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Current Opinion in Cardiology Sep 2022Hypertension (HTN) is a well known risk factor for atherosclerosis and peripheral arterial disease (PAD). PAD affects more than 250 million people globally and is... (Review)
Review
PURPOSE OF REVIEW
Hypertension (HTN) is a well known risk factor for atherosclerosis and peripheral arterial disease (PAD). PAD affects more than 250 million people globally and is associated with worse clinical outcomes. Although multiple studies have been performed to evaluate treatment of HTN in patients with PAD, blood pressure management in this high-risk cohort remains poor.
RECENT FINDINGS
There has been conflicting evidence regarding blood pressure goals in PAD with some recent studies showing adverse outcomes with low blood pressure in this patient population. Current guidelines, however, continue to recommend treatment goals in PAD patients similar to patients without PAD. To date, no single antihypertensive drug class has shown a clear benefit in PAD population over other antihypertensive drug classes.
SUMMARY
Prospective randomized trials enrolling PAD patients are required that can shed light on optimum blood pressure target and also distinguish between different antihypertensive drugs in terms of reducing adverse outcomes.
Topics: Antihypertensive Agents; Blood Pressure; Humans; Hypertension; Peripheral Arterial Disease; Prospective Studies
PubMed: 35880444
DOI: 10.1097/HCO.0000000000000983 -
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 -
Deutsche Medizinische Wochenschrift... Jan 2020
Topics: Antihypertensive Agents; Humans; Hypertension
PubMed: 31958852
DOI: 10.1055/a-0952-9418 -
Expert Opinion on Pharmacotherapy Jul 2020Fixed-combination glaucoma medications have altered the paradigm of ocular hypertension and glaucoma treatment and are in widespread use today. A comprehensive review of... (Review)
Review
INTRODUCTION
Fixed-combination glaucoma medications have altered the paradigm of ocular hypertension and glaucoma treatment and are in widespread use today. A comprehensive review of fixed-combination medications will help educate and inform providers for optimal patient care.
AREAS COVERED
In this review, the authors describe the composition, mechanism of action, efficacy, side effects, and safety profile of fixed-combination agents for the treatment of ocular hypertension and glaucoma as well as comparisons between the most frequently prescribed medications.
EXPERT OPINION
Fixed-combination therapeutics provide an effective and efficient means of lowering intraocular pressure with comparable side effects and outcomes to constituent parts with lower patient exposure to preservatives and improvement in compliance.
Topics: Antihypertensive Agents; Humans; Ocular Hypertension; Ophthalmic Solutions
PubMed: 32228188
DOI: 10.1080/14656566.2020.1743264 -
Handbook of Experimental Pharmacology 2022Extensive evidence demonstrates that lowering blood pressure can substantially reduce the risk of atherosclerotic cardiovascular disease and death.In light of the latest...
Extensive evidence demonstrates that lowering blood pressure can substantially reduce the risk of atherosclerotic cardiovascular disease and death.In light of the latest 2018 European Society of Cardiology/European Society of Hypertension Joint Guidelines, we summarize the current recommendations about lifestyle intervention strategies, pharmacotherapy, and device-based treatments for the management of arterial hypertension. Special attention is given to direct effects exerted by some antihypertensive drugs targeting vascular wall cell components that are involved in the pathogenesis of atherosclerosis.
Topics: Antihypertensive Agents; Blood Pressure; Blood Pressure Determination; Cardiology; Humans; Hypertension
PubMed: 32728994
DOI: 10.1007/164_2020_372 -
Advances in Pharmacology (San Diego,... 2023Hypertension is a major healthcare issue that afflicts one in every three adults worldwide and contributes to cardiovascular diseases, morbidity and mortality. Bioactive...
Hypertension is a major healthcare issue that afflicts one in every three adults worldwide and contributes to cardiovascular diseases, morbidity and mortality. Bioactive lipids contribute importantly to blood pressure regulation via actions on the vasculature, kidney, and inflammation. Vascular actions of bioactive lipids include blood pressure lowering vasodilation and blood pressure elevating vasoconstriction. Increased renin release by bioactive lipids in the kidney is pro-hypertensive whereas anti-hypertensive bioactive lipid actions result in increased sodium excretion. Bioactive lipids have pro-inflammatory and anti-inflammatory actions that increase or decrease reactive oxygen species and impact vascular and kidney function in hypertension. Human studies provide evidence that fatty acid metabolism and bioactive lipids contribute to sodium and blood pressure regulation in hypertension. Genetic changes identified in humans that impact arachidonic acid metabolism have been associated with hypertension. Arachidonic acid cyclooxygenase, lipoxygenase and cytochrome P450 metabolites have pro-hypertensive and anti-hypertensive actions. Omega-3 fish oil fatty acids eicosapentaenoic acid and docosahexaenoic acid are known to be anti-hypertensive and cardiovascular protective. Lastly, emerging fatty acid research areas include blood pressure regulation by isolevuglandins, nitrated fatty acids, and short chain fatty acids. Taken together, bioactive lipids are key contributors to blood pressure regulation and hypertension and their manipulation could decrease cardiovascular disease and associated morbidity and mortality.
Topics: Adult; Humans; Antihypertensive Agents; Hypertension; Cardiovascular Diseases; Sodium; Lipids; Fatty Acids
PubMed: 37236756
DOI: 10.1016/bs.apha.2023.01.001 -
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 -
Ugeskrift For Laeger Jun 2024Ongoing monitoring and targeted treatment are important to ensure the best blood-pressure control and thus prevent cardiovascular risks. In this review, we evaluate the... (Review)
Review
Ongoing monitoring and targeted treatment are important to ensure the best blood-pressure control and thus prevent cardiovascular risks. In this review, we evaluate the findings of four clinical studies investigating the effects of morning versus bedtime dosing of antihypertensives. In three out of four studies, overwhelming results were found favouring bedtime dosing. The same studies have been criticized for mechanistic implausible results and multiple study biases. No harmful effects were reported in relation to bedtime dosing. Thus, antihypertensives can be taken as it is most convenient for the patient.
Topics: Humans; Antihypertensive Agents; Hypertension; Drug Administration Schedule; Drug Chronotherapy; Blood Pressure
PubMed: 38903038
DOI: 10.61409/V11230700 -
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