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American Journal of Hypertension Feb 1991The use of antihypertensive drug treatment has altered the natural history of hypertension. Whereas congestive heart failure, cerebral hemorrhage, and renal failure were... (Review)
Review
The use of antihypertensive drug treatment has altered the natural history of hypertension. Whereas congestive heart failure, cerebral hemorrhage, and renal failure were the major complications of untreated severe hypertension, myocardial infarction and thrombotic stroke have emerged as the major problems in treated hypertensives. None of the major therapeutic trials in hypertension have provided evidence that reducing blood pressure reduces the risk of atherosclerotic complications of hypertension. Hypertension certainly aggravates the severity of atheromatous lesions in experimental animals and, thus, may do so in humans. However, atherosclerosis is more closely related to disturbances in lipoprotein metabolism than to other factors. The common finding that serum cholesterol is raised in hypertensive patients may be due to atherosclerosis being the primary lesion, with the hypertension as a secondary complication rather than the primary lesion.
Topics: Arteriosclerosis; Humans; Hypertension
PubMed: 2021454
DOI: 10.1093/ajh/4.2.103s -
Current Problems in Cardiology Apr 2007Hypertension is a growing public health problem worldwide. Only 37% of American hypertensives currently have their blood pressures controlled. Hypertension is... (Review)
Review
Hypertension is a growing public health problem worldwide. Only 37% of American hypertensives currently have their blood pressures controlled. Hypertension is traditionally diagnosed in the medical office, but both home and ambulatory blood pressure monitoring can help. Lifestyle modifications are recommended for everyone who has higher than "normal" blood pressure (<120/80 mm Hg). Voluminous clinical trial data support beginning drug therapy with low-dose chlorthalidone, unless the patient has a specific indication for a different drug. Additional drugs (typically in the sequence, angiotensin converting-enzyme inhibitor or angiotensin receptor blocker, calcium antagonist, beta-blocker, alpha-blocker, aldosterone antagonist, direct vasodilator, and centrally acting alpha(2)-agonist) can be added to achieve the blood pressure goal (usually <140/90 mm Hg, but <130/80 mm Hg for diabetics and those with chronic kidney disease). Special circumstances exist for treatment of hypertension in pregnancy, in childhood, in the elderly, and in both extremes of blood pressure (pre-hypertension or hypertensive emergencies).
Topics: Antihypertensive Agents; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Costs and Cost Analysis; Humans; Hypertension; Life Style; Risk Factors; Risk Reduction Behavior; United States
PubMed: 17398315
DOI: 10.1016/j.cpcardiol.2007.01.002 -
Revista Portuguesa de Cardiologia :... Feb 2012Levels of physical activity in modern urbanized society are clearly insufficient to maintain good health, and to prevent cardiovascular and other disease. Aerobic... (Review)
Review
Levels of physical activity in modern urbanized society are clearly insufficient to maintain good health, and to prevent cardiovascular and other disease. Aerobic exercise is almost completely free of secondary effects, and is a useful adjunctive therapy in treating hypertension. There are several possible mechanisms to account for the beneficial effects of exercise in reducing blood pressure, the resulting physiological effects usually being classified as acute, post-exercise or chronic. Variations in genetic background, hypertension etiology, pharmacodynamics and pharmacokinetics may explain the different blood pressure responses to exercise among hypertensive patients. The present review discusses the different pathophysiological aspects of the response to exercise in hypertensives, including its modulators and diagnostic and prognostic usefulness, as well as the latest guidelines on prescribing and monitoring exercise regimes and drug therapy in the clinical follow-up of active hypertensive patients.
Topics: Exercise Therapy; Humans; Hypertension; Monitoring, Physiologic; Risk Factors
PubMed: 22237005
DOI: 10.1016/j.repc.2011.12.012 -
Journal of Human Hypertension Aug 2014Resistant hypertension, defined as blood pressure (BP) remaining above goal despite the use of > or =3 antihypertensive medications at maximally tolerated doses (one... (Review)
Review
Resistant hypertension, defined as blood pressure (BP) remaining above goal despite the use of > or =3 antihypertensive medications at maximally tolerated doses (one ideally being a diuretic) or BP that requires > or =4 agents to achieve control, has received more attention with increased efforts to improve BP control rates and the emergence of device-based therapies for hypertension. This classically defined resistant group consists of patients with true resistant hypertension, controlled resistant hypertension and pseudo-resistant hypertension. In studies where pseudo-resistant hypertension cannot be excluded (for example, 24-h ambulatory BP not obtained), the term apparent resistant hypertension has been used to identify 'apparent' lack of control on > or =3 medications. Large, well-designed studies have recently reported the prevalence of resistant hypertension. Pooling prevalence data from these studies and others within North America and Europe with a combined sample size of >600,000 hypertensive participants, the prevalence of resistant hypertension is 14.8% of treated hypertensive patients and 12.5% of all hypertensives. However, the prevalence of true resistant hypertension, defined as uncontrolled both by office and 24-h ambulatory BP monitoring with confirmed medication adherence, may be more meaningful in terms of identifying risk and estimating benefit from newer therapies like renal denervation. Rates of cardiovascular events and mortality follow mean 24-h ambulatory BPs in patients with resistant hypertension, and true resistant hypertension represents the highest risk. The prevalence of true resistant hypertension has not been directly measured in large trials; however, combined data from smaller studies suggest that true resistant hypertension is present in half of the patients with resistant hypertension who are uncontrolled in the office. Our pooled analysis shows prevalence rates of 10.1% and 7.9% for uncontrolled resistant hypertension among individuals treated for hypertension and all hypertensive individuals, respectively.
Topics: Clinical Trials as Topic; Drug Resistance, Neoplasm; Humans; Hypertension; Prevalence
PubMed: 24430707
DOI: 10.1038/jhh.2013.140 -
Obesity Reviews : An Official Journal... May 2006Cardiovascular risk in a patient with obesity hypertension increases with the extent of risk factor clustering. It is therefore important to determine the global risk of... (Review)
Review
Cardiovascular risk in a patient with obesity hypertension increases with the extent of risk factor clustering. It is therefore important to determine the global risk of a patient with hypertension rather than to focus solely on blood pressure. Every hypertensive should be screened for other than blood pressure risk factors, target organ damage and concomitant diseases or accompanying clinical conditions. Assessment of blood pressure and target organ damage might be more difficult in obese hypertensives than in normal-weight patients. Intensive lifestyle interventions can reduce weight, and decrease blood pressure and cardiovascular risk in obese hypertensive patients. Current guidelines do not provide specific recommendation for pharmacological management of the hypertensive patients with obesity. Recent trials have consistently shown that therapy involving beta-blockers and diuretics may induce more new-onset diabetes compared with other combination therapies. Several lines of evidence suggest that anti-hypertensive agents that block the renin-angiotensin system may be especially beneficial in treating obese hypertensive patients. Hypertension management in obese individuals is complicated by poorer response to treatment, and the increased need for multiple medications. It is important to consider obstructive sleep apnoea in the differential diagnosis of hypertensive patients who respond poorly to combination therapy with anti-hypertensive medications.
Topics: Antihypertensive Agents; Cardiovascular Diseases; Diet, Reducing; Drug Therapy, Combination; Female; Humans; Hypertension; Life Style; Male; Obesity; Risk Factors; Treatment Outcome; Weight Loss
PubMed: 16629872
DOI: 10.1111/j.1467-789X.2006.00226.x -
Journal of Human Hypertension Apr 2014Among the vast population of hypertensive subjects, between 10 and 15% do not achieve an adequate blood pressure (BP) control despite the use of at least three... (Review)
Review
Among the vast population of hypertensive subjects, between 10 and 15% do not achieve an adequate blood pressure (BP) control despite the use of at least three antihypertensive agents. This group, designated as having resistant hypertension (RH), represents one of the most important clinical challenges in hypertension evaluation and management. Resistant hypertensives are characterized by several clinical particularities, such as a longer history of hypertension, obesity and other accompanying factors, such as diabetes, left ventricular hypertrophy, albuminuria and renal dysfunction. In addition to other diagnostic and therapeutic maneuvers, such as excluding secondary hypertension, ensuring treatment adherence and optimizing therapeutic schemes, ambulatory BP monitoring (ABPM) is crucial in the clinical evaluation of patients with RH. ABPM distinguish between those with out-of-office BP elevation (true resistant hypertensives) and those having white-coat RH (WCRH; normalcy of 24-h BPs), the prevalence of the latter estimated in about one-third of the population with RH. True resistant hypertensives also exhibit more frequently other co-morbidities, more severe target organ damage and a worse cardiovascular prognosis, in comparison to those with WCRH. Some device-based therapies have recently been developed for treatment of RH. This requires a better characterization of a potential candidate population. A better knowledge of the clinical features of resistant hypertensive subjects, the confirmation of elevated BP values out of the doctor's office, and improvements in the search for secondary causes would help to select those candidates for newer therapies, once the pharmacological possibilities have been exhausted.
Topics: Aged; Antihypertensive Agents; Blood Pressure Monitoring, Ambulatory; Diabetes Complications; Drug Resistance; Female; Humans; Hypertension; Male; Middle Aged; Obesity; Prevalence; Risk Factors; Treatment Outcome
PubMed: 23985879
DOI: 10.1038/jhh.2013.77 -
Journal of Clinical Hypertension... Apr 2020The purposes of this study were to describe the hypertensive population and therapeutic management of hypertension in adults between 18 and 74 years of age in France in...
The purposes of this study were to describe the hypertensive population and therapeutic management of hypertension in adults between 18 and 74 years of age in France in 2015. Esteban survey is a cross-sectional survey with a clinical examination conducted in a representative sample of French adults aged 18-74 years between 2014 and 2016. Esteban was entirely public-funded. Blood pressure (BP) was measured during clinical examination with a standardized protocol, and pharmacological treatment was collected through the exhaustive Système National des Données de Santé (SNDS) database. Hypertension was defined by systolic BP (SBP)> 140 mm Hg, diastolic BP (DBP)> 90 mm Hg or treatment with BP-lowering drugs. The therapeutic control of treated hypertensive patients was defined by SBP < 140 mm Hg and DBP < 90 mm Hg. Adherence to drug treatment was defined as more than 80% of days covered by BP-lowering drug per year. The prevalence of hypertension was 31.3%. 74.7% of aware hypertensive participants taking an antihypertensive drug, and 57.7% of them were treated with a single antihypertensive pharmacological class. Overall, among hypertensives, 24.3% had a satisfactory BP control. Only 49.7% of treated hypertensives participants were controlled, and 33.6% of them were adherent to their drug treatment. The prevalence of hypertension in France remains high, with only 74.7% of the aware hypertensive participants receiving pharmacological therapy and only 48.9% of aware hypertensives with a BP at goal. More effective measures are needed to improve clinical management of hypertension in France.
Topics: Adolescent; Adult; Aged; Antihypertensive Agents; Blood Pressure; Cross-Sectional Studies; France; Humans; Hypertension; Middle Aged; Young Adult
PubMed: 32092238
DOI: 10.1111/jch.13834 -
The Medical Clinics of North America Sep 1987Hypertension represents a problem of special importance in the black patient primarily because of frequency and increased severity. Differences between hypertension in... (Review)
Review
Hypertension represents a problem of special importance in the black patient primarily because of frequency and increased severity. Differences between hypertension in blacks and whites in the United States seem to be mostly epidemiological, pathophysiological, and in responsiveness to drug therapy. Black hypertensives seem to have more of a salt-sensitive, volume-dependent type of hypertension and, therefore, diuretic therapy appears to be particularly useful. Agents that seem to depend more on a stimulated renin-angiotensin-aldosterone system are generally less effective as monotherapy in this group of patients. However, proper combinations of low dose diuretics, with almost any other therapeutic agent, seems to produce a responsiveness in the black hypertensive that is equal to comparable white patients.
Topics: Age Factors; Antihypertensive Agents; Black People; Female; Humans; Hypertension; Male; United States
PubMed: 3306202
DOI: 10.1016/s0025-7125(16)30824-0 -
Primary Care Sep 1991The major differences that have been recognized between black and white hypertensives are primarily epidemiologic, with hypertension being more prevalent, having an... (Review)
Review
The major differences that have been recognized between black and white hypertensives are primarily epidemiologic, with hypertension being more prevalent, having an earlier onset, and having more severe sequelae in the black population. The cause of the problem in both black and white people remains obscure, but it appears that a difference in sodium handling may contribute to the particular hemodynamic and hormonal profile of black hypertensives. Salt sensitivity, expanded plasma volume and low renin levels have been the hallmark of the black hypertensive. Complications such as stroke and left ventricular hypertrophy remain the major sequelae of this disease in blacks. Finally, a current study confirmed the improved efficacy of antihypertensive therapy in blacks to diuretics and calcium channel blockers and a somewhat lower efficacy profile to angiotensin converting enzyme inhibitors and beta blockers, although the latter classes of agents have shown better response in blacks than previously thought.
Topics: Adolescent; Adult; Aged; Antihypertensive Agents; Black People; Causality; Diet, Sodium-Restricted; Female; Humans; Hypertension; Kidney; Life Style; Male; Middle Aged; Prevalence; White People
PubMed: 1946790
DOI: No ID Found -
Archives Des Maladies Du Coeur Et Des... Oct 2001Hypertension occurs in 10 to 15 p cent of pregnancies. Among them, 10 to 20% also have proteinuria. This situation defines preeclampsia, and involves a serious threat on... (Review)
Review
Hypertension occurs in 10 to 15 p cent of pregnancies. Among them, 10 to 20% also have proteinuria. This situation defines preeclampsia, and involves a serious threat on foetal and even maternal prognosis. Presence of the hepatic (HELLP) syndrome still severely worsens the prognosis. Pathophysiology of preeclampsia is based on a very early abnormality of placentation, leading to insufficient blood supply to the foeto-placental unit. At the maternal level, the main consequence of placental ischemia is diffuse endothelial dysfunction, responsible for systemic vasoconstriction and clotting abnormalities. In such a context, merely lowering blood pressure with drugs is quite inefficient, or even harmful. The prognosis of this disease is mainly related to the pertinence of obstetrical management. An early preventive strategy is the most logical approach of preeclampsia, its modalities remain under discussion. Hypertension has a high recurrence rate on subsequent pregnancies. It is most often linked to a high global vascular risk level, therefore many of those patients will become permanent hypertensives in the near future.
Topics: Adult; Antihypertensive Agents; Embolism; Female; HELLP Syndrome; Humans; Hypertension; Ischemia; Pre-Eclampsia; Pregnancy; Prognosis; Recurrence; Risk Factors
PubMed: 11725713
DOI: No ID Found