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High Blood Pressure & Cardiovascular... Dec 2020The vast majority of hypertensive patients are never sought for a cause of their high blood pressure, i.e. for a 'secondary' form of arterial hypertension. This under... (Review)
Review
The vast majority of hypertensive patients are never sought for a cause of their high blood pressure, i.e. for a 'secondary' form of arterial hypertension. This under detection explains why only a tiny percentage of hypertensive patients are ultimately diagnosed with a secondary form of arterial hypertension. The prevalence of these forms is, therefore, markedly underestimated, although, they can involve as many as one-third of the cases among referred patients and up to half of those with difficult to treat hypertension. The early detection of a secondary form is crucial, because if diagnosed in a timely manner, these forms can be cured at long-term, and even when cure cannot be achieved, their diagnosis provides a better control of high blood pressure, and allows prevention of hypertension-mediated organ damage, and related cardiovascular complications. Enormous progress has been made in the understanding, diagnostic work-up, and management of secondary hypertension in the last decades. The aim of this minireview is, therefore, to provide updated concise information on the screening, diagnosis, and management of the most common forms, including primary aldosteronism, renovascular hypertension, pheochromocytoma and paraganglioma, Cushing's syndrome, and obstructive sleep apnea.
Topics: Blood Pressure; Humans; Hypertension; Predictive Value of Tests; Risk Factors; Treatment Outcome
PubMed: 33159664
DOI: 10.1007/s40292-020-00415-9 -
Trends in Cardiovascular Medicine Apr 2020The ACC/AHA hypertension guidelines cover virtually all aspects of the diagnosis, evaluation, monitoring, secondary causes as well as drug and non-drug treatment of... (Review)
Review
The ACC/AHA hypertension guidelines cover virtually all aspects of the diagnosis, evaluation, monitoring, secondary causes as well as drug and non-drug treatment of hypertension. Substantial and appropriate emphasis has been given to the strategies necessary for accurate measurement of blood pressure in any setting where valid blood pressure measurements are desired. Most "errors" made during blood pressure measurement bias readings upwards resulting in over-diagnosis of hypertension and, amongst those already on drug therapy, underestimating the true magnitude of blood pressure lowering resulting in over-treatment. Hypertension is diagnosed when blood pressure is consistently ≥130 and/or ≥80 mm Hg. However, the majority of patients with hypertension between 130-139/80-89 mm Hg (stage 1 hypertension) do not qualify for immediate drug therapy. The guideline breaks new ground with some of its recommendations. Absolute cardiovascular risk is utilized, for the first time, to determine high-risk status when BP 130-139/80-89 mm Hg (Stage 1 hypertension) and high-risk patient characteristics/co-morbidities are absent including age 65 and older, diabetes, chronic kidney disease, known cardiovascular disease; high-risk individuals initiate drug therapy when BP ≥ 130/80 mm Hg. The exception amongst high-risk individuals is for secondary stroke prevention in drug naïve individuals as drug therapy is initiated when blood pressure ≥140/90 mm Hg. Non-high risk individuals will initiate drug therapy when BP is ≥140/90 mm Hg. Irrespective of blood pressure threshold for initiation of drug therapy, the target BP is minimally <130/80 mm Hg in most. However, target BP is <130 systolic amongst those 65 and older as the committee made no recommendation for a DBP target. Treatment should be initiated with two drugs having complementary mechanisms of action when blood pressure is >20/10 mm Hg above goal.
Topics: American Heart Association; Antihypertensive Agents; Blood Pressure; Blood Pressure Determination; Consensus; Drug Therapy, Combination; Humans; Hypertension; Practice Guidelines as Topic; Predictive Value of Tests; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; United States
PubMed: 31521481
DOI: 10.1016/j.tcm.2019.05.003 -
Current Hypertension Reviews 2020Hypertension is the most common chronic disease and the leading risk factor for disability and premature deaths in the world, accounting for more than 9 million deaths... (Review)
Review
Hypertension is the most common chronic disease and the leading risk factor for disability and premature deaths in the world, accounting for more than 9 million deaths annually. Resistant hypertension is a particularly severe form of hypertension. It was described 50 years ago and since then has been a very active field of research. This review aims at summarizing the most recent findings on resistant hypertension. The recent concepts of apparent- and true-resistant hypertension have stimulated a more precise definition of resistant hypertension taking into account not only the accuracy of blood pressure measurement and pharmacological class of prescribed drugs but also patient adherence to drugs and life-style recommendations. Recent epidemiological studies have reported a 10% prevalence of resistant hypertension among hypertensive subjects and demonstrated the high cardiovascular risk of these patients. In addition, these studies identified subgroups of patients with even higher morbidity and mortality risk, probably requiring a more aggressive medical management. In the meantime, guidelines provided more standardized clinical work-up to identify potentially reversible causes for resistant hypertension such as secondary hypertension. The debate is however still ongoing on which would be the optimal method(s) to screen for non-adherence to hypertension therapy, recognized as the major cause for (pseudo)-resistance to treatment. Recent randomized clinical trials have demonstrated the strong benefit of anti-aldosterone drugs (mostly spironolocatone) as fourth-line therapies in resistant hypertension whereas clinical trials with device-based therapies displayed contrasting results. New trials with improved devices and more carefully selected patients with resistant hypertension are ongoing.
Topics: Antihypertensive Agents; Arteriovenous Shunt, Surgical; Blood Pressure; Drug Resistance; Drug Therapy, Combination; Electric Stimulation Therapy; Humans; Hypertension; Medication Adherence; Risk Factors; Sympathectomy; Treatment Outcome; White Coat Hypertension
PubMed: 31622203
DOI: 10.2174/1573402115666191011111402 -
Circulation Research Apr 2021Several important findings bearing on the prevention, detection, and management of hypertension have been reported since publication of the 2017 American College of... (Review)
Review
Several important findings bearing on the prevention, detection, and management of hypertension have been reported since publication of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline. This review summarizes and places in context the results of relevant observational studies, randomized clinical trials, and meta-analyses published between January 2018 and March 2021. Topics covered include blood pressure measurement, patient evaluation for secondary hypertension, cardiovascular disease risk assessment and blood pressure threshold for drug therapy, lifestyle and pharmacological management, treatment target blood pressure goal, management of hypertension in older adults, diabetes, chronic kidney disease, resistant hypertension, and optimization of care using patient, provider, and health system approaches. Presenting new information in each of these areas has the potential to increase hypertension awareness, treatment, and control which remain essential for the prevention of cardiovascular disease and mortality in the future.
Topics: Age Factors; Aged; Antihypertensive Agents; Blood Pressure; Blood Pressure Determination; Diabetes Mellitus; Drug Resistance; Heart Disease Risk Factors; Humans; Hyperaldosteronism; Hypertension; Hypertension, Renovascular; Life Style; Meta-Analysis as Topic; Observational Studies as Topic; Randomized Controlled Trials as Topic; Renal Insufficiency, Chronic; Young Adult
PubMed: 33793326
DOI: 10.1161/CIRCRESAHA.121.318083 -
The Medical Clinics of North America Mar 2022Hypertension is a major cause of cardiovascular morbidity and mortality globally. Many patients with hypertension have secondary causes of hypertension that merit... (Review)
Review
Hypertension is a major cause of cardiovascular morbidity and mortality globally. Many patients with hypertension have secondary causes of hypertension that merit further evaluation. For example, secondary hypertension can result in target organ damage to the heart, kidneys, and brain independent of the effects of blood pressure. Several causes benefit from targeted therapies to supplement first-line antihypertensive agents. However, secondary hypertension is often underrecognized. The goal of this review is to highlight optimal approaches to the diagnosis and management of common causes of secondary hypertension, including primary aldosteronism, renovascular hypertension, obstructive sleep apnea, and drug-induced hypertension.
Topics: Antihypertensive Agents; Blood Pressure; Humans; Hypertension; Sleep Apnea, Obstructive
PubMed: 35227430
DOI: 10.1016/j.mcna.2021.11.004 -
Endocrinology and Metabolism Clinics of... Dec 2019Renovascular disease (RVD) is a major cause of secondary hypertension. Atherosclerotic renal artery stenosis is the most common type of RVD followed by fibromuscular... (Review)
Review
Renovascular disease (RVD) is a major cause of secondary hypertension. Atherosclerotic renal artery stenosis is the most common type of RVD followed by fibromuscular dysplasia. It has long been recognized as the prototype of angiotensin-dependent hypertension. However, the mechanisms underlying the physiopathology of hypertensive occlusive vascular renal disease are complex and distinction between the different causes of RVD should be made. Recognition of these distinct types of RVD with different degrees of renal occlusive disease is important for management. The greatest challenge is to individualize and implement the best approach for each patient in the setting of widely different comorbidities.
Topics: Fibromuscular Dysplasia; Humans; Hypertension, Renal; Hypertension, Renovascular; Nephritis; Renal Artery Obstruction
PubMed: 31655775
DOI: 10.1016/j.ecl.2019.08.007 -
International Journal of Molecular... Aug 2023Hypertension is a prevalent chronic disease associated with an increased risk of cardiovascular (CV) premature death, and its severe form manifests as resistant... (Review)
Review
Hypertension is a prevalent chronic disease associated with an increased risk of cardiovascular (CV) premature death, and its severe form manifests as resistant hypertension (RH). The accurate prevalence of resistant hypertension is difficult to determine due to the discrepancy in data from various populations, but according to recent publications, it ranges from 6% to 18% in hypertensive patients. However, a comprehensive understanding of the pathogenesis and treatment of RH is essential. This review emphasizes the importance of identifying the causes of treatment resistance in antihypertensive therapy and highlights the utilization of appropriate diagnostic methods. We discussed innovative therapies such as autonomic neuromodulation techniques like renal denervation (RDN) and carotid baroreceptor stimulation, along with invasive interventions such as arteriovenous anastomosis as potential approaches to support patients with inadequate medical treatment and enhance outcomes in RH.
Topics: Humans; Hypertension; Therapies, Investigational; Kidney; Autonomic Nervous System
PubMed: 37629095
DOI: 10.3390/ijms241612911 -
Reviews in Endocrine & Metabolic... Feb 2023Primary aldosteronism (PA) is the most common form of secondary hypertension. Although hypertensive disorders seem to affect around 5-10% of pregnancies worldwide,... (Review)
Review
Primary aldosteronism (PA) is the most common form of secondary hypertension. Although hypertensive disorders seem to affect around 5-10% of pregnancies worldwide, literature counts less than 80 cases of PA diagnosed during the peri-partum period. In this review we discuss about current knowledge on pathophysiology, natural history, diagnosis and treatment of PA in pregnancy. Because of the physiologic changes in the renin-angiotensin-aldosterone system (RAAS) and the contraindication to both confirmatory test and subtype differentiation, diagnosis of PA during pregnancy is challenging and relies mostly on detection of low/suppressed renin and high aldosterone levels. The course of pregnancy in patients with PA is highly variable, ranging from progesterone-induced amelioration of blood pressure (BP) control to severe and resistant hypertension with potential maternal and fetal complications. Mineralcorticoid receptor antagonists (MRA) are the recommended and most effective drugs for treatment of PA. As the anti-androgenic effect of spironolactone can potentially interfere with sexual development, their prescription is not recommended during pregnancy. On the other side, eplerenone, has proven to be safe and effective in 6 pregnant women and may be added to conventional first line drug regimen in presence of resistant hypertension or persistent hypokalemia. Ideally, patients with unilateral forms of PA should undergo adrenalectomy prior to conception, however, when PA is diagnosed during pregnancy and medical therapy fails to adequately control hypertension or its complications, adrenalectomy can be considered during the second trimester in case of unilateral adrenal mass at MRI-scan.
Topics: Humans; Female; Pregnancy; Hyperaldosteronism; Mineralocorticoid Receptor Antagonists; Spironolactone; Hypertension; Eplerenone
PubMed: 35536535
DOI: 10.1007/s11154-022-09729-6 -
Saudi Journal of Kidney Diseases and... 2022Renal artery stenosis is one of the most common causes of secondary hypertension (HTN). Renal artery stenosis-induced HTN can occur in the presence of unilateral or... (Review)
Review
Renal artery stenosis is one of the most common causes of secondary hypertension (HTN). Renal artery stenosis-induced HTN can occur in the presence of unilateral or bilateral narrowing and a solitary kidney with stenotic artery, which may subsequently lead to renal insufficiency (e.g., ischemic kidney disease) or pulmonary edema. Renal artery stenosis can be diagnosed using multiple modalities, including Doppler ultrasound, computed tomography angiography, magnetic resonance angiography, or selective angiogram. Although atherosclerotic renal artery stenosis management in patients with HTN has been greatly controversial, it is inevitable in the treatment of some selected cases. These cases can be treated by either percutaneous angioplasty (with or without stenting) or less common, open surgical approach revascularization, both of which have excellent primary patency rates. Generally, several trials on renal artery angioplasty or stenting in patients with atherosclerotic disease have shown that the long-term benefits in terms of blood pressure control and renal function over pharmacological management is not substantial. Furthermore, studies could not demonstrate a prolongation of event-free survival after renal vascularization. Moreover, endovascular procedures have substantial risks. Careful patient selection is required when considering revascularization, for including those with refractory HTN or progressive renal failure, to maximize the potential benefits. This paper discusses the epidemiology of atherosclerotic renal artery stenosis and its clinical presentation, diagnosis, treatment, prognosis, and future perspectives.
Topics: Humans; Renal Artery Obstruction; Kidney; Angioplasty; Renal Artery; Hypertension; Atherosclerosis; Stents; Treatment Outcome
PubMed: 36647988
DOI: 10.4103/1319-2442.367807 -
Revista Medica Del Instituto Mexicano... Feb 2022Background: Hypertension is the most common cardiovascular risk factor that is responsible for complications such as cerebrovascular events, heart failure, acute...
Background: Hypertension is the most common cardiovascular risk factor that is responsible for complications such as cerebrovascular events, heart failure, acute myocardial infarction, kidney failure, arrhythmias and blindness. About 30% of the adult population older than 20 years is a carrier. 40% of carriers are unaware of suffering from it since its onset is generally asymptomatic. Unfortunately, of those who are already known to be hypertensive, only half take drug treatment and of these, only half achieve control figures (<14/90 mmHg). For several decades it has not been possible to forcefully modify the natural history of this disease despite the advancement of therapeutic drugs. The Mexican Institute of Social Security launches the initiative of the Integrated Care Protocols (PAI) of the main diseases. This protocol shows how the three levels of medical care are concatenated, the role of each of the members of the multidisciplinary team for medical care, including: doctor, nurse, social work, psychologist, nutritionist, among others and, to patient sharing. The main changes in diagnostic criteria, in-office and out-of-office blood pressure measurement, drug therapy (monotherapy, dual therapy and triple therapy) and non-drug therapy, and follow-up are presented. The diagnostic-therapeutic approach using algorithm as well as the diagnostic approach to secondary hypertension and special forms of hypertension such as in pregnancy, hypertensive crisis, hypertension in the elderly, ischemic or nephropathy patients.
Topics: Adult; Aged; Antihypertensive Agents; Blood Pressure; Blood Pressure Determination; Delivery of Health Care, Integrated; Humans; Hypertension; Myocardial Infarction
PubMed: 35175695
DOI: No ID Found