technique, dosage and intensity of the prescribed exercise training are mandatory. With respect to the concomitant pharmacological treatment, it should be considered that the beneficial effects of lifestyle modification will not be counteracted by the chosen antihypertensive drug but, ideally, synergistically supported. Based on the individual clinical situation, principally all antihypertensive drugs recommended by the current European guidelines, may be prescribed as mono- or combination therapy.beta-receptor blockers are especially capable of controlling excessive exercise-induced blood pressure increase; however, they have metabolic and exercise physiological limitations. The neutrality concerning metabolic and exercise physiological parameters as well as the positive profile of side effects favor ACE inhibitors, long-acting calcium channel blockers and especially AT(1) antagonists in physically active hypertensive patients with concomitant metabolic syndrome.

Hypertension and type 2 diabetes: a cross-sectional study in Morocco (EPIDIAM Study).

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Berraho, Mohamed; El Achhab, Youness; Benslimane, Abdelilah; El Rhazi, Karima; Chikri, Mohamed; Nejjari, Chakib

2012-01-01

In Morocco, there are no studies that focused on the hypertension and its associated risk factors through patients with type 2 diabetes. Different findings show that the frequency of type 2 diabetes has risen rapidly in Morocco. The main objective of this study was to assess the prevalence of hypertension and its associated risk factors among a group of patients with type 2 diabetes and to examine the level of control of hypertension among type 2 diabetic patients with hypertension. A cross-sectional study was carried out on 525 type 2 diabetics in three Moroccan regions. The structured questionnaire was used to gather information on sociodemographic variables, history of hypertension, use of anti-hypertensive medications and duration of diabetes. Anthropometric measurements including weight and height were measured by trained staff. Blood pressure was measured using standardized sphygmomanometers. The prevalence of hypertension was 70.4%. The logistic regression indicated that hypertension was positively associated with age (peducation, counseling and behavioral interventions designed to modify lifestyle such as increasing physical activity and adopting recommended dietary changes, as well as compliance with medications.

2015 Oman Heart Association guidelines for the management of hypertension : practical recommendations from the Oman Heart Association (OHA).

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El-Deeb, Mohammed H; Sulaiman, Kadhim J; Al-Riyami, Abdullah A; Mohsin, Nabil; Al-Mukhaini, Mohamed; Al-Lamki, Mohamed; Al-Busaidi, Noor; Al-Salmi, Issa; Al-Lawati, Jawad; Al-Rawahi, Najib; Al-Riyami, Mohamed B; Abdul-Rahman, Said; Al-Hinai, Said; Jaffer, Batool; Al-Wahaebi, Ahmed; Al-Khalili, Hanan; Al-Zadjali, Matllooba

2015-03-01

Hypertension (HTN) is a major independent risk factor for the development of stroke, coronary artery disease (CAD), peripheral arterial disease (PAD), heart failure (HF) and chronic kidney disease (CKD). HTN is a growing public health problem in Oman, almost certainly the most prevalent modifiable risk factor for cardiovascular disease (CVD). The risk of CVD in patients with HTN can be greatly reduced with lifestyle modifications and effective antihypertensive therapy. Randomized trials have shown that blood pressure (BP) lowering produces rapid reductions in CV risk. Several studies have shown that the majority of the hypertensive patients remain uncontrolled. It is well established that the observed poor control of the disease is not only related to poor adherence to medications, but also to limited awareness and adherence to evidence-based management of hypertension among physicians. Several guidelines for the management of patients with hypertension have been published. However, the aim of this document is to provide the busy physicians in Oman with more concise and direct approach towards implementing these guidelines into clinical practice.

Hypertension and blood pressure variability management practices among physicians in Singapore.

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Setia, Sajita; Subramaniam, Kannan; Tay, Jam Chin; Teo, Boon Wee

2017-01-01

There are limited data on blood pressure variability (BPV) in Singapore. The absence of updated local guidelines might contribute to variations in diagnosis, treatment and control of hypertension and BPV between physicians. This study evaluated BPV awareness, hypertension management and associated training needs in physicians from Singapore. Physicians from Singapore were surveyed between September 8, 2016, and October 5, 2016. Those included were in public or private practice for ≥3 years, cared directly for patients ≥70% of the time and treated ≥30 patients for hypertension each month. The questionnaire covered 6 main categories: general blood pressure (BP) management, BPV awareness/diagnosis, home BP monitoring (HBPM), ambulatory BP monitoring (ABPM), BPV management and associated training needs. Responses from 60 physicians (30 general practitioners [GPs], 20 cardiologists, 10 nephrologists) were analyzed (77% male, 85% aged 31-60 years, mean 22 years of practice). Approximately 63% of physicians considered white-coat hypertension as part of BPV. The most common diagnostic tool was HBPM (overall 77%, GPs 63%, cardiologists 65%, nephrologists 70%), but ABPM was rated as the tool most valued by physicians (80% overall), especially specialists (97%). Withdrawn Singapore guidelines were still being used by 73% of GPs. Approximately 48% of physicians surveyed did not adhere to the BP cutoff recommended by most guidelines for diagnosing hypertension using HBPM (>135/85 mmHg). Hypertension treatment practices also varied from available guideline recommendations, although physicians did tend to use a lower BP target for patients with diabetes or kidney disease. There were a number of challenges to estimating BPV, the most common of which was patient refusal of ABPM/HBPM. The majority of physicians (82%) had no training on BPV, but stated that this would be useful. There appear to be gaps in knowledge and guideline adherence relating to the assessment and

Systolic hypertension in adult nigerians with hypertension

International Nuclear Information System (INIS)

Opadijo, O.G.; Salami, T.A.T.; Sanya, E.O.; Omotoso, A.B.O.

2007-01-01

To determine the prevalence of both systolic and diastolic hypertensions in relation to age and their impacts on target organ among adult Nigerians with hypertension. Newly diagnosed adult hypertensives, with blood pressure 140/90mm Hg, taken twice with mercury column sphygmomanometer at 3 weeks interval, were studied. The total number of hypertensive patients treated over this period was also taken into consideration. The newly diagnosed hypertensives were classified using JNC VI classification. The frequency of occurrence of target organ damage such as Left Ventricular Hypertrophy (LVH), heart failure, renal impairment etc. was charted according to systolic and or diastolic pressures. The occurrence of systolic or diastolic blood pressure was also related with the age of the patients. Blood metabolic parameters were compared in both systolic and diastolic blood pressures for their possible contributory role. Two thousand seven hundred and ninety-two adult hypertensive patients were managed over the study period. Of them, 218 (7.8%) were newly diagnosed and studied. There were 94 males and 124 females. Seventy-seven (35.3%) were aged 60 years and above with equal frequency in the gender. One hundred and seventy-eight (81.7%) cases had combined systolic and diastolic pressures. Twenty-nine (13.3%) patients had systolic hypertension. Twenty-five (86.2%) of these 29 were aged 50 years and above and 20 (69.0%) were aged 60 years and above. Eleven (5.0%) patients had isolated diastolic hypertension and they were all in the age bracket 40-49 years. Systolic blood pressure was found to be rising with advancing age while diastolic blood pressure peaked at mid 40's and declined. Target organ damage occurred more frequently with systolic hypertension and advancing age than with diastolic hypertension. Systolic hypertension occurred more frequently in this series of adult Nigerians with hypertension. It was higher with advancing age and associated with more target organ

A quality improvement plan for hypertension control: the INCOTECA Project (INterventions for COntrol of hyperTEnsion in CAtalonia).

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Vallès-Fernandez, Roser; Rosell-Murphy, Magdalena; Correcher-Aventin, Olga; Mengual-Martínez, Lucas; Aznar-Martínez, Núria; Prieto-De Lamo, Gemma; Franzi-Sisó, Alícia; Puig-Manresa, Jordi; Ma Bonet-Simó, Josep

2009-03-25

Different studies have shown insufficient blood pressure (BP) control in hypertensive patients. Multiple factors influence hypertension management, and the quality of primary care is one of them. We decided therefore to evaluate the effectiveness of a quality improvement plan directed at professionals of Primary Health Care Teams (PHCT) with the aim to achieve a better control of hypertension. The hypothesis of the study is that the implementation of a quality improvement plan will improve the control of hypertension. The primary aim of this study will be to evaluate the effectiveness of this plan. multicentric study quasi-experimental before - after with control group. The non-randomised allocation of the intervention will be done at PHCT level. 18 PHCT in the Barcelona province (Spain). all patients with a diagnosis of hypertension (population based study). patients with a diagnosis of hypertension made later than 01/01/2006 and patients younger than 18 years. a quality improvement plan, which targets primary health care professionals and includes educational sessions, feedback to health professionals, audit and implementation of recommended clinical practice guidelines for the management of hypertensive patients. age, sex, associated co-morbidity (diabetes mellitus type I and II, heart failure and renal failure). The following variables will be recorded: BP measurement, cardiovascular risk and antihypertensive drugs used. Results will be measured before the start of the intervention and twelve months after the start of the study. Dependent variable: prevalence of hypertensive patients with poor BP control. Chi-square test and Student's t-test will be used to measure the association between independent qualitative and quantitative variables, respectively. Non-parametric tests will be used for the analysis of non-normally distributed variables. Significance level (alpha) will be set at improvement plan might benefit the coordination of different professionals of

A quality improvement plan for hypertension control: the INCOTECA Project (INterventions for COntrol of hyperTEnsion in CAtalonia

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Vallès-Fernandez Roser

2009-03-01

Full Text Available Abstract Background Different studies have shown insufficient blood pressure (BP control in hypertensive patients. Multiple factors influence hypertension management, and the quality of primary care is one of them. We decided therefore to evaluate the effectiveness of a quality improvement plan directed at professionals of Primary Health Care Teams (PHCT with the aim to achieve a better control of hypertension. The hypothesis of the study is that the implementation of a quality improvement plan will improve the control of hypertension. The primary aim of this study will be to evaluate the effectiveness of this plan. Methods and design Design: multicentric study quasi-experimental before – after with control group. The non-randomised allocation of the intervention will be done at PHCT level. Setting: 18 PHCT in the Barcelona province (Spain. Sample: all patients with a diagnosis of hypertension (population based study. Exclusion criteria: patients with a diagnosis of hypertension made later than 01/01/2006 and patients younger than 18 years. Intervention: a quality improvement plan, which targets primary health care professionals and includes educational sessions, feedback to health professionals, audit and implementation of recommended clinical practice guidelines for the management of hypertensive patients. Measurements: age, sex, associated co-morbidity (diabetes mellitus type I and II, heart failure and renal failure. The following variables will be recorded: BP measurement, cardiovascular risk and antihypertensive drugs used. Results will be measured before the start of the intervention and twelve months after the start of the study. Dependent variable: prevalence of hypertensive patients with poor BP control. Analysis: Chi-square test and Student's t-test will be used to measure the association between independent qualitative and quantitative variables, respectively. Non-parametric tests will be used for the analysis of non

[Pulmonary hypertension: definition, classification and treatments].

Science.gov (United States)

Jutant, Etienne-Marie; Humbert, Marc

2016-01-01

Pulmonary hypertension (PH) is a cardio-pulmonary disorder that may involve multiple clinical conditions and can complicate the majority of cardiovascular and respiratory diseases. Its definition is an increase in mean pulmonary artery pressure (mPAP) \\hbox{$\\geqslant $} ⩾ 25 mmHg at rest, leading to right heart failure and ultimately death. The clinical classification of pulmonary hypertension (PH) categorizes PH into groups which share similar pathophysiological and hemodynamic characteristics and treatments. Five groups of disorders that cause PH are identified: pulmonary arterial hypertension (Group 1) which is a pre-capillary PH, defined by a normal pulmonary artery wedge pressure (PAWP) \\hbox{$\\leqslant $} ⩽ 15 mmH, due to remodelling of the small pulmonary arteries (15 mmHg; pulmonary hypertension due to chronic lung disease and/or hypoxia (Group 3); chronic thrombo-embolic pulmonary hypertension (Group 4); and pulmonary hypertension due to unclear and/or multifactorial mechanisms (Group 5). PAH (PH group 1) can be treated with agents targeting three dysfunctional endothelial pathways of PAH: nitric oxide (NO) pathway, endothelin-1 pathway and prostacyclin pathway. Patients at low or intermediate risk can be treated with either initial monotherapy or initial oral combination therapy. In patients at high risk initial combination therapy including intravenous prostacyclin analogues should be considered. Patients with inadequate clinical response to maximum treatment (triple therapy with an intravenous prostacyclin) should be assessed for lung transplantation. Despite progresses, PAH remains a fatal disease with a 3-year survival rate of 58%. Treatment of group 2, group 3 and group 5 PH is the treatment of the causal disease and PAH therapeutics are not recommended. Treatment of group 4 PH is pulmonary endarteriectomy if patients are eligible, otherwise balloon pulmonary angioplasty and/or medical therapy can be considered. © Société de Biologie

A conversation with Drs. Kaplan and Moser about conflicting data, confusing results, and some recent treatment recommendations for the management of hypertension.

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Post, Wendy; Moser, Marvin; Kaplan, Norman

2005-10-01

Following a hypertension symposium in Baltimore, MD, on June 1, 2005, Dr. Wendy Post from the Johns Hopkins University School of Medicine, Baltimore, MD, had the opportunity to interview two of the outstanding hypertension experts in the United States on several controversial issues in hypertension management. Dr. Norman Kaplan is Clinical Professor of Medicine at the Southwestern Health Science Center in Dallas, TX, and Dr. Marvin Moser is Clinical Professor of Medicine at the Yale University School of Medicine, New Haven, CT. Both have been leaders in the field of hypertension treatment and education for more than 40 years. Dr. Kaplan's book Clinical Hypertension has been a standard textbook since 1973 and is now in its ninth edition. Dr. Marvin Moser was the Senior Medical Consultant to the National High Blood Pressure Education Program from 1974 to 2002 and was Chairman of the first Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure and a member of the six subsequent committees. His book Clinical Management of Hypertension is in its seventh edition. Drs. Moser and Kaplan were corecipients of the 2004 International Society of Hypertension Award for Outstanding Contributions to Hypertension Treatment and Education and have lectured extensively throughout the United States and overseas.

Mexican registry of pulmonary hypertension: REMEHIP.

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Sandoval Zarate, Julio; Jerjes-Sanchez, Carlos; Ramirez-Rivera, Alicia; Zamudio, Tomas Pulido; Gutierrez-Fajardo, Pedro; Elizalde Gonzalez, Jose; Leon, Mario Seoane Garcia De; Gamez, Miguel Beltran; Abril, Francisco Moreno Hoyos; Michel, Rodolfo Parra; Aguilar, Humberto Garcia

REMEHIP is a prospective, multicentre registry on pulmonary hypertension. The main objective will be to identify the clinical profile, medical care, therapeutic trends and outcomes in adult and pediatric Mexican patients with well-characterized pulmonary hypertension. REMEHIP a multicenter registry began in 2015 with a planned recruitment time of 12 months and a 4-year follow-up. The study population will comprise a longitudinal cohort study, collecting data on patients with prevalent and incident pulmonary hypertension. Will be included patients of age >2 years and diagnosis of pulmonary hypertension by right heart catheterization within Group 1 and Group 4 of the World Health Organization classification. The structure, data collection and data analysis will be based on quality current recommendations for registries. The protocol has been approved by institutional ethics committees in all participant centers. All patients will sign an informed consent form. Currently in Mexico, there is a need of observational registries that include patients with treatment in the everyday clinical practice so the data could be validated and additional information could be obtained versus the one from the clinical trials. In this way, REMEHIP emerges as a link among randomized clinical trials developed by experts and previous Mexican experience. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

Ambulatory Blood Pressure Monitoring (ABPM) as the reference standard for diagnosis of hypertension and assessment of vascular risk in adults.

Science.gov (United States)

Hermida, Ramón C; Smolensky, Michael H; Ayala, Diana E; Portaluppi, Francesco

2015-01-01

New information has become available since the ISC, AAMCC, and SECAC released their first extensive guidedelines to improve the diagnosis and treatment of adult arterial hypertension. A critical assessment of evidence and a comparison of what international guidelines now propose are the basis for the following statements, which update the recommendations first issued in 2013. Office blood pressure (BP) measurements should no longer be considered to be the "gold standard" for the diagnosis of hypertension and assessment of cardiovascular risk. Relying on office BP, even when supplemented with at-home wake-time self-measurements, to identify high-risk individuals, disregarding circadian BP patterning and asleep BP level, leads to potential misclassification of 50% of all evaluated persons. Accordingly, ambulatory BP monitoring is the recommended reference standard for the diagnosis of true hypertension and accurate assessment of cardiovascular risk in all adults ≥18 yrs of age, regardless of whether office BP is normal or elevated. Asleep systolic BP mean is the most significant independent predictor of cardiovascular events. The sleep-time relative SBP decline adds prognostic value to the statistical model that already includes the asleep systolic BP mean and corrected for relevant confounding variables. Accordingly, the asleep systolic BP mean is the recommended protocol to diagnose hypertension, assess cardiovascular risk, and predict cardiovascular event-free interval. In men, and in the absence of compelling clinical conditions, reference thresholds for diagnosing hypertension are 120/70 mmHg for the asleep systolic/diastolic BP means derived from ambulatory BP monitoring. However, in women, in the absence of complicating co-morbidities, the same thresholds are lower by 10/5 mmHg, i.e., 110/65 mmHg for the asleep means. In high-risk patients, including those diagnosed with diabetes or chronic kidney disease, and/or those having experienced past

Pharmacological and non- pharmacological treatment of hypertension: A review article

Directory of Open Access Journals (Sweden)

Marjan Seyedmazhari

2013-01-01

Full Text Available BACKGROUND: Hypertension is a worldwide epidemic disease. It is more common and more severe in elderly persons. Various studies however have estimated 41.9 million men and 27.8 million women to have prehypertension. Diagnosis and early treatment of prehypertension are of utmost importance. Although hypertension is usually divided into 2 general categories of essential (primary and secondary hypertension, the initial treatment for hypertension often depends on its stage which is determined by systolic and diastolic blood pressure. Lifestyle modification is the first step in treating stage one hypertension. Pharmaceutical treatments including diuretics, angiotensin converting enzyme (ACE inhibitors, calcium blockers, beta blockers, and angiotensin receptor blockers will be recommended if lifestyle modification fails to control blood pressure.    METHODS: The PubMed database was searched by a number of keywords including hypertension, pharmaceutical treatment, and non-pharmaceutical treatment. The results were limited by determining a date range of 2008-11.    RESULTS: High blood pressure causes major health problems for many people around the world. It should be controlled because of its high mortality and morbidity. However, in order to select an appropriate treatment modality, it is initially important to diagnose the kinds and stages of hypertension. Pharmaceutical or non-pharmaceutical treatments can then be employed to control this serious disease.    CONCLUSION: Treating hypertension depends on the kinds and stages of this disease. Several tips should be considered when selecting a method of treatment.       Keywords: Hypertension, Pharmacological treatment, Non-pharmacological treatment

Hypertension

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... role in the start and continuation of primary hypertension. Secondary hypertension is due to other diseases such as kidney ... the body can greatly improve or even cure secondary hypertension. Obstructive sleep apnea is a potentially serious sleep ...

[Renal denervation for the treatment of resistant hypertension: definition, patient selection and description of the procedure. 2012 Position paper of the Italian Society of Hypertension].

Science.gov (United States)

Volpe, Massimo; Agabiti-Rosei, Enrico; Ambrosioni, Ettore; Cottone, Santina; Cuspidi, Cesare; Borghi, Claudio; De Luca, Nicola; Fallo, Francesco; Ferri, Claudio; Mancia, Giuseppe; Morganti, Alberto; Muiesan, Maria Lorenza; Sarzani, Riccardo; Sechi, Leonardo; Tocci, Giuliano; Virdis, Agostino

2012-12-01

Hypertension is responsible for a relevant burden of cardiovascular morbidity and mortality worldwide. Although several appropriate and integrated pharmacological strategies are available, blood pressure control still remains largely unsatisfactory. Failure to achieve effective blood pressure control in treated hypertensive patients may have a substantial impact on overall cardiovascular risk, since it significantly increases the risk of both macrovascular and microvascular complications. Hypertension is arbitrarily defined as "resistant" or "refractory" when recommended blood pressure goals (clinic blood pressure hypertension has recently become available. Renal sympathetic denervation is a minimally invasive procedure performed via femoral access that uses radiofrequency catheter ablation to disable renal sympathetic afferent and efferent nerves. It results in isolation of renal parenchymal and juxtaglomerular cells from the abnormal enhancement of renal adrenergic nerve activity. The present position paper of the Italian Society of Hypertension provides a diagnostic and therapeutic approach to the early identification and effective clinical management of patients with resistant hypertension, who may be candidates for renal denervation. These indications may have important implications not only from a clinical viewpoint but also from an economic perspective. The accurate identification of patients with resistant hypertension and the appropriate selection of patients eligible for this procedure may help improve blood pressure control and reduce the risk of cardiovascular and cerebrovascular complications in these patients.

Sedentary Behavior and Light Physical Activity Are Associated with Brachial and Central Blood Pressure in Hypertensive Patients

DEFF Research Database (Denmark)

Gerage, A. M.; Benedetti, T. R. B.; Farah, B. Q.

2015-01-01

of this study was to investigate the association between the time spent in physical activities of different intensities and blood pressure levels, arterial stiffness and autonomic modulation in hypertensive patients. Methods In this cross-sectional study, 87 hypertensive patients (57.5 +/- 9.9 years of age) had...... are associated with lower blood pressure, without affecting arterial stiffness and cardiac autonomic modulation in hypertensive patients.......Background Physical activity is recommended as a part of a comprehensive lifestyle approach in the treatment of hypertension, but there is a lack of data about the relationship between different intensities of physical activity and cardiovascular parameters in hypertensive patients. The purpose...

Elastography methods for the non-invasive assessment of portal hypertension.

Science.gov (United States)

Roccarina, Davide; Rosselli, Matteo; Genesca, Joan; Tsochatzis, Emmanuel A

2018-02-01

The gold standard to assess the presence and severity of portal hypertension remains the hepatic vein pressure gradient, however the recent development of non-invasive assessment using elastography techniques offers valuable alternatives. In this review, we discuss the diagnostic accuracy and utility of such techniques in patients with portal hypertension due to cirrhosis. Areas covered: A literature search focused on liver and spleen stiffness measurement with different elastographic techniques for the assessment of the presence and severity of portal hypertension and oesophageal varices in people with chronic liver disease. The combination of elastography with parameters such as platelet count and spleen size is also discussed. Expert commentary: Non-invasive assessment of liver fibrosis and portal hypertension is a validated tool for the diagnosis and follow-up of patients. Baveno VI recommended the combination of transient elastography and platelet count for ruling out varices needing treatment in patients with compensated advanced chronic liver disease. Assessment of aetiology specific cut-offs for ruling in and ruling out clinically significant portal hypertension is an unmet clinical need. The incorporation of spleen stiffness measurements in non-invasive algorithms using validated software and improved measuring scales might enhance the non-invasive diagnosis of portal hypertension in the next 5 years.

Prevalence Of Hypertension And Awareness Of The Causes And Effects Of Hypertension In Rural And Urban Communities Of Enugu State Nigeria

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Chinyere Okeke

2017-12-01

Full Text Available Developing countries face the double burden of communicable and non-communicable diseases and of the later hypertension is the most common. It is a major public health challenge with an ever increasing global prevalence which inherently increases the global disease burden whereas awareness of this disease and its determinants are poor. It contributes to about 500000 deaths every year. This was a cross-sectional descriptive community survey carried out in urban and rural communities of Enugu southeast Nigeria. A multi-staged sampling technique was used to recruit 260 participants and data was collected by administering questionnaires. Blood pressure measurement and weight of all the subjects were done. These were analysed using EPI info statistical software version 6.04. The result shows that the prevalence of hypertension in urban and rural areas was 15.4 and 13.8 respectively but was not statistically significantly different. About 17.6 and 23 were perceived hypertensives for urban and rural areas respectively. From the study 17 and 44.5 of urban and rural respondents respectively have suffered from hypertension related illnesses stroke kidney disease heart disease and eye problem. Approximately 45 of urban respondents and 83.7 of rural respondents believed that hypertension can be cured. The source of information and general knowledge of hypertension in urban and rural area was statistically significant pamp88040.05. In the urban area their method of cure include drugs and lifestyle modification while in the rural areas drugs and spiritual means was their way of curing the disease. Prevalence and awareness of hypertension is higher in the urban areas however both communities are grossly unaware of the hypertensive associated diseases. Proper health education is recommended to reduce the prevalence of complications of the disease change the trend and ultimately reduce the death in our environment.

Rauwolfia in the Treatment of Hypertension

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Lobay, Douglas

2015-01-01

Rauwolfia serpentina is a safe and effective treatment for hypertension. The plant was used by many physicians throughout India in the 1940s and then was used throughout the world in the 1950s, including in the United States and Canada. It fell out of popularity when adverse side effects, including depression and cancer, became associated with it. This author reviews the scientific literature with regard to the use of Rauwolfia and the treatment of hypertension. The author reviews the plant’s botany, chemistry, and pharmacology and provides a researched and documented method of action for the active ingredients. With special emphasis on the plant’s role in treating high blood pressure, the author looks at medical uses of the plant, critically examining its adverse side effects, toxicology, and carcinogenicity. The author refutes the association between the plant and carcinogenicity and discusses the importance of correct dosing and of screening patients to minimize the occurrence of depression. He concludes with the recommendation of use of low dose Rauwolfia (LDR) for suitable patients with hypertension. The plant provides clinicians with a safe and effective adjunct to pharmaceuticals in the treatment of high blood pressure. PMID:26770146

Transcatheter renal denervation for the treatment of resistant arterial hypertension: the Swiss expert consensus.

Science.gov (United States)

Wuerzner, Gregoire; Muller, Olivier; Erne, Paul; Cook, Stéphane; Sudano, Isabella; Lüscher, Thomas F; Noll, Georg; Kaufmann, Urs; Rickli, Hans; Waeber, Bernard; Kaiser, Christophe; Sticherling, Christian; Pechère-Bertschi, Antoinette; Baumgartner, Iris; Jacob, Augustinus L; Burnier, Michel; Qanadli, Salah D

2014-03-20

Transcatheter (or percutaneous) renal denervation is a novel technique developed for the treatment of resistant hypertension. So far, only one randomised controlled trial has been published, which has shown a reduction of office blood pressure. The Swiss Society of Hypertension, the Swiss Society of Cardiology, The Swiss Society of Angiology and the Swiss Society of Interventional Radiology decided to establish recommendations to practicing physicians and specialists for good clinical practice. The eligibility of patients for transcatheter renal denervation needs (1.) confirmation of truly resistant hypertension, (2.) exclusion of secondary forms of hypertension, (3.) a multidisciplinary decision confirming the eligibility, (4.) facilities that guarantee procedural safety and (5.) a long-term follow-up of the patients, if possible in cooperation with a hypertension specialist. These steps are essential until long-term data on safety and efficacy are available.

Renal artery stenosis and hypertension after abdominal irradiation for Hodgkin disease. Successful treatment with nephrectomy

International Nuclear Information System (INIS)

Salvi, S.; Green, D.M.; Brecher, M.L.; Magoos, I.; Gamboa, L.N.; Fisher, J.E.; Baliah, T.; Afshani, E.

1983-01-01

Hypertension secondary to stenosis of the left renal artery developed in a thirteen-year-old male six years after completion of inverted Y irradiation (3,600 rad) for abdominal Hodgkin disease. Surgical treatment with nephrectomy resulted in control of the hypertension without the use of antihypertensive agents. We review the literature for this unusual complication of abdominal irradiation, and recommend that a 99mTc-DMSA renal scan, selective renal vein sampling for renin determinations, and renal arteriography be performed on any patient in whom hypertension develops following abdominal irradiation in childhood

Current concepts in combination therapy for the treatment of hypertension: combined calcium channel blockers and RAAS inhibitors

Directory of Open Access Journals (Sweden)

Alberto F Rubio-Guerra

2009-11-01

Full Text Available Alberto F Rubio-Guerra1, David Castro-Serna2, Cesar I Elizalde Barrera2, Luz M Ramos-Brizuela21Metabolic and Research Clinic, 2Internal Medicine Department, Hospital General de Ticomán SS DF, MéxicoAbstract: Recent guidelines for the management of hypertension recommend target blood pressures <140/90 mmHg in hypertensive patients, or <130/80 mmHg in subjects with diabetes, chronic kidney disease, or coronary artery disease. Despite the availability and efficacy of antihypertensive drugs, most hypertensive patients do not reach the recommended treatment targets with monotherapy, making combination therapy necessary to achieve the therapeutic goal. Combination therapy with 2 or more agents is the most effective method for achieving strict blood pressure goals. Fixed-dose combination simplifies treatment, reduces costs, and improves adherence. There are many drug choices for combination therapy, but few data are available about the efficacy and safety of some specific combinations. Combination therapy of calcium antagonists and inhibitors of the renin-angiotensin-aldosterone system (RAAS are efficacious and safe, and have been considered rational by both the JNC 7 and the 2007 European Society of Hypertension – European Society of Cardiology guidelines for the management of arterial hypertension. The aim of this review is to discuss some relevant issues about the use of combinations with calcium channel blockers and RAAS inhibitors in the treatment of hypertension.Keywords: hypertension, calcium channel blockers, renin-angiotensin-aldosterone system inhibitors, fixed-dose combination, adherence

[Hypertension and exercise. Sports methods for the hypertensive patient].

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Thiele, Holger; Pohlink, Carla; Schuler, Gerhard

2004-06-01

Physical exercise is of paramount therapeutic importance in nonpharmacological interventions of arterial hypertension. The extent and the effects of exercise on blood pressure lowering are analyzed according to the actual literature. Suitable and nonsuitable activities are considered. Dynamic isotonic endurance training is more effective than static isometric exercise. A rather low or moderate extent of endurance training lowers the systolic and diastolic blood pressure by approximately 5-11 mmHg and 3-8 mmHg, respectively. This effect of exercise can be achieved besides the favorable effects on other cardiovascular risk factors. Intensity of exercise should be monitored by the heart rate. The mean intensity should not exceed 70% of the maximal heart rate. An initial ergometry might be suitable for the planning of training recommendations.

Cardiovascular Update: Risk, Guidelines, and Recommendations.

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Pearson, Tamera

2015-09-01

This article provides an update of the current status of cardiovascular disease (CVD) in the United States, including a brief review of the underlying pathophysiology and epidemiology. This article presents a discussion of the latest American Heart Association guidelines that introduce the concept of promoting ideal cardiovascular health, defined by seven identified metrics. Specific CVD risk factors and utilization of the 10-year CVD event prediction calculator are discussed. In addition, current management recommendations of health-related conditions that increase risk for CVD, such as hypertension and hypercholesterolemia, are provided. Finally, a discussion of detailed evidence-based lifestyle recommendations to promote cardiovascular health and reduce CVD risks concludes the update. © 2015 The Author(s).

Soccer improves fitness and attenuates cardiovascular risk factors in hypertensive men

DEFF Research Database (Denmark)

Krustrup, Peter; Randers, Morten Bredsgaard; Andersen, Lars Juel

2013-01-01

INTRODUCTION: The present study investigated the fitness and health effects of medium-term soccer training for untrained hypertensive middle-aged men. METHODS: Thirty-three untrained males (31-54 y) with mild-to-moderate hypertension were randomised 2:1 to a soccer training group (STG, two 1-h...... sessions per week, n=22, 68% on medication) and a doctor advice group receiving traditional physician-guided recommendations on cardiovascular risk factor modification (DAG, n=11, 73% on medication). Two-way repeated-measurement ANOVA time-group statistics was applied. RESULTS: During soccer training...

Sex differences in T cells in hypertension.

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Tipton, Ashlee J; Sullivan, Jennifer C

2014-12-01

Hypertension is a major risk factor for cardiovascular disease, stroke, and end-organ damage. There is a sex difference in blood pressure (BP) that begins in adolescence and continues into adulthood, in which men have a higher prevalence of hypertension compared with women until the sixth decade of life. Less than 50% of hypertensive adults in the United States manage to control their BP to recommended levels using current therapeutic options, and women are more likely than are men to have uncontrolled high BP. This, is despite the facts that more women compared with men are aware that they have hypertension and that women are more likely to seek treatment for the disease. Novel therapeutic targets need to be identified in both sexes to increase the percentage of hypertensive individuals with controlled BP. The purpose of this article was to review the available literature on the role of T cells in BP control in both sexes, and the potential therapeutic application/implications of targeting immune cells in hypertension. A search of PubMed was conducted to determine the impact of sex on T cell-mediated control of BP. The search terms included sex, gender, estrogen, testosterone, inflammation, T cells, T regulatory cells, Th17 cells, hypertension, and blood pressure. Additional data were included from our laboratory examinations of cytokine expression in the kidneys of male and female spontaneously hypertensive rats (SHRs) and differential gene expression in both the renal cortex and mesenteric arterial bed of male and female SHRs. There is a growing scientific literature base regarding the role of T cells in the pathogenesis of hypertension and BP control; however, the majority of these studies have been performed exclusively in males, despite the fact that both men and women develop hypertension. There is increasing evidence that although T cells also mediate BP in females, there are distinct differences in both the T-cell profile and the functional impact of sex

ASSESSMENT OF AWARENESS LEVEL OF OWN DISEASE IN PATIENTS WITH STABLE ARTERIAL HYPERTENSION

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G. F. Andreeva

2005-01-01

Full Text Available Arterial hypertension (AH is the most frequent risk factor of cardiovascular diseases and related mortality in all developed countries. Altough therapy with antihypertensive drugs significantly reduces this risk, patients with stable mild hypertension have poor compliance with the treatment. The reasons and levels of inadequacy of antihypertensive therapy in this group of patients are well-known.Aim. To evaluate the awareness level of own disease, adequacy of therapy only in those patients with stable mild arterial hypertension, who are complied with recommendations of physicians concerning AH treatment and changing of mode of life. It was also planned to reveal possible grounds for inadequate secondary prevention of cardiovascular disease.Materials and methods. 76 patiens with stable mild arterial hypertension were included into study. They didn’t have any serious concomitant diseases and were complied with the recommendations of physicians concerning secondary prevention of cardiovascular disease. Questionnaire of State Research Center for Preventive Medicine “Assessment of awareness level of own disease in patients with stable arterial hypertension” was used in the study.Results. It was revealed, that the majority of patients, invoved in the study, were nonsmokers and regularly took antihypertensive drugs. 70% of questioned patients reached the target arterial blood pressure levels, while patients with arterial hypertension in general Russia population received regular and efficient treatment in less than 30-20%. Drugs treatment of questioned patients almost didn’t differ from that, which received patients in out-patient clinics of Moscow: in both cases ACE inhibitors were preferred. Only 29% of questioned patients knew their lipid levels in blood and none of the patients took drugs, reducing levels of lipids in blood. Half of the patients, that took part in our study, had increased level of body mass index.Conclusions. Inadequate

Impact of Salt Intake on the Pathogenesis and Treatment of Hypertension.

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Rust, Petra; Ekmekcioglu, Cem

2017-01-01

Excessive dietary salt (sodium chloride) intake is associated with an increased risk for hypertension, which in turn is especially a major risk factor for stroke and other cardiovascular pathologies, but also kidney diseases. Besides, high salt intake or preference for salty food is discussed to be positive associated with stomach cancer, and according to recent studies probably also obesity risk. On the other hand a reduction of dietary salt intake leads to a considerable reduction in blood pressure, especially in hypertensive patients but to a lesser extent also in normotensives as several meta-analyses of interventional studies have shown. Various mechanisms for salt-dependent hypertension have been put forward including volume expansion, modified renal functions and disorders in sodium balance, impaired reaction of the renin-angiotensin-aldosterone-system and the associated receptors, central stimulation of the activity of the sympathetic nervous system, and possibly also inflammatory processes.Not every person reacts to changes in dietary salt intake with alterations in blood pressure, dividing people in salt sensitive and insensitive groups. It is estimated that about 50-60 % of hypertensives are salt sensitive. In addition to genetic polymorphisms, salt sensitivity is increased in aging, in black people, and in persons with metabolic syndrome or obesity. However, although mechanisms of salt-dependent hypertensive effects are increasingly known, more research on measurement, storage and kinetics of sodium, on physiological properties, and genetic determinants of salt sensitivity are necessary to harden the basis for salt reduction recommendations.Currently estimated dietary intake of salt is about 9-12 g per day in most countries of the world. These amounts are significantly above the WHO recommended level of less than 5 g salt per day. According to recent research results a moderate reduction of daily salt intake from current intakes to 5-6 g can reduce

A profile of hypertension among rural elderly Malaysians.

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Srinivas, P; Wong, K S; Chia, Y C; Poi, P J; Ebrahim, S

1998-12-01

The main objective of this study was to survey the prevalence of hypertension in Malaysians aged 55 years and above who responded to a public health screening campaign in Kuala Langat district, Selangor, Malaysia. The relationship between the detection, treatment and control in the study population was also examined. An epidemiological survey of the elderly was conducted in Kuala Langat, a rural district in Malaysia for a consecutive period of six weeks. The survey was conducted using a standardized questionnaire and interview by trained research assistants. The medical students and nurses were trained on the correct protocol of measuring blood pressure based on the recommendations of the British Hypertension Society. Newly detected persons with blood pressure readings 160/95 mmHg and above, were given a green card to return to the nearest health center for a further 2 visits to check his/her blood pressure. A total of 1,392 people with a mean age of 65 years and comprising of 53.1% males and 46.9% females responded to the health survey. Based on the history 335 (24.1%) of the respondents were known hypertensives and 82.1% of this hypertensive group were on regular treatment. However good control of hypertension was achieved only in 161 (48.1%) of them. Newly detected hypertension was found in 204 (14.6%) of the respondents. The overall prevalence of hypertension in our sample of respondents was 25.6%. There was no significant difference between the sexes and the races in terms of their detection, treatment and control. However there was a significant difference between the persons aged less than 65 years of age and those older than 65 years. There was a large proportion of previously known hypertensives among the survey population. Of those detected, not all were on regular medications and the majority on medications were not well controlled. Education of the public through intensive public health campaigns is vital to improve their knowledge on hypertension and

Knowledge and awareness of hypertension among patients with systemic hypertension.

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Familoni, B. Oluranti; Ogun, S. Abayomi; Aina, A. Olutoyin

2004-01-01

BACKGROUND: In Nigeria, systemic hypertension is the commonest noncommunicable disease, and public awareness about hypertension and its determinants is poor. This study aims to assess the knowledge and level of awareness of the disease among hypertensive patients attending the medical outpatient clinic of Olabisi Onabanjo University Teaching Hospital (OOUTH). METHODOLOGY: Hypertensive patients who attended the medical outpatient clinic during the one-year study period and gave their consent were recruited into the study. Response to a questionnaire on various aspects of hypertension was analyzed using the STATA for Windows software. RESULTS: There were 254 hypertensive patients, of which 111 were males and 143 were females, giving a male: female ratio of 1:1.3. The mean age (SD) of the patients was 51 years +/- 12.2; 52.4% of the participants were aware that hypertension was the commonest noncommunicable disease in Nigeria. About one in 10 patients (11.4%) was aware that "nil symptom" is the commonest symptom of hypertension, while 37% were not aware that hypertension could cause renal failure. Only about one-third (35.4%) of the patients knew that hypertension should ideally be treated for life, while 58.3% believed that antihypertensive drugs should be used only when there are symptoms. The remaining 6.3% believed that the treatment of hypertension should be for periods ranging from two weeks to five years but not for life. CONCLUSION: This study has demonstrated inadequate knowledge of hypertension in patients with hypertension in our study population. Conscious efforts should be made and time set aside to health educate hypertensive patients. Organization of "hypertensive club or society" could be encouraged. These will reduce dissemination of false or inaccurate information by hypertensive patients to the public and its attendant dangers. PMID:15160976

Liver surgery in cirrhosis and portal hypertension.

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Hackl, Christina; Schlitt, Hans J; Renner, Philipp; Lang, Sven A

2016-03-07

The prevalence of hepatic cirrhosis in Europe and the United States, currently 250 patients per 100000 inhabitants, is steadily increasing. Thus, we observe a significant increase in patients with cirrhosis and portal hypertension needing liver resections for primary or metastatic lesions. However, extended liver resections in patients with underlying hepatic cirrhosis and portal hypertension still represent a medical challenge in regard to perioperative morbidity, surgical management and postoperative outcome. The Barcelona Clinic Liver Cancer classification recommends to restrict curative liver resections for hepatocellular carcinoma in cirrhotic patients to early tumor stages in patients with Child A cirrhosis not showing portal hypertension. However, during the last two decades, relevant improvements in preoperative diagnostic, perioperative hepatologic and intensive care management as well as in surgical techniques during hepatic resections have rendered even extended liver resections in higher-degree cirrhotic patients with portal hypertension possible. However, there are few standard indications for hepatic resections in cirrhotic patients and risk stratifications have to be performed in an interdisciplinary setting for each individual patient. We here review the indications, the preoperative risk-stratifications, the morbidity and the mortality of extended resections for primary and metastatic lesions in cirrhotic livers. Furthermore, we provide a review of literature on perioperative management in cirrhotic patients needing extrahepatic abdominal surgery and an overview of surgical options in the treatment of hepatic cirrhosis.

Hypertension hos gravide

DEFF Research Database (Denmark)

Mathiesen, Elisabeth R; Johansen, Marianne; Kamper, Anne Lise

2009-01-01

There are four major hypertensive disorders in pregnancy: chronic hypertension, gestational hypertension, preeclampsia and chronic hypertension with superimposed preeclampsia. The indications and efficacy of antihypertensive treatment of the different hypertensive disorders are assessed. Advantages...

Implications of new hypertension guidelines in the United States.

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Bertoia, Monica L; Waring, Molly E; Gupta, Priya S; Roberts, Mary B; Eaton, Charles B

2011-09-01

The American Heart Association Task Force released a scientific statement in 2007 for the treatment of hypertension in the prevention of coronary artery disease (CAD). These guidelines recommend more aggressive control of blood pressure (BP) among those at high risk for CAD: individuals with diabetes mellitus, chronic kidney disease, cardiovascular disease, congestive heart failure, or a 10-year Framingham risk score ≥10%. These individuals are advised to maintain a BP definition of hypertension (>140/90 mm Hg), 98 million (21%) Americans have hypertension. Using the updated guidelines, an additional 52 million (11%) American adults now have elevated BP requiring treatment, for a total of 150 million adults (32%). Adults with diabetes mellitus have the greatest population burden of uncontrolled BP (50.6 million), followed by adults with chronic kidney disease (43.7 million) and cardiovascular disease (43.3 million). Although individuals at a higher risk for CAD are more likely to be aware of their hypertension and to be taking antihypertension medication, they are less likely to have their BP under control. Additional efforts are needed in the treatment of elevated BP, especially among individuals with an increased risk of CAD.

The Role of Sympatho-Inhibition in Combination Treatment of Obesity-Related Hypertension.

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Carnagarin, Revathy; Gregory, Cynthia; Azzam, Omar; Hillis, Graham S; Schultz, Carl; Watts, Gerald F; Bell, Damon; Matthews, Vance; Schlaich, Markus P

2017-10-28

Obesity-related hypertension is commonly characterized by increased sympathetic nerve activity and is therefore acknowledged as a predominantly neurogenic form of hypertension. The sustained sympatho-excitation not only contributes to the rise in blood pressure but also elicits a vicious cycle which facilitates further weight gain and progression of associated co-morbidities. While weight loss and exercise remain at the forefront of therapy for obesity and obesity-related hypertension, the difficulties in achieving and maintaining long-term weight loss with lifestyle measures and the variable blood pressure response to weight loss often necessitate prescription of antihypertensive drug therapy. Remarkably, there are no specific recommendations for pharmacologic treatment for obese patients with arterial hypertension in any of the current guidelines and general principles of antihypertensive treatment are applied. The use of β-blockers and diuretics is commonly discouraged as first- or second-line therapy due to their unfavorable metabolic effects. This review explores evolving therapeutic strategies which based on their interference with pathophysiologic mechanism relevant in the context of obesity may guide optimized treatment of obesity-related hypertension.

Physicians' health habits are associated with lifestyle counseling for hypertensive patients.

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Hung, Olivia Y; Keenan, Nora L; Fang, Jing

2013-02-01

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) recommended lifestyle interventions, either with or without pharmacologic treatment, for all patients with high blood pressure. The objective of this study is to determine the association of physicians' personal habits with their attitudes and behaviors regarding JNC VII lifestyle modification guidelines. One thousand primary care physicians completed DocStyles 2010, a voluntary web-based survey designed to provide insight into physician attitudes and behaviors regarding various health issues. The respondents' average age was 45.3 years, and 68% were male. In regards to physician behavior, 4.0% smoked at least once a week, 38.6% ate ≥5 cups of fruits and/or vegetables ≥5 days/week, and 27.4% exercised ≥5 days/week. When asked about specific types of advice offered to their hypertensive patients, physicians reported recommending that their patients eat a healthy diet (92.2%), or cut down on salt (96.1%), or attain or maintain a healthy weight (94.8%), or limit the use of alcohol (75.4%), or be physically active (94.4%). Collectively, 66.5% made all 5 lifestyle modification recommendations. Nonsmoking physicians were more likely to recommend each lifestyle intervention to their hypertensive patients. Those who exercised at least 1 day per week were more likely to recommend limiting alcohol use. The probability of recommending all 5 JNC VII interventions was greater for physicians who were nonsmoking and who exercised at least 1 day a week.

Rationale and design of the screening of pulmonary hypertension in systemic lupus erythematosus (SOPHIE) study.

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Huang, Duo; Cheng, Yang-Yang; Chan, Pak-Hei; Hai, Jojo; Yiu, Kai-Hang; Tse, Hung-Fat; Wong, Ka-Lam; Fan, Katherine; Li, Ying Wah; Ng, Woon-Leung; Yim, Cheuk-Wan; Wong, Cheuk-Hon John; Tam, Lai-Shan; Wong, Priscilla C H; Wong, Chi-Yuen; Ho, Chup-Hei; Leung, Alexander M H; Mok, Chi-Chiu; Lam, Ho; Lau, Chak-Sing; Cheung, Tommy; Ho, Carmen; Law, Sharon W Y; Chan, Esther W; Yin, Li-Xue; Yue, Wen-Sheng; Mok, Toi Meng; Evora, Mario Alberto; Siu, Chung-Wah

2018-01-01

Current guideline-recommended screening for pulmonary hypertension in patients with systemic sclerosis has not been evaluated in systemic lupus erythematosus (SLE), which is disproportionately prevalent in Asians. This multicentre, cross-sectional screening study aims to study the prevalence of pulmonary hypertension among SLE patients using these guidelines, and identify independent predictors and develop a prediction model for pulmonary hypertension in SLE patients. SLE patients from participating centres will undergo an echocardiography- and biomarker-based pulmonary hypertension screening procedure as in the DETECT study. Standard right heart catheterisation will be provided to patients with intermediate or high echocardiographic probability of pulmonary hypertension. Those with low echocardiographic probability will rescreen within 1 year. The primary measure will be the diagnosis and types of pulmonary hypertension and prevalence of pulmonary hypertension in SLE patients. The secondary measures will be the predictors and prediction models for pulmonary hypertension in SLE patients. The estimated sample size is approximately 895 participants. The results of the SOPHIE study will be an important contribution to the literature of SLE-related pulmonary hypertension and may be immediately translatable to real clinical practice. Ultimately, this study will provide the necessary evidence for establishing universal guidelines for screening of pulmonary hypertension in SLE patients.

Primary lung hypertension in-patient with hypertension portal

International Nuclear Information System (INIS)

Restrepo Uribe; Villa Restrepo, Alfredo

1990-01-01

Thorax x-rays were reviewed in 18 patients with portal hypertension. In 28% of these we found radiologic signs of pulmonary hypertension of the precapillary type. The existing relation between primary pulmonary hypertension and portal hypertension has been established in different scientific papers. In the published series the incidence of primary pulmonary hypertension is less than the one of found in these patients the physiopathology of this association is reviewed, and as a hypothetic manner it is postulated the possible roll of the hypoxaemia of the residents, at the altitude of the Bogota city. (2.640 mts) as a helping factor in this phenomenon

Resistant Hypertension.

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Doroszko, Adrian; Janus, Agnieszka; Szahidewicz-Krupska, Ewa; Mazur, Grzegorz; Derkacz, Arkadiusz

2016-01-01

Resistant hypertension is a severe medical condition which is estimated to appear in 9-18% of hypertensive patients. Due to higher cardiovascular risk, this disorder requires special diagnosis and treatment. The heterogeneous etiology, risk factors and comorbidities of resistant hypertension stand in need of sophisticated evaluation to confirm the diagnosis and select the best therapeutic options, which should consider lifestyle modifications as well as pharmacological and interventional treatment. After having excluded pseudohypertension, inappropriate blood pressure measurement and control as well as the white coat effect, suspicion of resistant hypertension requires an analysis of drugs which the hypertensive patient is treated with. According to one definition - ineffective treatment with 3 or more antihypertensive drugs including diuretics makes it possible to diagnose resistant hypertension. A multidrug therapy including angiotensin - converting enzyme inhibitors, angiotensin II receptor blockers, beta blockers, diuretics, long-acting calcium channel blockers and mineralocorticoid receptor antagonists has been demonstrated to be effective in resistant hypertension treatment. Nevertheless, optional, innovative therapies, e.g. a renal denervation or baroreflex activation, may create a novel pathway of blood pressure lowering procedures. The right diagnosis of this disease needs to eliminate the secondary causes of resistant hypertension e.g. obstructive sleep apnea, atherosclerosis and renal or hormonal disorders. This paper briefly summarizes the identification of the causes of resistant hypertension and therapeutic strategies, which may contribute to the proper diagnosis and an improvement of the long term management of resistant hypertension.

ESSENTIAL ARTERIAL HYPERTENSION AND RISK FACTORS ASSOCIATED WITH HYPERTENSIVE NEPHROPATHY

Directory of Open Access Journals (Sweden)

Boban Milojković

2014-12-01

Full Text Available Arterial hypertension is a major risk factor that predisposes to cardiovascular disorders and is responsible for most of the morbidity and mortality in patients. Hypertension is closely associated with the kidney, because kidney disease can be both the cause and consequence of increased blood pressure. Elevation of blood pressure is a strong independent risk factor for hypertensive nephropathy and development of ESRD. The pathogenesis of ischemic hypertensive nephropathy (IHN is multifactoral, and in addition to blood pressure other factors contribute to the development of this renal pathology and its progression to end-stage renal disease. These include obesity, smoking, male gender and other still unknown risk factors. The aim of this paper was to analyse the association between essential arterial hypertension and renal hypertensive disease and prevalence of other atherosclerotic risk factors in patients with developed hypertensive renal disease. In this prospective cross sectional study 283 patients of both genders with diagnosed essential hypertension and hypertensive renal disease were analysed. The anamnestic data related to age, duration of hypertension, history of smoking, presence of hypertensive retinopathy, hypertrophy of the left chamber and data about previous renal diseases were collected through conversation and medical documentation. The clinical examination comprise determination of blood pressure, body mass index (BMI, lipid parameters (total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides, serum urea and creatinine, urine, albumin and protein concentration. The total number of 283 patients (185 males and 98 females with HN was analyzed. The analysis revealed significantly higher proportion of males aged over 60 years with IHN. The mean age of examined hypertensive patients with IHN is 62.6±8.8 years with duration of hypertension 19.8±5.9 years. All examined patients had hypertensive retinopathy and

Secondary Hypertension

Science.gov (United States)

Secondary hypertension Overview Secondary hypertension (secondary high blood pressure) is high blood pressure that's caused by another medical condition. Secondary hypertension can be caused by conditions that affect your kidneys, ...

Prevalence of, and barriers to, preventive lifestyle behaviors in hypertension (from a national survey of Canadians with hypertension).

Science.gov (United States)

Gee, Marianne E; Bienek, Asako; Campbell, Norman R C; Bancej, Christina M; Robitaille, Cynthia; Kaczorowski, Janusz; Joffres, Michel; Dai, Sulan; Gwadry-Sridar, Femida; Nolan, Robert P

2012-02-15

Patients with hypertension are advised to lower their blood pressure to lifestyle modification and/or pharmacotherapy. To describe the use of lifestyle changes for blood pressure control and to identify the barriers to these behaviors, the data from 6,142 Canadians with hypertension who responded to the 2009 Survey on Living With Chronic Diseases in Canada were analyzed. Most Canadians with diagnosed hypertension reported limiting salt consumption (89%), having changed the types of food they eat (89%), engaging in physical activity (80%), trying to control or lose weight if overweight (77%), quitting smoking if currently smoking (78%), and reducing alcohol intake if currently drinking more than the recommended levels (57%) at least some of the time to control their blood pressure. Men, those aged 20 to 44 years, and those with lower educational attainment and lower income were, in general, less likely to report engaging in lifestyle behaviors for blood pressure control. A low desire, interest, or awareness were commonly reported barriers to salt restriction, changes in diet, weight loss, smoking cessation, and alcohol reduction. In contrast, the most common barrier to engaging in physical activity to regulate blood pressure was the self-reported challenge of managing a coexisting physical condition or time constraints. In conclusion, programs and interventions to improve the adherence to lifestyle changes to treat hypertension may need to consider the identified barriers to lifestyle behaviors in their design. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

Is the prevalence of hypertension in overweight children overestimated?

Science.gov (United States)

Wirix, Aleid J G; Nauta, Jeroen; Groothoff, Jaap W; Rabelink, Ton J; HiraSing, Remy A; Chinapaw, Mai Jm; Kist-van Holthe, Joana E

2016-11-01

The aim of this study is to explore different methods for screening and diagnosing hypertension-which definitions and criteria to use-in children and in addition to determine the prevalence of hypertension in Dutch overweight children. A cross-sectional study performed in the Dutch Child Health Care setting. Four Child Health Care centres in different cities in the Netherlands. 969 overweight (including obese) and 438 non-overweight children, median age 11.7 years (range 4.1-17.10), 49% boys. The main outcome was blood pressure, and the difference in prevalence of hypertension using different criteria for blood pressure interpretation: using the first blood pressure measurement, the mean of two measurements and the lowest of three measurements on two different occasions. Looking at the first measurement alone, 33% of overweight and 21% of non-overweight children had hypertension. By comparing the mean of the first two measurements with reference values, 28% of overweight children and 16% of non-overweight children had hypertension. Based on the lowest of three consecutive measurements, the prevalence decreased to 12% among overweight children and 5% among non-overweight children at visit one and at visit two 4% of overweight children still had hypertension. The prevalence of hypertension is highly dependent on the definitions and criteria used. We found a prevalence of 4% in overweight children, which is considerably lower than suggested by recent literature (4%-33%). This discrepancy can be explained by our more strict definition of hypertension. However, to draw any conclusions on the prevalence, normal values using the same definition of hypertension should be established. Despite the low prevalence, we recommend measuring blood pressure in all overweight children in view of later cardiovascular morbidity and mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

[Arterial hypertension at a crossroads: the search for an operative definition].

Science.gov (United States)

Orte Martínez, L M

2010-01-01

Hypertension (HT) is recognized as one of the major risk factors for vascular damage. Although current guidelines recommend an aggressive drug treatment with blood pressure control goals ever lower, the prevalence of uncontrolled hypertension is still apparently high. It is often forgotten that BP is a very labile hemodynamic parameter, which requires a correct methodology measurement that meets only rarely, leading to a misdiagnosis and wrong hypertensive monitoring. Even being an arbitrary limit the definition of HT has been set at 140/90 mmHg, based on casual BP taken in the office. This register itself can provide useful information beyond systolic and diastolic values, and with a certain hemodynamic meaning (pulse pressure and mean blood pressure). For a proper diagnosis of hypertensive patients is essential to enhance measure BP in any area with an strict methodology, and to incorporate into clinical practice new techniques such as 24 hours MAPA and AMPA at home, which still require definition of specific reference objectives. The application of these techniques has led to the emergence of several subgroups of hypertensive patients, such as white-coat hypertension and masked hypertension, which have their peculiarities in relation to the therapeutic management and prognosis. These techniques, together with the publication of new clinical trials using criteria of evidence, have led to the review of the Guidelines for the management of hypertension by modifying the limits of BP for some special clinical situations, and changing the paradigm of the lowest BP is the best, by that of: as early and more associated vascular risk factors were controlled it's better.

Loop Diuretics in the Treatment of Hypertension.

Science.gov (United States)

Malha, Line; Mann, Samuel J

2016-04-01

Loop diuretics are not recommended in current hypertension guidelines largely due to the lack of outcome data. Nevertheless, they have been shown to lower blood pressure and to offer potential advantages over thiazide-type diuretics. Torsemide offers advantages of longer duration of action and once daily dosing (vs. furosemide and bumetanide) and more reliable bioavailability (vs. furosemide). Studies show that the previously employed high doses of thiazide-type diuretics lower BP more than furosemide. Loop diuretics appear to have a preferable side effect profile (less hyponatremia, hypokalemia, and possibly less glucose intolerance). Studies comparing efficacy and side effect profiles of loop diuretics with the lower, currently widely prescribed, thiazide doses are needed. Research is needed to fill gaps in knowledge and common misconceptions about loop diuretic use in hypertension and to determine their rightful place in the antihypertensive arsenal.

Saudi guidelines on the diagnosis and treatment of pulmonary hypertension: 2014 updates

Science.gov (United States)

Idrees, Majdy M.; Saleemi, Sarfraz; Azem, M Ali; Aldammas, Saleh; Alhazmi, Manal; Khan, Javid; Gari, Abdulgafour; Aldabbagh, Maha; Sakkijha, Husam; Aldalaan, Abdulla; Alnajashi, Khalid; Alhabeeb, Waleed; Nizami, Imran; Kouatli, Amjad; Chehab, May; Tamimi, Omar; Banjar, Hanaa; Kashour, Tarek; Lopes, Antonio; Minai, Omar; Hassoun, Paul; Pasha, Qadar; Mayer, Eckhard; Butrous, Ghazwan; Bhagavathula, Sastry; Ghio, Stefano; Swiston, John; Boueiz, Adel; Tonelli, Adriano; Levy, Robert D.

2014-01-01

The Saudi Association for Pulmonary Hypertension (previously called Saudi Advisory Group for Pulmonary Hypertension) has published the first Saudi Guidelines on Diagnosis and Treatment of Pulmonary Arterial Hypertension back in 2008.[1] That guideline was very detailed and extensive and reviewed most aspects of pulmonary hypertension (PH). One of the disadvantages of such detailed guidelines is the difficulty that some of the readers who just want to get a quick guidance or looking for a specific piece of information might face. All efforts were made to develop this guideline in an easy-to-read form, making it very handy and helpful to clinicians dealing with PH patients to select the best management strategies for the typical patient suffering from a specific condition. This Guideline was designed to provide recommendations for problems frequently encountered by practicing clinicians involved in management of PH. This publication targets mainly adult and pediatric PH-treating physicians, but can also be used by other physicians interested in PH. PMID:25076987

Pattern of blood pressure and hypertension in adolescents in Port Harcourt, Nigeria.

Science.gov (United States)

Okpere, A N; Anochie, I C; Eke, F U

2013-01-01

The rate and prevalence of hypertension in children is increasing. Childhood hypertensionif untreated can lead to hypertension in adulthood with its consequent cardiovascular and renal complications. Early detection of paediatric hypertension may lead to improvement in cardiovascular health in adults. This study aims to determine the blood pressure (BP) pattern and prevalence of hypertension in asymptomatic secondary school children and factors associated with hypertension in these adolescents. A cross-sectional study of 820 adolescents selected from 12 secondary schools in Port Harcourt was conducted. BP was measured by the auscultatory method. The average of three readings was taken as the actual blood pressure. Hypertension was defined as systolic and/or diastolic blood pressures equal to or greater than the 95th percentile for age, sex and height. Data was analysed using SPSS version 17.0. Systolic and diastolic BP increased with age in all subjects. Male subjects had a higher systolic BP compared to females. Hypertension was seen in 26 (3.2%) subjects; 13 males and 13 females. The proportional prevalence was higher in the age group 15-17 years (3.9%); in those in social classes V (9.1%) and with family history of hypertension (3.6%), (p à 0.05 in all cases). It was however significantly higher in the obese subjects (p = 0.000). The prevalence of hypertension in adolescents in Port Harcourt is high and is strongly associated with obesity. We recommend blood pressure measurement as part of the school health programme in secondary schools.

[Guidelines for management of hypertension: why doesn't evidence lead to unanimity?].

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Zuccalà, A

2009-01-01

Guidelines are systematically developed statements to assist practitioner and patient decisions, and are being used to describe care based on scientific evidence. However, presence of multiple guidelines on the same subject does not help physicians make the best decision about healthcare. In this paper we examined the more recent guidelines (GL) for the management of arterial hypertension: World Health Organization-International Society of Hypertension (WHO-ISH) GL, European Society of Hypertension-European Society of Cardiology (ESH-ESC) GL, British Hypertension Society (BHS-IV) GL, and the report of Joint National Committee (JNC-7) from USA. Some differences emerged on the definition of hypertension, the blood pressure targets and the thresholds for treatment, the quantification of cardiovascular risk, the choice of initial drugs. These differences are likely to be based on divergent opinions about the relationship between hypertension and global cardiovascular risk (CVR). In the JNC-7 report, hypertension is thought to be the mainstay of CVR, hence BP treatment is to be started, taking into account the entity of blood pressure values and apart from other risk factors (with the exception of diabetes and renal insufficiency). The other GL, particularly BHS-IV GL, establish the thresholds for the start of treatment mainly taking into account the global CVR. Actually, BHS-IV GL do not recommend the start of pharmacological treatment in mild hypertension, provided that the global CVR was lower than 20% in ten years. Moreover, the difference in definition of hypertension, BP targets, choice of starting drug, is likely to spring from this different view on hypertensionglobal cardiovascular risk relationship.

Drug induced hypertension--An unappreciated cause of secondary hypertension.

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Grossman, Alon; Messerli, Franz H; Grossman, Ehud

2015-09-15

Most patients with hypertension have essential hypertension or well-known forms of secondary hypertension, such as renal disease, renal artery stenosis, or common endocrine diseases (hyperaldosteronism or pheochromocytoma). Physicians are less aware of drug induced hypertension. A variety of therapeutic agents or chemical substances may increase blood pressure. When a patient with well controlled hypertension is presented with acute blood pressure elevation, use of drug or chemical substance which increases blood pressure should be suspected. Drug-induced blood pressure increases are usually minor and short-lived, although rare hypertensive emergencies associated with use of certain drugs have been reported. Careful evaluation of prescription and non-prescription medications is crucial in the evaluation of the hypertensive individual and may obviate the need for expensive and unnecessary evaluations. Discontinuation of the offending agent will usually achieve adequate blood pressure control. When use of a chemical agent which increases blood pressure is mandatory, anti-hypertensive therapy may facilitate continued use of this agent. We summarize the therapeutic agents or chemical substances that elevate blood pressure and their mechanisms of action. Copyright © 2015 Elsevier B.V. All rights reserved.

hypertension

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Emine Hatipoglu

2013-05-01

Full Text Available Hypertension is a common disease associated with important cardiovascular complications. Persistent blood pressure of 140/90 or higher despite combined use of a reninangiotensin system blocker, calcium channel blocker and a diuretic at highest tolerated doses constitutes resistant hypertension. Excess sympathetic activity plays an important pathogenic role in resistant hypertension in addition to contributing to the development of metabolic problems, in particular diabetes. Reduction of renal sympathetic activity by percutaneous catheter-based radiofrequency ablation via the renal arteries has been shown in several studies to decrease blood pressure in patients with resistant hypertension, and importantly is largely free of significant complications. However, longer term follow-up is required to confirm both long-term safety and efficacy.

Portal Hypertension

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... Overview of Gallbladder Cancer Additional Content Medical News Portal Hypertension By Steven K. Herrine, MD, Professor of Medicine, ... Liver Hepatic Encephalopathy Jaundice in Adults Liver Failure Portal Hypertension Portal hypertension is abnormally high blood pressure in ...

Nocturnal Hypertension: Neglected Issue in Comprehensive Hypertension Management

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Andi Kristanto

2016-09-01

Full Text Available The body circardian rhythm affects blood pressure variability at day and night, therefore blood pressure at day and night might be different. Nocturnal hypertension is defined as increase of blood pressure >120/70mmHg at night, which is caused by disturbed circadian rhythm, and associated with higher cardiovascular and cerebrovascular events also mortality in hypertensive patients. Nocturnal hypertension and declining blood pressure pattern, can only be detected by continuous examination for 24 hours, also known as ambulatory blood pressure measurement (ABPM. Chronotherapy, has become a strategy for managing the hypertensive nocturnal patients, by taking hypertensive medication at night to obtain normal blood pressure decrease in accordance with the normal circadian rhythm and, improving blood pressure control.

Mineralocorticoid hypertension

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Vishal Gupta

2011-01-01

Full Text Available Hypertension affects about 10 - 25% of the population and is an important risk factor for cardiovascular and renal disease. The renin-angiotensin system is frequently implicated in the pathophysiology of hypertension, be it primary or secondary. The prevalence of primary aldosteronism increases with the severity of hypertension, from 2% in patients with grade 1 hypertension to 20% among resistant hypertensives. Mineralcorticoid hypertension includes a spectrum of disorders ranging from renin-producing pathologies (renin-secreting tumors, malignant hypertension, coarctation of aorta, aldosterone-producing pathologies (primary aldosteronism - Conns syndrome, familial hyperaldosteronism 1, 2, and 3, non-aldosterone mineralocorticoid producing pathologies (apparent mineralocorticoid excess syndrome, Liddle syndrome, deoxycorticosterone-secreting tumors, ectopic adrenocorticotropic hormones (ACTH syndrome, congenitalvadrenal hyperplasia, and drugs with mineraocorticoid activity (locorice, carbenoxole therapy to glucocorticoid receptor resistance syndromes. Clinical presentation includes hypertension with varying severity, hypokalemia, and alkalosis. Ratio of plasma aldosterone concentraion to plasma renin activity remains the best screening tool. Bilateral adrenal venous sampling is the best diagnostic test coupled with a CT scan. Treatment is either surgical (adrenelectomy for unilateral adrenal disease versus medical therapy for idiopathic, ambiguous, or bilateral disease. Medical therapy focuses on blood pressure control and correction of hypokalemia using a combination of anti-hypertensives (calcium channel blockers, angiotensin converting enzyme inhibitors, or angiotensin receptor blockers and potassium-raising therapies (mineralcorticoid receptor antagonist or potassium sparing diuretics. Direct aldosterone synthetase antagonists represent a promising future therapy.

Hypertension in postmenopausal women: how to approach hypertension in menopause.

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Modena, Maria Grazia

2014-09-01

During fertile life women are usually normo or hypotensive. Hypertension may appear during pregnancy and this represents a peculiar phenomenon increasing nowadays for delay time of pregnancy. Gestational hypertension appears partially similar to hypertension in the context of metabolic syndrome for a similar condition of increased waste circumference. Parity, for the same pathogenesis, has been reported to be associated to peri and postmenopausal hypertension, not confirmed by our study of parous women with transitional non persistent perimenopausal hypertension. Estrogen's deficiency inducing endothelial dysfunction and increased body mass index are the main cause for hypertension in this phase of life. For these reasons lifestyle modification, diet and endothelial active drugs represent the ideal treatment. Antioxidant agents may have a role in prevention and treatment of hypertension. In conclusion, hypertension in women represents a peculiar constellation of different biological and pathogenic factors, which need a specific gender related approach, independent from the male model.

Frequency of gastric varices in patients with portal hypertension based on endoscopic findings

International Nuclear Information System (INIS)

Mir, A.W.; Chaudry, A.A.; Mir, S.; Ahmed, N.; Khan, A.A.; Shahzadi, M.

2017-01-01

To find out the frequency of gastric varices in patients with portal hypertension based on endoscopic findings. Study Design: Descriptive Study. Place and Duration of Study: Department of Gastroenterology, Military Hospital, Rawalpindi from Jan to Jun 2011. Material and Methods: All patients fulfilling the inclusion criteria were selected through consecutive sampling. The patients presenting with hematemesis, melena or ascites with portal hypertension on ultrasound abdomen were admitted in the hospital. The patients were first stabilized hemodynamically and then kept empty stomach for at least four hours before endoscopy. The patients were sedated with intravenous midazolam and endoscopic findings obtained were entered on the patient proforma. Results: The overall frequency of gastric varices was 11 percent, whereas 89 percent had no gastric varices. Conclusion: A large number of patients with portal hypertension have gastric varices. It is recommended that endoscopy be carried out in all patients with identified portal hypertension. (author)

A qualitative study on hypertensive care behavior in primary health care settings in Malaysia

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Shima R

2014-11-01

Full Text Available Razatul Shima,1,3 Mohd Hairi Farizah,1,2 Hazreen Abdul Majid1,2 1Department of Social and Preventive Medicine; 2Centre for Population Health, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 3Ministry of Health Malaysia, Putrajaya, Malaysia Purpose: The aim of this study was to explore patients’ experiences with their illnesses and the reasons which influenced them in not following hypertensive care recommendations (antihypertensive medication intake, physical activity, and diet changes in primary health clinic settings. Patients and methods: A qualitative methodology was applied. The data were gathered from in-depth interviews with 25 hypertensive patients attending follow-up in nine government primary health clinics in two districts (Hulu Langat and Klang in the state of Selangor, Malaysia. The transcribed data were analyzed using thematic analysis.Results: There was evidence of lack of patient self-empowerment and community support in Malaysian society. Most of the participants did not take their antihypertensive medication or change their physical activity and diet after diagnosis. There was an agreement between the patients and the health care professionals before starting the treatment recommendation, but there lacked further counseling and monitoring. Most of the reasons given for not taking antihypertensive medication, not doing physical activity and not following diet recommendations were due to side effects or fear of the side effects of antihypertensive medication, patients’ attitudes, lack of information from health care professionals and insufficient social support from their surrounding environment. We also observed the differences on these reasons for nonadherence among the three ethnic groups.Conclusion: Health care professionals should move toward supporting adherence in the management of hypertensive patients by maintaining a dialogue. Patients need to be given time to enable them to overcome their

N-terminal pro brain natriuretic peptide in arterial hypertension--a marker for left ventricular dimensions and prognosis

DEFF Research Database (Denmark)

Hildebrandt, Per; Boesen, Mikael; Olsen, Michael

2004-01-01

In arterial hypertension risk factor evaluation, including LV mass measurements, and risk stratification using risk charts or programs, is generally recommended. In heart failure NT-proBNP has been shown to be a marker of LV dimensions and of prognosis. If the same diagnostic and prognostic value...... is present in arterial hypertension, risk factor evaluation would be easier. In 36 patients with arterial hypertension, electrocardiographic LV hypertrophy and preserved left ventricular function, NT-proBNP was eight-fold higher than in healthy subjects. The log NT-proBNP correlated with LV mass index (R=0.......47, P=0.0002) measured by magnetic resonance imaging. In other subjects with arterial hypertension a significant but weak correlation to diastolic properties has been demonstrated. As for prognosis, a recent study in patients with hypertension, electrocardiographic left ventricular hypertrophy...

Cost-effectiveness of ambulatory blood pressure monitoring in the management of hypertension.

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Costa, Diogo; Peixoto Lima, Ricardo

2017-02-01

The prevalence of hypertension in Portugal is between 29.1% and 42.2%. International studies show that 13% of individuals have masked hypertension and 13% of diagnoses based on office blood pressure measurements are in fact white coat hypertension. More sensitive and specific blood pressure measuring methods could avoid costs associated with misdiagnosis. The aim of this study was to review the cost-effectiveness of ambulatory blood pressure monitoring (ABPM) compared to other methods in the management of hypertension. We performed a literature search in CMA Infobase, Guidelines Finder, National Guideline Clearinghouse, Bandolier, BMJ Clinical Evidence, the Cochrane Library, DARE, Medline, the Trip Database, SUMSearch and Índex das Revistas Médicas Portuguesas. We researched articles published between January 2005 and August 2015 in Portuguese, English and Spanish, using the MeSH terms "Hypertension", "Blood Pressure Monitoring, Ambulatory" and "Cost-Benefit Analysis" and the Portuguese search terms "Hipertensão", "Monitorização Ambulatorial da Pressão Arterial" and "Análise Custo-Benefício". Levels of evidence and grades of recommendation were attributed according to the Oxford Centre for Evidence-Based Medicine scale. Five hundred and twenty-five articles were identified. We included five original studies and one clinical practice guideline. All of them state that ABPM is the most cost-effective method. Two report better blood pressure control, and a Portuguese study revealed a saving of 23%. The evidence shows that ABPM is cost-effective, avoiding iatrogenic effects and reducing expenditure on treatment (grade of recommendation B). The included studies provide a solid basis, but further evidence of reproducibility is needed in research that is not based mainly on analytical models. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Hypertension among 1000 patients with type 2 diabetes attending a national diabetes center in Jordan

International Nuclear Information System (INIS)

Mubarak, Fayzeh M.; Ajlouni, Kamel M.; Froelicher, Erika S.; Jaddou, Hashem Y.

2008-01-01

In Jordan there is a paucity of research on hypertension and its risk factors among patients with type 2 diabetes mellitus. The study was designed to assess the prevalence of hypertension, risk factors and the level of awareness and control of hypertension among outpatients with type 2 diabetes. A cross-sectional study was carried out on a sample of 1000 patients with type 2 diabetes who were attending the National Center for Diabetes, Endocrine and Genetic Diseases for follow-up during the period of June to December 2006. Data were collected from medical records and through a structured interview questionnaire. Logistic regression analysis was used to assess the independent effect of variables on hypertension. The prevalence of hypertension (PB>130/80 or on medication for high blood pressure) was 72.4% (70.9% of males and 73.9% of females). The logistic regression indicated that hypertension was positively associated with age (P=0.001), body mass index (P=0.001). About one-half of patients who were aware of having hypertension failed to keep their blood pressure under control. Hypertension is a common co-morbidity among diabetic patients. Despite a high rate of awareness of hypertension among study subjects (93%), hypertension was not controlled to the recommended levels of blood pressure in one but a one-half (50.4%) of patients. (author)

PP095. Guideline-based development of quality indicators for hypertensive diseases in pregnancy

DEFF Research Database (Denmark)

Luitjes, S.H.E.; Wouters, M; Franx, A.

2012-01-01

for care improvement.RESULTS: A representative set of 14 quality indicators was selected from 48 initial guideline recommendations. Indicators concerned both professional performance and organisation of care for patients with hypertension in pregnancy.CONCLUSION: This study describes the systematic...

Splenic trauma in a patient with portal hypertension and splenomegaly: A case report

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Ahmet Topçu

2017-08-01

Full Text Available The spleen is the most commonly injured organ in cases of blunt abdominal trauma. Currently, 50-80% of adults with blunt splenic injuries are treated nonoperatively. In this report, we present a blunt abdominal trauma patient having a history of portal hypertension and splenomegaly. In grade 3 and even grade 4 splenic injuries non-operative treatment is recommended in current literature. Management of splenic trauma with a patient with history of splenomegaly and portal hypertension is insufficiently discussed in literature. In presented case, hypersplenism and portal hypertension were burden on hemostasis. Even with massive resuscitation, thrombocyte level decreased to 40.000/mm³ after five hours. But, insistence on non-operative treatment in this situation could be fatal.

White coat hypertension in pediatrics.

Science.gov (United States)

Jurko, Alexander; Minarik, Milan; Jurko, Tomas; Tonhajzerova, Ingrid

2016-01-15

The article summarizes current information on blood pressure changes in children during clinic visit. White coat as a general dressing of physicians and health care personnel has been widely accepted at the end of the 19th century. Two problems can be associated with the use of white coat: white coat phenomenon and white coat hypertension. Children often attribute pain and other unpleasant experience to the white coat and refuse afterwards cooperation with examinations. Definition of white coat hypertension in the literature is not uniform. It has been defined as elevated blood pressure in the hospital or clinic with normal blood pressure at home measured during the day by ambulatory blood pressure monitoring system. White coat effect is defined as temporary increase in blood pressure before and during visit in the clinic, regardless what the average daily ambulatory blood pressure values are. Clinical importance of white coat hypertension is mainly because of higher risk for cardiovascular accidents that are dependent on end organ damage (heart, vessels, kidney). Current data do not allow any clear recommendations for the treatment. Pharmacological therapy is usually started in the presence of hypertrophic left ventricle, changes in intimal/medial wall thickness of carotic arteries, microalbuminuria and other cardiovascular risk factors. Nonpharmacological therapy is less controversial and certainly more appropriate. Patients have to change their life style, need to eliminate as much cardiovascular risk factors as possible and sustain a regular blood pressure monitoring.

Advanced pulmonary arterial hypertension: mechanical support and lung transplantation

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Sonja Bartolome

2017-12-01

Full Text Available The development of targeted therapies has transformed the outlook for patients with pulmonary arterial hypertension (PAH; however, some patients fail to achieve an adequate clinical response despite receiving maximal treatment. For these patients, lung transplantation remains an important therapeutic option, and recommendations for transplantation are included in the current European Society of Cardiology/European Respiratory Society guidelines for the diagnosis and treatment of pulmonary hypertension. Although lung transplantation is not without risk, overall long-term survival rates are good and substantial improvements in quality of life have been reported for lung transplant recipients. In this review, we describe the important considerations prior to, during and after transplantation, including the role of mechanical support, in patients with advanced PAH.

Hypertension control in industrial employees: findings from SHIMSCO study

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Alireza Khosravi

2012-03-01

Full Text Available Background: Hypertension prevention and control are among the most important public health priorities. We evaluated the impacts of a workplace intervention project "Stop Hypertension in Mobarakeh Steel Company" (SHIMSCO on controlling hypertension in industrial workers. Methods: The study was carried out in Mobarakeh Steel Company in Isfahan among 7286 male workers and employees. All individuals were evaluated for the presence of hypertension (HTN. According to examinations, 500 subjects with  systolic blood pressure (SBP ≥ 140 mmHg, and/or diastolic blood pressure (DBP ≥ 90 mmHg, and/or those using antihypertensive medications were confirmed to have HTN and thus included in this study. They were questioned for sociodemographic characteristics, past medical history and medication use. They received an educational program including healthy lifestyle and self-care recommendations of HTN management and control as well as training for accurate blood pressure measurement and home monitoring for two years. SBP, DBP, weight, height and routine lab tests were measured for all hypertensive subjects before and after the interventions. Paired t-test, generalized estimation equation (GEE and ordinary linear regression (OLR were used for statistical analysis in SPSS. Results: The comparison of SBP and DBP before and after the educational program showed significant reductions in both parameters (-7.97 ± 14.72 and -2.66 ± 9.96 mmHg, respectively. However, a greater decrease was detected in case of DBP. GEE showed SBP and DBP to decrease about -0.115 and -0.054 mmHg/month. OLR also revealed reductions of 4.88 and 2.57 mmHg respectively in SBP and DBP upon adding each antihypertensive drug. Conclusion: SHIMSCO, a 3-year interventional project in workplaces, was effective in reducing SBP and DBP among hypertensive employees and workers. We conclude that implementing simple educational programs in worksites can improve the management and control of

Hypertensive emergencies remain a clinical problem and are associated with high mortality.

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Roubsanthisuk, Weranuj; Wongsurin, Unticha; Buranakitjaroen, Peera

2010-01-01

We suspect that hypertensive emergencies remain a clinical problem and data on their long-term prognosis are lacking. This study was conducted in order to determine the frequency, management, and outcome of hypertensive emergencies in this era, in which hypertension treatment is more effective than in the past. We reviewed the medical records of patients with hypertensive emergencies admitted to the medical wards of Siriraj Hospital in 2003 and collected data on their characteristic, management, investigations, and follow-ups through 31 December 2007. There were 184 patients included. Hypertension has been previously diagnosed in 89% of cases. Nearly half also had diabetes mellitus and around a quarter had chronic kidney failure. Mean +/- SD of blood pressure at presentation was 205.96 +/- 21.36/114.60 +/- 20.59 mmHg. Cardiac complications and stroke accounted for 71% and 23% of all target organ damage, respectively. Intravenous nitroglycerine and furosemide were most frequently prescribed. Additional investigations to search for the causes of hypertension were performed in only 55 cases. The average hospital stay was 9.8 days. The in-hospital mortality rate was 15%. Some 26% of patients were lost to follow-up and another 20% died later. Only 19% of patients had regular follow-ups until the end of 2007 and remained on an average of 2.4 antihypertensive drugs. Hypertensive emergencies are usually found in patients with a history of hypertension and diabetes mellitus or kidney failure. Recommended investigations usually failed to identify the cause of hypertension. The mortality rate of these patients was extremely high while their adherence to treatment was extremely poor.

Unsuccessfully Treated Hypertension: A Major Public Health Problem With a Potential Solution.

Science.gov (United States)

Furberg, Curt D; Sealey, Jean E; Blumenfeld, Jon D

2017-09-01

About one-half of all hypertensive adults do not have their blood pressure controlled. They are often prescribed medications that conform to national guidelines but they continue to have elevated blood pressure. This public health problem might be improved by applying plasma renin guided therapy. A contributor to the public health problem of unsuccessfully treated hypertension is that the circulating renin-angiotensin system (RAS) is not recognized in treatment guidelines as clinically relevant for the treatment of hypertension or as important as the body salt status for determining blood pressure levels. Another contributor to the problem is the lack of specificity in the package inserts for antihypertensive drugs. They do not specifically state under the heading "Indications" that RAS blockers are primarily most effective in hypertensive subjects with medium and high plasma renin levels; by contrast, natriuretic drugs are most effective in those with low plasma renin levels. Literature review. To address the problem of unsuccessfully treated hypertension, we recommend that the "Indications" section of package inserts for antihypertensive drugs be more specific. The primary indication for RAS blockers ought to be hypertension with medium and high plasma renin levels, and natriuretic agents for those with low plasma renin levels. Similar language ought to be added to treatment guidelines. Additionally, 3 other reasons for lack of blood pressure control also need to be addressed-failure to prescribe antihypertensive drugs to hypertensive subjects, failure of patients to fill prescriptions, and low drug adherence. © American Journal of Hypertension, Ltd 2017. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Diet quality and adherence to a healthy diet in Japanese male workers with untreated hypertension.

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Kanauchi, Masao; Kanauchi, Kimiko

2015-07-10

As Japanese societies rapidly undergo westernisation, the prevalence of hypertension is increasing. We investigated the association between dietary quality and the prevalence of untreated hypertension in Japanese male workers. We conducted a cross-sectional study of 433 male workers who completed a brief food frequency questionnaire. Adherence to the WHO-based Healthy Diet Indicator (HDI), the American Heart Association 2006 Diet and Lifestyle Recommendations, the Dietary Approaches to Stop Hypertension (DASH) diet, and Mediterranean-style diet was assessed using four adherence indexes (HDI score, AI-84 score, DASH score and MED score). Hypertension classes were classified into three categories: non-hypertension, untreated hypertension and treated hypertension (ie, taking antihypertensive medication). The prevalence of untreated hypertension and treated hypertension was 22.4% and 8.5%, respectively. Patients with untreated hypertension had significantly lower HDI and AI-84 scores compared with non-hypertension. DASH and MED scores across the three hypertension classes were comparable. After adjusting for age, energy intake, smoking habit, alcohol drinking, physical activity and salt intake, a low adherence to HDI and a lowest quartile of AI-84 score were associated with a significantly higher prevalence of untreated hypertension, with an OR of 3.33 (95% CI 1.39 to 7.94, p=0.007) and 2.23 (1.09 to 4.53, p=0.027), respectively. A lower dietary quality was associated with increased prevalence of untreated hypertension in Japanese male workers. Our findings support a potential beneficial impact of nutritional assessment using diet qualities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Management of patients with severe hypertension in emergency department, Maharaj Nakorn Chiang Mai hospital.

Science.gov (United States)

Sruamsiri, Kamphee; Chenthanakij, Boriboon; Wittayachamnankul, Borwon

2014-09-01

Management of patients with severe hypertension without progressive target organ damage remains controversial. Some guidelines mentioned oral anti-hypertensive medication as a treatment to reduce blood pressure in the emergency department, while others recommended against such treatment. To review the management ofpatients with severe hypertension without progressive target organ damage in the emergency department, Maharaj Nakorn Chiang Mai hospital. In a retrospective descriptive analysis study, medical records ofadult patients diagnosed with severe hypertension without progressive target organ damage between January 2011 and December 2012 were reviewed. Patient demographics, data on management including investigation sent and treatment given were collected. Statistical analysis was done by using descriptive statistics and Kruskal-Wallis one-way analysis of variance test. One hundred fifty one medical records were reviewed. Four oral anti-hypertensive medication were used to reduce blood pressure, Amlodipine, Captopril, Hydralazine, and Nifedipine. There were no significant diference between each medication in terms of their effect on bloodpressure reduction (p = 0.513). No side effect or other complications from the use of oral anti-hypertensive medication were recorded The choice of medication used for the treatment of hypertensive urgency ranged from Amlodipine, Captopril, Hydralazine, and Nifedipine, which varied in dosage. However their efficacies were the same when compared with each other and none produced any notable side effects.

Hypertension in women

OpenAIRE

Hage, Fadi G; Mansur, Sulaf J; Xing, Dongqi; Oparil, Suzanne

2013-01-01

Hypertension is the most common modifiable risk factor for cardiovascular disease, the leading cause of death in both men and women. The prevalence and severity of hypertension rise markedly with age, and blood pressure control becomes more difficult with aging in both genders, particularly in women. In addition, there are forms of hypertension that occur exclusively in women, e.g., hypertension related to menopause, oral contraceptive use, or pregnancy (e.g., chronic hypertension, gestationa...

Increasing complexity: which drug class to choose for treatment of hypertension in the elderly?

Directory of Open Access Journals (Sweden)

Kaiser EA

2014-03-01

Full Text Available Edelgard Anna Kaiser,1 Ulrich Lotze,2 Hans Hendrik Schäfer1,31Roche Diagnostics International AG, Rotkreuz, Switzerland; 2Department of Internal Medicine, DRK-Manniske-Krankenhaus Bad Frankenhausen, Bad Frankenhausen, Germany; 3Institute of Anatomy II, University Hospital Jena, Friedrich-Schiller University, Jena, GermanyAbstract: Treatment of hypertension in the elderly is expected to become more complex in the coming decades. Based on the current landscape of clinical trials, guideline recommendations remain inconclusive. The present review discusses the latest evidence derived from studies available in 2013 and investigates optimal blood pressure (BP and preferred treatment substances. Three common archetypes are discussed that hamper the treatment of hypertension in the very elderly. In addition, this paper presents the current recommendations of the NICE 2011, JNC7 2013-update, ESH/ESC 2013, CHEP 2013, JNC8 and ASH/ISH guidelines for elderly patients. Advantages of the six main substance classes, namely diuretics, beta-blockers (BBs, calcium channel blockers (CCBs, angiotensin-converting enzyme inhibitors (ACEIs, angiotensin receptor blockers (ARBs, and direct renin inhibitors (DRIs are discussed. Medical and economic implications of drug administration in the very elderly are presented. Avoidance of treatment-related adverse effects has become increasingly relevant. Current substance classes are equally effective, with similar effects on cardiovascular outcomes. Selection of substances should therefore also be based on collateral advantages of drugs that extend beyond BP reduction. The combination of ACEIs and diuretics appears to be favorable in managing systolic/diastolic hypertension. Diuretics are a preferred and cheap combination drug, and the combination with CCBs is recommended for patients with isolated systolic hypertension. ACEIs and CCBs are favorable for patients with dementia, while CCBs and ARBs imply substantial cost

[2013 Ambulatory blood pressure monitoring recommendations for the diagnosis of adult hypertension, assessment of cardiovascular and other hypertension-associated risk, and attainment of therapeutic goals (summary). Joint recommendations from the International Society for Chronobiology (ISC), American Association of Medical Chronobiology and Chronotherapeutics (AAMCC), Spanish Society of Applied Chronobiology, Chronotherapy, and Vascular Risk (SECAC), Spanish Society of Atherosclerosis (SEA), and Romanian Society of Internal Medicine (RSIM)].

Science.gov (United States)

Hermida, Ramón C; Smolensky, Michael H; Ayala, Diana E; Portaluppi, Francesco; Crespo, Juan J; Fabbian, Fabio; Haus, Erhard; Manfredini, Roberto; Mojón, Artemio; Moyá, Ana; Piñeiro, Luis; Ríos, María T; Otero, Alfonso; Balan, Horia; Fernández, José R

2013-01-01

Correlation between systolic (SBP) and diastolic (DBP) blood pressure (BP) level and target organ damage, cardiovascular disease (CVD) risk, and long-term prognosis is much greater for ambulatory BP monitoring (ABPM) than daytime office measurements. The 2013 ABPM guidelines specified herein are based on ABPM patient outcomes studies and constitute a substantial revision of current knowledge. The asleep SBP mean and sleep-time relative SBP decline are the most significant predictors of CVD events, both individually as well as jointly when combined with other ABPM-derived prognostic markers. Thus, they should be preferably used to diagnose hypertension and assess CVD and other associated risks. Progressive decrease by therapeutic intervention in the asleep BP mean is the most significant predictor of CVD event-free interval. The 24 h BP mean is not recommended to diagnose hypertension because it disregards the more valuable clinical information pertaining to the features of the 24 h BP pattern. Persons with the same 24 h BP mean may display radically different 24 h BP patterns, ranging from extreme-dipper to riser types, representative of markedly different risk states. Classification of individuals by comparing office with either the 24 h or awake BP mean as "masked normotensives" (elevated clinic BP but normal ABPM), which should replace the terms of "isolated office" or "white-coat hypertension", and "masked hypertensives" (normal clinic BP but elevated ABPM) is misleading and should be avoided because it disregards the clinical significance of the asleep BP mean. Outcome-based ABPM reference thresholds for men, which in the absence of compelling clinical conditions are 135/85 mmHg for the awake and 120/70 mmHg for the asleep SBP/DBP means, are lower by 10/5 mmHg for SBP/DBP in uncomplicated, low-CVD risk, women and lower by 15/10 mmHg for SBP/DBP in male and female high-risk patients, e.g., with diabetes, chronic kidney disease (CKD), and/or past CVD events. In

Therapeutic strategies to improve control of hypertension.

Science.gov (United States)

Armario, Pedro; Waeber, Bernard

2013-03-01

Blood pressure is poorly controlled in most European countries and the control rate is even lower in high-risk patients such as patients with chronic kidney disease, diabetic patients or previous coronary heart disease. Several factors have been associated with poor control, some of which involve the characteristic of the patients themselves, such as socioeconomic factors, or unsuitable life-styles, other factors related to hypertension or to associated comorbidity, but there are also factors directly associated with antihypertensive therapy, mainly involving adherence problems, therapeutic inertia and therapeutic strategies unsuited to difficult-to-control hypertensive patients. It is common knowledge that only 30% of hypertensive patients can be controlled using monotherapy; all the rest require a combination of two or more antihypertensive drugs, and this can be a barrier to good adherence and log-term persistence in patients who also often need to use other drugs, such as antidiabetic agents, statins or antiplatelet agents. The fixed combinations of three antihypertensive agents currently available can facilitate long-term control of these patients in clinical practice. If well tolerated, a long-term therapeutic regimen that includes a diuretic, an ACE inhibitor or an angiotensin receptor blocker, and a calcium channel blocker is the recommended optimal triple therapy.

Perioperative management of pulmonary hypertension during lung transplantation (a lesson for other anaesthesia settings).

Science.gov (United States)

Rabanal, J M; Real, M I; Williams, M

2014-10-01

Patients with pulmonary hypertension are some of the most challenging for an anaesthesiologist to manage. Pulmonary hypertension in patients undergoing surgical procedures is associated with high morbidity and mortality due to right ventricular failure, arrhythmias and ischaemia leading to haemodynamic instability. Lung transplantation is the only therapeutic option for end-stage lung disease. Patients undergoing lung transplantation present a variety of challenges for anaesthesia team, but pulmonary hypertension remains the most important. The purpose of this article is to review the anaesthetic management of pulmonary hypertension during lung transplantation, with particular emphasis on the choice of anaesthesia, pulmonary vasodilator therapy, inotropic and vasopressor therapy, and the most recent intraoperative monitoring recommendations to optimize patient care. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension

Science.gov (United States)

Biecker, Erwin

2013-01-01

Gastrointestinal bleeding related to portal hypertension is a serious complication in patients with liver cirrhosis. Most patients bleed from esophageal or gastric varices, but bleeding from ectopic varices or portal hypertensive gastropathy is also possible. The management of acute bleeding has changed over the last years. Patients are managed with a combination of endoscopic and pharmacologic treatment. The endoscopic treatment of choice for esophageal variceal bleeding is variceal band ligation. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the time point of endoscopy. The first-line treatment for primary prophylaxis of esophageal variceal bleeding is nonselective beta blockers. Pharmacologic therapy is recommended for most patients; band ligation is an alternative in patients with contraindications for or intolerability of beta blockers. Treatment options for secondary prophylaxis include variceal band ligation, beta blockers, a combination of nitrates and beta blockers, and combination of band ligation and pharmacologic treatment. A clear superiority of one treatment over the other has not been shown. Bleeding from portal hypertensive gastropathy or ectopic varices is less common. Treatment options include beta blocker therapy, injection therapy, and interventional radiology. PMID:27335828

Recent clinical and translational advances in pediatric hypertension.

Science.gov (United States)

Falkner, Bonita

2015-05-01

Epidemiological reports describe a child population increase in BP level and an increase in prevalence of hypertension, that is largely, but not entirely, driven by a concurrent increase in childhood obesity. Given current estimates, ≈10% of adolescents have hypertension or prehypertension. In addition to obesity, dietary salt intake and waist circumference, a marker of visceral obesity, are found to be independently associated with the rise in BP among children and adolescents. Dietary salt intake in urban children is well above recommended levels largely because of consumption of processed and fast foods. Childhood exposures, such as stress,52 salt, and fructose, as well as lifestyles, including food sources, sleep patterns, and reductions in physical activity may have a role in obesity-high BP associations. In addition, clinical and translational evidence is mounting that intrauterine exposures alter can effect changes in fetal development that have an enduring effect on cardiovascular and metabolic function later in life. These effects can be detected even in children who are products of a term otherwise normal pregnancy. Hypertension in childhood has been defined statistically (BP ≥ 95th percentile) because of lack of outcome data that links a BP level with heightened risk for future cardiovascular events. Therefore, primary hypertension had been considered a risk factor for later hypertension in adulthood. Intermediate markers of TOD, including cardiac hypertrophy, vascular stiffness, and increases in cIMT, are detectable in adolescents with primary hypertension. Evidence that vascular injury is present in the early phase of hypertension and even in prehypertension warrants consideration on the current definition of pediatric hypertension. With further studies on TOD and other risk factors in addition to high BP, it may be possible to shift from a statistical definition to a definition of childhood hypertension that is evidence based. Preventing or

Adherence to Hypertension Management Recommendations for Patient Follow-Up Care and Lifestyle Modifications Made by Military Healthcare Providers

National Research Council Canada - National Science Library

Collins, Timothy

2000-01-01

The purpose of this study was to describe military healthcare providers adherence to nationally recognized hypertensive patient guidelines concerning lifestyle modifications and follow-up instructions...

Twenty weeks of isometric handgrip home training to lower blood pressure in hypertensive older adults

DEFF Research Database (Denmark)

Jørgensen, Martin Grønbech; Ryg, Jesper; Danielsen, Mathias Brix

2018-01-01

lower blood pressure levels beyond the 10-week mark. Recently, we developed a novel method for monitoring handgrip intensity using a standard Nintendo Wii Board (Wii). The primary aim of this study is to explore the effects of a 20-week IHG home training facilitated by a Wii in hypertensive older adults......) or to a control group (hypertension guidelines on lifestyle changes). Participants in the intervention group will perform IHG home training (30% of maximum grip strength for a total of 8 min per day per hand) three times a week for 20 weeks. Resting blood pressure and maximal handgrip strength will be obtained......BACKGROUND: Hypertension markedly increases the risk of cardiovascular diseases and overall mortality. Lifestyle modifications, such as increased levels of physical activity, are recommended as the first line of anti-hypertensive treatment. A recent systematic review showed that isometric handgrip...

Hypertension in Asymptomatic, Young Medical Students with Parental History of Hypertension

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Simran Sidhu

2017-11-01

Full Text Available Introduction: Family history of hypertension in medical students is an important, non-modifiable risk factor for hypertension in future. Aim: To determine the prevalence of sustained hypertension in young asymptomatic medical students with a parental history of hypertension. Materials and Methods: A cross-sectional study was conducted in a medical college of Dehradun. A total of 104 medical students with parental history of hypertension (Group A and 100 medical students without a parental history of hypertension (Group B were included. Electronically blood pressures were recorded on two separate occasions at an interval of 15 days. Comparison was done using Chi-square test/Likelihood ratio, Un-paired t-test and ANCOVA. Results: Overall, Group A had significantly higher percentage of prehypertensive (56.7% and hypertensive (17.3% students as compared to Group B which were 19% and 1%, respectively. Group A students had significantly higher Systolic Blood Pressure (SBP and Diastolic Blood Pressure (DBP as compared to Group B, even after controlling for the differences in Body Mass Index (BMI and gender (p<0.001. Conclusion: Hypertension was significantly higher in asymptomatic, healthy medical students with parental history of hypertension as compared to those with normotensive parents. We need to orient medical students to improve their knowledge, attitude and lifestyle practices early in life to prevent, treat hypertension and prevent its subsequent morbidity and mortality.

Hypertensive target organ damage in Ghanaian civil servants with hypertension.

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Juliet Addo

2009-08-01

Full Text Available Low levels of detection, treatment and control of hypertension have repeatedly been reported from sub Saharan Africa, potentially increasing the likelihood of target organ damage.A cross-sectional study was conducted on 1015 urban civil servants aged > or = 25 years from seven central government ministries in Accra, Ghana. Participants diagnosed to have hypertension were examined for target organ involvement. Hypertensive target organ damage was defined as the detection of any of the following: left ventricular hypertrophy diagnosed by electrocardiogram, reduction in glomerular filtration rate, the presence of hypertensive retinopathy or a history of a stroke.Of the 219 hypertensive participants examined, 104 (47.5% had evidence of target organ damage. The presence of target organ damage was associated with higher systolic and diastolic blood pressure levels. The odds of developing hypertensive target organ damage was five to six times higher in participants with blood pressure (BP > or = 180/110 mmHg compared to those with BP < 140/90 mmHg, and there was a trend to higher odds of target organ damage with increasing BP (p = 0.001. Women had about lower odds of developing target organ damage compared to men.The high prevalence of target organ damage in this working population associated with increasing blood pressure, emphasises the need for hypertension control programs aimed at improving the detection of hypertension, and importantly addressing the issues inhibiting the effective treatment and control of people with hypertension in the population.

Essential hypertensive controlled and normotensive patients. If there are differences?

Directory of Open Access Journals (Sweden)

V. V. Syvolap

2016-10-01

Full Text Available Ambulatory blood pressure monitoring (ABPM is a modern method of blood pressure (BP investigation recommended by international scientific associations for diagnostics of essential hypertension (EH. However, there are some methodological aspects which are not regulated. Particularly, ABPM parameters have not yet established for those patients in different age groups and pathologies. The aim of the study was to determine peculiarities of ABPM parameters in treated controlled hypertensive and normotensive patients. Materials and methods. 71 patients were included into the study and divided into two groups according to the level of 24-h systolic BP (SBP and 24-h diastolic BP (DBP. There were 50 controlled patients with EH in the first group and 21 normotensive individuals without EH in the second group. Results. In EH patients and normotensive individuals we had statistician difference of such parameters, like the hypertension time index (TI of day SBP parameters (20 (8–31 % vs. 8 (4–18 %; р=0.040; of the square index (SI of hypertension (24 (11–41 mm2/h vs. 8 (2–23 mm2/h; р=0.021; of the square index normalized (SIN of hypertension (1.4 (0.6–2.4 U vs. 0.4 (0.1–1.2 U; р=0.018, and the morning surge of SBP (45±14 mm Hg vs. 37±14 mm Hg; р=0.028, respectively. There is no different in other ABPM parameters. Conclusion. The present data shows that treated controlled hypertensive patients and individuals without EH have statistician difference only in daily SBP of hypertensive indexes (TI, SI, SIN and the morning surge of SBP. The other ABPM parameters, included new one, such as the arterial stiffness index, did not represent statistical difference between groups.

When and how to recommend 'alternative approaches' in the management of high blood pressure.

Science.gov (United States)

Brook, Robert D; Jackson, Elizabeth A; Giorgini, Paolo; McGowan, Cheri L

2015-06-01

Several nonpharmacologic therapies, such as sodium restriction and weight loss, have been promoted by hypertension guidelines based on the trial evidence supporting their capacity to lower blood pressure. However, many patients may not respond or be able to adhere to these nonpharmacologic treatments. Despite numerous formal diet and lifestyle recommendations, the prevalence of hypertension continues to grow worldwide. As such, additional approaches are needed to help combat this public health epidemic. In this review, we outline the evidence supporting the efficacy of a number of alternative approaches for blood pressure lowering. On the basis of the recommendations by a recent American Heart Association scientific statement, we also provide guidance on when and how to implement these methods in clinical practice. The available evidence supports several approaches, including Transcendental Meditation, device-guided slow breathing, and aerobic, resistance, and isometric exercises. Nonetheless, many questions remain, and future recommendations for using alternative approaches will need to be updated as new trials are published. Copyright © 2015 Elsevier Inc. All rights reserved.

Hypertension and prehypertension among adolescents in secondary schools in Enugu, South East Nigeria.

Science.gov (United States)

Ujunwa, Fortune A; Ikefuna, Anthony N; Nwokocha, Ada R C; Chinawa, Josephat M

2013-11-02

Hypertension is a prevalent cardiovascular disease risk factor among blacks and adolescent hypertension can progress into adulthood. To determine the prevalence of hypertension and prehypertension among secondary school adolescents in Enugu South East Nigeria. A study of 2694 adolescents aged 10-18 years in Enugu metropolis was carried out. Socio-demographic profile anthropometric and blood pressure readings were obtained. Derived measurements such as Prehypertension, hypertension and BMI were obtained. The results showed that the mean systolic blood pressure and diastolic blood pressure for males were 106.66+ 11.80 mmHg and 70.25 + 7.34 mmHg respectively. The mean SBP and DBP for females were 109.83+ 11.66 mmHg and 72.23 + 8.26 mmHg respectively (p Blood pressure was found to increase with age. Prevalence of hypertension and prehypertension was 5.4% and 17.3% respectively with a higher rate in females (6.9%) than males (3.8%). Prevalence of prehypertension among males and females were 14.3% and 20.1% respectively. The prevalence of obesity was 1.9%. Modifiable risk factors exist among adolescents. Early lifestyle modification and a strengthened school health are recommended.

Salt (sodium chloride) content of retail samples of Nigerian white bread: implications for the daily salt intake of normotensive and hypertensive adults.

Science.gov (United States)

Nwanguma, B C; Okorie, C H

2013-10-01

Bread has been identified as a major contributor to the excessive salt (sodium chloride) intake of consumers in many countries, some of which have very high incidences of hypertension and related cardiovascular complications, such as stroke. This has prompted a global rise in interest in the salt content of breads produced and consumed in many other countries. The sodium contents of retail samples of 100 brands of Nigerian white bread were determined by photometry with a view to estimating the relative contribution of bread to the recommended daily sodium intake of both normotensive and hypertensive adults in the country. The salt content of the bread samples varied extensively, ranging from 0.51 g per 100 g (0.51%) to 1.8 g per 100 g (1.8%). The average salt content was 1.36 g per 100 g. Based on an estimated consumption of six slices of bread (about 180 g) per meal of bread, this equates to a daily intake of between 0.99 g and 3.33 g of salt from bread alone. This represents between 19.8% and 66.6% of the recommended daily allowance of 5 g for normotensive adults, and between 24.75% and 83.25% of the recommended daily allowance of 4 g for hypertensive adults. The consumption of some brands of bread by normotensive and hypertensive adults puts them at great risk of exceeding their recommended daily allowance for salt. Thus, there is an urgent need to regulate the amount of salt added to bread. In the interim, compelling bakers to declare the salt content of their products on the packaging could help consumers, especially hypertensive adults, avoid brands with a high salt content. © 2013 The Authors Journal of Human Nutrition and Dietetics © 2013 The British Dietetic Association Ltd.

Resistant hypertension.

Science.gov (United States)

Wei, Fang-Fei; Zhang, Zhen-Yu; Huang, Qi-Fang; Yang, Wen-Yi; Staessen, Jan A

2018-06-15

The publication of the first non-randomised proof-of-concept trial of renal denervation as a treatment modality in treatment-resistant hypertension set the stage for a search for novel devices with the expectation that technology would reduce the burden of hypertension by reducing or eliminating the costly and lifelong use of blood pressure lowering medications. As we demonstrate in this review, this idea so attractive to manufacturers and invasive cardiologists and radiologists overlooked decades of careful pathophysiological research in a disease, which still remains enigmatic but remains the major cause of cardiovascular mortality worldwide. To make our point, we first reviewed the prevalence and risks associated with treatment-resistant hypertension. Next, we highlighted the key points required for the diagnosis of treatment-resistant hypertension, including the recording of the ambulatory blood pressure and the assessment of adherence to medication. Finally, we summarised new insights in the management of treatment-resistant hypertension by medication and devices and in the future research. Throughout our review, we focused on new evidence became available since 2013. Our conclusion is that optimising medical treatment based on simple algorithms remains the state of the art in treatment-resistant hypertension.

Longitudinal Study of Hypertensive Subjects With Type 2 Diabetes Mellitus: Overall and Cardiovascular Risk.

Science.gov (United States)

Safar, Michel E; Gnakaméné, Jean-Barthélémy; Bahous, Sola Aoun; Yannoutsos, Alexandra; Thomas, Frédérique

2017-06-01

Despite adequate glycemic and blood pressure control, treated type 2 diabetic hypertensive subjects have a significantly elevated overall/cardiovascular risk. We studied 244 816 normotensive and 99 720 hypertensive subjects (including 7480 type 2 diabetics) attending medical checkups between 1992 and 2011. We sought to identify significant differences in overall/cardiovascular risk between hypertension with and without diabetes mellitus. Mean follow-up was 12.7 years; 14 050 all-cause deaths were reported. From normotensive to hypertensive populations, a significant progression in overall/cardiovascular mortality was observed. Mortality was significantly greater among diabetic than nondiabetic hypertensive subjects (all-cause mortality, 14.05% versus 7.43%; and cardiovascular mortality, 1.28% versus 0.7%). No interaction was observed between hemodynamic measurements and overall/cardiovascular risk, suggesting that blood pressure factors, even during drug therapy, could not explain the differences in mortality rates between diabetic and nondiabetic hypertensive patients. Using cross-sectional regression models, a significant association was observed between higher education levels, lower levels of anxiety and depression, and reduced overall mortality in diabetic hypertensive subjects, while impaired renal function, a history of stroke and myocardial infarction, and increased alcohol and tobacco consumption were significantly associated with increased mortality. Blood pressure and glycemic control alone cannot reverse overall/cardiovascular risk in diabetics with hypertension. Together with cardiovascular measures, overall prevention should include recommendations to reduce alcohol and tobacco consumption and improve stress, education levels, and physical activity. © 2017 American Heart Association, Inc.

Intensification of regular physical activity in patients with resistant hypertension

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Piotr Kruk

2017-09-01

Full Text Available Introduction: Regular physical activity is recommended in patients with arterial hypertension as part of the necessary lifestyle modifications. Aim of the study: The aim of the study was to assess the possibility of increasing the physical activity of patients with resistant hypertension. Material and methods: The study group consisted of 27 patients meeting the diagnosis criteria of resistant hypertension and 26 patients with well-controlled hypertension, as a control group. Anthropometric and bioimpedance-based body composition measurements were performed three times within the course of the 6-month-long study, at baseline and after 3 and 6 months, and a physical activity profile was determined based on the International Physical Activity Questionnaire. The study also included accelerometer measurements conducted for 72 consecutive hours. The participants were recommended to perform regular aerobic physical activity, chosen individually during meetings with the study scientist, in accordance with the guidelines of the American Heart Association. Moreover, the patients were motivated to perform physical activity with short text messages and phone calls. Results: A significant change in the resistant hypertensives was observed after 6 months, regarding the number of steps taken (17,361 ± 6,815 vs. 23,067 ± 7,741; p < 0.005, metabolic equivalent of task (1.325 ± 0.3 vs. 1.464 ± 0.3; p = 0.001, duration of rest (1,595 ± 265 vs. 1,458 ± 292 min; p < 0.05 and sleep (1,278 ± 228 vs. 1,147 ± 270 min; p = 0.02, as assessed based on 3-day accelerometer measurements. An increase in activity was also observed based on the International Physical Activity Questionnaire and positive changes in body composition were determined. Conclusions: In the case of patients with resistant hypertension, intensification of physical activity is a well-tolerated, implementable and

Pulmonary hypertension associated with non-cirrhotic portal hypertension in systemic lupus erythematosus.

OpenAIRE

Woolf, D.; Voigt, M. D.; Jaskiewicz, K.; Kalla, A. A.

1994-01-01

A case of non-cirrhotic portal hypertension in a patient with systemic lupus erythematosus, the first of our knowledge, is described. Severe pulmonary hypertension was associated with the portal hypertension and with markers of active auto-immunity. Pulmonary hypertension has not previously been associated with non-cirrhotic portal hypertension. The coexistence of vasculopathy of the portal and pulmonary vascular beds in this patient with active autoimmunity supports the postulate that portal...

Idiopathic portal hypertension

International Nuclear Information System (INIS)

Han, Tae Kyun; Ryu, Dae Sik; Kim, Heung Chul; Hur, Hun; Eom, Kyeung Tae; Namkung, Sook; Park, Man Soo; Hwang, Woo Chul; Lee, Kwan Seop

1996-01-01

To describe the radiologic findings of idiopathic portal hypertension and to find the points of differentiation between idiopathic portal hypertension and liver cirrhosis. Four portograms in five patients who for four years had suffered from pathologically confirmed idiopathic portal hypertension were retrospectively analyzed and compared with a portogram obtained from a control subject with liver cirrhosis. Portographic finding s of idiopathic portal hypertension were paucity of medium-sized portal branches, irregular and obtuse-angled division of peripheral branches, abrupt interruption and an avascular area beneath the liver margin. A portogram of idiopathic portal hypertension may be useful in differentiation this and liver cirrhosis

Physio-pathological effects of alcohol on the cardiovascular system: its role in hypertension and cardiovascular disease.

Science.gov (United States)

Kawano, Yuhei

2010-03-01

Alcohol has complex effects on the cardiovascular system. The purpose of this article is to review physio-pathological effects of alcohol on cardiovascular and related systems and to describe its role in hypertension and cardiovascular disease. The relationship between alcohol and hypertension is well known, and a reduction in the alcohol intake is widely recommended in the management of hypertension. Moreover, alcohol has both pressor and depressor actions. The latter actions are clear in Oriental subjects, especially in those who show alcohol flush because of the genetic variation in aldehyde dehydrogenase activity. Repeated alcohol intake in the evening causes an elevation in daytime and a reduction in nighttime blood pressure (BP), with little change in the average 24-h BP in Japanese men. Thus, the hypertensive effect of alcohol seems to be overestimated by the measurement of casual BP during the day. Heavy alcohol intake seems to increase the risk of several cardiovascular diseases, such as hemorrhagic stroke, arrhythmia and heart failure. On the other hand, alcohol may act to prevent atherosclerosis and to decrease the risk of ischemic heart disease, mainly by increasing HDL cholesterol and inhibiting thrombus formation. A J- or U-shaped relationship has been observed between the level of alcohol intake and risk of cardiovascular mortality and total mortality. It is reasonable to reduce the alcohol intake to less than 30 ml per day for men and 15 ml per day for women in the management of hypertension. As a small amount of alcohol seems to be beneficial, abstinence from alcohol is not recommended to prevent cardiovascular disease.

Malignant hypertension and hypertensive encephalopathy in primary aldosteronism caused by adrenal adenoma

Directory of Open Access Journals (Sweden)

Bortolotto Luiz Aparecido

2003-01-01

Full Text Available Two cases are reported as follows: 1 1 female patient with accelerated-malignant hypertension secondary to an aldosterone-producing adrenal adenoma; and 2 1 female patient with adrenal adenoma, severe hypertension, and hypertensive encephalopathy. This association is a rare clinical finding, and malignant hypertension may modify the hormonal characteristic of primary aldosteronism, making its diagnosis more difficult. The diagnosis of primary aldosteronism should be considered in patients with malignant hypertension or hypertensive encephalopathy if persistent hypokalemia occurs. Identification of primary aldosteronism is of paramount importance for the patient's evolution, because the surgical treatment makes the prognosis more favorable.

Multimodality Imaging in Patients with Secondary Hypertension: With a Focus on Appropriate Imaging Approaches Depending on the Etiologies.

Science.gov (United States)

Ahn, Hyungwoo; Chun, Eun Ju; Lee, Hak Jong; Hwang, Sung Il; Choi, Dong-Ju; Chae, In-Ho; Lee, Kyung Won

2018-01-01

Although the causes of hypertension are usually unknown, about 10% of the cases occur secondary to specific etiologies, which are often treatable. Common categories of secondary hypertension include renal parenchymal disease, renovascular stenosis, vascular and endocrinologic disorders. For diseases involving the renal parenchyma and adrenal glands, ultrasonography (US), computed tomography (CT) or magnetic resonance (MR) imaging is recommended. For renovascular stenosis and vascular disorders, Doppler US, conventional or noninvasive (CT or MR) angiography is an appropriate modality. Nuclear imaging can be useful in the differential diagnosis of endocrine causes. Radiologists should understand the role of each imaging modality and its typical findings in various causes of secondary hypertension. This article focuses on appropriate imaging approaches in accordance with the categorized etiologies leading to hypertension.

Masked Hypertension and Incident Clinic Hypertension among African Americans in the Jackson Heart Study

Science.gov (United States)

Abdalla, Marwah; Booth, John N.; Seals, Samantha R.; Spruill, Tanya M.; Viera, Anthony J.; Diaz, Keith M.; Sims, Mario; Muntner, Paul; Shimbo, Daichi

2016-01-01

Masked hypertension, defined as non-elevated clinic blood pressure and elevated out-of-clinic blood pressure may be an intermediary stage in the progression from normotension to hypertension. We examined the associations of out-of-clinic blood pressure and masked hypertension using ambulatory blood pressure monitoring with incident clinic hypertension in the Jackson Heart Study, a prospective cohort of African Americans. Analyses included 317 participants with clinic blood pressure hypertension was defined as mean daytime blood pressure ≥135/85mmHg; masked nighttime hypertension as mean nighttime blood pressure ≥120/70mmHg; and masked 24-hour hypertension as mean 24-hour blood pressure ≥130/80mmHg. Incident clinic hypertension, assessed at study visits in 2005–2008 and 2009–2012, was defined as the first visit with clinic systolic/diastolic blood pressure ≥140/90mmHg or antihypertensive medication use. During a median follow-up of 8.1 years, there were 187 (59.0%) incident cases of clinic hypertension. Clinic hypertension developed in 79.2% and 42.2% of participants with and without any masked hypertension, 85.7% and 50.4% with and without masked daytime hypertension, 79.9% and 43.7% with and without masked nighttime hypertension and 85.7% and 48.2% with and without masked 24-hour hypertension, respectively. Multivariable-adjusted hazard ratios (95% CI) of incident clinic hypertension for any masked hypertension and masked daytime, nighttime, and 24-hour hypertension were 2.13 (1.51–3.02), 1.79 (1.24–2.60), 2.22 (1.58–3.12), and 1.91 (1.32–2.75), respectively. These findings suggest that ambulatory blood pressure monitoring can identify African Americans at increased risk for developing clinic hypertension. PMID:27185746

[Hypertension in women].

Science.gov (United States)

Tagle, Rodrigo; Tagle V, Rodrigo; Acevedo, Mónica; Valdés, Gloria

2013-02-01

The present review examines the types of hypertension that women may suffer throughout life, their physiopathological characteristics and management. In early life, the currently used low-dose oral contraceptives seldom cause hypertension. Pregnancy provokes preeclampsia, its main medical complication, secondary to inadequate transformation of the spiral arteries and the subsequent multisystem endothelial damage caused by deportation of placental factors and microparticles. Hypertension in preeclampsia is an epiphenomenon which needs to be controlled at levels that reduce maternal risk without impairing placental perfusion. The hemodynamic changes of pregnancy may unmask a hypertensive phenotype, may exacerbate a chronic hypertension, or may complicate hypertension secondary to lupus, renovascular lesions, and pheochromocytoma. On the other hand a primary aldosteronism may benefit from the effect of progesterone and present as a postpartum hypertension. A hypertensive pregnancy, especially preeclampsia, represents a risk for cardiac, vascular and renal disease in later life. Menopause may mimic a pheochromocytoma, and is associated to endothelial dysfunction and salt-sensitivity. Among women, non-pharmacological treatment should be forcefully advocated, except for sodium restriction during pregnancy. The blockade of the renin-angiotensin system should be avoided in women at risk of pregnancy; betablockers could be used with precautions during pregnancy; diuretics, ACE inhibitors and angiotensin receptor antagonists should not be used during breast feeding. Collateral effects of antihypertensives, such as hyponatremia, cough and edema are more common in women. Thus, hypertension in women should be managed according to the different life stages.

Hormones and Hypertension

Science.gov (United States)

... role in the start and continuation of primary hypertension. Secondary hypertension is due to other diseases such as kidney ... the body can greatly improve or even cure secondary hypertension. Resources • Find-an-Endocrinologist: www.hormone.org or ...

Chronic Management of Hypertension after Stroke: The Role of Ambulatory Blood Pressure Monitoring

Science.gov (United States)

Castilla-Guerra, Luis; Fernandez-Moreno, Maria del Carmen

2016-01-01

Hypertension is the most important potentially reversible risk factor for stroke in all age groups; high blood pressure (BP) is also associated with increased risk of recurrent stroke in patients who have already had an ischemic or hemorrhagic event. Twenty-four hour ambulatory BP monitoring (ABPM) has become an important tool for improving the diagnosis and management of hypertension, and is increasingly used to assess patients with hypertension. Nevertheless, although ABPM devices are increasingly used for assessment of hypertension, their value in the chronic management of hypertension in patients with stroke has not been systematically studied. In fact, among large-scale randomized trials for secondary stroke prevention, only the Morbidity and Mortality After Stroke, Eprosartan Compared With Nitrendipine for Secondary Prevention trial included 24-hour ABPM. ABPM has demonstrated chronic disruption of the circadian rhythm of BP after acute phase of stroke and has shown higher sensitivity compared to office BP in evaluating the effectiveness of antihypertensive treatment among stroke survivors. High 24-hour BP is an independent predictor for cerebrovascular events, brain microbleeds, and subsequent development of dementia. Nevertheless, although stroke care guidelines endorse the importance of hypertension management, the specific role of ABPM among stroke survivors after the acute phase of disease has not been established. Further studies are needed to clarify whether routine application of ABPM among these patients should be recommended. PMID:26687120

Clinical Observation on Hypertension in Diabetes Mellitus(Hypertension : Pathophysiology and Treatment)

OpenAIRE

奈良, 芳則; 尾崎, 信紘; 山田, 彬; 浜, 斉; 谷, 長行; Nara, Yoshinori; Ozaki, Nobuhiro; Yamada, Akira; Hama, Hitoshi; Tani, Nagayuki

1989-01-01

The incidence of hypertension is approximately twice as common in patients with diabetes mellitus as it is in those without. Both hypertension and diabetes mellitus are major risk factors for arteriosclerotic diseases (cerebral infarction, cardiovascular disease etw). A positive correlation exists between the presence of hypertension and retinopathy or nephropathy in patients with diabetes mellitus. This article provides practical approach in the management of hypertension with diabetes melli...

Sexual function in hypertensive patients receiving treatment

Directory of Open Access Journals (Sweden)

Thorsten Reffelmann

2006-12-01

Full Text Available Thorsten Reffelmann, Robert A KlonerUniversity of Southern California, The Heart Institute, Good Samaritan Hospital, Division of Cardiovascular Medicine, Keck School of Medicine, Los Angeles, CA, USAAbstract: In many forms of erectile dysfunction (ED, cardiovascular risk factors, in particular arterial hypertension, seem to be extremely common. While causes for ED are related to a broad spectrum of diseases, a generalized vascular process seems to be the underlying mechanism in many patients, which in a large portion of clinical cases involves endothelial dysfunction, ie, inadequate vasodilation in response to endothelium-dependent stimuli, both in the systemic vasculature and the penile arteries. Due to this close association of cardiovascular disease and ED, patients with ED should be evaluated as to whether they may suffer from cardiovascular risk factors including hypertension, cardiovascular disease or silent myocardial ischemia. On the other hand, cardiovascular patients, seeking treatment of ED, must be evaluated in order to decide whether treatment of ED or sexual activity can be recommended without significantly increased cardiac risk. The guideline from the first and second Princeton Consensus Conference may be applied in this context. While consequent treatment of cardiovascular risk factors should be accomplished in these patients, many antihypertensive drugs may worsen sexual function as a drug specific side-effect. Importantly, effective treatment for arterial hypertension should not be discontinued as hypertension itself may contribute to altered sexual functioning; to the contrary, alternative antihypertensive regimes should be administered with individually tailored drug regimes with minimal side-effects on sexual function. When phosphodiesterase-5 inhibitors, such as sildenafil, tadalafil and vardenafil, are prescribed to hypertensive patients on antihypertensive drugs, these combinations of antihypertensive drugs and

Arteriomesentericography in patients with extrahepatic forms of portal hypertension

International Nuclear Information System (INIS)

Semenov, V.S.; Gotman, L.N.

1980-01-01

The reverse contrast examination of the system, carried out by means of superior arteriomesentericography, is the optimal method for diagnosing pathological changes in the portal channel of splenectomized patients with the syndrome of the extrahepatic form of portal hypertension. The selective catheterization of the superior mesenteric artery was made in 36 patients with the prerenal block of the portal system. In all cases the venous phase of portography was obtained, which served as a basis for selecting the amount of surgical intervention in these patients. Depending on the level of the block of the portal channel, the patients fell into 3 groups. The characteristic X-ray appearance of portal hypertension, manifested mainly by the presence of portoportal and portocaval collaterals, is described for each group. The thrombosis of the main vessels of the loose type of their structure excludes the possibility of portocaval anastomosis, while in the presence of the pronounced surgical trunk of the superior mesenteric vein vascular shunting may be recommended. Portal hypertension, in contrast to the normal state, requires prolonged contrast examination of the venous phase due to a slower portorenal blood flow

Preventing cardiovascular disease after hypertensive disorders of pregnancy : Searching for the how and when

NARCIS (Netherlands)

Groenhof, T. Katrien J.; van Rijn, Bas B.; Franx, Arie; Roeters Van Lennep, Jeanine E.; Bots, Michiel L.; Lely, A. Titia

2017-01-01

Background: Women with a history of a hypertensive disorder during pregnancy (HDP) have an increased risk of cardiovascular events. Guidelines recommend assessment of cardiovascular risk factors in these women later in life, but provide limited advice on how this follow-up should be organized.

Preventing cardiovascular disease after hypertensive disorders of pregnancy: Searching for the how and when

NARCIS (Netherlands)

Groenhof, T.K.J. (T Katrien J); B.B. van Rijn (Bas); A. Franx (Arie); J.E. Roeters van Lennep (Jeanine); M.L. Bots (Michiel); A.T. Lely (Titia)

2017-01-01

textabstractBackground: Women with a history of a hypertensive disorder during pregnancy (HDP) have an increased risk of cardiovascular events. Guidelines recommend assessment of cardiovascular risk factors in these women later in life, but provide limited advice on how this follow-up should be

Genetik og hypertension

DEFF Research Database (Denmark)

Ellervik, Christina; Tarnow, Lisa; Pedersen, Erling Bjerregaard

2009-01-01

Monogenic forms of hypertension are very rare, but have a well-characterized heredity. Primary hypertension is very common with a complex and polygenic heredity. Primary hypertension arises due to an interaction between multiple genetic and environmental factors. Its heredity is unknown, although...

Noncirrhotic portal hypertension.

Science.gov (United States)

Da, Ben L; Koh, Christopher; Heller, Theo

2018-05-01

Noncirrhotic portal hypertension represents a heterogeneous group of liver disorders that is characterized by portal hypertension in the absence of cirrhosis. The purpose of this review is to serve as a guide on how to approach a patient with noncirrhotic portal hypertension with a focus on recent developments. Recent studies pertaining to noncirrhotic portal hypertension have investigated aetiological causes, mechanisms of disease, noninvasive diagnostic modalities, clinical characteristics in the paediatric population and novel treatment targets. Noncirrhotic portal hypertension is an underappreciated clinical entity that can be difficult to diagnosis without a healthy suspicion. Diagnosis then relies on a comprehensive understanding of the causes and clinical manifestations of this disease, as well as a careful interpretation of the liver biopsy. Noninvasive approaches to diagnosis may play a significant role moving forward in this disease. Treatment in NCPH remains largely targeted at the individual sequalae of portal hypertension.

Association between blood cholesterol and sodium intake in hypertensive women with excess weight.

Science.gov (United States)

Padilha, Bruna Merten; Ferreira, Raphaela Costa; Bueno, Nassib Bezerra; Tassitano, Rafael Miranda; Holanda, Lidiana de Souza; Vasconcelos, Sandra Mary Lima; Cabral, Poliana Coelho

2018-04-01

Restricted sodium intake has been recommended for more than 1 century for the treatment of hypertension. However, restriction seems to increase blood cholesterol. In women with excess weight, blood cholesterol may increase even more because of insulin resistance and the high lipolytic activity of adipose tissue.The aim of this study was to assess the association between blood cholesterol and sodium intake in hypertensive women with and without excess weight.This was a cross-sectional study with hypertensive and nondiabetic women aged 20 to 59 years, recruited at the primary healthcare units of Maceio, Alagoas, Brazilian Northeast. Excess weight was defined as body mass index (BMI) ≥25.0 kg/m. Sodium intake was estimated by the 24-hour urinary excretion of sodium. Blood cholesterol was the primary outcome investigated by this study, and its relationship with sodium intake and other variables was assessed by Pearson correlation and multivariate linear regression using a significance level of 5%.This study included 165 hypertensive women. Of these, 135 (81.8%) were with excess weight. The mean sodium intake was 3.7 g (±1.9) and 3.4 g (±2.4) in hypertensive women with and without excess weight, respectively. The multiple normal linear regression models fitted to the "blood cholesterol" in the 2 groups reveal that for the group of hypertensive women without excess weight only 1 independent variable "age" is statistically significant to explain the variability of the blood cholesterol levels. However, for the group of hypertensive women with excess weight, 2 independent variables, age and sodium intake, can statistically explain variations of the blood cholesterol levels.Blood cholesterol is statistically inversely related to sodium intake for hypertensive women with excess weight, but it is not statistically related to sodium intake for hypertensive women without excess weight.

Primary hypertension and special aspects of hypertension in older children and adolescents

Directory of Open Access Journals (Sweden)

Ellis D

2011-07-01

Full Text Available Demetrius Ellis, Yosuke MiyashitaChildren’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, PA, USAAbstract: The prevalence of hypertension has increased at an accelerated rate in older children and adolescents. This has raised great concern about premature development of cardiovascular disease, which has major long-term health and financial implications. While obesity and sedentary habits largely explain this phenomenon, there are other social and cultural influences that may unmask genetic susceptibility to hypertension in the pediatric population. While it is essential to exclude numerous causes of secondary hypertension in every child, these disorders are not discussed in this review. Rather, the aim of this review is to familiarize pediatricians with casual and ambulatory blood pressure measurement, epidemiology, pathophysiology, and management of several common conditions that play a role in the development of hypertension in children and adolescents. Besides primary hypertension and obesity-related hypertension, emphasis is given to epidemiology, measurement of blood pressure, including ambulatory blood pressure monitoring, hypertension associated with drug use, teenage pregnancy, and video and computer games. Lastly, because pediatricians are increasingly confronted with special issues concerning the management of the hypertensive athlete, this topic is also addressed.Keywords: hypertension, adolescents, obesity, drugs, pregnancy, athletes

[Knowledge level of hypertensive patients about hypertension. Relationship between knowledge level and hypertension control].

Science.gov (United States)

Benítez Camps, M; Egocheaga Cabello, M Isabel; Dalfó Baqué, A; Bajo García, J; Vara González, L; Sanchis Doménech, C; Martín Rioboo, E; Ureña Fernández, T; Domínguez Sardiña, M; Bonet Pla, A

2015-01-01

To assess the knowledge of the hypertensive patients about their hypertension and their relation to its control. Cross-sectional study among 400 hypertensive patients, all over 18 years, selected from 50 primary-care centres, who responded to an hypertension-related survey. Included variables were survey items, age, gender, educational level, professional occupation, blood pressure data and antihypertensive treatment. The obtained differences were analyzed using the chi-square test, Kruskal-Wallis, Wilcoxon, Anova and Bonferroni methods. There were 323 valid surveys. 52.9% of respondents were women, the average age: 65.4 years (SD: 11.2), 54.8% of them had primary education. 39.6% were aware of the objectives of systolic BP control. Only 19.6% having knowledge of those for diastolic BP control, with no differences between controlled and uncontrolled (systolic BP: 39% vs 38.1%, P=.887; diastolic BP: 19.2% vs 21%, P=.721). Over 70% knew about lifestyle changes, without significant differences between controlled and uncontrolled respondents. 82% of controlled respondents, and 79% of those uncontrolled, recognized the chronical nature of the treatment (P=.548), but 15.1% of the controlled respondents and 12.4% of uncontrolled respondents did not see the relation between the treatment and hypertension control (P=.525). 31.1% believed to be well-controlled, but in fact was not. Our patients doesn't know blood pressure targets of control. There isn't relationship between this knowledge and control of hypertension. Copyright © 2014 SEHLELHA. Published by Elsevier Espana. All rights reserved.

[Eating habits in the prevention of cardiovascular diseases and associated factors in elderly hypertensive individuals].

Science.gov (United States)

Gadenz, Sabrina Dalbosco; Benvegnú, Luís Antônio

2013-12-01

Cardiovascular diseases are the leading cause of death and disability in the elderly. In this study, healthy eating habits and associated factors in the prevention of cardiovascular disease in elderly hypertensive individuals were identified. It involved a cross-sectional study gathering primary data in a family health unit in a city in the interior of the state of Rio Grande do Sul and 212 elderly hypertensive individuals participated in the study. A higher prevalence among the lower age bracket of elderly individuals, female, with little schooling and low income was revealed. Healthy eating habits among the elderly hypertensive individuals assessed are below those recommended in the prevention of cardiovascular disease. Social and economic factors, health characteristics and the use of health services influenced the adoption of healthy eating habits. The results of this study suggest that elderly hypertensive individuals find it difficult to adopt healthy eating habits. This contributes further to the definition of strategies for routine prevention and control of cardiovascular diseases in the elderly.

Hypertension Control and co-morbidities in primary health care centers in Riyadh

Energy Technology Data Exchange (ETDEWEB)

Al-Tuwijri, Abdulmohsin A [Dept. of Family Medicine, Ministry of Health, Riyadh (Saudi Arabia); Al-Rukban, Mohammed Othman [Dept. of Family and Community Medicine, Coll. of Medicine, King Saud Univ., Riyadh (Saudi Arabia)

2006-07-01

The prevalence of hypertension in Saudi Arabia has been assessed only in preliminary reports. The aim of this study was to determine the degree of control of blood pressure and the prevalence of common hypertension co-morbidities among hypertensive patients attending primary health care (PHC) centers in Riyadh. A cross sectional study was conducted by reviewing medical records of hypertensive patients during May and June 2001. Two hundred fifty-five medical records selected by a stratified randomization process according to the distribution of the 73 PHC centers in the city and the total number of hypertensive patients registered in the mini-clinic of each PHC-center. Trained mini-clinic nurses collected data using a data collection form developed for this purpose. Of 255 patients, 121 (47.5%) were males and 134 (52.5%) were females, the mean age was 57.2+-11.1 years and 8.3% were smokers. The majority 204 (85.7%) had greater than normal body weight. Only 101 (40.4%) had controlled systolic BP. The most common co-morbidity was diabetes mellitus found in 98 (38.4%), followed by dislipidemia in 50 (19.6%), bronchial asthma in 28 (11.0%) and renal diseases in 12 (4.7%). Except for osteoporosis, which was reported by females only (P=0.003), the occurrences of hypertensive co-morbidities did not vary from other demographic characteristics. This study demonstrated poor blood pressure control in the mini-clinics in the PHC-centers. To improve the quality of care for hypertensive patients, we recommend an improvement in PHC physician knowledge of and attitudes toward the importance of achieving targeted blood pressure levels. (author)

Hypertension Control and co-morbidities in primary health care centers in Riyadh

International Nuclear Information System (INIS)

Al-Tuwijri, Abdulmohsin A.; Al-Rukban, Mohammed Othman

2006-01-01

The prevalence of hypertension in Saudi Arabia has been assessed only in preliminary reports. The aim of this study was to determine the degree of control of blood pressure and the prevalence of common hypertension co-morbidities among hypertensive patients attending primary health care (PHC) centers in Riyadh. A cross sectional study was conducted by reviewing medical records of hypertensive patients during May and June 2001. Two hundred fifty-five medical records selected by a stratified randomization process according to the distribution of the 73 PHC centers in the city and the total number of hypertensive patients registered in the mini-clinic of each PHC-center. Trained mini-clinic nurses collected data using a data collection form developed for this purpose. Of 255 patients, 121 (47.5%) were males and 134 (52.5%) were females, the mean age was 57.2+-11.1 years and 8.3% were smokers. The majority 204 (85.7%) had greater than normal body weight. Only 101 (40.4%) had controlled systolic BP. The most common co-morbidity was diabetes mellitus found in 98 (38.4%), followed by dislipidemia in 50 (19.6%), bronchial asthma in 28 (11.0%) and renal diseases in 12 (4.7%). Except for osteoporosis, which was reported by females only (P=0.003), the occurrences of hypertensive co-morbidities did not vary from other demographic characteristics. This study demonstrated poor blood pressure control in the mini-clinics in the PHC-centers. To improve the quality of care for hypertensive patients, we recommend an improvement in PHC physician knowledge of and attitudes toward the importance of achieving targeted blood pressure levels. (author)

Management of arterial hypertension in Cotonou city, Benin: general practitioners' knowledge, attitudes and practice.

Science.gov (United States)

Houenassi, Martin Dèdonougbo; Codjo, Léopold Houétondji; Dokoui, David; Dohou, Serge Hugues Mahougnon; Wanvoegbe, Armand; Agbodande, Anthelme; Attinsounon, Angelo Cossi; Alassani, Adebayo; Ahoui, Séraphin; Dovonou, Albert Comlan; Adoukonou, Thierry Armel

2016-08-23

We aimed to assess the management of hypertensive patients by general practitioners in Cotonou city. This was a cross-sectional study based on a multicentre survey conducted from 1 May to 31 July 2011. We recruited all consenting general practitioners who worked in public and private centres in Cotonou city. We used the 7th report of the Joint National Committee to assess the management of hypertension by general practitioners. A tested and validated self-questionnaire was used to collect the data on hypertension management by general practitioners. In eight centres that approved the study, 41 general practitioners were included. The definition of hypertension was known by 20 (48.8%) practitioners. Only 25 (61.0%) could describe the conditions for blood pressure measurement. Ten of them were unable to list half of the minimum recommended tests for hypertension, and the majority (92.7%) did not have any idea of global cardiovascular risk. The blood pressure goal was known by only 18 (43.9%) practitioners. Lifestyle (82.9%) and monotherapy (70.7%) were the therapeutic modalities most prescribed. Antihypertensive agents commonly used by practitioners were calcium channel blockers (82.9%), angiotensin converting enzyme inhibitors (53.7%) and diuretics (36.6%). The general practitioners referred their patients to cardiologists mainly for uncontrolled hypertension (63.4%) and the onset of acute complications (56.1%). The general practitioners' knowledge of hypertension was insufficient and their management did not reflect international guidelines.

European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring.

Science.gov (United States)

Parati, Gianfranco; Stergiou, George; O'Brien, Eoin; Asmar, Roland; Beilin, Lawrence; Bilo, Grzegorz; Clement, Denis; de la Sierra, Alejandro; de Leeuw, Peter; Dolan, Eamon; Fagard, Robert; Graves, John; Head, Geoffrey A; Imai, Yutaka; Kario, Kazuomi; Lurbe, Empar; Mallion, Jean-Michel; Mancia, Giuseppe; Mengden, Thomas; Myers, Martin; Ogedegbe, Gbenga; Ohkubo, Takayoshi; Omboni, Stefano; Palatini, Paolo; Redon, Josep; Ruilope, Luis M; Shennan, Andrew; Staessen, Jan A; vanMontfrans, Gert; Verdecchia, Paolo; Waeber, Bernard; Wang, Jiguang; Zanchetti, Alberto; Zhang, Yuqing

2014-07-01

Given the increasing use of ambulatory blood pressure monitoring (ABPM) in both clinical practice and hypertension research, a group of scientists, participating in the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability, in year 2013 published a comprehensive position paper dealing with all aspects of the technique, based on the available scientific evidence for ABPM. The present work represents an updated schematic summary of the most important aspects related to the use of ABPM in daily practice, and is aimed at providing recommendations for proper use of this technique in a clinical setting by both specialists and practicing physicians. The present article details the requirements and the methodological issues to be addressed for using ABPM in clinical practice, The clinical indications for ABPM suggested by the available studies, among which white-coat phenomena, masked hypertension, and nocturnal hypertension, are outlined in detail, and the place of home measurement of blood pressure in relation to ABPM is discussed. The role of ABPM in pharmacological, epidemiological, and clinical research is also briefly mentioned. Finally, the implementation of ABPM in practice is considered in relation to the situation of different countries with regard to the reimbursement and the availability of ABPM in primary care practices, hospital clinics, and pharmacies.

Focus on prevention, diagnosis and treatment of hypertension in children and adolescents

Science.gov (United States)

2013-01-01

The European Society of Hypertension has recently published its recommendations on prevention, diagnosis and treatment of high blood pressure in children and adolescents. Taking this contribution as a starting point the Study Group of Hypertension of the Italian Society of Pediatrics together with the Italian Society of Hypertension has conducted a reappraisal of the most recent literature on this subject. The present review does not claim to be an exhaustive description of hypertension in the pediatric population but intends to provide Pediatricians with practical and updated indications in order to guide them in this often unappreciated problem. This document pays particular attention to the primary hypertension which represents a growing problem in children and adolescents. Subjects at elevated risk of hypertension are those overweight, with low birth weight and presenting a family history of hypertension. However, also children who do not present these risk factors may have elevated blood pressure levels. In pediatric age diagnosis of hypertension or high normal blood pressure is made with repeated office blood pressure measurements that show values exceeding the reference values. Blood pressure should be monitored at least once a year with adequate methods and instrumentation and the observed values have to be interpreted according to the most updated nomograms that are adjusted for children’s gender, age and height. Currently other available methods such as ambulatory blood pressure monitoring and home blood pressure measurement are not yet adequately validated for use as diagnostic instruments. To diagnose primary hypertension it is necessary to exclude secondary forms. The probability of facing a secondary form of hypertension is inversely proportional to the child’s age and directly proportional to blood pressure levels. Medical history, clinical data and blood tests may guide the differential diagnosis of primary versus secondary forms. The prevention

Hypertensive Crisis

Science.gov (United States)

... Artery Disease Venous Thromboembolism Aortic Aneurysm More Hypertensive Crisis: When You Should Call 9-1-1 for ... Nov 13,2017 A hypertensive ( high blood pressure ) crisis is when blood pressure rises quickly and severely ...

CT guided interventional therapy for hypertensive cerebral hemorrhage

International Nuclear Information System (INIS)

Lin Bo; Duan Bing

2009-01-01

Objective: To discuss the curative effect of CT-guided puncture and drainage in treating hypertensive cerebral hemorrhage. Methods: Adjusting the suitable point and direction of puncture according to the form and size of the haematoma and patient's status, the haematoma was eliminated by minimally invasive puncture and drainage guided under CT layer image in 40 cases of hypertensive cerebral hemorrhage. Results: Modality rate of treatment group was 12.5% (5/40), and is much lower than control group, which was 45% (13/30) (P<0.01). When asscess the Activities of Daily Living (ADL) after 6 months follow-up, the ADL1-ADL3 scale in treatment group was 27 cases (70%), and was much higher than that in control group, which was 29.4% (5/17), (P < 0.05). Conclusion: Minimal invasive therapy of cerebral hemorrhage has great superiority in elimination most part of the hematoma such as simple, accurate location, low cost, safe and effective, and is worthy of recommendation clinically. (authors)

Significance of White-Coat Hypertension in Older Persons With Isolated Systolic Hypertension

Science.gov (United States)

Franklin, Stanley S.; Thijs, Lutgarde; Hansen, Tine W.; Li, Yan; Boggia, José; Kikuya, Masahiro; Björklund-Bodegård, Kristina; Ohkubo, Takayoshi; Jeppesen, Jørgen; Torp-Pedersen, Christian; Dolan, Eamon; Kuznetsova, Tatiana; Stolarz-Skrzypek, Katarzyna; Tikhonoff, Valérie; Malyutina, Sofia; Casiglia, Edoardo; Nikitin, Yuri; Lind, Lars; Sandoya, Edgardo; Kawecka-Jaszcz, Kalina; Imai, Yutaka; Wang, Jiguang; Ibsen, Hans; O’Brien, Eoin; Staessen, Jan A.

2013-01-01

The significance of white-coat hypertension in older persons with isolated systolic hypertension remains poorly understood. We analyzed subjects from the population-based 11-country International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes database who had daytime ambulatory blood pressure (BP; ABP) and conventional BP (CBP) measurements. After excluding persons with diastolic hypertension by CBP (≥90 mm Hg) or by daytime ABP (≥85 mm Hg), a history of cardiovascular disease, and persons hypertension. During a median follow-up of 10.6 years, there was a total of 655 fatal and nonfatal cardiovascular events. The analyses were stratified by treatment status. In untreated subjects, those with white-coat hypertension (CBP ≥140/hypertension, the cardiovascular risk was similar in elevated conventional and normal daytime systolic BP as compared with those with normal conventional and normal daytime BPs (adjusted hazard rate: 1.10 [95% CI: 0.79–1.53]; P=0.57). However, both treated isolated systolic hypertension subjects with white-coat hypertension (adjusted hazard rate: 2.00; [95% CI: 1.43–2.79]; Phypertension who have their ABP normalized on antihypertensive therapy but with residual white-coat effect by CBP measurement have an entity that we have termed, “treated normalized hypertension.” Therefore, one should be cautious in applying the term “white-coat hypertension” to persons receiving antihypertensive treatment. PMID:22252396

Pre-Hypertension and Hypertension in Adolescence: How much ...

African Journals Online (AJOL)

Background: Hypertension is an important worldwide public-health challenge because of its high frequency and concomitant risks of cardiovascular and kidney disease. Previous studies have documented that hypertension may begin in adolescence, perhaps even in childhood. Objectives: This study set out to determine ...

Pulmonary hypertension in patients with hepatic cirrhosis and portal hypertension. An echographic study.

Science.gov (United States)

Gurghean, Adriana V; Tudor, Ioana A

2017-01-01

The aim of the study is to determine the frequency of pulmonary hypertension in patients with hepatic cirrhosis and portal hypertension, to determine the possibility of an accurate ultrasound diagnosis of the characteristics of this complication. 347 patients with liver cirrhosis consecutively hospitalized at Coltea Clinical Hospital were screened. 61 were excluded because of other possible causes of portal or pulmonary hypertension. All patients were investigated clinically and by abdominal and cardiac ultrasonography. Of the remaining 286 patients, 116 had portal hypertension, 27 of them (23%) having pulmonary hypertension. In this group we found a higher cardiac index and right atrial volume, higher pressures in the right atrium, suggesting a hyperdynamic state. Porto-pulmonary hypertension was found in only one patient. Echocardiography permits characterization of patients with cirrhosis and portal hypertension.

How to manage hypertension with atherosclerotic renal artery stenosis?

Science.gov (United States)

Ricco, Jean-Baptiste; Belmonte, Romain; Illuminati, Guilio; Barral, Xavier; Schneider, Fabrice; Chavent, Bertrand

2017-04-01

The management of atherosclerotic renal artery stenosis (ARAS) in patients with hypertension has been the topic of great controversy. Major contemporary clinical trials such as the Cardiovascular Outcomes for Renal Artery lesions (CORAL) and Angioplasty and Stenting for Renal Atherosclerotic lesions (ASTRAL) have failed to show significant benefit of revascularization over medical management in controlling blood pressure and preserving renal function. We present here the implications and limitations of these trials and formulate recommendations for management of ARAS.

Isolation of a novel molecule belonging to the group urobilinoids

Czech Academy of Sciences Publication Activity Database

Vítek, L.; Jirásková, A.; Malina, J.; Ubik, Karel

2002-01-01

Roč. 17, - (2002), s. A30 ISSN 0815-9319. [Asian Pacific Association for the Study of the Liver (APASL) Meeting. 26.09.2002-29.09.2002, Taipei] Institutional research plan: CEZ:AV0Z4055905 Keywords : urobilinoids Subject RIV: CE - Biochemistry

Current Situation of Medication Adherence in Hypertension.

Science.gov (United States)

Vrijens, Bernard; Antoniou, Sotiris; Burnier, Michel; de la Sierra, Alejandro; Volpe, Massimo

2017-01-01

Despite increased awareness, poor adherence to treatments for chronic diseases remains a global problem. Adherence issues are common in patients taking antihypertensive therapy and associated with increased risks of coronary and cerebrovascular events. Whilst there has been a gradual trend toward improved control of hypertension, the number of patients with blood pressure values above goal has remained constant. This has both personal and economic consequences. Medication adherence is a multifaceted issue and consists of three components: initiation, implementation, and persistence. A combination of methods is recommended to measure adherence, with electronic monitoring and drug measurement being the most accurate. Pill burden, resulting from free combinations of blood pressure lowering treatments, makes the daily routine of medication taking complex, which can be a barrier to optimal adherence. Single-pill fixed-dose combinations simplify the habit of medication taking and improve medication adherence. Re-packing of medication is also being utilized as a method of improving adherence. This paper presents the outcomes of discussions by a European group of experts on the current situation of medication adherence in hypertension.

Garlic for hypertension: A systematic review and meta-analysis of randomized controlled trials.

Science.gov (United States)

Xiong, X J; Wang, P Q; Li, S J; Li, X K; Zhang, Y Q; Wang, J

2015-03-15

In the past decade, garlic has become one of the most popular complementary therapies for blood pressure (BP) control used by hypertensive patients. Numerous clinical studies have focused on the BP-lowering effect of garlic, but results have been inconsistent. Overall, there is a dearth of information available to guide the clinical community on the efficacy of garlic in hypertensive patients. To systematically review the medical literature to investigate the current evidence of garlic for the treatment of hypertension. PubMed, the Cochrane Library and EMBASE were searched for appropriate articles from their respective inceptions until August 2014. Randomized, placebo-controlled trials comparing garlic vs. a placebo in patients with hypertension were considered. Papers were independently reviewed by two reviewers and were analyzed using Cochrane software Revman 5.2. A total of seven randomized, placebo-controlled trials were identified. Compared with the placebo, this meta-analysis revealed a significant lowering effect of garlic on both systolic BP (WMD: -6.71 mmHg; 95% CI: -12.44 to -0.99; P = 0.02) and diastolic BP (WMD: -4.79 mmHg; 95% CI: -6.60 to -2.99; P garlic is an effective and safe approach for hypertension. However, more rigorously designed randomized controlled trials focusing on primary endpoints with long-term follow-up are still warranted before garlic can be recommended to treat hypertensive patients. Copyright © 2015 Elsevier GmbH. All rights reserved.

Number of blood pressure measurements needed for screening of hypertension in children and adolescents

Directory of Open Access Journals (Sweden)

Madarina Julia

2009-08-01

Conclusions It is necessary to measure blood pressure repeatedly to minimize the risk of over-diagnosing in hypertension in children and adolescents. Using the average of three measurements in three visits is recommended, but drawing conclusions based on two measurements in two occasions have yielded sufficiently high specificity.

A Unique Opportunity for an Intercultural Discussion on CAM and Liver Disease

Directory of Open Access Journals (Sweden)

Francesco Marotta

2005-01-01

Full Text Available The meeting of the APASL, Asian Pacific Association for the Study of the Liver, was held in December 2004, in New Delhi, India. The meeting was held under the patronage of the APASL Committee and Board of Presidents of the National Liver Association and in conjunction with the annual conference of the Indian Association for the Study of Liver (INASL. The congress was designed to have a core meeting with three parallel sessions running throughout, dedicated research workshops and intensive breakfast sessions. This report concentrates on the two sessions devoted to complementary and alternative medicine (CAM and shows the latest research in CAM for liver disease and the concerns of doctors about integrating CAM with more traditional treatments. With researchers and practitioners gathering from all over the world, it was a unique opportunity for an intercultural discussion on CAM and liver disease.

[Hypertension in polycystic ovary syndrome].

Science.gov (United States)

Ben Salem Hachmi, L; Ben Salem Hachmi, S; Bouzid, C; Younsi, N; Smida, H; Bouguerra, R; Ben Slama, C

2006-01-01

Polycystic ovary syndrome (PCOS) is associated with multiple cardiovascular risk factors. The aims of this study are to investigate the prevalence of hypertension in a female population with PCOS and to correlate hypertension with her clinical and hormonal profile. it is a transversal study of 79 PCOS patients with mean age of 25 +/- 7 years (range 13-44). PCOS diagnosis is made by Rotterdam consensus criteria's (2003). WHO definition of hypertension is used (BP 140/90 mmHg). Blood pressure is measured three times in each patient. Ovarian echography and biochemical assays (GnRH test, androgens, cholesterol, triglycerides, and oral glucose tolerance test) are made before the 5th day of the menstrual cycle. 12% of PCOS women have hypertension. Family history of hypertension is not a predictive factor of hypertension in our study. PCOS patients with hypertension are not significantly older than those without hypertension (28.4 +/- 6.5 vs. 25.2 +/- 7; p = 0.12). If compared to PCOS women without hypertension, those with hypertension have a significantly higher BMI (39.2 +/- 7 vs. 29.6; p = 0.0004). PCOS patients with and without hypertension do not differ significantly in their level of androgens and total cholesterol. Triglycerides level is higher in PCOS patients with hypertension (p = 0.06). In oral glucose tolerance test, areas under the curve of insulin and glucose are significantly higher in PCOS patients with hypertension (respectively p = 0.06 and 0.02). The area under the curve of LH during GnRH test is lower in PCOS patients with hypertension (p = 0.04).

Hypertension care at primary health care centers: a report from Abha, Saudi Arabia.

Science.gov (United States)

Al-Homrany, Mohammed A; Khan, Mohd Yunus; Al-Khaldi, Yahia Mater; Al-Gelban, Khalid S; Al-Amri, Hasan Saed

2008-11-01

It is well known that effective management of hypertension reduces the incidence of myo-cardial infarction, stroke and vascular complications. The Ministry of Health, Kingdom of Saudi Arabia, introduced the Quality Assurance Guidelines with the hope to improve the management of hypertension in its centers. We conducted an audit of two Primary Health Care Centers namely, Al-Manhal (MPHCC) and Al-Numais (NPHCC), to evaluate how well hypertension was managened at these centers. A check list was derived from the Quality Assurance Manual to audit the process and to assess the health outcome. A retrospective study on a chosen sample of 120 files of hypertensive patients, out of 256 from both the Primary Health Care Centers was performed, during the last three months of the year 2000. Results showed that 61% of the patients were between 45-64 years of age, 56% were females, 85% were married, 54% were illiterate and 7.5% were smokers. A total of 92% of the patients had primary hypertension and 25% had a positive family history of hypertension. Beta-blockers were the most commonly used drugs in both the centers. Although the recording of the information was not perfect, there was no statistical difference in the socio-demongraphic data and also the means of the total score in both the centres. On the other hand, carrying out the important procedures for hypertensive patients was found to be better at MPHCC in comparison to NPHCC (p compliance to appointment in both the centers. Our study reveals that the process of hypertension care at the two Primary Health Care Centres in Aseer region was not in accordance with the recommended national standards. The reasons include lack of updating systems, recall system and provision of laboratory services and all these factors need to be addressed to improve care.

Intracerebroventricular metformin attenuates salt-induced hypertension in spontaneously hypertensive rats

DEFF Research Database (Denmark)

Petersen, J S; Andersen, D; Muntzel, M S

2001-01-01

The aim of this study was to examine the effects of long-term continuous intracerebroventricular (icv) infusion of metformin on blood pressure (BP) in spontaneously hypertensive rats (SHR). To accelerate the development of hypertension, SHR were fed a 8% NaCl diet during the 3-week study period...... to hexamethonium was attenuated by all doses of metformin suggesting that chronic icv metformin decreased central sympathetic outflow. The highest doses of metformin (100 and 200 microg/day) also prevented development of hypertension, but these doses were highly neurotoxic as demonstrated by histologic evaluation...... doses of metformin attenuates hypertension and decreases the hypotensive responses to ganglionic blockade in SHR, suggesting a centrally elicited sympathoinhibitory action....

Hypertension in women.

Science.gov (United States)

Pimenta, Eduardo

2012-02-01

Hypertension is an important modifiable risk factor for cardiovascular (CV) morbidity and mortality, and a highly prevalent condition in both men and women. However, the prevalence of hypertension is predicted to increase more among women than men. Combined oral contraceptives (COCs) can induce hypertension in a small group of women and, increase CV risk especially among those with hypertension. Both COC-related increased CV risk and blood pressure (BP) returns to pretreatment levels by 3 months of its discontinuation. The effects of menopause and hormone replacement therapy (HRT) on BP are controversial, and COCs and HRT containing the new generation progestin drospirenone are preferred in women with established hypertension. Despite the high incidence of cancer in women, CV disease remains the major cause of death in women and comparable benefit of antihypertensive treatment have been demonstrated in both women and men.

Hypertension and Spina Bifida

Science.gov (United States)

SBA National Resource Center: 800-621-3141 Hypertension A disease that often goes undetected. What is hypertension? Hypertension, also called high blood pressure , is a condition in which the arteries of ...

Revisiting essential hypertension--a "mechanism-based" approach may argue for a better definition of hypertension.

Science.gov (United States)

Calò, L A

2009-08-01

Several major overarching themes have recently emerged in our understanding of the pathophysiology of hypertension which may allow to revisit essential hypertension with an eye towards the possibility of adopting a more rational "mechanistic-based" definition of hypertension and moving away from the unsatisfactory "essential" label for hypertension from unknown cause. As our understanding of the biochemical and physiological mechanisms that control blood pressure rapidly evolves, the "essential" label of hypertension is losing both value as well as utility as it will describe an increasingly small number of hypertensive patients. This paper uses some recently identified pathways central to hypertension and uses this understanding of pathophysiology to argue for a better definition of hypertension.

Genetics of pulmonary hypertension in the clinic.

Science.gov (United States)

Girerd, Barbara; Lau, Edmund; Montani, David; Humbert, Marc

2017-09-01

Heritable pulmonary arterial hypertension (PAH) is an autosomal dominant disease with incomplete penetrance because of mutations in bone morphogenetic protein receptor-II (BMPR2), activin A receptor type II-like kinase 1, endoglin, caveolin-1, potassium channel subfamily K, member 3, and T-box gene 4 genes. Heritable pulmonary veno-occlusive disease and/or pulmonary capillary hemangiomatosis (PVOD/PCH) is an autosomal recessive disease because of biallelic mutations in the eukaryotic translation initiation factor 2 alpha kinase 4 gene. The 2015 european society of cardiology (ESC) and european respiratory society (ERS) pulmonary hypertension guidelines recommend genetic counselling and testing to adults and children with PAH or PVOD/PCH as well as in adult relatives at risk of carrying a predisposing mutation. In France, genetic counseling and testing are offered to all patients displaying sporadic or familial form of PAH or PVOD/PCH and to their relatives at high risk of carrying a predisposing mutation. Patients with a heritable form of PAH are younger at diagnosis with a worse hemodynamic and a dismal prognosis. Patients with a heritable form of PVOD/PCH are younger at diagnosis with a worse response to specific PAH therapies. A program to detect PAH in an early phase was offered to all asymptomatic BMPR2 mutation carriers, according to the 2015 ESC/ERS guidelines. Finally, preimplantation genetic diagnosis has been performed in families with a history of BMPR2 mutations. Genetic counseling and testing has to be implemented in pulmonary hypertension centers.

Chinese Mobile Health APPs for Hypertension Management: A Systematic Evaluation of Usefulness

Science.gov (United States)

Jia, Yuxi; Zhu, Wei

2018-01-01

Objective To analyze and compare the usefulness of hypertension management APPs released in the Chinese market; to understand the general situations, characteristics, problems, and trends in hypertension management mHealth APPs; and to identify the gaps between mainland China products and non-mainland China products with the aim to provide recommendations for developers in industry and assist hypertensive patients in selecting suitable APPs. Methods The hypertension management APPs available by October 2016 in China were analyzed from the perspective of data items and function usefulness. Sample sets were determined through PRISMA. An evaluation item set was developed based on the usability framework of TURF and the Chinese Guideline for the Management of Hypertension and used to quantitatively analyze the functionalities and data items collected from the sample APPs from the perspective of designers, users, and activity models. Results Among the 73 Chinese-supported APPs, none of the hypertension management APPs could fully cover the usefulness item set (mean = 37.4%). Regarding the use of mobile terminal hardware, only cameras and positioning sensors are commonly used in information collection. Regarding the data items and services provided, the most commonly collected data are “demographic information” (88% versus 100%) and “vital signs” (76% versus 100%), but APPs developed in mainland China and non-mainland China provided significantly different services and profit-making patterns. Regarding data security and privacy protection, the APPs from mainland China provided far lower usefulness (31% versus 56%). Conclusions mHealth APPs can promptly and efficiently acquire sign-related data by improving the professionality and scientificity of data about healthy living habits. APPs also improve the preventive usefulness of the collected data and bring about new opportunities for the management and control of hypertension. Other important research trends

Chinese Mobile Health APPs for Hypertension Management: A Systematic Evaluation of Usefulness

Directory of Open Access Journals (Sweden)

Jun Liang

2018-01-01

Full Text Available Objective. To analyze and compare the usefulness of hypertension management APPs released in the Chinese market; to understand the general situations, characteristics, problems, and trends in hypertension management mHealth APPs; and to identify the gaps between mainland China products and non-mainland China products with the aim to provide recommendations for developers in industry and assist hypertensive patients in selecting suitable APPs. Methods. The hypertension management APPs available by October 2016 in China were analyzed from the perspective of data items and function usefulness. Sample sets were determined through PRISMA. An evaluation item set was developed based on the usability framework of TURF and the Chinese Guideline for the Management of Hypertension and used to quantitatively analyze the functionalities and data items collected from the sample APPs from the perspective of designers, users, and activity models. Results. Among the 73 Chinese-supported APPs, none of the hypertension management APPs could fully cover the usefulness item set (mean = 37.4%. Regarding the use of mobile terminal hardware, only cameras and positioning sensors are commonly used in information collection. Regarding the data items and services provided, the most commonly collected data are “demographic information” (88% versus 100% and “vital signs” (76% versus 100%, but APPs developed in mainland China and non-mainland China provided significantly different services and profit-making patterns. Regarding data security and privacy protection, the APPs from mainland China provided far lower usefulness (31% versus 56%. Conclusions. mHealth APPs can promptly and efficiently acquire sign-related data by improving the professionality and scientificity of data about healthy living habits. APPs also improve the preventive usefulness of the collected data and bring about new opportunities for the management and control of hypertension. Other

Adrenal Mass Causing Secondary Hypertension.

Science.gov (United States)

Robinson, Darlene Y

2015-11-01

Most hypertensive patients have essential (primary) hypertension; only 5% to 10% have a secondary cause. Two clinical characteristics suggestive of secondary hypertension are early onset (hypertension (>180/110 mm Hg). When faced with these findings, clinicians should consider a secondary cause of hypertension. A 22-year-old woman being evaluated for asthma exacerbation in the emergency department was noted to have severe persistent hypertension. Additional evaluation revealed severe hypokalemia, metabolic alkalosis, and hypernatremia. The patient was admitted to the hospital for blood pressure management, electrolyte replacement, and further evaluation of presumed hyperaldosteronism. Diagnostic imaging revealed a large adrenal mass. Surgical resection was performed, leading to a diagnosis of hyperaldosteronism caused by adrenal carcinoma. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Secondary hypertension is far less common than essential hypertension; however, considering the large volume of patients seen in emergency departments, it is likely that some will have secondary hypertension. Emergency physicians should be aware of the clinical characteristics that suggest secondary hypertension so that the appropriate diagnostic and treatment pathways can be pursued. Copyright © 2015 Elsevier Inc. All rights reserved.

Evaluation of BAG3 levels in healthy subjects, hypertensive patients, and hypertensive diabetic patients.

Science.gov (United States)

Derosa, Giuseppe; Maffioli, Pamela; Rosati, Alessandra; M, De Marco; Basile, Anna; D'Angelo, Angela; Romano, Davide; Sahebkar, Amirhossein; Falco, Antonia; Turco, Maria C

2018-03-01

BAG3 is a member of human BAG (Bcl-2-associated athanogene) proteins and plays a role in apoptosis, cell adhesion, cytoskeleton remodeling, and autophagy. The aim of this study was to evaluate BAG3 levels in healthy subjects, hypertensive patients, and hypertensive diabetic patients. We enrolled 209 Caucasian adults, of both sex, 18-75 years of age, 77 were healthy controls, 62 were affected by hypertension, and 70 were affected by hypertension and type 2 diabetes. All patients underwent an assessment that included medical history, physical examination, vital signs, a 12-lead electrocardiogram, measurements of systolic (SBP), and diastolic blood pressure (DBP), heart rate (HR), fasting plasma glucose (FPG), glycated hemoglobin (HbA 1c ), triglycerides (TG), transaminases, high sensitivity C-reactive protein (Hs-CRP), and BAG3. We observed higher blood pressure values in hypertensive, and hypertensive diabetic patients compared to controls. As expected, FPG and HbA 1c were higher in diabetic hypertensive patients, compared to the other two groups. No Tg levels differences were recorded among the three groups. Hs-CRP was higher in diabetic hypertensive patients compared to healthy subjects. Finally, BAG3 levels were higher in hypertensives, and hypertensive diabetic patients compared to controls. We observed higher levels of BAG3 in hypertensive patients compared to healthy controls, and even higher levels in hypertensive diabetic patients compared to healthy subjects. This paper could be the first of a long way to identify potential involvement of deregulated BAG3 levels in cardiometabolic diseases. © 2017 Wiley Periodicals, Inc.

Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension.

Science.gov (United States)

Pedrosa, Rodrigo P; Drager, Luciano F; Gonzaga, Carolina C; Sousa, Marcio G; de Paula, Lílian K G; Amaro, Aline C S; Amodeo, Celso; Bortolotto, Luiz A; Krieger, Eduardo M; Bradley, T Douglas; Lorenzi-Filho, Geraldo

2011-11-01

Recognition and treatment of secondary causes of hypertension among patients with resistant hypertension may help to control blood pressure and reduce cardiovascular risk. However, there are no studies systematically evaluating secondary causes of hypertension according to the Seventh Joint National Committee. Consecutive patients with resistant hypertension were investigated for known causes of hypertension irrespective of symptoms and signs, including aortic coarctation, Cushing syndrome, obstructive sleep apnea, drugs, pheochromocytoma, primary aldosteronism, renal parenchymal disease, renovascular hypertension, and thyroid disorders. Among 125 patients (age: 52±1 years, 43% males, systolic and diastolic blood pressure: 176±31 and 107±19 mm Hg, respectively), obstructive sleep apnea (apnea-hypopnea index: >15 events per hour) was the most common condition associated with resistant hypertension (64.0%), followed by primary aldosteronism (5.6%), renal artery stenosis (2.4%), renal parenchymal disease (1.6%), oral contraceptives (1.6%), and thyroid disorders (0.8%). In 34.4%, no secondary cause of hypertension was identified (primary hypertension). Two concomitant secondary causes of hypertension were found in 6.4% of patients. Age >50 years (odds ratio: 5.2 [95% CI: 1.9-14.2]; Phypertension. Age >50 years, large neck circumference measurement, and snoring are good predictors of obstructive sleep apnea in this population.

Intracranial Hypertension Research Foundation

Science.gov (United States)

... PARTNERSHIPS Meet our Fundraising Partners Tweet Welcome Intracranial hypertension (IH) is the general term for the neurological ... high. (Old names for IH include Benign Intracranial Hypertension and Pseudotumor Cerebri). The Intracranial Hypertension Research Foundation ...

HIV and Pulmonary Hypertension

Science.gov (United States)

... What do I need to know about pulmonary hypertension in connection with HIV? Although pulmonary hypertension and ... Should an HIV patient be tested for pulmonary hypertension? HIV patients know that medical supervision is critical ...

Awareness of hypertension guidelines in primary care: results of a regionwide survey in Italy.

Science.gov (United States)

Cuspidi, C; Michev, I; Meani, S; Severgnini, B; Sala, C; Salerno, M; Valerio, C; Bertazzoli, G; Leonetti, G; Magrini, F; Zanchetti, A

2003-08-01

Unsatisfactory blood pressure (BP) control so often described in treated hypertensive populations is also explained by insufficient physicians' awareness of experts' guidelines. We assessed awareness of current recommendations about hypertension management in a general practice setting, using the World Health Organization/International Society of Hypertension (WHO/ISH) 1999 guidelines as reference. In a regionwide survey, a total of 5133 physicians (three-quarters of all active general practitioners in Lombardy, a region of north-western Italy) were contacted by letter and received a multiple choice 10-item questionnaire. Data on physicians' demographic characteristics, information on hypertension prevalence and their perception of BP control among their patients were also requested in an additional form. The number of answers in agreement with WHO/ISH guidelines was used as an awareness measure. This was considered adequate if correct answers to six out of 10 questions, including an appropriate definition of hypertension, were provided. Of the 1256 returned questionnaires (a 24.5% response rate), 1162 were suitable for analysis. The mean score of correct answers was 5.3 points and only 20.1% of the study population correctly answered at least six of the questions (including that on the definition of hypertension in the elderly). Guidelines awareness was negatively related to increase in physicians' age and duration of clinical practice and by the male gender. Finally, the physicians reported a high rate of achieved BP control, and those who were considered to have achieved highest rates (>75%) of control in their patients had a lower rate of adequate knowledge than those who reported less-successful therapeutic results (18 vs 25%, P<0.01), suggesting that they ignored or disregarded the goal BP recommended by the guidelines. This large regional survey shows that a sufficient degree of guidelines awareness is present in a minority of primary-care physicians in the

Hypertension in Danish seafarers

DEFF Research Database (Denmark)

Tu, Mingshan; Jepsen, Jørgen Riis

2016-01-01

Background: Due to the high prevalence of arterial hypertension and its role in the development of athe- rosclerosis, myocardial infarction and stroke, hypertension is a major public health challenge worldwide. There is limited knowledge of the prevalence of hypertension among seafarers who......, however, are known to have an excess morbidity and mortality from these disorders. This article addresses the prevalence of hypertension among Danish seafarers and discusses potential risk factors for hypertension in maritime settings. Materials and methods: A representative sample of 629 Danish seafarers...... who had statutory medical examinations was studied from the beginning of October 2011 to the end of June 2012. The medical examination included measurements of blood pressure. The prevalence of hypertension in the study po- pulation was stratified by age, work place on board, smoking status, alcohol...

General practitioner's reported use of clinical guidelines for hypertension and ambulatory blood pressure.

LENUS (Irish Health Repository)

Flynn, E

2012-03-01

ABPM is an invaluable clinical tool, as it has been shown to improve blood pressure control in primary care. Many clinical guidelines for hypertension advocate ambulatory blood pressure monitoring. This study aims to quantify the use of clinical guidelines for hypertension and to explore the role of ABPM in Primary Care. A questionnaire survey was sent to GPs working in the West of Ireland. 88% (n=139) of GPs use clinical guidelines that recommend the use of ABPM. 82% (n=130) of GPs find use of clinic blood pressure monitoring insufficient for the diagnosis and monitoring of hypertension. Despite good access to ABPM, GPs report lack of remuneration, 72% (n=116), cost 68% (n=108), and lack of time, 51% (n=83) as the main limiting factors to use of ABPM. GPs recognise the clinical value of ABPM, but this study identifies definite barriers to the use of ABPM in Primary Care.

Toward a definition of masked hypertension and white-coat hypertension among hemodialysis patients.

Science.gov (United States)

Agarwal, Rajiv; Sinha, Arjun D; Light, Robert P

2011-08-01

Among people with essential hypertension, ambulatory BP measurement is superior to BP obtained in the clinic in predicting cardiovascular outcomes. In part, this is because it can detect white-coat hypertension and masked hypertension. Whether the same is true for hemodialysis patients is not known. Using a threshold of 140/80 mmHg for median midweek dialysis-unit BP and 135/85 mmHg for 44-hour ambulatory BP, we defined four categories of BP: sustained normotension (SN), white-coat hypertension (WCH), masked hypertension (MHTN), and sustained hypertension (SHTN). Among 355 long-term hemodialysis patients, the prevalence of SN was 35%, WCH 15%, MHTN 15%, and SHTN 35%. Over a mean follow-up of 29.6 (SD 21.7) months, 102 patients died (29%), yielding a crude mortality rate of 121/1000 patient-years. Unadjusted and multivariate-adjusted analyses showed increasing all-cause mortality with increasing severity of hypertension (unadjusted hazard ratios from SN, WCH, MHTN, SHTN: 1, 1.12, 1.70, 1.80, respectively [P for trend hypertension population, MHTN and WCH have prognostic significance. The prognostic value of BP obtained in the dialysis unit can be refined with ambulatory BP monitoring.

Economic evaluation for first-line anti-hypertensive medicines: applications for the Philippines

Directory of Open Access Journals (Sweden)

Geroy Lester Sam Araneta

2012-12-01

Full Text Available Abstract Background Medicines to control hypertension, a leading cause of morbidity and mortality, are a major component of health expenditures in the Philippines. This study aims to review economic studies for first line anti-hypertensive medical treatment without co-morbidities; and discuss practical, informational and policy implications on the use of economic evaluation in the Philippines. Methods A systematic literature review was performed using the following databases: MEDLINE, EMBASE, BIOSIS, PubMed, The Cochrane Library, Health Economics Evaluations Database (HEED and the Centre for Reviews and Dissemination – NHS NICE. Six existing economic analytical frameworks were reviewed and one framework for critical appraisal was developed. Results Out of 1336 searched articles, 12 fulfilled the inclusion criteria. The studies were summarized according to their background characteristics (year, journal, intervention and comparators, objective/study question, target audience, economic study type, study population, setting and country and source of funding/conflict of interest and technical characteristics (perspective, time horizon, methodology/modeling, search strategy for parameters, costs, effectiveness measures, discounting, assumptions and biases, results, cost-effectiveness ratio, endpoints, sensitivity analysis, generalizability, strengths and limitations, conclusions, implications and feasibility and recommendations. The studies represented different countries, perspectives and stakeholders. Conclusions Diuretics were the most cost-effective drug class for first-line treatment of hypertension without co-morbidities. Although the Philippine Health Insurance Corporation may apply the recommendations given in previous studies (i.e. to subsidize diuretics, ACE inhibitors and calcium channel blockers, it is uncertain how much public funding is justified. There is an information gap on clinical data (transition probabilities, relative risks

Hypertension management in the oldest old: Findings from a large long-term care facility.

Science.gov (United States)

Schwinn, Susan; McKay, Robin; Dinkel, Shirley; Mansfield, Bobbe; Da Cunha, Brooke Faria; Cummins, Savanna; Brunin, Krystal

2017-03-01

The purpose of this quality improvement project was to evaluate hypertension (HTN) management in patients 80 years of age and older who reside in a large, long-term care (LTC) facility. A retrospective chart audit was conducted on 75 charts of patients 80 years of age and older and who had a diagnosis of HTN. Using the 2011 American College of Cardiology Foundation/American Heart Association (ACCF/AHA) Expert Consensus Document on Management of Hypertension in the Elderly as a guide, blood pressure readings, significant comorbidities, and antihypertensive medication utilization were analyzed. LTC residents in this sample were often not treated according to expert recommendations. Specifically, analysis revealed overtreatment of uncomplicated HTN and undertreatment of those with comorbid conditions. Additionally, those with diabetes mellitus and chronic kidney disease were infrequently prescribed ace inhibitors/angiotensin receptor blockers, as recommended. Utilizing evidence-based practice (EBP) guidelines affords the best avenue for providing safe and effective treatment of HTN. While expert recommendations are available, researchers seldom recruit frail elders in LTC facilities into treatment investigations. In the absence of population-specific EBP guidelines, nurse practitioners must rely on expert opinion and diagnostic reasoning to individualize HTN treatment to this unique and vulnerable population. ©2016 American Association of Nurse Practitioners.

Joint UK societies’ 2014 consensus statement on renal denervation for resistant hypertension

Science.gov (United States)

Lobo, Melvin D; de Belder, Mark A; Cleveland, Trevor; Collier, David; Dasgupta, Indranil; Deanfield, John; Kapil, Vikas; Knight, Charles; Matson, Matthew; Moss, Jonathan; Paton, Julian F R; Poulter, Neil; Simpson, Iain; Williams, Bryan; Caulfield, Mark J

2015-01-01

Resistant hypertension continues to pose a major challenge to clinicians worldwide and has serious implications for patients who are at increased risk of cardiovascular morbidity and mortality with this diagnosis. Pharmacological therapy for resistant hypertension follows guidelines-based regimens although there is surprisingly scant evidence for beneficial outcomes using additional drug treatment after three antihypertensives have failed to achieve target blood pressure. Recently there has been considerable interest in the use of endoluminal renal denervation as an interventional technique to achieve renal nerve ablation and lower blood pressure. Although initial clinical trials of renal denervation in patients with resistant hypertension demonstrated encouraging office blood pressure reduction, a large randomised control trial (Symplicity HTN-3) with a sham-control limb, failed to meet its primary efficacy end point. The trial however was subject to a number of flaws which must be taken into consideration in interpreting the final results. Moreover a substantial body of evidence from non-randomised smaller trials does suggest that renal denervation may have an important role in the management of hypertension and other disease states characterised by overactivation of the sympathetic nervous system. The Joint UK Societies does not recommend the use of renal denervation for treatment of resistant hypertension in routine clinical practice but remains committed to supporting research activity in this field. A number of research strategies are identified and much that can be improved upon to ensure better design and conduct of future randomised studies. PMID:25431461

Hypertension in patients with type 2 diabetes mellitus: Targets and management.

Science.gov (United States)

Pavlou, Dimitra I; Paschou, Stavroula Α; Anagnostis, Panagiotis; Spartalis, Michael; Spartalis, Eleftherios; Vryonidou, Andromachi; Tentolouris, Nicholas; Siasos, Gerasimos

2018-06-01

Two-thirds of patients with type 2 diabetes mellitus (T2DM) have arterial hypertension. Hypertension increases the incidence of both micro- and macrovascular complications in these patients, while the co-existence of these two major risk factors leads to a four-fold increased risk for cardiovascular disease (CVD) compared with normotensive non-diabetic controls. The aim of this article is to comprehensively review the literature and present updated information on targets for blood pressure (BP) and on the management of hypertension in patients with T2DM. A BP target of <140/90 mmHg applies to most patients, but individualization is always important. All classes of antihypertensive drugs can be used in the management of hypertension in patients with T2DM, as long as they are effective and safe and after taking co-morbidities into account. Angiotensin-converting-enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are the ideal choice for initial or early treatment of hypertension in patients with T2DM and albuminuria. Combination of two or more drugs seems to be inevitable as most of these patients demonstrate resistant hypertension. The combination of ACE inhibitors with ARBs should be avoided. Thiazide and thiazide-like diuretics might be beneficial, alone or in a fixed-dose combination with ACE inhibitors or ARBs. Calcium channel blockers (CCBs) constitute an ideal option as a second- or third-line agent. Beta-blockers are not considered as first-line antihypertensive agents, except for those patients with heart failure or previous myocardial infarction. The addition of mineralocorticoid receptor antagonists to a triple-drug therapy seems the next ideal step. Gender-specific characteristics regarding BP, T2DM and CVD should be taken into consideration, even if different recommendations do not exist yet. Copyright © 2018. Published by Elsevier B.V.

[Early diagnosis and therapy in pulmonary hypertension--aspects of a vision].

Science.gov (United States)

Ewert, R; Olschewski, H; Ghofrani, H A; Opitz, C F

2013-07-01

In patients with pulmonary hypertension progressive vascular changes in the lung precede the clinical and hemodynamic manifestations of the disease. Therefore, early diagnosis and timely treatment of the disease are crucial. This has been the topic of an expert meeting in Greifswald, Germany in June 2012. The current definition of pulmonary hypertension requires a mean pulmonary artery pressure ≥ 25 mmHg at rest, a hemodynamic abnormality already reflecting pulmonary vascular changes beyond early disease. There is increasing evidence supporting the concept that a lower pressure threshold at rest or an abnormal pressure response with exercise better characterize early disease. While right heart catheterization at rest remains the diagnostic gold standard other methods for detecting early disease are explored with echocardiography being the most frequently used technique. Targeted therapy has been approved for patients with pulmonary arterial hypertension (PAH, WHO-group I) in functional class II-IV. Preliminary data in functional class I patients suggest therapeutic potential of theses drugs in early disease as well. Current guidelines propose therapeutic goals based on parameters with prognostic importance. However, these recommendations are based on mostly retrospective analyses of pre-treatment data obtained in patients with pulmonary hypertension in functional class II-IV. Therefore, evidence-based therapeutic goals for early interventions in functional class I patients are lacking. © Georg Thieme Verlag KG Stuttgart · New York.

SECONDARY (ENDOCRINE HYPERTENSION: LECTURE

Directory of Open Access Journals (Sweden)

M. Yu. Yukina

2016-01-01

Full Text Available Hypertension is a  very common disease with high morbidity and reduction in quality of life. Endocrine disorders are the most common cause of secondary hypertension affecting ~3% of the population. Primary aldosteronism can be the cause of endocrine hypertension more often than other endocrine disorders. Other less common causes of endocrine hypertension include Cushing syndrome, pheochromocytoma, thyroid disorders, and hyperparathyroidism. Endocrine hypertension is potentially curable if the underlying cause is identified and treated accordingly. Younger age at manifestation of resistance to multiple antihypertensive drugs, together with other clinical signs of an endocrine disorder, should raise the suspicion and prompt the appropriate evaluation.

Resistant Hypertension, Time-Updated Blood Pressure Values and Renal Outcome in Type 2 Diabetes Mellitus.

Science.gov (United States)

Viazzi, Francesca; Piscitelli, Pamela; Ceriello, Antonio; Fioretto, Paola; Giorda, Carlo; Guida, Pietro; Russo, Giuseppina; De Cosmo, Salvatore; Pontremoli, Roberto

2017-09-22

Apparent treatment resistant hypertension (aTRH) is highly prevalent in patients with type 2 diabetes mellitus (T2D) and entails worse cardiovascular prognosis. The impact of aTRH and long-term achievement of recommended blood pressure (BP) values on renal outcome remains largely unknown. We assessed the role of aTRH and BP on the development of chronic kidney disease in patients with T2D and hypertension in real-life clinical practice. Clinical records from a total of 29 923 patients with T2D and hypertension, with normal baseline estimated glomerular filtration rate and regular visits during a 4-year follow-up, were retrieved and analyzed. The association between time-updated BP control (ie, 75% of visits with BP hypertension. BP control is not associated with a more-favorable renal outcome in aTRH. The relationship between time-updated BP and renal function seems to be J-shaped, with optimal systolic BP values between 120 and 140 mm Hg. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension.

Science.gov (United States)

Rothwell, Peter M

2010-03-13

Although hypertension is the most prevalent treatable vascular risk factor, how it causes end-organ damage and vascular events is poorly understood. Yet, a widespread belief exists that underlying usual blood pressure can alone account for all blood-pressure-related risk of vascular events and for the benefits of antihypertensive drugs, and this notion has come to underpin all major clinical guidelines on diagnosis and treatment of hypertension. Other potentially informative measures, such as variability in clinic blood pressure or maximum blood pressure reached, have been neglected, and effects of antihypertensive drugs on such measures are largely unknown. Clinical guidelines recommend that episodic hypertension is not treated, and the potential risks of residual variability in blood pressure in treated hypertensive patients have been ignored. This Review discusses shortcomings of the usual blood-pressure hypothesis, provides background to accompanying reports on the importance of blood-pressure variability in prediction of risk of vascular events and in accounting for benefits of antihypertensive drugs, and draws attention to clinical implications and directions for future research. Copyright 2010 Elsevier Ltd. All rights reserved.

Development and Psychometric Validation of HIPER-Q to Assess Knowledge of Hypertensive Patients in Cardiac Rehabilitation.

Science.gov (United States)

Santos, Rafaella Zulianello Dos; Bonin, Christiani Decker Batista; Martins, Eliara Ten Caten; Pereira Junior, Moacir; Ghisi, Gabriela Lima de Melo; Macedo, Kassia Rosangela Paz de; Benetti, Magnus

2018-01-01

The absence of instruments capable of measuring the level of knowledge of hypertensive patients in cardiac rehabilitation programs about their disease reflects the lack of specific recommendations for these patients. To develop and validate a questionnaire to evaluate the knowledge of hypertensive patients in cardiac rehabilitation programs about their disease. A total of 184 hypertensive patients (mean age 60.5 ± 10 years, 66.8% men) were evaluated. Reproducibility was assessed by calculation of the intraclass correlation coefficient using the test-retest method. Internal consistency was assessed by the Cronbach's alpha and the construct validity by the exploratory factorial analysis. The final version of the instrument had 17 questions organized in areas considered important for patient education. The instrument proposed showed a clarity index of 8.7 (0.25). The intraclass correlation coefficient was 0.804 and the Cronbach's correlation coefficient was 0.648. Factor analysis revealed five factors associated with knowledge areas. Regarding the criterion validity, patients with higher education level and higher family income showed greater knowledge about hypertension. The instrument has a satisfactory clarity index and adequate validity, and can be used to evaluate the knowledge of hypertensive participants in cardiac rehabilitation programs.

Adherence to physical activity recommendations and physical and mental health risk in people with severe mental illness in Uganda.

Science.gov (United States)

Vancampfort, Davy; Probst, Michel; Basangwa, David; De Hert, Marc; Myin-Germeys, Inez; van Winkel, Ruud; Ward, Philip B; Rosenbaum, Simon; Mugisha, James

2017-11-29

This study investigated cardio-metabolic risk factors among patients with severe mental illness who do or do not meet the recommendations of 150min per week of physical activity. A secondary aim was to assess whether those that do meet the recommendations report lower levels of mental health symptoms. 107 (60♀) Ugandan in- and outpatients (mean age=34.4 ± 9.7 years) with severe mental illness (depression=7, bipolar disorder=55, schizophrenia=45) completed the Physical Activity Vital Sign (PAVS) method and Brief Symptoms Inventory -18. Participants were also screened for abdominal obesity (waist circumference>90cm), overweight (body mass index≥25) and hypertension (systolic pressure≥140mmHg and/or diastolic pressure≥90mmHg).48.6% (n = 52) of patients met the physical activity recommendations as assessed by the PAVS method. 41.1% (n = 44) were overweight, 40.2% (n = 43) had abdominal obesity and 23.4% (n = 25) had hypertension. Those who did not meet the physical activity recommendations were significantly older, had a higher BSI-18 somatisation score, and had a higher risk of overweight [relative risk (RR) = 2.88, 95% confidence interval (CI) = 1.59-4.99], abdominal obesity (RR = 1.82, 95%CI = 1.13-2.93), and hypertension (RR = 2.16, 95%CI = 0.99-4.73). The PAVS is a feasible method of assessing physical activity among patients with severe mental illness in a low resource setting. The PAVS may have clinical utility for physical and mental health risk stratification. Copyright © 2017 Elsevier B.V. All rights reserved.

Pediatric portal hypertension

Science.gov (United States)

Vogel, Clarissa Barbon

2017-01-01

Abstract: Pediatric portal hypertension management is a team approach between the patient, the patient's family, the primary caregiver, and specialty providers. Evidence-based practice guidelines have not been established in pediatrics. This article serves as a review for the primary care NP in the management of pediatric portal hypertension, discussing the etiology, pathophysiology, and clinical presentation of pediatric portal hypertension, diagnostic tests, and treatment and management options. PMID:28406835

Pulmonary Hypertension in Scleroderma

Science.gov (United States)

PULMONARY HYPERTENSION IN SCLERODERMA PULMONARY HYPERTENSION Pulmonary hypertension (PH) is high blood pressure in the blood vessels of the lungs. If the high ... the right side of the heart. Patients with scleroderma are at increased risk for developing PH from ...

Exercise Hypertension.

Science.gov (United States)

Schultz, Martin G; Sharman, James E

2014-05-01

Irrespective of apparent 'normal' resting blood pressure (BP), some individuals may experience an excessive elevation in BP with exercise (i.e. systolic BP ≥210 mm Hg in men or ≥190 mm Hg in women or diastolic BP ≥110 mm Hg in men or women), a condition termed exercise hypertension or a 'hypertensive response to exercise' (HRE). An HRE is a relatively common condition that is identified during standard exercise stress testing; however, due to a lack of information with respect to the clinical ramifications of an HRE, little value is usually placed on such a finding. In this review, we discuss both the clinical importance and underlying physiological contributors of exercise hypertension. Indeed, an HRE is associated with an increased propensity for target organ damage and also predicts the future development of hypertension, cardiovascular events and mortality, independent of resting BP. Moreover, recent work has highlighted that some of the elevated cardiovascular risks associated with an HRE may be related to high-normal resting BP (pre-hypertension) or ambulatory 'masked' hypertension and that an HRE may be an early warning signal of abnormal BP control that is otherwise undetected with clinic BP. Whilst an HRE may be amenable to treatment via pharmacological and lifestyle interventions, the exact physiological mechanism of an HRE remains elusive, but it is likely a manifestation of multiple factors including large artery stiffness, increased peripheral resistance, neural circulatory control and metabolic irregularity. Future research focus may be directed towards determining threshold values to denote the increased risk associated with an HRE and further resolution of the underlying physiological factors involved in the pathogenesis of an HRE.

Dietary habits of hypertensive patients in a tertiary hypertension ...

African Journals Online (AJOL)

Introduction: The prescriptions regarding non-pharmacological care in the management of hypertension has been carefully defined by the various practice guidelines. However, there is paucity of data on dietary practices in our environment, therefore this study set out to determine the dietary practices of hypertensive ...

Hypertension

OpenAIRE

Farrugia, Emanuel

2004-01-01

Hypertension is a rapidly moving clinical field with frequent developments in new pharmacologic agents and management strategies. Perhaps more importantly, there have been substantial improvements in our understanding of how best to use the drugs available to us. In this article, I will review some of the more important advances in our understanding of hypertension over the past two years, specifically by reviewing six important trials, one survey and two sets of guidelines, all published bet...

Maskeret hypertension i graviditeten

DEFF Research Database (Denmark)

Fischer, Margit Bistrup; Thingaard, Ebbe; Andersen, Anita Sylvest

2018-01-01

Hypertension during pregnancy is one of the leading causes of maternal and foetal morbidity and mortality. Monitoring of blood pressure is therefore an essential part of prenatal care. Masked hypertension, where blood pressure levels are elevated at home despite normal blood pressure levels...... monitored in a clinical setting, may lead to cardiovascular and obstetric complications equal to those of sustained hypertension. This article discusses masked hypertension and the need for further investigation of blood pressure monitoring during pregnancy....

Maskeret hypertension i graviditeten

DEFF Research Database (Denmark)

Fischer, Margit Bistrup; Thingaard, Ebbe; Andersen, Anita Sylvest

2018-01-01

Hypertension during pregnancy is one of the leading causes of maternal and foetal morbidity and mortality. Monitoring of blood pressure is therefore an essential part of prenatal care. Masked hypertension, where blood pressure levels are elevated at home despite normal blood pressure levels monit...... monitored in a clinical setting, may lead to cardiovascular and obstetric complications equal to those of sustained hypertension. This article discusses masked hypertension and the need for further investigation of blood pressure monitoring during pregnancy....

Ruling out secondary causes of hypertension.

Science.gov (United States)

Ott, Christian; Schneider, Markus P; Schmieder, Roland E

2013-05-01

In the majority of hypertensive patients, no particular cause for abnormal blood pressure is evident (primary or essential hypertension). In contrast, in the minority of patients with secondary hypertension a specific underlying cause is responsible for the elevated blood pressure. The prevalence of secondary hypertension is higher in patients with resistant hypertension than in the general hypertensive population and increases with age. The list of secondary forms of hypertension is long and prevalence of the individual causes of secondary hypertension varies. Hence, this review divides them into two categories: common causes and rare causes. If appropriately diagnosed and treated, patients with a secondary form of hypertension might be cured, or at least show an improvement in their blood pressure control. Consequently, screening for secondary causes of hypertension plays an essential part in the care of patients with arterial hypertension. If the basal work-up raises the suspicion of a secondary cause of hypertension, specific diagnostic procedures become necessary, some of which can be performed by primary care physicians, while others require specialist input.

Epidemiology of hypertensive kidney disease.

Science.gov (United States)

Udani, Suneel; Lazich, Ivana; Bakris, George L

2011-01-01

The prevalence of hypertension, chronic kidney disease (CKD) and end-stage renal disease (ESRD) attributable to hypertension continues to rise worldwide. Identifying the precise prevalence of CKD attributable to hypertension is difficult owing to the absence of uniform criteria to establish a diagnosis of hypertensive nephropathy. Despite the increasing prevalence of CKD-associated hypertension, awareness of hypertension among individuals with CKD remains suboptimal and rates of blood-pressure control remain poor. Targeted subgroups involved in studies of CKD seem to reach better rates of blood-pressure control, suggesting that this therapeutic goal can be achieved in patients with CKD. Elevated blood-pressure levels are associated with CKD progression. However, the optimal blood-pressure level and pharmacological agent remains unclear. Physicians treating patients with CKD must recognize the importance of maintaining optimal salt and volume balance to achieve blood-pressure goals. Furthermore, agents that modify the renin-angiotensin-aldosterone axis can be an important adjunct to therapy and physicians must monitor expected changes in serum creatinine and electrolyte levels after their administration. Hypertension remains a common factor complicating CKD. Future investigations identifying early signs of hypertension-related CKD, increasing awareness of the effects of hypertension in CKD and determining optimal therapeutic interventions might help reduce the incidence of hypertensive nephropathy.

Prevalence of hypertension and its risk factors among individuals attending outpatient department of rural health training centre, Haldwani

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Janki Bartwal

2014-03-01

Full Text Available Introduction: Hypertension is one of the major health and development challenges of the 21st century, which, for most countries, has developed together with rapid cultural and social changes, ageing populations, increasing urbanization, dietary changes, reduced physical activity, and other unhealthy behaviours. Objectives: 1 To find out the prevalence of Hypertension in study subjects 2 To identify the risk factors associated with Hypertension. Materials and Methods: A Cross-sectional study was carried out among 369 individuals of 30 years and above attending Out Patient Department (OPD in Rural Health Training Centre (RHTC under the Department of Community Medicine, Government Medical College, Haldwani during June 2013-August 2013. A pretested predesigned questionnaire was used to collect demographic data by interview technique .The blood pressure was recorded and classified using JNC VII criteria to grade hypertension. Data was compiled, entered & analyzed using SPSS version 20. Results: Among 369 patients, the prevalence of hypertension was 41.7%; out of this, 28.7% were aware of their hypertensive status while 13% were newly diagnosed cases. The association between hypertension with increase in age, family history of hypertension, increase salt intake, consuming mixed diet, increase waist circumference, waist hip ratio and body mass index was found significant. Physical inactivity, gender, tobacco and alcohol consumption were not significantly associated with hypertension. Conclusions: The prevalence of hypertension in rural area is relatively high. Extensive efforts are required for raising the awareness level & regular screening of high-risk population is recommended for preventing the complications & disability.

Biomarkers in white-coat hypertension

OpenAIRE

Martin, Catherine Ann

2017-01-01

The introduction of ambulatory blood pressure monitoring in the 1960s provided new insights into the nature of high blood pressure disorders. Blood pressure is now categorised into four quadrants:normotension, masked hypertension, hypertension and white-coat hypertension. In white-coat hypertension blood pressure is elevated when taken at the doctor’s office but normal if taken outside the doctor’s office. Several controversies are associated with white-coat hypertension, which are discuss...

Hypercortisolism in obesity-associated hypertension.

Science.gov (United States)

Varughese, Amy G; Nimkevych, Oksana; Uwaifo, Gabriel I

2014-07-01

Obesity is prevalent worldwide and associated with co-morbidities that result in increased cardiovascular risk. Hypertension is the most prevalent obesity comorbidity associated with increased cardiovascular risk. Obesity hypertension is a distinct subtype of essential hypertension. While endogenous Cushing's syndrome is an uncommon cause of both obesity and hypertension, the recent recognition of other hypercortisolemic states has raised the profile of hypercortisolism as an important contributor in obesity hypertension. The high prevalence of exogenous, iatrogenic, pseudo, and subclinical Cushing's syndromes makes hypercortisolism an important diagnostic consideration in the evaluation and management of patients with obesity hypertension who are resistant to conventional management. Available data suggest that the renin-angiotensin-aldosterone system modulating antihypertensives have the best efficacy in hypercortisolism-mediated obesity hypertension. Strategies aimed at reducing cortisol production and action also have utility. This review provides a comprehensive overview of the epidemiology, etiopathogenesis and management options available for glucocorticoid-mediated obesity hypertension.

Provider Adherence to National Guidelines for Managing Hypertension in African Americans

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Jeanette Sessoms

2015-01-01

Full Text Available Purpose. To evaluate provider adherence to national guidelines for the treatment of hypertension in African Americans. Design. A descriptive, preexperimental, quantitative method. Methods. Electronic medical records were reviewed and data were obtained from 62 charts. Clinical data collected included blood pressure readings, medications prescribed, laboratory studies, lifestyle modification, referral to hypertension specialist, and follow-up care. Findings. Overall provider adherence was 75%. Weight loss, sodium restriction, and physical activity recommendations were documented on 82.3% of patients. DASH diet and alcohol consumption were documented in 6.5% of participants. Follow-up was documented in 96.6% of the patients with controlled blood pressure and 9.1% in patients with uncontrolled blood pressure. Adherence in prescribing ACEIs in patients with a comorbidity of DM was documented in 70% of participants. Microalbumin levels were ordered in 15.2% of participants. Laboratory adherence prior to prescribing medications was documented in 0% of the patients and biannual routine labs were documented in 65% of participants. Conclusion. Provider adherence overall was moderate. Despite moderate provider adherence, BP outcomes and provider adherence were not related. Contributing factors that may explain this lack of correlation include patient barriers such as nonadherence to medication and lifestyle modification recommendations and lack of adequate follow-up. Further research is warranted.

Definition and classification of pulmonary hypertension.

Science.gov (United States)

Humbert, Marc; Montani, David; Evgenov, Oleg V; Simonneau, Gérald

2013-01-01

Pulmonary hypertension is defined as an increase of mean pulmonary arterial pressure ≥25 mmHg at rest as assessed by right heart catheterization. According to different combinations of values of pulmonary wedge pressure, pulmonary vascular resistance and cardiac output, a hemodynamic classification of pulmonary hypertension has been proposed. Of major importance is the pulmonary wedge pressure which allows to distinguish pre-capillary (pulmonary wedge pressure ≤15 mmHg) and post-capillary (pulmonary wedge pressure >15 mmHg) pulmonary hypertension. Pre-capillary pulmonary hypertension includes the clinical groups 1 (pulmonary arterial hypertension), 3 (pulmonary hypertension due to lung diseases and/or hypoxia), 4 (chronic thrombo-embolic pulmonary hypertension) and 5 (pulmonary hypertension with unclear and/or multifactorial mechanisms). Post-capillary pulmonary hypertension corresponds to the clinical group 2 (pulmonary hypertension due to left heart diseases).

Efficiency of complex physical rehabilitation at hypertensive illness of I degree on ambulatory-policlinic the stage

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Buksha S.B.

2012-01-01

Full Text Available The results of application of аromatherapy with a massage and autogenic training are examined in a physical rehabilitation. In research took part men aged 50-55 years, sufferings hypertensive illness of the I degree. It is marked that major reason of development of hypertensive illness is a decline of motive activity of patients, susceptibility to the nervous overloads and stresses, unbalanced feed, violation of the mode of labour and rest. Application of complex physical rehabilitation is recommended: medical gymnastics with the elements of the autogenic training, аromatherapy with a massage, dietotherapy, physiotherapy.

How evidence-based are the recommendations in evidence-based guidelines?

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Finlay A McAlister

2007-08-01

Full Text Available BACKGROUND: Treatment recommendations for the same condition from different guideline bodies often disagree, even when the same randomized controlled trial (RCT evidence is cited. Guideline appraisal tools focus on methodology and quality of reporting, but not on the nature of the supporting evidence. This study was done to evaluate the quality of the evidence (based on consideration of its internal validity, clinical relevance, and applicability underlying therapy recommendations in evidence-based clinical practice guidelines. METHODS AND FINDINGS: A cross-sectional analysis of cardiovascular risk management recommendations was performed for three different conditions (diabetes mellitus, dyslipidemia, and hypertension from three pan-national guideline panels (from the United States, Canada, and Europe. Of the 338 treatment recommendations in these nine guidelines, 231 (68% cited RCT evidence but only 105 (45% of these RCT-based recommendations were based on high-quality evidence. RCT-based evidence was downgraded most often because of reservations about the applicability of the RCT to the populations specified in the guideline recommendation (64/126 cases, 51% or because the RCT reported surrogate outcomes (59/126 cases, 47%. CONCLUSIONS: The results of internally valid RCTs may not be applicable to the populations, interventions, or outcomes specified in a guideline recommendation and therefore should not always be assumed to provide high-quality evidence for therapy recommendations.

Management of hypertension in the setting of acute ischemic stroke.

Science.gov (United States)

Heitsch, Laura; Jauch, Edward C

2007-12-01

The optimal management of blood pressure in the first 24 hours of ischemic stroke remains a controversial topic. Most patients are hypertensive at presentation and subsequently experience a spontaneous decline in blood pressure. Decreasing penumbral blood flow and exacerbating vasogenic edema are significant concerns in whether to treat blood pressure elevations. Although an initially elevated blood pressure has been associated with poor outcome, attempts to acutely lower blood pressure are also associated with worsened outcomes. Thus, the current approach in acute ischemic stroke is permissive hypertension, in which antihypertensive treatment is warranted in patients with systolic blood pressure greater than 220 mm Hg, receiving thrombolytic therapy, or with concomitant medical issues. The use of predictable and titratable medications that judiciously reduce (approximately 10% to 15%) the initial presenting mean arterial pressure is recommended in these situations. Future study must define optimal blood pressure goals, likely on an individual basis.

Hypertension after kidney transplantation

NARCIS (Netherlands)

Dobrowolski, L.C.

2016-01-01

Hypertension increases the cardiovascular risk in kidney transplant recipients (KTRs). In chapter 2 we found that hypertension was highly prevalent in adult (77.2%), paediatric (62.7%) and young adult (86.4%) KTRs. Transition from the paediatric to adult care did not affect hypertension and there

Hypertension care at primary health care centers: A report from Abha, Saudi Arabia

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Al-Homrany Mohammed

2008-01-01

Full Text Available It is well known that effective management of hypertension reduces the incidence of myo-cardial infarction, stroke and vascular complications. The Ministry of Health, Kingdom of Saudi Arabia, introduced the Quality Assurance Guidelines with the hope to improve the management of hypertension in its centers. We conducted an audit of two Primary Health Care Centers namely, Al-Manhal (MPHCC and Al-Numais (NPHCC, to evaluate how well hypertension was managened at these centers. A check list was derived from the Quality Assurance Manual to audit the process and to assess the health outcome. A retrospective study on a chosen sample of 120 files of hypertensive patients, out of 256 from both the Primary Health Care Centers was performed, during the last three months of the year 2000. Results showed that 61% of the patients were between 45-64 years of age, 56% were females, 85% were married, 54% were illiterate and 7.5% were smokers. A total of 92% of the patients had primary hypertension and 25% had a positive family history of hypertension. Beta-blockers were the most commonly used drugs in both the centers. Although the recording of the information was not perfect, there was no statistical difference in the socio-demongraphic data and also the means of the total score in both the centres. On the other hand, carrying out the important procedures for hypertensive patients was found to be better at MPHCC in com-parison to NPHCC (p < 0.05. The commonly missed procedures were chest x-rays, electrolytes and ECG. Hypertension was well controlled in 63% of the patients, 58% were found to have obesity, 9% suffered from hypertension-related complications while almost 50% had good compliance to appointment in both the centers. Our study reveals that the process of hypertension care at the two Primary Health Care Centres in Aseer region was not in accordance with the recommended national standards. The reasons include lack of updating systems, recall system and

Biology of portal hypertension.

Science.gov (United States)

McConnell, Matthew; Iwakiri, Yasuko

2018-02-01

Portal hypertension develops as a result of increased intrahepatic vascular resistance often caused by chronic liver disease that leads to structural distortion by fibrosis, microvascular thrombosis, dysfunction of liver sinusoidal endothelial cells (LSECs), and hepatic stellate cell (HSC) activation. While the basic mechanisms of LSEC and HSC dysregulation have been extensively studied, the role of microvascular thrombosis and platelet function in the pathogenesis of portal hypertension remains to be clearly characterized. As a secondary event, portal hypertension results in splanchnic and systemic arterial vasodilation, leading to the development of a hyperdynamic circulatory syndrome and subsequently to clinically devastating complications including gastroesophageal varices and variceal hemorrhage, hepatic encephalopathy from the formation of portosystemic shunts, ascites, and renal failure due to the hepatorenal syndrome. This review article discusses: (1) mechanisms of sinusoidal portal hypertension, focusing on HSC and LSEC biology, pathological angiogenesis, and the role of microvascular thrombosis and platelets, (2) the mesenteric vasculature in portal hypertension, and (3) future directions for vascular biology research in portal hypertension.

X-ray examination of the portal hypertension by means of indirect arterial portography

Energy Technology Data Exchange (ETDEWEB)

Vadon, G; Engloner, L; Kupcsulik, P; Konya, A [Semmelweis Orvostudomanyi Egyetem, Budapest (Hungary). Radiologiai Klinika; Semmelweis Orvostudomanyi Egyetem, Budapest (Hungary). 2. Sebeszeti Klinika)

1982-01-01

The blood flow in the portal system, its collaterals and the presence of any thrombus was examined by serial radiograms taken in the venous phase after catheterization of the a. coeliaca, linealis or mesenterica superior. In 127 out of 131 cases the examination was successful and gave valuable information. The method is recommended as a first investigation in cases of suspected portal hypertension.

Morphologic changes of cerebral veins in hypertensive rats: venous collagenosis is associated with hypertension.

Science.gov (United States)

Zhou, Min; Mao, Lijuan; Wang, Ying; Wang, Qian; Yang, Zhiyun; Li, Shurong; Li, Ling

2015-03-01

The aims of this study were to determine whether arterial hypertension could affect the venous system of brain and to find out the consequent pathologic changes of cerebral veins. Thirty male Sprague-Dawley rats were divided into 2 groups: a sham-clipped group and a stroke-prone renovascular hypertensive rat group. A 2-kidney 2-clip rat model was used to induce renovascular hypertension in the hypertensive group. Systolic blood pressure was measured by tail cuff once each week. Susceptibility-weighted imaging (SWI) was performed at 12, 16, and 20 weeks after surgery. All the rats were sacrificed after the SWI examination at 20 weeks after surgery. The brains were extracted and embedded in paraffin for histologic examination. Masson trichrome staining was performed to identify venous collagenosis. The sham group demonstrated less prominence of cerebral veins compared with hypertensive groups (P veins on SWI as a sign of venous hypertension and the thickened cerebral venous walls (venous collagenosis), which may play a role in cerebral ischemia and/or infarction, are both consequences of long-term hypertension in hypertensive rats. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Neurological disorders in hypertensive patients

Directory of Open Access Journals (Sweden)

N. V. Vakhnina

2015-01-01

Full Text Available Hypertension is one of the most common vascular diseases. The brain as target organs in hypertension is damaged more often and earlier. Neurological complications due to hypertension are frequently hyperdiagnosed in Russian neurological practice. Thus, headache, dizziness, impaired recall of recent events, nocturnal sleep disorders, and many other complaints in a hypertensive patient are usually regarded as a manifestation of dyscirculatory encephalopathy. At the same time headaches (tension headache and migraine in hypertensive patients are predominantly primary; headache associated with dramatic marked elevations in blood pressure is encountered in only a small number of patients. The role of cerebrovascular diseases in the development of dizziness in hypertensive patients is also overestimated. The vast majority of cases, patients with this complaint are in fact identified to have benign paroxysmal postural vertigo, Mеniеre’s disease, vestibular neuronitis, or vestibular migraine. Psychogenic disorders or multisensory insufficiency are generally responsible for non-systemic vertigo in hypertensive patients. Chronic cerebral circulatory insufficiency may cause non-systemic vertigo as a subjective equivalent of postural instability.Cognitive impairments (CIs are the most common and earliest manifestation of cerebrovascular lesion in hypertension. In most cases, CIs in hypertension were vascular and associated with cerebrovascular lesion due to lacunar infarcts and leukoaraiosis. However, mixed CIs frequently occur when hypertensive patients are also found to have signs of a degenerative disease, most commonly in Alzheimer’s disease.

Non-compliance to anti-hypertensive medication and its associated factors among hypertensives

International Nuclear Information System (INIS)

Bilal, A.; Riaz, M.; Shafiq, N.U.; Ahmed, M.; Sheikh, S.; Rasheed, S.

2015-01-01

Non-compliance to anti-hypertensive drugs can have negative impact on cardiovascular outcome. Various studies have been conducted on the issue but the factors are not yet explored properly, particularly in Pakistan. This study was conducted to determine the frequency and factors associated with non-compliance to anti-hypertensive medications in Karachi. Methods: This descriptive cross sectional study was conducted on 113 indoor hypertensive patients included by purposive sampling, aged 30 years and above diagnosed at least 6 months back in public sector tertiary care institutes of Karachi from March to October 2011. Data was collected through a questionnaire in Urdu. Demographic data, hypertension diagnosis, medical co-morbidity, current number of anti-hypertensive medicines, frequency of missing prescribed antihypertensive therapy and other factors affecting compliance pertaining to medicines, patient, physician and health care centre were included in the questionnaire. Results: This study revealed that 68.14% patients were non-compliant. Non-compliance was found to be associated with gender and socioeconomic status. Duration of hypertension, duration between follow up visits to physician, number of drugs, careless attitude, role of physician and limiting access to health care center are found to be important factors in non-compliance. Conclusions: Multiple factors including patients, medicine and health care system related, which can be prevented with simple measures, were found responsible for higher prevalence of non-compliance against anti-hypertensive medicines. (author)

Liver cirrhosis and arterial hypertension

DEFF Research Database (Denmark)

Henriksen, Jens Henrik; Møller, Søren

2006-01-01

blood pressure. This review considers the alterations in systemic hemodynamics in patients with cirrhosis in relation to essential hypertension and arterial hypertension of the renal origin. Subjects with arterial hypertension (essential, secondary) may become normotensive during the development...... of cirrhosis, and arterial hypertension is rarely manifested in patients with cirrhosis, even in cases with renovascular disease and high circulating renin activity. There is much dispute as to the understanding of homoeostatic regulation in cirrhotic patients with manifest arterial hypertension. This most...

[Clinico-statistical analysis of arterial hypertension complicated with hypertensive crisis in Moscow in 2005-2009].

Science.gov (United States)

Gaponova, N I; Plavunov, N F; Tereshchenko, S N; Baratashvili, V L; Abdurakhmanov, V R; Komissarenko, I A; Filippov, D V; Podkopaev, D V

2011-01-01

Clinicostatistical analysis of arterial hypertension complicated with hypertensive crisis using data of Moscow A.S.Puchkov Station of Urgent and Emergent Medical Aid revealed 14% rise in number of hypertensive crises during the period from 2005 to 2009. Number of hypertensive crises increased among persons of young age (18-35 years). Frequency of cerebrovascular complications of hypertensive crises was age dependent with maximal values among men aged 36-74 years and women older than 75 years.

Hypertensive heart disease

Science.gov (United States)

... page: //medlineplus.gov/ency/article/000163.htm Hypertensive heart disease To use the sharing features on this page, please enable JavaScript. Hypertensive heart disease refers to heart problems that occur because of ...

Implementation of recommended measures in patients with stable coronary artery disease: the data from 2014 Russian registry

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Korotin A.S.

2015-03-01

Full Text Available A report presents the data on assessment of recommended treatment implementation in patients with stable coronary artery disease (CAD. The source of the data of the year 2014 was multicenter Russian registry of hypertension, CAD and chronic heart failure.

Renovascular hypertension in spontaneous hypertensive rats: an experimental model of renal artery stenosis superimposed on essential hypertension.

Science.gov (United States)

Rosenthal, T; Bass, A; Grossman, E; Shani, M; Griffel, B; Adar, R

1987-09-01

Renovascular hypertension superimposed on essential hypertension, a condition encountered in the elderly, was studied. An experimental animal model consisting of a two-kidney one-clip Goldblatt preparation in the spontaneous hypertensive (SHR) rat, that would simulate this condition, was designed. A 0.25 mm silver clip was placed on the left renal artery of SHR male rats. The same procedure performed on WKY rats served as control. All experiments were performed on low, normal, and rich sodium diet. Systolic blood pressure (BP) was measured by tail-cuff method. Plasma renin concentration (PRC) was determined before and after clipping of the renal artery. Results were as follows: Mean systolic BP increased significantly in clipped rats fed with normal and rich sodium diets. SHR showed an increase from 144 +/- 3 (mean + s.e.m.) to 168 +/- 3 mmHg, and WKY rats showed an increase from 120 +/- 2 to 139 +/- 5 mmHg. There was a two- to threefold rise in PRC. A low-salt diet given prior to clipping prevented the appearance of renovascular hypertension despite a significant rise in PRC. We concluded that renal artery narrowing plays a significant role in the rise of BP in the basically essential type of hypertension.

[Diuretics in monotherapy and in combination with other diuretics and nondiuretics in the treatment of hypertension].

Science.gov (United States)

Spinar, J; Spinarová, L; Vítovec, J

2013-06-01

Diuretics belong to the basic group of medicines for the treatment of hypertension and heart failure. In the case of hypertension treatment, their main indication is higher age and isolated systolic hypertension. In the case of heart failure they are used for the treatment of swellings and shortness of breath. The most frequently prescribed group of diuretics is thiazides and similar products. In patients with renal insufficiency, loop diuretics are administered. In the case of hypertension, diuretics are mainly used in the combination treatment. The most frequently used diuretic in combination is again hydrochlorothiazide, which is combined with reninangiotensin system blockers. It is mainly the combination of an ACE inhibitor + indapamide that seems to be modern and promising, and it is, on the basis of large clinical trials, recommended also for diabetics (ADVANCE) or for secondary prevention following a cerebrovascular accident (PROGRESS) or for the elderly (HYVET). Also a combination of two diuretics is popular -  mainly hydrochlorothiazide + amiloride. A combination of a betablocker and diuretic is less suitable.

Hypertensive retinopathy (image)

Science.gov (United States)

... retina from high blood pressure is called hypertensive retinopathy. It occurs as the existing high blood pressure ... flame hemorrhages and cotton wool spots. As hypertensive retinopathy progresses, hard exudates can appear around the macula ...

Dietary determinants of pregnancy induced hypertension in Isfahan

Directory of Open Access Journals (Sweden)

Zamzam Paknahad

2008-02-01

Full Text Available

• BACKGROUND: Pregnancy-induced hypertension (PIH is a pregnancy-specific condition that occurs after the 20th week of gestation. These physiologic changes can be aggravated by undernutrition. There are some evidence based on the importance of nutrient deficiency in developing this syndrome. Therefore, the aim of present study was to determine the nutritional risk factors for pregnancy induced hypertension in a group of pregnant women in Isfahan.
• METHODS: In this case-control study, we recruited 46 Isfahanian pregnant women in two groups (with and without PIH. They were 19 to 45 year-old and they did not consume any antihypertensive or diuretic medications. Demographic questionnaire and food frequency questionnaire were filled in both groups.
• RESULTS: There were no significant differences in energy and vitamin E and C intakes between the two groups. Zinc and calcium intakes were lower in women with PIH compared to those without PIH (P = 0.04 and P = 0.007, respectively. Riboflavin and protein intakes were lower in women with PIH compared to subjects without PIH (P = 0.03 and P = 0.01, respectively.
• CONCLUSIONS: Lower intake of calcium, zinc, riboflavin and protein should be considered as possible risk factors for PIH. Adequate intake of dairy products which are good sources of mentioned nutrients are recommended to prevent PIH.
• KEYWORDS: Pregnancy induced hypertension, diet, nutrient.

Dose-Response Association Between Physical Activity and Incident Hypertension: A Systematic Review and Meta-Analysis of Cohort Studies.

Science.gov (United States)

Liu, Xuejiao; Zhang, Dongdong; Liu, Yu; Sun, Xizhuo; Han, Chengyi; Wang, Bingyuan; Ren, Yongcheng; Zhou, Junmei; Zhao, Yang; Shi, Yuanyuan; Hu, Dongsheng; Zhang, Ming

2017-05-01

Despite the inverse association between physical activity (PA) and incident hypertension, a comprehensive assessment of the quantitative dose-response association between PA and hypertension has not been reported. We performed a meta-analysis, including dose-response analysis, to quantitatively evaluate this association. We searched PubMed and Embase databases for articles published up to November 1, 2016. Random effects generalized least squares regression models were used to assess the quantitative association between PA and hypertension risk across studies. Restricted cubic splines were used to model the dose-response association. We identified 22 articles (29 studies) investigating the risk of hypertension with leisure-time PA or total PA, including 330 222 individuals and 67 698 incident cases of hypertension. The risk of hypertension was reduced by 6% (relative risk, 0.94; 95% confidence interval, 0.92-0.96) with each 10 metabolic equivalent of task h/wk increment of leisure-time PA. We found no evidence of a nonlinear dose-response association of PA and hypertension ( P nonlinearity =0.094 for leisure-time PA and 0.771 for total PA). With the linear cubic spline model, when compared with inactive individuals, for those who met the guidelines recommended minimum level of moderate PA (10 metabolic equivalent of task h/wk), the risk of hypertension was reduced by 6% (relative risk, 0.94; 95% confidence interval, 0.92-0.97). This meta-analysis suggests that additional benefits for hypertension prevention occur as the amount of PA increases. © 2017 American Heart Association, Inc.

Hypertension og nyresygdom

DEFF Research Database (Denmark)

Kamper, Anne-Lise; Pedersen, Erling B; Strandgaard, Svend

2009-01-01

Renal mechanisms, in particular the renin-angiotensin system and renal salt handling, are of major importance in blood pressure regulation. Co-existence of hypertension and decreased renal function may be due to nephrosclerosis secondary to hypertension, or primary renal disease with secondary...... hypertension. Mild degrees of chronic kidney disease (CKD) can be detected in around 10% of the population, and detection is important as CKD is an important risk factor for atherosclerotic cardiovascular disease. Conversely, heart failure may cause an impairment of renal function. In chronic progressive...

[Arterial hypertension and RU-486: a complex case of secondary hypertension].

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Leone, Alessandra; Pisaneschi, Silvia; Montereggi, Francesco; Canu, Letizia; Corsini, Elisa; Mannelli, Massimo; Montereggi, Alessio

2013-06-01

Secondary hypertension accounts for 10-15% of all cases of hypertension, and early diagnosis with identification of its etiology can be challenging. In this scenario, therapeutic management of affected patients may be difficult. Hypercortisolism is one of the possible causes of secondary hypertension, but its low prevalence and atypical clinical symptoms can lead to a delayed diagnosis. The complex clinical presentation and potential complications need a close collaboration among different clinicians in order to plan optimal or new treatment protocols.

Olmesartan medoxomil combined with hydrochlorothiazide for the treatment of hypertension

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Mark Greathouse

2006-12-01

Full Text Available Mark GreathouseSouth Hills Cardiology Associates of Pittsburgh, Pittsburgh, PA, USAAbstract: In most patients with hypertension, especially Stage 2 hypertension, adequate control of blood pressure (BP is only achieved with combination drug therapy. When using combination therapy, antihypertensive agents with complementary mechanisms of action are recommended, for example, an angiotensin receptor blocker (ARB in combination with hydrochlorothiazide (HCTZ, a β-blocker + HCTZ, an ACE inhibitor + HCTZ, or a calcium channel blocker + an ACE inhibitor. One such combination is olmesartan medoxomil + HCTZ, which is available as fixed-dose, single-tablet combinations for once-daily administration. In clinical trials, olmesartan medoxomil/HCTZ reduced systolic BP (SBP and diastolic BP (DBP to a greater extent than either component as monotherapy. A clinical study in patients with Stage 1 or 2 hypertension showed that olmesartan medoxomil/HCTZ achieved a similar mean reduction in DBP, but a significantly greater mean reduction in SBP and higher rate of BP control (<140/90 mmHg than observed with losartan/HCTZ, at US/European-approved starting doses. In a non-inferiority trial, the antihypertensive efficacy of olmesartan medoxomil/HCTZ was comparable to that of atenolol/HCTZ. Furthermore, indirect comparisons have shown that olmesartan medoxomil/HCTZ compares favorably with other antihypertensive combination therapies, including other ARB/HCTZ combinations and amlodipine besylate/benazepril. Olmesartan medoxomil/HCTZ is generally well tolerated. In conclusion, olmesartan medoxomil/HCTZ is an effective and well-tolerated combination antihypertensive therapy that results in significant BP reductions and BP control in many patients. Keywords: olmesartan medoxomil, hydrochlorothiazide, angiotensin II receptor blocker, hypertension

Short-term variability and nocturnal decline in ambulatory blood pressure in normotension, white-coat hypertension, masked hypertension and sustained hypertension: a population-based study of older individuals in Spain.

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Gijón-Conde, Teresa; Graciani, Auxiliadora; López-García, Esther; Guallar-Castillón, Pilar; García-Esquinas, Esther; Rodríguez-Artalejo, Fernando; Banegas, José R

2017-06-01

Blood pressure (BP) variability and nocturnal decline in blood pressure are associated with cardiovascular outcomes. However, little is known about whether these indexes are associated with white-coat and masked hypertension. We performed a cross-sectional analysis of 1047 community-dwelling individuals aged ⩾60 years in Spain in 2012. Three observer-measured home BPs and 24-h ambulatory blood pressure monitoring (ABPM) were performed under standardized conditions. BP variability was defined as BP s.d. and coefficient of variation. Differences in BP variability and nocturnal BP decrease between groups were adjusted for sociodemographic and clinical covariates using generalized linear models. Of the cohort, 21.7% had white-coat hypertension, 7.0% had masked hypertension, 21.4% had sustained hypertension, and 49.9% were normotensive. Twenty-four hour, daytime and night-time systolic BP s.d. and coefficients of variation were significantly higher in subjects with white-coat hypertension than those with normotension (Pcoat hypertension than in those with normotension (Pcoat hypertension group and lowest in the masked hypertension group in all patients and untreated patients (Pcoat hypertension, 78.1% of subjects with masked hypertension, and 72.2% of subjects with sustained hypertension (Pcoat hypertension and blunted nocturnal BP decrease was observed more frequently in subjects with masked hypertension. These findings may help to explain the reports of increased cardiovascular risk in patients with white-coat hypertension and poor prognosis in those with masked hypertension, highlighting the importance of ABPM.

Emergency Management of Hypertension in Children

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Dinesh Singh

2012-01-01

Full Text Available Systemic arterial hypertension in children has traditionally been thought to be secondary in origin. Increased incidence of risk factors like obesity, sedentary life-styles, and faulty dietary habits has led to increased prevalence of the primary arterial hypertension (PAH, particularly in adolescent age children. PAH has become a global epidemic worldwide imposing huge economic constraint on health care. Sudden acute increase in systolic and diastolic blood pressure can lead to hypertensive crisis. While it generally pertains to secondary hypertension, occurrence of hypertensive crisis in PAH is however rare in children. Hypertensive crisis has been further subclassified depending on presence or absence of end-organ damage into hypertensive emergency or urgency. Both hypertensive emergencies and urgencies are known to cause significant morbidity and mortality. Increasing awareness among the physicians, targeted at investigation of the pathophysiology of hypertension and its complications, better screening methods, generation, and implementation of novel treatment modalities will impact overall outcomes. In this paper, we discuss the etiology, pathogenesis, and management of hypertensive crisis in children. An extensive database search using keywords was done to obtain the information.

Renal denervation therapy for the treatment of resistant hypertension: a position statement by the Canadian Hypertension Education Program.

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Khan, Nadia A; Herman, Robert J; Quinn, Robert R; Rabkin, Simon W; Ravani, Pietro; Tobe, Sheldon W; Feldman, Ross D; Wijeysundera, Harindra C; Padwal, Raj S

2014-01-01

Renal denervation is a novel catheter-based, percutaneous procedure using radiofrequency energy to ablate nerves within the renal arteries. This procedure might help to significantly lower blood pressure (BP) in patients with resistant hypertension, defined as BP > 140/90 mm Hg (> 130/80 mm Hg for those with diabetes) despite use of ≥ 3 optimally dosed antihypertensive agents, ideally including 1 diuretic agent. The Canadian Hypertension Education Program Recommendations Task Force reviewed the current evidence on safety and efficacy of this procedure. Eleven studies on renal denervation were examined and most of the evidence evaluating renal denervation was derived from the Symplicity studies. In patients with systolic BP ≥ 160 mm Hg (≥ 150 mm Hg for patients with type 2 diabetes) despite use of ≥ 3 antihypertensive agents, bilateral renal denervation was associated with significantly lower BP (-22/11 to -34/13 mm Hg) at 6 months with a low periprocedural complication rate. Few patients underwent 24-hour ambulatory BP monitoring and ambulatory BP monitoring showed more modest BP lowering (0 to -11/7 mm Hg). Although early results on short-term safety and blood pressure-lowering are encouraging, there are no long-term efficacy and safety data, or hard cardiovascular end point data. The discrepancy between office BP reductions and 24-hour ambulatory BP monitor reductions needs to be further investigated. Until more data are available, renal sympathetic denervation should be considered as a treatment option of last resort for patients with resistant hypertension who have exhausted all other available medical management options. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Development and Psychometric Validation of HIPER-Q to Assess Knowledge of Hypertensive Patients in Cardiac Rehabilitation

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Rafaella Zulianello dos Santos

2018-02-01

Full Text Available Abstract Background: The absence of instruments capable of measuring the level of knowledge of hypertensive patients in cardiac rehabilitation programs about their disease reflects the lack of specific recommendations for these patients. Objective: To develop and validate a questionnaire to evaluate the knowledge of hypertensive patients in cardiac rehabilitation programs about their disease. Methods: A total of 184 hypertensive patients (mean age 60.5 ± 10 years, 66.8% men were evaluated. Reproducibility was assessed by calculation of the intraclass correlation coefficient using the test-retest method. Internal consistency was assessed by the Cronbach’s alpha and the construct validity by the exploratory factorial analysis. Results: The final version of the instrument had 17 questions organized in areas considered important for patient education. The instrument proposed showed a clarity index of 8.7 (0.25. The intraclass correlation coefficient was 0.804 and the Cronbach’s correlation coefficient was 0.648. Factor analysis revealed five factors associated with knowledge areas. Regarding the criterion validity, patients with higher education level and higher family income showed greater knowledge about hypertension. Conclusion: The instrument has a satisfactory clarity index and adequate validity, and can be used to evaluate the knowledge of hypertensive participants in cardiac rehabilitation programs.

Vascular inflammatory cells in hypertension

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David G. Harrison

2012-05-01

Full Text Available Hypertension is a common disorder with uncertain etiology. In the last several years, it has become evident that components of both the innate and adaptive immune system play an essential role in hypertension. Macrophages and T cells accumulate in the perivascular fat, the heart and the kidney of hypertensive patients and in animals with experimental hypertension. Various immunosuppressive agents lower blood pressure and prevent end-organ damage. Mice lacking lymphocytes are protected against hypertension, and adoptive transfer of T cells, but not B cells in the animals restores their blood pressure response to stimuli such as angiotensin II or high salt. Recent studies have shown that mice lacking macrophages have blunted hypertension in response to angiotensin II and that genetic deletion of macrophages markedly reduces experimental hypertension. Dendritic cells have also been implicated in this disease. Many hypertensive stimuli have triggering effects on the central nervous system and signals arising from the circumventricular organ seem to promote inflammation. Studies have suggested that central signals activate macrophages and T cells, which home to the kidney and vasculature and release cytokines, including IL-6 and IL-17, which in turn cause renal and vascular dysfunction and lead to blood pressure elevation. These recent discoveries provide a new understanding of hypertension and provide novel therapeutic opportunities for treatment of this serious disease.

Overweight, adipocytokines and hypertension

DEFF Research Database (Denmark)

Seven, Ekim; Husemoen, Lise L N; Wachtell, Kristian

2014-01-01

OBJECTIVE:: The adipocytokines, leptin, adiponectin, and interleukin-6, which stimulate liver C-reactive protein (CRP) production, are regarded as potential candidate intermediates between adipose tissue and overweight-induced hypertension. METHODS:: We examined the associations between leptin......, adiponectin, and CRP levels with both prevalent and 5-year incident hypertension (IHT) in a general population of Danish adults (n = 5868, 51.3% women, mean age 45.8 ± 7.9 years). RESULTS:: We recorded 2195 prevalent and 379 incident cases of hypertension. In models including leptin, CRP, adiponectin, sex.......023) in the fully adjusted model. The population attributable risk estimate of IHT owing to overweight was 31%. CONCLUSION:: Leptin, but not adiponectin or CRP, may play a mediating role in overweight-induced hypertension. However, as BMI was a strong independent predictor of hypertension, other factors than leptin...

Overweight, adipocytokines and hypertension

DEFF Research Database (Denmark)

Seven, Ekim; Husemoen, Lise L N; Wachtell, Kristian

2014-01-01

OBJECTIVE: The adipocytokines, leptin, adiponectin, and interleukin-6, which stimulate liver C-reactive protein (CRP) production, are regarded as potential candidate intermediates between adipose tissue and overweight-induced hypertension. METHODS: We examined the associations between leptin......, adiponectin, and CRP levels with both prevalent and 5-year incident hypertension (IHT) in a general population of Danish adults (n = 5,868, 51.3% women, mean age 45.8 ± 7.9 years). RESULTS: We recorded 2195 prevalent and 379 incident cases of hypertension. In models including leptin, CRP, adiponectin, sex.......023) in the fully adjusted model. The population attributable risk estimate of IHT owing to overweight was 31%. CONCLUSION: Leptin, but not adiponectin or CRP, may play a mediating role in overweight-induced hypertension. However, as BMI was a strong independent predictor of hypertension, other factors than leptin...

Management of hypertension in pregnancy.

Science.gov (United States)

Chung, N A; Beevers, D G; Lip, G Y

2001-01-01

Hypertension is an important cause of both maternal and fetal morbidity and mortality in pregnant women. There are still no definitive guidelines as to when and how patients should be treated, but it is important that appropriate treatment is initiated early in patients at highest risk and they are closely monitored. Hypertension in pregnancy can be a difficult condition to diagnose and treat because of the numerous and differing classification systems that have been used in the past. One classification system, which accounts for the multisystem involvement which can occur in pre-eclampsia and eclampsia, divides hypertension in pregnancy into 3 main groups: pre-eclampsia, gestational hypertension and chronic hypertension. Little benefit to the fetus has been shown from treating gestational and chronic hypertension, but studies in this area have been small and would not have had the power to show a difference in outcome between treated and untreated groups. However, the reduction in morbidity and mortality in the treatment of pre-eclampsia is significant. Therefore, all pregnancies complicated by hypertension require monitoring to detect the possible onset of superimposed pre-eclampsia/eclampsia. Institutions should have a management strategy for those mothers with severe hypertension including a multidisciplinary approach, where the patient is to be monitored and which antihypertensive agents are to be used. It should not be forgotten that the definitive treatment for severe hypertension is delivery of the fetus despite risks to fetal morbidity and mortality. This will reduce blood pressure, but hypertension per se may still persist post partum requiring short term therapy.

[Diagnostic of secondary hypertension in clinical practice].

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Somlóová, Z; Rosa, J; Petrák, O; Strauch, B; Zelinka, T; Holaj, R; Widimský, J

2011-09-01

Arterial hypertension is a common worldwide disease with a prevalence of approximately 26%. Secondary cause is known in 5-10% of patients with hypertension. We should think of secondary hypertension in all patients with resistant hypertension, in patients with sudden deterioration in the control of hypertension and in patients with laboratory and clinical signs of diseases associated with secondary hypertension. It is important to distinguish between secondary hypertension and pseudo-resistance (noncompliance to treatment, white coat syndrome). Secondary causes of hypertension can be divided into endocrine (primary aldosteronism, pheochromocytoma, hypercortisolism, hyperparathyreoidism), renal - renovascular and renal parenchymal hypertension, and other causes as sleep apnoe syndrome, hypertension in pregnancy, coarctation of the aorta and intracranial tumors.

Monitoring of awareness level in dispensary patients with arterial hypertension.

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Smiianov, Vladyslav; Witczak, Izabela; Smiianova, Olga; Rudenko, Lesia

2017-01-01

Results of monitoring of awareness level in dispensary patients with arterial hypertension (AH) are given in the article. The objective of the study was to investigate awareness level of dispensary patients with hypertension in Sumy as for the course of their disease, implementation of preventive measures, diagnosis and treatment, and to use the obtained information in the process of management of healthcare quality. The results of close-ended questionnaires were used in the capacity of materials. A total of 2019 patients were surveyed. Despite the high level of patients' awareness of AH course and possible complications, the survey showed insufficient level of their own responsibility for their health. The main reasons for poor adherence to doctor's recommendations are forgetfulness, lack of time, reluctance. Measures were developed to increase awareness level in patients with AH by means of strengthening awareness-raising activities and communications, as well as creation and implementation of effective targeted health-and-social programs.

Prevention of hypertension in patients with pre-hypertension: protocol for the PREVER-prevention trial

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Neto José

2011-03-01

Full Text Available Abstract Background Blood pressure (BP within pre-hypertensive levels confers higher cardiovascular risk and is an intermediate stage for full hypertension, which develops in an annual rate of 7 out of 100 individuals with 40 to 50 years of age. Non-drug interventions to prevent hypertension have had low effectiveness. In individuals with previous cardiovascular disease or diabetes, the use of BP-lowering agents reduces the incidence of major cardiovascular events. In the absence of higher baseline risk, the use of BP agents reduces the incidence of hypertension. The PREVER-prevention trial aims to investigate the efficacy, safety and feasibility of a population-based intervention to prevent the incidence of hypertension and the development of target-organ damage. Methods This is a randomized, double-blind, placebo-controlled clinical trial, with participants aged 30 to 70 years, with pre-hypertension. The trial arms will be chlorthalidone 12.5 mg plus amiloride 2.5 mg or identical placebo. The primary outcomes will be the incidence of hypertension, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new sub-clinical atherosclerosis, and sudden death. The study will last 18 months. The sample size was calculated on the basis of an incidence of hypertension of 14% in the control group, a size effect of 40%, power of 85% and P alpha of 5%, resulting in 625 participants per group. The project was approved by the Ethics committee of each participating institution. Discussion The early use of blood pressure-lowering drugs, particularly diuretics, which act on the main mechanism of blood pressure rising with age, may prevent cardiovascular events and the incidence of hypertension in individuals with hypertension. If this intervention shows to be effective and safe

Sex differences in resting hemodynamics and arterial stiffness following 4 weeks of resistance versus aerobic exercise training in individuals with pre-hypertension to stage 1 hypertension

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Collier Scott R

2011-08-01

Full Text Available Abstract Background Hypertension (HTN exhibits sexual dimorphism; the incidence for women surpasses men during the sixth decade of life, while the pharmacological treatments are less effective and produce more side-effects in women than in men. Aerobic exercise (AE has been shown to prevent and treat HTN; however, resistance exercise (RE is not recommended as a strategy to treat HTN. In this study, we investigated the potential sex differences of AE versus RE in a cohort of unmedicated patients with hypertension. Methods In total, 40 moderately active, pre-hypertensive or stage 1 essential hypertensive male (M and female (F participants aged 40 to 60 years were randomly divided into four groups: M AE, M RE, F AE, and F. Each group exercised at moderate intensity, 3 days/week for 4 weeks. Hemodynamic, vascular and blood-flow data were collected before and after exercise training. Results Men showed a significant increase in central pulse wave velocity following RE while females showed no significant changes (12 ± to 13.9 ± vs. 9.2 ± to 9.6 ± m/s, respectively. RE showed significantly greater increases in peak blood flow when compared to AE (F RE 15 ± to 20 ± vs. F AE 17.5 ± to19.5 ±, M RE 19 ± to 24 ± vs M AE 21 ± to 25 ± ml* 100 ml*min, respectively. In addition, systolic and diastolic BP decreased greater for women following RE when compared to AE whereas men showed comparable decreases in BP following either exercise mode. Conclusion Moderate-intensity RE training may be a more favorable for women as a treatment option for hypertension because of greater decreases in diastolic BP and significant increases in flow-mediated dilation without concomitant increases in arterial stiffness, compared with their male counterparts.

From malignant hypertension to hypertension-MOD: a modern definition for an old but still dangerous emergency

NARCIS (Netherlands)

Cremer, A.; Amraoui, F.; Lip, G. Y. H.; Morales, E.; Rubin, S.; Segura, J.; van den Born, B. J.; Gosse, P.

2016-01-01

The prevalence of malignant hypertension has clearly fallen with the advent of anti-hypertensive medication but has remained stable over the past 30-40 years in spite of progress in diagnosis and management of hypertension. A diagnosis of malignant hypertension is usually based on the association of

Hypertension, a health economics perspective.

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Alcocer, Luis; Cueto, Liliana

2008-06-01

The economic aspects of hypertension are critical to modern medicine. The medical, economic, and human costs of untreated and inadequately controlled hypertension are enormous. Hypertension is distributed unequally and with iniquity in different countries and regions of the world. Treatment of hypertension requires an investment over many years to prolong disease-free quality years of life. The high prevalence and high cost of the disease impacts on the microeconomics and macroeconomics of countries and regions. The criteria used for inclusion in clinical guidelines for hypertension impact on the cost and cost/utility of diagnosis or treatment.

Prevalence and persistence of masked hypertension in treated hypertensive patients

NARCIS (Netherlands)

Verberk, Willem J.; Thien, Theo; Kroon, Abraham A.; Lenders, Jacques W. M.; van Montfrans, Gert A.; Smit, Andries J.; de Leeuw, Peter W.

2007-01-01

Background: Masked hypertension (MH) is defined as a normal blood pressure in the physician's office and an elevated blood pressure when measured out-of-office. The cause of MH may be termed the masked hypertension effect (MHE), and is not restricted to blood-pressure (BP) values around the

Prevalence and persistence of masked hypertension in treated hypertensive patients.

NARCIS (Netherlands)

Verberk, W.J.; Thien, Th.; Kroon, A.A.; Lenders, J.W.M.; Montfrans, G.A. van; Smit, A.J.; Leeuw, P.W. de

2007-01-01

BACKGROUND: Masked hypertension (MH) is defined as a normal blood pressure in the physician's office and an elevated blood pressure when measured out-of-office. The cause of MH may be termed the masked hypertension effect (MHE), and is not restricted to blood-pressure (BP) values around the

Prevalence and persistence of masked hypertension in treated hypertensive patients

NARCIS (Netherlands)

Verberk, Willem J.; Thien, Theo; Kroon, Abraham A.; Lenders, Jacques W. M.; van Montfrans, Gert A.; Smit, Andries J.; de Leeuw, Peter W.

2007-01-01

BACKGROUND: Masked hypertension (MH) is defined as a normal blood pressure in the physician's office and an elevated blood pressure when measured out-of-office. The cause of MH may be termed the masked hypertension effect (MHE), and is not restricted to blood-pressure (BP) values around the

Self-monitoring blood pressure in patients with hypertension: an internet-based survey of UK GPs.

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Fletcher, Benjamin R; Hinton, Lisa; Bray, Emma P; Hayen, Andrew; Hobbs, Fd Richard; Mant, Jonathan; Potter, John F; McManus, Richard J

2016-11-01

Previous research suggests that most GPs in the UK use self-monitoring of blood pressure (SMBP) to monitor the control of hypertension rather than for diagnosis. This study sought to assess current practice in the use of self-monitoring and any changes in practice following more recent guideline recommendations. To survey the views and practice of UK GPs in 2015 with regard to SMBP and compare them with a previous survey carried out in 2011. Web-based survey of a regionally representative sample of 300 UK GPs. GPs completed an online questionnaire concerning the use of SMBP in the management of hypertension. Analyses comprised descriptive statistics, tests for between-group differences (z, Wilcoxon signed-rank, and χ 2 tests), and multivariate logistic regression. Results were available for 300 GPs (94% of those who started the survey). GPs reported using self-monitoring to diagnose hypertension (169/291; 58%; 95% confidence interval (CI) = 52 to 64) and to monitor control (245/291; 84%; 95% CI = 80 to 88), the former having significantly increased since 2011 (from 37%; 95% CI = 33 to 41; Pmonitoring for control. More than half of GPs used higher systolic thresholds for diagnosis (118/169; 70%; 95% CI = 63 to 77) and treatment (168/225; 75%; 95% CI = 69 to 80) than recommended in guidelines, and under half (120/289; 42%; 95% CI = 36 to 47) adjusted the SMBP results to guide treatment decisions. Since new UK national guidance in 2011, GPs are more likely to use SMBP to diagnose hypertension. However, significant proportions of GPs continue to use non-standard diagnostic and monitoring thresholds. The use of out-of-office methods to improve the accuracy of diagnosis is unlikely to be beneficial if suboptimal thresholds are used. © British Journal of General Practice 2016.

Hunting for genes for hypertension: the Millennium Genome Project for Hypertension.

Science.gov (United States)

Tabara, Yasuharu; Kohara, Katsuhiko; Miki, Tetsuro

2012-06-01

The Millennium Genome Project for Hypertension was started in 2000 to identify genetic variants conferring susceptibility to hypertension, with the aim of furthering the understanding of the pathogenesis of this condition and realizing genome-based personalized medical care. Two different approaches were launched, genome-wide association analysis using single-nucleotide polymorphisms (SNPs) and microsatellite markers, and systematic candidate gene analysis, under the hypothesis that common variants have an important role in the etiology of common diseases. These multilateral approaches identified ATP2B1 as a gene responsible for hypertension in not only Japanese but also Caucasians. The high blood pressure susceptibility conferred by certain alleles of ATP2B1 has been widely replicated in various populations. Ex vivo mRNA expression analysis in umbilical artery smooth muscle cells indicated that reduced expression of this gene associated with the risk allele may be an underlying mechanism relating the ATP2B1 variant to hypertension. However, the effect size of a SNP was too small to clarify the entire picture of the genetic basis of hypertension. Further, dense genome analysis with accurate phenotype data may be required.

[Control of hypertension in nursing homes].

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Thomas, J M; Alvarez, W; Mulaj, M; De Breucker, S; Leeman, M; Pepersack, T

2006-09-01

In a cross sectional study we determined prevalence of hypertension among institutionalized old subjects. Prevalence of hypertension was 69%. Among detected hypertensive patients, 76% received an antihypertensive drug treatment. 61% of the declared hypertensive patients and 80% of the treated hypertensive patients had their blood pressure controlled. The general practitioners should better detect and treat this common geriatric problem associated with a high comorbidity.

Pulmonary Arterial Hypertension

Science.gov (United States)

... heart). This type of pulmonary hypertension was called “secondary pulmonary hypertension” but is now referred to as PH, because the cause is known to be from lung disease, heart disease, or chronic thromboemboli (blood clots). Pulmonary Arterial Hypertension (PAH) used to be ...

Hypertension in the African American population: A succinct look at its epidemiology, pathogenesis, and therapy

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Luis M. Ortega

2015-03-01

Full Text Available Arterial hypertension is prevalent in the black population in the United States. It is directly related to cardiovascular and kidney damage. Its pathogenesis is complex and includes the high incidence of obesity, salt sensitivity and the activation of the renin-angiotensinaldosterone system. This complexity requires a therapeutic combination that includes changes in dietary habits and appropriate antihypertensive regimes. The International Society of Hypertension in Blacks recommends initiating dietary intervention for values of systolic/diastolic arterial blood pressure above 115/75 mmHg and maintaining arterial blood pressure below 135/85 mmHg using appropiate antihypertensive medication. The most adequate antihypertensive drug for this population has yet to be determined.

Hypertension in the African American population: A succinct look at its epidemiology, pathogenesis, and therapy

Directory of Open Access Journals (Sweden)

Luis M Ortega

2015-03-01

Full Text Available Arterial hypertension is prevalent in the black population in the United States. It is directly related to cardiovascular and kidney damage. Its pathogenesis is complex and includes the high incidence of obesity, salt sensitivity and the activation of the renin-angiotensinaldosterone system. This complexity requires a therapeutic combination that includes changes in dietary habits and appropriate antihypertensive regimes. The International Society of Hypertension in Blacks recommends initiating dietary intervention for values of systolic/ diastolic arterial blood pressure above 115/75 mmHg and maintaining arterial blood pressure below 135/85 mmHg using appropiate antihypertensive medication. The most adequate antihypertensive drug for this population has yet to be determined.

Taste and hypertension in humans

DEFF Research Database (Denmark)

Roura, Eugeni; Foster, Simon; Winklebach, Anja

2016-01-01

The association between salty taste and NaCl intake with hypertension is well-established, although it is far from completely understood. Other taste types such as sweet, umami or bitter have also been related to alterations in blood pressure. Here, we review the mutual relationship between taste...... and hypertension to identify potential avenues to better control blood pressure. This review focuses on published data involving humans, with the exception of a section on molecular mechanisms. There is compelling evidence to suggest that changes in salty taste sensitivity can be used to predict the onset...... of hypertension. This goes hand in hand with the medical concept of sodium sensitivity, which also increases with age, particularly in hypertensive patients. The association of hypertension with the loss of taste acuity less definitive with some data/conclusions masked by the use of anti-hypertensive drugs...

Pulmonary Hypertension and Pulmonary Vasodilators.

Science.gov (United States)

Keller, Roberta L

2016-03-01

Pulmonary hypertension in the perinatal period can present acutely (persistent pulmonary hypertension of the newborn) or chronically. Clinical and echocardiographic diagnosis of acute pulmonary hypertension is well accepted but there are no broadly validated criteria for echocardiographic diagnosis of pulmonary hypertension later in the clinical course, although there are significant populations of infants with lung disease at risk for this diagnosis. Contributing cardiovascular comorbidities are common in infants with pulmonary hypertension and lung disease. It is not clear who should be treated without confirmation of pulmonary vascular disease by cardiac catheterization, with concurrent evaluation of any contributing cardiovascular comorbidities. Copyright © 2016 Elsevier Inc. All rights reserved.

From malignant hypertension to hypertension-MOD: a modern definition for an old but still dangerous emergency.

Science.gov (United States)

Cremer, A; Amraoui, F; Lip, G Y H; Morales, E; Rubin, S; Segura, J; Van den Born, B J; Gosse, P

2016-08-01

The prevalence of malignant hypertension has clearly fallen with the advent of anti-hypertensive medication but has remained stable over the past 30-40 years in spite of progress in diagnosis and management of hypertension. A diagnosis of malignant hypertension is usually based on the association of severely elevated blood pressure with a Keith and Wagener stage III or IV retinopathy. We believe that this definition can be reconsidered for several reasons. Although simple and pragmatic, this definition corresponds to a time when there were few techniques for assessment of hypertensive target organ involvement, and does not take into account involvement of kidney, brain and heart; whereas the overall prognosis largely depends on how much they are affected. On the contrary, the acute blood pressure level and especially diastolic should not be a hard diagnostic criterion as it does not itself constitute the prognosis of the condition. We propose to consider that malignant hypertension with retinopathy is only one of a number of possible presentation(s) of acute hypertension with multi organ damage (hypertension multi organ damage (MOD)) and that the recognition of these hypertensive emergencies, when retinopathy is lacking, be based on acute elevation of BP associated with impairment of at least three different target organs. The objective of a new and expanded definition is to facilitate recognition of these true emergencies. The condition is more common than usually perceived and would have a much worse prognosis than the usual forms of hypertension. Early recognition and management of hypertension-MOD are fundamental to any improvement in prognosis.

Characteristics of Resistant Hypertension in a Large Ethnically Diverse Hypertension Population of an Integrated Health System

Science.gov (United States)

Sim, John J.; Bhandari, Simran K.; Shi, Jiaxiao; In Liu, Lu A.; Calhoun, David A.; McGlynn, Elizabeth A.; Kalantar-Zadeh, Kamyar; Jacobsen, Steven J.

2013-01-01

Objective To evaluate the prevalence and characterize resistant hypertension from a large representative population with successful hypertension management and reliable health information. Patient and Methods We performed a cross sectional study using clinical encounter, laboratory, and administrative information from the Kaiser Permanente Southern California health system during 1/1/2006–12/31/2007. From individuals age >17 years with hypertension, resistant hypertension was identified and prevalence determined. Multivariable logistic regression was used to calculate odds ratios (OR) with adjustments for demographics, clinical variables, and medication use. Results Among 470,386 hypertensive individuals, 12.8% were identified as resistant representing15.3% of those on medications. Overall, 37,061 (7.9%) had uncontrolled hypertension while on ≥ 3 medicines. OR (95% confidence interval) for resistant hypertension were greater for black race (1.68, 1.62–1.75), older age (1.11, 1.10–1.11 for every 5 year increase), males (1.06, 1.03–1.10), and obesity (1.46, 1.42–1.51). Medication adherence rates were higher in resistant hypertension (93 vs 90%, phypertension. Conclusion Within a more standardized hypertension treatment environment, we observed a rate of resistant hypertension comparable to past studies using more fragmented data sources. Past observations have been limited due to non-representative populations, reliability of the data, heterogeneity of the treatment environments, and less than ideal control rates. This cohort which was established with an electronic medical record based approach has the potential to provide a better understanding of resistant hypertension and outcomes. PMID:24079679

Hyperuricemia in Childhood Primary Hypertension

OpenAIRE

Feig, Daniel I.; Johnson, Richard J.

2003-01-01

Experimental animal models suggest that uric acid might have a pathogenic role in the early development of primary hypertension. We hypothesized that serum uric acid is correlated with blood pressure in children with new-onset, untreated, primary hypertension. We evaluated 125 consecutive children referred to the Baylor Pediatric Renal Program for evaluation of hypertension. None of the subjects had previously been evaluated or treated for hypertension. The children ranged in age from 6 to 18...

The Role of Headache in the Classification and Management of Hypertensive Disorders in Pregnancy.

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Sperling, Jeffrey D; Dahlke, Joshua D; Huber, Warren J; Sibai, Baha M

2015-08-01

Hypertensive disorders of pregnancy remain among the leading causes of maternal morbidity and mortality. The onset of headaches in patients with hypertensive disorders of pregnancy has been considered as a premonitory symptom for eclampsia and other adverse maternal outcomes. Headaches are very common symptoms during pregnancy and the postpartum period with a reported incidence of 39%; however, headache is absent in 30-50% of women before the onset of eclampsia and is a poor predictor of eclampsia and adverse maternal outcomes. If included in the definition of cerebral or visual disturbances, headache may be considered a symptom of preeclampsia, a diagnostic feature of preeclampsia with severe features, a premonitory symptom of eclampsia, and an indication for delivery. Inclusion of this nonspecific symptom in the diagnosis and management of hypertensive disorders of pregnancy in the absence of an evidence basis may lead to unintended consequences including excessive testing, visits to outpatient offices or emergency departments, additional hospitalization, and iatrogenic preterm delivery without proven benefit. If a cerebral disturbance such as severe or persistent headache presents for the first time during pregnancy or postpartum, an evaluation should be performed that considers a broad differential diagnosis, including but not limited to hypertensive disorders of pregnancy, and the diagnostic evaluation is similar to that in nonpregnant adults. This commentary draws attention to the implications of considering the cerebral disturbance of headache as a symptom that portends adverse pregnancy outcome in the current recommendations for diagnosing and managing hypertensive disorders of pregnancy.

Atorvastatin calcium plus amlodipine for the treatment of hypertension.

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Delgado-Montero, Antonia; Zamorano, Jose L

2012-12-01

Hypertension (HTN) and dyslipemia (DYL) are two of the major modifiable cardiovascular (CV) risk factors, determinants in the development of cerebrovascular and coronary heart disease (CHD). Many patients have both risk factors which increase their total CV risk compared with patients with only one risk factor. Treatment guideline recommendations are poorly implemented in real practice, in part due to numerous and complicated drug regimes which hamper patient´s adherence. In this article the authors describe the first combined fixed-dose pill of an antihypertensive and a lipid-lowering agent, the single-pill combination of amlodipine besylate and atorvastatin calcium (SPAA). They summarize the pharmacokinetic and pharmacodynamic properties of both compounds and the main randomized clinical studies, as well as real-world observational studies, made with the new combined formulation. The use of the single-pill amlodipine and atorvastatin is an adequate option for the clinician to treat hypertensive patients with DYL or high CV risk burden, with proven efficacy, tolerability, cost-effectiveness, and the advantage of improving patient treatment compliance.

Prevention and treatment of the chronic thromboembolic pulmonary hypertension.

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Pesavento, Raffaele; Prandoni, Paolo

2018-04-01

Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon and late complication of pulmonary embolism resulting from misguided remodelling of residual pulmonary thromboembolic material and small-vessel arteriopathy. CTEPH is the only form of pulmonary hypertension (PH) potentially curable by pulmonary endarterectomy (PEA). Unfortunately, several patients have either an unacceptable risk-benefit ratio for undergoing the surgical intervention or develop persistent PH after PEA. Novel medical and endovascular therapies can be considered for them. The soluble guanylate cyclase stimulator riociguat is recommended for the treatment of patients with inoperable disease or with recurrent/persistent PH after PEA. Other drugs developed for the treatment of other forms of PH, as prostanoids, phosphodiesterase-5 inhibitors and endothelin receptor antagonists have been used in the treatment of CTEPH, with limited benefit. Balloon pulmonary angioplasty is a novel and promising technique and is progressively emerging from the pioneering phase. Highly specialized training level and complex protocols of postoperative care are mandatory to consolidate the technical success of the surgical and endovascular intervention. Copyright © 2018 Elsevier Ltd. All rights reserved.

Significance of white-coat hypertension in older persons with isolated systolic hypertension

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Franklin, Stanley S; Thijs, Lutgarde; Hansen, Tine W

2012-01-01

The significance of white-coat hypertension in older persons with isolated systolic hypertension remains poorly understood. We analyzed subjects from the population-based 11-country International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes database who ...... had daytime ambulatory blood pressure (BP; ABP) and conventional BP (CBP) measurements. After excluding persons with diastolic hypertension by CBP (=90 mm Hg) or by daytime ABP (=85 mm Hg), a history of cardiovascular disease, and persons...

Prevalence of hypertension in the rural adult population of Osun State, southwestern Nigeria

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Asekun-Olarinmoye EO

2013-04-01

least a three times greater likelihood of developing hypertension than those with BMI < 25 (odds ratio 2.9, 95% confidence interval 0.007–0.056, P = 0.011.Conclusion: The prevalence of hypertension is high in this study population and we recommend scaling up primary prevention efforts to reduce this in Nigerian communities.Keywords: prevalence, hypertension, anthropometry, body mass index, rural community

Prevalence of hypertension and its risk factors in southwest Ethiopia: a hospital-based cross-sectional survey

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Gudina EK

2013-07-01

Full Text Available Esayas Kebede Gudina,1 Yadani Michael,1 Sahilu Assegid2 1Department of Internal Medicine, Jimma University, Jimma, Ethiopia; 2Department of Epidemiology, Jimma University, Jimma, Ethiopia Background: Hypertension is a common medical condition worldwide. It is an important public health challenge because of the associated morbidity, mortality, and the cost to the society. The objective of this study was to determine the prevalence of hypertension and its risk factors among attendants of adult outpatient departments at Jimma University Specialized Hospital in southwest Ethiopia. Materials and methods: A hospital-based cross-sectional study was conducted on 734 participants aged 15 years or older from May 2012 to June 2012. A pretested structured questionnaire consisting of characteristics related to sociodemographic profiles and risk factors for hypertension was used for data collection. Three separate measurements of blood pressure and relevant anthropometric evaluation were taken according to current recommended standards. Chi-square test and other statistical analyses were done to employ appropriate interpretations of the findings. P-values of <0.05 were considered statistically significant. Results: The mean age of the participants was 42.3 ± 13.2 years and 71.7% of them were 35 years and older; 58% of them were females. Overall prevalence of hypertension – defined by systolic blood pressure ≥140 and/or diastolic blood pressure ≥90 or reporting history of hypertension – was found to be 13.2%. Only 35.1% of them were aware of their hypertension and only 23.7% were on treatment. The overall control rate was 15.5%. Family history of hypertension, having diabetes mellitus, being overweight, and oral contraceptive use were associated with high blood pressure. Conclusion: Hypertension was found to be prevalent; morbidity, awareness, treatment, and control in those with hypertension were low. Hence, intervention measures should be undertaken

Hypertension prevalence and influence of basal metabolic rate on blood pressure among adult students in Bangladesh.

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Ali, Nurshad; Mahmood, Shakil; Manirujjaman, M; Perveen, Rasheda; Al Nahid, Abdullah; Ahmed, Shamim; Khanum, Farida Adib; Rahman, Mustafizur

2017-07-25

study also showed a positive association between BMR and blood pressure among the participants. A large scale longitudinal study across the country is needed to find out the underlying causes of hypertension in the Bangladeshi adults. In addition, comprehensive and integrated intervention programs focusing on modifiable risk factors are recommended to make awareness and prevent hypertension.

The evaluation of arterial stiffness of essential hypertension and white coat hypertension in children: a case-control study.

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Tokgöz, Semiha Terlemez; Yılmaz, Dilek; Tokgöz, Yavuz; Çelik, Bülent; Bulut, Yasin

2018-03-01

The aim of this study was to determine and compare cardiovascular risks by assessing arterial stiffness in children with essential hypertension and white coat hypertension. Paediatric patients followed up with essential hypertension and white coat hypertension diagnoses and with no established end organ damage were involved in the study. Arterial stiffness in children included in the study was evaluated and compared by using the oscillometric device (Mobil-O-Graph) method. A total of 62 essential hypertension (34 male, 28 female), 38 white coat hypertension (21 male, 17 female), and 60 healthy controls (33 male, 27 female) were assessed in the present study. Pulse wave velocity of the essential hypertension, white coat hypertension, and control group was, respectively, as follows: 5.3±0.6 (m/s), 5.1±0.4 (m/s), 4.3±0.4 (m/s) (pcoat hypertension were found to be higher compared with the control group. This level was identified as correlated with the duration of hypertension in both patient groups (pcoat hypertension was impaired compared with healthy children. This finding has made us think that white coat hypertension is not an innocent clinical situation. This information should be taken into consideration in the follow-up and treatment approaches of the patients.

The evolving definition of systemic arterial hypertension.

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Ram, C Venkata S; Giles, Thomas D

2010-05-01

Systemic hypertension is an important risk factor for premature cardiovascular disease. Hypertension also contributes to excessive morbidity and mortality. Whereas excellent therapeutic options are available to treat hypertension, there is an unsettled issue about the very definition of hypertension. At what level of blood pressure should we treat hypertension? Does the definition of hypertension change in the presence of co-morbid conditions? This article covers in detail the evolving concepts in the diagnosis and management of hypertension.

[Neurovascular compression of the medulla oblongata: a rare cause of secondary hypertension].

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Nádas, Judit; Czirják, Sándor; Igaz, Péter; Vörös, Erika; Jermendy, György; Rácz, Károly; Tóth, Miklós

2014-05-25

Compression of the rostral ventrolateral medulla oblongata is one of the rarely identified causes of refractory hypertension. In patients with severe, intractable hypertension caused by neurovascular compression, neurosurgical decompression should be considered. The authors present the history of a 20-year-old man with severe hypertension. After excluding other possible causes of secondary hypertension, the underlying cause of his high blood pressure was identified by the demonstration of neurovascular compression shown by magnetic resonance angiography and an increased sympathetic activity (sinus tachycardia) during the high blood pressure episodes. Due to frequent episodes of hypertensive crises, surgical decompression was recommended, which was performed with the placement of an isograft between the brainstem and the left vertebral artery. In the first six months after the operation, the patient's blood pressure could be kept in the normal range with significantly reduced doses of antihypertensive medication. Repeat magnetic resonance angiography confirmed the cessation of brainstem compression. After six months, increased blood pressure returned periodically, but to a smaller extent and less frequently. Based on the result of magnetic resonance angiography performed 22 months after surgery, re-operation was considered. According to previous literature data long-term success can only be achieved in one third of patients after surgical decompression. In the majority of patients surgery results in a significant decrease of blood pressure, an increased efficiency of antihypertensive therapy as well as a decrease in the frequency of highly increased blood pressure episodes. Thus, a significant improvement of the patient's quality of life can be achieved. The case of this patient is an example of the latter scenario.

Joint UK societies' 2014 consensus statement on renal denervation for resistant hypertension.

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Lobo, Melvin D; de Belder, Mark A; Cleveland, Trevor; Collier, David; Dasgupta, Indranil; Deanfield, John; Kapil, Vikas; Knight, Charles; Matson, Matthew; Moss, Jonathan; Paton, Julian F R; Poulter, Neil; Simpson, Iain; Williams, Bryan; Caulfield, Mark J

2015-01-01

Resistant hypertension continues to pose a major challenge to clinicians worldwide and has serious implications for patients who are at increased risk of cardiovascular morbidity and mortality with this diagnosis. Pharmacological therapy for resistant hypertension follows guidelines-based regimens although there is surprisingly scant evidence for beneficial outcomes using additional drug treatment after three antihypertensives have failed to achieve target blood pressure. Recently there has been considerable interest in the use of endoluminal renal denervation as an interventional technique to achieve renal nerve ablation and lower blood pressure. Although initial clinical trials of renal denervation in patients with resistant hypertension demonstrated encouraging office blood pressure reduction, a large randomised control trial (Symplicity HTN-3) with a sham-control limb, failed to meet its primary efficacy end point. The trial however was subject to a number of flaws which must be taken into consideration in interpreting the final results. Moreover a substantial body of evidence from non-randomised smaller trials does suggest that renal denervation may have an important role in the management of hypertension and other disease states characterised by overactivation of the sympathetic nervous system. The Joint UK Societies does not recommend the use of renal denervation for treatment of resistant hypertension in routine clinical practice but remains committed to supporting research activity in this field. A number of research strategies are identified and much that can be improved upon to ensure better design and conduct of future randomised studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Secondary Hypertension: Discovering the Underlying Cause.

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Charles, Lesley; Triscott, Jean; Dobbs, Bonnie

2017-10-01

Most patients with hypertension have no clear etiology and are classified as having primary hypertension. However, 5% to 10% of these patients may have secondary hypertension, which indicates an underlying and potentially reversible cause. The prevalence and potential etiologies of secondary hypertension vary by age. The most common causes in children are renal parenchymal disease and coarctation of the aorta. In adults 65 years and older, atherosclerotic renal artery stenosis, renal failure, and hypothyroidism are common causes. Secondary hypertension should be considered in the presence of suggestive symptoms and signs, such as severe or resistant hypertension, age of onset younger than 30 years (especially before puberty), malignant or accelerated hypertension, and an acute rise in blood pressure from previously stable readings. Additionally, renovascular hypertension should be considered in patients with an increase in serum creatinine of at least 50% occurring within one week of initiating angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy; severe hypertension and a unilateral smaller kidney or difference in kidney size greater than 1.5 cm; or recurrent flash pulmonary edema. Other underlying causes of secondary hypertension include hyperaldosteronism, obstructive sleep apnea, pheochromocytoma, Cushing syndrome, thyroid disease, coarctation of the aorta, and use of certain medications.

Prognostic model for chronic hypertension in women with a history of hypertensive pregnancy disorders at term.

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Visser, V S; Hermes, W; Twisk, J; Franx, A; van Pampus, M G; Koopmans, C; Mol, B W J; de Groot, C J M

2017-10-01

The association between hypertensive pregnancy disorders and cardiovascular disease later in life is well described. In this study we aim to develop a prognostic model from patients characteristics known before, early in, during and after pregnancy to identify women at increased risk of cardiovascular disease e.g. chronic hypertension years after pregnancy complicated by hypertension at term. We included women with a history of singleton pregnancy complicated by hypertension at term. Women using antihypertensive medication before pregnancy were excluded. We measured hypertension in these women more than 2years postpartum. Different patients characteristics before, early in, during and after pregnancy were considered to develop a prognostic model of chronic hypertension at 2-years. These included amongst others maternal age, blood pressure at pregnancy intake and blood pressure six weeks post-partum. Univariable analyses followed by a multivariable logistic regression analysis was performed to determine which combination of predictors best predicted chronic hypertension. Model performance was assessed by calibration (graphical plot) and discrimination (area under the receiver operating characteristic (AUC)). Of the 305 women in who blood pressure 2.5years after pregnancy was assessed, 105 women (34%) had chronic hypertension. The following patient characteristics were significant associated with chronic hypertension: higher maternal age, lower education, negative family history on hypertensive pregnancy disorders, higher BMI at booking, higher diastolic blood pressure at pregnancy intake, higher systolic blood pressure during pregnancy and higher diastolic blood pressure at six weeks post-partum. These characteristics were included in the prognostic model for chronic hypertension. Model performance was good as indicated by good calibration and good discrimination (AUC; 0.83 (95% CI 0.75 - 0.92). Chronic hypertension can be expected from patient characteristics

Prognosis of white-coat and masked hypertension: International Database of HOme blood pressure in relation to Cardiovascular Outcome.

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Stergiou, George S; Asayama, Kei; Thijs, Lutgarde; Kollias, Anastasios; Niiranen, Teemu J; Hozawa, Atsushi; Boggia, José; Johansson, Jouni K; Ohkubo, Takayoshi; Tsuji, Ichiro; Jula, Antti M; Imai, Yutaka; Staessen, Jan A

2014-04-01

Home blood pressure monitoring is useful in detecting white-coat and masked hypertension and is recommended for patients with suspected or treated hypertension. The prognostic significance of white-coat and masked hypertension detected by home measurement was investigated in 6458 participants from 5 populations enrolled in the International Database of HOme blood pressure in relation to Cardiovascular Outcomes. During a median follow-up of 8.3 years, 714 fatal plus nonfatal cardiovascular events occurred. Among untreated subjects (n=5007), cardiovascular risk was higher in those with white-coat hypertension (adjusted hazard ratio 1.42; 95% CI [1.06-1.91]; P=0.02), masked hypertension (1.55; 95% CI [1.12-2.14]; P<0.01) and sustained hypertension (2.13; 95% CI [1.66-2.73]; P<0.0001) compared with normotensive subjects. Among treated patients (n=1451), the cardiovascular risk did not differ between those with high office and low home blood pressure (white-coat) and treated controlled subjects (low office and home blood pressure; 1.16; 95% CI [0.79-1.72]; P=0.45). However, treated subjects with masked hypertension (low office and high home blood pressure; 1.76; 95% CI [1.23-2.53]; P=0.002) and uncontrolled hypertension (high office and home blood pressure; 1.40; 95% CI [1.02-1.94]; P=0.04) had higher cardiovascular risk than treated controlled patients. In conclusion, white-coat hypertension assessed by home measurements is a cardiovascular risk factor in untreated but not in treated subjects probably because the latter receive effective treatment on the basis of their elevated office blood pressure. In contrast, masked uncontrolled hypertension is associated with increased cardiovascular risk in both untreated and treated patients, who are probably undertreated because of their low office blood pressure.

Cervical Spondylosis and Hypertension

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Peng, Baogan; Pang, Xiaodong; Li, Duanming; Yang, Hong

2015-01-01

Abstract Cervical spondylosis and hypertension are all common diseases, but the relationship between them has never been studied. Patients with cervical spondylosis are often accompanied with vertigo. Anterior cervical discectomy and fusion is an effective method of treatment for cervical spondylosis with cervical vertigo that is unresponsive to conservative therapy. We report 2 patients of cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully with anterior cervical discectomy and fusion. Stimulation of sympathetic nerve fibers in pathologically degenerative disc could produce sympathetic excitation, and induce a sympathetic reflex to cause cervical vertigo and hypertension. In addition, chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms. Cervical spondylosis may be one of the causes of secondary hypertension. Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis. PMID:25761188

Preventing cardiovascular disease after hypertensive disorders of pregnancy: Searching for the how and when.

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Groenhof, T Katrien J; van Rijn, Bas B; Franx, Arie; Roeters van Lennep, Jeanine E; Bots, Michiel L; Lely, A Titia

2017-11-01

Background Women with a history of a hypertensive disorder during pregnancy (HDP) have an increased risk of cardiovascular events. Guidelines recommend assessment of cardiovascular risk factors in these women later in life, but provide limited advice on how this follow-up should be organized. Design Systematic review and meta-regression analysis. Methods The aim of our study was to provide an overview of existing knowledge on the changes over time in three major modifiable components of cardiovascular risk assessment after HDP: blood pressure, glucose homeostasis and lipid levels. Data from 44 studies and up to 6904 women with a history of a HDP were compared with risk factor levels reported for women of corresponding age in the National Health And Nutrition Examination Survey, Estudio Epidemiólogico de la Insuficiencia Renal en España and Hong Kong cohorts ( N = 27,803). Results Compared with the reference cohort, women with a HDP presented with higher mean blood pressure. Hypertension was present in a higher rate among women with a previous HDP from 15 years postpartum onwards. At 15 years postpartum (±age 45), one in five women with a history of a HDP suffer from hypertension. No differences in glucose homeostasis parameters or lipid levels were observed. Conclusions Based on our analysis, it is not possible to point out a time point to commence screening for cardiovascular risk factors in women after a HDP. We recommend redirection of future research towards the development of a stepwise approach identifying the women with the highest cardiovascular risk.

EMERGENCY STATES IN ARTERIAL HYPERTENSION

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M. A. Gurevich

2014-01-01

Full Text Available The article describes in detail potential emergency states in patients with different stages of arterial hypertension with special attention to diagnosis and rational management of hypertensive crisis. Differentiated approach to management of different forms of hypertensive crisis is specified.

Hypertension and experimental stroke therapies

OpenAIRE

O'Collins, Victoria E; Donnan, Geoffrey A; Macleod, Malcolm R; Howells, David W

2013-01-01

Hypertension is an established target for long-term stroke prevention but procedures for management of hypertension in acute stroke are less certain. Here, we analyze basic science data to examine the impact of hypertension on candidate stroke therapies and of anti-hypertensive treatments on stroke outcome. Methods: Data were pooled from 3,288 acute ischemic stroke experiments (47,899 animals) testing the effect of therapies on infarct size (published 1978–2010). Data were combined using meta...

ESH-ESC guidelines for the management of hypertension.

Science.gov (United States)

Erdine, Serap; Ari, Oben; Zanchetti, A; Cifkova, R; Fagard, R; Kjeldsen, S; Mancia, G; Poulter, N; Rahn, K H; Rodicio, J L; Ruilope, L M; Staessen, J; van Zwieten, P; Waeber, B; Williams, B

2006-06-01

The following is a brief statement of the 2003 European Society of Hypertension (ESH)-European Society of Cardiology (ESC) guidelines for the management of arterial hypertension. The continuous relationship between the level of blood pressure and cardiovascular risk makes the definition of hypertension arbitrary. Since risk factors cluster in hypertensive individuals, risk stratification should be made and decision about the management should not be based on blood pressure alone, but also according to the presence or absence of other risk factors, target organ damage, diabetes, and cardiovascular or renal damage, as well as on other aspects of the patient's personal, medical and social situation. Blood pressure values measured in the doctor's office or the clinic should commonly be used as reference. Ambulatory blood pressure monitoring may have clinical value, when considerable variability of office blood pressure is found over the same or different visits, high office blood pressure is measured in subjects otherwise at low global cardiovascular risk, there is marked discrepancy between blood pressure values measured in the office and at home, resistance to drug treatment is suspected, or research is involved. Secondary hypertension should always be investigated. The primary goal of treatment of patient with high blood pressure is to achieve the maximum reduction in long-term total risk of cardiovascular morbidity and mortality. This requires treatment of all the reversible factors identified, including smoking, dislipidemia, or diabetes, and the appropriate management of associated clinical conditions, as well as treatment of the raised blood pressure per se. On the basis of current evidence from trials, it can be recommended that blood pressure, both systolic and diastolic, be intensively lowered at least below 140/90 mmHg and to definitely lower values, if tolerated, in all hypertensive patients, and below 130/80 mmHg in diabetics. Lifestyle measures should be

Severe pulmonary hypertension associated with the acute motor sensory axonal neuropathy subtype of Guillain-Barré syndrome.

Science.gov (United States)

Rooney, Kris A; Thomas, Neal J

2010-01-01

To evaluate pulmonary hypertension associated with acute motor sensory axonal neuropathy subtype of Guillain-Barré syndrome. Guillain-Barré syndrome consists of a group of autoimmune disorders that generally manifest as symmetric, progressive, ascending paralysis. There are five subtypes of Guillain-Barré syndrome, and autonomic involvement has been described in all subtypes, including cardiovascular, vasomotor, or pseudomotor dysfunction of both the sympathetic and parasympathetic systems. Case report. Tertiary care pediatric intensive care unit. Three-yr-old female patient. None. Serial measurements of pulmonary artery pressure. We report the case of a young girl with acute motor sensory axonal neuropathy who presented with severe cardiovascular collapse secondary to severe pulmonary hypertension. In this patient, multiple factors may have played a role in the development of pulmonary hypertension including autonomic dysfunction, hypoventilation, and immobility as a risk for thrombosis and pulmonary emboli. It is possible that many other individuals suffering from severe forms of Guillain-Barré syndrome, especially those with significant autonomic dysfunction, may actually have undiagnosed and therefore untreated pulmonary hypertension. Therefore, it is recommended that clinicians caring for critically ill children with Guillain-Barré syndrome have a high index of suspicion for pulmonary hypertension and consider echocardiography if there are clinical signs of this potentially fatal process.

Liver cirrhosis and arterial hypertension

DEFF Research Database (Denmark)

Henriksen, Jens Henrik; Møller, Søren

2006-01-01

blood pressure. This review considers the alterations in systemic hemodynamics in patients with cirrhosis in relation to essential hypertension and arterial hypertension of the renal origin. Subjects with arterial hypertension (essential, secondary) may become normotensive during the development......Characteristic findings in patients with cirrhosis are vasodilatation with low overall systemic vascular resistance, high arterial compliance, increased cardiac output, secondary activation of counter-regulatory systems (renin-angiotensin-aldosterone system, sympathetic nervous system, release...... of cirrhosis, and arterial hypertension is rarely manifested in patients with cirrhosis, even in cases with renovascular disease and high circulating renin activity. There is much dispute as to the understanding of homoeostatic regulation in cirrhotic patients with manifest arterial hypertension. This most...

Pulmonary arterial hypertension

Science.gov (United States)

2013-01-01

Pulmonary arterial hypertension (PAH) is a chronic and progressive disease leading to right heart failure and ultimately death if untreated. The first classification of PH was proposed in 1973. In 2008, the fourth World Symposium on PH held in Dana Point (California, USA) revised previous classifications. Currently, PH is devided into five subgroups. Group 1 includes patients suffering from idiopathic or familial PAH with or without germline mutations. Patients with a diagnosis of PAH should systematically been screened regarding to underlying mutations of BMPR2 gene (bone morphogenetic protein receptor type 2) or more rarely of ACVRL1 (activine receptor-like kinase type 1), ENG (endogline) or Smad8 genes. Pulmonary veno occusive disease and pulmonary capillary hemagiomatosis are individualized and designated as clinical group 1'. Group 2 'Pulmonary hypertension due to left heart diseases' is divided into three sub-groups: systolic dysfonction, diastolic dysfonction and valvular dysfonction. Group 3 'Pulmonary hypertension due to respiratory diseases' includes a heterogenous subgroup of respiratory diseases like PH due to pulmonary fibrosis, COPD, lung emphysema or interstitial lung disease for exemple. Group 4 includes chronic thromboembolic pulmonary hypertension without any distinction of proximal or distal forms. Group 5 regroup PH patients with unclear multifactorial mechanisms. Invasive hemodynamic assessment with right heart catheterization is requested to confirm the definite diagnosis of PH showing a resting mean pulmonary artery pressure (mPAP) of ≥ 25 mmHg and a normal pulmonary capillary wedge pressure (PCWP) of ≤ 15 mmHg. The assessment of PCWP may allow the distinction between pre-capillary and post-capillary PH (PCWP > 15 mmHg). Echocardiography is an important tool in the management of patients with underlying suspicion of PH. The European Society of Cardiology and the European Respiratory Society (ESC-ERS) guidelines specify its role

Prevalence of hypertension in type 2 diabetes mellitus: impact of the tightening definition of high blood pressure and association with confounding risk factors.

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Kabakov, Emma; Norymberg, Clara; Osher, Esther; Koffler, Michael; Tordjman, Karen; Greenman, Yona; Stern, Naftali

2006-01-01

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) has recommended a downward shift in target blood pressure to definition of hypertension at 130/80 mm Hg. The authors performed a retrospective chart analysis of 2227 type 2 diabetes patients treated in one hospital-based and two community-based clinics in central Israel to determine the prevalence of hypertension as a function of three diagnostic threshold levels. The prevalence of hypertension in this cohort was 60.2%, 76.5%, and 85.8% at blood pressure thresholds of 140/90, 130/85, and 130/80 mm Hg respectively. Hypertension prevalence increased with age, reaching a rate of 94.4% in patients aged 80 years or more when the cutoff value of 130/80 mm Hg was used. At this cutoff, 93.3% and 86.6% of patients with a body mass index over or under 30 kg/m(2), respectively, were diagnosed with hypertension. As hypertension appears to eventually afflict the vast majority of diabetic patients, the minority of subjects not developing hypertension emerges as a unique group, which potentially deserves further in-depth study.

Therapeutic Target Achievement in Type 2 Diabetic Patients after Hyperglycemia, Hypertension, Dyslipidemia Management

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Ah Young Kang

2011-06-01

Full Text Available BackgroundOur study group established "3H care" in 2002. The meaning of "3H care" attain and maintain adequate controls over hypertension, hyperlipidemia, and hyperglycemia in type 2 diabetic patients. This study evaluated the achievement of target goals after one year or more of "3H care" by specialists in our diabetic clinic.MethodsThis was a retrospective study of 200 type 2 diabetic patients who received "3H care" for one year or more in our diabetic clinic. We evaluated achievement of target goals for metabolic controls as suggested by the American Diabetes Association.ResultsOverall, 200 type 2 diabetes patients were enrolled, of whom 106 were males (53% and 94 were females (47%. After one year of "3H care," the mean HbA1c was 7.2±1.5% and the percentage of patients achieving glycemic control (HbA1c <7% was 51.8%. However only 32.2% of hypertensive patients achieved the recommended target. After one year of "3H care," the percentages of those who achieved the target value for dyslipidemia were 80.0% for total cholesterol, 66.3% for low density lipoprotein cholesterol, 57.9% for triglyceride, and 51.8% for high density lipoprotein cholesterol. The percentage that achieved all three targets level was only 4.4% after one year and 14.8% after two years.ConclusionThe results of this study demonstrate that only a minor proportion of patients with type 2 diabetes achieved the recommended goals despite the implementation of "3H care." It is our suggestion that better treatment strategies and methods should be used to control hypertension, hyperlipidemia and hyperglycemia.

Hypertension in Patients with Cancer

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Souza, Vinicius Barbosa de; Silva, Eduardo Nani; Ribeiro, Mario Luiz; Martins, Wolney de Andrade, E-mail: wolney@cardiol.br [Curso de Pós-Graduação em Ciências Cardiovasculares da Universidade Federal Fluminense, Niterói, RJ (Brazil)

2015-03-15

There is a known association between chemotherapy and radiotherapy for treatment of cancer patients and development or worsening of hypertension. The aim of this article is to review this association. A literature search was conducted for articles reporting this association on the databases PubMed, SciELO and LILACS between 1993 and 2013. There was a high coprevalence of hypertension and cancer, since both diseases share the same risk factors, such as sedentary lifestyle, obesity, smoking, unhealthy diet and alcohol abuse. The use of chemotherapy and adjuvant drugs effective in the treatment of cancer increased the survival rate of these patients and, consequently, increased the incidence of hypertension. We described the association between the use of angiogenesis inhibitors (bevacizumab, sorafenib and sunitinib), corticosteroids, erythropoietin and non-steroidal anti-inflammatory drugs with the development of hypertension. We also described the relationship between hypertension and carotid baroreceptor injury secondary to cervical radiotherapy. Morbidity and mortality increased in patients with cancer and hypertension without proper antihypertensive treatment. We concluded that there is need for early diagnosis, effective monitoring and treatment strategies for hypertension in cancer patients in order to reduce cardiovascular morbidity and mortality.

Hypertension in Patients with Cancer

International Nuclear Information System (INIS)

Souza, Vinicius Barbosa de; Silva, Eduardo Nani; Ribeiro, Mario Luiz; Martins, Wolney de Andrade

2015-01-01

There is a known association between chemotherapy and radiotherapy for treatment of cancer patients and development or worsening of hypertension. The aim of this article is to review this association. A literature search was conducted for articles reporting this association on the databases PubMed, SciELO and LILACS between 1993 and 2013. There was a high coprevalence of hypertension and cancer, since both diseases share the same risk factors, such as sedentary lifestyle, obesity, smoking, unhealthy diet and alcohol abuse. The use of chemotherapy and adjuvant drugs effective in the treatment of cancer increased the survival rate of these patients and, consequently, increased the incidence of hypertension. We described the association between the use of angiogenesis inhibitors (bevacizumab, sorafenib and sunitinib), corticosteroids, erythropoietin and non-steroidal anti-inflammatory drugs with the development of hypertension. We also described the relationship between hypertension and carotid baroreceptor injury secondary to cervical radiotherapy. Morbidity and mortality increased in patients with cancer and hypertension without proper antihypertensive treatment. We concluded that there is need for early diagnosis, effective monitoring and treatment strategies for hypertension in cancer patients in order to reduce cardiovascular morbidity and mortality

Body weight variation and control of cardiovascular risk factors in essential hypertension.

Science.gov (United States)

Pascual, Jose Maria; Rodilla, Enrique; Costa, Jose Antonio; Perez-Lahiguera, Francisco; Gonzalez, Carmen; Lurbe, Empar; Redón, Josep

2009-01-01

The objective was to assess the impact of weight changes on blood pressure (BP), lipids and glucose goals in a cohort of hypertensive subjects. Prospective follow-up. Hypertension clinic. 326 hypertensive non-diabetic subjects, 46% with metabolic syndrome (MS). Usual care treatment, which included diet, physical exercise and drugs prescribed when indicated. All patients were observed for up to 1 year. BP and low-density lipoprotein-cholesterol (LDL-C) goal were those in ESH/ESC and ATP III recommendations, respectively. The glucose goal was to delay progression to type 2 diabetes mellitus, or to achieve blood glucose <100 mg/dl for non-diabetics. According to body weight changes, patients were categorized using adjusted ROC curves models. Overall, there was a significant weight increment of 0.5 kg (95% CI 0.1-0.9 kg); 28 patients (8.6%) lost more than 5 kg, and only four (1.2%) lost more than 10 kg. BP, LDL-C and glucose goals were achieved in 56%, 78% and 61% of patients, respectively. To lose or not gain weight was an independent prognostic factor to achieve the BP goal in all the patients and the LDL goal in the presence of MS. For glucose control, being treated with beta-blockers and/or diuretics was a negative factor. In hypertensive subjects, even small changes in weight may have an important impact on achieving cardiovascular goals, mainly in those with MS.

An ethnobotanical study of medicinal plants administered for the treatment of hypertension.

Science.gov (United States)

Baharvand-Ahmadi, Babak; Bahmani, Mahmoud; Tajeddini, Pegah; Rafieian-Kopaei, Mahmoud; Naghdi, Nasrollah

2016-01-01

The incidence of cardiovascular diseases (CVDs) is very high in human societies and their prevention and treatment are the most important priority in many countries. Hypertension makes an important contribution to the development of CVDs. This study aimed to collect the ethno-medicinal knowledge of the traditional healers of Shiraz on medicinal plants used in the treatment of hypertension. Ethno-medicinal data were collected from September 2012 to July 2013 through direct interview. Twenty-five healers were interviewed using semi-structured questionnaires and their traditional ethno-medicinal knowledge was recorded. Questionnaires were included apothecary personal information, plant local name, plant parts used, method of preparation, season of harvest and traditional use. Data collected from surveys and interviews were transferred to Microsoft Excel 2007 and analyzed. Analysis of data showed that, 27 medicinal plants from 22 families are used for the treatment of hypertension. The families with most antihypertensive species were Apiaceae (8%), Rosaceae (8%) and Papaveraceae (8%). The most frequently used plant parts were leaves (36%) followed by fruits (30%), aerial part (17%) and branches (7%). The most frequently used preparation method was decoction (95%). Borago officinalis (51.85%), Berberis vulgaris (51.58%) had the highest frequency of mention. The ethno-medicinal survey of medicinal plants recommended by traditional healers for the treatment of hypertension provides new areas of research on the antihypertensive effect of medicinal plants. In the case of safety and effectiveness, they can be refined and processed to produce natural drugs.

Angiotensinogen gene polymorphism predicts hypertension, and iridological constitutional classification enhances the risk for hypertension in Koreans.

Science.gov (United States)

Cho, Joo-Jang; Hwang, Woo-Jun; Hong, Seung-Heon; Jeong, Hyun-Ja; Lee, Hye-Jung; Kim, Hyung-Min; Um, Jae-Young

2008-05-01

This study investigated the relationship between iridological constitution and angiotensinogen (AGN) gene polymorphism in hypertensives. In addition to angiotensin converting enzyme gene, AGN genotype is also one of the most well studied genetic markers of hypertension. Furthermore, iridology, one of complementary and alternative medicine, is the diagnosis of the medical conditions through noting irregularities of the pigmentation in the iris. Iridological constitution has a strong familial aggregation and is implicated in heredity. Therefore, the study classified 87 hypertensive patients with familial history of cerebral infarction and controls (n = 88) according to Iris constitution, and determined AGN genotype. As a result, the AGN/TT genotype was associated with hypertension (chi2 = 13.413, p iridological constitutional classification increased the relative risk for hypertension in the subjects with AGN/T allele. These results suggest that AGN polymorphism predicts hypertension, and iridological constitutional classification enhances the risk for hypertension associated with AGN/T in a Korean population.

Hypertension og nyresygdom

DEFF Research Database (Denmark)

Kamper, Anne-Lise; Pedersen, Erling B; Strandgaard, Svend

2009-01-01

Renal mechanisms, in particular the renin-angiotensin system and renal salt handling, are of major importance in blood pressure regulation. Co-existence of hypertension and decreased renal function may be due to nephrosclerosis secondary to hypertension, or primary renal disease with secondary...... hypertension. Mild degrees of chronic kidney disease (CKD) can be detected in around 10% of the population, and detection is important as CKD is an important risk factor for atherosclerotic cardiovascular disease. Conversely, heart failure may cause an impairment of renal function. In chronic progressive...... nephropathy, effective blood pressure lowering is of paramount importance, and angiotensin converting enzyme inhibitors and angiotensin receptor blockers are agents of choice....

[Hypertension in women (contraception and menopause].

Science.gov (United States)

Beaufils, M

2000-11-01

There are three circumstances where hypertension develops specifically in women: oral contraception, pregnancy, and menopause. Oral contraception usually shifts the blood pressure moderately upwards, but hypertension appears in less than 5% of women. Still it may (rarely) be very severe. Hypertension is poorly related to the dosage of the estrogenic compound, but rather to the nature and dosage of the progestive part. This hypertension does not significantly increase the cardiovascular risk of these women. The role of menopause itself in the trigging of hypertension remains uncertain. It seems however that confounding factors such as age, body weight, sodium balance and so on explain the increased incidence of hypertension after menopause. The latter is also associated with an increase of cardiovascular risk, which requires adequate treatment. Hormone replacement therapy is not contra-indicated, even in hypertensive patients.

Diuretics in the treatment of hypertension.

Science.gov (United States)

Blowey, Douglas L

2016-12-01

Diuretics have long been used for the treatment of hypertension. Thiazide diuretics are the most commonly prescribed diuretics for hypertension, but other classes of diuretics may be useful in alternative circumstances. Although diuretics are no longer considered the preferred agent for treatment of hypertension in adults and children, they remain acceptable first-line options. Diuretics effectively decrease blood pressure in hypertensive patients, and in adults with hypertension reduce the risk of adverse cardiovascular outcomes. Because of varied pharmacokinetic and pharmacodynamic differences, chlorthalidone may be the preferred thiazide diuretic in the treatment of primary hypertension. Other types of diuretics (e.g., loop, potassium sparing) may be useful for the treatment of hypertension related to chronic kidney disease (CKD) and other varied conditions. Common side effects of thiazides are mostly dose-related and involve electrolyte and metabolic abnormalities.

Blood pressure monitoring: theory and practice. European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability Teaching Course Proceedings.

Science.gov (United States)

Stergiou, George S; Palatini, Paolo; Asmar, Roland; Bilo, Grzegorz; de la Sierra, Alejandro; Head, Geoff; Kario, Kazuomi; Mihailidou, Anastasia; Wang, Jiguang; Mancia, Giuseppe; O'Brien, Eoin; Parati, Gianfranco

2018-02-01

The European Society of Hypertension (ESH) Working Group on Blood Pressure (BP) Monitoring and Cardiovascular Variability organized a Teaching Course on 'Blood Pressure Monitoring: Theory and Practice' during the 2017 ESH Meeting in Milan, Italy. This course performed by 11 international BP monitoring experts covered key topics of BP monitoring, including office BP measurement, ambulatory BP monitoring, home BP monitoring, ambulatory versus home BP, white-coat and masked hypertension, cuff use, and BP variability. This article presents a summary of the proceedings of the ESH BP Monitoring Teaching Course, including essential information, practical issues, and recommendations on the clinical application of BP monitoring methods, aiming to the optimal management of patients with suspected or diagnosed hypertension.

Socioeconomic inequality in hypertension in Iran.

Science.gov (United States)

Fateh, Mansooreh; Emamian, Mohammad Hassan; Asgari, Fereshteh; Alami, Ali; Fotouhi, Akbar

2014-09-01

Hypertension covers a large portion of burden of diseases, especially in the developing countries. The unequal distribution of hypertension in the population may affect 'health for all' goal. This study aimed to investigate the socioeconomic inequality of hypertension in Iran and to identify its influencing factors. We used data from Iran's surveillance system for risk factors of noncommunicable diseases which was conducted on 89 400 individuals aged 15-64 years in 2005. To determine the socioeconomic status of participants, a new variable was created using a principal component analysis. We examined hypertension at different levels of this new variable and calculated slop index of inequality (SII) and concentration index (C) for hypertension. We then applied Oaxaca-Blinder decomposition analysis to determine the causes of inequality. The SII and C for hypertension were -32.3 and -0.170, respectively. The concentration indices varied widely between different provinces in Iran and was lower (more unequal) in women than in men. There was significant socioeconomic inequality in hypertension. The results of decomposition indicated that 40.5% of the low-socioeconomic group (n = 18190) and 16.4% of the high-socioeconomic group (n = 16335) had hypertension. Age, education level, sex and residency location were the main associated factors of the difference among groups. According to our results, there was an inequality in hypertension in Iran, so that individuals with low socioeconomic status had a higher prevalence of hypertension. Age was the most contributed factor in this inequality and women in low-socioeconomic group were the most vulnerable people for hypertension.

N-terminal pro brain natriuretic peptide in arterial hypertension--a marker for left ventricular dimensions and prognosis

DEFF Research Database (Denmark)

Hildebrandt, Per; Boesen, Mikael; Olsen, Michael

2004-01-01

In arterial hypertension risk factor evaluation, including LV mass measurements, and risk stratification using risk charts or programs, is generally recommended. In heart failure NT-proBNP has been shown to be a marker of LV dimensions and of prognosis. If the same diagnostic and prognostic value...... is present in arterial hypertension, risk factor evaluation would be easier. In 36 patients with arterial hypertension, electrocardiographic LV hypertrophy and preserved left ventricular function, NT-proBNP was eight-fold higher than in healthy subjects. The log NT-proBNP correlated with LV mass index (R=0...... and preserved LV function demonstrated that NT-proBNP was a very strong prognostic marker, especially combined with a history of cardiovascular disease. Patients with high NT-proBNP and known cardiovascular disease had a seven-fold increase in CV events compared to patients with low NT-proBNP and no CV disease...

Using the Global Burden of Disease study to assist development of nation-specific fact sheets to promote prevention and control of hypertension and reduction in dietary salt: a resource from the World Hypertension League.

Science.gov (United States)

Campbell, Norm R C; Lackland, Daniel T; Lisheng, Liu; Niebylski, Mark L; Nilsson, Peter M; Zhang, Xin-Hua

2015-03-01

Increased blood pressure and high dietary salt are leading risks for death and disability globally. Reducing the burden of both health risks are United Nations' targets for reducing noncommunicable disease. Nongovernmental organizations and individuals can assist by ensuring widespread dissemination of the best available facts and recommended interventions for both health risks. Simple but impactful fact sheets can be useful for informing the public, healthcare professionals, and policy makers. The World Hypertension League has developed fact sheets on dietary salt and hypertension but in many circumstances the greatest impact would be obtained from national-level fact sheets. This manuscript provides instructions and a template for developing fact sheets based on the Global Burden of Disease study and national survey data. ©2015 Wiley Periodicals, Inc.

Pulmonary hypertension in older adults.

Science.gov (United States)

McArdle, John R; Trow, Terence K; Lerz, Kathryn

2007-12-01

Pulmonary hypertension is a frequently encountered problem in older patients. True idiopathic pulmonary arterial hypertension can also be seen and requires careful exclusion in older patients. Institution of therapies must be tempered with an appreciation of individual comorbidities and functional limitations that may affect patients' ability to comply and benefit from the complex treatments available for pulmonary arterial hypertension. This article reviews the existing data on the various forms of pulmonary hypertension presenting in older patients and on appropriate therapy in this challenging population.

Hypertension and liver disease

DEFF Research Database (Denmark)

Henriksen, Jens H; Møller, Søren

2004-01-01

to increased arterial blood pressure. Subjects with established arterial hypertension (essential, secondary) may become normotensive during the development of cirrhosis, and arterial hypertension is rarely manifested in patients with cirrhosis, even in cases with renovascular disease and high circulating renin......Arterial hypertension is a common disorder with a frequency of 10% to 15% in subjects in the 40- to 60-year age group. Yet most reports find the prevalence of arterial hypertension in patients with chronic liver disease (cirrhosis) much lower. In this review, we consider the alterations in systemic...... hemodynamics in cirrhosis. The most characteristic findings in cirrhotic patients are vasodilatation with low systemic vascular resistance, increased cardiac output, high arterial compliance, secondary activation of counterregulatory systems (sympathetic nervous system, renin-angiotensin-aldosterone system...

Hypertension and cardiac arrhythmias

DEFF Research Database (Denmark)

Lip, Gregory Y.H.; Coca, Antonio; Kahan, Thomas

2017-01-01

Hypertension is a common cardiovascular risk factor leading to heart failure (HF), coronary artery disease, stroke, peripheral artery disease and chronic renal insufficiency. Hypertensive heart disease can manifest as many cardiac arrhythmias, most commonly being atrial fibrillation (AF). Both...... supraventricular and ventricular arrhythmias may occur in hypertensive patients, especially in those with left ventricular hypertrophy (LVH) or HF. Also, some of the antihypertensive drugs commonly used to reduce blood pressure, such as thiazide diuretics, may result in electrolyte abnormalities (e.g. hypokalaemia......, hypomagnesemia), further contributing to arrhythmias, whereas effective control of blood pressure may prevent the development of the arrhythmias such as AF. In recognizing this close relationship between hypertension and arrhythmias, the European Heart Rhythm Association (EHRA) and the European Society...

Do we over treat mild hypertension?

Science.gov (United States)

Zanchetti, Alberto

2015-06-01

The important question whether 'mild' hypertension should or should not be treated by drugs is difficult to answer, because the only randomized controlled trials (RCTs) investigating this question were conducted when the definition of 'mild' hypertension was based on diastolic blood pressure only, whereas the present definition of grade 1 hypertension includes both systolic and diastolic values (SBP/DBP), and the concept of 'mild' hypertension also includes that of low-moderate cardiovascular risk (hypertension only on the basis of expert opinion. However, recent meta-analyses have provided some support to drug treatment intervention in low-moderate risk grade 1 hypertensives and have shown that, when treatment is deferred until organ damage or cardiovascular disease occur, absolute residual risk (events occurring despite treatment) markedly increases. Although evidence favoring therapeutic intervention in mild hypertension is nowadays stronger than expert opinion, meta-analyses are not substitutes for specific RCTs, and the wide BP spans defining grade 1 hypertension as well as the span defining low-moderate risk leave a wide space for individualized or personalized decisions.

Endokrin hypertension

DEFF Research Database (Denmark)

Poulsen, Per Løgstrup; Ibsen, Hans

2009-01-01

Endocrine hypertension is rare, but frequently refractory. Adenomas are common incidental findings. Biochemical tests confirm the diagnosis. Primary aldosteronism is the most common form. Hypokalaemia is an important sign, but 50% of patients may be normokalaemic. The plasma-aldosterone-to-renin ......Endocrine hypertension is rare, but frequently refractory. Adenomas are common incidental findings. Biochemical tests confirm the diagnosis. Primary aldosteronism is the most common form. Hypokalaemia is an important sign, but 50% of patients may be normokalaemic. The plasma...

ECG Markers of Hemodynamic Improvement in Patients with Pulmonary Hypertension

Directory of Open Access Journals (Sweden)

Marcin Waligóra

2018-01-01

Full Text Available Introduction. Several diagnostic tests have been recommended for risk assessment in pulmonary hypertension (PH, but the role of electrocardiography (ECG in monitoring of PH patients has not been yet established. Therefore the aim of the study was to evaluate which ECG patterns characteristic for pulmonary hypertension can predict hemodynamic improvement in patients treated with targeted therapies. Methods. Consecutive patients with pulmonary arterial hypertension (PAH or chronic thromboembolic pulmonary hypertension (CTEPH were eligible to be included if they had had performed two consecutive right heart catheterization (RHC procedures before and after starting of targeted therapies. Patients were followed up from June 2009 to July 2017. ECG patterns of right ventricular hypertrophy according to American College of Cardiology Foundation were assessed. Results. We enrolled 80 patients with PAH and 11 patients with inoperable CTEPH. The follow-up RHC was performed within 12.6±10.0 months after starting therapy. Based on median change of pulmonary vascular resistance, we divided our patients into two subgroups: with and without significant hemodynamic improvement. RV1, max⁡RV1,2 + max⁡SI,aVL-SV1, and PII improved along with the improvement of hemodynamic parameters including PVR. They predicted hemodynamic improvement with similarly good accuracy as shown in ROC analysis: RV1 (AUC: 0.75; 95% CI: 0.63–0.84, PII (AUC: 0.67, 95% CI: 0.56–0.77, and max⁡RV1,2+max⁡SI,aVL-SV1 (0.73; 95% CI: 0.63–0.82. In Cox regression only change in RV1 remained significant mortality predictor (HR: 1.12, 95% CI: 1.01–1.24. Conclusion. Electrocardiogram may be useful in predicting hemodynamic effects of targeted therapy in precapillary pulmonary hypertension. Decrease of RV1, max⁡RV1,2+max⁡SI,aVL-SV1, and PII corresponds with hemodynamic improvement after treatment. Of these changes a decrease of R wave amplitude in V1 is associated with better

Resistant Hypertension and Cardiorenovascular Risk

Directory of Open Access Journals (Sweden)

Prkacin Ingrid

2017-06-01

Full Text Available Studies have documented independent contribution of sympathetic activation to the cardiovascular disease continuum. Hypertension is one of the leading modifiable factors. Most if not all the benefit of antihypertensive treatment depends on blood pressure lowering, regardless how it is obtained. Resistant hypertension is defined as blood pressure that remains uncontrolled in spite of the concurrent use of three antihypertensive drugs of different classes. Ideally, one of the three drugs should be a diuretic, and all drugs should be prescribed at optimal dose amounts. Poor adherence to antihypertensive therapy, undiscovered secondary causes (e.g. obstructive sleep apnea, primary aldosteronism, renal artery stenosis, and lifestyle factors (e.g. obesity, excessive sodium intake, heavy alcohol intake, various drug interactions are the most common causes of resistant hypertension. Cardio(renovascular morbidity and mortality are significantly higher in resistant hypertensive than in general hypertensive population, as such patients are typically presented with a long-standing history of poorly controlled hypertension. Early diagnosis and treatment is needed to avoid further end-organ damage to prevent cardiorenovascular remodeling. Treatment strategy includes lifestyle changes, adding a mineralocorticoid receptor antagonist, treatment adherence in cardiovascular prevention and, in case of failure to control blood pressure, renal sympathetic denervation or baroreceptor activation therapy. The comparative outcomes in resistant hypertension deserve better understanding. In this review, the most current approaches to resistant hypertension and cardiovascular risk based on the available literature evidence will be discussed.

Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline.

Science.gov (United States)

Carey, Robert M; Whelton, Paul K

2018-03-06

In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a clinical practice guideline for the prevention, detection, evaluation, and treatment of high blood pressure (BP) in adults. This article summarizes the major recommendations. In 2014, the ACC and the AHA appointed a multidisciplinary committee to update previous reports of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The committee reviewed literature and commissioned systematic reviews and meta-analyses on out-of-office BP monitoring, the optimal target for BP lowering, the comparative benefits and harms of different classes of antihypertensive agents, and the comparative benefits and harms of initiating therapy with a single antihypertensive agent or a combination of 2 agents. This article summarizes key recommendations in the following areas: BP classification, BP measurement, screening for secondary hypertension, nonpharmacologic therapy, BP thresholds and cardiac risk estimation to guide drug treatment, treatment goals (general and for patients with diabetes mellitus, chronic kidney disease, and advanced age), choice of initial drug therapy, resistant hypertension, and strategies to improve hypertension control.

Waist circumference cut-off values to predict the incidence of hypertension: an estimation from a Brazilian population-based cohort.

Science.gov (United States)

Gus, M; Cichelero, F Tremea; Moreira, C Medaglia; Escobar, G Fortes; Moreira, L Beltrami; Wiehe, M; Fuchs, S Costa; Fuchs, F Danni

2009-01-01

Central obesity is a key component in the definition of the metabolic syndrome, but the cut-off values proposed to define abnormal values vary among different guidelines and are mostly based on cross-sectional studies. In this study, we identify the best cut-off values for waist circumference (WC) associated with the incidence of hypertension. Participants for this prospectively planned cohort study were 589 individuals who were free of hypertension and selected at random from the community of Porto Alegre, Brazil. Hypertension was defined by a blood pressure measurement >or= 140/90 mmHg or the use of blood pressure lowering drugs. A logistic regression model established the association between WC and the incidence of hypertension. A receiver operating characteristics (ROC) curve analysis was used to select the best WC cut-off point to predict the incidence of hypertension. During a mean follow-up of 5.5+/-0.9 years, 127 subjects developed hypertension. The hazard ratios for the development of hypertension, adjusted for age, baseline systolic blood pressure, alcohol consumption, gender and scholarship were 1.02 (95% CI; 1.00-1.04; P=0.02) for WC. The best cut-off WC values to predict hypertension were 87 cm in men and 80 cm in women, with an area under the curve of 0.56 (95% CI; 0.47-0.64; P=0.17) and 0.70 (95% CI; 0.63-0.77; Phypertension in individuals living in communities in Brazil, and this risk begins at lower values of WC that those recommended by some guidelines.

Does exercise pulmonary hypertension exist?

Science.gov (United States)

Lau, Edmund M; Chemla, Denis; Whyte, Kenneth; Kovacs, Gabor; Olschewski, Horst; Herve, Philippe

2016-09-01

The exercise definition of pulmonary hypertension using a mean pulmonary artery pressure threshold of greater than 30 mmHg was abandoned following the 4th World Pulmonary Hypertension Symposium in 2008, as this definition was not supported by evidence and healthy individuals frequently exceed this threshold. Meanwhile, the clinical value of exercise pulmonary hemodynamic testing has also been questioned. Recent data support the notion that an abnormal pulmonary hemodynamic response during exercise (or exercise pulmonary hypertension) is associated with symptoms and exercise limitation. Pathophysiologic mechanisms accounting for the development of exercise pulmonary hypertension include increased vascular resistance, excessive elevation in left atrial pressure and/or increased volume of trapped air during exercise, resulting in a steep rise in pulmonary artery pressure relative to cardiac output. Recent evidence suggests that exercise pulmonary hypertension may be defined by a mean pulmonary artery pressure surpassing 30 mmHg together with a simultaneous total pulmonary resistance exceeding 3 WU. Exercise pulmonary hypertension is a clinically relevant entity and an improved definition has been suggested based on new evidence. Exercise pulmonary hemodynamics may help unmask early or latent disease, particularly in populations that are at high risk for the development of pulmonary hypertension.

Magnetic resonance imaging in pulmonary hypertension. Magnetresonanztomographie bei pulmonaler Hypertension

Energy Technology Data Exchange (ETDEWEB)

Neuhold, A.; Stiskal, M.; Czerny, C. (Institut fuer Bildgebende Diagnostik, Rudolfinerhaus, Vienna (Austria)); Frank, H.; Globits, S.; Glogar, D.; Mlczoch, J. (Universitaetsklinik fuer Kardiologie, Vienna (Austria))

1992-09-01

We examined 23 patients with pulmonary hypertension of varying aetiology by MRI and compared the results with those of right heart catheterisation. The best correlation was obtained between right ventricular mural thickness and mean pulmonary pressure (R = 0.91, p = 0.001). There was significant correlation (R = 0.85, p = 0.001) for the diameter of the inferior vena cava, which was dilated in all patients with pulmonary hypertension. There was no significant correlation between mean pulmonary pressure and the diameters of the superior vena cava or the main pulmonary artery branches (R = 0.55 and 0.75 respectively, p < 0.05). Amongst functional measurements there was a correlation between right ventricular ejection fraction and mean pulmonary artery pressure (R = 0.71, p = 0.001). There was no correlation between right ventricular end-systolic and end-diastolic volume. In all patients with pulmonary hypertension, dynamic flow sensitive gradient echo sequences showed the presence of tricuspid insufficiency. A further semiquantitative criterion for the presence of pulmonary hypertension in 4 patients (17%) was an abnormal signal from the main pulmonary artery in early to mid-systole shown on T[sub 1]-weighted transverse sections. (orig./GDG).

Prevalence and determinants of hypertension in Myanmar - a nationwide cross-sectional study.

Science.gov (United States)

Bjertness, Marius B; Htet, Aung Soe; Meyer, Haakon E; Htike, Maung Maung Than; Zaw, Ko Ko; Oo, Win Myint; Latt, Tint Swe; Sherpa, Lhamo Y; Bjertness, Espen

2016-07-18

Non-communicable diseases (NCDs), malaria and tuberculosis dominate the disease pattern in Myanmar. Due to urbanization, westernized lifestyle and economic development, it is likely that NCDs such as cerebrovascular disease and ischemic heart disease are on a rise. The leading behavioral- and metabolic NCDs risk factors are tobacco smoke, dietary risks and alcohol use, and high blood pressure and body mass index, respectively. The study aimed at estimating the prevalence and determinants of hypertension, including metabolic-, behavioral- and socio-demographic risk factors. A nationwide, cross-sectional study of 7429 citizens of Myanmar aged 15-64 years were examined in 2009, using the WHO STEPS methodology. In separate analyses by gender, odds radios (ORs) and 95 % confidence intervals (CIs) for determinants of hypertension were estimated using logistic regression analyses. Confounders included in analyses were chosen based on Directed acyclic graphs (DAGs). The prevalence of hypertension was 30.1 % (95 % CI: 28.4-31.8) in males and 29.8 % (28.5-31.1) in females. The mean BMI was 21.7 (SD 4.3) kg/m(2) for males and 23.0 (5.1) kg/m(2) for females. In fully adjusted analyses, we found in both genders increased OR for hypertension if the participants had high BMI (males: OR = 2.6; 95 % CI 2.1-3.3, females: OR = 2.3; 2.0-2.7) and high waist circumference (males: OR = 3.4; 1.8-6.8, females: OR = 2.7; 2.2-3.3). In both sexes, associations were also found between hypertension and low physical activity at work, or living in urban areas or the delta region. Being underweight and use of sesame oil in cooking was associated with lower odds for hypertension. The prevalence of hypertension was high and associated with metabolic-, behavioral- and socio-demographic factors. Due to expected rapid economic growth in Myanmar we recommend similar studies in the future to follow up and describe trends in the risk factors, especially modifiable factors, which will

Comparison of demographic, clinical, and laboratory parameters between patients with sustained normotension, white coat hypertension, masked hypertension, and sustained hypertension.

Science.gov (United States)

Afsar, Baris

2013-03-01

After measurement of office blood pressure (BP) and ambulatory BP monitoring (ABPM), 4 groups of patients were identified namely: (i) sustained normotensive patients (BPs are normal both clinically and by ABPM); (ii) white coat hypertensive patients (clinical BP were above limits, but ABPM were normal); (iii) masked hypertensive patients (clinical BP were normal, but ABPM were high); (iv) sustained hypertensive patients (both office and ABPM were high). The exact pathophysiologic mechanisms of these conditions are not exactly known. Besides in the literature there are only few studies that compare the 4 groups of patients together. Thus the study was carried out to compare patients with sustained normotension (SNT), white coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT). All patients underwent history taking, physical examination, laboratory analysis, and ABPM. They were referred to the cardiology department for echocardiographic evaluation. In total 85 patients with SNT, 112 patients with WCHT, 31 patients with MHT, and 81 patients with SHT were included. Going from SNT to SHT, body mass index (p<0.0001), waist circumference (p<0.0001), fasting blood glucose (p=0.002), and uric acid (p=0.029) rose progressively. Presence of metabolic syndrome was also highest in SHT and lowest in SNT (p<0.0001). Most of the metabolic risk factors were higher in patients with MHT and SHT when compared to SNT and WCHT. Studies are needed to determine whether metabolic risk factors play a causative role for the development of MHT and SHT. Copyright © 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Hypertension--forekomst og behandling

DEFF Research Database (Denmark)

Ibsen, Hans; Jørgensen, Torben; Jensen, Gorm B

2009-01-01

Hypertension is the most important modifiable risk factor for cardiovascular disease. However, less than half of all hypertensives have their blood pressure reduced to relevant goals. The prevalence of hypertension in Denmark was found to be between 26% and 40% of the adult population. Just over ...... half were aware of the diagnosis, but less than half were in treatment. Blood pressure control in patients who are undergoing treatment has improved during recent years, but there is still a gap to achievable control rates....

Hypertension--forekomst og behandling

DEFF Research Database (Denmark)

Ibsen, Hans; Jørgensen, Torben; Jensen, Gorm B

2009-01-01

Hypertension is the most important modifiable risk factor for cardiovascular disease. However, less than half of all hypertensives have their blood pressure reduced to relevant goals. The prevalence of hypertension in Denmark was found to be between 26% and 40% of the adult population. Just over...... half were aware of the diagnosis, but less than half were in treatment. Blood pressure control in patients who are undergoing treatment has improved during recent years, but there is still a gap to achievable control rates....

Hypertension og nyresygdom

DEFF Research Database (Denmark)

Kamper, Anne-Lise; Pedersen, Erling B; Strandgaard, Svend

2009-01-01

Renal mechanisms, in particular the renin-angiotensin system and renal salt handling, are of major importance in blood pressure regulation. Co-existence of hypertension and decreased renal function may be due to nephrosclerosis secondary to hypertension, or primary renal disease with secondary...... hypertension. Mild degrees of chronic kidney disease (CKD) can be detected in around 10% of the population, and detection is important as CKD is an important risk factor for atherosclerotic cardiovascular disease. Conversely, heart failure may cause an impairment of renal function. In chronic progressive...... nephropathy, effective blood pressure lowering is of paramount importance, and angiotensin converting enzyme inhibitors and angiotensin receptor blockers are agents of choice. Udgivelsesdato: 2009-Jun-15...

Primary lung hypertension in-patient with hypertension portal; Hipertension pulmonar primaria en pacientes con hipertension portal

Energy Technology Data Exchange (ETDEWEB)

Uribe, Restrepo; Villa Restrepo, Alfredo

1990-04-01

Thorax x-rays were reviewed in 18 patients with portal hypertension. In 28% of these we found radiologic signs of pulmonary hypertension of the precapillary type. The existing relation between primary pulmonary hypertension and portal hypertension has been established in different scientific papers. In the published series the incidence of primary pulmonary hypertension is less than the one of found in these patients the physiopathology of this association is reviewed, and as a hypothetic manner it is postulated the possible roll of the hypoxaemia of the residents, at the altitude of the Bogota city. (2.640 mts) as a helping factor in this phenomenon.

Chronic Hypertension in Pregnancy

Science.gov (United States)

... org/ by guest on June 19, 2018 Chronic Hypertension in Pregnancy Ellen W. Seely, MD; Cynthia Maxwell, ... M any women have been diag- nosed with hypertension (blood pressure Ͼ 140/ 90 mm Hg) when ...

Resistance training alone reduces systolic and diastolic blood pressure in prehypertensive and hypertensive individuals: meta-analysis.

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de Sousa, Evitom Corrêa; Abrahin, Odilon; Ferreira, Ana Lorena Lima; Rodrigues, Rejane Pequeno; Alves, Erik Artur Cortinhas; Vieira, Rodolfo Paula

2017-11-01

The purpose of this study was to evaluate the effects of resistance training alone on the systolic and diastolic blood pressure in prehypertensive and hypertensive individuals. Our meta-analysis, followed the guidelines of PRISMA. The search for articles was realized by November 2016 using the following electronic databases: BIREME, PubMed, Cochrane Library, LILACS and SciELO and a search strategy that included the combination of titles of medical affairs and terms of free text to the key concepts: 'hypertension' 'hypertensive', 'prehypertensive', 'resistance training', 'strength training', and 'weight-lifting'. These terms were combined with a search strategy to identify randomized controlled trials (RCTs) and identified a total of 1608 articles: 644 articles BIREME, 53 SciELO, 722 PubMed, 122 Cochrane Library and 67 LILACS. Of these, five RCTs met the inclusion criteria and provided data on 201 individuals. The results showed significant reductions for systolic blood pressure (-8.2 mm Hg CI -10.9 to -5.5;I 2 : 22.5% P valor for heterogeneity=0.271 and effect size=-0.97) and diastolic blood pressure (-4.1 mm Hg CI -6.3 to -1.9; I 2 : 46.5% P valor for heterogeneity=0.113 and effect size=-0.60) when compared to group control. In conclusion, resistance training alone reduces systolic and diastolic blood pressure in prehypertensive and hypertensive subjects. The RCTs studies that investigated the effects of resistance training alone in prehypertensive and hypertensive patients support the recommendation of resistance training as a tool for management of systemic hypertension.

Masked Uncontrolled Hypertension in CKD.

Science.gov (United States)

Agarwal, Rajiv; Pappas, Maria K; Sinha, Arjun D

2016-03-01

Masked uncontrolled hypertension (MUCH) is diagnosed in patients treated for hypertension who are normotensive in the clinic but hypertensive outside. In this study of 333 veterans with CKD, we prospectively evaluated the prevalence of MUCH as determined by ambulatory BP monitoring using three definitions of hypertension (daytime hypertension ≥135/85 mmHg; either nighttime hypertension ≥120/70 mmHg or daytime hypertension; and 24-hour hypertension ≥130/80 mmHg) or by home BP monitoring (hypertension ≥135/85 mmHg). The prevalence of MUCH was 26.7% by daytime ambulatory BP, 32.8% by 24-hour ambulatory BP, 56.1% by daytime or night-time ambulatory BP, and 50.8% by home BP. To assess the reproducibility of the diagnosis, we repeated these measurements after 4 weeks. Agreement in MUCH diagnosis by ambulatory BP was 75-78% (κ coefficient for agreement, 0.44-0.51), depending on the definition used. In contrast, home BP showed an agreement of only 63% and a κ coefficient of 0.25. Prevalence of MUCH increased with increasing clinic systolic BP: 2% in the 90-110 mmHg group, 17% in the 110-119 mmHg group, 34% in the 120-129 mmHg group, and 66% in the 130-139 mmHg group. Clinic BP was a good determinant of MUCH (receiver operating characteristic area under the curve 0.82; 95% confidence interval 0.76-0.87). In diagnosing MUCH, home BP was not different from clinic BP. In conclusion, among people with CKD, MUCH is common and reproducible, and should be suspected when clinic BP is in the prehypertensive range. Confirmation of MUCH diagnosis should rely on ambulatory BP monitoring. Copyright © 2016 by the American Society of Nephrology.

Effect of Age on Hypertension: Analysis of Over 4,800 Referred Hypertensive Patients

Directory of Open Access Journals (Sweden)

Anderson Gunnar

1999-01-01

Full Text Available We evaluate in this study the factors associated with the effect of age on blood pressure in more than 4800 patients. Their physicians referred them to evaluate for secondary causes for their hypertension. Factors studied included history and physical examination, serum sodium, potassium and creatinine, a stimulated plasma renin and catecholamine. We also studied the blood pressure response to infusion of either saralasin (an angiotensin II analogue or enalapril (an angiotensin converting enzyme inhibitor, and plasma aldosterone and cortisol after infusion of saline. We measured serum thyroxin and thyroid stimulating hormone concentrations on 1061 consecutive patients in this series. The results of our study show that increased age is associated with a significant increase in the prevalence of hypertension and especially of systolic hypertension after age 60 years. Increased obesity between age 30-50 years is associated with significant increases in diastolic blood pressure and this trend is also seen in African-Americans who are heavier than whites. Increased age is associated with an increased prevalence of secondary forms of hypertension including atherosclerotic renovascular hypertension, renal insufficiency and primary hypothyroidism.

Intracranial hemorrhage in normotensive and hypertensive patients receiving streptokinase after decreasing elevated blood pressure

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H Shemirani

2005-09-01

Full Text Available Background: Many patients with suspected acute myocardial infarction (AMI and eligible for thrombolytic therapy may not be treated because of association between hemorrhagic complications especially intracranial hemorrhage (ICH, and severe hypertension (HTN at presentation. Unfortunately, this leads to under use or delay in thrombolytic therapy. We assessed effect of decreasing elevated blood pressure before thrombolytic therapy in order to reduce the incidence of ICH without increasing mortality rate. Methods: This observational and analytical cohort study enrolled 293 patients (215males and 78 female with STsegment elevation (AMI that were hospitalized in emergency department of Noor hospital, Isfahan, Iran. Severe hypertension (blood pressure ≥180/110mmHg was diagnosed in 132 patients. All of them received 1.5 million units streptokinase within one hour intravenously. In the hypertensive group, elevated blood pressure was lowered to less than180/110mmhg before thrombolysis and they were observed to detect development of symptomatic ICH and they underwent Brain CT scan, if required. Results: The incidence of total stroke, ICH and death were 1.4%, 0.7% and 4.8%, respectively. The incidence of death and ICH in patients with severe hypertension was less than control group (P value=0.13 and 0.59, respectively Conclusion: Although we did not find any increase in ICH incidence in severe hypertensive patients treated be streptokinase due to AMI, but we recommend a multi-centric study with more cases and varied thrombolytic protocols. Key words: Acute myocardial infarction, Intracranial hemorrhage, Thrombolytic therapy

Emergency and disaster preparedness for chronically ill patients: a review of recommendations

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Tomio J

2014-12-01

Full Text Available Jun Tomio,1 Hajime Sato2 1Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 2Department of Health Policy and Technology Assessment, National Institute of Public Health, Wako, Japan Abstract: Recent disasters, especially those in developed countries, have highlighted the importance of disaster preparedness measures for chronic diseases. A number of surviving patients experienced the exacerbation of a chronic illness, such as hypertension, diabetes, cancer, and chronic respiratory diseases, due to disaster-related stress, interruption of care, or both; for some patients, these exacerbations resulted in death. Here, we review reports from recent disasters in developed countries and summarize the recommendations for disaster preparedness of chronically ill patients. A considerable number of recommendations based on the lessons learned from recent disasters have been developed, and they provide practical and essential steps to prevent treatment interruption during and after a disaster. To improve preparedness efforts, we suggest that health care providers should be aware of the following three suggestions: 1 recommendations should be evidence-based; 2 recommendations should contain consistent messages; and 3 recommendations should be feasible. Keywords: disaster, chronic illness, preparedness

Renovascular hypertension

International Nuclear Information System (INIS)

Thomsen, H.S.; Sos, T.A.; Nielsen, S.L.; Koebenhavns Amts Sygehus, Herlev; Cornell Univ., New York

1989-01-01

Hypertension constitutes a major health problem and the challenge is to identify patients having 'surgically' curable renal vascular disease among the majority with so-called essential hypertension. The best of unsatisfactory diagnostic tests are renography and plasma renin activity both before and during angiotensin II blockade. The necessity of better screening tests has increased because of the recent advances in surgical techniques and especially percutaneous transluminal renal angioplasty. The latter has definitely become the method of choice for correction of suspected hemodynamically significant artery stenoses whenever technically feasible. With improved angioplasty techniques the risk of treating renal artery stenosis without hemodynamic and clinical importance (so-called cosmetic repair) has increased. Unfortunately randomized trials including surgery versus angioplasty are not available. It should be kept in mind that only after correction of the stenosis is achieved and the blood pressure has become normal, can the diagnosis of renovascular hypertension be made with certainty. (orig.)

Recent advances in the management of resistant hypertension

OpenAIRE

Manolis, Athanasios J.; Kallistratos, Manolis S.; Doumas, Michalis; Pagoni, Stamatina; Poulimenos, Leonidas

2015-01-01

And suddenly, following the preliminary results of renal denervation and carotid baroreceptor stimulation, a big interest in resistant hypertension rose, and all interventionists, many of them with no previous experience with hypertension, fell in love with hypertension and especially resistant hypertension. In the European Society of Hypertension/International Society of Hypertension (ESH/ISH) 2014 Joint Hypertension meeting in Athens, there were no more than four to five sessions related to...

Combination of Echocardiography and Pulse Wave Velocity Provides Clues for the Differentiation between White Coat Hypertension and Hypertension in Postmenopausal Women.

Science.gov (United States)

Suzuki, Hiromichi; Kobayashi, Kazuhiro; Okada, Hirokazu

2014-05-01

To determine whether or not noninvasive assessment of the cardiovascular system can discriminate white coat hypertension and hypertension in postmenopausal women. The major reason is the high prevalence of white coat hypertension in these subjects and the uncertain associations of white coat hypertension with cardiovascular risk. Selected women were required to be naturally or surgically menopausal for at least 1 year but not more than 5 years past their menstrual period. White coat hypertension patients were defined as subjects who had office blood pressures >150/90 mm Hg but who had both systolic and diastolic ambulatory pressures coat hypertension based on the criteria in the trial. Pulse wave patterns were different between subjects with white coat hypertension and those with hypertension. PWV of subjects with white coat hypertension was 1.32 ± 0.33 m/s and that of patients with hypertension was 1.46 ± 0.37 m/s (p coat hypertension could be easily differentiated from hypertension. The combination of blood pressure self-monitoring, echocardiographic data, and PWV can be a powerful indicator for the treatment of hypertension in postmenopausal women.

Hypertension--forekomst og behandling

DEFF Research Database (Denmark)

Ibsen, Hans; Jørgensen, Torben; Jensen, Gorm B

2009-01-01

Hypertension is the most important modifiable risk factor for cardiovascular disease. However, less than half of all hypertensives have their blood pressure reduced to relevant goals. The prevalence of hypertension in Denmark was found to be between 26% and 40% of the adult population. Just over...... half were aware of the diagnosis, but less than half were in treatment. Blood pressure control in patients who are undergoing treatment has improved during recent years, but there is still a gap to achievable control rates. Udgivelsesdato: 2009-Jun-8...

Hypertension and Cardiac Arrhythmias

DEFF Research Database (Denmark)

Lip, Gregory Y H; Coca, Antonio; Kahan, Thomas

2017-01-01

Hypertension (HTN) is a common cardiovascular risk factor leading to heart failure (HF), coronary artery disease (CAD), stroke, peripheral artery disease and chronic renal failure. Hypertensive heart disease can manifest as many types of cardiac arrhythmias, most commonly being atrial fibrillation......) Council on Hypertension convened a Task Force, with representation from the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE), with the remit of comprehensively reviewing the available evidence...

[Hepatopulmonary syndrome and portopulmonary hypertension].

Science.gov (United States)

Marcu, Cristina; Schiffer, Eduardo; Aubert, John-David; Vionnet, Julien; Yerly, Patrick; Deltenre, Pierre; Marot, Astrid

2017-08-30

Hepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH) are two frequent pulmonary complications of liver disease. Portal hypertension is a key element in the pathogenesis of both disorders, which are however distinct in terms of pathogenesis, diagnosis and treatment. HPS corresponds to an abnormal arterial oxygenation in relation with the development of intrapulmonary vascular dilatations. POPH is a pulmonary arterial hypertension in the setting of portal hypertension and elevated pulmonary vascular resistance. As both diseases are associated with an increased risk of morbidity and mortality, it is important to screen and evaluate the severity of these two disorders particularly in liver transplant candidates.

[Particularities and management of arterial hypertension in sub-saharan Africa].

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Fourcade, Laurent; Touze, Jean-Etienne

2011-06-01

More than 25% of adults worldwide have high blood pressure, and this proportion is expected to rise in coming years. In sub-Saharan Africa, it is estimated that 150 million persons will be hypertensive by 2025. This increase appears to be related to the growth and aging of the population, as well as to the growing number of overweight and obese persons. The association with type-2 diabetes is frequent and deleterious. These trends are associated with urbanization and lifestyle westernization. Hypertension presents several etiopathogenic particularities in sub-Saharan Africa, especially with respect to sodium sensitivity and low renin activity. Target organ damage is more common, due to delayed and inadequate therapeutic management and to a likely genetic predisposition. Heart failure, stroke and renal failure often occur in young people. The mainstay of treatment is the use of thiazide diuretics and calcium channel blockers, combined with lifestyle and dietary measures (especially sodium restriction). Because of logistic and economic difficulties, recommendations issued by international societies may not be applicable at the community level.

Genetics Home Reference: pulmonary arterial hypertension

Science.gov (United States)

... Home Health Conditions Pulmonary arterial hypertension Pulmonary arterial hypertension Printable PDF Open All Close All Enable Javascript ... view the expand/collapse boxes. Description Pulmonary arterial hypertension is a progressive disorder characterized by abnormally high ...

Hypertension prevalence and influence of basal metabolic rate on blood pressure among adult students in Bangladesh

Directory of Open Access Journals (Sweden)

Nurshad Ali

2017-07-01

of hypertension in the Bangladeshi adult students. The study also showed a positive association between BMR and blood pressure among the participants. A large scale longitudinal study across the country is needed to find out the underlying causes of hypertension in the Bangladeshi adults. In addition, comprehensive and integrated intervention programs focusing on modifiable risk factors are recommended to make awareness and prevent hypertension.

Systemic hypertension and non-cardiac surgery.

Science.gov (United States)

Misra, Satyajeet

2017-09-01

Primary systemic hypertension affects 10%-25% of individuals presenting for surgery and anaesthesia and constitutes an important cause of cancellation of elective surgeries. Much of the fear stems from the fact that hypertension may lead to adverse perioperative outcomes. Although long-standing hypertension increases the risk of stroke, renal dysfunction or major adverse cardiovascular events, the same is usually not seen in the perioperative period if blood pressure is <180/110 mmHg and this has been the overriding theme in the recent guidelines on perioperative blood pressure management. Newer concepts include isolated systolic hypertension and pulse pressure hypertension that are increasingly used to stratify risk. The aim of this review is to focus on the adult patient with chronic primary systemic hypertension posted for elective non-cardiac surgery and outline the perioperative concerns.

Renal sympathetic denervation attenuates hypertension and vascular remodeling in renovascular hypertensive rats.

Science.gov (United States)

Li, Peng; Huang, Pei-Pei; Yang, Yun; Liu, Chi; Lu, Yan; Wang, Fang; Sun, Wei; Kong, Xiang-Qing

2017-01-01

Li P, Huang P, Yang Y, Liu C, Lu Y, Wang F, Sun W, Kong X. Renal sympathetic denervation attenuates hypertension and vascular remodeling in renovascular hypertensive rats. J Appl Physiol 122: 121-129, 2017. First published October 14, 2016; doi:10.1152/japplphysiol.01019.2015-Sympathetic activity is enhanced in patients with essential or secondary hypertension, as well as in various hypertensive animal models. Therapeutic targeting of sympathetic activation is considered an effective antihypertensive strategy. We hypothesized that renal sympathetic denervation (RSD) attenuates hypertension and improves vascular remodeling and renal disease in the 2-kidney, 1-clip (2K1C) rat model. Rats underwent 2K1C modeling or sham surgery; then rats underwent RSD or sham surgery 4 wk later, thus resulting in four groups (normotensive-sham, normotensive-RSD, 2K1C-sham, and 2K1C-RSD). Norepinephrine was measured by ELISA. Echocardiography was used to assess heart function. Fibrosis and apoptosis were assessed by Masson and TUNEL staining. Changes in mean arterial blood pressure in response to hexamethonium and plasma norepinephrine levels were used to evaluate basal sympathetic nerve activity. The 2K1C modeling success rate was 86.8%. RSD reversed the elevated systolic blood pressure induced by 2K1C, but had no effect on body weight. Compared with rats in the 2K1C-sham group, rats in the 2K1C-RSD group showed lower left ventricular mass/body weight ratio, interventricular septal thickness in diastole, left ventricular end-systolic diameter, and left ventricular posterior wall thickness in systole, whereas fractional shortening and ejection fraction were higher. Right kidney apoptosis and left kidney hypertrophy were not changed by RSD. Arterial fibrosis was lower in animals in the 2K1C-RSD group compared with those in the 2K1C-sham group. RSD reduced plasma norepinephrine and basal sympathetic activity in rats in the 2K1C-RSD group compared with rats in the 2K1C-sham group. These

Comparing standard office-based follow-up with text-based remote monitoring in the management of postpartum hypertension: a randomised clinical trial.

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Hirshberg, Adi; Downes, Katheryne; Srinivas, Sindhu

2018-04-27

Monitoring blood pressure at 72 hours and 7-10 days post partum in women with hypertensive disorders is recommended to decrease morbidity. However, there are no recommendations as to how to achieve this. To compare the effectiveness of text-based blood pressure monitoring to in-person visits for women with hypertensive disorders of pregnancy in the immediate postpartum period. Randomised clinical trial among 206 postpartum women with pregnancy-related hypertension diagnosed during the delivery admission between August 2016 and January 2017. Women were randomised to 2 weeks of text-based surveillance using a home blood pressure cuff and previously tested automated platform or usual care blood pressure check at their prenatal clinic 4-6 days following discharge. The primary study outcome was a single recorded blood pressure in the first 10 days post partum. The ability to meet American Congress of Obstetricians and Gynecologists (ACOG) guidelines, defined as having a blood pressure recorded on postpartum days 3-4 and 7-10 was evaluated in the text message group. The study was powered to detect a 1.4-fold increase in a single recorded blood pressure using text messaging. All outcomes were analysed as intention to treat. 206 women were randomised (103 in each arm). Baseline characteristics were similar. There was a statistically significant increase in a single blood pressure obtained in the texting group in the first 10 days post partum as compared with the office group (92.2% vs 43.7%; adjusted OR 58.2 (16.2-208.1), p<0.001). Eighty-four per cent of patients undergoing text-based surveillance met ACOG criteria for blood pressures at both recommended points. Text-based monitoring is more effective in obtaining blood pressures and meeting current clinical guidelines in the immediate postdischarge period in women with pregnancy-related hypertension compared with traditional office-based follow-up. NCT03185455, Remote Surveillance of Postpartum Hypertension (Text

ORIGINAL ARTICLES Hypertension Guideline 2003 Update

African Journals Online (AJOL)

reduction of BP in the elderly and in those with severe hypertension should .... management of hypertension in adults by health care .... They may demonstrate postural and post- ..... Persons with severe hypertension fall into three categories.

Immune regulation of systemic hypertension, pulmonary arterial hypertension, and preeclampsia: shared disease mechanisms and translational opportunities.

Science.gov (United States)

Jafri, Salema; Ormiston, Mark L

2017-12-01

Systemic hypertension, preeclampsia, and pulmonary arterial hypertension (PAH) are diseases of high blood pressure in the systemic or pulmonary circulation. Beyond the well-defined contribution of more traditional pathophysiological mechanisms, such as changes in the renin-angiotensin-aldosterone system, to the development of these hypertensive disorders, there is substantial clinical evidence supporting an important role for inflammation and immunity in the pathogenesis of each of these three conditions. Over the last decade, work in small animal models, bearing targeted deficiencies in specific cytokines or immune cell subsets, has begun to clarify the immune-mediated mechanisms that drive changes in vascular structure and tone in hypertensive disease. By summarizing the clinical and experimental evidence supporting a contribution of the immune system to systemic hypertension, preeclampsia, and PAH, the current review highlights the cellular and molecular pathways that are common to all three hypertensive disorders. These mechanisms are centered on an imbalance in CD4 + helper T cell populations, defined by excessive Th17 responses and impaired T reg activity, as well as the excessive activation or impairment of additional immune cell types, including macrophages, dendritic cells, CD8 + T cells, B cells, and natural killer cells. The identification of common immune mechanisms in systemic hypertension, preeclampsia, and PAH raises the possibility of new therapeutic strategies that target the immune component of hypertension across multiple disorders. Copyright © 2017 the American Physiological Society.

Radiation-induced renovascular hypertension

International Nuclear Information System (INIS)

Staab, G.E.; Tegtmeyer, C.J.; Constable, W.C.

1976-01-01

Radiation is known to produce changes in the small vessels and interstitium of the kidneys resulting in hypertension. Two cases of renal artery stenosis and resultant hypertension secondary to abdominal irradiation are reported and the literature is reviewed

Management of diabetic hypertensives

Science.gov (United States)

Ganesh, Jai; Viswanathan, Vijay

2011-01-01

Hypertension occurs twice as commonly in diabetics than in comparable nondiabetics. Patients with both disorders have a markedly higher risk for premature microvascular and macrovascular complications. Aggressive control of blood pressure (BP) reduces both micro- and macrovascular complications. In diabetic hypertensives, angiotensin converting enzyme inhibitors (ACEIs) are the first line in management of hypertension, and can be replaced by angiotensin II receptor blockers (ARBs) if patients are intolerant of them. Recent studies suggest ARBs to be on par with ACEI in reducing both macro- and microvascular risks. Adding both these agents may have a beneficial effect on proteinuria, but no extra macrovascular risk reduction. Thiazides can also be used as first line drugs, but are better used along with ACEI/ARBs. Beta-blockers [especially if the patient has coronary artery disease] and calcium channel blockers are used as second line add-on drugs. Multidrug regimens are commonly needed in diabetic hypertensives. Achieving the target BP of <130/80 is the priority rather than the drug combination used in order to arrest and prevent the progression of macro- and microvascular complications in diabetic hypertensives. PMID:22145142

Compliance to antihypertensive drugs, salt restriction, exercise and control of systemic hypertension in hypertensive patients at abbottabad

International Nuclear Information System (INIS)

Ahmed, N.; Waqas, A.; Khaliq, M.A.

2008-01-01

Hypertension is one of the most important cardiovascular risk factor but its control is still a challenge for physicians all around the world. Control of blood pressure can reduce cardiovascular morbidity and mortality, so the compliance to antihypertensive drugs and life style modification play an important role for the control of hypertension. This analytical (cross-sectional) study was conducted to assess prevalence of control of hypertension among hypertensive patients and to assess the relationship of control of hypertension with factors like compliance to antihypertensive drugs, salt restriction and exercise among the hypertensive patients. This study was conducted at outpatient clinic of medicine at Shahina Jamil Hospital Abbottabad from April 2007 to September 2007. Eighty-nine patients seen in the outpatient clinic of medicine were enrolled in the study. All the patients with age 15 years or above, diagnosed as a case of systemic hypertension were included. Among eighty nine patients, 67 were female and 22 were male with mean age of 55.8+-13.4 years, mean systolic and diastolic blood pressure of 160+-28.6 and 97.8+-14.1 mm Hg respectively, and pulse rate of 85.9+-11.4 per minutes. Out of 89 patients, 25.8% were having controlled hypertension, 48.3% were compliant and 51.7% were not compliant to antihypertensive drugs, 55.1% were having salt restriction and 44.9% were having no salt restriction and 23.6% were used to do physical activity while 76.4% were not used to do physical activity. In group A consisted of patients with controlled hypertension, 95.7% patients were compliant to antihypertensive patients, 95.7% were having salt restriction and 43.5% were used to do physical activity. In group B consisted of patients with uncontrolled hypertension, only 31.8% were compliant to antihypertensive drugs, 40.9% were having salt restriction, 16.7% were used to do physical activity. Hypertension can be controlled if the hypertensive patients have good compliance

Diet quality is associated with obesity and hypertension in Australian adults: a cross sectional study

Directory of Open Access Journals (Sweden)

Katherine M. Livingstone

2016-10-01

Full Text Available Abstract Background Poor diet, characterized by a low diet quality score, has been associated with greater prevelence of obesity and hypertension. However, the evidence is inconsistent across diet quality scores and by sex. The aim was to investigate the relationship between diet quality and obesity and hypertension. Methods Adults (n = 4908; age 45.2 ± 0.24 years were included from the cross-sectional Australian Health Survey 2011–2013. Two 24-h dietary recalls were used to derive the dietary guideline index (DGI and recommended food score (RFS. Logistic regression investigated relationships between diet quality score and odds ratio of obesity, hypertension and obesity-associated hypertension. Results In the highest tertile of DGI, but not RFS, individuals were less likely to be obese (men: OR 0.64, CI: 0.45, 0.92, P-trend = 0.014; women: 0.68, 0.48, 0.96, P-trend = 0.025 and to have central adiposity (men: 0.68, 0.48, 0.97, P-trend = 0.030; women: 0.53, 0.37, 0.77, P-trend = 0.001 compared with the lowest tertile. Men, but not women, in the highest tertile of DGI and RFS were less likely to be hypertensive (DGI: 0.56, 0.37, 0.85, P-trend = 0.006; RFS: 0.62, 0.41, 0.94, P-trend = 0.021 compared with the lowest tertile. In men with obesity, but not normal weight men or women, those in the highest tertile of DGI were less likely to be hypertensive (0.53, 0.36, 0.78, P-trend = 0.001 compared with the highest tertile. Conclusions Higher diet quality, as estimated using DGI, was associated with lower odds ratio of obesity in men and women. Odds ratio of hypertension was lower in men, but not women, with a high diet quality score compared with a low score, while obesity-associated hypertension was only associated with diet quality score in men with obesity. Longitudinal studies are needed to evaluate whether diet quality predicts risk of obesity and hypertension.

E1. Risk of chronic hypertension in women with a history of hypertensive disorders of pregnancy

DEFF Research Database (Denmark)

Behrens, I; Basit, S; Melbye, M

2016-01-01

BACKGROUND: Women with a history of hypertensive disorders of pregnancy (HDP) are known to have an increased risk of hypertension years after their pregnancy. However, how soon after an affected pregnancy the risk of hypertension increases and how/whether this risk evolves over time, is unclear. ...

Definition and classification of hypertension: an update.

Science.gov (United States)

Giles, Thomas D; Materson, Barry J; Cohn, Jay N; Kostis, John B

2009-11-01

Since the publication of a paper by the American Society of Hypertension, Inc. Writing Group in 2003, some refinements have occurred in the definition of hypertension. Blood pressure is now recognized as a biomarker for hypertension, and a distinction is made between the various stages of hypertension and global cardiovascular risk. This paper discusses the logic underlying the refinements in the definition of hypertension. 2009 Wiley Periodical, Inc.

[Severe hypertension: definition and patients profiles].

Science.gov (United States)

Mourad, Jean-Jacques

2013-05-01

Severe arterial hypertension gathers relatively different clinical situations explained by the heterogeneity of the definitions of this clinical setting. From a medical point of view, severe hypertension is a short course situation defined by very high values of blood pressure corresponding to grade 3 hypertension. In France, until 2011, the social security also included in the definition of severe HTA chronic situations characterized by moderate blood pressure values requiring at least triple anthihypertensive therapies associated with a clinical or infraclinical target organ damages. These clinical profiles, much more frequent than grade 3 hypertension, allowed the full reimbursement of care costs for these patients. In France, it is estimated that 10% of hypertensive patients present a severe form with an annual incidence of 50,000 patients. The patients with severe hypertension have an increased cardiovascular morbidity justifying a closer clinical monitoring. From an economic point of view, these severe forms of hypertension have a higher cost of care, explained primarily by a more frequent need of specialized referrals, radiological exams and hospitalizations. This excess cost justified the existence of a full coverage of induced costs by the social security, since the incidence of severe hypertension is more frequent in the low social categories, and in patients with economic fragility.

Pulmonary hypertension associated with thalassemia syndromes

Science.gov (United States)

Fraidenburg, Dustin R.; Machado, Roberto F.

2016-01-01

Chronic hemolytic anemia has increasingly been identified as an important risk factor for the development of pulmonary hypertension. Within the thalassemia syndromes, there are multiple mechanisms, both distinct and overlapping, by which pulmonary hypertension develops and that differ among β-thalassemia major or intermedia patients. Pulmonary hypertension in β-thalassemia major correlates with the severity of hemolysis, yet in patients whose disease is well treated with chronic transfusion therapy, the development of pulmonary hypertension can be related to cardiac dysfunction and the subsequent toxic effects of iron overload rather than hemolysis. β-thalassemia intermedia, on the other hand, has a higher incidence of pulmonary hypertension owing to the low level of hemolysis that exists over years without the requirement for frequent transfusions, while splenectomy is shown to play an important role in both types. Standard therapies such as chronic transfusion have been shown to mitigate pulmonary hypertension, and appropriate chelation therapy can avoid the toxic effects of iron overload, yet is not indicated in many patients. Limited evidence exists for the use of pulmonary vasodilators or other therapies, such as l-carnitine, to treat pulmonary hypertension associated with thalassemia. Here we review the most recent findings regarding the pathogenic mechanisms, epidemiology, presentation, diagnosis, and treatment of pulmonary hypertension in thalassemia syndromes. PMID:27008311

Cerebrovascular gene expression in spontaneously hypertensive rats

DEFF Research Database (Denmark)

Grell, Anne-Sofie; Frederiksen, Simona Denise; Edvinsson, Lars

2017-01-01

Hypertension is a hemodynamic disorder and one of the most important and well-established risk factors for vascular diseases such as stroke. Blood vessels exposed to chronic shear stress develop structural changes and remodeling of the vascular wall through many complex mechanisms. However......, the molecular mechanisms involved are not fully understood. Hypertension-susceptible genes may provide a novel insight into potential molecular mechanisms of hypertension and secondary complications associated with hypertension. The aim of this exploratory study was to identify gene expression differences......, the identified genes in the middle cerebral arteries from spontaneously hypertensive rats could be possible mediators of the vascular changes and secondary complications associated with hypertension. This study supports the selection of key genes to investigate in the future research of hypertension-induced end...

Hypertension (High Blood Pressure)

Science.gov (United States)

... Safe Videos for Educators Search English Español Hypertension (High Blood Pressure) KidsHealth / For Teens / Hypertension (High Blood Pressure) What's ... rest temperature diet emotions posture medicines Why Is High Blood Pressure Bad? High blood pressure means a person's heart ...

[Hypertension during pregnancy: Epidemiology, definition].

Science.gov (United States)

Fauvel, Jean-Pierre

2016-01-01

Hypertension in pregnancy has several forms that differ by their mechanisms and their consequences for mothers and fetus. Chronic hypertension is defined by SBP≥140mm Hg or DBP≥90mm Hg before pregnancy or before the 20th week of amenorrhea. Gestational hypertension is defined by SBP≥140mm Hg or DBP≥90mm Hg during or after the 20th week of amenorrhea. Preeclampsia is the occurrence of hypertension and proteinuria after 20weeks of amenorrhea. Severe preeclampsia is accompanied by clinical signs and symptoms indicating visceral pain. The HELLP syndrome is a severe preeclampsia accompanied by intravascular hemolysis and hepatic cytolysis. Eclampsia is characterized by seizures of the tonic-clonic type. A chronic hypertension is observed in 1-5% of pregnancies. Gestational hypertension without proteinuria appears in 5-6% of pregnancies. A preeclampsia develops in 1-2% of pregnancies, but much more frequently (up 34%) in the presence of risk factors. High blood pressure during pregnancy remains, by its complications, the leading cause of maternal morbidity and mortality. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Pulmonary hypertension in patients with Martorell hypertensive leg ulcer: a case control study

Science.gov (United States)

2012-01-01

Background Martorell hypertensive ischemic leg ulcer (Martorell ulcer) is characterized by distinct alterations in the arteriolar wall of subcutaneous vessels, leading to progressive narrowing of the vascular lumen and increase of vascular resistance. These changes are similar to the alterations observed in pulmonary arterioles in patients with chronic pulmonary hypertension (PH). This study was aimed to assess an association between the two disorders. Methods In this case–control study, 14 patients with Martorell ulcer were clinically assessed for the presence of pulmonary hypertension using transthoracic Doppler echocardiography. Data from patients were compared to 28 matched hypertensive controls. Results Systolic pulmonary arterial pressure (sPAP) in patients with Martorell ulcer was significantly higher than in the control group (33.8 ± 16.9 vs 25.3 ± 6.5 mmHg, p = 0.023); the prevalence of pulmonary hypertension was 31% (5/14) in patients and 7% (2/28) in controls (p = 0.031). No differences were seen in left heart size and function between patients and controls. Conclusion This study provides first evidence that subcutaneous arteriolosclerosis, the hallmark of Martorell ulcer, is associated with PH. These findings suggest that patients with Martorell leg ulcer might be at significant risk to develop elevated pulmonary arterial pressure. Patients with leg ulcers who present with dyspnea should be evaluated by echocardiography for the presence of pulmonary hypertension. PMID:22686459

Update on chronic thromboembolic pulmonary hypertension.

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Robbins, Ivan M; Pugh, Meredith E; Hemnes, Anna R

2017-01-01

Chronic, unresolved thromboemboli are an important cause of pulmonary hypertension (PH) with specific treatment strategies differing from other types of PH. Chronic thromboembolic pulmonary hypertension (CTEPH) is classified as group 4 PH by the World Health Organization. It is a rare, but underdiagnosed, complication of acute pulmonary embolism that does not resolve and results in occlusion of large pulmonary arteries with a fibro-thrombotic material. The etiology of CTEPH remains uncertain, and it is unknown why certain patients with acute pulmonary embolism develop this disorder. The evaluation for CTEPH is an important part of the evaluation for PH in general, and it is crucial not to overlook this diagnosis, as it is the only form of PH that is potentially curable. Patients diagnosed with CTEPH should be referred to an expert center for consideration of pulmonary endarterectomy, and surgical removal of the chronic thromboembolic material. Not all patients with CTEPH are surgical candidates, however, and there are emerging treatments-medical therapy and balloon pulmonary angioplasty-that have shown benefit in this patient population. Without treatment, CTEPH can lead to progressive pulmonary vascular obstruction, right heart failure, and death. Thus, it is important for clinicians to recognize this subtype of PH. In this review, we provide an overview of current understanding of the pathogenesis of CTEPH and highlight recommendations and recent advances in the evaluation and treatment of CTEPH. Copyright © 2016 Elsevier Inc. All rights reserved.

Myocardial Performance Index in Childhood Onset Essential Hypertension and White Coat Hypertension.

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Gupta-Malhotra, Monesha; Hamzeh, Rabih K; Poffenbarger, Tim; McNiece-Redwine, Karen; Hashmi, Syed Shahrukh

2016-03-01

As a global measure of ventricular systolic and diastolic function, the myocardial performance index (MPI) can be an early indicator of hypertensive cardiomyopathy in children with essential hypertension (EH). Children with untreated newly diagnosed EH and white coat hypertension (WCH) by a 24-hour ambulatory blood pressure monitoring (ABPM), both groups without any identifiable etiology for the hypertension, were enrolled for the study. Echocardiograms and vascular ultrasounds for carotid artery intimal medial thickness were performed on all children prior to therapy. Diastolic function (peak E and A velocities, E/A ratio, isovolumic relaxation time, and deceleration times) and MPI were evaluated by simultaneous transmitral and transaortic spectral Doppler flow velocities. Systolic function was evaluated by shortening fraction and ejection fraction. A cohort of 66 children (24 with EH, 42 with WCH, males 61%, median age of 13 years, range 10-17 years) were enrolled in the study. The demographic, anthropometric, laboratory tests, vascular ultrasound, and conventional echocardiographic parameters were similar between the 2 groups. There was a very small difference in MPI between the EH and WCH children (0.28 SD: 0.07 vs. 0.31 SD: 0.08, P = 0.045). However, in EH children, MPI increased by 0.14 units for every 10 unit increase in mean ABPM systolic BP (95% confidence interval: 0.03-0.25). We found the increasing MPI was associated with increasing 24-hour mean systolic BP in children with EH. Therefore, MPI may have utility as a single, quick, noninvasive method of detection and tracking of subclinical hypertensive heart disease. © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The renal transcriptome in experimental hypertension

NARCIS (Netherlands)

Wesseling, S.

2007-01-01

The renal transcriptome in experimental hypertension The kidneys importantly determine blood pressure. Kidney dysfunction can result in hypertension, which in turn leads to renal damage. In primary hypertension the cause is unknown. The condition is polygenic, however, which genetic defects cause

High Blood Pressure (Hypertension) (For Parents)

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... Safe Videos for Educators Search English Español Hypertension (High Blood Pressure) KidsHealth / For Parents / Hypertension (High Blood Pressure) What's ... High Blood Pressure) Treated? Print What Is Hypertension (High Blood Pressure)? Blood pressure is the pressure of blood against ...

Isolated Systolic Hypertension: A Health Concern?

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Isolated systolic hypertension: A health concern? Is having a high top number (systolic) blood pressure, but a normal bottom number (diastolic) ... mm Hg, you have a common type of high blood pressure called isolated systolic hypertension. Isolated systolic hypertension can ...

2015 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension

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Chern-En Chiang

2015-01-01

The TSOC/THS hypertension guidelines provide the most updated information available in the management of hypertension. The guidelines are not mandatory, and members of the task force fully realize that treatment of hypertension should be individualized to address each patient's circumstances. Ultimately, the decision of the physician decision remains of the utmost importance in hypertension management.

The prevalence of ocular lesions associated with hypertension in a population of geriatric cats in Auckland, New Zealand.

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Carter, J M; Irving, A C; Bridges, J P; Jones, B R

2014-01-01

hypertensive ocular lesions, often before the owner or veterinarian is aware the cat has a problem with its vision. This may result in diagnosis of systemic hypertension allowing early treatment and resolution of lesions. The current study demonstrates that ocular lesions resulting from hypertension occur frequently enough in cats in Auckland to support the recommendation for fundic examination in cats over eight years of age as part of the routine physical examination.

Pulmonary hypertension in patients with chronic myeloproliferative disorders

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Yochai Adir

2015-09-01

Full Text Available Pulmonary hypertension (PH is a major complication of several haematological disorders. Chronic myeloproliferative diseases (CMPDs associated with pulmonary hypertension have been included in group five of the clinical classification for pulmonary hypertension, corresponding to pulmonary hypertension for which the aetiology is unclear and/or multifactorial. The aim of this review is to discuss the epidemiology, pathogenic mechanism and treatment approaches of the more common forms of pulmonary hypertension in the context of CMPD's: chronic thromboembolic pulmonary hypertension, precapillary pulmonary hypertension and drug-induced PH.

Vascular Remodeling in Experimental Hypertension

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Norma R. Risler

2005-01-01

Full Text Available The basic hemodynamic abnormality in hypertension is an increased peripheral resistance that is due mainly to a decreased vascular lumen derived from structural changes in the small arteries wall, named (as a whole vascular remodeling. The vascular wall is an active, flexible, and integrated organ made up of cellular (endothelial cells, smooth muscle cells, adventitia cells, and fibroblasts and noncellular (extracellular matrix components, which in a dynamic way change shape or number, or reorganize in response to physiological and pathological stimuli, maintaining the integrity of the vessel wall in physiological conditions or participating in the vascular changes in cardiovascular diseases such as hypertension. Research focused on new signaling pathways and molecules that can participate in the mechanisms of vascular remodeling has provided evidence showing that vascular structure is not only affected by blood pressure, but also by mechanisms that are independent of the increased pressure. This review will provide an overview of the evidence, explaining some of the pathophysiologic mechanisms participating in the development of the vascular remodeling, in experimental models of hypertension, with special reference to the findings in spontaneously hypertensive rats as a model of essential hypertension, and in fructose-fed rats as a model of secondary hypertension, in the context of the metabolic syndrome. The understanding of the mechanisms producing the vascular alterations will allow the development of novel pharmacological tools for vascular protection in hypertensive disease.

Causal mechanisms of masked hypertension: socio-psychological aspects.

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Ogedegbe, Gbenga

2010-04-01

The contribution of Dr Thomas Pickering's study to the measurement of blood pressure (BP) is the defining aspect of his academic career and achievement - narrowly defined. In this regard, two important areas characterized his study as it relates to masked hypertension. First, he introduced the term, masked hypertension, to replace the rather inappropriate term 'reverse white-coat hypertension' and 'white-coat normotension'; thus drawing attention to the fact that these patients are genuinely hypertensive by ambulatory BP but were missed by normal office BP. More importantly, he rightly maintained that masked hypertension is a true continuum of sustained hypertension rather than an aberrant measurement artifact. Second, is his pivotal study on the important role of psychosocial factors as a potential mechanism for the development of masked hypertension. In this regard, he explained masked hypertension as a conditioned response to anxiety in office settings, and highlighted the role that diagnostic labeling plays in its development. His view of masked hypertension is that of a continuum from prehypertension (based on office BP measurement) to masked hypertension (based on ambulatory BP) and finally to sustained hypertension (based on both office and ambulatory BP). He strongly believes that it is the prehypertensive patients who progress to masked hypertension. Subsequently, patients who are prehypertensive should be screened for masked hypertension and treated. In this manuscript, we summarize his study as it relates to the definition of masked hypertension, the psychosocial characteristics, mechanisms and its clinical relevance.

Renal artery denervation for treating resistant hypertension : definition of the disease, patient selection and description of the procedure.

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Volpe, Massimo; Rosei, Enrico Agabiti; Ambrosioni, Ettore; Cottone, Santina; Cuspidi, Cesare; Borghi, Claudio; De Luca, Nicola; Fallo, Francesco; Ferri, Claudio; Mancia, Giuseppe; Morganti, Alberto; Muiesan, Maria Lorenza; Sarzani, Riccardo; Sechi, Leonardo; Tocci, Giuliano; Virdis, Agostino

2012-12-01

Arterial hypertension is responsible for a significant burden of cardiovascular morbidity and mortality, worldwide. Although several rational and integrated pharmacological strategies are available, the control of high blood pressure still remains largely unsatisfactory. Failure to achieve effective blood pressure control in treated hypertensive patients may have a substantial impact on individual global cardiovascular risk, since it significantly increases the risk of developing hypertension-related macrovascular and microvascular complications. Arterial hypertension is arbitrarily defined as 'resistant' or 'refractory' when the recommended blood pressure goals (clinic blood pressure below 140/90 mmHg or below 130/80 mmHg in patients with type 2 diabetes mellitus or nephropathy) are not achieved in the presence of a therapeutic strategy that includes lifestyle changes and at least three classes of antihypertensive drugs, including a diuretic, at adequate doses. Recently, an innovative non-pharmacological option has become available for treating resistant hypertension. Sympathetic denervation of renal arteries is a minimally invasive procedure that is performed via percutaneous access from the femoral artery. It consists of radiofrequency ablation of the afferent and efferent nerves of the renal sympathetic nervous system, with consequent isolation of renal parenchymal and juxtaglomerular structures from abnormal stimulation of the efferent adrenergic system. The present position paper of the Italian Society of Hypertension (SIIA) offers a diagnostic and therapeutic approach for the proper identification and effective clinical management of patients with resistant hypertension, who are candidates for renal artery denervation. These indications may have important implications not only from a clinical point of view, but also from an economic point of view, since a proper identification of patients with true resistant hypertension and an accurate selection of patients

[Secondary Arterial Hypertension: Uncertainties in Diagnosis].

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Dinis, Paulo Gomes; Cachulo, Maria Carmo; Fernandes, Andreia; Paiva, Luis; Gonçalves, Lino

2017-06-30

Arterial hypertension is regarded today as a global public health problem, and the prevalence rate in Portugal is 26.9%. According to the etiology, is classified into primary or secondary arterial hypertension. In about 90% of cases it is not possible to establish a cause, so is called primary arterial hypertension. In the remaining 5 to 10%, it can be identified secondary causes, which are potentially treatable. For secondary arterial hypertension study to be cost-effective, it is essential to understand which patients investigate, and evaluate the best strategy to adopt. The main causes identified as responsible for secondary arterial hypertension are: kidney disease; endocrine and vascular diseases and obstructive sleep apnea. Among these some are consensual, and others more controversial in the literature. In this regard we present two cases of arterial hypertension, which are potentially secondary in etiology, but still focus of debate.

Lifestyle in progression from hypertensive disorders of pregnancy to chronic hypertension in Nurses' Health Study II: observational cohort study.

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Timpka, Simon; Stuart, Jennifer J; Tanz, Lauren J; Rimm, Eric B; Franks, Paul W; Rich-Edwards, Janet W

2017-07-12

Objectives  To study the association between lifestyle risk factors and chronic hypertension by history of hypertensive disorders of pregnancy (HDP: gestational hypertension and pre-eclampsia) and investigate the extent to which these risk factors modify the association between HDP and chronic hypertension. Design  Prospective cohort study. Setting  Nurses' Health Study II (1991-2013). Participants  54 588 parous women aged 32 to 59 years with data on reproductive history and without previous chronic hypertension, stroke, or myocardial infarction. Main outcome measure  Chronic hypertension diagnosed by a physician and indicated through nurse participant self report. Multivariable Cox proportional hazards models were used to investigate the development of chronic hypertension contingent on history of HDP and four lifestyle risk factors: post-pregnancy body mass index, physical activity, adherence to the Dietary Approaches to Stop Hypertension (DASH) diet, and dietary sodium/potassium intake. Potential effect modification (interaction) between each lifestyle factor and previous HDP was evaluated with the relative excess risk due to interaction. Results  10% (n=5520) of women had a history of HDP at baseline. 13 971 cases of chronic hypertension occurred during 689 988 person years of follow-up. Being overweight or obese was the only lifestyle factor consistently associated with higher risk of chronic hypertension. Higher body mass index, in particular, also increased the risk of chronic hypertension associated with history of HDP (relative excess risk due to interaction Psodium/potassium intake on the association between HDP and chronic hypertension. Conclusion  This study suggests that the risk of chronic hypertension after HDP might be markedly reduced by adherence to a beneficial lifestyle. Compared with women without a history of HDP, keeping a healthy weight seems to be especially important with such a history.

The influence of frailty syndrome on medication adherence among elderly patients with hypertension

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Jankowska-Polańska B

2016-12-01

Full Text Available Beata Jankowska-Polańska,1 Krzysztof Dudek,2 Anna Szymanska-Chabowska,3 Izabella Uchmanowicz1 1Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 2Department of Logistic and Transport Systems, Faculty of Mechanical Engineering, Wroclaw University of Technology, 3Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland Background: Hypertension affects about 80% of people older than 80 years; however, diagnosis and treatment are difficult because about 55% of them do not adhere to treatment recommendations due to low socioeconomic status, comorbidities, age, physical limitations, and frailty syndrome.Aims: The purposes of this study were to evaluate the influence of frailty on medication adherence among elderly hypertensive patients and to assess whether other factors influence adherence in this group of patients.Methods and results: The study included 296 patients (mean age 68.8±8.0 divided into frail (n=198 and non-frail (n=98 groups. The Polish versions of the Tilburg Frailty Indicator (TFI for frailty assessment and 8-item Morisky Medication Adherence Scale for adherence assessment were used. The frail patients had lower medication adherence in comparison to the non-frail subjects (6.60±1.89 vs 7.11±1.42; P=0.028. Spearman’s rank correlation coefficients showed that significant determinants with negative influence on the level of adherence were physical (rho =-0.117, psychological (rho =-0.183, and social domain (rho =-0.163 of TFI as well as the total score of the questionnaire (rho =-0.183. However, multiple regression analysis revealed that only knowledge about complications of untreated hypertension (β=0.395 and satisfaction with the home environment (β=0.897 were found to be independent stimulants of adherence level.Conclusion: Frailty is highly prevalent among elderly hypertensive patients. Higher level of frailty

Hypertension og det metaboliske syndrom

DEFF Research Database (Denmark)

Olsen, Michael Hecht; Jeppesen, Jørgen; Larsen, Mogens Lytken

2009-01-01

The metabolic syndrome is a relatively prevalent condition characterized by co-existence of several metabolic and cardiovascular risk factors including hypertension. Patients with hypertension have an increased risk of developing the metabolic syndrome which, in turn, increases the cardiovascular...... syndrome is of clinical importance as it makes the treating physician test for other elements of the syndrome in patients with one of the elements, e.g. hypertension. Udgivelsesdato: 2009-Jun...

Hypertension og det metaboliske syndrom

DEFF Research Database (Denmark)

Olsen, Michael; Jeppesen, Jørgen; Larsen, Mogens

2009-01-01

The metabolic syndrome is a relatively prevalent condition characterized by co-existence of several metabolic and cardiovascular risk factors including hypertension. Patients with hypertension have an increased risk of developing the metabolic syndrome which, in turn, increases the cardiovascular...... syndrome is of clinical importance as it makes the treating physician test for other elements of the syndrome in patients with one of the elements, e.g. hypertension. Udgivelsesdato: 2009-Jun-15...

Secondary hypertension: the ways of management.

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Rossi, Gian P; Seccia, Teresa M; Pessina, Achille C

2010-11-01

The prevalence of secondary hypertension is lower than that of primary (essential) hypertension, but it is likely that it has been underestimated because appropriate tests were not generally performed. Hence, before embarking on a search for secondary hypertension physicians are generally advised to select populations of patients with a high pre-test probability of secondary forms of hypertension in order to maximize the positive predictive value and the gain in "ruling in" of the diagnostic tests. Based on updated information on prevalence and pathophysiology we herein critically review the general diagnostic strategy and the management of the main forms of secondary hypertension. In particular, strategies for identifying primary aldosteronism, the most frequent form of endocrine secondary hypertension, and for determining its unilateral or bilateral causes are discussed in details, because of the differences of treatment that requires adrenalectomy in the unilateral forms and mineralocorticoid receptor blockade in the bilateral forms. The tests available for the diagnosing pheochromocytoma (pheo), which is much rarer but extremely important to identify, as it can be fatal if unrecognized are also discussed, with emphasis on the recent developments in genetic testing. Renovascular hypertension is also a common curable form of hypertension, which should be identified as early as possible to avoid the onset of cardiovascular target organ damage and events, is also discussed.

Level of knowledge of the Physical Education Professional working with hypertensive students in gyms DOI: 10.5007/1980-0037.2010v12n4p262

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Luciana Zaranza Monteiro

2010-01-01

Full Text Available Arterial hypertension is one of the main risk factors for the development of cardiovascular diseases and affects a substantial part of the Brazilian population. The objective of this study was to compare the level of knowledge between Physical Education Professionals who worked with hypertensive students in gyms and those who did not. A total of 400 professionals working in gyms in the Municipality of Fortaleza-CE participated in the study. A questionnaire containing the following information was used: knowledge about criteria for hypertension, types of laboratory tests, types of hypertension in the students, general care during physical activity, and recommendations for a better control of hypertension. Among the 400 professionals, 302 (75.5% worked with hypertensive students. Of these, 236 (59% based their diagnosis of hypertension solely on the report of the students. Regarding the situations in which the professionals contraindicated physical activity for the hypertensive students, 43.1% reported high blood pressure, 15.5% reported no situation, and 21.5% had no information. With respect o blood pressure measurement before and after physical activity, most of the professionals (62.3% working with hypertensive students did not measure the student’s blood pressure. The knowledge of the professionals about hypertension in gyms was insufficient. More specific studies are necessary to obtain data that will contribute to the development of programs designed for Physical Education Professionals that establish the needs of hypertensive students in gyms.

Pregnancy with Portal Hypertension

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Aggarwal, Neelam; Negi, Neha; Aggarwal, Aakash; Bodh, Vijay; Dhiman, Radha K.

2014-01-01

Even though pregnancy is rare with cirrhosis and advanced liver disease, but it may co-exist in the setting of non-cirrhotic portal hypertension as liver function is preserved but whenever encountered together is a complex clinical dilemma. Pregnancy in a patient with portal hypertension presents a special challenge to the obstetrician as so-called physiological hemodynamic changes associated with pregnancy, needed for meeting demands of the growing fetus, worsen the portal hypertension thereby putting mother at risk of potentially life-threatening complications like variceal hemorrhage. Risks of variceal bleed and hepatic decompensation increase many fold during pregnancy. Optimal management revolves round managing the portal hypertension and its complications. Thus management of such cases requires multi-speciality approach involving obstetricians experienced in dealing with high risk cases, hepatologists, anesthetists and neonatologists. With advancement in medical field, pregnancy is not contra-indicated in these women, as was previously believed. This article focuses on the different aspects of pregnancy with portal hypertension with special emphasis on specific cause wise treatment options to decrease the variceal bleed and hepatic decompensation. Based on extensive review of literature, management from pre-conceptional period to postpartum is outlined in order to have optimal maternal and perinatal outcomes. PMID:25755552

Hypertension

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Allegheny County / City of Pittsburgh / Western PA Regional Data Center — These datasets provide de-identified insurance data for hypertension hyperlipidemia. The data is provided by three managed care organizations in Allegheny County...

Apparent and true resistant hypertension: definition, prevalence and outcomes.

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Judd, E; Calhoun, D A

2014-08-01

Resistant hypertension, defined as blood pressure (BP) remaining above goal despite the use of > or =3 antihypertensive medications at maximally tolerated doses (one ideally being a diuretic) or BP that requires > or =4 agents to achieve control, has received more attention with increased efforts to improve BP control rates and the emergence of device-based therapies for hypertension. This classically defined resistant group consists of patients with true resistant hypertension, controlled resistant hypertension and pseudo-resistant hypertension. In studies where pseudo-resistant hypertension cannot be excluded (for example, 24-h ambulatory BP not obtained), the term apparent resistant hypertension has been used to identify 'apparent' lack of control on > or =3 medications. Large, well-designed studies have recently reported the prevalence of resistant hypertension. Pooling prevalence data from these studies and others within North America and Europe with a combined sample size of >600,000 hypertensive participants, the prevalence of resistant hypertension is 14.8% of treated hypertensive patients and 12.5% of all hypertensives. However, the prevalence of true resistant hypertension, defined as uncontrolled both by office and 24-h ambulatory BP monitoring with confirmed medication adherence, may be more meaningful in terms of identifying risk and estimating benefit from newer therapies like renal denervation. Rates of cardiovascular events and mortality follow mean 24-h ambulatory BPs in patients with resistant hypertension, and true resistant hypertension represents the highest risk. The prevalence of true resistant hypertension has not been directly measured in large trials; however, combined data from smaller studies suggest that true resistant hypertension is present in half of the patients with resistant hypertension who are uncontrolled in the office. Our pooled analysis shows prevalence rates of 10.1% and 7.9% for uncontrolled resistant hypertension among

SYSTOLIC HYPERTENSION. IMPACT ON CEREBROVASCULAR DISEASE

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Juan Eloy Cruz Quesada

2011-08-01

Full Text Available Background: Atherosclerosis is a multifactor process in which several risk factors are involved. It is the leading cause of death and morbidity in hospital admitted patients, and it may cause a marked decrease in blood flow to all organs of the body.Objective: To determine the impact of systolic hypertension on cerebrovascular disease.Methods: A cross-sectional, observational and analytical study was conducted in 59 death patients who suffered from hypertension. Cerebral arteries were analyzed and atherosclerotic lesion and its variety were quantified by using the atherometric system. The different types of hypertension were considered. Statistical (central tendency measures and comparative (comparison test based on Student’s arithmetic t-test procedures were used.Results: Recent strokes were more frequent in systodiastolic hypertensive patients. There was no significant difference in the injury onset age for both sexes, but women with systolic hypertension were significantly more damaged (from a morphometric point of view. Significant correlation for both groups of hypertensive patients was observed between type of stroke and atherometric system variables.Conclusions: Systolic hypertension is an important factor in the genesis of cerebrovascular disease and is associated with the progression of atherosclerotic plaque.

Hypertensive crisis during pregnancy and postpartum period.

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Too, Gloria T; Hill, James B

2013-08-01

Hypertension affects 10% of pregnancies, many with underlying chronic hypertension, and approximately 1-2% will undergo a hypertensive crisis at some point during their lives. Hypertensive crisis includes hypertensive urgency and emergency; the American College of Obstetricians and Gynecologists describes a hypertensive emergency in pregnancy as persistent (lasting 15 min or more), acute-onset, severe hypertension, defined as systolic BP greater than 160 mmHg or diastolic BP >110 mmHg in the setting of pre-eclampsia or eclampsia. Pregnancy may be complicated by hypertensive crisis, with lower blood pressure threshold for end-organ damage than non-pregnant patients. Maternal assessment should include a thorough history. Fetal assessment should include heart rate tracing, ultrasound for growth and amniotic assessment, and Doppler evaluation if growth restriction is suspected. Initial management of hypertensive emergency (systolic BP >160 mmHg or diastolic BP >110 mmHg in the setting of pre-eclampsia or eclampsia) generally includes the rapid reduction of blood pressure through the use of intravenous antihypertensive medications, with goal systolic blood pressure between 140 mmHg and 150 mmHg and diastolic pressure between 90 mmHg and 100 mmHg. First-line intravenous drugs include labetalol and hydralazine, but other agents may be used, including esmolol, nicardipine, nifedipine, and, as a last resort, sodium nitroprusside. Among patients with hypertensive urgency, slower blood pressure reduction can be provided with oral agents. The objective of this article is to review the current understanding, diagnosis, and management of hypertensive crisis during pregnancy and the postpartum period. Copyright © 2013 Elsevier Inc. All rights reserved.

Managing hypertension in the newborn infants

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Azar Nickavar

2014-01-01

Full Text Available Hypertension in newborn infants, particularly those requiring intensive care, is becoming increasingly recognized, with prevalence of 0.2-3%. Recent studies have established normative tables for blood pressure (BP in both term and pre-term infants based on the gestational age, postnatal age, gender, weight and height, identifying the neonates at increased risk for early-onset cardiovascular disease. Common causes of neonatal hypertension include thromboembolic complications secondary to umbilical artery catheterization, congenital renal structural malformation, renovascular disease, aortic coarctation, as well as acute kidney injury and certain medications. A careful diagnostic evaluation should lead to identification of the underlying cause of hypertension in most infants. Treatment options should be tailored to the severity; and underlying cause of hypertension, including intravenous and/or oral therapy. This review summarizes recent work in these areas, focusing on optimal BP measurement, definition, evaluation and management of hypertension as well as advances in drug therapy of neonatal hypertension.

Hypertension in obese children and adolescents

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Peco-Antić Amira

2009-01-01

Full Text Available Obesity, especially upper body fat distribution, has become an increasingly important medical problem in children and adolescents. Outcomes related to childhood obesity include, as in adult population, hypertension, type 2 diabetes mellitus, dyslipidemia, left ventricular hypertrophy, obstructive sleep apnea, orthopedic and socio-psychological problems. Obese children are at approximately 3-fold higher risk for hypertension from non-obese ones. Obesity-hypertension appears to be characterized by a preponderance of isolated systolic hypertension, increased heart rate and blood pressure variability, increased levels of plasma catecholamine and aldosterone, and salt-sensitivity. Lifestyle changes of weight loss, healthier diet and regular physical exercise are effective in obesity-hypertension control, though pharmacological treatment is frequently necessary. Screening for dyslipidemia and impaired glucose tolerance should be performed in paediatric patients with obese hypertension on regular basis, at least once annually or semiannually to discover metabolic syndrome and to prevent its increased cardiovascular risk. Of course, prevention of obesity is the primary goal. .

Alterations of the Gut Microbiome in Hypertension

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Qiulong Yan

2017-08-01

Full Text Available Introduction: Human gut microbiota is believed to be directly or indirectly involved in cardiovascular diseases and hypertension. However, the identification and functional status of the hypertension-related gut microbe(s have not yet been surveyed in a comprehensive manner.Methods: Here we characterized the gut microbiome in hypertension status by comparing fecal samples of 60 patients with primary hypertension and 60 gender-, age-, and body weight-matched healthy controls based on whole-metagenome shotgun sequencing.Results: Hypertension implicated a remarkable gut dysbiosis with significant reduction in within-sample diversity and shift in microbial composition. Metagenome-wide association study (MGWAS revealed 53,953 microbial genes that differ in distribution between the patients and healthy controls (false discovery rate, 0.05 and can be grouped into 68 clusters representing bacterial species. Opportunistic pathogenic taxa, such as, Klebsiella spp., Streptococcus spp., and Parabacteroides merdae were frequently distributed in hypertensive gut microbiome, whereas the short-chain fatty acid producer, such as, Roseburia spp. and Faecalibacterium prausnitzii, were higher in controls. The number of hypertension-associated species also showed stronger correlation to the severity of disease. Functionally, the hypertensive gut microbiome exhibited higher membrane transport, lipopolysaccharide biosynthesis and steroid degradation, while in controls the metabolism of amino acid, cofactors and vitamins was found to be higher. We further provided the microbial markers for disease discrimination and achieved an area under the receiver operator characteristic curve (AUC of 0.78, demonstrating the potential of gut microbiota in prediction of hypertension.Conclusion: These findings represent specific alterations in microbial diversity, genes, species and functions of the hypertensive gut microbiome. Further studies on the causality relationship between

Secondary hypertension in adults.

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Puar, Troy Hai Kiat; Mok, Yingjuan; Debajyoti, Roy; Khoo, Joan; How, Choon How; Ng, Alvin Kok Heong

2016-05-01

Secondary hypertension occurs in a significant proportion of adult patients (~10%). In young patients, renal causes (glomerulonephritis) and coarctation of the aorta should be considered. In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. Primary aldosteronism can be screened by taking morning aldosterone and renin levels, and should be considered in patients with severe, resistant or hypokalaemia-associated hypertension. Symptoms of obstructive sleep apnoea should be sought. Worsening of renal function after starting an angiotensin-converting enzyme inhibitor suggests the possibility of renal artery stenosis. Recognition, diagnosis and treatment of secondary causes of hypertension lead to good clinical outcomes and the possible reversal of end-organ damage, in addition to blood pressure control. As most patients with hypertension are managed at the primary care level, it is important for primary care physicians to recognise these conditions and refer patients appropriately. Copyright: © Singapore Medical Association.

Hypertension prevalence, awareness, treatment and its correlates among people 35 years and older: Result from pilot phase of the Azar cohort study.

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Ghorbani, Zohreh; Shamshirgaran, Seyed Morteza; Ghaffari, Samad; Sarbakhsh, Parvin; Najafipour, Farzad; Aminisani, Nayyereh

2018-01-01

There is remarkable alteration in hypertension prevalence and awareness, and their correlates among various geographic locations and ethnic groups. The aim of this study was to report hypertension prevalence, awareness, and its correlates as well as hypertension treatment, and control among Azari people aged 35 years and older. The pilot phase of the Azar Cohort Study; a state level of a nationwide PERSIAN cohort study was conducted in Khameneh city between October 2014 and January 2015. All people 35 years of age and above were invited to take part in this study. A comprehensive range of different biomarkers, lifestyle, socioeconomic factors, and health-related factors was collected. Blood pressure was measured by a trained nurse/midwife. Descriptive statistical methods were used to present general characteristics of the study population as frequency tables. Separate multiple logistic regression models were built to assess the predictors of hypertension prevalence. A total of 1038 people were included in this study. The overall prevalence of hypertension was 22.9%. Awareness of hypertension was 60.5% and in those with known hypertension, 84% were using the antihypertensive medications, of those 68.5% had controlled hypertension. After adjustment; age (odds ratios [OR] adj = 1.12 95% confidence interval [CI]: 1.09-1.15), gender (OR adj = 1.65 95% CI: 1.08-2.51), obesity OR adj = 2.51 (1.40-4.88), waist-to-hip ratio (WHR) (OR adj = 1.70 (1.05-2.75), and comorbidities (OR adj = 2.51 (1.72-3.66) were independent predictors of hypertension. Age, sex, body mass index, WHR, and comorbidities were known as predictors of hypertension in this study, health promotion strategies including lifestyle modification to reduce overweight/obesity and secondary prevention programs for early detection of hypertension in high-risk groups according to age, gender, and disease profile are recommended.

Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy: nationwide cohort study.

Science.gov (United States)

Behrens, Ida; Basit, Saima; Melbye, Mads; Lykke, Jacob A; Wohlfahrt, Jan; Bundgaard, Henning; Thilaganathan, Baskaran; Boyd, Heather A

2017-07-12

Objectives  To determine how soon after delivery the risk of post-pregnancy hypertension increases in women with hypertensive disorders of pregnancy and how the risk evolves over time. Design  Nationwide register based cohort study. Setting  Denmark. Populations  482 972 primiparous women with a first live birth or stillbirth between 1995 and 2012 (cumulative incidence analyses), and 1 025 118 women with at least one live birth or stillbirth between 1978 and 2012 (Cox regression analyses). Main outcome measures  10 year cumulative incidences of post-pregnancy hypertension requiring treatment with prescription drugs, and hazard ratios estimated using Cox regression. Results  Of women with a hypertensive disorder of pregnancy in a first pregnancy in their 20s, 14% developed hypertension in the first decade post partum, compared with 4% of women with normotensive first pregnancies in their 20s. The corresponding percentages for women with a first pregnancy in their 40s were 32% and 11%, respectively. In the year after delivery, women with a hypertensive disorder of pregnancy had 12-fold to 25-fold higher rates of hypertension than did women with a normotensive pregnancy. Rates in women with a hypertensive disorder of pregnancy were threefold to 10-fold higher 1-10 years post partum and remained twice as high even 20 or more years later. Conclusions  The risk of hypertension associated with hypertensive disorders of pregnancy is high immediately after an affected pregnancy and persists for more than 20 years. Up to one third of women with a hypertensive disorder of pregnancy may develop hypertension within a decade of an affected pregnancy, indicating that cardiovascular disease prevention in these women should include blood pressure monitoring initiated soon after pregnancy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada.

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Joffres, Michel R; Campbell, Norm R C; Manns, Braden; Tu, Karen

2007-05-01

Hypertension is the leading risk factor for mortality worldwide. One-quarter of the adult Canadian population has hypertension, and more than 90% of the population is estimated to develop hypertension if they live an average lifespan. Reductions in dietary sodium additives significantly lower systolic and diastolic blood pressure, and population reductions in dietary sodium are recommended by major scientific and public health organizations. To estimate the reduction in hypertension prevalence and specific hypertension management cost savings associated with a population-wide reduction in dietary sodium additives. Based on data from clinical trials, reducing dietary sodium additives by 1840 mg/day would result in a decrease of 5.06 mmHg (systolic) and 2.7 mmHg (diastolic) blood pressures. Using Canadian Heart Health Survey data, the resulting reduction in hypertension was estimated. Costs of laboratory testing and physician visits were based on 2001 to 2003 Ontario Health Insurance Plan data, and the number of physician visits and costs of medications for patients with hypertension were taken from 2003 IMS Canada. To estimate the reduction in total physician visits and laboratory costs, current estimates of aware hypertensive patients in Canada were used from the Canadian Community Health Survey. Reducing dietary sodium additives may decrease hypertension prevalence by 30%, resulting in one million fewer hypertensive patients in Canada, and almost double the treatment and control rate. Direct cost savings related to fewer physician visits, laboratory tests and lower medication use are estimated to be approximately $430 million per year. Physician visits and laboratory costs would decrease by 6.5%, and 23% fewer treated hypertensive patients would require medications for control of blood pressure. Based on these estimates, lowering dietary sodium additives would lead to a large reduction in hypertension prevalence and result in health care cost savings in Canada.

[Comparison of arterial stiffness in non-hypertensive and hypertensive population of various age groups].

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Zhang, Y J; Wu, S L; Li, H Y; Zhao, Q H; Ning, C H; Zhang, R Y; Yu, J X; Li, W; Chen, S H; Gao, J S

2018-01-24

Objective: To investigate the impact of blood pressure and age on arterial stiffness in general population. Methods: Participants who took part in 2010, 2012 and 2014 Kailuan health examination were included. Data of brachial ankle pulse wave velocity (baPWV) examination were analyzed. According to the WHO criteria of age, participants were divided into 3 age groups: 18-44 years group ( n= 11 608), 45-59 years group ( n= 12 757), above 60 years group ( n= 5 002). Participants were further divided into hypertension group and non-hypertension group according to the diagnostic criteria for hypertension (2010 Chinese guidelines for the managemengt of hypertension). Multiple linear regression analysis was used to analyze the association between systolic blood pressure (SBP) with baPWV in the total participants and then stratified by age groups. Multivariate logistic regression model was used to analyze the influence of blood pressure on arterial stiffness (baPWV≥1 400 cm/s) of various groups. Results: (1)The baseline characteristics of all participants: 35 350 participants completed 2010, 2012 and 2014 Kailuan examinations and took part in baPWV examination. 2 237 participants without blood pressure measurement values were excluded, 1 569 participants with history of peripheral artery disease were excluded, we also excluded 1 016 participants with history of cardiac-cerebral vascular disease. Data from 29 367 participants were analyzed. The age was (48.0±12.4) years old, 21 305 were males (72.5%). (2) Distribution of baPWV in various age groups: baPWV increased with aging. In non-hypertension population, baPWV in 18-44 years group, 45-59 years group, above 60 years group were as follows: 1 299.3, 1 428.7 and 1 704.6 cm/s, respectively. For hypertension participants, the respective values of baPWV were: 1 498.4, 1 640.7 and 1 921.4 cm/s. BaPWV was significantly higher in hypertension group than non-hypertension group of respective age groups ( Page groups ( t -value

New therapies for arterial hypertension.

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Pagliaro, Beniamino; Santolamazza, Caterina; Rubattu, Speranza; Volpe, Massimo

2016-03-01

Arterial hypertension is the most common chronic disease in developed countries and it is the leading risk factor for stroke, ischemic heart disease, congestive heart failure, chronic renal failure and peripheral artery disease. Its prevalence appears to be about 30-45% of the general population. Recent European guidelines estimate that up to 15-20% of the hypertensive patients are not controlled on a dual antihypertensive combination and they require three or more different antihypertensive drug classes to achieve adequate blood pressure control. The guidelines confirmed that diuretics, beta-blockers, calcium-channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are suitable for the initiation and maintenance of antihypertensive treatment, either as monotherapy or in combination therapy. Very few antihypertensive agents have reached the market over the last few years, but no new therapeutic class has really emerged. The long-term adherence to cardiovascular drugs is still low in both primary and secondary prevention of cardiovascular diseases. In particular, the issue of compliance is persistently high in hypertension, despite the fixed-dose combination therapy. As a consequence, a cohort of high-risk hypertensive population, represented by patients affected by refractory and resistant hypertension, can be identified. Therefore, the need of controlling BP in high-risk patients may be addressed, in part, by the development of new drugs, devices and procedures that are designed to treat hypertension and comorbidities. In this review we will comprehensively discuss the current literature on recent therapeutic advances in hypertension, including both medical therapy and interventional procedures.

Hypertension in pregnancy: A community-based study

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Bharti Mehta

2015-01-01

Full Text Available Background: Hypertensive disorders during pregnancy occur in women with preexisting primary or secondary chronic hypertension, and in women who develop new-onset hypertension in the second half of pregnancy. The present study was undertaken to study the prevalence and correlates of hypertension in pregnancy in a rural block of Haryana. Materials and Methods: This cross-sectional study was carried out in the all 20 subcenters under Community Health Center (CHC Chiri, Block Lakhanmajra. All the pregnant women registered at the particular subcenter at a point of time of visit were included in the study. Appropriate statistical tests were used for analysis. Results: A total of 931 pregnant women were included in the present study. Prevalence of hypertension in pregnancy was found to be 6.9%. Maternal age ΃25 years, gestational period ͳ20 weeks, history of cesarean section, history of preterm delivery, and history of hypertension in previous pregnancy were found to be significantly associated with prevalence of hypertension in pregnancy. Conclusion: Nearly one in 14 pregnant women in rural areas of Haryana suffers from a hypertensive disorder of pregnancy. Early diagnosis and treatment through regular antenatal checkup is a key factor to prevent hypertensive disorders of pregnancy and its complications.

Does hypertension remain after kidney transplantation?

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Gholamreza Pourmand

2015-05-01

Full Text Available Hypertension is a common complication of kidney transplantation with the prevalence of 80%. Studies in adults have shown a high prevalence of hypertension (HTN in the first three months of transplantation while this rate is reduced to 50- 60% at the end of the first year. HTN remains as a major risk factor for cardiovascular diseases, lower graft survival rates and poor function of transplanted kidney in adults and children. In this retrospective study, medical records of 400 kidney transplantation patients of Sina Hospital were evaluated. Patients were followed monthly for the 1st year, every two months in the 2nd year and every three months after that. In this study 244 (61% patients were male. Mean ± SD age of recipients was 39.3 ± 13.8 years. In most patients (40.8% the cause of end-stage renal disease (ESRD was unknown followed by HTN (26.3%. A total of 166 (41.5% patients had been hypertensive before transplantation and 234 (58.5% had normal blood pressure. Among these 234 individuals, 94 (40.2% developed post-transplantation HTN. On the other hand, among 166 pre-transplant hypertensive patients, 86 patients (56.8% remained hypertensive after transplantation. Totally 180 (45% patients had post-transplantation HTN and 220 patients (55% didn't develop HTN. Based on the findings, the incidence of post-transplantation hypertension is high, and kidney transplantation does not lead to remission of hypertension. On the other hand, hypertension is one of the main causes of ESRD. Thus, early screening of hypertension can prevent kidney damage and reduce further problems in renal transplant recipients.

Therapeutic Exercise and Hypertension

African Journals Online (AJOL)

Nekky Umera

patients but may not reduce the BP of normotensive individual. Exercise function ... and mortality in all age groups; it also creates major social, personal and financial ... drug therapy by as symptomatic hypertensive and high cost of drugs particularly in a ..... Events in hypertensive patients randomized to doxagosin versus.

Use of β-Blockers in Pulmonary Hypertension.

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Perros, Frédéric; de Man, Frances S; Bogaard, Harm J; Antigny, Fabrice; Simonneau, Gérald; Bonnet, Sébastien; Provencher, Steeve; Galiè, Nazzareno; Humbert, Marc

2017-04-01

Contrasting with the major attention that left heart failure has received, right heart failure remains understudied both at the preclinical and clinical levels. However, right ventricle failure is a major predictor of outcomes in patients with precapillary pulmonary hypertension because of pulmonary arterial hypertension, and in patients with postcapillary pulmonary hypertension because of left heart disease. In pulmonary hypertension, the status of the right ventricle is one of the most important predictors of both morbidity and mortality. Paradoxically, there are currently no approved therapies targeting the right ventricle in pulmonary hypertension. By analogy with the key role of β-blockers in the management of left heart failure, some authors have proposed to use these agents to support the right ventricle function in pulmonary hypertension. In this review, we summarize the current knowledge on the use of β-blockers in pulmonary hypertension. © 2017 American Heart Association, Inc.

Prevalence, awareness, medication, control, and risk factors associated with hypertension in Yi ethnic group aged 50 years and over in rural China: the Yunnan minority eye study.

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Chen, Lixing; Zong, Yuan; Wei, Tao; Sheng, Xun; Shen, Wei; Li, Jun; Niu, Zhiqiang; Zhou, Hua; Zhang, Yang; Yuan, Yuansheng; Chen, Qin; Zhong, Hua

2015-04-15

Hypertension is an important public health issue in China, but there are few studies examining hypertension in ethnic groups in Yunnan, China. This study, Yunnan Minority Eye Study (YMES), was initially designed to determine the prevalence and impact of eye diseases, including hypertension and diabetes mellitus. As a part of YMES, the prevalence, awareness, treatment, and control of hypertension and the associated risk factors among the Yi ethnic population in rural China are reported. A population-based survey was conducted in 2012 with adult participants over 50 from rural communities in Shilin Yi Autonomous County, Yunnan Province, located in southwest China. A random cluster sampling method was used to select a representative sample. The participants' blood pressure, height, weight, and waist circumference were measured. Hypertension was defined as mean systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, and/or current use of antihypertensive medications. A total of 2208 adults were assessed. The prevalence of hypertension was 38.5%, and the age- and gender-adjusted prevalence was 37.0%. The proportion of patients who were aware of their hypertension among those diagnosed with hypertension was 24.8%. Of those aware of having hypertension, 23.6% took antihypertensive drugs. Among all hypertensive patients, only 7.2% had controlled their hypertension (population of the Yi ethnic group in China. The ratio of awareness, treatment, and control of hypertension were considerately low. Hypertension education and screening programs in rural China are recommended to improve the health status of this population.

The Evolving Classification of Pulmonary Hypertension.

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Foshat, Michelle; Boroumand, Nahal

2017-05-01

- An explosion of information on pulmonary hypertension has occurred during the past few decades. The perception of this disease has shifted from purely clinical to incorporate new knowledge of the underlying pathology. This transfer has occurred in light of advancements in pathophysiology, histology, and molecular medical diagnostics. - To update readers about the evolving understanding of the etiology and pathogenesis of pulmonary hypertension and to demonstrate how pathology has shaped the current classification. - Information presented at the 5 World Symposia on pulmonary hypertension held since 1973, with the last meeting occurring in 2013, was used in this review. - Pulmonary hypertension represents a heterogeneous group of disorders that are differentiated based on differences in clinical, hemodynamic, and histopathologic features. Early concepts of pulmonary hypertension were largely influenced by pharmacotherapy, hemodynamic function, and clinical presentation of the disease. The initial nomenclature for pulmonary hypertension segregated the clinical classifications from pathologic subtypes. Major restructuring of this disease classification occurred between the first and second symposia, which was the first to unite clinical and pathologic information in the categorization scheme. Additional changes were introduced in subsequent meetings, particularly between the third and fourth World Symposia meetings, when additional pathophysiologic information was gained. Discoveries in molecular diagnostics significantly progressed the understanding of idiopathic pulmonary arterial hypertension. Continued advancements in imaging modalities, mechanistic pathogenicity, and molecular biomarkers will enable physicians to define pulmonary hypertension phenotypes based on the pathobiology and allow for treatment customization.

Prevalence and determinants of hypertension in Myanmar - a nationwide cross-sectional study

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Marius B. Bjertness

2016-07-01

Full Text Available Abstract Background Non-communicable diseases (NCDs, malaria and tuberculosis dominate the disease pattern in Myanmar. Due to urbanization, westernized lifestyle and economic development, it is likely that NCDs such as cerebrovascular disease and ischemic heart disease are on a rise. The leading behavioral- and metabolic NCDs risk factors are tobacco smoke, dietary risks and alcohol use, and high blood pressure and body mass index, respectively. The study aimed at estimating the prevalence and determinants of hypertension, including metabolic-, behavioral- and socio-demographic risk factors. Methods A nationwide, cross-sectional study of 7429 citizens of Myanmar aged 15–64 years were examined in 2009, using the WHO STEPS methodology. In separate analyses by gender, odds radios (ORs and 95 % confidence intervals (CIs for determinants of hypertension were estimated using logistic regression analyses. Confounders included in analyses were chosen based on Directed acyclic graphs (DAGs. Results The prevalence of hypertension was 30.1 % (95 % CI: 28.4–31.8 in males and 29.8 % (28.5–31.1 in females. The mean BMI was 21.7 (SD 4.3 kg/m2 for males and 23.0 (5.1 kg/m2 for females. In fully adjusted analyses, we found in both genders increased OR for hypertension if the participants had high BMI (males: OR = 2.6; 95 % CI 2.1–3.3, females: OR = 2.3; 2.0–2.7 and high waist circumference (males: OR = 3.4; 1.8–6.8, females: OR = 2.7; 2.2–3.3. In both sexes, associations were also found between hypertension and low physical activity at work, or living in urban areas or the delta region. Being underweight and use of sesame oil in cooking was associated with lower odds for hypertension. Conclusions The prevalence of hypertension was high and associated with metabolic-, behavioral- and socio-demographic factors. Due to expected rapid economic growth in Myanmar we recommend similar studies in the future to follow up and describe

Diastolic Pressure Difference to Classify Pulmonary Hypertension in the Assessment of Heart Transplant Candidates.

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Wright, Stephen P; Moayedi, Yasbanoo; Foroutan, Farid; Agarwal, Suhail; Paradero, Geraldine; Alba, Ana C; Baumwol, Jay; Mak, Susanna

2017-09-01

The diastolic pressure difference (DPD) is recommended to differentiate between isolated postcapillary and combined pre-/postcapillary pulmonary hypertension (Cpc-PH) in left heart disease (PH-LHD). However, in usual practice, negative DPD values are commonly calculated, potentially related to the use of mean pulmonary artery wedge pressure (PAWP). We used the ECG to gate late-diastolic PAWP measurements. We examined the method's impact on calculated DPD, PH-LHD subclassification, hemodynamic profiles, and mortality. We studied patients with advanced heart failure undergoing right heart catheterization to assess cardiac transplantation candidacy (N=141). Pressure tracings were analyzed offline over 8 to 10 beat intervals. Diastolic pulmonary artery pressure and mean PAWP were measured to calculate the DPD as per usual practice (diastolic pulmonary artery pressure-mean PAWP). Within the same intervals, PAWP was measured gated to the ECG QRS complex to calculate the QRS-gated DPD (diastolic pulmonary artery pressure-QRS-gated PAWP). Outcomes occurring within 1 year were collected retrospectively from chart review. Overall, 72 of 141 cases demonstrated PH-LHD. Within PH-LHD, the QRS-gated DPD yielded higher calculated DPD values (3 [-1 to 6] versus 0 [-4 to 3] mm Hg; P pulmonary hypertension ( P pulmonary hypertension. The QRS-gated DPD reclassifies a subset of PH-LHD patients from isolated postcapillary pulmonary hypertension to Cpc-PH, which is characterized by an adverse hemodynamic profile. © 2017 American Heart Association, Inc.

Expanding the definition and classification of hypertension.

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Giles, Thomas D; Berk, Bradford C; Black, Henry R; Cohn, Jay N; Kostis, John B; Izzo, Joseph L; Weber, Michael A

2005-09-01

Cardiovascular abnormalities are frequently the cause, as well as the effect, of elevated blood pressure. As such, early cardiovascular disease (CVD) may be established before identifiable blood pressure thresholds are crossed. To identify individuals at risk for CVD at an earlier point in the disease process, as well as to avoid labeling persons as hypertensive who are at low risk for CVD, the Hypertension Writing Group proposes incorporating the presence or absence of cardiovascular risk factors, early disease markers, and target organ damage into the definition and classification scheme of hypertension. To describe both the complexity and progressive nature of hypertension, the following definition is proposed: "Hypertension is a progressive cardiovascular syndrome arising from complex and interrelated etiologies. Early markers of the syndrome are often present before blood pressure elevation is observed; therefore, hypertension cannot be classified solely by discrete blood pressure thresholds. Progression is strongly associated with functional and structural cardiac and vascular abnormalities that damage the heart, kidneys, brain, vasculature, and other organs and lead to premature morbidity and death." Classification of hypertension must involve assessing global cardiovascular risk to situate an individual's risk for CVD and events along a continuum. As knowledge of early CVD continues to evolve, the approach to classifying individuals along that continuum can be expected to evolve accordingly. The four categories currently used to classify hypertension are normal, prehypertension, and stages 1 and 2 hypertension. The population identified with prehypertension includes a subgroup with early CVD. We believe it would be preferable to classify all individuals as either normal or hypertensive, based on their cardiovascular evaluation, using the four categories of normal and stages 1, 2, and 3 hypertension.

Adrenal incidentaloma in adults - management recommendations by the Polish Society of Endocrinology.

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Bednarczuk, Tomasz; Bolanowski, Marek; Sworczak, Krzysztof; Górnicka, Barbara; Cieszanowski, Andrzej; Otto, Maciej; Ambroziak, Urszula; Pachucki, Janusz; Kubicka, Eliza; Babińska, Anna; Koperski, Łukasz; Januszewicz, Andrzej; Prejbisz, Aleksander; Górska, Maria; Jarząb, Barbara; Hubalewska-Dydejczyk, Alicja; Glinicki, Piotr; Ruchała, Marek; Kasperlik-Załuska, Anna

2016-01-01

A wide use of imaging techniques results in more frequent diagnosis of adrenal incidenataloma. To analyse the current state of knowledge on adrenal incidentaloma in adults in order to prepare practical management recommendations. Following a discussion, the Polish Society of Endocrinology expert working group have analysed the available data and summarised the analysis results in the form of recommendations. Unenhanced adrenal computed tomography (CT) may be recommended as an initial assessment examination helpful in the differentiation between adenomas and "non-adenomatous" lesions. In the case of density > 10 Hounsfield units, CT with contrast medium washout assessment or MRI are recommended. However, in all patients with adrenal incidentaloma, hormonal assessment is recommended in order to exclude pheochromocytoma and hypercortisolism, notwithstanding the clinical picture or concomitant diseases. In addition, examination to exclude primary hyperaldosteronism is suggested in patients with diagnosed hypertension or hypokalaemia. Surgical treatment should be recommended in patients with adrenal incidentaloma, where imaging examinations suggest a malignant lesion (oncological indication) or with confirmed hormonal activity (endocrinological indication). The basis of the surgical treatment is laparoscopic adrenalectomy. Patients with suspected pheochromocytoma must be pharmacologically prepared prior to surgery. In patients not qualified for surgery, control examinations (imaging and laboratory tests) should be established individually, taking into consideration such features as the size, image, and growth dynamics of the tumour, clinical symptoms, hormonal tests results, and concomitant diseases.

Prediction of primary vs secondary hypertension in children.

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Baracco, Rossana; Kapur, Gaurav; Mattoo, Tej; Jain, Amrish; Valentini, Rudolph; Ahmed, Maheen; Thomas, Ronald

2012-05-01

Despite current guidelines, variability exists in the workup of hypertensive children due to physician preferences. The study evaluates primary vs secondary hypertension diagnosis from investigations routinely performed in hypertensive children. This retrospective study included children 5 to 19 years with primary and secondary hypertension. The proportions of abnormal laboratory and imaging tests were compared between primary and secondary hypertension groups. Risk factors for primary vs secondary hypertension were evaluated by logistic regression and likelihood function analysis. Patients with secondary hypertension were younger (5-12 years) and had a higher proportion of abnormal creatinine, renal ultrasound, and echocardiogram findings. There was no significant difference in abnormal results of thyroid function, urine catecholamines, plasma renin, and aldosterone. Abnormal renal ultrasound findings and age were predictors of secondary hypertension by regression and likelihood function analysis. Children aged 5 to 12 years with abnormal renal ultrasound findings and high diastolic blood pressures are at higher risk for secondary hypertension that requires detailed evaluation. © 2012 Wiley Periodicals, Inc.

Association of masked hypertension and left ventricular remodeling with the hypertensive response to exercise.

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Sharman, James E; Hare, James L; Thomas, Scott; Davies, Justin E; Leano, Rodel; Jenkins, Carly; Marwick, Thomas H

2011-08-01

A hypertensive response to exercise (HRE; defined as normal clinic blood pressure (BP) and exercise systolic BP (SBP) ≥210 mm Hg in men or ≥190 mm Hg in women, or diastolic BP (DBP) ≥105 mm Hg) independently predicts mortality. The mechanisms remain unclear but may be related to masked hypertension. This study aimed to assess the prevalence of masked hypertension and its association with cardiovascular risk factors, including left ventricular (LV) mass, in patients with a HRE. Comprehensive clinical and echocardiographic evaluation (including central BP, aortic pulse wave velocity by tonometry) and 24-h ambulatory BP monitoring (ABPM) were performed in 72 untreated patients with HRE (aged 54 ± 9 years; 60% male; free from coronary artery disease confirmed by exercise stress echocardiography). Masked hypertension was defined according to guidelines as daytime ABPM ≥135/85 mm Hg and clinic BP hypertension was present in 42 patients (58%). These patients had higher LV mass index (41.5 ± 8.7 g/m(2.7) vs. 35.9 ± 8.5 g/m(2.7); P = 0.01), LV relative wall thickness (RWT; 0.42 ± 0.09 vs. 0.37 ± 0.06; P = 0.004) and exercise SBP (222 ± 17 mm Hg vs. 212 ± 14 mm Hg; P = 0.01), but no significant difference in aortic pulse wave velocity or central pulse pressure (P > 0.05 for both). The strongest independent determinant of LV mass index was the presence of masked hypertension (unstandardized β = 5.6; P = 0.007), which was also independently related to LV RWT (unstandardized β = 0.04; P = 0.03). Masked hypertension is highly prevalent in HRE patients with a normal resting office BP and is associated with increased LV mass index and RWT. Clinicians should consider measuring ABPM or home BP in HRE patients.

Endothelial function in children with white-coat hypertension.

Science.gov (United States)

Jurko, Alexander; Jurko, Tomas; Minarik, Milan; Mestanik, Michal; Mestanikova, Andrea; Micieta, Vladimir; Visnovcova, Zuzana; Tonhajzerova, Ingrid

2018-01-29

Several studies have demonstrated endothelial dysfunction in patients with essential hypertension. However, the presence of endothelial dysfunction in children with white-coat hypertension has not been studied. We evaluated the endothelial function in children with white-coat hypertension and essential hypertension using a novel method based on the assessment of flow-mediated dilation (FMD). Study involved 106 children: 30 white-coat hypertensives (age 16.3 ± 1.3 years, mean ± SD), 30 essential hypertensives (age 16.4 ± 1.3 years), and 46 healthy controls (age 16.2 ± 1.4 years). Ultrasound scans of the right brachial artery were performed using Prosound F75 Aloka system during protocol: baseline (1 min), forearm ischemia (5 min), and post-occlusion phase (3 min). FMD (%) was expressed as a change of the arterial diameter from baseline to maximum post-occlusion value and the values coat hypertension compared to control group (p coat hypertensives compared to controls (p coat hypertension could help to elucidate the mechanisms of the increased cardiovascular risk that could be similar as found in essential hypertension; therefore, white-coat hypertension should not be considered a benign phenomenon.

Detection of Secondary Causes and Coexisting Diseases in Hypertensive Patients: OSA and PA Are the Common Causes Associated with Hypertension.

Science.gov (United States)

Wang, Lei; Li, Nanfang; Yao, Xiaoguang; Chang, Guijuan; Zhang, Delian; Heizhati, Mulalibieke; Wang, Menghui; Luo, Qin; Kong, Jianqiong

2017-01-01

Since the control rate of blood pressure is lower in mainland China, the aim of this study is to investigate the proportion of secondary causes and coexisting diseases of hypertension in hypertensive patients. Data on consecutive patients with hypertension who visited the Hypertension Center. Diseases were detected using an established strict screening protocol. Detection rate of secondary causes and coexisting diseases of hypertension was 39.5% among 3003 hypertensive patients. Obstructive sleep apnea (OSA) was the most common, accounting for 24.7% of patients, followed by primary aldosteronism (PA) (5.8%) and PA + OSA (4.9%). Endocrine hypertension accounted for 12.1% of patients, including 10.7% of patients with PA, 1.1% with hypothyroidism, 0.1% with pheochromocytoma, 0.1% with Cushing's syndrome, and 0.1% with hyperthyroidism, respectively. Those who smoke, those who are obese, and those who have diabetes accounted for 31.3%, 27.5%, and 16.6% of total patients, respectively. There were overlapping conditions in secondary causes and coexisting diseases of hypertension. OSA was the most common in each age- and BMI-stratified group. Findings from the current study suggest an increasing frequency of secondary forms of hypertension, highlighting the burden of OSA and PA in hypertensive patients.

Detection of Secondary Causes and Coexisting Diseases in Hypertensive Patients: OSA and PA Are the Common Causes Associated with Hypertension

Directory of Open Access Journals (Sweden)

Lei Wang

2017-01-01

Full Text Available Background. Since the control rate of blood pressure is lower in mainland China, the aim of this study is to investigate the proportion of secondary causes and coexisting diseases of hypertension in hypertensive patients. Methods. Data on consecutive patients with hypertension who visited the Hypertension Center. Diseases were detected using an established strict screening protocol. Results. Detection rate of secondary causes and coexisting diseases of hypertension was 39.5% among 3003 hypertensive patients. Obstructive sleep apnea (OSA was the most common, accounting for 24.7% of patients, followed by primary aldosteronism (PA (5.8% and PA + OSA (4.9%. Endocrine hypertension accounted for 12.1% of patients, including 10.7% of patients with PA, 1.1% with hypothyroidism, 0.1% with pheochromocytoma, 0.1% with Cushing’s syndrome, and 0.1% with hyperthyroidism, respectively. Those who smoke, those who are obese, and those who have diabetes accounted for 31.3%, 27.5%, and 16.6% of total patients, respectively. There were overlapping conditions in secondary causes and coexisting diseases of hypertension. OSA was the most common in each age- and BMI-stratified group. Conclusion. Findings from the current study suggest an increasing frequency of secondary forms of hypertension, highlighting the burden of OSA and PA in hypertensive patients.

Setting thresholds to varying blood pressure monitoring intervals differentially affects risk estimates associated with white-coat and masked hypertension in the population

DEFF Research Database (Denmark)

Asayama, Kei; Thijs, Lutgarde; Li, Yan

2014-01-01

Outcome-driven recommendations about time intervals during which ambulatory blood pressure should be measured to diagnose white-coat or masked hypertension are lacking. We cross-classified 8237 untreated participants (mean age, 50.7 years; 48.4% women) enrolled in 12 population studies, using ≥14...

Normotension, hypertension and body fluid regulation

DEFF Research Database (Denmark)

Bie, Peter; Evans, R G

2017-01-01

The fraction of hypertensive patients with essential hypertension (EH) is decreasing as the knowledge of mechanisms of secondary hypertension increases, but in most new cases of hypertension the pathophysiology remains unknown. Separate neurocentric and renocentric concepts of aetiology have...... activity are elevated in about 50% of cases; (iii) in EH as in normal conditions, mediators other than arterial blood pressure are the major determinants of renal sodium excretion; (iv) chronic hypertension is always associated with a shift in the pressure-natriuresis curve, but this may...... prevailed without much interaction. In this regard, several questions regarding the relationships between body fluid and blood pressure regulation are pertinent. Are all forms of EH associated with sympathetic overdrive or a shift in the pressure-natriuresis curve? Is body fluid homoeostasis normally driven...