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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 -
Blood Purification 2014Numerous experimental and clinical studies suggest that uric acid might have pathobiologic implications in the development and progression of hypertension, kidney... (Review)
Review
Numerous experimental and clinical studies suggest that uric acid might have pathobiologic implications in the development and progression of hypertension, kidney disease, and coronary heart disease, among others, resulting in renewed interest in uric acid as a potential pathogenic mediator in these clinical conditions. Despite encouraging animal studies showing beneficial roles of allopurinol, clinical studies and randomized controlled trials remain scarce, and, despite available clinical evidence supporting a therapeutic role for allopurinol, multiple issues remain before routine use of allopurinol can be recommended for use in patients with hyperuricemia and hypertension, kidney disease, or coronary heart disease. These include a need for more robust clinical trial data that evaluate efficacy on hard clinical outcomes, optimal dose, duration of treatment, and the potential for serious allergic reactions. In this article we review the current available evidence describing the effects of allopurinol in hypertension, kidney disease, and coronary heart disease, highlighting unresolved issues surrounding allopurinol use for uric acid lowering in individuals without gout.
Topics: Allopurinol; Antihypertensive Agents; Cardiotonic Agents; Chronic Disease; Coronary Disease; Gout Suppressants; Humans; Hypertension, Renal; Randomized Controlled Trials as Topic; Uric Acid
PubMed: 24903910
DOI: 10.1159/000360520 -
Yonsei Medical Journal Feb 2023Although the majority of individuals with hypertension (HTN) have primary and polygenic HTN, monogenic HTN is a secondary type that is widely thought to play a key role... (Review)
Review
Although the majority of individuals with hypertension (HTN) have primary and polygenic HTN, monogenic HTN is a secondary type that is widely thought to play a key role in pediatric HTN, which has the characteristics of early onset, refractory HTN with a positive family history, and electrolyte disorders. Monogenic HTN results from single genetic mutations that contribute to the dysregulation of blood pressure (BP) in the kidneys and adrenal glands. It is pathophysiologically associated with increased sodium reabsorption in the distal tubule, intravascular volume expansion, and HTN, as well as low renin and varying aldosterone levels. Simultaneously increased or decreased potassium levels also provide clues for the diagnosis of monogenic HTN. Discovering the genetic factors that cause an increase in BP has been shown to be related to the choice of and responses to antihypertensive medications. Therefore, early and precise diagnosis with genetic sequencing and effective treatment with accurate antihypertensive agents are critical in the management of monogenic HTN. In addition, understanding the genetic architecture of BP, causative molecular pathways perturbing BP regulation, and pharmacogenomics can help with the selection of precision and personalized medicine, as well as improve morbidity and mortality in adulthood.
Topics: Child; Humans; Hypertension; Blood Pressure; Antihypertensive Agents; Treatment Outcome; Precision Medicine
PubMed: 36719014
DOI: 10.3349/ymj.2022.0316 -
Pediatric Nephrology (Berlin, Germany) Oct 2023Severe childhood hypertension is uncommon and frequently not recognised and is best defined as a systolic blood pressure (SBP) above the stage 2 threshold of the 95th... (Review)
Review
Severe childhood hypertension is uncommon and frequently not recognised and is best defined as a systolic blood pressure (SBP) above the stage 2 threshold of the 95th centile + 12 mmHg. If no signs of end-organ damage are present, this is urgent hypertension which can be managed by the slow introduction of oral or sublingual medication, but if signs are present, the child has emergency hypertension (or hypertensive encephalopathy if they include irritability, visual impairment, fits, coma, or facial palsy), and treatment must be started promptly to prevent progression to permanent neurological damage or death. However, detailed evidence from case series shows that the SBP must be lowered in a controlled manner over about 2 days by infusing short-acting intravenous hypotensive agents, with saline boluses ready in case of overshoot, unless the child had documented normotension within the last day. This is because sustained hypertension may increase pressure thresholds of cerebrovascular autoregulation which take time to reverse. A recent PICU study that suggested otherwise was significantly flawed. The target is to reduce the admission SBP by its excess, to just above the 95th centile, in three equal steps lasting about ≥ 6 h, 12 h, and finally ≥ 24 h, before introducing oral therapy. Few of the current clinical guidelines are comprehensive, and some advise reducing the SBP by a fixed percentage, which may be dangerous and has no evidence base. This review suggests criteria for future guidelines and argues that these should be evaluated by establishing prospective national or international databases.
Topics: Child; Humans; Prospective Studies; Hypertension; Antihypertensive Agents; Blood Pressure; Administration, Intravenous
PubMed: 36862252
DOI: 10.1007/s00467-023-05896-z -
Journal of Clinical Hypertension... Sep 2011KEY POINTS AND PRACTICAL RECOMMENDATIONS: • Hydralazine and minoxidil act by dilating resistance arterioles, thus reducing peripheral resistance, with no dilating... (Review)
Review
KEY POINTS AND PRACTICAL RECOMMENDATIONS: • Hydralazine and minoxidil act by dilating resistance arterioles, thus reducing peripheral resistance, with no dilating effect on the venous side of the circulation. • There is a baroreflex-mediated venoconstriction, resulting in an increase in venous return to the heart, along with a direct catecholamine-mediated positive inotropic and chronotropic stimulation of the heart. • Hydralazine therapy is usually combined with a sympathetic inhibitor to prevent expression of this reflex, as well as with a diuretic agent to prevent sodium retention caused by reduction in renal perfusion pressure. • Hydralazine is indicated in the long-term therapy of essential hypertension, in the short-term therapy of pregnancy-induced hypertension and eclampsia, and in the therapy of hypertensive crisis. • Adverse effects include the anticipated tachycardia, fluid retention, and headache, caused by the vasodilation, especially in the early days of therapy, but may frequently be prevented by the concomitant use of a β-blocker. • As with other drugs that are N-acetylated, there is a low risk of lupus-like syndrome with high doses and long-term use. • Because of the severity of adverse effects with minoxidil, its usage is limited to persons with severe hypertension unresponsive to other treatments. • Hirsutism, a common side effect of minoxidil, is particularly bothersome in women and reverses in a few months after discontinuation. • Sodium nitroprusside is used in the intensive care setting to lower pressure in hypertensive crisis or to treat severe left ventricular failure, particularly valuable when elevated pressure or severe left ventricular failure threatens the patient's survival. • Although nitrates have not achieved widespread use as antihypertensive agents, they are effective in producing sustained blood pressure (BP) reductions when added to other antihypertensive regimens.
Topics: Antihypertensive Agents; Hirsutism; Humans; Hydralazine; Hypertension; Minoxidil; Tachycardia; Treatment Outcome; Vasodilator Agents
PubMed: 21896152
DOI: 10.1111/j.1751-7176.2011.00507.x -
International Journal of Molecular... Feb 2023Hypertension is the third leading cause of the global disease burden, and while populations live longer, adopt more sedentary lifestyles, and become less economically... (Review)
Review
Hypertension is the third leading cause of the global disease burden, and while populations live longer, adopt more sedentary lifestyles, and become less economically concerned, the prevalence of hypertension is expected to increase. Pathologically elevated blood pressure (BP) is the strongest risk factor for cardiovascular disease (CVD) and related disability, thus making it imperative to treat this disease. Effective standard pharmacological treatments, i.e., diuretics, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blocker (ARBs), beta-adrenergic receptor blockers (BARBs), and calcium channel blockers (CCBs), are available. Vitamin D (vitD) is known best for its role in bone and mineral homeostasis. Studies with vitamin D receptor (VDR) knockout mice show an increased renin-angiotensin-aldosterone system (RAAS) activity and increased hypertension, suggesting a key role for vitD as a potential antihypertensive agent. Similar studies in humans displayed ambiguous and mixed results. No direct antihypertensive effect was shown, nor a significant impact on the human RAAS. Interestingly, human studies supplementing vitD with other antihypertensive agents reported more promising results. VitD is considered a safe supplement, proposing its great potential as antihypertensive supplement. The aim of this review is to examine the current knowledge about vitD and its role in the treatment of hypertension.
Topics: Animals; Humans; Mice; Adrenergic beta-Antagonists; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Calcium Channel Blockers; Hypertension; Renin-Angiotensin System; Vitamin D; Receptors, Calcitriol; Bone Density Conservation Agents
PubMed: 36902110
DOI: 10.3390/ijms24054679 -
Current Cardiology Reports Oct 2021In the United States (US), 46% of adults have hypertension (systolic blood pressure ≥ 130 mmHg, diastolic blood pressure ≥ 80 mmHg). Approximately, 16% of... (Review)
Review
PURPOSE OF REVIEW
In the United States (US), 46% of adults have hypertension (systolic blood pressure ≥ 130 mmHg, diastolic blood pressure ≥ 80 mmHg). Approximately, 16% of patients with hypertension have apparent treatment-resistant hypertension (aTRH) and the incidence of true resistant hypertension (RHT) is thought to be much lower (~ 2%). These patients with RHT are at a higher risk for adverse events and worse clinical outcomes.
RECENT FINDINGS
Although lifestyle interventions have proven to be effective as the first line of defense in treating hypertension, their role in the management of patients with RHT is not well established. Despite fewer in number, available studies examining lifestyle interventions in patients with RHT do indeed show promising results. In this review, we aim to discuss the role of common lifestyle interventions such as physical activity, exercise, weight loss, and dietary modifications on blood pressure control in patients with RHT.
Topics: Adult; Antihypertensive Agents; Blood Pressure; Exercise; Humans; Hypertension; Life Style; United States
PubMed: 34599399
DOI: 10.1007/s11886-021-01601-4 -
The American Journal of Managed Care Mar 2021Pulmonary arterial hypertension (PAH) is a severe disease with poor prognosis and shortened life expectancy. Treatment has traditionally involved the sequential use of... (Review)
Review
Pulmonary arterial hypertension (PAH) is a severe disease with poor prognosis and shortened life expectancy. Treatment has traditionally involved the sequential use of endothelin receptor agonists, prostacyclin therapies, and nitric oxide pathway modulators, which each have distinct mechanisms of action leading to pulmonary vasodilation, and improvement in exercise capacity, hemodynamic measures, and clinical outcomes for patients with PAH. This article provides a review of goals of therapy in PAH, determinants of prognosis and levels of patient risk, and additional factors that guide treatment decision making. Recent research in combination therapies has created a paradigm shift in the treatment of PAH and will be reviewed. Additionally, recent updates to the American College of Chest Physicians guidelines will be reviewed along with the updated evidence-based treatment algorithm. Finally, trial data will be evaluated for the recently developed agent selexipag and improved treprostinil delivery formulations that may provide enhanced convenience.
Topics: Antihypertensive Agents; Humans; Hypertension, Pulmonary; Prognosis; Prostaglandins I; Pulmonary Arterial Hypertension; Vasodilation
PubMed: 33710843
DOI: 10.37765/ajmc.2021.88610 -
Current Cardiology Reports Jul 2022This review provides a contemporary perspective and approach for the treatment of hypertension (HTN) among patients hospitalized for non-cardiac reasons. (Review)
Review
PURPOSE OF REVIEW
This review provides a contemporary perspective and approach for the treatment of hypertension (HTN) among patients hospitalized for non-cardiac reasons.
RECENT FINDINGS
Elevated blood pressure (BP) is a common dilemma encountered by physicians, but guidelines are lacking to assist providers in managing hospitalized patients with elevated BP. Inpatient HTN is common, and management remains challenging given the paucity of data and misperceptions among training and practicing physicians. The outcomes associated with intensifying BP treatment during hospitalization can be harmful, with little to no long-term benefits. Data also suggests that medication intensification at discharge is not associated with improved outpatient BP control. Routine inpatient HTN control in the absence of end-organ damage has not shown to be helpful and may have deleterious effects. Since routine use of intravenous antihypertensives in hospitalized non-cardiac patients has been shown to prolong inpatient stay without benefits, their routine use should be avoided for inpatient HTN control. Future large-scale trials measuring clinical outcomes during prolonged follow-up may help to identify specific circumstances where inpatient HTN control may be beneficial.
Topics: Antihypertensive Agents; Blood Pressure; Hospitalization; Humans; Hypertension; Patient Discharge
PubMed: 35524879
DOI: 10.1007/s11886-022-01699-0