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Kardiologia Polska Aug 2020Dietary modification is one of the cornerstones in the treatment of arterial hypertension (AH). Current American and European guidelines recommend people to ingest... (Review)
Review
Dietary modification is one of the cornerstones in the treatment of arterial hypertension (AH). Current American and European guidelines recommend people to ingest fruit, vegetables, whole grains, and low‑fat dairy products as well as to decrease the consumption of red meat, sugar, and trans fats. This review aimed to summarize available evidence on dietary patterns associated with lower blood pressure (BP). Research has shown that the Dietary Approach to Stop Hypertension (DASH) diet can lower BP equally effectively or even more significantly than some antihypertensive drugs. The Mediterranean diet also leads to a considerable reduction in BP. Vegans and vegetarians have been shown to have a lower prevalence of AH than omnivores. Caloric restriction may decrease BP in normotensive, prehypertensive, and hypertensive populations. Blood pressure can also be lowered by certain nutraceuticals (such as beetroot juice, magnesium, vitamin C, catechin‑rich beverages, or soy isoflavones). Diet effects on BP are mediated by body weight loss, amelioration of inflammation, increased insulin sensitivity, and antihypertensive properties of some individual nutrients. There is robust evidence that vegetarian and vegan diets have the ability to reduce BP. The presence of the so-called floor effect makes these diets usable in normo- and prehypertensive people at high risk of developing AH. However, the dietary and nutraceutical approach to BP lowering cannot substitute drug treatment when the latter is needed.
Topics: Antihypertensive Agents; Blood Pressure; Diet; Dietary Supplements; Humans; Hypertension
PubMed: 32631027
DOI: 10.33963/KP.15468 -
Hypertension (Dallas, Tex. : 1979) Sep 2023Clinical practice guidelines are ideally suited to the provision of advice on the prevention, diagnosis, evaluation, and management of high blood pressure (BP). The...
Clinical practice guidelines are ideally suited to the provision of advice on the prevention, diagnosis, evaluation, and management of high blood pressure (BP). The recently published European Society of Hypertension (ESH) 2023 ESH Guidelines for the management of arterial hypertension is the latest in a long series of high BP clinical practice guidelines. It closely resembles the 2018 European Society of Cardiology/ESH guidelines, with incremental rather than major changes. Although the ESH guidelines are primarily written for European clinicians and public health workers, there is a high degree of concordance between its recommendations and those in the other major BP guidelines. Despite the large number of national and international BP guidelines around the world, general population surveys demonstrate that BP guidelines are not being well implemented in any part of the world. The level of BP, which is the basis for diagnosis and management, continues to be poorly measured in routine clinical practice and control of hypertension remains suboptimal, even to a conservative BP target such as a systolic/diastolic BP <140/90 mm Hg. BP guidelines need to focus much more on implementation of recommendations for accurate diagnosis and strategies for improved control in those being treated for hypertension. An evolving body of implementation science can assist in meeting this goal. Given the enormous health, social, and financial burden of high BP, better diagnosis and management should be an imperative for clinicians, government, and others responsible for the provision of health care services. Hopefully, the 2023 ESH will help enable this.
Topics: Humans; Antihypertensive Agents; Hypertension; Blood Pressure; Blood Pressure Determination; Cardiology
PubMed: 37354199
DOI: 10.1161/HYPERTENSIONAHA.123.21592 -
Advances in Experimental Medicine and... 2020Hypertension is still the number one global killer. No matter what causes are, lowering blood pressure can significantly reduce cardiovascular complications,... (Review)
Review
Hypertension is still the number one global killer. No matter what causes are, lowering blood pressure can significantly reduce cardiovascular complications, cardiovascular death, and total death. Unfortunately, some hypertensive individuals simply do not know having hypertension. Some knew it but either not being treated or treated but blood pressure does not achieve goal. The reasons for inadequate control of blood pressure are many. One important reason is that we are not very familiar with antihypertensive agents and less attention has been paid to comorbidities, complications as well as the hypertension-modified target organ damage in patients with hypertension. The right antihypertensive drug was not given to the right hypertensive patients at right time. This reviewer studied comprehensively the literature, hopefully that the review will help improve antihypertensive drug selection and antihypertensive therapy.
Topics: Antihypertensive Agents; Blood Pressure; Humans; Hypertension
PubMed: 32246447
DOI: 10.1007/978-981-15-2517-9_6 -
Advances in Chronic Kidney Disease Sep 2021Cancer is one of the leading causes of death worldwide. With the introduction of newer chemotherapeutic agents, targeted therapies, and immunotherapy, the prognosis and... (Review)
Review
Cancer is one of the leading causes of death worldwide. With the introduction of newer chemotherapeutic agents, targeted therapies, and immunotherapy, the prognosis and survival of patients with cancer has remarkably improved. As a result, patients are living longer and experiencing long-term cardiovascular complications. Hypertension is an important risk factor for cardiovascular diseases. Patients with malignancy have multiple etiologies of hypertension development, worsening, or association. This is because of the complex interplay between cancer type, chemotherapeutic agent, patient age, antihypertensive agent, and preexisting comorbidities in the etiology and pathogenesis of hypertension. Management of hypertension in patients with cancer requires accurate blood pressure measurement and considering factors such as adjuvant therapy and cancer-related pain. There are no set guidelines for management of hypertension in this unique cohort, and the therapy should be individualized based on the treatment guidelines for the general population. Onco-hypertension is an emerging subspeciality and entails a multidisciplinary approach between oncology, primary care physicians, nephrology, and cardiology.
Topics: Antihypertensive Agents; Antineoplastic Agents; Cardiology; Humans; Hypertension; Medical Oncology; Neoplasms
PubMed: 35190114
DOI: 10.1053/j.ackd.2021.09.011 -
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 -
Expert Opinion on Drug Safety Oct 2020Hypertension and cardiovascular diseases (CVD) are very common conditions and account for significant medical disability and death worldwide. Therefore, their successful... (Review)
Review
INTRODUCTION
Hypertension and cardiovascular diseases (CVD) are very common conditions and account for significant medical disability and death worldwide. Therefore, their successful management is very critical for the prevention of the significant cardiovascular and socioeconomic consequences arising from their poor management. : Although we have several effective cardiovascular (CV) drugs for their treatment, they are not all completely successful for the effective management of CVD and hypertension. Thus, the need for the discovery and development of new drugs is necessary. For this review, a Medline search of the English language was conducted between 2010 and June 2020 and 62 pertinent papers were retrieved. These papers contain information on newly released and emerging new cardiovascular drugs.
EXPERT OPINION
These new chemical entities have different mechanisms of action and in preliminary studies have been successful in the treatment of hypertension, CVD, heart failure, stroke, and type 2 diabetes mellitus. These drugs can be used either alone or in combination with other antihypertensive and cardiovascular drugs. Hopefully, these new classes of cardiovascular drugs would be effective for the treatment of hypertension and CVD and decrease their socioeconomic consequences.
Topics: Animals; Antihypertensive Agents; Cardiovascular Agents; Cardiovascular Diseases; Drug Development; Drug Discovery; Humans; Hypertension
PubMed: 32799574
DOI: 10.1080/14740338.2020.1810232 -
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 -
Journal of Hypertension Apr 2020: Suboptimal adherence to antihypertensive medication is a major contributor to poor blood pressure control. Several methods, direct or indirect, are available for... (Review)
Review
: Suboptimal adherence to antihypertensive medication is a major contributor to poor blood pressure control. Several methods, direct or indirect, are available for measuring adherence, including the recently developed biochemical screening, although there is no gold-standard method routinely used in clinical practice to accurately assess the different facets of adherence. Adherence to treatment is a complex phenomenon and several of the barriers to adherence will need to be addressed at the healthcare system level; however, when looking at adherence from a more practical side and from the practitioner's perspective, the patient-practitioner relationship is a key element both in detecting adherence and in attempting to choose interventions tailored to the patient's profile. The use of single-pill combinations enabling simplification of treatment regimen, the implementation of a collaborative team-based approach and the development of electronic health tools also hold promise for improving adherence, and thus impacting cardiovascular outcomes and healthcare costs.
Topics: Antihypertensive Agents; Blood Pressure; Humans; Hypertension; Medication Adherence
PubMed: 31834123
DOI: 10.1097/HJH.0000000000002294