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JACC. Heart Failure Feb 2021
Topics: Antihypertensive Agents; Friends; Heart Failure; Humans; Hypertension; Kidney
PubMed: 33309577
DOI: 10.1016/j.jchf.2020.10.007 -
The Medical Letter on Drugs and... May 2024
Review
Topics: Humans; Hypertension; Antihypertensive Agents; Blood Pressure
PubMed: 38771738
DOI: 10.58347/tml.2024.1703a -
Current Cardiology Reports Nov 2023To provide an update and review approaches to the treatment of resistant hypertension (RH) with a focus on emerging potential therapies. (Review)
Review
PURPOSE OF REVIEW
To provide an update and review approaches to the treatment of resistant hypertension (RH) with a focus on emerging potential therapies.
RECENT FINDINGS
Resistant hypertension is defined as a blood pressure that remains elevated above a patient's individualized target despite the concurrent use of 3 antihypertensive agents of different classes including a diuretic or use of 4 or more antihypertensive agents. Patients with RH have an increased risk of adverse cardiovascular and renal outcomes. Most RH is attributed to apparent RH and is not true RH. True RH is a diagnosis of exclusion after apparent RH has been excluded. Treatment of RH is challenging, and blood pressure goal is often difficult to achieve. Currently several new therapies have emerged with forthcoming data that provide promise for improved blood pressure control in those with resistant hypertension. Once RH has been diagnosed, patients should be on standardized therapy that includes agents from three different classes including a diuretic with addition in most cases of a mineralocorticoid as a fourth line agent. There are newer agents in development currently being studied in clinical trials including dual endothelin receptor antagonists and aldosterone synthase inhibitors that appear to be efficacious. Other approved medications including SGLT2 inhibitors and non-steroidal mineralocorticoids such as finerenone also need to be incorporated into treatment paradigms. Renal denervation with catheter based devices is another potential promising treatment option in this population.
Topics: Humans; Antihypertensive Agents; Hypertension; Blood Pressure; Kidney; Diuretics; Mineralocorticoid Receptor Antagonists
PubMed: 37755638
DOI: 10.1007/s11886-023-01966-8 -
Clinical Medicine (London, England) Sep 2021Severe hypertension in pregnancy is defined as a sustained systolic blood pressure of 160 mmHg or over or diastolic blood pressure of 110 mmHg or over and should be...
Severe hypertension in pregnancy is defined as a sustained systolic blood pressure of 160 mmHg or over or diastolic blood pressure of 110 mmHg or over and should be assessed in hospital. Severe hypertension before 20 weeks' gestation is rare and usually due to chronic hypertension; assessment for target organ damage and exclusion of secondary hypertension are warranted. The most common cause of severe hypertension in pregnancy is pre-eclampsia, which presents after 20 weeks' gestation. This warrants more rapid control of blood pressure due to the risk of haemorrhagic stroke, and intravenous antihypertensive agents may be required. Treatment is determined by licensing, availability and clinician experience, with no high-level evidence to guide prescribing. Labetalol is the agent most commonly used, both orally and intravenously, in pregnancy in the UK. Severe hypertension is a risk factor for sustained hypertension after pregnancy. Hypertension in pregnancy is associated with increased cardiovascular risk.
Topics: Antihypertensive Agents; Blood Pressure; Female; Humans; Hypertension; Labetalol; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular
PubMed: 34507929
DOI: 10.7861/clinmed.2021-0508 -
Biochemia Medica Feb 2023In the initial diagnostics of arterial hypertension (AH) laboratory medicine is a cornerstone, along with a blood pressure (BP) measurement and an electrocardiogram. It... (Review)
Review
In the initial diagnostics of arterial hypertension (AH) laboratory medicine is a cornerstone, along with a blood pressure (BP) measurement and an electrocardiogram. It mainly refers to routine blood and urine tests for diagnosis and monitoring primary hypertension and its associated conditions such as asymptomatic hypertension-mediated organ damage, chronic kidney disease and hypertensive disorders of pregnancy. In addition, long term non-fatal and fatal risks for cardiovascular (CV) events in hypertension are assessed based on clinical and laboratory data. Furthermore, laboratory medicine is involved in the management of hypertension, especially in monitoring the disease progression. However, antihypertensive drugs may interfere with laboratory test results. Diuretics, especially thiazides, can affect blood and urine sodium concentrations, or angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can affect the blood biomarkers of the renin-angiotensin-aldosterone system (RAAS). It's dysfunction plays a critical role in primary aldosteronism (PA), the most common endocrine disorder in secondary hypertension, which accounts for only small proportion of AH in relative terms but substantial proportion of hypertensives in absolute terms, affecting younger population and carrying a higher risk of CV mortality and morbidity. When screening for PA, aldosterone-to-renin ratio still contributes massively to the increased incidence of the disease, despite certain limits. In conclusion, laboratory medicine is involved in the screening, diagnosis, monitoring and prognosis of hypertension. It is of great importance to understand the preanalytical and analytical factors influencing final laboratory result.
Topics: Humans; Hypertension; Antihypertensive Agents; Angiotensin-Converting Enzyme Inhibitors; Renin-Angiotensin System; Prognosis
PubMed: 36817852
DOI: 10.11613/BM.2023.010501 -
Current Opinion in Cardiology Jul 2022High blood pressure (BP) is the world's leading risk factor for cardiovascular disease (CVD) and death. This review highlights findings during the past 18 months that... (Meta-Analysis)
Meta-Analysis Review
PURPOSE OF REVIEW
High blood pressure (BP) is the world's leading risk factor for cardiovascular disease (CVD) and death. This review highlights findings during the past 18 months that apply to the management of high BP in adults in the context of the 2017 American College of Cardiology/American Heart Association (AHA) BP guideline.
RECENT FINDINGS
A comprehensive meta-analysis of clinical trials that employed a novel statistical method identified a substantially linear relationship between dietary sodium intake and BP, strongly supporting the AHA daily dietary sodium intake recommendation of less than 1500 mg/day but suggesting that any reduction in sodium intake is likely to be beneficial. Among adults with hypertension, use of a salt substitute (containing reduced sodium and enhanced potassium) led to striking reductions in CVD outcomes. Young adults with stage 1 hypertension and a low 10-year atherosclerotic CVD risk score should be started on a 6-month course of vigorous lifestyle modification; if their BP treatment goal is not achieved, a first-line antihypertensive agent should be added to the lifestyle modification intervention. In patients with stage 4 renal disease, the thiazide-like diuretic chlorthalidone (as add-on therapy) lowered BP markedly compared with placebo. Nonsteroidal mineralocorticoid receptor antagonists (MRAs) represent a new class of MRA that has been shown to lower BP and provide significant CVD protection. In Chinese adults aged 60-80 years at baseline, intensive BP control with a SBP target of 110-129 compared with 130-149 mmHg reduced CVD events with minimal side effects.
SUMMARY
Recent findings have advanced our knowledge of hypertension management, clarifying, amplifying and supporting the 2017 ACC/AHA BP guideline recommendations.
Topics: Antihypertensive Agents; Blood Pressure; Cardiovascular Diseases; Humans; Hypertension; Sodium, Dietary; United States; Young Adult
PubMed: 35731676
DOI: 10.1097/HCO.0000000000000980 -
Advances in Chronic Kidney Disease Mar 2016Hypertension is a multifactorial condition with diverse physiological systems contributing to its pathogenesis. Individuals exhibit significant variation in their... (Review)
Review
Hypertension is a multifactorial condition with diverse physiological systems contributing to its pathogenesis. Individuals exhibit significant variation in their response to antihypertensive agents. Traditional markers, such as age, gender, diet, plasma renin level, and ethnicity, aid in drug selection. However, this review explores the contribution of genetics to facilitate antihypertensive agent selection and predict treatment efficacy. The findings, reproducibility, and limitations of published studies are examined, with emphasis placed on candidate genetic variants affecting drug metabolism, the renin-angiotensin system, adrenergic signalling, and renal sodium reabsorption. Single-nucleotide polymorphisms identified and replicated in unbiased genome-wide association studies of hypertension treatment are reviewed to illustrate the evolving understanding of the disease's complex and polygenic pathophysiology. Implementation efforts at academic centers seek to overcome barriers to the broad adoption of pharmacogenomics in the treatment of hypertension. The level of evidence required to support the implementation of pharmacogenomics in clinical practice is considered.
Topics: Antihypertensive Agents; Cytochrome P-450 Enzyme System; Genome-Wide Association Study; Humans; Hypertension; Pharmacogenetics; Polymorphism, Genetic; Receptors, Adrenergic, beta; Renin-Angiotensin System; Signal Transduction; Sodium
PubMed: 26979148
DOI: 10.1053/j.ackd.2016.02.003 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Mar 2021The objective of this study is to determine the impact of applying lifestyle intervention in the form of a continuous care model (CCM) on reducing dietary sodium intake... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The objective of this study is to determine the impact of applying lifestyle intervention in the form of a continuous care model (CCM) on reducing dietary sodium intake and blood pressure (BP) in patients with hypertension.
METHODS
This randomized controlled trial was conducted in a 2-group design on a total of 50 patients who were hypertensive (experimental and control) as a pre‒post test study. A healthy lifestyle (emphasizing physical activity and heart-healthy diet) in the form of CCM, which considers the patient as an active agent in the health process, was conducted in the experimental group over a period of 4 months. The mean BP value and dietary sodium intake in both groups were measured at the beginning and the end of the study.
RESULTS
The mean sodium intake, the mean systolic BP, and the mean diastolic BP decreased to 2.42±0.73 mm Hg (from 3.12±0.79), 128.4±13.04 mm Hg (from 144.20±13.12), and 79.4±8.93 mm Hg (from 89±9.12), respectively, after the intervention in the experimental group (p=0.021, p<0.001, and p=0.011, respectively).
CONCLUSION
Applying lifestyle intervention in the form of CCM may be recommended to reduce dietary sodium intake and mean systolic and diastolic BP in patients who are hypertensive. Considering the fact that lifestyle modifications are quite important regardless of the use of antihypertensive drugs, lifestyle intervention in the form of CCM is recommended to improve patient's adherence to dietary restrictions and consequently, treatment outcomes in patients who are hypertensive.
Topics: Adult; Aged; Antihypertensive Agents; Blood Pressure; Diet, Sodium-Restricted; Exercise; Female; Humans; Hypertension; Life Style; Male; Middle Aged
PubMed: 33709920
DOI: 10.5543/tkda.2021.81669 -
Expert Opinion on Pharmacotherapy Jul 2020Hypertension is the most prevalent disease in Japan. However, it is estimated that only 50% of hypertensive patients receiving antihypertensive drug treatment achieve... (Review)
Review
INTRODUCTION
Hypertension is the most prevalent disease in Japan. However, it is estimated that only 50% of hypertensive patients receiving antihypertensive drug treatment achieve blood pressure of less than 140/90 mmHg. Consequently, hypertension is the leading cause of cardiovascular death in Japan. Innovative high-risk strategies are necessary to reduce hypertension-related morbidity and mortality in Japan.
AREAS COVERED
This perspective summarizes the current prescription status of antihypertensive drug treatment, the clinical role of antihypertensive drug treatment in the management of hypertension and provides future perspectives in the management of hypertension in Japan.
EXPERT OPINION
Earlier and lower blood pressure control throughout 24 h is currently recommended for the management of hypertension. Management of nighttime blood pressure is clinically important since nighttime blood pressure has been shown to be more closely associated than daytime blood pressure with cardiovascular events in patients receiving antihypertensive drug treatment. An appropriate selection of antihypertensive drugs and bedtime dosing of antihypertensive drugs may be effective for reducing nighttime blood pressure. The development and advancement of home blood pressure monitoring would enable tailor-made antihypertensive drug treatment.
Topics: Antihypertensive Agents; Humans; Hypertension; Japan
PubMed: 32037893
DOI: 10.1080/14656566.2020.1724958 -
Current Opinion in Ophthalmology Mar 2016The purpose of this article is to review the current status of cannabis in the treatment of glaucoma, including the greater availability of marijuana in the USA. (Review)
Review
PURPOSE OF REVIEW
The purpose of this article is to review the current status of cannabis in the treatment of glaucoma, including the greater availability of marijuana in the USA.
RECENT FINDINGS
The potency of marijuana, as measured by the concentration of Δ-tetrahydrocannabinol, has increased from ∼2 to 3% in the 1970s to ∼20% today. Many US states have passed laws allowing either medicinal or recreational use of marijuana.
SUMMARY
The pharmacology of marijuana and its effect on intraocular pressure has not changed since the research in the 1970s and 1980s. Marijuana is an effective ocular hypotensive agent. However, cardiovascular and neurological effects are observed at the same dose, and may theoretically reduce the beneficial effect of lowering intraocular pressure by reducing ocular blood flow. The clinician must be cognizant of this potential in diagnosis, prognosis, and therapy.
Topics: Antihypertensive Agents; Cannabinoids; Cannabis; Glaucoma; Humans; Intraocular Pressure; Tonometry, Ocular
PubMed: 26840343
DOI: 10.1097/ICU.0000000000000242