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Sample records for hypertension apasl recommendations

  1. APASL consensus statements and recommendation on treatment of hepatitis C.

    PubMed

    Omata, Masao; Kanda, Tatsuo; Wei, Lai; Yu, Ming-Lung; Chuang, Wang-Long; Ibrahim, Alaaeldin; Lesmana, Cosmas Rinaldi Adithya; Sollano, Jose; Kumar, Manoj; Jindal, Ankur; Sharma, Barjesh Chander; Hamid, Saeed S; Dokmeci, A Kadir; Mamun-Al-Mahtab; McCaughan, Geofferey W; Wasim, Jafri; Crawford, Darrell H G; Kao, Jia-Horng; Yokosuka, Osamu; Lau, George K K; Sarin, Shiv Kumar

    2016-09-01

    The Asian-Pacific Association for the Study of the Liver (APASL) convened an international working party on the "APASL consensus statements and recommendation on management of hepatitis C" in March, 2015, in order to revise "APASL consensus statements and management algorithms for hepatitis C virus infection (Hepatol Int 6:409-435, 2012)". The working party consisted of expert hepatologists from the Asian-Pacific region gathered at Istanbul Congress Center, Istanbul, Turkey on 13 March 2015. New data were presented, discussed and debated to draft a revision. Participants of the consensus meeting assessed the quality of cited studies. Finalized recommendations on treatment of hepatitis C are presented in this review. PMID:27130427

  2. APASL consensus statements and recommendations for hepatitis C prevention, epidemiology, and laboratory testing.

    PubMed

    Omata, Masao; Kanda, Tatsuo; Wei, Lai; Yu, Ming-Lung; Chuang, Wang-Long; Ibrahim, Alaaeldin; Lesmana, Cosmas Rinaldi Adithya; Sollano, Jose; Kumar, Manoj; Jindal, Ankur; Sharma, Barjesh Chander; Hamid, Saeed S; Dokmeci, A Kadir; Al-Mahtab, Mamun; McCaughan, Geofferey W; Wasim, Jafri; Crawford, Darrell H G; Kao, Jia-Horng; Yokosuka, Osamu; Lau, George K K; Sarin, Shiv Kumar

    2016-09-01

    The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on "APASL consensus statements and recommendations for management of hepatitis C" in March 2015 to revise the "APASL consensus statements and management algorithms for hepatitis C virus infection" (Hepatol Int 6:409-435, 2012). The working party consisted of expert hepatologists from the Asian-Pacific region gathered at the Istanbul Congress Center, Istanbul, Turkey on 13 March 2015. New data were presented, discussed, and debated during the course of drafting a revision. Participants of the consensus meeting assessed the quality of the cited studies. The finalized recommendations for hepatitis C prevention, epidemiology, and laboratory testing are presented in this review. PMID:27229718

  3. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014.

    PubMed

    Sarin, Shiv Kumar; Kedarisetty, Chandan Kumar; Abbas, Zaigham; Amarapurkar, Deepak; Bihari, Chhagan; Chan, Albert C; Chawla, Yogesh Kumar; Dokmeci, A Kadir; Garg, Hitendra; Ghazinyan, Hasmik; Hamid, Saeed; Kim, Dong Joon; Komolmit, Piyawat; Lata, Suman; Lee, Guan Huei; Lesmana, Laurentius A; Mahtab, Mamun; Maiwall, Rakhi; Moreau, Richard; Ning, Qin; Pamecha, Viniyendra; Payawal, Diana Alcantara; Rastogi, Archana; Rahman, Salimur; Rela, Mohamed; Saraya, Anoop; Samuel, Didier; Saraswat, Vivek; Shah, Samir; Shiha, Gamal; Sharma, Brajesh Chander; Sharma, Manoj Kumar; Sharma, Kapil; Butt, Amna Subhan; Tan, Soek Siam; Vashishtha, Chitranshu; Wani, Zeeshan Ahmed; Yuen, Man-Fung; Yokosuka, Osamu

    2014-10-01

    The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. Due to the rapid advancements in the knowledge and available information, a consortium of members from countries across Asia Pacific, "APASL ACLF Research Consortium (AARC)," was formed in 2012. A large cohort of retrospective and prospective data of ACLF patients was collated and followed up in this data base. The current ACLF definition was reassessed based on the new AARC data base. These initiatives were concluded on a 2-day meeting in February 2014 at New Delhi and led to the development of the final AARC consensus. Only those statements which were based on the evidence and were unanimously recommended were accepted. These statements were circulated again to all the experts and subsequently presented at the annual conference of the APASL at Brisbane, on March 14, 2014. The suggestions from the delegates were analyzed by the expert panel, and the modifications in the consensus were made. The final consensus and guidelines document was prepared. After detailed deliberations and data analysis, the original proposed definition was found to withstand the test of time and identify a homogenous group of patients presenting with liver failure. Based on the AARC data, liver failure grading, and its impact on the "Golden therapeutic Window," extra-hepatic organ failure and development of sepsis were analyzed. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals, and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information are presented here. PMID:26202751

  4. Recommendations for the treatment of hypertension in elderly people.

    PubMed

    Rubio-Guerra, Alberto F; Duran-Salgado, Montserrat B

    2015-01-01

    High blood pressure is a major cardiovascular risk factor. The prevalence of hypertension increases with aging. As a consequence of changes in arterial wall that leads to arterial stiffness, the majority of elderly patients suffer isolated systolic hypertension. The evidence strongly supports that hypertension in the elderly is associated with an increase in stroke risk and cardiovascular mortality and morbidity. Several trials have shown the benefits of treating hypertension in elderly patients. Even in the very old patients, the use of antihypertensive agents such as calcium channel blockers, thiazide and thiazide-like diuretics, and inhibitors of the renin-angiotensin system reduce the risk of complications in those patients. However, most patients will need two or more drugs to reach the recommended goals. Hypertension in the elderly has special conditions that must be assessed in the evaluation of the patient (as pseudohypertension and white coat hypertension), and issues that may affect the therapeutic choice and the response to treatment, as comorbidities and polypharmacy. PMID:25761106

  5. The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: Part II – Therapy

    PubMed Central

    Khan, Nadia A; McAlister, Finlay A; Rabkin, Simon W; Padwal, Raj; Feldman, Ross D; Campbell, Norman RC; Leiter, Lawrence A; Lewanczuk, Richard Z; Schiffrin, Ernesto L; Hill, Michael D; Arnold, Malcolm; Moe, Gordon; Campbell, Tavis S; Herbert, Carol; Milot, Alain; Stone, James A; Burgess, Ellen; Hemmelgarn, B; Jones, Charlotte; Larochelle, Pierre; Ogilvie, Richard I; Houlden, Robyn; Herman, Robert J; Hamet, Pavel; Fodor, George; Carruthers, George; Culleton, Bruce; deChamplain, Jacques; Pylypchuk, George; Logan, Alexander G; Gledhill, Norm; Petrella, Robert; Tobe, Sheldon; Touyz, Rhian M

    2006-01-01

    OBJECTIVE To provide updated, evidence-based recommendations for the management of hypertension in adults. OPTIONS AND OUTCOMES For lifestyle and pharmacological interventions, evidence from randomized, controlled trials and systematic reviews of trials was preferentially reviewed. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. For lifestyle interventions, blood pressure (BP) lowering was accepted as a primary outcome given the lack of long-term morbidity/mortality data in this field. For treatment of patients with kidney disease, the development of proteinuria or worsening of kidney function was also accepted as a clinically relevant primary outcome. EVIDENCE MEDLINE searches were conducted from November 2004 to October 2005 to update the 2005 recommendations. In addition, reference lists were scanned and experts were contacted to identify additional published studies. All relevant articles were reviewed and appraised independently by content and methodological experts using prespecified levels of evidence. RECOMMENDATIONS Lifestyle modifications to prevent and/or treat hypertension include the following: perform 30 min to 60 min of aerobic exercise four to seven days per week; maintain a healthy body weight (body mass index of 18.5 kg/m2 to 24.9 kg/m2) and waist circumference (less than 102 cm for men and less than 88 cm for women); limit alcohol consumption to no more than 14 standard drinks per week in men or nine standard drinks per week in women; follow a diet that is reduced in saturated fat and cholesterol and that emphasizes fruits, vegetables and low-fat dairy products; restrict salt intake; and consider stress management in selected individuals. Treatment thresholds and targets should take into account each individual’s global atherosclerotic risk, target organ damage and comorbid conditions. BP should be lowered to less than 140/90 mmHg in all patients, and to less than 130/80 mmHg in those with diabetes

  6. The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension.

    PubMed

    Daskalopoulou, Stella S; Rabi, Doreen M; Zarnke, Kelly B; Dasgupta, Kaberi; Nerenberg, Kara; Cloutier, Lyne; Gelfer, Mark; Lamarre-Cliche, Maxime; Milot, Alain; Bolli, Peter; McKay, Donald W; Tremblay, Guy; McLean, Donna; Tobe, Sheldon W; Ruzicka, Marcel; Burns, Kevin D; Vallée, Michel; Ramesh Prasad, G V; Lebel, Marcel; Feldman, Ross D; Selby, Peter; Pipe, Andrew; Schiffrin, Ernesto L; McFarlane, Philip A; Oh, Paul; Hegele, Robert A; Khara, Milan; Wilson, Thomas W; Brian Penner, S; Burgess, Ellen; Herman, Robert J; Bacon, Simon L; Rabkin, Simon W; Gilbert, Richard E; Campbell, Tavis S; Grover, Steven; Honos, George; Lindsay, Patrice; Hill, Michael D; Coutts, Shelagh B; Gubitz, Gord; Campbell, Norman R C; Moe, Gordon W; Howlett, Jonathan G; Boulanger, Jean-Martin; Prebtani, Ally; Larochelle, Pierre; Leiter, Lawrence A; Jones, Charlotte; Ogilvie, Richard I; Woo, Vincent; Kaczorowski, Janusz; Trudeau, Luc; Petrella, Robert J; Hiremath, Swapnil; Stone, James A; Drouin, Denis; Lavoie, Kim L; Hamet, Pavel; Fodor, George; Grégoire, Jean C; Fournier, Anne; Lewanczuk, Richard; Dresser, George K; Sharma, Mukul; Reid, Debra; Benoit, Geneviève; Feber, Janusz; Harris, Kevin C; Poirier, Luc; Padwal, Raj S

    2015-05-01

    The Canadian Hypertension Education Program reviews the hypertension literature annually and provides detailed recommendations regarding hypertension diagnosis, assessment, prevention, and treatment. This report provides the updated evidence-based recommendations for 2015. This year, 4 new recommendations were added and 2 existing recommendations were modified. A revised algorithm for the diagnosis of hypertension is presented. Two major changes are proposed: (1) measurement using validated electronic (oscillometric) upper arm devices is preferred over auscultation for accurate office blood pressure measurement; (2) if the visit 1 mean blood pressure is increased but < 180/110 mm Hg, out-of-office blood pressure measurements using ambulatory blood pressure monitoring (preferably) or home blood pressure monitoring should be performed before visit 2 to rule out white coat hypertension, for which pharmacologic treatment is not recommended. A standardized ambulatory blood pressure monitoring protocol and an update on automated office blood pressure are also presented. Several other recommendations on accurate measurement of blood pressure and criteria for diagnosis of hypertension have been reorganized. Two other new recommendations refer to smoking cessation: (1) tobacco use status should be updated regularly and advice to quit smoking should be provided; and (2) advice in combination with pharmacotherapy for smoking cessation should be offered to all smokers. The following recommendations were modified: (1) renal artery stenosis should be primarily managed medically; and (2) renal artery angioplasty and stenting could be considered for patients with renal artery stenosis and complicated, uncontrolled hypertension. The rationale for these recommendation changes is discussed. PMID:25936483

  7. The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2 – therapy

    PubMed Central

    Khan, Nadia A; Hemmelgarn, Brenda; Padwal, Raj; Larochelle, Pierre; Mahon, Jeff L; Lewanczuk, Richard Z; McAlister, Finlay A; Rabkin, Simon W; Hill, Michael D; Feldman, Ross D; Schiffrin, Ernesto L; Campbell, Norman RC; Logan, Alexander G; Arnold, Malcolm; Moe, Gordon; Campbell, Tavis S; Milot, Alain; Stone, James A; Jones, Charlotte; Leiter, Lawrence A; Ogilvie, Richard I; Herman, Robert J; Hamet, Pavel; Fodor, George; Carruthers, George; Culleton, Bruce; Burns, Kevin D; Ruzicka, Marcel; deChamplain, Jacques; Pylypchuk, George; Gledhill, Norm; Petrella, Robert; Boulanger, Jean-Martin; Trudeau, Luc; Hegele, Robert A; Woo, Vincent; McFarlane, Phil; Touyz, Rhian M; Tobe, Sheldon W

    2007-01-01

    OBJECTIVE: To provide updated, evidence-based recommendations for the prevention and management of hypertension in adults. OPTIONS AND OUTCOMES: For lifestyle and pharmacological interventions, evidence was reviewed from randomized controlled trials and systematic reviews of trials. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. However, for lifestyle interventions, blood pressure lowering was accepted as a primary outcome given the lack of long-term morbidity and mortality data in this field. For treatment of patients with kidney disease, the progression of kidney dysfunction was also accepted as a clinically relevant primary outcome. EVIDENCE: A Cochrane collaboration librarian conducted an independent MEDLINE search from 2005 to August 2006 to update the 2006 Canadian Hypertension Education Program recommendations. In addition, reference lists were scanned and experts were contacted to identify additional published studies. All relevant articles were reviewed and appraised independently by both content and methodological experts using prespecified levels of evidence. RECOMMENDATIONS: Dietary lifestyle modifications for prevention of hypertension, in addition to a well-balanced diet, include a dietary sodium intake of less than 100 mmol/day. In hypertensive patients, the dietary sodium intake should be limited to 65 mmol/day to 100 mmol/day. Other lifestyle modifications for both normotensive and hypertensive patients include: performing 30 min to 60 min of aerobic exercise four to seven days per week; maintaining a healthy body weight (body mass index of 18.5 kg/m2 to 24.9 kg/m2) and waist circumference (less than 102 cm in men and less than 88 cm in women); limiting alcohol consumption to no more than 14 units per week in men or nine units per week in women; following a diet reduced in saturated fat and cholesterol, and one that emphasizes fruits, vegetables and low-fat dairy products, dietary and soluble fibre, whole

  8. The 2008 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2 – therapy

    PubMed Central

    Khan, Nadia A; Hemmelgarn, Brenda; Herman, Robert J; Rabkin, Simon W; McAlister, Finlay A; Bell, Chaim M; Touyz, Rhian M; Padwal, Raj; Leiter, Lawrence A; Mahon, Jeff L; Hill, Michael D; Larochelle, Pierre; Feldman, Ross D; Schiffrin, Ernesto L; Campbell, Norman RC; Arnold, Malcolm O; Moe, Gordon; Campbell, Tavis S; Milot, Alain; Stone, James A; Jones, Charlotte; Ogilvie, Richard I; Hamet, Pavel; Fodor, George; Carruthers, George; Burns, Kevin D; Ruzicka, Marcel; deChamplain, Jacques; Pylypchuk, George; Petrella, Robert; Boulanger, Jean-Martin; Trudeau, Luc; Hegele, Robert A; Woo, Vincent; McFarlane, Phil; Vallée, Michel; Howlett, Jonathan; Katzmarzyk, Peter; Tobe, Sheldon; Lewanczuk, Richard Z

    2008-01-01

    OBJECTIVE: To update the evidence-based recommendations for the prevention and management of hypertension in adults. OPTIONS AND OUTCOMES: For lifestyle and pharmacological interventions, evidence was preferentially reviewed from randomized controlled trials and systematic reviews of trials. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. However, for lifestyle interventions, blood pressure lowering was accepted as a primary outcome given the lack of long-term morbidity and mortality data in this field. Progression of kidney dysfunction was also accepted as a clinically relevant primary outcome among patients with chronic kidney disease. EVIDENCE: A Cochrane collaboration librarian conducted an independent MEDLINE search from 2006 to August 2007 to update the 2007 recommendations. To identify additional published studies, reference lists were reviewed and experts were contacted. All relevant articles were reviewed and appraised independently by content and methodological experts using prespecified levels of evidence. RECOMMENDATIONS: For lifestyle modifications to prevent and treat hypertension, restrict dietary sodium intake to less than 100 mmol/day (and 65 mmol/day to 100 mmol/day in hypertensive patients); perform 30 min to 60 min of aerobic exercise four to seven days per week; maintain a healthy body weight (body mass index 18.5 kg/m2 to 24.9 kg/m2) and waist circumference (smaller than 102 cm for men and smaller than 88 cm for women); limit alcohol consumption to no more than 14 units per week in men or nine units per week in women; follow a diet that is reduced in saturated fat and cholesterol, and one that emphasizes fruits, vegetables and low-fat dairy products, dietary and soluble fibre, whole grains and protein from plant sources; and consider stress management in selected individuals with hypertension. For the pharmacological management of hypertension, treatment thresholds and targets should be predicated on by

  9. Exercise for Hypertension: A Prescription Update Integrating Existing Recommendations with Emerging Research.

    PubMed

    Pescatello, Linda S; MacDonald, Hayley V; Lamberti, Lauren; Johnson, Blair T

    2015-11-01

    Hypertension is the most common, costly, and preventable cardiovascular disease risk factor. Numerous professional organizations and committees recommend exercise as initial lifestyle therapy to prevent, treat, and control hypertension. Yet, these recommendations differ in the components of the Frequency, Intensity, Time, and Type (FITT) principle of exercise prescription (Ex Rx); the evidence upon which they are based is only of fair methodological quality; and the individual studies upon which they are based generally do not include people with hypertension, which are some of the limitations in this literature. The purposes of this review are to (1) overview the professional exercise recommendations for hypertension in terms of the FITT principle of Ex Rx; (2) discuss new and emerging research related to Ex Rx for hypertension; and (3) present an updated FITT Ex Rx for adults with hypertension that integrates the existing recommendations with this new and emerging research. PMID:26423529

  10. Context-Awareness Based Personalized Recommendation of Anti-Hypertension Drugs.

    PubMed

    Chen, Dexin; Jin, Dawei; Goh, Tiong-Thye; Li, Na; Wei, Leiru

    2016-09-01

    The World Health Organization estimates that almost one-third of the world's adult population are suffering from hypertension which has gradually become a "silent killer". Due to the varieties of anti-hypertensive drugs, patients are interested in how these drugs can be selected to match their respective conditions. This study provides a personalized recommendation service system of anti-hypertensive drugs based on context-awareness and designs a context ontology framework of the service. In addition, this paper introduces a Semantic Web Rule Language (SWRL)-based rule to provide high-level context reasoning and information recommendation and to overcome the limitation of ontology reasoning. To make the information recommendation of the drugs more personalized, this study also devises three categories of information recommendation rules that match different priority levels and uses a ranking algorithm to optimize the recommendation. The experiment conducted shows that combining the anti-hypertensive drugs personalized recommendation service context ontology (HyRCO) with the optimized rule reasoning can achieve a higher-quality personalized drug recommendation service. Accordingly this exploratory study of the personalized recommendation service for hypertensive drugs and its method can be easily adopted for other diseases. PMID:27473866

  11. [Recommendations for the management of hypertensive crisis. A Consensus document of the Chilean Society of Hypertension].

    PubMed

    Valdés, Gloria; Roessler, Emilio

    2002-03-01

    The management of severe hypertension in the emergency setting demands a careful evaluation of the different underlying clinical situations, and of the impending risk for the life of the patient or of acute organ damage. Hypertensive emergencies and urgencies have to be identified, and distinguished from chronic severe hypertension, a frequent presentation to the emergency services. A thorough clinical evaluation, and not the magnitude of the blood pressure elevation, should be the basis of the differential diagnosis; this will guide the setting required for treatment (intensive care unit, ward or ambulatory), the drugs of choice, as well as the velocity of blood pressure reduction. Special emphasis has to be given to the management of cerebrovascular accidents and severe preeclampsia, as the reduction of blood pressure entails a risk of hypoperfusion of critical territories as the brain and fetus respectively. A wide range of drugs permits a tailored treatment of a variety of clinical situations. Efforts have to be made to detect and manage chronic hypertensive patients in order to reduce the consultation load represented by severe hypertensives in emergency services, by preventing hypertensive crisis, in order to focalize on real situations of risk. PMID:12043377

  12. Drug treatment of hypertension in pregnancy: a critical review of adult guideline recommendations.

    PubMed

    Al Khaja, Khalid A J; Sequeira, Reginald P; Alkhaja, Alwaleed K; Damanhori, Awatif H H

    2014-03-01

    This review evaluates the guideline recommendations for the management of hypertension in pregnancy as presented by 25 national/international guidelines developed for the management of arterial hypertension in adults. There is a general consensus that oral α-methyldopa and parenteral labetalol are the drugs of choice for nonsevere and severe hypertension in pregnancy, respectively. Long-acting nifedipine is recommended by various guidelines as an alternative for first-line and second-line therapy in nonsevere and severe hypertension. The safety of β-blockers, atenolol in particular, in early and late stages of pregnancy is unresolved; their use is contraindicated according to several guidelines. Diuretic-associated harmful effects on maternal and fetal outcomes are controversial: their use is discouraged in pregnancy. It is important to develop specific guidelines for treating hypertension in special groups such as adult females of childbearing age and sexually active female adolescents to minimize the risk of adverse effects of drugs on the fetus. In several guidelines, the antihypertensive classes, recommended drug(s), intended drug formulation, and route of administration are not explicit. These omissions should be addressed in future guideline revisions in order to enhance the guidelines' utility and credibility in clinical practice. PMID:24384846

  13. Hypertension.

    PubMed

    Oparil, S; Calhoun, D A

    1989-03-01

    effectively lower BP in the majority of patients with mild or moderate essential hypertension. Thus, a single agent from one of four classes: diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, and beta-adrenergic blockers, usually provides effective BP control with minimal side effects in most patients. Therapy should be initiated with the agent most likely to be effective in BP lowering and best tolerated. If the initial agent is ineffective at maximal recommended therapeutic doses or has undue side effects, an alternative agent from another class should be tried. When monotherapy is unsuccessful, a second agent, usually of a different mechanism of action, should be PMID:2565199

  14. Do Hypertensive Individuals Who Are Aware of Their Disease Follow Lifestyle Recommendations Better than Those Who Are Not Aware?

    PubMed Central

    Kim, Yuna; Kong, Kyoung Ae

    2015-01-01

    Lifestyle modification is the first step in hypertension management. Our objective was to assess adherence to lifestyle recommendations by individuals who were aware of their hypertension and to identify characteristics associated with non-adherence. Using data from the Korea National Health and Nutrition Examination Survey conducted in 2010–2012, we compared the adherence to six lifestyle recommendations of hypertensive subjects aware of the status of their condition with that of those who were not aware, based on survey regression analysis. The characteristics associated with non-adherence were assessed by multiple logistic regression analysis. Of all hypertensive subjects, <20% adhered to a healthy diet and reduced salt intake and about 80% moderated alcohol consumption and did not smoke. Half of all subjects maintained normal body weight and engaged in physical activity. Most lifestyle features of aware hypertensive Koreans did not differ greatly from those of hypertensive individuals who were not aware. Reduction in salt intake was slightly more prevalent among those aware of their hypertensive status. Obesity was more prevalent among the aware hypertensive subjects, and the prevalence of obesity increased with the duration of hypertension. Male gender, younger age, residence in a rural area, low income, and the use of antihypertensive medication were associated with non-adherence to lifestyle recommendations by hypertensive individuals. Many hypertensive Koreans do not comply with lifestyle recommendations for the management of hypertension. The association between the use of antihypertensive medications and non-adherence suggested an over-reliance on medication rather than a commitment to a healthy lifestyle. Our study highlights that efforts encouraging healthy lifestyles, as the first step in hypertension management, need to be increased. PMID:26317336

  15. Frequency and predictors of non-compliance to dietary recommendations among hypertensive patients.

    PubMed

    Khan, Muhammad Shahzeb; Bawany, Faizan Imran; Mirza, Arslan; Hussain, Mehwish; Khan, Asadullah; Lashari, Muhammad Nawaz

    2014-08-01

    Compliance to dietary recommendations among hypertensive people is a major health care issue. Non-compliance can nullify the effects of even the most scientific and optimum treatment plan. The main aim of this study was to determine the frequency and predictors of non-adherence in our region. We also investigated the possible factors based on patient opinions that could increase compliance. A sample of 400 adult patients, diagnosed with hypertension for at least 3 years, who visited Civil Hospital during the time period April-June 2013 were included in this cross sectional study. Patient data and opinions were collected by two trained interviewers using a pre-coded questionnaire. Compliance was assessed based on patients self report. More than three quarters (n = 310, 77.5%) of the hypertensive patients were non-compliant. More than one social gathering in a week, peer-influence, no friends to follow the recommended diet plan and lack of believe regarding diet as an effective measure to control blood pressure were found to be the significant predictors of non-compliance (P values <0.0001). Counseling was thought to be the most effective way by the patients to increase adherence. Non-compliance to dietary recommendations is a major problem prevalent especially in Pakistan. There is an urgent need for doctors and nurses to counsel their patients effectively to prevent future morbidities and mortalities because of non-compliance. PMID:24452406

  16. Perioperative management of patients with severe pulmonary hypertension in major orthopedic surgery: experience-based recommendations

    PubMed Central

    Seyfarth, Hans-Jürgen; Gille, Jochen; Sablotzki, Armin; Gerlach, Stefan; Malcharek, Michael; Gosse, Andreas; Gahr, Ralf H.; Czeslick, Elke

    2015-01-01

    Introduction: It is known that pulmonary hypertension is associated with worse outcome in both cardiac and non-cardiac surgery. The aims of our retrospective analysis were to evaluate the outcomes of our patients with pulmonary hypertension undergoing major orthopedic surgery and to give experience-based recommendations for the perioperative management. Material and methods: From 92 patients with pulmonary hypertension undergoing different kinds of surgical procedures from 2011–2014 in a tertiary academic hospital we evaluated 16 patients with major orthopedic surgery for perioperative morbidity and mortality. Results: Regarding the in-hospital morbidity and mortality, one patient died postoperatively due to pulmonary infection and right heart failure (6.25%) and 6 patients suffered significant postoperative complications (37.5%; bleeding = 1, infection = 1, wound healing deficits = 3; dysrhythmia = 1). Conclusion: Our data show that major orthopedic surgery is feasible with satisfactory outcome even in cases of severe pulmonary hypertension by an individualized, disease-adapted interdisciplinary treatment concept. PMID:26504732

  17. Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

    PubMed Central

    Lesmana, Laurentius A.; Tateishi, Ryosuke; Chen, Pei-Jer; Lin, Shi-Ming; Yoshida, Haruhiko; Kudo, Masatoshi; Lee, Jeong Min; Choi, Byung Ihn; Poon, Ronnie T. P.; Shiina, Shuichiro; Cheng, Ann Lii; Jia, Ji-Dong; Obi, Shuntaro; Han, Kwang Hyub; Jafri, Wasim; Chow, Pierce; Lim, Seng Gee; Chawla, Yogesh K.; Budihusodo, Unggul; Gani, Rino A.; Lesmana, C. Rinaldi; Putranto, Terawan Agus; Liaw, Yun Fan; Sarin, Shiv Kumar

    2010-01-01

    Introduction The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. Methods The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. Results Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference. PMID:20827404

  18. Capacity of Health Facilities to Manage Hypertension in Mukono and Buikwe Districts in Uganda: Challenges and Recommendations

    PubMed Central

    Musinguzi, Geofrey; Bastiaens, Hilde; Wanyenze, Rhoda K.; Mukose, Aggrey; Van geertruyden, Jean-Pierre; Nuwaha, Fred

    2015-01-01

    Background The burden of chronic diseases is increasing in both low- and middle-income countries. However, healthcare systems in low-income countries are inadequately equipped to deal with the growing disease burden, which requires chronic care for patients. The aim of this study was to assess the capacity of health facilities to manage hypertension in two districts in Uganda. Methods In a cross-sectional study conducted between June and October 2012, we surveyed 126 health facilities (6 hospitals, 4 Health Center IV (HCIV), 23 Health Center III (HCIII), 41 Health Center II (HCII) and 52 private clinics/dispensaries) in Mukono and Buikwe districts in Uganda. We assessed records, conducted structured interviews with heads of facilities, and administered questionnaires to 271 health workers. The study assessed service provision for hypertension, availability of supplies such as medicines, guidelines and equipment, in-service training for hypertension, knowledge of hypertension management, challenges and recommendations. Results Of the 126 health facilities, 92.9% reported managing (diagnosing/treating) patients with hypertension, and most (80.2%) were run by non-medical doctors or non-physician health workers (NPHW). Less than half (46%) of the facilities had guidelines for managing hypertension. A 10th of the facilities lacked functioning blood pressure devices and 28% did not have stethoscopes. No facilities ever calibrated their BP devices except one. About a half of the facilities had anti-hypertensive medicines in stock; mainly thiazide diuretics (46%), beta blockers (56%) and calcium channel blockers (48.4%). Alpha blockers, mixed alpha & beta blockers and angiotensin II receptor antagonists were only stocked by private clinics/dispensaries. Most HCIIs lacked anti-hypertensive medicines, including the first line thiazide diuretics. Significant knowledge gaps in classification of patients as hypertensive were noted among respondents. All health workers (except 5

  19. Australian perspective regarding recommendations for physical activity and exercise rehabilitation in pulmonary arterial hypertension

    PubMed Central

    Fowler, Robin; Jenkins, Sue; Maiorana, Andrew; Gain, Kevin; O’Driscoll, Gerry; Gabbay, Eli

    2011-01-01

    Aim To determine the opinion of health care professionals within Australia, regarding acceptable levels of exertion and symptoms, and referral for exercise rehabilitation in patients with pulmonary arterial hypertension (PAH). Method In 2010, 76 health care professionals at a specialist pulmonary hypertension meeting in Australia were surveyed using a self-administered questionnaire. The questionnaire included case studies of patients with PAH in World Health Organization (WHO) functional classes II–IV. For each case study, respondents were asked to report their opinion regarding the acceptable level of exertion and symptoms during daily activities, and whether they would refer the patient for exercise rehabilitation. Three additional questions asked about advice in relation to four specific physical activities. Results The response rate was 70% (n = 53). Overall, 58% of respondents recommended patients undertake daily activities ‘as tolerated’. There was no consensus regarding acceptable levels of breathlessness or fatigue, but the majority of respondents considered patients should have no chest pain (73%) and no more than mild light-headedness (92%) during daily activities. Overall, 63% of respondents would have referred patients for exercise rehabilitation. There was little difference in opinion regarding the acceptable level of exertion or symptoms, or referral for exercise rehabilitation, according to functional class. However, the patients’ functional class did influence the advice given regarding the specific physical activities. Conclusion In 2010, there were inconsistencies between individual health care professionals within Australia regarding appropriate levels of physical exertion and acceptable symptoms during daily activities. Almost two-thirds of the respondents reported they would refer patients for exercise rehabilitation. PMID:22247620

  20. Hypertension.

    PubMed

    Poulter, Neil R; Prabhakaran, Dorairaj; Caulfield, Mark

    2015-08-22

    Raised blood pressure is the biggest single contributor to the global burden of disease and to global mortality. The numbers of people affected and the prevalence of high blood pressure worldwide are expected to increase over the next decade. Preventive strategies are therefore urgently needed, especially in less developed countries, and management of hypertension must be optimised. Genetic advances in some rare causes of hypertension have been made lately, but the aggregate effect on blood pressure of all the genetic loci identified to date is small. Hence, intervention on key environmental determinants and effective implementation of trial-based therapies are needed. Three-drug combinations can control hypertension in about 90% of patients but only if resources allow identification of patients and drug delivery is affordable. Furthermore, assessment of optimal drug therapy for each ethnic group is needed. PMID:25832858

  1. Recommendations

    ERIC Educational Resources Information Center

    Brazelton, G. Blue; Renn, Kristen A.; Stewart, Dafina-Lazarus

    2015-01-01

    In this chapter, the editors provide a summary of the information shared in this sourcebook about the success of students who have minoritized identities of sexuality or gender and offer recommendations for policy, practice, and further research.

  2. Prevalence of Sodium and Fluid Restriction Recommendations for Patients with Pulmonary Hypertension

    PubMed Central

    Zeiger, Tonya; Cueva Cobo, Giovanna; Dillingham, Christine; Burger, Charles D.

    2015-01-01

    Background: Patients with pulmonary hypertension (PH) are often afflicted with the consequences of right heart failure including volume overload. Counseling to assist the patient in the dietary restriction of sodium and fluid may be underutilized. Methods: Consecutive patients seen in the PH Clinic at Mayo Clinic in Florida from June to November 2013. Results: 100 patients were included; 70 were women and most had group 1 PH (n = 69). Patient characteristics using mean (±SD) were: Age 63 ± 13 years, functional class 3 ± 1, brain natriuretic peptide 302 ± 696 pg/mL, 6-min walk 337 ± 116 m, right atrial pressure 8 ± 5 mmHg, and mean pulmonary artery pressure 42 ± 13 mmHg. Overall, 79 had had complete (32) or partial instruction (47) and 21 had no prior counseling to restrict sodium or fluid. Of the 47 with partial instruction, 42 received complete education during the PH Clinic visit. Of the 21 without prior instruction, 19 received complete education during the PH visit. Seven patients with the opportunity to have their education enhanced or provided did not receive any additional counseling during the PH visit. Conclusion: Sodium and fluid restriction is an important but perhaps underutilized strategy to manage volume overload in patients with right heart failure. Focused questioning and education may permit an increase in the patients receiving instruction in this regard.

  3. Lifestyle modifications to prevent and control hypertension. 3. Recommendations on alcohol consumption. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada

    PubMed Central

    Campbell, NR; Ashley, MJ; Carruthers, SG; Lacourciere, Y; McKay, DW

    1999-01-01

    OBJECTIVE: To provide updated, evidence-based recommendations concerning the effects of alcohol consumption on the prevention and control of hypertension in otherwise healthy adults (except pregnant women). OPTIONS: There are 2 main options for those at risk for hypertension: avert the condition by limiting alcohol consumption or by using other nonpharmacologic methods, or maintain or increase the risk of hypertension by making no change in alcohol consumption. The options for those who already have hypertension include decreasing alcohol consumption or using another nonpharmacologic method to reduce hypertension; commencing, continuing or intensifying antihypertensive medication; or taking no action and remaining at increased risk of cardiovascular disease. OUTCOMES: The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A MEDLINE search was conducted for the period 1966-1996 with the terms ethyl alcohol and hypertension. Other relevant evidence was obtained from the reference lists of articles identified, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design, and graded according to the level of evidence. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS, HARMS AND COSTS: A reduction in alcohol consumption from more than 2 standard drinks per day reduces the blood pressure of both hypertensive and normotensive people. The lowest overall mortality rates in observational studies were associated with drinking habits that were within these guidelines. Side effects and costs were not measured in any of the studies. RECOMMENDATIONS: (1) It is recommended that health care professionals determine how much alcohol their patients consume. (2) To reduce blood pressure in the

  4. Diagnosing hypertension

    PubMed Central

    Gelfer, Mark; Dawes, Martin; Kaczorowski, Janusz; Padwal, Raj; Cloutier, Lyne

    2015-01-01

    Abstract Objective To highlight the 2015 Canadian Hypertension Education Program (CHEP) recommendations for the diagnosis and assessment of hypertension. Quality of evidence A systematic search was performed current to August 2014 by a Cochrane Collaboration librarian using the MEDLINE and PubMed databases. The search results were critically appraised by the CHEP subcommittee on blood pressure (BP) measurement and diagnosis, and evidence-based recommendations were presented to the CHEP Central Review Committee for independent review and grading. Finally, the findings and recommendations were presented to the Recommendations Task Force for discussion, debate, approval, and voting. The main recommendations are based on level II evidence. Main message Based on the most recent evidence, CHEP has made 4 recommendations in 2 broad categories for 2015 to improve BP measurement and the way hypertension is diagnosed. A strong recommendation is made to use electronic BP measurement in the office setting to replace auscultatory BP measurement. For patients with elevated office readings, CHEP is recommending early use of out-of-office BP measurement, preferably ambulatory BP measurement, in order to identify early in the process those patients with white-coat hypertension. Conclusion Improvements in diagnostic accuracy are critical to optimizing hypertension management in Canada. The annual updates provided by CHEP ensure that practitioners have up-to-date evidence-based information to inform practice. PMID:26564654

  5. Pulmonary hypertension

    MedlinePlus

    Pulmonary arterial hypertension; Sporadic primary pulmonary hypertension; Familial primary pulmonary hypertension; Idiopathic pulmonary arterial hypertension; Primary pulmonary hypertension; PPH; Secondary pulmonary ...

  6. The goal of blood pressure in the hypertensive patient with diabetes is defined: now the challenge is go from recommendations to practice.

    PubMed

    Lopez-Jaramillo, Patricio; Lopez-Lopez, Jose; Lopez-Lopez, Cristina; Rodriguez-Alvarez, Miguel I

    2014-01-01

    The recent Latin American and European guidelines published this year has proposed as a goal for blood pressure control in patients with diabetes type 2 a value similar or inferior to 140/90 mmHg. High blood pressure is the leading cause of cardiovascular diseases and deaths globally. Although once hypertension is detected, 80% of individuals are on a pharmacologic therapy only a minority is controlled. Diabetes also is a risk factor for other serious chronic diseases, including cardiovascular disease. Whether specifically targeting lower fasting glucose levels can reduce cardiovascular outcomes remains unknown. Hypertension is present in 20% to 60% of patients with type 2 diabetes, depending on age, ethnicity, obesity, and the presence of micro or macro albuminuria. High blood pressure substantially increases the risk of both macro and micro vascular complications, doubling the risk of all-cause mortality and stroke, tripling the risk of coronary heart disease and significantly hastening the progression of diabetic nephropathy, retinopathy, and neuropathy. Thus, blood pressure lowering is a major priority in preventing cardiovascular and renal events in patients with diabetes and hypertension. During many years the BP goals recommended in patients with diabetes were more aggressive than in patients without diabetes. As reviewed in this article many clinical trials have demonstrated not only the lack of benefits of lowering the BP below 130/80 mmHg, but also the J-shaped relationship in DM patients. Overall we discuss the importance of define the group of patients in whom significant BP reduction could be particularly dangerous and, on the other hand, those with a high risk of stroke who could benefit most from an intensive hypotensive therapy. In any case, the big challenge now is avoid the therapeutic inertia (leaving diabetic patients with BP values of 140/90 mmHg or higher) at all costs, as this would lead to an unacceptable toll in terms of human lives

  7. Hypertensive crisis.

    PubMed

    Rubenstein, E B; Escalante, C

    1989-07-01

    Hypertensive crisis is an acute emergency requiring aggressive management. Its incidence has decreased in recent years but still is prevalent in the medical community. From review of past and present treatment regimens, the following recommendations can be considered. (1) In the treatment of malignant hypertension with associated CHF, sodium nitroprusside is still an excellent agent. It has a rapid onset of action and blood pressure can be easily titrated. Nitroglycerin is also another agent that can be used in this situation. (2) In the treatment of malignant hypertension with associated aortic dissection, trimethophan camsylate is the preferred agent. An alternative choice is the combination of nitroprusside and labetalol. (3) In the treatment of malignant hypertension with associated myocardial ischemia, an excellent choice is nitroglycerin. Labetalol also should be considered in this situation. (4) In the treatment of hypertension during pregnancy, hydralazine is still a good choice. Labetalol has also been shown to be efficacious. (5) In the treatment of malignant hypertension with associated cerebral ischemia, the following drugs should be considered: nitroprusside, nitroglycerin, and labetalol. The most important attribute of these agents is that they are nonsedating and rapid in onset. (6) In the treatment of postoperative hypertension the choices best suited are labetalol, enalapril, nitroprusside, and nitroglycerin. These agents are rapid in onset and all can be administered intravenously. PMID:2670090

  8. Recommendations for utilization of the paracorporeal lung assist device in neonates and young children with pulmonary hypertension.

    PubMed

    Gazit, Avihu Z; Sweet, Stuart C; Grady, R Mark; Boston, Umar S; Huddleston, Charles B; Hoganson, David M; Shepard, Mark; Raithel, Steve; Mehegan, Mary; Doctor, Allan; Spinella, Philip C; Eghtesady, Pirooz

    2016-03-01

    The management of decompensating critically ill children with severe PH is extremely challenging and requires a multidisciplinary approach. Unfortunately, even with optimal care, these children might continue to deteriorate and develop inadequate systemic perfusion and at times cardiac arrest secondary to a pulmonary hypertensive crisis. Tools to support these children are limited, and at times, the team should proceed with offering extracorporeal support, especially in newly diagnosed patients who have not benefitted from medical therapy prior to their acute deterioration, in patients with severe pulmonary venous disease and in patients with alveolar capillary dysplasia. Currently, the only approved mode for extracorporeal support in pediatric patients with PH eligible for lung transplantation is ECMO. To decrease the risks associated with ECMO, and offer potential for increased duration of support, extubation, and rehabilitation, we transitioned four small children with refractory PH from ECMO to a device comprising an oxygenator interposed between the PA and LA. This work describes in great detail our experience with this mode of support with emphasis on exclusion criteria, the implantation procedure, and the post-implantation management. PMID:26899454

  9. Ocular Hypertension

    MedlinePlus

    ... Español Eye Health / Eye Health A-Z Ocular Hypertension Sections What Is Ocular Hypertension? Ocular Hypertension Causes ... Hypertension Diagnosis Ocular Hypertension Treatment What Is Ocular Hypertension? Written by: Kierstan Boyd Reviewed by: J Kevin ...

  10. Systemic hypertension.

    PubMed

    Elliott, William J

    2007-04-01

    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). PMID:17398315

  11. Olmesartan vs ramipril in the treatment of hypertension and associated clinical conditions in the elderly: a reanalysis of two large double-blind, randomized studies at the light of the most recent blood pressure targets recommended by guidelines

    PubMed Central

    Omboni, Stefano; Malacco, Ettore; Mallion, Jean-Michel; Volpe, Massimo

    2015-01-01

    In this paper, we present the results of a reanalysis of the data of two large randomized, double-blind, parallel group studies with a similar design, comparing the efficacy of an angiotensin-receptor blocker (olmesartan medoxomil) with that of an angiotensin-converting enzyme inhibitor (ramipril), by applying two different blood pressure targets recently recommended by hypertension guidelines for all patients, irrespective of the presence of diabetes (<140/90 mmHg), and for elderly hypertensive patients (<150/90 mmHg). The efficacy of olmesartan was not negatively affected by age, sex, hypertension type, diabetes status or other concomitant clinical conditions, or cardiovascular risk factors. In most cases, olmesartan provided better blood pressure control than ramipril. Olmesartan was significantly more effective than ramipril in male patients, in younger patients (aged 65–69 years), in those with metabolic syndrome, obesity, dyslipidemia, preserved renal function, diastolic ± systolic hypertension, and, in general, in patients with a high or very high cardiovascular risk. Interestingly, patients previously untreated or treated with two or more antihypertensive drugs showed a significantly larger response with olmesartan than with ramipril. Thus, our results confirm the good efficacy of olmesartan in elderly hypertensives even when new blood pressure targets for antihypertensive treatment are considered. Such results may be relevant for the clinical practice, providing some hint on the possible different response of elderly hypertensive patients to two different drugs acting on the renin–angiotensin system, when patients are targeted according to the blood pressure levels recommended by recent hypertension guidelines. PMID:26491273

  12. Recommendations and guidelines regarding the preferred research protocol for investigating the impact of an optimal healing environment on patients with hypertension.

    PubMed

    Wesa, Kathleen M; Grimm, Richard H

    2004-01-01

    Cardiovascular disease is the leading cause of death in the United States. Hypertension is the most common single reason for visits to primary care physicians accounting for more than 35 million visits annually. Pharmacotherapy can achieve adequate control of blood pressure. Multiple interventions compares to single therapies are more efficacious in treating hypertension, and this fact supports using the holistic approach to hypertension treatment. Implementing an optimal healing environment (OHE) in a hypertension treatment regimen has the potential to impact not only health care costs, but also to optimize blood pressure control, and thus decrease the total cardiovascular disease burden. The research questions for the study of OHE in hypertension may differ between the individual patient perspective and the public health perspective. The use of a 2 x 2 factorial design would allow analysis of both perspectives simultaneously. Using an OHE setting with multiple interventions in formulating an individualized approach to hypertension management merits further exploration and research. PMID:15630841

  13. Effects of recommendations to follow the Dietary Approaches to Stop Hypertension (DASH) diet v. usual dietary advice on childhood metabolic syndrome: a randomised cross-over clinical trial.

    PubMed

    Saneei, Parvane; Hashemipour, Mahin; Kelishadi, Roya; Rajaei, Somayeh; Esmaillzadeh, Ahmad

    2013-12-01

    The effects of the Dietary Approaches to Stop Hypertension (DASH) eating plan on childhood metabolic syndrome (MetS) and insulin resistance remain to be determined. The present study aimed to assess the effects of recommendations to follow the DASH diet v. usual dietary advice (UDA) on the MetS and its features in adolescents. In this randomised cross-over clinical trial, sixty post-pubescent adolescent girls with the MetS were randomly assigned to receive either the recommendations to follow the DASH diet or UDA for 6 weeks. After a 4-week washout period, the participants were crossed over to the alternate arm. The DASH group was recommended to consume a diet rich in fruits, vegetables and low-fat dairy products and low in saturated fats, total fats and cholesterol. UDA consisted of general oral advice and written information about healthy food choices based on healthy MyPlate. Compliance was assessed through the quantification of plasma vitamin C levels. In both the groups, fasting venous blood samples were obtained at baseline and at the end of each phase of the intervention. The mean age and weight of the participants were 14.2 (SD 1.7) years and 69 (SD 14.5) kg, respectively. Their mean BMI and waist circumference were 27.3 kg/m2 and 85.6 cm, respectively. Serum vitamin C levels tended to be higher in the DASH phase than in the UDA phase (860 (SE 104) v. 663 (SE 76) ng/l, respectively, P= 0.06). Changes in weight, waist circumference and BMI were not significantly different between the two intervention phases. Although changes in systolic blood pressure were not statistically significant between the two groups (P= 0.13), recommendations to follow the DASH diet prevented the increase in diastolic blood pressure compared with UDA (P= 0.01). We found a significant within-group decrease in serum insulin levels (101.4 (SE 6.2) v. 90.0 (SE 5.5) pmol/l, respectively, P= 0.04) and a non-significant reduction in the homeostasis model assessment for insulin resistance

  14. Hypertensive emergencies in pregnancy.

    PubMed

    Vadhera, Rakesh B; Simon, Michelle

    2014-12-01

    Hypertensive disorders of pregnancy complicate 7% to 10% of pregnancies and are among the major causes of maternal and perinatal morbidity and mortality. Recently American College of Obstetricians and Gynecologists Taskforce on Hypertension during Pregnancy modified the diagnosis and management of hypertension in pregnancy, recommending prompt diagnosis, admission, close monitoring, and treatment. They strive to decrease maternal mortality and systemic complications. Labetalol, hydralazine, or nifedipine are considered first-line treatment, and either can be used to stabilize the patient with similar outcomes. Definite treatment is delivery of the fetus and should be considered based on the etiology of the hypertensive crisis and gestational age. PMID:25314092

  15. [Secondary hypertension].

    PubMed

    Yoshida, Yuichi; Shibata, Hirotaka

    2015-11-01

    Hypertension is a common disease and a crucial predisposing factor of cardiovascular diseases. Approximately 10% of hypertensive patients are secondary hypertension, a pathogenetic factor of which can be identified. Secondary hypertension consists of endocrine, renal, and other diseases. Primary aldosteronism, Cushing's syndrome, pheochromocytoma, hyperthyroidism, and hypothyroidism result in endocrine hypertension. Renal parenchymal hypertension and renovascular hypertension result in renal hypertension. Other diseases such as obstructive sleep apnea syndrome are also very prevalent in secondary hypertension. It is very crucial to find and treat secondary hypertension at earlier stages since most secondary hypertension is curable or can be dramatically improved by specific treatment. One should keep in mind that screening of secondary hypertension should be done at least once in a daily clinical practice. PMID:26619670

  16. Portal Hypertension

    MedlinePlus

    ... Chronic Hepatitis C Additional Content Medical News Portal Hypertension By Steven K. Herrine, MD NOTE: This is ... Hepatic Encephalopathy Jaundice in Adults Liver Failure Portal Hypertension Portal hypertension is abnormally high blood pressure in ...

  17. Update in Hypertension Therapy.

    PubMed

    Mankin, Leonard A

    2016-07-01

    Hypertension is the leading cause of early mortality in the world, and reduction of blood pressure can help to reduce that burden. There is an enormous and ever-expanding body of literature on hypertension, with a 2016 Medline search for hypertension retrieving more than 113,000 publications. Recent guidelines from major societies have been published, and often present conflicting recommendations based on the same data. Using a question-and-answer format, this article reviews some of the recent developments and opinions on management of blood pressure and provides practical suggestions for management in the clinical arena. PMID:27235610

  18. Perioperative hypertension management

    PubMed Central

    Varon, Joseph; Marik, Paul E

    2008-01-01

    Perioperative hypertension is commonly encountered in patients that undergo surgery. While attempts have been made to standardize the method to characterize the intraoperative hemodynamics, these methods still vary widely. In addition, there is a lack of consensus concerning treatment thresholds and appropriate therapeutic targets, making absolute recommendations about treatment difficult. Nevertheless, perioperative hypertension requires careful management. When treatment is necessary, therapy should be individualized for the patient. This paper reviews the pharmacologic agents and strategies commonly used in the management of perioperative hypertension. PMID:18827911

  19. Hypertension in the athlete.

    PubMed

    Sachtleben, Thomas; Fields, Karl B

    2003-04-01

    Athletes with hypertension are frequently encountered in clinical settings and during preparticipation examinations. This common condition merits special attention in athletes, as they have particular physiologic and sport-specific demands. Awareness of the pressor response to both isometric and isotonic exercise is valuable in managing hypertensive athletes. Recommendations regarding physical activity in hypertensive patients and clearance for sports participation among competitive athletes are reviewed. Nonpharmacologic measures and the use of customary antihypertensives in athletes is essential. However, knowledge of side-effect profiles and possible negative effects on exercise tolerance guide appropriate medication choices. PMID:12831663

  20. A comparison of food-based recommendations and nutrient values of three food guides: USDA's MyPyramid, NHLBI's Dietary Approaches to Stop Hypertension Eating Plan, and Harvard's Healthy Eating Pyramid.

    PubMed

    Reedy, Jill; Krebs-Smith, Susan M

    2008-03-01

    The purpose of this research was to compare food-based recommendations and nutrient values of three food guides: the US Department of Agriculture's MyPyramid; the National Heart, Lung, and Blood Institute's Dietary Approaches to Stop Hypertension Eating Plan, and Harvard University's Healthy Eating Pyramid. Estimates of nutrient values associated with following each of the food guides at the 2,000-calorie level were made using a composite approach. This approach calculates population-weighted nutrient composites for each food group and subgroup, assuming average choices within food groups. Nutrient estimates were compared to the Dietary Reference Intakes and other goals and limits. Recommendations were similar regarding almost all food groups for both the type and amount of foods. Primary differences were seen in the types of vegetables and protein sources recommended and the amount of dairy products and total oil recommended. Overall nutrient values were also similar for most nutrients, except vitamin A, vitamin E, and calcium. These food guides were derived from different types of nutrition research, yet they share consistent messages: eat more fruits, vegetables, legumes, and whole grains; eat less added sugar and saturated fat; and emphasize plant oils. PMID:18313434

  1. [Treatment for pulmonary arterial hypertension under the new French hospital financing system. Recommendations of the Pulmonary Vascular Diseases Working Group of the French Society of Pulmonary Medicine].

    PubMed

    Sitbon, O; Humbert, M; Simonneau, G

    2005-11-01

    Activity-based financing (that is, casemix-based hospital payments, known as T2A) is intended to harmonize and improve the fairness of remuneration of public and private hospitals. T2A will ultimately rely mainly on a flat rate per admission, set according to the diagnosis-related group (DRG). Although payment for drugs is usually included in the DRG price, some expensive drugs will be reimbursed on an additional cost basis after implementation of a "best practices" agreement. Four drugs used for treatment of pulmonary arterial hypertension are eligible for this additional reimbursement: 3 prostacyclin derivatives (intravenous epoprostenol, inhaled iloprost, and subcutaneous treprostinil), and oral bosentan, an endothelin receptor antagonist. The Pulmonary Vascular Diseases working group of the French Society of Pulmonary Medicine has developed guidelines for the best practices in use of these drugs. PMID:16301977

  2. The 2014 hypertension guidelines: processing the information.

    PubMed

    Gelatic, Randee

    2014-11-01

    Recent guidelines on hypertension management offer conflicting recommendations. This article describes the JNC 8 and ASH/ISH guidelines and the four medications recommended for controlling BP in various patient populations. PMID:25343431

  3. Renovascular hypertension

    MedlinePlus

    Renal hypertension; Hypertension - renovascular; Renal artery occlusion; Stenosis - renal artery; Renal artery stenosis ... Renal artery stenosis is a narrowing or blockage of the arteries that supply blood to the kidneys. The most ...

  4. Hypertension - overview

    MedlinePlus Videos and Cool Tools

    If left untreated, hypertension can lead to the thickening of arterial walls causing its lumen, or blood passage way, to narrow in diameter. ... the narrowed arterial openings. In addition, people with hypertension may be more susceptible to stroke.

  5. Renovascular hypertension

    MedlinePlus

    Renal hypertension; Hypertension - renovascular; Renal artery occlusion; Stenosis - renal artery; Renal artery stenosis ... blood pressure to rise. Risk factors for atherosclerosis: High blood pressure Smoking Diabetes High cholesterol Heavy alcohol use Cocaine ...

  6. Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, and Assessment of Risk of Pediatric Hypertension.

    PubMed

    Harris, Kevin C; Benoit, Geneviève; Dionne, Janis; Feber, Janusz; Cloutier, Lyne; Zarnke, Kelly B; Padwal, Raj S; Rabi, Doreen M; Fournier, Anne

    2016-05-01

    We present the inaugural evidence-based Canadian recommendations for the measurement of blood pressure in children and the diagnosis and evaluation of pediatric hypertension. Rates of pediatric hypertension are increasing concomitant with increased rates of childhood obesity. With this, there is growing awareness of the need to measure blood pressure in children. Consequently, the present recommendations have been developed to address an important gap and improve the clinical care of children. For 2016, a total of 15 recommendations are presented. These are categorized in a fashion similar to that of the existing adult recommendations. Specifically, we present recommendations on (1) accurate measurement of blood pressure in children, (2) criteria for diagnosis of hypertension in children, (3) assessment of overall cardiovascular risk in hypertensive children, (4) routine laboratory tests for the investigation of children with hypertension, (5) ambulatory blood pressure measurement in children, and (6) the role of echocardiography. We discuss the rationale for the recommendations and present additional supporting material for the clinician, including tables with standardized techniques for blood pressure measurement and determination of normative blood pressure values for children. Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force will update the recommendations annually and develop future evidence-based recommendations to guide prevention and treatment of pediatric hypertension. PMID:27118292

  7. [Childhood hypertension].

    PubMed

    Takemura, Tsukasa

    2015-11-01

    For accurate diagnosis of childhood hypertension, selection of appropriate manchette size according to the child age and the circumstantial size of upper limb is essentially important. In addition, except for the emergency case of hypertension, repeated measurement of blood pressure would be desirable in several weeks interval. Recently, childhood hypertension might be closely related to the abnormality of maternal gestational period caused by the strict diet and the maternal smoking. Developmental Origins of Health and Disease(DOHaD) theory is now highlighted in the pathogenesis of adulthood hypertension. To prevent hypertension of small-for-date baby in later phase of life, maternal education for child nursing should be conducted. In children, secondary hypertension caused by renal, endocrinologic, or malignant disease is predominant rather than idiopathic hypertension. PMID:26619664

  8. Resistant Hypertension.

    PubMed

    Doroszko, Adrian; Janus, Agnieszka; Szahidewicz-Krupska, Ewa; Mazur, Grzegorz; Derkacz, Arkadiusz

    2016-01-01

    Resistant hypertension is a severe medical condition which is estimated to appear in 9-18% of hypertensive patients. Due to higher cardiovascular risk, this disorder requires special diagnosis and treatment. The heterogeneous etiology, risk factors and comorbidities of resistant hypertension stand in need of sophisticated evaluation to confirm the diagnosis and select the best therapeutic options, which should consider lifestyle modifications as well as pharmacological and interventional treatment. After having excluded pseudohypertension, inappropriate blood pressure measurement and control as well as the white coat effect, suspicion of resistant hypertension requires an analysis of drugs which the hypertensive patient is treated with. According to one definition - ineffective treatment with 3 or more antihypertensive drugs including diuretics makes it possible to diagnose resistant hypertension. A multidrug therapy including angiotensin - converting enzyme inhibitors, angiotensin II receptor blockers, beta blockers, diuretics, long-acting calcium channel blockers and mineralocorticoid receptor antagonists has been demonstrated to be effective in resistant hypertension treatment. Nevertheless, optional, innovative therapies, e.g. a renal denervation or baroreflex activation, may create a novel pathway of blood pressure lowering procedures. The right diagnosis of this disease needs to eliminate the secondary causes of resistant hypertension e.g. obstructive sleep apnea, atherosclerosis and renal or hormonal disorders. This paper briefly summarizes the identification of the causes of resistant hypertension and therapeutic strategies, which may contribute to the proper diagnosis and an improvement of the long term management of resistant hypertension. PMID:26935512

  9. Malignant hypertension

    MedlinePlus

    ... Lippincott Williams & Wilkins; 2009:chap 89. Read More Acute kidney failure Alertness - decreased Angina Heart attack Preeclampsia Pulmonary edema Renovascular hypertension Seizures Stroke Update ...

  10. Mineralocorticoid hypertension

    PubMed Central

    Gupta, Vishal

    2011-01-01

    Hypertension affects about 10 – 25% of the population and is an important risk factor for cardiovascular and renal disease. The renin-angiotensin system is frequently implicated in the pathophysiology of hypertension, be it primary or secondary. The prevalence of primary aldosteronism increases with the severity of hypertension, from 2% in patients with grade 1 hypertension to 20% among resistant hypertensives. Mineralcorticoid hypertension includes a spectrum of disorders ranging from renin-producing pathologies (renin-secreting tumors, malignant hypertension, coarctation of aorta), aldosterone-producing pathologies (primary aldosteronism – Conns syndrome, familial hyperaldosteronism 1, 2, and 3), non-aldosterone mineralocorticoid producing pathologies (apparent mineralocorticoid excess syndrome, Liddle syndrome, deoxycorticosterone-secreting tumors, ectopic adrenocorticotropic hormones (ACTH) syndrome, congenitalvadrenal hyperplasia), and drugs with mineraocorticoid activity (locorice, carbenoxole therapy) to glucocorticoid receptor resistance syndromes. Clinical presentation includes hypertension with varying severity, hypokalemia, and alkalosis. Ratio of plasma aldosterone concentraion to plasma renin activity remains the best screening tool. Bilateral adrenal venous sampling is the best diagnostic test coupled with a CT scan. Treatment is either surgical (adrenelectomy) for unilateral adrenal disease versus medical therapy for idiopathic, ambiguous, or bilateral disease. Medical therapy focuses on blood pressure control and correction of hypokalemia using a combination of anti-hypertensives (calcium channel blockers, angiotensin converting enzyme inhibitors, or angiotensin receptor blockers) and potassium-raising therapies (mineralcorticoid receptor antagonist or potassium sparing diuretics). Direct aldosterone synthetase antagonists represent a promising future therapy. PMID:22145132

  11. [Resistant hypertension].

    PubMed

    Feldstein, Carlos A

    2008-04-01

    Resistant hypertension, defined as a persistent blood pressure over 140/90 mmHg despite the use of three antihypertensive drugs including a diuretic, is unusual. The diagnosis requires ruling out initially pseudoresistance and a lack of compliance with treatment. Ambulatory blood pressure recording allow the recognition of white coat hypertension. When there is a clinical or laboratory suspicion, secondary causes of hypertension should be discarded. Excessive salt intake, the presence of concomitant diseases such as diabetes mellitus, chronic renal disease, obesity, and psychiatric conditions such as panic attacks, anxiety and depression, should also be sought. The presence of target organ damage requires a more aggressive treatment of hypertension. Recent clinical studies indicate that the administration of aldosterone antagonists as a fourth therapeutic line provides significant additional blood pressure reduction, when added to previous antihypertensive regimens in subjects with resistant hypertension. The possible blood pressure lowering effects of prolonged electrical activation of carotid baroreceptors is under investigation. PMID:18769797

  12. Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension.

    PubMed

    Leung, Alexander A; Nerenberg, Kara; Daskalopoulou, Stella S; McBrien, Kerry; Zarnke, Kelly B; Dasgupta, Kaberi; Cloutier, Lyne; Gelfer, Mark; Lamarre-Cliche, Maxime; Milot, Alain; Bolli, Peter; Tremblay, Guy; McLean, Donna; Tobe, Sheldon W; Ruzicka, Marcel; Burns, Kevin D; Vallée, Michel; Prasad, G V Ramesh; Lebel, Marcel; Feldman, Ross D; Selby, Peter; Pipe, Andrew; Schiffrin, Ernesto L; McFarlane, Philip A; Oh, Paul; Hegele, Robert A; Khara, Milan; Wilson, Thomas W; Penner, S Brian; Burgess, Ellen; Herman, Robert J; Bacon, Simon L; Rabkin, Simon W; Gilbert, Richard E; Campbell, Tavis S; Grover, Steven; Honos, George; Lindsay, Patrice; Hill, Michael D; Coutts, Shelagh B; Gubitz, Gord; Campbell, Norman R C; Moe, Gordon W; Howlett, Jonathan G; Boulanger, Jean-Martin; Prebtani, Ally; Larochelle, Pierre; Leiter, Lawrence A; Jones, Charlotte; Ogilvie, Richard I; Woo, Vincent; Kaczorowski, Janusz; Trudeau, Luc; Petrella, Robert J; Hiremath, Swapnil; Drouin, Denis; Lavoie, Kim L; Hamet, Pavel; Fodor, George; Grégoire, Jean C; Lewanczuk, Richard; Dresser, George K; Sharma, Mukul; Reid, Debra; Lear, Scott A; Moullec, Gregory; Gupta, Milan; Magee, Laura A; Logan, Alexander G; Harris, Kevin C; Dionne, Janis; Fournier, Anne; Benoit, Geneviève; Feber, Janusz; Poirier, Luc; Padwal, Raj S; Rabi, Doreen M

    2016-05-01

    Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force provides annually updated, evidence-based recommendations to guide the diagnosis, assessment, prevention, and treatment of hypertension. This year, we present 4 new recommendations, as well as revisions to 2 previous recommendations. In the diagnosis and assessment of hypertension, automated office blood pressure, taken without patient-health provider interaction, is now recommended as the preferred method of measuring in-office blood pressure. Also, although a serum lipid panel remains part of the routine laboratory testing for patients with hypertension, fasting and nonfasting collections are now considered acceptable. For individuals with secondary hypertension arising from primary hyperaldosteronism, adrenal vein sampling is recommended for those who are candidates for potential adrenalectomy. With respect to the treatment of hypertension, a new recommendation that has been added is for increasing dietary potassium to reduce blood pressure in those who are not at high risk for hyperkalemia. Furthermore, in selected high-risk patients, intensive blood pressure reduction to a target systolic blood pressure ≤ 120 mm Hg should be considered to decrease the risk of cardiovascular events. Finally, in hypertensive individuals with uncomplicated, stable angina pectoris, either a β-blocker or calcium channel blocker may be considered for initial therapy. The specific evidence and rationale underlying each of these recommendations are discussed. Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force will continue to provide annual updates. PMID:27118291

  13. Chronic thromboembolic pulmonary hypertension.

    PubMed

    O'Connell, Caroline; Montani, David; Savale, Laurent; Sitbon, Olivier; Parent, Florence; Seferian, Andrei; Bulifon, Sophie; Fadel, Elie; Mercier, Olaf; Mussot, Sacha; Fabre, Dominique; Dartevelle, Philippe; Humbert, Marc; Simonneau, Gérald; Jaïs, Xavier

    2015-12-01

    diagnosis and treatment of pulmonary hypertension recommend the use of riociguat and say that off-label use of drugs approved for PAH and pulmonary angioplasty may be considered in expert centres. PMID:26585271

  14. Pulmonary Hypertension

    MedlinePlus

    Pulmonary hypertension (PH) is high blood pressure in the arteries to your lungs. It is a serious condition. If you have ... and you can develop heart failure. Symptoms of PH include Shortness of breath during routine activity, such ...

  15. Hypertension screening

    NASA Technical Reports Server (NTRS)

    Foulke, J. M.

    1975-01-01

    An attempt was made to measure the response to an announcement of hypertension screening at the Goddard Space Center, to compare the results to those of previous statistics. Education and patient awareness of the problem were stressed.

  16. [Hypertensive retinopathy].

    PubMed

    Genevois, Olivier; Paques, Michel

    2010-01-20

    Acute hypertensive retinopathy should be distinguished from retinal arteriolosclerosis. The presence of microvascular abnormalities in the ocular fundus increases the risk of heart and/or brain attack. At the clinical level, the current classification of chronic hypertensive retinopathy is based on the long-term risk of stroke. In research, a great number of studies are focused on the predictive value of retinal vascular diameters related to the general micro- and macrovascular disease. PMID:20222306

  17. Pulmonary Hypertension

    PubMed Central

    Newman, John H.

    2005-01-01

    The modern era in cardiopulmonary medicine began in the 1940s, when Cournand and Richards pioneered right-heart catheterization. Until that time, no direct measurement of central vascular pressure had been performed in humans. Right-heart catheterization ignited an explosion of insights into function and dysfunction of the pulmonary circulation, cardiac performance, ventilation–perfusion relationships, lung–heart interactions, valvular function, and congenital heart disease. It marked the beginnings of angiocardiography with its diagnostic implications for diseases of the left heart and peripheral circulation. Pulmonary hypertension was discovered to be the consequence of a large variety of diseases that either raised pressure downstream of the pulmonary capillaries, induced vasoconstriction, increased blood flow to the lung, or obstructed the pulmonary vessels, either by embolism or in situ fibrosis. Hypoxic vasoconstriction was found to be a major cause of acute and chronic pulmonary hypertension, and surprising vasoreactivity of the pulmonary vascular bed was discovered to be present in many cases of severe pulmonary hypertension, initially in mitral stenosis. Diseases as disparate as scleroderma, cystic fibrosis, kyphoscoliosis, sleep apnea, and sickle cell disease were found to have shared consequences in the pulmonary circulation. Some of the achievements of Cournand and Richards and their scientific descendents are discussed in this article, including success in the diagnosis and treatment of idiopathic pulmonary arterial hypertension, chronic thromboembolic pulmonary hypertension, and management of hypoxic pulmonary hypertension. PMID:15994464

  18. Hypertensive emergencies.

    PubMed

    Murphy, C

    1995-11-01

    Hypertensive emergencies are uncommon and physiologically diverse. Consequently, it is difficult for most physicians to develop a familiarity with all the different hypertensive crises and with all drugs available for treating them (Table 4). Clinicians should not agonize over which is the perfect therapeutic agent for a particular emergency, but instead, they should focus on scrupulous monitoring and familiarize themselves with a few agents that will serve in most situations. Generally, these agents will be sodium nitroprusside and nitroglycerin. Vigilant neurologic monitoring is mandatory in all hypertensive emergencies. The early symptoms and signs of cerebral hypoperfusion can be vague and subtle, but if recognized, serious complications of therapy can be avoided. Remember, the patient may still be hypertensive. Avoid acute (during the first hour) reductions in MAP of more than 20% whenever possible; subsequent reductions should be gradual. In patients known to have markedly elevated ICP and who need acute reductions in their BP, serious consideration should be given to direct monitoring of the ICP so that CPP can be maintained within safe limits. In general, oral agents should not be used for the treatment of hypertensive emergencies. Intravenous Labetalol and intravenous nicardipine are not suitable for general use in hypertensive emergencies. In special situations (e.g., perioperative hypertension and subarachnoid hemorrhage), however, they may be employed. Their role may expand with further study. Trimethaphan may be superior to nitroprusside for hypertension complicated by elevated ICP or cerebral dysfunction. Realistically, most physicians will continue to use nitroprusside. Intense neurologic monitoring is more important than the specific agent used. Nitroglycerin is the agent of choice for acute ischemic heart disease complicated by severe hypertension; if it fails, use nitroprusside. For aortic dissection, the combination of nitroprusside and IV

  19. Hypertension: Strengths and limitations of the JNC 8 hypertension guidelines.

    PubMed

    Mancia, Giuseppe

    2014-04-01

    The Eighth Joint National Committee (JNC 8) guidelines on hypertension have generated great interest among physicians. These guidelines differ from those published in 2003 (the JNC 7) - in the document format, blood-pressure cut-off values, and recommendations for antihypertensive drug use. The JNC 8 have some limitations that could affect clinical practice. PMID:24514021

  20. Types of Pulmonary Hypertension

    MedlinePlus

    ... from the NHLBI on Twitter. Types of Pulmonary Hypertension The World Health Organization divides pulmonary hypertension (PH) ... are called pulmonary hypertension.) Group 1 Pulmonary Arterial Hypertension Group 1 PAH includes: PAH that has no ...

  1. [Portopulmonary hypertension].

    PubMed

    Halank, M; Miehlke, S; Kolditz, M; Hoeffken, G

    2005-07-01

    Patients with portal hypertension may develop pulmonary complications such as hepatopulmonary syndrome (HPS) or portopulmonary hypertension (PPHT). PPHT is defined as elevated pulmonary pressure, elevated pulmonary vascular resistance, a normal pulmonary capillary wedge pressure, and portal hypertension in the absence of other known causes pulmonary hypertension. Various factors such as hyperdynamic circulation, volume overload, and circulating vasoactive mediators are suspected to be involved in the pathogenesis of PPHT. The prognosis of patients with severe PPHT is significantly reduced due to the risk of right heart failure. In patients with moderate to severe PPHT liver transplantation is associated with a significantly increased mortality. The chief symptom of PPHT may be dyspnoe in the presence of typical histomorphological alterations comparable with idiopathic pulmonary hypertension. Continuous intravenous application of prostacyclin is currently regarded as the treatment of choice for patients with severe PPHT. Inhaled prostacyclin or its analogue iloprost or oral treatment with the endothelin-receptor antagonist bosentan may be promising alternatives which should be further investigated in randomized controlled trials. PMID:16001350

  2. [Hypertensive Disorders in Pregnancy].

    PubMed

    Middeke, Martin

    2016-09-01

    In pregnancy, both mother and fetus benefit from blood pressure in normal ranges. There is discrepancy in the normenclature and thresholds for classification of hypertension in pregnancy and for initiation of antihypertensive treatment in different international guidelines. Systolic and diastolic blood pressure values that are associated with normal outcome are notably lower than any recommended treatment threshold in pregnancy. Tight blood pressure control under 85 mmHg diastolic is save and significantly prevents severe maternal hypertension as could be demonstrated in CHIPS. Close blood pressure monitoring comprising modern methods and devices including telemonitoring allows early recognition of risk developments and optimal guidance of antihypertensive therapy starting early in pregnancy. Only a few pharmacological substances are suitable for antihypertensive treatment in pregnancy. PMID:27598915

  3. Pulmonary Hypertension

    MedlinePlus

    Pulmonary hypertension (PH) is high blood pressure in the arteries to your lungs. It is a serious condition. If you have it, the blood ... heart has to work harder to pump the blood through. Over time, your heart weakens and ... of PH include Shortness of breath during routine activity, such ...

  4. Portopulmonary hypertension.

    PubMed

    Lv, Yong; Han, Guohong; Fan, Daiming

    2016-07-01

    Portopulmonary hypertension (PoPH) refers to the condition that pulmonary arterial hypertension (PAH) occur in the stetting of portal hypertension. The development of PoPH is thought to be independent of the severity of portal hypertension or the etiology or severity of liver disease. PoPH results from excessive vasoconstriction, vascular remodeling, and proliferative and thrombotic events within the pulmonary circulation that lead to progressive right ventricular failure and ultimately to death. Untreated PoPH is associated with a poor prognosis. As PoPH is frequently asymptomatic or symptoms are generally non-specific, patients should be actively screened for the presence of PoPH. Two-dimensional transthoracic echocardiography is a useful non-invasive screening tool, but a definitive diagnosis requires invasive hemodynamic confirmation by right heart catheterization. Despite a dearth of randomized, prospective data, an ever-expanding clinical experience shows that patients with PoPH benefit from therapy with PAH-specific medications including with endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and/or prostanoids. Due to high perioperative mortality, transplantation should be avoided in those patients who have severe PoPH that is refractory to medical therapy. PMID:27002212

  5. Pulmonary Hypertension

    MedlinePlus

    ... Anticoagulants (blood-thinning medicine) Calcium channel blockers Diuretics (water pills) Digoxin Your doctor will decide what type of medicine is right for you. In some cases, people who have pulmonary hypertension need surgical treatment. Surgical treatment options include a lung transplant and ...

  6. Hypertensive leucocytosis.

    PubMed

    Rajkumari, Rolinda; Laishram, Deben; Thiyam, Joshna; Javan, Ng

    2013-04-01

    There are studies showing association of high WBC count with the higher incidence of hypertension though a few are done in the Indian population. The present study was conducted with the view to find any significant increase in total leucocyte count and differential leucocyte count in hypertensive patient Twenty-seven hypertensives with 12 males and 15 females and 27 age and sex matched control subjects (normotensive) were studied. Hypertension was defined when the systolic BP > or = 140 mmHg or diastolic BP > or = 90 mmHg or history of taking antihypertensive medicine. Three blood pressure recordings at an interval of 2 minutes were taken after the patient was made to sit for 30 minutes with a standard mercury sphygmomanometer in the left arm. The disappearance of sound was used for diastolic blood pressure. Blood was drawn into EDTA containing vials. Two separate counts were performed: First for total leucocyte count (TLC) and second for determination of percentage of polymorphonuclear cells. For the TLC, 0.5 part of blood mixed with 10 part of Turk's fluid followed by counting of leucocyte in a counting chamber under light microscope. The percentage of polymorphonuclear leucocyte was performed on a slide after making the slide and staining it with Leishman's stain. The erythrocyte sedimentation rate (ESR) was performed using Wintrobe's methods. The first 1 hour reading on the Wintrobe's tube was taken for analysis. The total leucocyte count (TLC) for the study group as compared to the controls were 7413.70 +/- 735.45 cells/cmm and 5236.30 +/- 528.77 cells/ cmm which was statistically significant. The mean percentage neutrophils were 62.04 +/- 4.99 for study group and 53.00 +/- 3.44 for the controls; the mean percentage lymphocytes for the study group and the controls were 34.37 +/- 4.55 and 39.11 +/- 4.40 respectively. Both the mean percentage neutrophils and lymphocytes showed significant differences. The mean erythrocyte sedimentation rate (ESR) also showed

  7. Salt intake and hypertension therapy.

    PubMed

    Milan, Alberto; Mulatero, Paolo; Rabbia, Franco; Veglio, Franco

    2002-01-01

    Hypertension is a risk factor for cardiovascular and renal organ damage. Environmental conditions affect the development of high blood pressure (BP), although genetic influences are also important. Current international guidelines recommend reducing dietary sodium to no more than 100 mmol (about 2.4 g sodium or approximately 6 g salt) per day to prevent BP rising; the current intake of sodium in industrialized countries is approximately double the recommended amount. Clinical trials (DASH and TOHP studies) have shown that dietary factors are fundamental in the prevention and control of BP. Low dietary sodium intake is particularly effective in preventing hypertension in subjects with an increased risk such as the overweight, borderline hypertensives or the elderly. A low-salt diet combined with anti-hypertensive therapies facilitates BP reduction independent of race. The hypotensive effect of calcium channel blockers is less dependent on salt intake than other drugs, such as ACE inhibitors or diuretics. Reduced sodium intake associated with other dietary changes (such as weight loss, and increasing potassium, calcium and magnesium intake) are important instruments for the prevention and therapy of hypertension. PMID:11936420

  8. Hypertension in Chronic Glomerulonephritis.

    PubMed

    Ihm, Chun-Gyoo

    2015-12-01

    Chronic glomerulonephritis (GN), which includes focal segmental glomerulosclerosis and proliferative forms of GN such as IgA nephropathy, increases the risk of hypertension. Hypertension in chronic GN is primarily volume dependent, and this increase in blood volume is not related to the deterioration of renal function. Patients with chronic GN become salt sensitive as renal damage including arteriolosclerosis progresses and the consequent renal ischemia causes the stimulation of the intrarenal renin-angiotensin-aldosterone system(RAAS). Overactivity of the sympathetic nervous system also contributes to hypertension in chronic GN. According to the KDIGO guideline, the available evidence indicates that the target BP should be ≤140mmHg systolic and ≤90mmHg diastolic in chronic kidney disease patients without albuminuria. In most patients with an albumin excretion rate of ≥30mg/24 h (i.e., those with both micro-and macroalbuminuria), a lower target of ≤130mmHg systolic and ≤80mmHg diastolic is suggested. The use of agents that block the RAAS system is recommended or suggested in all patients with an albumin excretion rate of ≥30mg/ 24 h. The combination of a RAAS blockade with a calcium channel blocker and a diuretic may be effective in attaining the target BP, and in reducing the amount of urinary protein excretion in patients with chronic GN. PMID:26848302

  9. Hypertension Subtypes among Hypertensive Patients in Ibadan

    PubMed Central

    Salako, Babatunde L.; Ogunniyi, Adesola; Cooper, Richard S.

    2014-01-01

    Background. Certain hypertension subtypes have been shown to increase the risk for cardiovascular morbidity and mortality and may be related to specific underlying genetic determinants. Inappropriate characterization of subtypes of hypertension makes efforts at elucidating the genetic contributions to the etiology of hypertension largely vapid. We report the hypertension subtypes among patients with hypertension from South-Western Nigeria. Methods. A total of 1858 subjects comprising 76% female, hypertensive, aged 18 and above were recruited into the study from two centers in Ibadan, Nigeria. Hypertension was identified using JNCVII definition and was further grouped into four subtypes: controlled hypertension (CH), isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). Results. Systolic-diastolic hypertension was the most prevalent. Whereas SDH (77.6% versus 73.5%) and IDH (4.9% versus 4.7%) were more prevalent among females, ISH (10.1% versus 6.2%) was higher among males (P = 0.048). Female subjects were more obese (P < 0.0001) and SDH was prevalent among the obese group. Conclusion. Gender and obesity significantly influenced the distribution of the hypertension subtypes. Characterization of hypertension by subtypes in genetic association studies could lead to identification of previously unknown genetic variants involved in the etiology of hypertension. Large-scale studies among various ethnic groups may be needed to confirm these observations. PMID:25389499

  10. Pharmacologic management of childhood hypertension.

    PubMed

    Sinaiko, A R

    1993-02-01

    Antihypertensive drug therapy is used in children primarily to treat secondary forms of hypertension, because the prevalence of essential hypertension in the first decade of life is considerably less than 1% of the childhood population. This prevalence increases during the second decade of life, but the percentage of teenagers with essential hypertension continues to be low. Pharmaceutical companies have been able to target drug development to specific physiologic and biochemical systems. The converting enzyme inhibitors and calcium-channel blockers have greatly improved the success of therapy concomitant with a reduction in the incidence of adverse effects. The result has been a major change during the past decade in the recommendations for antihypertensive drug therapy. PMID:8417406

  11. Pulmonary Arterial Hypertension

    MedlinePlus

    ... What Is Pulmonary Hypertension? To understand pulmonary hypertension (PH) it helps to understand how blood ows throughout ... is too high, it is called pulmonary hypertension (PH). How the pressure in the right side of ...

  12. Hypertension and Spina Bifida

    MedlinePlus

    SBA National Resource Center: 800-621-3141 Hypertension A disease that often goes undetected. What is hypertension? Hypertension, also called high blood pressure , is a condition in which the arteries of ...

  13. What Causes Pulmonary Hypertension?

    MedlinePlus

    ... from the NHLBI on Twitter. What Causes Pulmonary Hypertension? Pulmonary hypertension (PH) begins with inflammation and changes in the ... different types of PH. Group 1 pulmonary arterial hypertension (PAH) may have no known cause, or the ...

  14. Hormones and Hypertension

    MedlinePlus

    Fact Sheet Hormones and Hypertension What is hypertension? Hypertension, or chronic (long-term) high blood pressure, is a main cause of ... tobacco, alcohol, and certain medications play a part. Hormones made in the kidneys and in blood vessels ...

  15. [Blood pressure control in eldery hypertension].

    PubMed

    Shimamoto, Kazuaki

    2006-01-01

    Case of diabetes mellitus associated with essential hypertension are mostly type 2 diabetes mellitus(NIDDM) in elderly patients. In the JNC VI and JSH 2004, it is recommended that the therapeutic target blood pressure level should be lower then 130/80 mmHg in hypertension complicated with diabetes mellitus, and this target has recently obtained wide acceptance. On the other hand, the target blood pressure in elderly is recommended below 140/90 mmHg. Accordingly, diabetes mellitus in elderly hypertensives should be treated similarly as in the young and middle-aged. Because ACE inhibitors/ARBs or Ca blockers increase insulin sensitivity, these drugs should be used as the first choice in cases of elderly hypertensive patients complicated with diabetes mellitus. PMID:16408451

  16. Essential Hypertension vs. Secondary Hypertension Among Children

    PubMed Central

    Banker, Ashish; Shete, Sanjay; Hashmi, Syed Sharukh; Tyson, John E.; Barratt, Michelle S.; Hecht, Jacqueline T.; Milewicz, Diane M.; Boerwinkle, Eric

    2015-01-01

    BACKGROUND The aim was to determine the proportions and correlates of essential hypertension among children in a tertiary pediatric hypertension clinic. METHODS We evaluated 423 consecutive children and collected demographic and clinical history by retrospective chart review. RESULTS We identified 275 (65%) hypertensive children (blood pressure >95th percentile per the “Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents”) from 423 children referred to the clinic for history of elevated blood pressure. The remainder of the patients had normotension (11%), white coat hypertension (11%), prehypertension (10%), and pending diagnosis (3%). Among the 275 hypertensive children, 43% (n = 119; boys = 56%; median age = 12 years; range = 3–17 years) had essential hypertension and 57% (n = 156; boys = 66%; median age = 9 years; range = 0.08–19 years) had secondary hypertension. When compared with those with secondary hypertension, those with essential hypertension had a significantly older age at diagnosis (P = 0.0002), stronger family history of hypertension (94% vs. 68%; P < 0.0001), and lower prevalence of preterm birth (20% vs. 46%; P < 0.001). There was a bimodal distribution of age of diagnosis in those with secondary hypertension. CONCLUSIONS The phenotype of essential hypertension can present as early as 3 years of age and is the predominant form of hypertension in children after age of 6 years. Among children with hypertension, those with essential hypertension present at an older age, have a stronger family history of hypertension, and have lower prevalence of preterm birth. PMID:24842390

  17. [Hypertensive emergencies and urgencies].

    PubMed

    Reingardiene, Dagmara

    2005-01-01

    Hypertension is one of the most common medical problems affecting approximately 1 billion individuals worldwide. Severe hypertension that is a potentially life-threatening condition refers to a hypertensive crisis. Severe hypertension is further classified into hypertensive emergencies or hypertensive urgencies. Hypertensive emergency refers to a severe hypertension that is associated with new or progressive end-organ damage. In these clinical situations, blood pressure should be reduced immediately to prevent or minimize organ dysfunction. Hypertensive urgency refers to severe hypertension without evidence of new or worsening end-organ injury. Blood pressure can be lowered less rapidly in this condition. In this review article it is discussed about clinical assessment of patients under these conditions, evaluating neurological, cardiovascular, renal end-organ damage; how much blood pressure should be lowered, which medication should be used to lower blood pressure, treating hypertensive emergencies and urgencies; and management of specific conditions (acute intracranial events, acute left ventricular dysfunction etc). PMID:15998994

  18. Review of new hypertension guidelines.

    PubMed

    Zhang, P-Y

    2015-01-01

    The Eighth Joint National Committee (JNC 8) released its new guidelines on the management of adult hypertension in Dec 2013. The key departures from JNC 7 include target blood pressures and thresholds for initiation of elderly patients and in patients under age 60 with diabetes and kidney disease. In this review, we analyse the critical questions, basis of new recommendations, major deviations from JNC 7, the strengths and limitations of changes in previous management guidelines. PMID:25683948

  19. On Recommending.

    ERIC Educational Resources Information Center

    Furner, Jonathan

    2002-01-01

    Discusses recommendation, or preference ordering, in document retrieval systems that ranks documents in order of the likelihood with which they match the preferences of any person searching the system. Describes the ERIn (Evaluation-Recommendation-Information) model, a decision-theoretic framework for understanding information-related activity…

  20. Recommender systems

    NASA Astrophysics Data System (ADS)

    Lü, Linyuan; Medo, Matúš; Yeung, Chi Ho; Zhang, Yi-Cheng; Zhang, Zi-Ke; Zhou, Tao

    2012-10-01

    The ongoing rapid expansion of the Internet greatly increases the necessity of effective recommender systems for filtering the abundant information. Extensive research for recommender systems is conducted by a broad range of communities including social and computer scientists, physicists, and interdisciplinary researchers. Despite substantial theoretical and practical achievements, unification and comparison of different approaches are lacking, which impedes further advances. In this article, we review recent developments in recommender systems and discuss the major challenges. We compare and evaluate available algorithms and examine their roles in the future developments. In addition to algorithms, physical aspects are described to illustrate macroscopic behavior of recommender systems. Potential impacts and future directions are discussed. We emphasize that recommendation has great scientific depth and combines diverse research fields which makes it interesting for physicists as well as interdisciplinary researchers.

  1. Hypertensive Emergencies in Pregnancy.

    PubMed

    Olson-Chen, Courtney; Seligman, Neil S

    2016-01-01

    The prevalence of hypertensive disorders in pregnancy is increasing. The etiology and pathophysiology of hypertensive disorders in pregnancy remain poorly understood. Hypertensive disorders are a major cause of maternal and perinatal morbidity and mortality. Treatment of hypertension decreases the incidence of severe hypertension, but it does not impact rates of preeclampsia or other pregnancy complications. Several antihypertensive medications are commonly used in pregnancy, although there is a lack of randomized controlled trials. Severe hypertension should be treated immediately to prevent maternal end-organ damage. Appropriate antepartum, intrapartum, and postpartum management is important in caring for patients with hypertensive disorders. PMID:26600442

  2. An approach to the young hypertensive patient.

    PubMed

    Mangena, P; Saban, S; Hlabyago, K E; Rayner, B

    2016-01-01

    Hypertension is the leading cause of death worldwide. Globally and locally there has been an increase in hypertension in children, adolescents and young adults<40 years of age. In South Africa, the first decade of the millennium saw a doubling of the prevalence rate among adolescents and young adults aged 15-24 years. This increase suggests that an explosion of cerebrovascular disease, cardiovascular disease and chronic kidney disease can be expected in the forthcoming decades. A large part of the increased prevalence can be attributed to lifestyle factors such as diet and physical inactivity, which lead to overweight and obesity. The majority (>90%) of young patients will have essential or primary hypertension, while only a minority (<10%) will have secondary hypertension. We do not recommend an extensive workup for all newly diagnosed young hypertensives, as has been the practice in the past. We propose a rational approach that comprises a history to identify risk factors, an examination that establishes the presence of target-organ damage and identifies clues suggesting secondary hypertension, and a limited set of basic investigations. More specialised tests should be performed only where there is a clinical suspicion that a secondary cause for hypertension exists. There have been no randomised clinical trials on the treatment of hypertension in young patients. Expert opinion advises an initial emphasis on lifestyle modification. This can comprise a diet with reduced salt and refined carbohydrate intake, an exercise programme and management of substance abuse issues. Failure of lifestyle measures or the presence of target-organ damage should prompt the clinician to initiate pharmacotherapy. We recommend referral to a specialist practitioner in cases of resistant hypertension, where there is severe target-organ damage and when a secondary cause is suspected. PMID:26933708

  3. Understanding and treating hypertension in diabetic populations

    PubMed Central

    Battistoni, Allegra; Savoia, Carmine; Tocci, Giuliano

    2015-01-01

    Hypertension and diabetes frequently occurs in the same individuals in clinical practice. Moreover, the presence of hypertension does increase the risk of new-onset diabetes, as well as diabetes does promote development of hypertension. Whatever the case, the concomitant presence of these conditions confers a high risk of major cardiovascular complications and promotes the use integrated pharmacological interventions, aimed at achieving the recommended therapeutic targets. While the benefits of lowering abnormal fasting glucose levels in patients with hypertension and diabetes have been consistently demonstrated, the blood pressure (BP) targets to be achieved to get a benefit in patients with diabetes have been recently reconsidered. In the past, randomized clinical trials have, indeed, demonstrated that lowering BP levels to less than 140/90 mmHg was associated to a substantial reduction of the risk of developing macrovascular and microvascular complications in hypertensive patients with diabetes. In addition, epidemiological and clinical reports suggested that “the lower, the better” for BP in diabetes, so that levels of BP even lower than 130/80 mmHg have been recommended. Recent randomized clinical trials, however, designed to evaluate the potential benefits obtained with an intensive antihypertensive therapy, aimed at achieving a target systolic BP level below 120 mmHg as compared to those obtained with less stringent therapy, have challenged the previous recommendations from international guidelines. In fact, detailed analyses of these trials showed a paradoxically increased risk of coronary events, mostly myocardial infarction, in those patients who achieved the lowest BP levels, particularly in the high-risk subsets of hypertensive populations with diabetes. In the light of these considerations, the present article will briefly review the common pathophysiological mechanisms, the potential sites of therapeutic interactions and the currently recommended

  4. Recommended Paperbacks.

    ERIC Educational Resources Information Center

    Horn Book Magazine, 1980

    1980-01-01

    Lists recommended paperback books for children in the following categories: picture books; stories for younger, for intermediate, and for older readers; folklore, legend, and mythology; and nonfiction. Tells if and when the original editions were reviewed in this journal. (GT)

  5. Developing hypertension guidelines: an evolving process.

    PubMed

    Kotchen, Theodore A

    2014-06-01

    Hypertension guidelines provide up-to-date information and recommendations for hypertension management to healthcare providers, and they facilitate translation of new knowledge into clinical practice. Guidelines represent consensus statements by expert panels, and the process of guideline development has inherent vulnerabilities. Between 1977 and 2003, under the direction of the National Institutes of Health (NIH), the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC) issued 7 reports. The evolution of the JNC recommendations reflects the acquisition of observational and clinical trial data and the availability of newer antihypertensive drugs. Despite 5 years in preparation, NIH did not release a JNC 8 report and recently made the decision to withdraw from issuing guidelines. The responsibility for issuing hypertension-related guidelines was transferred to the American Heart Association (AHA) and the American College of Cardiology. Without the endorsement of the NIH or the AHA, JNC 8 committee members recently published their guideline report. Notably, there have been discrepancies of JNC recommendations over time as well as discrepancies with recommendations of other professional organizations. The Institute of Medicine recently recommended criteria for "trustworthy" guidelines. Criticisms of the guideline process, and of the guidelines themselves, should not obscure their likely contribution to improved hypertension control and to decreases of mortality rates of stroke and cardiovascular disease over the past several decades. Nevertheless, translation of guidelines into clinical practice remains a challenge. PMID:24572703

  6. Non-interventional management of resistant hypertension

    PubMed Central

    Doumas, Michael; Tsioufis, Costas; Faselis, Charles; Lazaridis, Antonios; Grassos, Haris; Papademetriou, Vasilios

    2014-01-01

    Hypertension is one of the most popular fields of research in modern medicine due to its high prevalence and its major impact on cardiovascular risk and consequently on global health. Indeed, about one third of individuals worldwide has hypertension and is under increased long-term risk of myocardial infarction, stroke or cardiovascular death. On the other hand, resistant hypertension, the “uncontrollable” part of arterial hypertension despite appropriate therapy, comprises a much greater menace since long-standing, high levels of blood pressure along with concomitant debilitating entities such as chronic kidney disease and diabetes mellitus create a prominent high cardiovascular risk milieu. However, despite the alarming consequences, resistant hypertension and its effective management still have not received proper scientific attention. Aspects like the exact prevalence and prognosis are yet to be clarified. In an effort to manage patients with resistant hypertension appropriately, clinical doctors are still racking their brains in order to find the best therapeutic algorithm and surmount the substantial difficulties in controlling this clinical entity. This review aims to shed light on the effective management of resistant hypertension and provide practical recommendations for clinicians dealing with such patients. PMID:25349652

  7. [Treatment of hypertension associated with prediabetes].

    PubMed

    Barna, István

    2009-05-17

    Condition prior to diabetes is designated as prediabetes. The use of this term is recommended if fasting plasma glucose exceeds normal level but does not reach the characteristic result of real diabetes. Prediabetes is often characterized by combination of visceral obesity, glucose and lipid metabolism disorders and changes in blood pressure. Change of life style is more important in the treatment of prediabetes associated hypertension than in other hypertensive diseases. In this case, metabolically neutral antihypertensive medication is the treatment of choice. The growing obesity epidemic underlines the significance of prediabetes associated hypertension in public health. While 25% of the adult population suffering from this kind of hypertensive disease, the optimal solution has to be found together with patients, physicians and the money lenders of the social security system. PMID:19423489

  8. Key Points of the Japanese Society of Hypertension Guidelines for the Management of Hypertension in 2014

    PubMed Central

    Kario, Kazuomi

    2015-01-01

    The Japanese Society of Hypertension (JSH) published the new JSH guidelines for the management of hypertension in 2014, which is the revision of the JSH guidelines of 2009. The primary objective of the guideline is to provide physicians the standard treatment strategy of hypertension to prevent the hypertension-related target organ damage and cardiovascular events. The management of hypertension should be performed in hypertensive patients with a blood pressure of ≥140/90 mm Hg. As Asians have a higher prevalence of stroke than of coronary artery disease and stroke is more steeply associated with the level of blood pressure, the target blood pressure should be lower than 130/80 mm Hg for high-risk patients such as those with diabetes or chronic kidney disease. Because of the increasing prevalence of obesity and the related metabolic syndrome, more salt intake and higher salt sensitivity in the population, lifestyle modifications are necessary in hypertensive patients and subjects with high normal blood pressure. This guideline provides evidence-based recommendations for the management of patients with hypertension with the characteristics of our society. PMID:26587456

  9. Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Pulmonary hypertension due to lung diseases and/or hypoxia

    PubMed Central

    Sakkijha, Husam; Idrees, Majdy M.

    2014-01-01

    Chronic lung diseases are common causes of pulmonary hypertension. It ranks second after the left heart disease. Both obstructive and restrictive lung diseases are know to cause pulmonary hypertension. The pathophysiology of the disease is complex, and includes factors affecting the blood vessels, airways, and lung parenchyma. Hypoxia and the inhalation of toxic materials are another contributing factors. Recent guidelines have further clarified the association between pulmonary hypertension and chronic lung disease and made general guidelines concerning the diagnosis and management. In this article, we will provide a detailed revision about the new classification and give general recommendations about the management of pulmonary hypertension in chronic lung diseases. PMID:25076998

  10. Hypertension and aging.

    PubMed

    Buford, Thomas W

    2016-03-01

    Hypertension is a highly prevalent condition with numerous health risks, and the incidence of hypertension is greatest among older adults. Traditional discussions of hypertension have largely focused on the risks for cardiovascular disease and associated events. However, there are a number of collateral effects, including risks for dementia, physical disability, and falls/fractures which are increasingly garnering attention in the hypertension literature. Several key mechanisms - including inflammation, oxidative stress, and endothelial dysfunction - are common to biologic aging and hypertension development and appear to have key mechanistic roles in the development of the cardiovascular and collateral risks of late-life hypertension. The objective of the present review is to highlight the multi-dimensional risks of hypertension among older adults and discuss potential strategies for treatment and future areas of research for improving overall care for older adults with hypertension. PMID:26835847

  11. Cirrhosis and Portal Hypertension

    MedlinePlus

    MENU Return to Web version Cirrhosis and Portal Hypertension Overview What is cirrhosis? In people who have ... lead to coma and death. What is portal hypertension? Normally, blood is carried to the liver by ...

  12. Depression in hypertensive subjects.

    PubMed

    Ramachandran, V; Parikh, G J; Srinivasan, V

    1983-10-01

    168 patients attending hypertension clinic were randomly selected for the study. They were thoroughly investigated using E.C.G., X-ray chest, Urine analysis, Blood sugar, Blood urea, Serum cholesterol, Serum K, Serum Na, Scrum creatinine and Uric acid level. Detailed psychiatric case history and mental examination was carried out. Beck Rating Scale was used to measure the depression. 25% of hypertensive subjects exhibited depressive features and their mean score in Beck Rating scale is 21.76. The mean score of non-depressives is 4.46. All patients were receiving methyl dopa.25 mg. twice or thrice daily with thiazide diuretic. No significant difference in the incidence of depression with the duration of medication was observed.The hypertension was classified into mild, moderate and severe depending on the diastolic pressure. Depression was more frequent in severe hypertensives but not to the statistically significant level.Further hypertensives were classified into:1. Hypertension without organ involvement2. Hypertension with LVH only3. Hypertension with additional organ involvement4. Malignant hypertensionDepression was significantly more frequent in hypertensives with complications and also hypertensives in whom the B.P. remained uncontrolled. As all the patients were on the same drug, the drug effect is common to all; hence, the higher incidence of depression in hypertensives with complications is due to the limitation and distress caused by the illness. PMID:21847301

  13. Evaluation of 'partnership care model' in the control of hypertension.

    PubMed

    Mohammadi, Eesa; Abedi, Heidar Ali; Jalali, Farzad; Gofranipour, Fazlolah; Kazemnejad, Anoshirvan

    2006-06-01

    One of the shared common goals of World Hypertension League (WHL) and World Health Organization (WHO) is the control of hypertension. Despite many local and international interventions, the goal has not been achieved. This study evaluated an intervention based on the partnership care model to control hypertension in a rural population in the north of Iran. The results showed that the intervention was effective in decreasing systolic and diastolic blood pressure and in increasing the rate of controlled hypertensives (based on criteria of WHO/WHL). The intervention also had positive effects on health-related quality of life, body mass index, anxiety, high density lipoprotein level and compliance score. Based on these results, the partnership care model is effective in hypertension control and is recommended as a model to replace previous approaches in hypertension control. PMID:16674782

  14. Arterial pulmonary hypertension in noncardiac intensive care unit

    PubMed Central

    Tsapenko, Mykola V; Tsapenko, Arseniy V; Comfere, Thomas BO; Mour, Girish K; Mankad, Sunil V; Gajic, Ognjen

    2008-01-01

    Pulmonary artery pressure elevation complicates the course of many complex disorders treated in a noncardiac intensive care unit. Acute pulmonary hypertension, however, remains underdiagnosed and its treatment frequently begins only after serious complications have developed. Significant pathophysiologic differences between acute and chronic pulmonary hypertension make current classification and treatment recommendations for chronic pulmonary hypertension barely applicable to acute pulmonary hypertension. In order to clarify the terminology of acute pulmonary hypertension and distinguish it from chronic pulmonary hypertension, we provide a classification of acute pulmonary hypertension according to underlying pathophysiologic mechanisms, clinical features, natural history, and response to treatment. Based on available data, therapy of acute arterial pulmonary hypertension should generally be aimed at acutely relieving right ventricular (RV) pressure overload and preventing RV dysfunction. Cases of severe acute pulmonary hypertension complicated by RV failure and systemic arterial hypotension are real clinical challenges requiring tight hemodynamic monitoring and aggressive treatment including combinations of pulmonary vasodilators, inotropic agents and systemic arterial vasoconstrictors. The choice of vasopressor and inotropes in patients with acute pulmonary hypertension should take into consideration their effects on vascular resistance and cardiac output when used alone or in combinations with other agents, and must be individualized based on patient response. PMID:19183752

  15. The International Society of Hypertension and World Hypertension League call on governments, nongovernmental organizations and the food industry to work to reduce dietary sodium.

    PubMed

    Campbell, Norman R C; Lackland, Daniel T; Chockalingam, Arun; Lisheng, Liu; Harrap, Stephen B; Touyz, Rhian M; Burrell, Louise M; Ramírez, Agustín J; Schmieder, Roland E; Schutte, Aletta E; Prabhakaran, Dorairaj; Schiffrin, Ernesto L

    2014-02-01

    The International Society of Hypertension and the World Hypertension League have developed a policy statement calling for reducing dietary salt. The policy supports the WHO and the United Nations recommendations, which are based on a comprehensive and up-to-date review of relevant research. The policy statement calls for broad societal action to reduce dietary salt, thus reducing blood pressure and preventing hypertension and its related burden of cardiovascular disease. The hypertension organizations and experts need to become more engaged in the efforts to prevent hypertension and to advocate strongly to have dietary salt reduction policies implemented. The statement is being circulated to national hypertension organizations and to international nongovernmental health organizations for consideration of endorsement. Member organizations of the International Society of Hypertension and the World Hypertension League are urged to support this effort. PMID:24430121

  16. South African hypertension practice guideline 2014

    PubMed Central

    Seedat, YK; Rayner, BL; Veriava, Yosuf

    2014-01-01

    Summary Outcomes Extensive data from many randomised, controlled trials have shown the benefit of treating hypertension (HTN). The target blood pressure (BP) for antihypertensive management is systolic < 140 mmHg and diastolic < 90 mmHg, with minimal or no drug side effects. Lower targets are no longer recommended. The reduction of BP in the elderly should be achieved gradually over one month. Co-existent cardiovascular (CV) risk factors should also be controlled. Benefits Reduction in risk of stroke, cardiac failure, chronic kidney disease and coronary artery disease. Recommendations Correct BP measurement procedure is described. Evaluation of cardiovascular risk factors and recommendations for antihypertensive therapy are stipulated. Lifestyle modification and patient education are cornerstones of management. The major indications, precautions and contra-indications are listed for each antihypertensive drug recommended. Drug therapy for the patient with uncomplicated HTN is either mono- or combination therapy with a low-dose diuretic, calcium channel blocker (CCB) and an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB). Combination therapy should be considered ab initio if the BP is ≥ 160/100 mmHg. In black patients, either a diuretic and/or a CCB is recommended initially because the response rate is better compared to an ACEI. In resistant hypertension, add an alpha-blocker, spironolactone, vasodilator or β-blocker. Validity The guideline was developed by the Southern African Hypertension Society 2014©. PMID:25629715

  17. [Guidelines for the management of hypertension].

    PubMed

    Prieto-Díaz, Miguel Ángel

    2014-09-01

    In the last year, several scientific societies have published guidelines for the management of arterial hypertension. In Spain, two clinical practice guidelines have had a strong impact and have been closely followed in the last few years: the first is the Guideline of the National Heart, Lung and Blood Institute, although their last report (JNC 7) was published in 2003; the second is the clinical practice guideline for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH), whose latest version was published in 2007, although an update was published in 2009. A new ESC/ESH document, published in 2013, adopts a mainly educational stance, closely rooted in clinical practice. Many of the recommendations maintain the same criteria as previous guidelines. However, the new publication shows greater rigor and contains major contributions such as specification of the level of evidence and grade of recommendation for each recommendation, which was lacking in the previous guidelines of these societies. The document is both practical and easy to consult, consisting of 17 tables, 5 figures and 18 blocks of recommendations. The JNC 8 report, however, has a single objective: to respond to three questions that are considered a priority and which refer exclusively to drug therapy. Nine recommendations are made relating to these three questions. PMID:25595347

  18. [Mexican consensus on portal hypertension].

    PubMed

    Narváez-Rivera, R M; Cortez-Hernández, C A; González-González, J A; Tamayo-de la Cuesta, J L; Zamarripa-Dorsey, F; Torre-Delgadillo, A; Rivera-Ramos, J F J; Vinageras-Barroso, J I; Muneta-Kishigami, J E; Blancas-Valencia, J M; Antonio-Manrique, M; Valdovinos-Andraca, F; Brito-Lugo, P; Hernández-Guerrero, A; Bernal-Reyes, R; Sobrino-Cossío, S; Aceves-Tavares, G R; Huerta-Guerrero, H M; Moreno-Gómez, N; Bosques-Padilla, F J

    2013-01-01

    The aim of the Mexican Consensus on Portal Hypertension was to develop documented guidelines to facilitate clinical practice when dealing with key events of the patient presenting with portal hypertension and variceal bleeding. The panel of experts was made up of Mexican gastroenterologists, hepatologists, and endoscopists, all distinguished professionals. The document analyzes themes of interest in the following modules: preprimary and primary prophylaxis, acute variceal hemorrhage, and secondary prophylaxis. The management of variceal bleeding has improved considerably in recent years. Current information indicates that the general management of the cirrhotic patient presenting with variceal bleeding should be carried out by a multidisciplinary team, with such an approach playing a major role in the final outcome. The combination of drug and endoscopic therapies is recommended for initial management; vasoactive drugs should be started as soon as variceal bleeding is suspected and maintained for 5 days. After the patient is stabilized, urgent diagnostic endoscopy should be carried out by a qualified endoscopist, who then performs the corresponding endoscopic variceal treatment. Antibiotic prophylaxis should be regarded as an integral part of treatment, started upon hospital admittance and continued for 5 days. If there is treatment failure, rescue therapies should be carried out immediately, taking into account that interventional radiology therapies are very effective in controlling refractory variceal bleeding. These guidelines have been developed for the purpose of achieving greater clinical efficacy and are based on the best evidence of portal hypertension that is presently available. PMID:23664429

  19. Pulmonary arterial hypertension

    PubMed Central

    2013-01-01

    Pulmonary arterial hypertension (PAH) is a chronic and progressive disease leading to right heart failure and ultimately death if untreated. The first classification of PH was proposed in 1973. In 2008, the fourth World Symposium on PH held in Dana Point (California, USA) revised previous classifications. Currently, PH is devided into five subgroups. Group 1 includes patients suffering from idiopathic or familial PAH with or without germline mutations. Patients with a diagnosis of PAH should systematically been screened regarding to underlying mutations of BMPR2 gene (bone morphogenetic protein receptor type 2) or more rarely of ACVRL1 (activine receptor-like kinase type 1), ENG (endogline) or Smad8 genes. Pulmonary veno occusive disease and pulmonary capillary hemagiomatosis are individualized and designated as clinical group 1'. Group 2 'Pulmonary hypertension due to left heart diseases' is divided into three sub-groups: systolic dysfonction, diastolic dysfonction and valvular dysfonction. Group 3 'Pulmonary hypertension due to respiratory diseases' includes a heterogenous subgroup of respiratory diseases like PH due to pulmonary fibrosis, COPD, lung emphysema or interstitial lung disease for exemple. Group 4 includes chronic thromboembolic pulmonary hypertension without any distinction of proximal or distal forms. Group 5 regroup PH patients with unclear multifactorial mechanisms. Invasive hemodynamic assessment with right heart catheterization is requested to confirm the definite diagnosis of PH showing a resting mean pulmonary artery pressure (mPAP) of ≥ 25 mmHg and a normal pulmonary capillary wedge pressure (PCWP) of ≤ 15 mmHg. The assessment of PCWP may allow the distinction between pre-capillary and post-capillary PH (PCWP > 15 mmHg). Echocardiography is an important tool in the management of patients with underlying suspicion of PH. The European Society of Cardiology and the European Respiratory Society (ESC-ERS) guidelines specify its role

  20. Pulmonary arterial hypertension.

    PubMed

    Montani, David; Günther, Sven; Dorfmüller, Peter; Perros, Frédéric; Girerd, Barbara; Garcia, Gilles; Jaïs, Xavier; Savale, Laurent; Artaud-Macari, Elise; Price, Laura C; Humbert, Marc; Simonneau, Gérald; Sitbon, Olivier

    2013-01-01

    Pulmonary arterial hypertension (PAH) is a chronic and progressive disease leading to right heart failure and ultimately death if untreated. The first classification of PH was proposed in 1973. In 2008, the fourth World Symposium on PH held in Dana Point (California, USA) revised previous classifications. Currently, PH is devided into five subgroups. Group 1 includes patients suffering from idiopathic or familial PAH with or without germline mutations. Patients with a diagnosis of PAH should systematically been screened regarding to underlying mutations of BMPR2 gene (bone morphogenetic protein receptor type 2) or more rarely of ACVRL1 (activine receptor-like kinase type 1), ENG (endogline) or Smad8 genes. Pulmonary veno occusive disease and pulmonary capillary hemagiomatosis are individualized and designated as clinical group 1'. Group 2 'Pulmonary hypertension due to left heart diseases' is divided into three sub-groups: systolic dysfonction, diastolic dysfonction and valvular dysfonction. Group 3 'Pulmonary hypertension due to respiratory diseases' includes a heterogenous subgroup of respiratory diseases like PH due to pulmonary fibrosis, COPD, lung emphysema or interstitial lung disease for exemple. Group 4 includes chronic thromboembolic pulmonary hypertension without any distinction of proximal or distal forms. Group 5 regroup PH patients with unclear multifactorial mechanisms. Invasive hemodynamic assessment with right heart catheterization is requested to confirm the definite diagnosis of PH showing a resting mean pulmonary artery pressure (mPAP) of ≥ 25 mmHg and a normal pulmonary capillary wedge pressure (PCWP) of ≤ 15 mmHg. The assessment of PCWP may allow the distinction between pre-capillary and post-capillary PH (PCWP > 15 mmHg). Echocardiography is an important tool in the management of patients with underlying suspicion of PH. The European Society of Cardiology and the European Respiratory Society (ESC-ERS) guidelines specify its role

  1. Timeline of History of Hypertension Treatment

    PubMed Central

    Saklayen, Mohammad G.; Deshpande, Neeraj V.

    2016-01-01

    It is surprising that only about 50 years ago hypertension was considered an essential malady and not a treatable condition. Introduction of thiazide diuretics in late 50s made some headway in successful treatment of hypertension and ambitious multicenter VA co-operative study (phase 1 and 2) started in 1964 for diastolic hypertension ranging between 90 and 129 mmHg and completed by 1971 established for the first time that treating diastolic hypertension reduced CV events such as stroke and heart failure and improved mortality. In the following decade, these results were confirmed for the wider US and non-US population, including women and goal-oriented BP treatment to diastolic 90 became the standard therapy recommendation. But isolated systolic hypertension (accounting for two-thirds of the 70 million hypertensive population in USA alone) was not considered treatable until 1991 when SHEP study (systolic hypertension in elderly program) was completed and showed tremendous benefits of treating systolic BP over 160 mmHg using only a simple regimen using small dose chlorthalidone with addition of atenolol if needed. In the next two decades, ALLHAT and other studies examined the comparability of outcomes with use of different classes and combinations of antihypertensive drugs. Although diastolic BP goal was established as 90 in the late 70s and later confirmed by HOT study, the goal BP for systolic hypertension was not settled until very recently with completion of SPRINT study. ACCORD study showed no significant difference in outcome with sys 140 vs. 120 in diabetics. But recently completed SPRINT study with somewhat similar protocol as in ACCORD but in non-diabetic showed almost one-quarter reduction in all-cause mortality and one-third reduction of CV events with systolic BP goal 120. PMID:26942184

  2. [Treatment of pulmonary arterial hypertension].

    PubMed

    Roman, Antonio; López-Meseguer, Manuel; Domingo, Enric

    2015-06-22

    Treatment of pulmonary arterial hypertension has achieved significant progress over the past 20 years. Currently, 3 groups of drugs have proven useful for the treatment of this disease: endothelin receptor antagonist, phosphodiesterase inhibitors and prostacyclin and its analogues. It is recommended to initiate treatment with one of these drugs, the choice depending on the initial severity of patient disease and the preferences of the treating physician. When the patient does not have a satisfactory response, new drugs acting at a different pathway are most commonly added. At this time, considering referral for lung transplantation could be an alternative. Most experts recommend grouping maximum experience in what is known as expert centers. Treatment has led to better survival in these patients, but there is still a long way to cure this life-threatening disease. PMID:25070518

  3. Diagnosis, Epidemiology, and Management of Hypertension in Children.

    PubMed

    Rao, Goutham

    2016-08-01

    National guidelines for the diagnosis and management of hypertension in children have been available for nearly 40 years. Unfortunately, knowledge and recognition of the problem by clinicians remain poor. Prevalence estimates are highly variable because of differing standards, populations, and blood pressure (BP) measurement techniques. Estimates in the United States range from 0.3% to 4.5%. Risk factors for primary hypertension include overweight and obesity, male sex, older age, high sodium intake, and African American or Latino ancestry. Data relating hypertension in childhood to later cardiovascular events is currently lacking. It is known that BP in childhood is highly predictive of BP in adulthood. Compelling data about target organ damage is available, including the association of hypertension with left ventricular hypertrophy, carotid-intima media thickness, and microalbuminuria. Guidelines from both the United States and Europe include detailed recommendations for diagnosis and management. Diagnostic standards are based on clinic readings, ambulatory BP monitoring is useful in confirming diagnosis of hypertension and identifying white-coat hypertension, masked hypertension, and secondary hypertension, as well as monitoring response to therapy. Research priorities include the need for reliable prevalence estimates based on diverse populations and data about the long-term impact of childhood hypertension on cardiovascular morbidity and mortality. Priorities to improve clinical practice include more education among clinicians about diagnosis and management, clinical decision support to aid in diagnosis, and routine use of ambulatory BP monitoring to aid in diagnosis and to monitor response to treatment. PMID:27405770

  4. Valproate Induced Hypertensive Urgency

    PubMed Central

    Sivananthan, Mauran

    2016-01-01

    Valproate is a medication used in the treatment of seizures, bipolar disorder, migraines, and behavioral problems. Here we present a case of an 8-year-old boy who presented with hypertensive urgency after initiation of valproate. Primary treatment of his hypertension was ineffective. Blood pressure stabilization was achieved following discontinuation of valproate. Clinicians should be aware of the risk of developing hypertensive urgency with administration of valproate. PMID:27403366

  5. Pediatric endocrine hypertension

    PubMed Central

    Bhavani, Nisha

    2011-01-01

    Endocrine causes of hypertension are rare in children and screening for endocrine hypertension in children should be carried out only after ruling out renal and renovascular causes. Excess levels and/or action of mineralocorticoids associated with low renin levels lead to childhood hypertension and this can be caused by various conditions which are discussed in detail in the article. Childhood pheochromocytomas are being increasingly diagnosed because of the improved application of genetic testing for familial syndromes associated with pheochromocytomas. Adolescents with polycystic ovarian syndrome (PCOS) can also have hypertension associated with their obese phenotype. PMID:22145140

  6. How Is Pulmonary Hypertension Diagnosed?

    MedlinePlus

    ... from the NHLBI on Twitter. How Is Pulmonary Hypertension Diagnosed? Your doctor will diagnose pulmonary hypertension (PH) ... To Look for the Underlying Cause of Pulmonary Hypertension PH has many causes, so many tests may ...

  7. Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)

    MedlinePlus

    ... Asked Questions Español Condiciones Chinese Conditions Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) En Español Read in Chinese What is idiopathic intracranial hypertension? Idiopathic intracranial hypertension (IIH) is a disorder that ...

  8. [Should hypertensive patients adapt their antihypertensive drugs during high altitude exposure?].

    PubMed

    Wuerzner, G; Allemann, Y

    2015-09-01

    High altitude exposure during leisure time is becoming more and more frequent. Due to the high prevalence of hypertension in the general population, high altitude exposure in hypertensive patients may not be uncommon. The increase in blood pressure with altitude has been confirmed by ambulatory blood pressure measurement in normotensive as well as in hypertensive patients. Compared to a placebo, most hypertensive drugs keep their blood pressure lowering effect up to a certain altitude. It is recommended that hypertensive patients measure their blood pressure during high altitude, exposure and plan a possible adaptation of treatment with their physician before their sojourn. PMID:26540993

  9. Hypertension in the military patient.

    PubMed

    Hunter, Alys; Holdsworth, D A; D'Arcy, J; Bailey, K; Casadei, B

    2015-09-01

    Hypertension and hypertension-related diseases are a leading cause of morbidity and mortality worldwide. A diagnosis of hypertension can have serious occupational implications for military personnel. This article examines the diagnosis and management of hypertension in military personnel, in the context of current international standards. We consider the consequences of hypertension in the military environment and potential military-specific issues relating to hypertension. PMID:26253125

  10. Management of Hypertension among Patients with Coronary Heart Disease.

    PubMed

    Olafiranye, Oladipupo; Zizi, Ferdinand; Brimah, Perry; Jean-Louis, Girardin; Makaryus, Amgad N; McFarlane, Samy; Ogedegbe, Gbenga

    2011-01-01

    Evidence suggests that coronary heart disease (CHD) is the most common outcome of hypertension. Hypertension accelerates the development of atherosclerosis, and sustained elevation of blood pressure (BP) can destabilize vascular lesions and precipitate acute coronary events. Hypertension can cause myocardial ischemia in the absence of CHD. These cardiovascular risks attributed to hypertension can be reduced by optimal BP control. Although several antihypertensive agents exist, the choice of agent and the appropriate target BP for patients with CHD remain controversial. In this succinct paper, we examine the evidence and the mechanisms for the linkage between hypertension and CHD and we discuss the treatment options and the goals of therapy that are consistent with the report of the seventh Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and American Heart Association scientific statement. We anticipate changes in the recommendations of the forthcoming JNC 8. PMID:21785704

  11. African Americans, hypertension and the renin angiotensin system

    PubMed Central

    Williams, Sandra F; Nicholas, Susanne B; Vaziri, Nosratola D; Norris, Keith C

    2014-01-01

    African Americans have exceptionally high rates of hypertension and hypertension related complications. It is commonly reported that the blood pressure lowering efficacy of renin angiotensin system (RAS) inhibitors is attenuated in African Americans due to a greater likelihood of having a low renin profile. Therefore these agents are often not recommended as initial therapy in African Americans with hypertension. However, the high prevalence of comorbid conditions, such as diabetes, cardiovascular and chronic kidney disease makes treatment with RAS inhibitors more compelling. Despite lower circulating renin levels and a less significant fall in blood pressure in response to RAS inhibitors in African Americans, numerous clinical trials support the efficacy of RAS inhibitors to improve clinical outcomes in this population, especially in those with hypertension and risk factors for cardiovascular and related diseases. Here, we discuss the rationale of RAS blockade as part of a comprehensive approach to attenuate the high rates of premature morbidity and mortality associated with hypertension among African Americans. PMID:25276290

  12. [Combination treatment of hypertension in 2015].

    PubMed

    Špinar, Jindřich; Vítovec, Jiří; Špinarová, Lenka; Bendová, Miroslava

    2015-05-01

    We present an overview of the present views on combination treatment and on fixed combinations in the treatment of hypertension according to guidelines of ESH/ESC and ČSH from 2013. The most frequently recommended dual combinations include a blocker of the renin-angiotensin system (ACEI or sartan) and a calcium channel blocker, and further a blocker of the renin-angiotensin system and a diuretic and a calcium channel blocker and a diuretic. In 2014 a fixed-dose combination of an ACE inhibitor (perindopril), a calcium channel blocker (amlodipine) and an diuretic (indapamide) appeared on the Czech market. Within the PIANIST study including 4 731 insufficiently controlled hypertensives, a fixed-dose triple combination of perindopril, amlodipine and indapamide led to a decrease in blood pressure by 28.3/13.8 mm Hg and to a sufficient control of hypertension in 92 % of patients. The advantage of fixed combinations primarily consists in greater compliance of patients and thereby in a better control of hypertension. About 1/3 of hypertensives need a triple combination for a satisfactory blood pressure control. PMID:26075856

  13. Drug Treatment of Hypertension in Pregnancy

    PubMed Central

    Brown, Catherine M.; Garovic, Vesna D.

    2015-01-01

    Hypertensive disorders represent major causes of pregnancy related maternal mortality worldwide. Similar to the non-pregnant population, hypertension is the most common medical disorder encountered during pregnancy and is estimated to occur in about 6–8% of pregnancies [1]. A recent report highlighted hypertensive disorders as one of the major causes of pregnancy-related maternal deaths in the United States, accounting for 579 of the 4693 (12.3%) maternal deaths that occurred between 1998 and 2005 [2]. In low-income and middle-income countries, preeclampsia and its convulsive form, eclampsia, are associated with 10–15% of direct maternal deaths [3]. The optimal timing and choice of therapy for hypertensive pregnancy disorders involves carefully weighing the risk-versus-benefit ratio for each individual patient, with an overall goal of improving maternal and fetal outcomes. In this review we have compared and contrasted the recommendations in different treatment guidelines and we have outlined some newer perspectives on management. We have aimed to provide a clinically orientated guide to the drug treatment of hypertension in pregnancy. PMID:24554373

  14. [Approach to hypertension in the older population].

    PubMed

    Roca, Francisco Valls

    2014-05-01

    Hypertension is one of the most frequent causes for seeking primary care attention and its prevalence increases with age, affecting 68% of people older than 60 years. Data indicate that the prevalence of hypertense individuals older than 65 years has increased from 48% in 2002 to 58% in 2010. High blood pressure is related to 1 out of every 2 deaths from cardiovascular causes in the Spanish population ≥ 50 years and causes 13.5% of premature deaths worldwide, both in persons with hypertension and in those with high-normal blood pressure. Although few clinical trials have been performed in the older population, especially in the very old, there is evidence that diastolic and systolic blood pressure control reduces cardiovascular morbidity and mortality in older hypertense individuals. Consequently, the updates of the various clinical practice guidelines continue to include among their objectives-with some nuances-good blood pressure control in this population group. The present article reviews new evidence on the approach to hypertension in the elderly, which has modified some of the recommendations made in the clinical practice guidelines of several scientific societies. PMID:25263637

  15. Noncirrhotic Portal Hypertension

    PubMed Central

    Rajekar, Harshal; Vasishta, Rakesh K; Chawla, Yogesh K; Dhiman, Radha K

    2011-01-01

    Portal hypertension is characterized by an increase in portal pressure (> 10 mmHg) and could be a result of cirrhosis of the liver or of noncirrhotic diseases. When portal hypertension occurs in the absence of liver cirrhosis, noncirrhotic portal hypertension (NCPH) must be considered. The prognosis of this disease is much better than that of cirrhosis. Noncirrhotic diseases are the common cause of portal hypertension in developing countries, especially in Asia. NCPH is a heterogeneous group of diseases that is due to intrahepatic or extrahepatic etiologies. In general, the lesions in NCPH are vascular in nature and can be classified based on the site of resistance to blood flow. In most cases, these disorders can be explained by endothelial cell lesions, intimal thickening, thrombotic obliterations, or scarring of the intrahepatic portal or hepatic venous circulation. Many different conditions can determine NCPH through the association of these various lesions in various degrees. Many clinical manifestations of NCPH result from the secondary effects of portal hypertension. Patients with NCPH present with upper gastrointestinal bleeding, splenomegaly, ascites after gastrointestinal bleeding, features of hypersplenism, growth retardation, and jaundice due to portal hypertensive biliopathy. Other sequelae include hyperdynamic circulation, pulmonary complications, and other effects of portosystemic collateral circulation like portosystemic encephalopathy. At present, pharmacologic and endoscopic treatments are the treatments of choice for portal hypertension. The therapy of all disorders causing NCPH involves the reduction of portal pressure by pharmacotherapy or portosystemic shunting, apart from prevention and treatment of complications of portal hypertension. PMID:25755321

  16. What Is Pulmonary Hypertension?

    MedlinePlus

    ... Pressure Tools & Resources Stroke More What is Pulmonary Hypertension? Updated:Aug 12,2014 Is pulmonary hypertension different ... content was last reviewed on 08/04/2014. High Blood Pressure • Home • About High Blood Pressure (HBP) Introduction What ...

  17. Hypertension and cognitive function.

    PubMed

    Paglieri, Cristina; Bisbocci, Daniela; Caserta, Mimma; Rabbia, Franco; Bertello, Chiara; Canadè, Antonella; Veglio, Franco

    2008-11-01

    Arterial hypertension, cerebrovascular disease, and dementia are related pathologies. This paper has reviewed comparatively the incidence of arterial hypertension and adult-onset dementia disorders. Hypertension is associated with cerebrovascular disease, which is in turn associated with dementia. It is the most important modifiable risk factor for stroke, which is a recognized cause of vascular dementia. In terms of pathophysiology of hypertensive brain damage, several hypotheses were developed, such as that vascular alterations induced by hypertension can induce lacunar or cortical infarcts and leucoaraiosis, that hypertension is responsible for cerebrovascular disease and acts into the contest of a pre-existing subclinic Alzheimer's disease (AD), that hypertension determines neurobiologic alterations (such as beta-amyloid accumulation) resulting in neuropathologic damage, and that aging and cerebrovascular risk factors act together to cause cerebral capillary degeneration, mitochondrial disruption, reduced glucose oxidation, and reduced ATP synthesis. The consequence of these alterations are neuronal death and dementia. Macroscopic results of these mechanisms are the so-called white matter lesions (WML), the significance of which is analyzed. Increasing clinical evidence suggests a close relationship between the reduction of elevated blood pressure and countering of both vascular dementia and AD. Antihypertensive treatment probably influences cognitive performances and prevents cognitive function alterations and the development of dementia. It is therefore important to evaluate as soon as possible cognitive functions of hypertensive patients. PMID:19021021

  18. Hypertension in the elderly

    PubMed Central

    Lionakis, Nikolaos; Mendrinos, Dimitrios; Sanidas, Elias; Favatas, Georgios; Georgopoulou, Maria

    2012-01-01

    The elderly are the most rapidly growing population group in the world. Data collected over a 30-year period have demonstrated the increasing prevalence of hypertension with age. The risk of coronary artery disease, stroke, congestive heart disease, chronic kidney insufficiency and dementia is also increased in this subgroup of hypertensives. Hypertension in the elderly patients represents a management dilemma to cardiovascular specialists and other practioners. During the last years and before the findings of the Systolic Hypertension in Europe Trial were published, the general medical opinion considered not to decrease blood pressure values similarly to other younger patients, in order to avoid possible ischemic events and poor oxygenation of the organs (brain, heart, kidney). The aim of this review article is to highlight the importance of treating hypertension in aged population in order to improve their quality of life and lower the incidence of the cardiovascular complications. PMID:22655162

  19. Cervical Spondylosis and Hypertension

    PubMed Central

    Peng, Baogan; Pang, Xiaodong; Li, Duanming; Yang, Hong

    2015-01-01

    Abstract Cervical spondylosis and hypertension are all common diseases, but the relationship between them has never been studied. Patients with cervical spondylosis are often accompanied with vertigo. Anterior cervical discectomy and fusion is an effective method of treatment for cervical spondylosis with cervical vertigo that is unresponsive to conservative therapy. We report 2 patients of cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully with anterior cervical discectomy and fusion. Stimulation of sympathetic nerve fibers in pathologically degenerative disc could produce sympathetic excitation, and induce a sympathetic reflex to cause cervical vertigo and hypertension. In addition, chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms. Cervical spondylosis may be one of the causes of secondary hypertension. Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis. PMID:25761188

  20. Resistance Training in Spontaneously Hypertensive Rats with Severe Hypertension

    PubMed Central

    Neves, Rodrigo Vanerson Passos; Souza, Michel Kendy; Passos, Clévia Santos; Bacurau, Reury Frank Pereira; Simoes, Herbert Gustavo; Prestes, Jonato; Boim, Mirian Aparecida; Câmara, Niels Olsen Saraiva; Franco, Maria do Carmo Pinho; Moraes, Milton Rocha

    2016-01-01

    Background Resistance training (RT) has been recommended as a non-pharmacological treatment for moderate hypertension. In spite of the important role of exercise intensity on training prescription, there is still no data regarding the effects of RT intensity on severe hypertension (SH). Objective This study examined the effects of two RT protocols (vertical ladder climbing), performed at different overloads of maximal weight carried (MWC), on blood pressure (BP) and muscle strength of spontaneously hypertensive rats (SHR) with SH. Methods Fifteen male SHR [206 ± 10 mmHg of systolic BP (SBP)] and five Wistar Kyoto rats (WKY; 119 ± 10 mmHg of SBP) were divided into 4 groups: sedentary (SED-WKY) and SHR (SED-SHR); RT1-SHR training relative to body weight (~40% of MWC); and RT2-SHR training relative to MWC test (~70% of MWC). Systolic BP and heart rate (HR) were measured weekly using the tail-cuff method. The progression of muscle strength was determined once every fifteen days. The RT consisted of 3 weekly sessions on non-consecutive days for 12-weeks. Results Both RT protocols prevented the increase in SBP (delta - 5 and -7 mmHg, respectively; p > 0.05), whereas SBP of the SED-SHR group increased by 19 mmHg (p < 0.05). There was a decrease in HR only for the RT1 group (p < 0.05). There was a higher increase in strength in the RT2 (140%; p < 0.05) group as compared with RT1 (11%; p > 0.05). Conclusions Our data indicated that both RT protocols were effective in preventing chronic elevation of SBP in SH. Additionally, a higher RT overload induced a greater increase in muscle strength. PMID:26840054

  1. Elevated Urinary T Helper 1 Chemokine Levels in Newly Diagnosed Hypertensive Obese Children

    PubMed Central

    Övünç Hacıhamdioğlu, Duygu; Zeybek, Cengiz; Gök, Faysal; Pekel, Aysel; Muşabak, Uğur

    2015-01-01

    Objective: Increasing evidence suggests that T helper (Th) cells play a significant role in the pathogenesis of hypertension. The aim of this study was to evaluate the effect of obesity and anti-hypertensive treatment on urinary Th1 chemokines. Methods: The study groups consisted of three types of patients: hypertensive obese, healthy, and non-hypertensive obese. Pre-treatment and post-treatment samples of the hypertensive obese group and one sample from the other two groups were evaluated for urinary chemokine: regulated on activation, normal T cell expressed and secreted (RANTES), interferon-gamma-inducible protein 10 (IP10), and monokine induced by interferon-gamma (MIG). In the hypertensive obese group, urine microalbumin: creatinine ratio was examined before and after treatment. We recommended lifestyle changes to all patients. Captopril was started in those who could not be controlled with lifestyle changes and those who had stage 2 hypertension. Results: Twenty-four hypertensive obese (mean age 13.1), 27 healthy (mean age 11.2) and 22 non-hypertensive obese (mean age 11.5) children were investigated. The pre-treatment urine albumin: creatinine ratio was positively correlated with pre-treatment MIG levels (r=0.41, p<0.05). RANTES was significantly higher in the pre-treatment hypertensive and non-hypertensive obese group than in the controls. The urinary IP10 and MIG levels were higher in the pre-treatment hypertensive obese group than in the non-hypertensive obese. Comparison of the pre- and post-treatment values indicated significant decreases in RANTES, IP10, and MIG levels in the hypertensive obese group (p<0.05). Conclusion: Th1 cells could be activated in obese hypertensive children before the onset of clinical indicators of target organ damage. Urinary RANTES seemed to be affected by both hypertension and obesity, and urinary IP10 and MIG seemed to be affected predominantly by hypertension. PMID:26831550

  2. Hypertension in Malaysia

    PubMed Central

    Naing, Cho; Yeoh, Peng Nam; Wai, Victor Nyunt; Win, Ni Ni; Kuan, Lai Pei; Aung, Kyan

    2016-01-01

    Abstract This study aimed to determine trends in prevalence, awareness, and control of hypertension in Malaysia and to assess the relationship between socioeconomic determinants and prevalence of hypertension in Malaysia. The distribution of hypertension in Malaysia was assessed based on available data in 3 National Health and Morbidity Surveys (NHMSs) and 1 large scale non-NHMS during the period of 1996 to 2011. Summary statistics was used to characterize the included surveys. Differences in prevalence, awareness, and control of hypertension between any 2 surveys were expressed as ratios. To assess the independent associations between the predictors and the outcome variables, regression analyses were employed with prevalence of hypertension as an outcome variable. Overall, there was a rising trend in the prevalence of hypertension in adults ≥30 years: 32.9% (30%–35.8%) in 1996, 42.6% (37.5%–43.5%) in 2006, and 43.5% (40.4%–46.6%) in 2011. There were significant increase of 32% from 1996 to 2011 (P < 0.001) and of 29% from 1996 to 2006 (P < 0.05), but only a small change of 1% from 2006 to 2011 (P = 0.6). For population ≥18 years, only a 1% increase in prevalence of hypertension occurred from the 2006 NHMS (32.2%) to the 2011 NHMS (32.7%) (P = 0.25). A relative increase of 13% occurred in those with primary education (P < 0.001) and a 15% increase was seen in those with secondary education (P < 0.001). The rate of increase in the prevalence of hypertension in the population with income level RM 3000–3999 was the highest (18%) during this period. In general, the older age group had higher prevalence of hypertension in the 2006 and 2011 NHMSs. The prevalence peaked at 74.1% among population aged 65 to 69 years in the 2011 NHMS. Both the proportion of awareness and the control of hypertension in Malaysia improved from 1996 to 2006. A change in the control of hypertension was 13% higher in women than in men. The findings suggest that

  3. [ESC guidelines 2015 on pulmonary hypertension].

    PubMed

    Olschewski, H; Kovacs, G

    2015-12-01

    The European Society of Cardiology (ESC) and European Respiratory Society (ERS) guidelines published in 2015 include the most important recommendations for the diagnosis and treatment of pulmonary hypertension (PH). The classification of PH into five groups remained unchanged as compared to the previous recommendations; however, there are minor shifts within the groups. Accordingly, a distinction is made between pulmonary arterial hypertension (PAH), PH due to left heart disease, PH due to chronic hypoxia or lung disease, chronic thromboembolic PH and PH due to unclear or multifactorial mechanisms. The diagnosis of PH is based on right heart catheterization where PH is defined as a mean pulmonary arterial pressure ≥ 25 mmHg at rest. For the definition of PAH, in addition to a pulmonary capillary wedge pressure ≤ 15 mmHg, a pulmonary vascular resistance > 3 Wood units is obligatory. Echocardiography is considered to be the most important non-invasive procedure within the diagnostic algorithm and for patients with collagen vascular disease. This is recommended during initial diagnostic work-up and should be followed-up annually. Several novel drugs which were approved since publication of the previous guidelines, were included in the new recommendations. For the first time there is a recommendation for a targeted drug for inoperable chronic thromboembolic PH. An important part of the guidelines is the discussion on PAH upfront combination therapy. PMID:26626554

  4. Resistant hypertension - an update.

    PubMed

    Pasha, K; Towhiduzzaman, M; Manwar, A; Jahan, M U

    2015-04-01

    Patients with hypertension are increasing in Bangladesh. Among these patients a growing number of patients are having resistant hypertension faced by both primary care physicians and specialists. There is no data regarding prevalence of resistant hypertension in Bangladesh, but clinical trials abroad suggests that it is not rare, involving perhaps 20% to 30% of study participants. Cardiovascular risk is undoubtedly increased in such patients and the condition is often complicated by multiple other cardiovascular risk factors such as obesity, sleep apnea, diabetes, and chronic kidney disease. Resistant hypertension is almost always multifactorial in etiology. Successful treatment requires identification and reversal of lifestyle factors contributing to treatment resistance; diagnosis and appropriate treatment of secondary causes of hypertension; and use of effective multi drug regimens. Studies of resistant hypertension are limited by the high cardiovascular risk of patients within this subgroup, which generally precludes safe withdrawal of medications; presence of multiple disease processes and their associated medical therapies, which confound interpretation of study results. Therefore we should concentrate on expanding our knowledge of the causes of resistant hypertension which will allow for more effective prevention and/or treatment which is essential to improve long-term clinical management of this condition. PMID:26007281

  5. Lung Disease and Hypertension

    PubMed Central

    Imaizumi, Yuki; Eguchi, Kazuo; Kario, Kazuomi

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) patients are at a high risk of developing cardiovascular diseases. Airflow limitation is a predictor of future risks of hypertension and cardiovascular events. COPD is now understood as a systemic inflammatory disease, with the focus on inflammation of the lungs. An association between inflammation and sympathetic overactivity has also been reported. In this article, we review the association between chronic lung disease and the risks of hypertension, cardiovascular morbidity, the underlying mechanisms, and the therapeutic approach to hypertension and cardiovascular diseases in patients with lung diseases. PMID:26587450

  6. Hypertension in Pregnancy: Is it time for a new approach to treatment?

    PubMed Central

    MOSER, Marvin; BROWN, Catherine M.; ROSE, Carl H.; GAROVIC, Vesna D.

    2013-01-01

    Hypertensive disorders represent major causes of pregnancy-related maternal mortality worldwide. The current definition and treatment recommendations for elevated blood pressure during pregnancy in the US have remained unchanged for many years, unlike the recommendations for hypertension treatment in the general population. Clinical studies have provided convincing evidence that women with hypertensive pregnancy disorders are at both immediate and long-term risk for cardiovascular complications; these findings suggest that consideration be given to lowering the presently recommended blood pressure thresholds, both for the initiation of therapy and for therapeutic targets, and to simplifying the approach to the management of elevated blood pressure in pregnancy. This review focuses on the current treatment strategies for hypertensive pregnancy disorders, new developments in the field of hypertension, in general, and in pregnant patients, in particular, and their potential impact on contemporary blood pressure goals and the use of specific antihypertensive medications in pregnancy. PMID:22573074

  7. Hypothalamic signaling mechanisms in hypertension.

    PubMed

    Carmichael, Casey Y; Wainford, Richard D

    2015-05-01

    The etiology of hypertension, a critical public health issue affecting one in three US adults, involves the integration of the actions of multiple organ systems, including the central nervous system. Increased activation of the central nervous system, driving enhanced sympathetic outflow and increased blood pressure, has emerged as a major contributor to the pathogenesis of hypertension. The hypothalamus is a key brain site acting to integrate central and peripheral inputs to ultimately impact blood pressure in multiple disease states that evoke hypertension. This review highlights recent advances that have identified novel signal transduction mechanisms within multiple hypothalamic nuclei (e.g., paraventricular nucleus, arcuate nucleus) acting to drive the pathophysiology of hypertension in neurogenic hypertension, angiotensin II hypertension, salt-sensitive hypertension, chronic intermittent hypoxia, and obesity-induced hypertension. Increased understanding of hypothalamic activity in hypertension has the potential to identify novel targets for future therapeutic interventions designed to treat hypertension. PMID:25860531

  8. Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of hypertensive disorders in pregnancy

    PubMed Central

    Rey, E; LeLorier, J; Burgess, E; Lange, I R; Leduc, L

    1997-01-01

    OBJECTIVE: To provide Canadian physicians with evidence-based guidelines for the pharmacologic treatment of hypertensive disorders in pregnancy. OPTIONS: No medication, or treatment with antihypertensive or anticonvulsant drugs. OUTCOMES: Prevention of maternal complications, and prevention of perinatal complications and death. EVIDENCE: Pertinent articles published from 1962 to September 1996 retrieved from the Pregnancy and Childbirth Module of the Cochrane Database of Systematic Reviews and from MEDLINE; additional articles retrieved through a manual search of bibliographies; and expert opinion. Recommendations were graded according to levels of evidence. VALUES: Maternal and fetal well-being were equally valued, with the belief that treatment side effects should be minimized. BENEFITS, HARMS AND COSTS: Reduction in the rate of adverse perinatal outcomes, including death. Potential side effects of antihypertensive drugs include placental hypoperfusion, intrauterine growth retardation and long-term effects on the infant. RECOMMENDATIONS: A systolic blood pressure greater than 169 mm Hg or a diastolic pressure greater than 109 mm Hg in a pregnant woman should be considered an emergency and pharmacologic treatment with hydralazine, labetalol or nifedipine started. Otherwise, the thresholds at which to start antihypertensive treatment are a systolic pressure of 140 mm Hg or a diastolic pressure of 90 mm Hg in women with gestational hypertension without proteinuria or pre-existing hypertension before 28 weeks' gestation, those with gestational hypertension and proteinuria or symptoms at any time during the pregnancy, those with pre-existing hypertension and underlying conditions or target-organ damage, and those with pre-existing hypertension and superimposed gestational hypertension. The thresholds in other circumstances are a systolic pressure of 150 mm Hg or a diastolic pressure of 95 mm Hg. For nonsevere hypertension, methyldopa is the first-line drug; labetalol

  9. Secondary hypertension in adults

    PubMed Central

    Puar, Troy Hai Kiat; Mok, Yingjuan; Debajyoti, Roy; Khoo, Joan; How, Choon How; Ng, Alvin Kok Heong

    2016-01-01

    Secondary hypertension occurs in a significant proportion of adult patients (~10%). In young patients, renal causes (glomerulonephritis) and coarctation of the aorta should be considered. In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. Primary aldosteronism can be screened by taking morning aldosterone and renin levels, and should be considered in patients with severe, resistant or hypokalaemia-associated hypertension. Symptoms of obstructive sleep apnoea should be sought. Worsening of renal function after starting an angiotensin-converting enzyme inhibitor suggests the possibility of renal artery stenosis. Recognition, diagnosis and treatment of secondary causes of hypertension lead to good clinical outcomes and the possible reversal of end-organ damage, in addition to blood pressure control. As most patients with hypertension are managed at the primary care level, it is important for primary care physicians to recognise these conditions and refer patients appropriately. PMID:27211205

  10. Hypertensive heart disease

    MedlinePlus

    ... failure: pathophysiology and diagnosis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 24th ed. Philadelphia, PA: ... Victor RG. Arterial hypertension. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 24th ed. Philadelphia, PA: ...

  11. Hypertension (High Blood Pressure)

    MedlinePlus

    ... pressure to live. Without it, blood can't flow through our bodies and carry oxygen to our vital organs. But when blood pressure gets too high — a condition called hypertension — it can lead to ...

  12. High Blood Pressure (Hypertension)

    MedlinePlus

    ... Print Page Text Size: A A A Listen High Blood Pressure (Hypertension) Nearly 1 in 3 American adults has high ... weight. How Will I Know if I Have High Blood Pressure? High blood pressure is a silent problem — you ...

  13. Hypertension (High Blood Pressure)

    MedlinePlus

    ... blood pressure with the development of a practical method to measure it. Physicians began to note associations between hypertension and risk of heart failure, stroke, and kidney failure. Although scientists had yet to prove that lowering blood pressure ...

  14. Cost of hypertension treatment.

    PubMed

    Odell, T W; Gregory, M C

    1995-12-01

    A retrospective analysis was conducted of the cost of hypertension care at one internal medicine clinic, looking at the cost of office visits, laboratory tests, and medications. Cost of hypertension care was $947 the first year of treatment, $575 the second year, and $420 per year thereafter. Drug costs were the major determinant of cost of care, comprising 80% of the total cost of treatment after the first year of therapy. PMID:8770721

  15. Hypertensive emergencies of pregnancy.

    PubMed

    Alexander, James M; Wilson, Karen L

    2013-03-01

    Hypertension is commonly encountered in pregnancy and has both maternal and fetal effects. Acute hypertensive crisis most commonly occurs in severe preeclampsia and is associated with maternal stroke, cardiopulmonary decompensation, fetal decompensation due to decreased uterine perfusion, abruption, and stillbirth. Immediate stabilization of the mother including the use of intervenous antihypertensives is required and often delivery is indicated. With appropriate management, maternal and fetal outcomes can be excellent. PMID:23466139

  16. Resistant hypertension and chronotherapy.

    PubMed

    Prkacin, Ingrid; Balenovic, Diana; Djermanovic-Dobrota, Vesna; Lukac, Iva; Drazic, Petra; Pranjic, Iva-Klara

    2015-04-01

    Resistant hypertension is defined as blood pressure that remains above 140/90 mmHg in spite of the continuous use of three antihypertensive agents in optimal dose, including diuretic, and lifestyle changes. According to data from United States of America and Europe, the prevalence ranges from 10 up to 30% in patients with hypertension. Numerous biological and lifestyle factors can contribute to the development of resistant hypertension: medications, volume overload, obesity, diabetes mellitus, older age, renal parenchymal and renovascular disease, primary aldosteronism, obstructive sleep apnea, pheochormocytoma, Cushing's syndrome, thyroid diseases, aortic coarctation. For diagnosing patient's history is important, assessing compliance, regular blood pressure measurement, physical examination, biochemical evaluation and noninvasive imaging. The evaluation including 24h ambulatory monitoring of blood pressure (ABPM) in the identification of "non-dipper" hypertension. Non-dipper has particular importance and the prevalence of abnormally high sleep blood pressure is very often in chronic kidney patients. Therapeutic restoration of normal physiologic blood pressure reduction during night-time sleep (circadial variation) is the most significant independent predictor of decreased risk and the basis for the chronotherapy. The resistant hypertension treatment is achieved with nonpharmacological and pharmacological approach, treating secondary hypertension causes and invasive procedures. PMID:26005390

  17. Resistant Hypertension and Chronotherapy

    PubMed Central

    Prkacin, Ingrid; Balenovic, Diana; Djermanovic-Dobrota, Vesna; Lukac, Iva; Drazic, Petra; Pranjic, Iva-Klara

    2015-01-01

    Resistant hypertension is defined as blood pressure that remains above 140/90 mmHg in spite of the continuous use of three antihypertensive agents in optimal dose, including diuretic, and lifestyle changes. According to data from United States of America and Europe, the prevalence ranges from 10 up to 30% in patients with hypertension. Numerous biological and lifestyle factors can contribute to the development of resistant hypertension: medications, volume overload, obesity, diabetes mellitus, older age, renal parenchymal and renovascular disease, primary aldosteronism, obstructive sleep apnea, pheochormocytoma, Cushing’s syndrome, thyroid diseases, aortic coarctation. For diagnosing patient’s history is important, assessing compliance, regular blood pressure measurement, physical examination, biochemical evaluation and noninvasive imaging. The evaluation including 24h ambulatory monitoring of blood pressure (ABPM) in the identification of “non-dipper” hypertension. Non-dipper has particular importance and the prevalence of abnormally high sleep blood pressure is very often in chronic kidney patients. Therapeutic restoration of normal physiologic blood pressure reduction during night-time sleep (circadial variation) is the most significant independent predictor of decreased risk and the basis for the chronotherapy. The resistant hypertension treatment is achieved with nonpharmacological and pharmacological approach, treating secondary hypertension causes and invasive procedures. PMID:26005390

  18. Liver surgery in cirrhosis and portal hypertension

    PubMed Central

    Hackl, Christina; Schlitt, Hans J; Renner, Philipp; Lang, Sven A

    2016-01-01

    The prevalence of hepatic cirrhosis in Europe and the United States, currently 250 patients per 100000 inhabitants, is steadily increasing. Thus, we observe a significant increase in patients with cirrhosis and portal hypertension needing liver resections for primary or metastatic lesions. However, extended liver resections in patients with underlying hepatic cirrhosis and portal hypertension still represent a medical challenge in regard to perioperative morbidity, surgical management and postoperative outcome. The Barcelona Clinic Liver Cancer classification recommends to restrict curative liver resections for hepatocellular carcinoma in cirrhotic patients to early tumor stages in patients with Child A cirrhosis not showing portal hypertension. However, during the last two decades, relevant improvements in preoperative diagnostic, perioperative hepatologic and intensive care management as well as in surgical techniques during hepatic resections have rendered even extended liver resections in higher-degree cirrhotic patients with portal hypertension possible. However, there are few standard indications for hepatic resections in cirrhotic patients and risk stratifications have to be performed in an interdisciplinary setting for each individual patient. We here review the indications, the preoperative risk-stratifications, the morbidity and the mortality of extended resections for primary and metastatic lesions in cirrhotic livers. Furthermore, we provide a review of literature on perioperative management in cirrhotic patients needing extrahepatic abdominal surgery and an overview of surgical options in the treatment of hepatic cirrhosis. PMID:26973411

  19. Natural antioxidants and hypertension: promise and challenges.

    PubMed

    Kizhakekuttu, Tinoy J; Widlansky, Michael E

    2010-08-01

    Hypertension reigns as a leading cause of cardiovascular morbidity and mortality worldwide. Excessive reactive oxygen species (ROS) have emerged as a central common pathway by which disparate influences may induce and exacerbate hypertension. Potential sources of excessive ROS in hypertension include nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, mitochondria, xanthine oxidase, endothelium-derived NO synthase, cyclooxygenase 1 and 2, cytochrome P450 epoxygenase, and transition metals. While a significant body of epidemiological and clinical data suggests that antioxidant-rich diets reduce blood pressure and cardiovascular risk, randomized trials and population studies using natural antioxidants have yielded disappointing results. The reasons behind this lack of efficacy are not completely clear, but likely include a combination of (1) ineffective dosing regimens, (2) the potential pro-oxidant capacity of some of these agents, (3) selection of subjects less likely to benefit from antioxidant therapy (too healthy or too sick), and (4) inefficiency of nonspecific quenching of prevalent ROS versus prevention of excessive ROS production. Commonly used antioxidants include Vitamins A, C and E, L-arginine, flavanoids, and mitochondria-targeted agents (Coenzyme Q10, acetyl-L-carnitine, and alpha-lipoic acid). Various reasons, including incomplete knowledge of the mechanisms of action of these agents, lack of target specificity, and potential interindividual differences in therapeutic efficacy preclude us from recommending any specific natural antioxidant for antihypertensive therapy at this time. This review focuses on recent literature evaluating naturally occurring antioxidants with respect to their impact on hypertension. PMID:20370791

  20. Screening recommendations for the elderly.

    PubMed Central

    Beers, M H; Fink, A; Beck, J C

    1991-01-01

    BACKGROUND. Studies have documented the potential contributions of preventive health care programs. Yet little is known about which screening tests should be included in public health programs for older persons. This study offers recommendations regarding these tests. METHODS. The recommendations come from synthesizing the findings of the US Preventive Services Task Force, the literature, and the consensus of experts in geriatrics, gerontology, and health policy research. The literature was evaluated to identify methodologically sound studies of the prevalence of selected disorders and benefits and availability of screening procedures for those disorders. Experts from various fields specializing in the care of the elderly formed panels to assist in evaluating the literature and providing further information from gerontological and public health perspectives. RESULTS. We recommend vision testing for refractive error; inspection of the skin surface for fungal infection and skin cancer, drug eruptions, and xerosis; a history for symptoms of xerosis; audiometric testing for presbycusis; surveys for hearing loss; otoscopic inspection for cerumen impaction; dental examination for caries; measurement of blood pressure for hypertension; and breast examination and mammography for cancer. CONCLUSIONS. Our study suggests that these screening procedures are useful for public health screening programs. More information is needed on the effects of screening services on the health and functioning of older persons. PMID:1951823

  1. A New Algorithm for the Diagnosis of Hypertension in Canada.

    PubMed

    Cloutier, Lyne; Daskalopoulou, Stella S; Padwal, Raj S; Lamarre-Cliche, Maxime; Bolli, Peter; McLean, Donna; Milot, Alain; Tobe, Sheldon W; Tremblay, Guy; McKay, Donald W; Townsend, Raymond; Campbell, Norm; Gelfer, Mark

    2015-05-01

    Accurate blood pressure measurement is critical to properly identify and treat individuals with hypertension. In 2005, the Canadian Hypertension Education Program produced a revised algorithm to be used for the diagnosis of hypertension. Subsequent annual reviews of the literature have identified 2 major deficiencies in the current diagnostic process. First, auscultatory measurements performed in routine clinical settings have serious accuracy limitations that have not been overcome despite great efforts to educate health care professionals over several years. Thus, alternatives to auscultatory measurements should be used. Second, recent data indicate that patients with white coat hypertension must be identified earlier in the process and in a systematic manner rather than on an ad hoc or voluntary basis so they are not unnecessarily treated with antihypertensive medications. The economic and health consequences of white coat hypertension are reviewed. In this article evidence for a revised algorithm to diagnose hypertension is presented. Protocols for home blood pressure measurement and ambulatory blood pressure monitoring are reviewed. The role of automated office blood pressure measurement is updated. The revised algorithm strongly encourages the use of validated electronic digital oscillometric devices and recommends that out-of-office blood pressure measurements, ambulatory blood pressure monitoring (preferred), or home blood pressure measurement, should be performed to confirm the diagnosis of hypertension. PMID:25828374

  2. [Hypertensive crisis in kidney patients].

    PubMed

    Scrivano, Jacopo; Giuliani, Anna; Pettorini, Laura; Punzo, Giorgio; Mene', Paolo; Pirozzi, Nicola

    2011-01-01

    The classification and management of hypertensive crisis have been recently reviewed in the context of both European and American guidelines. The key points for proper blood pressure control in severe arterial hypertension are: 1 - Distinction between urgent intervention and emergencies 2 - Choice of the best drug(s) 3 - Choice of the correct route of administration. In patients with renal disease, beside the common causes of hypertension/ hypertensive crises, kidney-specific causes should be taken into account such as renal parenchymal hypertension, renovascular hypertension, sclerodermic crises, and preeclampsia. PMID:22028263

  3. Prevalence of hypertension in school going children of Surat city, Western India

    PubMed Central

    Buch, Nirav; Goyal, Jagdish P.; Kumar, Nagendra; Parmar, Indira; Shah, Vijay B.; Charan, Jaykaran

    2011-01-01

    Background: Early diagnosis of hypertension (HT) is an important strategy in its control. Previous studies have documented that hypertension may begin in adolescence, perhaps even in childhood. The purpose of this study was to determine the prevalence of hypertension and risk factors among school going children in Surat city, south Gujarat, India. Materials and Methods: School going children aged between 6 to 18 years, of two schools were selected by purposive sampling method and blood pressure measurements were taken by mercury sphygmomanometer as per recommendation of American heart association. Hypertension is considered when blood pressure is more than 95th percentile according to update on task force report (2004) and children having hypertension in first and second recording repeat measurement was done to confirm hypertension after a week. Results: Total prevalence of hypertension in our study was 6.48%. Hypertension in males was 6.74% (<10 yrs 5.88%, 10-13yrs 6.04%, >13yrs 9.19%) and in females was 6.13% (<10yrs 0.62%, 10-13yrs 8.67%,.13yrs 8.48%). Prevalence of obesity in hypertension was 8.7% against normotensive 1.1% (P <0.05). Prevalence of hypertension in family members of hypertensive was 18.6% and in normotensive 13.1% (P =0.1). Prevalence of diabetes mellitus in family members of hypertensive was 23.4% and 13.7% in normotensive (P<0.05); while prevalence of ischemic heart disease in family members was 12.34% in hypertensive and 8.3% in normotensive (P <0.05). Conclusion: Prevalence of hypertension was 6.48% in the study subjects. We identified obesity, family history of diabetes mellitus, ischemic heart disease was found to be significant association for childhood hypertension. PMID:22135481

  4. Exercise and cardiovascular risk in patients with hypertension.

    PubMed

    Sharman, James E; La Gerche, Andre; Coombes, Jeff S

    2015-02-01

    Evidence for the benefits of regular exercise is irrefutable and increasing physical activity levels should be a major goal at all levels of health care. People with hypertension are less physically active than those without hypertension and there is strong evidence supporting the blood pressure-lowering ability of regular exercise, especially in hypertensive individuals. This narrative review discusses evidence relating to exercise and cardiovascular (CV) risk in people with hypertension. Comparisons between aerobic, dynamic resistance, and static resistance exercise have been made along with the merit of different exercise volumes. High-intensity interval training and isometric resistance training appear to have strong CV protective effects, but with limited data in hypertensive people, more work is needed in this area. Screening recommendations, exercise prescriptions, and special considerations are provided as a guide to decrease CV risk among hypertensive people who exercise or wish to begin. It is recommended that hypertensive individuals should aim to perform moderate intensity aerobic exercise activity for at least 30 minutes on most (preferably all) days of the week in addition to resistance exercises on 2-3 days/week. Professionals with expertise in exercise prescription may provide additional benefit to patients with high CV risk or in whom more intense exercise training is planned. Despite lay and media perceptions, CV events associated with exercise are rare and the benefits of regular exercise far outweigh the risks. In summary, current evidence supports the assertion of exercise being a cornerstone therapy in reducing CV risk and in the prevention, treatment, and control of hypertension. PMID:25305061

  5. Dietary Salt Intake and Hypertension

    PubMed Central

    2014-01-01

    Over the past century, salt has been the subject of intense scientific research related to blood pressure elevation and cardiovascular mortalities. Moderate reduction of dietary salt intake is generally an effective measure to reduce blood pressure. However, recently some in the academic society and lay media dispute the benefits of salt restriction, pointing to inconsistent outcomes noted in some observational studies. A reduction in dietary salt from the current intake of 9-12 g/day to the recommended level of less than 5-6 g/day will have major beneficial effects on cardiovascular health along with major healthcare cost savings around the world. The World Health Organization (WHO) strongly recommended to reduce dietary salt intake as one of the top priority actions to tackle the global non-communicable disease crisis and has urged member nations to take action to reduce population wide dietary salt intake to decrease the number of deaths from hypertension, cardiovascular disease and stroke. However, some scientists still advocate the possibility of increased risk of CVD morbidity and mortality at extremes of low salt intake. Future research may inform the optimal sodium reduction strategies and intake targets for general populations. Until then, we have to continue to build consensus around the greatest benefits of salt reduction for CVD prevention, and dietary salt intake reduction strategies must remain at the top of the public health agenda. PMID:25061468

  6. Keeping an eye on dialysis: the association of hemodialysis with intraocular hypertension.

    PubMed

    William, Jeffrey H; Gilbert, Aubrey L; Rosas, Sylvia E

    2015-11-01

    Intraocular hypertension is common during hemodialysis. Dialysis disequilibrium syndrome and intraocular hypertension occur via similar pathophysiologic mechanisms. These mechanisms may contribute to the development of glaucoma and cataracts in a patient population already at high risk for ocular abnormalities, given the common risk factors for chronic kidney disease and impaired aqueous humor outflow. We describe a patient with complicated diabetes mellitus, end-stage renal disease, and recent cataract surgery who developed severe intraocular hypertension during hemodialysis. We recommend increased awareness of the symptoms of intraocular hypertension and subsequent ophthalmologic surveillance in order to prevent long-term visual complications. PMID:26042412

  7. Pregnancy with Portal Hypertension

    PubMed Central

    Aggarwal, Neelam; Negi, Neha; Aggarwal, Aakash; Bodh, Vijay; Dhiman, Radha K.

    2014-01-01

    Even though pregnancy is rare with cirrhosis and advanced liver disease, but it may co-exist in the setting of non-cirrhotic portal hypertension as liver function is preserved but whenever encountered together is a complex clinical dilemma. Pregnancy in a patient with portal hypertension presents a special challenge to the obstetrician as so-called physiological hemodynamic changes associated with pregnancy, needed for meeting demands of the growing fetus, worsen the portal hypertension thereby putting mother at risk of potentially life-threatening complications like variceal hemorrhage. Risks of variceal bleed and hepatic decompensation increase many fold during pregnancy. Optimal management revolves round managing the portal hypertension and its complications. Thus management of such cases requires multi-speciality approach involving obstetricians experienced in dealing with high risk cases, hepatologists, anesthetists and neonatologists. With advancement in medical field, pregnancy is not contra-indicated in these women, as was previously believed. This article focuses on the different aspects of pregnancy with portal hypertension with special emphasis on specific cause wise treatment options to decrease the variceal bleed and hepatic decompensation. Based on extensive review of literature, management from pre-conceptional period to postpartum is outlined in order to have optimal maternal and perinatal outcomes. PMID:25755552

  8. Pulmonary arterial hypertension: a clot in question.

    PubMed

    Patel, Bhavin; Pakala, Aneesh; Aronson, Willard; Magharyous, Hany; Brown, Brent

    2014-07-01

    Pulmonary arterial hypertension (PAH) is a group of disorders characterized by a progressive increase in pulmonary vascular resistance leading to right heart failure and premature death. We present an unusual case of PAH diagnosed initially as Idiopathic PAH (IPAH) after secondary causes were excluded which was successfully managed for a number of years with vasodilators and anticoagulation. Over the months after stopping anticoagulation (because of recurring small bowel hemorrhaging) patient developed progressive findings of right heart failure, which failed to respond to escalating doses of prostacyclin. The patient died and an autopsy revealed the surprising finding of extensive organized central pulmonary artery thrombi as is seen in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We discuss the question of whether these thrombi are generally embolic or develop in situ and recommend that clinicians have a high index of suspicion for central thrombi in patients with IPAH were anticoagulation is contraindicated. PMID:25223151

  9. Loop Diuretics in the Treatment of Hypertension.

    PubMed

    Malha, Line; Mann, Samuel J

    2016-04-01

    Loop diuretics are not recommended in current hypertension guidelines largely due to the lack of outcome data. Nevertheless, they have been shown to lower blood pressure and to offer potential advantages over thiazide-type diuretics. Torsemide offers advantages of longer duration of action and once daily dosing (vs. furosemide and bumetanide) and more reliable bioavailability (vs. furosemide). Studies show that the previously employed high doses of thiazide-type diuretics lower BP more than furosemide. Loop diuretics appear to have a preferable side effect profile (less hyponatremia, hypokalemia, and possibly less glucose intolerance). Studies comparing efficacy and side effect profiles of loop diuretics with the lower, currently widely prescribed, thiazide doses are needed. Research is needed to fill gaps in knowledge and common misconceptions about loop diuretic use in hypertension and to determine their rightful place in the antihypertensive arsenal. PMID:26951244

  10. Stress and hypertension.

    PubMed Central

    Mustacchi, P.

    1990-01-01

    In susceptible persons emotional stress results in immediate sympathetic stimulation, with a vasomotor response that results in a high-output state and elevated blood pressure; the vasopressor response seems to be transient. There seems to be no longitudinal epidemiologic validation of the attractive hypothesis that transiently elevated blood pressures are the prelude to fixed hypertension, however. The acquisition of hypertension by populations abandoning their traditional mode of living has been attributed to the sociocultural stress inherent in westernization, but these studies usually have not taken into account concomitants of this type of acculturation, such as dietary changes and increased body weight. The inverse relationship of blood pressure levels to education could explain the development of hypertension when aspiration to upward mobility is thwarted. The severity of perceived occupational stress relates inversely to blood pressure, suggesting that familiarity with a job renders the demands made by the work environment more predictable and less threatening in terms of vasopressor response. PMID:2219875

  11. Hypertension and cerebrovascular damage.

    PubMed

    Veglio, Franco; Paglieri, Cristina; Rabbia, Franco; Bisbocci, Daniela; Bergui, Mauro; Cerrato, Paolo

    2009-08-01

    Hypertension is the most important modifiable factor for cerebrovascular disease. Stroke and dementia are growing health problems that have considerable social and economical consequences. Hypertension causes brain lesions by several mechanisms predisposing to lacunar infarctions, leucoaraiosis, and white matter changes as well as to intracerebral haemorrhages. These parenchymal damages determine evident or silent neurological alterations that often precede the onset of cognitive decline. It is important to recognize cerebrovascular disease and, above all, to correlate typical lesions to hypertension. Antihypertensive therapy has shown clinical benefits in primary and secondary prevention of stroke. These drugs represent important instruments against cerebrovascular disease but their effects on cognition are still matter of debate. Cerebral parenchymal and functional damages have to be considered together to make medical intervention more incisive. PMID:19100549

  12. Perspectives on research in hypertension.

    PubMed

    Seedat, Y K

    2009-01-01

    This is a review of my published research on hypertension over 45 years on the three main racial groups residing in KwaZulu-Natal and its main city Durban. These three groups are blacks - mainly Zulu, whites and Indians. The research focused mainly on epidemiology, determinants of the aetiology of hypertension, clinical features, varying responses to hypotensive agents among the racial groups, complications that result from hypertension and the control of hypertension. PMID:19287815

  13. Association between pregnancy-related hypertension and severity of hypertension.

    PubMed

    Moreira, L B; Gus, M; Nunes, G; Gonçalves, C B C; Martins, J; Wiehe, M; Fuchs, F D

    2009-06-01

    Hypertension in pregnancy is an emerging sex-specific risk factor for cardiovascular disease and may lead to more severe hypertension after pregnancy. The objectives of this study were to investigate the frequency of pregnancy-related hypertension among patients referred to a hypertension clinic and its association with the severity of hypertension and evidence of end-organ damage. In this cross-sectional study, women with hypertension were submitted to a systematic clinical evaluation. The occurrence of pregnancy-related hypertension was investigated by questionnaire. The association between pregnancy-related hypertension and severity of hypertension (stage 2 according to Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII)) and end-organ damage was assessed in a logistic regression model. The mean age, systolic and diastolic blood pressure and body mass index (BMI) of the 768 women examined were 51.6+/-12.7 years, 158.2+/-26.6 mm Hg, 93.8+/-14.3 mm Hg and 29.4+/-5.6 kg/m(2), respectively. The proportion of women with pregnancy-related hypertension was 32.9%. It was significantly associated with hypertension at stage 2 (OR: 1.60, 95% CI: 1.14-2.24; P=0.01) after controlling for confounders. The occurrence of a pregnancy-related hypertension was not associated with evidence of optic fundi abnormalities, left ventricular hypertrophy or abnormalities in kidney function. In conclusion, pregnancy-related hypertension is frequent in women referred to a hypertension clinic, and is associated with severe hypertension but not with evidence of end-organ damage. PMID:19020534

  14. Pulmonary hypertension caused by pulmonary venous hypertension

    PubMed Central

    2014-01-01

    Abstract The effect of pulmonary venous hypertension (PVH) on the pulmonary circulation is extraordinarily variable, ranging from no impact on pulmonary vascular resistance (PVR) to a marked increase. The reasons for this are unknown. Both acutely reversible pulmonary vasoconstriction and pathological remodeling (especially medial hypertrophy and intimal hyperplasia) account for increased PVR when present. The mechanisms involved in vasoconstriction and remodeling are not clearly defined, but increased wall stress, especially in small pulmonary arteries, presumably plays an important role. Myogenic contraction may account for increased vascular tone and also indirectly stimulate remodeling of the vessel wall. Increased wall stress may also directly cause smooth muscle growth, migration, and intimal hyperplasia. Even long-standing and severe pulmonary hypertension (PH) usually abates with elimination of PVH, but PVH-PH is an important clinical problem, especially because PVH due to left ventricular noncompliance lacks definitive therapy. The role of targeted PH therapy in patients with PVH-PH is unclear at this time. Most prospective studies indicate that these medications are not helpful or worse, but there is ample reason to think that a subset of patients with PVH-PH may benefit from phosphodiesterase inhibitors or other agents. A different approach to evaluating possible pharmacologic therapy for PVH-PH may be required to better define its possible utility. PMID:25610595

  15. How do Urban African Americans and Latinos View the Influence of Diet on Hypertension?

    PubMed Central

    Horowitz, Carol R.; Tuzzio, Leah; Rojas, Mary; Monteith, Sharifa A.; Sisk, Jane E.

    2015-01-01

    Uncontrolled hypertension and its complications continue to be major health problems that disproportionately affect poor minority communities. Although dietary modification is an effective treatment for hypertension, it is not clear how hypertensive minority patients view diet as part of their treatment, and what barriers affect their abilities to eat healthy diets. We conducted nine focus groups with 88 African American and Latino patients treated for hypertension to assess their knowledge, attitudes, behaviors, and beliefs concerning hypertension. Participants generally agreed that certain foods and food additives play an important role in the cause and treatment of hypertension. However, they found clinician-recommended diets difficult to follow in the context of their family lives, social situations, and cultures. These diets were often considered expensive, an unwelcome departure from traditional and preferred diets, socially isolating, and not effective enough to obviate the need for medications. These findings suggest the importance of culturally sensitive approaches to dietary improvements. PMID:15531820

  16. [Hypertensive emergency and urgence].

    PubMed

    Gegenhuber, Alfons; Lenz, Kurt

    2003-12-01

    DEFINITION, PATHOPHYSIOLOGY, THERAPY: The hypertensive crisis is characterized by a massive, acute rise in blood pressure. Patients with underlying hypertensive disease usually have an increase in systolic blood pressure values > 220 mmHg and diastolic values > 120 mmHg. The severity of the condition, however, is not determined by the absolute blood pressure level but by the magnitude of the acute increase in blood pressure. Thus, in the presence of primarily normotensive baseline values (such as those in eclampsia), even a systolic blood pressure > 170 mmHg may lead to a life-threatening condition. The most important causes are non-compliance (reduction or interruption of therapy), inadequate therapy, endocrine disease, renal (vessel) disease, pregnancy and intoxication (drugs). The management of this condition greatly depends on whether the patient has a hypertensive crisis with organ manifestation (hypertensive emergency) or a crisis without organ manifestation (hypertensive urgency). By documenting the medical history, the medical status and by simple diagnostic procedures, the differential diagnosis can be established at the emergency site within a very short period of time. In the absence of organ manifestations (hypertensive urgency) the patient may have non-specific symptoms such as palpitations, headache, malaise and a general feeling of illness in addition to the increase in blood pressure. In a hypertensive urgency the patient's blood pressure should not be reduced within a few minutes but within a period of 24 to 48 hours. Such adjustment can be achieved on an out-patient basis, however, only if the patient can be followed up adequately for early detection of a renewed attack. In the absence of follow-up facilities, the patient's blood pressure should be reduced over a period of 4 to 6 hours, if necessary in an out-patient emergency service. While intravenous medication is given preference when a rapid effect is desired, oral medication may be used for

  17. Gender Differences in Hypertension and Hypertension Awareness Among Young Adults

    PubMed Central

    EVERETT, BETHANY; ZAJACOVA, ANNA

    2016-01-01

    Previous research has shown that men have higher levels of hypertension and lower levels of hypertension awareness than women, but it remains unclear if these differences emerge among young adults. Using the National Longitudinal Study of Adolescent to Adult Health (Add Health), this study examines gender differences in hypertension and hypertension awareness among U.S. young adults, with special focus on factors that may contribute to observed disparities (N = 14,497). Our results show that the gender disparities in hypertension status were already evident among men and women in their twenties: women were far less likely to be hypertensive compared to men (12% vs. 27%). The results also reveal very low levels of hypertension awareness among young women (32% of hypertensive women were aware of their status) and even lower levels among men (25%). Finally, this study identifies key factors that contribute to these observed gender disparities. In particular, health care use, while not related to the actual hypertension status, fully explains the gender differences in hypertension awareness. The findings thus suggest that regular medical visits are critical for improving hypertension awareness among young adults and reducing gender disparities in cardiovascular health. PMID:25879259

  18. Oxidative stress and hypertension: Possibility of hypertension therapy with antioxidants

    PubMed Central

    Baradaran, Azar; Nasri, Hamid; Rafieian-Kopaei, Mahmoud

    2014-01-01

    Hypertension is a major risk factor for myocardial infarction, heart failure, stroke, peripheral arterial disease, and aortic aneurysm, and is a cause of chronic kidney disease. Hypertension is often associated with metabolic abnormalities such as diabetes and dyslipidemia, and the rate of these diseases is increasing nowadays. Recently it has been hypothesized that oxidative stress is a key player in the pathogenesis of hypertension. A reduction in superoxide dismutase and glutathione peroxidase activity has been observed in newly diagnosed and untreated hypertensive subjects, which are inversely correlated with blood pressure. Hydrogen peroxide production is also higher in hypertensive subjects. Furthermore, hypertensive patients have higher lipid hydroperoxide production. Oxidative stress is also markedly increased in hypertensive patients with renovascular disease. If oxidative stress is indeed a cause of hypertension, then, antioxidants should have beneficial effects on hypertension control and reduction of oxidative damage should result in a reduction in blood pressure. Although dietary antioxidants may have beneficial effects on hypertension and cardiovascular risk factors, however, antioxidant supplementation has not been shown consistently to be effective and improvement is not usually seen in blood pressure after treatment with single or combination antioxidant therapy in subjects thought to be at high risk of cardiovascular disease. This matter is the main focus of this paper. A list of medicinal plants that have been reported to be effective in hypertension is also presented. PMID:25097610

  19. Hypertension in adolescents.

    PubMed

    Aglony, Marlene; Acevedo, Monica; Ambrosio, Giuseppe

    2009-12-01

    In adults, hypertension has long been perceived as a public health problem. By contrast, its impact in childhood is far less appreciated. In fact, quite often, high blood pressure in children is not even diagnosed. Blood pressure is a vital sign that is routinely obtained during a physical examination of adults, but only very seldom in children. The diagnosis of hypertension in children is complicated because 'normal' blood pressure values vary with age, sex and height. As a consequence, almost 75% of the cases of arterial hypertension and 90% of the cases of prehypertension in children and adolescents are currently undiagnosed. Furthermore, adolescence hypertension is increasing in prevalence as the prevalence of pediatric obesity has increased. Ambulatory blood pressure monitoring is a useful method for risk evaluation in adolescents. In addition to being viewed as an important cardiovascular risk factor in adolescents, elevated blood pressure should prompt a thorough search for other modifiable risk factors that, if treated, might reduce teenagers' risk of developing cardiovascular disease in adulthood. Thus, assessing blood pressure values in children represents one of the most important measurable markers of cardiovascular risk later in life and a major step in preventive medicine. PMID:19954321

  20. Carvedilol in hypertension treatment

    PubMed Central

    Stafylas, Panagiotis C; Sarafidis, Pantelis A

    2008-01-01

    Although β-blockers have been previously shown to effectively reduce blood pressure (BP) and have been used for hypertension treatment for over 40 years, their effect on cardiovascular morbidity and mortality in hypertensive patients remains controversial and its use in uncomplicated hypertension is currently under debate. However, data on the above field derive mainly from studies which were conducted with older agents, such as atenolol and metoprolol, while considerable pharamacokinetic and pharmacodynamic heterogeneity is present within the class of β-blockers. Carvedilol, a vasodilating non-cardioselective β-blocker, is a compound that seems to give the opportunity to the clinician to use a cardioprotective agent without the concerning hemodynamic and metabolic actions of traditional β-blocker therapy. In contrast with conventional β-blockers, carvedilol maintains cardiac output, has a less extended effect on heart rate and reduces BP by decreasing vascular resistance. Further, several studies has shown that carvedilol has a beneficial or at least neutral effect on metabolic parameters, such as glycemic control, insulin sensitivity, and lipid metabolism, suggesting that they could be used in subjects with the metabolic syndrome or diabetes without negative consequences. This article summarizes the distinct pharmacologic, hemodynamic, and metabolic properties of carvedilol in relation to conventional β-blockers, attempting to examine the potential use of this agent for hypertension treatment. PMID:18629377

  1. High Blood Pressure (Hypertension)

    MedlinePlus

    ... For Consumers Consumer Information by Audience For Women High Blood Pressure (Hypertension) Share Tweet Linkedin Pin it More sharing options ... En Español Who is at risk? How is high blood pressure treated? Understanding your blood pressure: What do the ...

  2. Idiopathic pulmonary arterial hypertension.

    PubMed

    Souza, Rogerio; Jardim, Carlos; Humbert, Marc

    2013-10-01

    Idiopathic pulmonary arterial hypertension (IPAH), formerly called primary pulmonary hypertension, is a rare disease (incidence and prevalence rates of approximately one and six cases per million inhabitants, respectively) with different clinical phenotypes. A group of diverse conditions manifest pulmonary arterial hypertension (PAH) and share similar pathological and/or clinical findings with IPAH. By definition, IPAH is diagnosed only after alternative diagnoses have been ruled out. Extensive investigation is needed to determine if PAH is associated with thyroid diseases, infectious diseases, autoimmune conditions, exposure to certain drugs (particularly anorexigens), certain genetic mutations, and so on. The presence of genetic abnormalities and risk factors (such as specific drug exposures) reinforces the "multiple hit" concept for the development of pulmonary hypertension. Fortunately, within the past two decades, therapeutic options have become available for IPAH, resulting in improved survival and clinical outcomes. At least seven different compounds have been registered for PAH treatment. However, even with aggressive PAH-specific therapy, mortality rates remain high (∼40% at 5 years). Given the high mortality rates, the use of combinations of agents that work by different pathways has been advocated (either as "add-on" therapy or initial "up front" therapy). Further, new therapeutic agents and treatment strategies are on the near horizon, aiming to further improve survival from the remarkable progress already seen. PMID:24037625

  3. Pregnancy-Induced Hypertension

    MedlinePlus

    ... upper arm. Then they listen to your blood flow with a stethoscope. High blood pressure (also called hypertension) occurs when your ... is not a good idea if you have high blood pressure during pregnancy. Your body needs salt to keep up the flow of fluid in your body, so you need ...

  4. Hypertension, a health economics perspective.

    PubMed

    Alcocer, Luis; Cueto, Liliana

    2008-06-01

    The economic aspects of hypertension are critical to modern medicine. The medical, economic, and human costs of untreated and inadequately controlled hypertension are enormous. Hypertension is distributed unequally and with iniquity in different countries and regions of the world. Treatment of hypertension requires an investment over many years to prolong disease-free quality years of life. The high prevalence and high cost of the disease impacts on the microeconomics and macroeconomics of countries and regions. The criteria used for inclusion in clinical guidelines for hypertension impact on the cost and cost/utility of diagnosis or treatment. PMID:19124418

  5. Cognitive function in hypertensive children.

    PubMed

    Lande, Marc B; Kupferman, Juan C

    2015-01-01

    Young hypertensive adults demonstrate decreased performance on neurocognitive testing compared with that of normotensive controls. There is emerging, preliminary evidence that children with hypertension also manifest cognitive differences when compared to normotensive controls. These preliminary studies consist mostly of database and single-center studies that focus primarily on differences in neurocognitive test performance and differences in cerebrovascular reactivity between hypertensive and normotensive subjects. Lessons from the literature on cognition in adult hypertensives and experience from the preliminary studies in children informed the design of a current, multicenter, ongoing study of cognition in children with primary hypertension. PMID:25432900

  6. The Korean Society of Hypertension Guidelines for the Management of Hypertension in 2013: Its Essentials and Key Points.

    PubMed

    Lee, Hae-Young; Park, Jeong Bae

    2015-05-01

    The Korean Society of Hypertension published new guidelines for the management of hypertension in 2013 which fully revised the first Korean hypertension treatment guideline published in 2004. Due to shortage of Korean data, the Committee decided to establish the guideline in the form of an 'adaptation' of the recently released guidelines. The prevalence of hypertension was 28.5% in the recent Korean National Health and Nutrition Examination Survey in 2011, and the awareness, treatment, and control rates are generally improving. However, the risks for cerebrovascular disease and coronary artery disease which are attributable to hypertension were the highest in Korea. The classification of hypertension is the same as in other guidelines. The remarkable difference is that prehypertension is further classified as stage 1 and 2 prehypertension because the cardiovascular risk is significantly different within the prehypertensive range. Although the decision-making was based on office blood pressure (BP) measured by the auscultation method using a stethoscope, the importance of home BP measurement and ambulatory BP monitoring is also stressed. The Korean guideline does not recommend a drug therapy in patients within the prehypertensive range, even in patients with prediabetes, diabetes mellitus, stroke, or coronary artery disease. In an elderly population over 65 years old, drug therapy can be initiated when the systolic BP (SBP) is ≥160 mm Hg. The target BP is generally an SBP of <140 mm Hg and a diastolic BP (DBP) of <90 mm Hg regardless of previous cardiovascular events. However, in patients with hypertension and diabetes, the lower DBP control <85 mm Hg is recommended. Also, in patients with hypertension with prominent albuminuria, a more strict SBP control <130 mm Hg can be recommended. In lifestyle modification, sodium reduction is the most important factor in Korea. Five classes of antihypertensive drugs, including angiotensin-converting enzyme inhibitors,

  7. Preventing the progression of prehypertension to hypertension: role of antihypertensives.

    PubMed

    Fuchs, Flávio Danni; de Mello, Renato Bandeira; Fuchs, Sandra Costa

    2015-01-01

    Recent guidelines for the diagnosis and management of hypertension reversed the historical trend to recommend lower blood pressure (BP) thresholds to diagnose hypertension in high-risk individuals, such as patients with diabetes and elderly patients. The decision to raise the BP thresholds for diagnosis of hypertension in patients with diabetes was mostly based on the findings of the ACCORD trial. Nonetheless, the results of the ACCORD trial are within the predicted benefit to prevent coronary artery disease and stroke by meta-analysis of randomized controlled trials (RCT), particularly in regard to the prevention of stroke. The Eighth Joint National Committee (JNC 8) did not address prehypertension. There are many RCT done in individuals with prehypertension and concomitant cardiovascular disease showing the benefit of treatment of these patients. Trials exploring the efficacy of interventions to prevent cardiovascular disease in individuals with prehypertension free of cardiovascular disease would be hardly feasible in face of the low absolute risk of these individuals. Considering the risks of prehypertension for cardiovascular disease and the fast progression to hypertension of a large proportion of individuals with prehypertension, it is worth to consider drug treatment for individuals with prehypertension. RCT showed that the progression to hypertension can be partially halted by BP-lowering agents. These and ongoing clinical trials are herein revised. Prehypertension may be a window of opportunity to prevent hypertension and its cardiovascular consequences. PMID:25432897

  8. Self-Care Behaviors and Related Factors in Hypertensive Patients

    PubMed Central

    Zinat Motlagh, Sayed Fazel; Chaman, Reza; Sadeghi, Erfan; Eslami, Ahmad Ali

    2016-01-01

    Background An assessment of an individual’s hypertension self-care behavior may provide clinicians and practitioners with important information regarding how to better control hypertension. Objectives The objective of this study was to investigate the self-care behaviors of hypertensive patients. Patients and Methods This cross-sectional study was conducted in 2014 in a sample of 1836 patients of both genders who had been diagnosed with hypertension in urban and rural health centers in the Kohgiluyeh Boyerahmad Province in southern Iran. They were randomly selected and were invited to participate in the study. Self-care activities were measured using the H-hypertension self-care activity level effects. Results The mean age of the respondents was 63 (range: 30 - 92), and 36.1% reported adherence to the recommended levels of medication; 24.5% followed the physical activity level guidelines. Less than half (39.2%) met the criteria for practices related to weight management, and adherence to low-salt diet recommendations was also low (12.3%). Overall, 86.7% were nonsmokers, and 100% abstained from alcohol. The results of a logistic regression indicated that gender was significantly associated with adherence to physical activity (OR = 0.716) and non-smoking (OR = 1.503) recommendations; that is, women were more likely to take part in physical activity than men. There was also a significant association between age and adherence to both a low-salt diet (OR = 1.497) and medication (OR = 1.435). Conclusions Based on our findings, it is crucial to implement well-designed educational programs to improve hypertension self-care behaviors.

  9. Current challenges in pediatric pulmonary hypertension.

    PubMed

    Takatsuki, Shinichi; Ivy, David Dunbar

    2013-10-01

    Pulmonary arterial hypertension (PAH) in the pediatric population is associated with a variety of underlying diseases and causes, significantly morbidity and mortality. In the majority of patients, PAH in children is idiopathic or associated with congenital heart disease (CHD), with pulmonary hypertension (PH) associated with connective tissue disease, a rare cause in children. Classification of pediatric PH has generally followed the WHO classification, but recognition of the importance of fetal origins of PH and developmental abnormalities have led to the formation of a new pediatric-specific classification. Incidence data from the Netherlands has revealed an annual incidence and point prevalence of 0.7 and 4.4 for idiopathic PAH and 2.2 and 15.6 for associated pulmonary arterial hypertension-CHD cases per million children. Although the treatment with new selective pulmonary vasodilators offers hemodynamic and functional improvement in pediatric populations, the treatments in children largely depend on results from evidence-based adult studies and experience of clinicians treating children. A recent randomized clinical trial of sildenafil and its long-term extension has led to disparate recommendations in the United States and Europe. PMID:24037630

  10. Rauwolfia in the Treatment of Hypertension

    PubMed Central

    Lobay, Douglas

    2015-01-01

    Rauwolfia serpentina is a safe and effective treatment for hypertension. The plant was used by many physicians throughout India in the 1940s and then was used throughout the world in the 1950s, including in the United States and Canada. It fell out of popularity when adverse side effects, including depression and cancer, became associated with it. This author reviews the scientific literature with regard to the use of Rauwolfia and the treatment of hypertension. The author reviews the plant’s botany, chemistry, and pharmacology and provides a researched and documented method of action for the active ingredients. With special emphasis on the plant’s role in treating high blood pressure, the author looks at medical uses of the plant, critically examining its adverse side effects, toxicology, and carcinogenicity. The author refutes the association between the plant and carcinogenicity and discusses the importance of correct dosing and of screening patients to minimize the occurrence of depression. He concludes with the recommendation of use of low dose Rauwolfia (LDR) for suitable patients with hypertension. The plant provides clinicians with a safe and effective adjunct to pharmaceuticals in the treatment of high blood pressure. PMID:26770146

  11. Rauwolfia in the Treatment of Hypertension.

    PubMed

    Lobay, Douglas

    2015-06-01

    Rauwolfia serpentina is a safe and effective treatment for hypertension. The plant was used by many physicians throughout India in the 1940s and then was used throughout the world in the 1950s, including in the United States and Canada. It fell out of popularity when adverse side effects, including depression and cancer, became associated with it. This author reviews the scientific literature with regard to the use of Rauwolfia and the treatment of hypertension. The author reviews the plant's botany, chemistry, and pharmacology and provides a researched and documented method of action for the active ingredients. With special emphasis on the plant's role in treating high blood pressure, the author looks at medical uses of the plant, critically examining its adverse side effects, toxicology, and carcinogenicity. The author refutes the association between the plant and carcinogenicity and discusses the importance of correct dosing and of screening patients to minimize the occurrence of depression. He concludes with the recommendation of use of low dose Rauwolfia (LDR) for suitable patients with hypertension. The plant provides clinicians with a safe and effective adjunct to pharmaceuticals in the treatment of high blood pressure. PMID:26770146

  12. Hemorheology in complicated hypertension.

    PubMed

    Cicco, G; Vicenti, P; Stingi, G D; Tarallo; Pirrelli, A

    1999-01-01

    During essential and secondary arterial hypertension it is possible to observe changes in microcirculation perfusion associated with a reduction in tissue oxygenation due in part to hemorheological changes such as an increase in blood viscosity or the formation of the red blood cell "rouleaux" which favour an increase in peripheral resistance and can cause or worsen arterial hypertension. We studied 21 healthy subjects (11 male and 10 female aged 42 +/- 4) and 26 hypertensive subjects (14 male and 12 female aged 49 +/- 3). The patients were non smokers and non suffering from respiratory or haemathological pathologies. They were not undergoing antihypertensive or vasodilatory pharmaceutical treatment. The patients suffered from mild hypertension (II WHO) with Peripheral Occlusive Arterial Disease (POAD II "a" acc. to Leriche-Fontaine class.). The patients showed an increase in cholesterolaemia (6.42 +/- 0.81 mmol/l) and trygliceridaemia (2.73 +/- 0.09 mmol/l) at an average level. The patients were studied in standard conditions with a constant temperature of 22 degrees C. We measured SBP, DBP, MBP, and the HR. We also measured the elongation index (EI) (with shear stress range 0.30 to 30 pascals) using LORCA, acc. to Hardeman method (1994), in order to study the erythrocyte deformability and aggregation kinetics in dynamic condition. To evaluate deformability in static conditions we calculated the Erythrocyte Morphologic Index (EMI), acc. to Forconi method, via the bowl/discocyte ratio (for 100 red blood cells fixed in glutaraldehyde at 0.3% and observed with an optical microscope under immersion in glycerol). Peripheral oxygenation was taken transcutaneously (TcpO2). To establish the level of vascular disease we used the Regional Perfusion Index (RPI = TcpO2 foot/TcpO2 subclavean) and doppler guided Winsor Index (WI). The Student "t" test and linear regression were used for the statistical analysis. Our data confirm a reduction in peripheral tissue oxygenation in

  13. [Fixed-drug combinations for hypertension].

    PubMed

    Sato, Nobuyuki; Hasebe, Naoyuki

    2014-08-01

    The recent guidelines for the treatment of hypertension recommend a fixed-dose combination (polypill) therapy to achieve optimal blood pressure (BP) control. Among them, angiotensin receptor blockers (ARBs) with calcium channel blockers (CCBs) or diuretics are the representative recommended combination since each drug has evidence of reducing cardiovascular events. Recent studies using ambulatory blood pressure monitoring have also suggested that the fixed-dose ARB-based combination therapies with either CCBs or diuretics are well tolerated and effectively lower the BP throughout a 24-hour interval by their long-acting half-lives, nighttime BP lowering effect and improving adherence. It will become more important to use these fixed-dose antihypertensive drugs adequately for controlling the 24-hour blood pressure. PMID:25167756

  14. The Effect of Hibiscus sabdariffa L. Tisane on Blood Pressure in Prehypertensive and Mildly Hypertensive Men and Women

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Changes in diet and physical activity are recommended for individuals with pre-hypertension and mild Stage 1 hypertension. Hibiscus sabdariffa calyces are a common ingredient in tisane (herbal tea) blends sold in the U.S. Water extracts of hibiscus possess antioxidant properties in vitro, and produc...

  15. Hypertension: the missing WNKs.

    PubMed

    Dbouk, Hashem A; Huang, Chou-Long; Cobb, Melanie H

    2016-07-01

    The With no Lysine [K] (WNK) family of enzymes are central in the regulation of blood pressure. WNKs have been implicated in hereditary hypertension disorders, mainly through control of the activity and levels of ion cotransporters and channels. Actions of WNKs in the kidney have been heavily investigated, and recent studies have provided insight into not only the regulation of these enzymes but also how mutations in WNKs and their interacting partners contribute to hypertensive disorders. Defining the roles of WNKs in the cardiovascular system will provide clues about additional mechanisms by which WNKs can regulate blood pressure. This review summarizes recent developments in the regulation of the WNK signaling cascade and its role in regulation of blood pressure. PMID:27009339

  16. Hypertension in perspective

    PubMed Central

    Terpstra, W.F.; Zijlstra, F.

    2005-01-01

    Decisions about the management of hypertensive patients should not be based on the level of blood pressure alone, but also on the presence of other risk factors, target organ damage and cardiovascular and renal disease. The results of echocardiography and carotid ultrasonography aids in the stratification of absolute cardiovascular risk as recently advocated by the guidelines of the European Society of Hypertension 2003. Therefore, the detection of target organ damage by ultrasound techniques allows an accurate identification of high-risk patients. Cardiovascular risk stratification only based on a simple routine work-up can often underestimate overall risk, thus leading to a potentially inadequate therapeutic management especially of low-medium risk patients. PMID:25696486

  17. An update on hypertensive emergencies and urgencies.

    PubMed

    Muiesan, Maria Lorenza; Salvetti, Massimo; Amadoro, Valentina; di Somma, Salvatore; Perlini, Stefano; Semplicini, Andrea; Borghi, Claudio; Volpe, Massimo; Saba, Pier Sergio; Cameli, Matteo; Ciccone, Marco Matteo; Maiello, Maria; Modesti, Pietro Amedeo; Novo, Salvatore; Palmiero, Pasquale; Scicchitano, Pietro; Rosei, Enrico Agabiti; Pedrinelli, Roberto

    2015-05-01

    Severe acute arterial hypertension is usually defined as 'hypertensive crisis', although 'hypertensive emergencies' or 'hypertensive urgencies', as suggested by the Joint National Committee and the European Society of Hypertension, have completely different diagnostic and therapeutic approaches.The prevalence and demographics of hypertensive emergencies and urgencies have changed over the last four decades, but hypertensive emergencies and urgencies are still associated with significant morbidity and mortality.Different scientific societies have repeatedly produced up-to-date guidelines; however, the treatment of hypertensive emergencies and urgencies is still inappropriate, with potential clinical implications.This review focuses on hypertensive emergencies and urgencies management and treatment, as suggested by recent data. PMID:25575271

  18. Measles -- Recommendations for Prevention

    MedlinePlus

    ... Prevent News and Media Resources News Newsletters Events Measles - Recommendations for Prevention Recommend on Facebook Tweet Share ... safest protection you can give your child against measles. Children should be given the first dose of ...

  19. Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Pulmonary hypertension in children

    PubMed Central

    Al Dabbagh, Maha; Banjar, Hanna; Galal, Nasser; Kouatli, Amjad; Kandil, Hammam; Chehab, May

    2014-01-01

    Pulmonary hypertension (PH) is relatively uncommon in children. Pulmonary arterial hypertension (PAH) in pediatric comprises a wide spectrum of diseases, from a transient neonatal condition to a progressive disease associated with morbidity and mortality. Most common PAH in pediatric are idiopathic (IPAH) or PAH associated with congenital heart disease (PAH-CHD), while other associated conditions, such as connective tissue disease (CTD), are less common in pediatrics. Despite better understanding of PH and the availability of new medications during recent decades; the diagnosis, investigation and choice of therapy remain a challenge in children, as evidence-based recommendations depend mainly on adult studies. In this review, we provide a detailed discussion about the distinctive features of PAH in pediatric, mainly emphacysing on classification and diagnostic algorithm. PMID:25076989

  20. Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Pulmonary hypertension in children.

    PubMed

    Al Dabbagh, Maha; Banjar, Hanna; Galal, Nasser; Kouatli, Amjad; Kandil, Hammam; Chehab, May

    2014-07-01

    Pulmonary hypertension (PH) is relatively uncommon in children. Pulmonary arterial hypertension (PAH) in pediatric comprises a wide spectrum of diseases, from a transient neonatal condition to a progressive disease associated with morbidity and mortality. Most common PAH in pediatric are idiopathic (IPAH) or PAH associated with congenital heart disease (PAH-CHD), while other associated conditions, such as connective tissue disease (CTD), are less common in pediatrics. Despite better understanding of PH and the availability of new medications during recent decades; the diagnosis, investigation and choice of therapy remain a challenge in children, as evidence-based recommendations depend mainly on adult studies. In this review, we provide a detailed discussion about the distinctive features of PAH in pediatric, mainly emphacysing on classification and diagnostic algorithm. PMID:25076989

  1. Renal denervation and hypertension.

    PubMed

    Schlaich, Markus P; Krum, Henry; Sobotka, Paul A; Esler, Murray D

    2011-06-01

    Essential hypertension remains one of the biggest challenges in medicine with an enormous impact on both individual and society levels. With the exception of relatively rare monogenetic forms of hypertension, there is now general agreement that the condition is multifactorial in nature and hence requires therapeutic approaches targeting several aspects of the underlying pathophysiology. Accordingly, all major guidelines promote a combination of lifestyle interventions and combination pharmacotherapy to reach target blood pressure (BP) levels in order to reduce overall cardiovascular risk in affected patients. Although this approach works for many, it fails in a considerable number of patients for various reasons including drug-intolerance, noncompliance, physician inertia, and others, leaving them at unacceptably high cardiovascular risk. The quest for additional therapeutic approaches to safely and effectively manage hypertension continues and expands to the reappraisal of older concepts such as renal denervation. Based on the robust preclinical and clinical data surrounding the role of renal sympathetic nerves in various aspects of BP control very recent efforts have led to the development of a novel catheter-based approach using radiofrequency (RF) energy to selectively target and disrupt the renal nerves. The available evidence from the limited number of uncontrolled hypertensive patients in whom renal denervation has been performed are auspicious and indicate that the procedure has a favorable safety profile and is associated with a substantial and presumably sustained BP reduction. Although promising, a myriad of questions are far from being conclusively answered and require our concerted research efforts to explore the full potential and possible risks of this approach. Here we briefly review the science surrounding renal denervation, summarize the current data on safety and efficacy of renal nerve ablation, and discuss some of the open questions that need

  2. Drug Treatment of Hypertension

    PubMed Central

    Ryan, Douglas R.

    1991-01-01

    Hypertension is an important contributor to cardiovascular disease, which accounts for about half of all deaths in Western societies. Proper control of elevated blood pressure is therefore important. Support has grown for an approach to care in which antihypertensive drug therapy is individually tailored for each patient. Management strategy based on this approach is discussed, and the advantages and disadvantages of the various antihypertensive agents are reviewed. PMID:21229011

  3. Classification of Pulmonary Hypertension.

    PubMed

    Oudiz, Ronald J

    2016-08-01

    The classification of pulmonary hypertension (PH) is an attempt to define subtypes of PH based on clinical presentation, underlying physiology, and treatment implications. Five groups of PH have been defined, and the classification scheme has been refined over the years to guide clinicians in the diagnosis and management of PH. Understanding the classification of PH is paramount before embarking on a work-up of patients with PH or suspected PH because treatment and outcome can vary greatly. PMID:27443133

  4. Robust Collaborative Recommendation

    NASA Astrophysics Data System (ADS)

    Burke, Robin; O'Mahony, Michael P.; Hurley, Neil J.

    Collaborative recommender systems are vulnerable to malicious users who seek to bias their output, causing them to recommend (or not recommend) particular items. This problem has been an active research topic since 2002. Researchers have found that the most widely-studied memory-based algorithms have significant vulnerabilities to attacks that can be fairly easily mounted. This chapter discusses these findings and the responses that have been investigated, especially detection of attack profiles and the implementation of robust recommendation algorithms.

  5. Portal hypertensive enteropathy

    PubMed Central

    Mekaroonkamol, Parit; Cohen, Robert; Chawla, Saurabh

    2015-01-01

    Portal hypertensive enteropathy (PHE) is a condition that describes the pathologic changes and mucosal abnormalities observed in the small intestine of patients with portal hypertension. This entity is being increasingly recognized and better understood over the past decade due to increased accessibility of the small intestine made possible by the introduction of video capsule endoscopy and deep enteroscopy. Though challenged by its diverse endoscopic appearance, multiple scoring systems have been proposed to classify the endoscopic presentation and grade its severity. Endoscopic findings can be broadly categorized into vascular and non-vascular lesions with many subtypes of both categories. Clinical manifestations of PHE can range from asymptomatic incidental findings to fatal gastrointestinal hemorrhage. Classic endoscopic findings in the setting of portal hypertension may lead to a prompt diagnosis. Occasionally histopathology and cross sectional imaging like computed tomography or magnetic resonance imaging may be helpful in establishing a diagnosis. Management of overt bleeding requires multidisciplinary approach involving hepatologists, endoscopists, surgeons, and interventional radiologists. Adequate resuscitation, reduction of portal pressure, and endoscopic therapeutic intervention remain the main principles of the initial treatment. This article reviews the existing evidence on PHE with emphasis on its classification, diagnosis, clinical manifestations, endoscopic appearance, pathological findings, and clinical management. A new schematic management of ectopic variceal bleed is also proposed. PMID:25729469

  6. [Chronic thromboembolic pulmonary hypertension].

    PubMed

    Zonzin, Pietro; Vizza, Carmine Dario; Favretto, Giuseppe

    2003-10-01

    Chronic thromboembolic pulmonary hypertension is due to unresolved or recurrent pulmonary embolism. In the United States the estimated prevalence is 0.1-0.5% among survived patients with pulmonary embolism. The survival rate at 5 years was 30% among patients with a mean pulmonary artery pressure > 40 mmHg at the time of diagnosis and only 10% among those with a value > 50 mmHg. The interval between the onset of disturbances and the diagnosis may be as long as 3 years. Doppler echocardiography permits to establish the diagnosis of pulmonary hypertension. Radionuclide scanning determines whether pulmonary hypertension has a thromboembolic basis. Right heart catheterization and pulmonary angiography are performed in order to establish the extension and the accessibility to surgery of thrombi and to rule out other causes. The surgical treatment is thromboendarterectomy. A dramatic reduction in the pulmonary vascular resistance can be achieved; corresponding improvements in the NYHA class--from class III or IV before surgery to class I-II after surgery--are usually observed. Patients who are not considered candidates for thromboendarterectomy may be considered candidates for lung transplantation. PMID:14664293

  7. Hypertension in the elderly.

    PubMed

    Coope, J

    1987-08-01

    Hypertension is a common finding in patients aged over 60 years, but the following questions need answering. How dangerous is it? Will lowering the blood pressure reduce the attendant risks? What is the 'cost' of such treatment in terms of side effects, drug-induced disease and health service finance? Two recently completed trials throw light on these problems: EWPHE (European Working Party on Hypertension in the Elderly), a European study based on hospital-clinic attenders, using a diuretic backed up with methyldopa; and HEP (randomized trial of treatment of Hypertension in Elderly Patients in Primary Care), based on general-practice screening in England and Wales using atenolol and bendrofluazide. The results of these trials were compared and the findings were broadly similar in the two studies. Some of the differences may be due to the different selection of patients. It is concluded that elderly patients with sustained blood pressures greater or equal to 170/90 mmHg would benefit from treatment by substantial reduction of stroke. Diuretics or beta-blockers, alone or together, are acceptable treatments in elderly subjects. PMID:3312529

  8. Management of hypertension emergencies.

    PubMed

    Elliott, William J

    2003-12-01

    Although they have become less common, hypertensive emergencies occur with an incidence of approximately 1 to 2/100,000 people per year. Our knowledge about this problem, its pathophysiology, risk factors, and appropriate treatment options has expanded during the past decade. A hypertensive emergency can be declared when an elevated blood pressure is associated with acute target-organ damage. Rapid evaluation and treatment (typically with an intravenously administered agent) should be instituted, usually in an intensive care unit setting, and the patient should be observed carefully during acute blood-pressure lowering. When properly treated, the prognosis for these patients is not nearly as dismal as it was more than 60 years ago, and the initial level of function of target organs (brain, heart, kidneys) is more indicative of an emergency than the actual level of blood pressure. Therapeutic options include the time-tested sodium nitroprusside (which has toxic metabolic products and is contraindicated in pregnancy, tobacco amblyopia, and Leber's optic atrophy); fenoldopam mesylate; and nicardipine. When properly treated, "malignant hypertension" need be considered malignant no longer. PMID:14594569

  9. Managing hypertension by polyphenols.

    PubMed

    Fernández-Arroyo, Salvador; Camps, Jordi; Menendez, Javier A; Joven, Jorge

    2015-06-01

    Some polyphenols, obtained from plants of broad use, induce a favorable endothelial response in hypertension and beneficial effects in the management of other metabolic cardiovascular risks. Previous studies in our laboratories using the calyces of Hibiscus sabdariffa as a source of polyphenols show that significant effects on hypertension are noticeable in humans only when provided in high amounts. Available data are suggestive in animal models and ex vivo experiments, but data in humans are difficult to acquire. Additionally, and despite the low bioavailability of polyphenols, intervention studies provide evidence for the protective effects of secondary plant metabolites. Assumptions on public health benefits are limited by the lack of scientific knowledge, robust data derived from large randomized clinical trials, and an accurate assessment of the bioactive components provided by common foodstuff. Because it is likely that clinical effects are the result of multiple interactions among different polyphenols rather than the isolated action of unique compounds, to provide polyphenol-rich botanical extracts as dietary supplements is a suggestive option. Unfortunately, the lack of patent perspectives for the pharmaceutical industries and the high cost of production and release for alimentary industries will hamper the performance of the necessary clinical trials. Here we briefly discuss whether and how such limitations may complicate the extensive use of plant-derived products in the management of hypertension and which steps are the necessary to deal with the predictable complexity in a possible clinical practice. PMID:25714729

  10. Hypertension in the elderly.

    PubMed

    Robles, Nicolas R; Macias, Juan F

    2015-01-01

    Data collected over a 30-year period have demonstrated the increasing prevalence of hypertension with age. Aging is an inevitable part of life and brings along two inconvenient events: physiologic decline and disease state. High blood pressure (HBP) is an important risk factor for cardiovascular morbidity and mortality, particularly in the elderly. It is a significant and often asymptomatic chronic disease, which requires optimal control and persistent adherence to prescribed medication to reduce the risks of cardiovascular, cerebrovascular and renal disease. Hypertension in the elderly patients represents a management dilemma to geriatric and cardiovascular specialists and other practitioners. Furthermore, with the wide adoption of multiple drug strategies targeting subgroups of hypertensive patients with specific risk conditions to lower blood pressure (BP), difficult questions arise about how aggressive treatment of elderly patients should be. The purpose of the following chapter article is to review the pathophysiology of aging as well as the epidemiology and the clinical assessment of high blood pressure (HBP) in older people. PMID:25761101

  11. Pulmonary Hypertension in Cardiac Surgery

    PubMed Central

    Denault, André; Deschamps, Alain; Tardif, Jean-Claude; Lambert, Jean; Perrault, Louis

    2010-01-01

    Pulmonary hypertension is an important prognostic factor in cardiac surgery associated with increased morbidity and mortality. With the aging population and the associated increase severity of illness, the prevalence of pulmonary hypertension in cardiac surgical patients will increase. In this review, the definition of pulmonary hypertension, the mechanisms and its relationship to right ventricular dysfunction will be presented. Finally, pharmacological and non-pharmacological therapeutic and preventive approaches will be presented. PMID:21286273

  12. Hypertension as a risk factor for migraine chronification.

    PubMed

    Barbanti, P; Aurilia, C; Egeo, G; Fofi, L

    2010-06-01

    Progression of episodic migraine to chronic migraine may be related to comorbid medical conditions. In this study, we focused on the role played by arterial hypertension in migraine transformation. Several studies reveal that hypertension is associated with chronic migraine and may induce migraine chronification. Hypertension probably amplifies the effects of migraine on the vascular wall further enhancing the endothelial dysfunction in cerebral vasculature. Consequently, monitoring of blood pressure is recommended in migraineurs showing an otherwise unexplained increase in attack frequency. Studies are needed to verify if prophylactic treatment with drugs improving endothelial function (e.g. calcium channel blockers, beta blockers, calcium inhibitors, ACE inhibitors and sartans) may selectively ameliorate the course of migraine in these patients. PMID:20464581

  13. Pharmacologic Treatment of Pediatric Hypertension.

    PubMed

    Dhull, Rachita S; Baracco, Rossana; Jain, Amrish; Mattoo, Tej K

    2016-04-01

    Prevalence of hypertension is increasing in children and adolescents. Uncontrolled hypertension in children not only causes end organ damage but also increases the risk of adult hypertension and cardiovascular disease. Clinical trials have proven efficacy of antihypertensive medications in children. These medications are well tolerated by children with acceptable safety profile. The choice of agent is usually driven by underlying etiology of hypertension, profile of its side effects, and clinician's preference. This article will review currently available pediatric data on mechanism of action, common adverse effects, pediatric indication, recent clinical trial, and newer drugs in the common classes of antihypertensive medications. PMID:27048353

  14. Epidemiology and Genetics of Hypertension.

    PubMed

    Sarkar, Taposh; Singh, Narinder Pal

    2015-09-01

    The prevalence of hypertension is increasing in India as well as in the world. The average prevalence of hypertension in India is 25-30%. The median prevalence of total hypertension in 2009 was 37.6% in men and 40.1% in women in U.S. Hypertension is a major risk factor for majority of patients with cardiovascular, cerebrovascular and renal morbidity and mortality. Environmental factors as well as genetic factors account for regulation of blood pressure and its control. Understanding of genetic factor may not only help in recognising those at risk but also help in treatment. Discovering hypertension susceptibility genes would help recognizing those at risk for developing the disease before the expression of clinical symptoms. Genetic and epidemiological studies have suggested that essential hypertension is a polygenic and multifactorial disorder that results from genetic and/or environmental factors. In India awareness, treatment and control status of hypertension is low, with only half of the urban and a quarter of the rural hypertensive individuals being aware of its presence. In this review we have discussed epidemiology and genetics of hypertension, both the monogenic and polygenic forms. PMID:27608868

  15. Vascular Inflammatory Cells in Hypertension

    PubMed Central

    Harrison, David G.; Marvar, Paul J.; Titze, Jens M.

    2012-01-01

    Hypertension is a common disorder with uncertain etiology. In the last several years, it has become evident that components of both the innate and adaptive immune system play an essential role in hypertension. Macrophages and T cells accumulate in the perivascular fat, the heart and the kidney of hypertensive patients, and in animals with experimental hypertension. Various immunosuppressive agents lower blood pressure and prevent end-organ damage. Mice lacking lymphocytes are protected against hypertension, and adoptive transfer of T cells, but not B cells in the animals restores their blood pressure response to stimuli such as angiotensin II or high salt. Recent studies have shown that mice lacking macrophages have blunted hypertension in response to angiotensin II and that genetic deletion of macrophages markedly reduces experimental hypertension. Dendritic cells have also been implicated in this disease. Many hypertensive stimuli have triggering effects on the central nervous system and signals arising from the circumventricular organ seem to promote inflammation. Studies have suggested that central signals activate macrophages and T cells, which home to the kidney and vasculature and release cytokines, including IL-6 and IL-17, which in turn cause renal and vascular dysfunction and lead to blood pressure elevation. These recent discoveries provide a new understanding of hypertension and provide novel therapeutic opportunities for treatment of this serious disease. PMID:22586409

  16. Hyperuricemia and uncontrolled hypertension in treated hypertensive patients

    PubMed Central

    Cho, Jaelim; Kim, Changsoo; Kang, Dae Ryong; Park, Jeong Bae

    2016-01-01

    Abstract Previous epidemiological studies have suggested that uric acid is an independent risk factor for incident hypertension, whereas few studies have evaluated the effect of hyperuricemia on blood pressure control in hypertensive patients. We investigated whether hyperuricemia predicts uncontrolled hypertension through a large-scale prospective cohort study with hypertensive patients treated with fimasartan in the Republic of Korea (the Kanarb–Metabolic Syndrome study). Of the 10,601 hypertensive patients who were recruited from 582 private clinics and 11 university hospitals at baseline, 7725 completed the follow-up after 3 months of fimasartan medication, and 6506 were included in the analysis after excluding those with missing values. We estimated the risk of uncontrolled hypertension after 3 months (≥130/80 mm Hg in those with diabetes or chronic renal failure and ≥140/90 mm Hg in the remaining patients) related with baseline hyperuricemia (serum uric acid ≥7 mg/dL in males ≥6 mg/dL in females) using multiple logistic regression models. Hyperuricemia increased the risk of uncontrolled hypertension after 3 months of fimasartan medication (odds ratio, 1.247; 95% confidence interval, 1.063–1.462). Males in the highest quartile of uric acid level were at a 1.322 (95% confidence interval, 1.053–1.660) times higher risk of uncontrolled hypertension in reference to the lowest quartile; the same analyses in females were not significant. Patients without metabolic syndrome had significantly higher odds of uncontrolled hypertension with hyperuricemia (odds ratio, 1.328; 95% confidence interval, 1.007–1.751). Hyperuricemia predicted uncontrolled hypertension even after 3 months of fimasartan treatment in hypertensive patients. PMID:27428212

  17. Genetics Home Reference: pulmonary arterial hypertension

    MedlinePlus

    ... Primary pulmonary hypertension 2 Primary pulmonary hypertension 3 Primary pulmonary hypertension 4 ClinicalTrials.gov (1 link) ClinicalTrials.gov Scientific articles on PubMed (1 link) PubMed OMIM (4 links) ...

  18. Cardiovascular Update: Risk, Guidelines, and Recommendations.

    PubMed

    Pearson, Tamera

    2015-09-01

    This article provides an update of the current status of cardiovascular disease (CVD) in the United States, including a brief review of the underlying pathophysiology and epidemiology. This article presents a discussion of the latest American Heart Association guidelines that introduce the concept of promoting ideal cardiovascular health, defined by seven identified metrics. Specific CVD risk factors and utilization of the 10-year CVD event prediction calculator are discussed. In addition, current management recommendations of health-related conditions that increase risk for CVD, such as hypertension and hypercholesterolemia, are provided. Finally, a discussion of detailed evidence-based lifestyle recommendations to promote cardiovascular health and reduce CVD risks concludes the update. PMID:26156147

  19. What is the evidence base for diagnosing hypertension and for subsequent blood pressure treatment targets in the prevention of cardiovascular disease?

    PubMed

    Schwartz, Claire L; McManus, Richard J

    2015-01-01

    Diagnosing and treating hypertension plays an important role in minimising the risk of cardiovascular disease and stroke. Early and accurate diagnosis of hypertension, as well as regular monitoring, is essential to meet treatment targets. In this article, current recommendations for the screening and diagnosis of hypertension are reviewed. The evidence for treatment targets specified in contemporary guidelines is evaluated and recommendations from the USA, Canada, Europe and the UK are compared. Finally, consideration is given as to how diagnosis and management of hypertension might develop in the future. PMID:26456709

  20. Pediatric Pulmonary Hypertension: Guidelines From the American Heart Association and American Thoracic Society.

    PubMed

    Abman, Steven H; Hansmann, Georg; Archer, Stephen L; Ivy, D Dunbar; Adatia, Ian; Chung, Wendy K; Hanna, Brian D; Rosenzweig, Erika B; Raj, J Usha; Cornfield, David; Stenmark, Kurt R; Steinhorn, Robin; Thébaud, Bernard; Fineman, Jeffrey R; Kuehne, Titus; Feinstein, Jeffrey A; Friedberg, Mark K; Earing, Michael; Barst, Robyn J; Keller, Roberta L; Kinsella, John P; Mullen, Mary; Deterding, Robin; Kulik, Thomas; Mallory, George; Humpl, Tilman; Wessel, David L

    2015-11-24

    Pulmonary hypertension is associated with diverse cardiac, pulmonary, and systemic diseases in neonates, infants, and older children and contributes to significant morbidity and mortality. However, current approaches to caring for pediatric patients with pulmonary hypertension have been limited by the lack of consensus guidelines from experts in the field. In a joint effort from the American Heart Association and American Thoracic Society, a panel of experienced clinicians and clinician-scientists was assembled to review the current literature and to make recommendations on the diagnosis, evaluation, and treatment of pediatric pulmonary hypertension. This publication presents the results of extensive literature reviews, discussions, and formal scoring of recommendations for the care of children with pulmonary hypertension. PMID:26534956

  1. Dietary Calcium: a low priority in treatment of essential hypertension by Toronto family practitioners

    PubMed Central

    Hayman, EK

    1986-01-01

    A sample of Toronto family practitioners was surveyed in order to ascertain whether increased dietary calcium was recommended in the treatment of essential hypertension. It was found that in excess of four-fifths of the same make no dietary calcium recommendations. It was concluded that this was the result of one or more of the following: 1. the low priority granted to nutrition in medical schools and continuing education courses contributes to a lack of awareness of nutritional therapies; 2. the relatively small body of literature pertaining to calcium and hypertension in contrast to the large volume of publications concerning drug therapies may contribute to a lack of familiarity with the research into calcium and hypertension; 3. the fact that the data to date have not established a definite causal relationship between low dietary calcium and hypertension may contribute to a lack of conviction as to the efficacy of increased dietary calcium as a treatment.

  2. [Management of arterial hypertension before 20weeks gestation in pregnant women].

    PubMed

    Seguro, Florent; Duly Bouhanick, Béatrice; Chamontin, Bernard; Amar, Jacques

    2016-01-01

    In the first 6 months of pregnancy, the primary goal of antihypertensive treatment is to prevent the complications of severe hypertension. Initiation of antihypertensive drug treatment is recommended in pregnant women with severe hypertension (blood pressure>160/110mmHg). Initiation of antihypertensive drug treatment should also be considered in pregnant women at high cardiovascular risk (diabetes, chronic kidney disease, personal history of cardiovascular disease) with moderate hypertension (blood pressure between 140-159/90-109mmHg). A systolic blood pressure goal<160 and a diastolic blood pressure goal between 85 and 100mmHg is recommended in pregnancy. Labetalol, nifedipine, nicardipine and alphamethyldopa should be considered preferential antihypertensive drugs in pregnancy. Salt restriction, physical exercise and weight loss have not demonstrated any effect in the prevention of preeclampsia and serious maternal complications of hypertension. PMID:27554460

  3. Diagnosing and Managing Primary Aldosteronism in Hypertensive Patients: a Case-Based Approach.

    PubMed

    Carey, Robert M

    2016-10-01

    Primary aldosteronism with a prevalence of 8 % of hypertension and 20 % of pharmacologically resistant hypertension is the most common secondary cause of hypertension. Yet, the diagnosis is missed in the vast majority of patients. Current clinical practice guidelines recommend screening for primary aldosteronism in patients with sustained elevation of blood pressure (BP) ≥150/100 mmHg if possible prior to initiation of antihypertensive therapy, and in patients with resistant hypertension, spontaneous or diuretic-induced hypokalemia, adrenal incidentaloma, obstructive sleep apnea, a family history of early onset of hypertension or cerebrovascular accident

  4. Pheochromocytoma induced hypertension.

    PubMed

    Andrews, Deborah

    2010-12-01

    Pheochromocytoma (Pheo) is a rare tumor that develops in the core of a chromaffin cell. This article will focus on pheochromocytoma and its affect on the heart. Because the signs and symptoms of a pheochromocytoma are those of the sympathetic nervous system, this tumor is hard to detect and might not be considered early on. In addition, there are many common deferential diagnoses that may lead to a delay of the correct diagnosis of a pheochromocytoma. Uncontrollable hypertension is one of the primary effects of pheochromocytoma. A severe increase in blood pressure (hypertensive crisis) may occur and this can be a life threatening condition that leads to stroke or arrhythmias. African-Americans are disproportionately affected by hypertension and they often go undiagnosed because of a lack of resources or access to care. This tumor is difficult to detect and its effects often mimic many other diagnoses, which often leads to this tumor being a late consideration. The long-term effects of a pheochromocytoma can lead to damage to the heart muscle, congestive heart failure (CHF), increased risk of diabetes, and even death. Nurses need to be aware of the key signs and symptoms of a pheochromocytoma, and to know when testing for this tumor what symptoms should be considered. Patients who suffer from a diagnosis of this tumor need a lot of emotional support and they must follow a strict diet and medication regimen. Nurses can play a vital role in raising awareness in our community about this tumor as well as being a patient advocate. PMID:21516925

  5. Aliskiren-hydrochlorothiazide combination for the treatment of hypertension.

    PubMed

    Chrysant, Steven G

    2008-03-01

    Hypertension is a major risk factor for cardiovascular morbidity and mortality and currently has been estimated at 30% of the US population. Of these, only 36.8% have their blood pressure reduced to recommended levels of lower than 140/90 mmHg for uncomplicated hypertension, or less than 130/80 mmHg for patients with diabetes mellitus or renal disease. Since monotherapy controls blood pressure in less than 50% of treated hypertensive patients, combination therapy is often required to bring blood pressure to the recommended levels of the 7th Joint National Committee report. One of the most effective and widely used combinations is the combination of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker with hydrochlorothiazide (HCTZ). Aliskiren, a new blocker of the renin-angiotensin system has been developed and approved by the US FDA on 18th January 2008 for the treatment of hypertension. Aliskiren is a direct inhibitor of renin, the rate-limiting enzyme for the production of angiotensin II, a powerful vasoconstrictive peptide. Several randomized clinical trials have demonstrated that aliskiren administered in single daily doses of 150, 300 or 600 mg alone and in combination with HCTZ 12.5 and 25 mg is effective in lowering blood pressure, and is safe and well tolerated. In this article, the pharmacokinetic and pharmacodynamic profile and the clinical application of aliskiren alone and in combination with HCTZ will be discussed. PMID:18327992

  6. [Low-flow xenon anesthesia in surgical patients with hypertension].

    PubMed

    Rashchupkin, A B; Burov, N E

    2011-01-01

    A comparative study of central hemodynamics in 60 patients with essential hypertension during low flow anesthesia with xenon and nitrous oxide is carried out. The main group consisted of 30 patients, 22 male and 8 female, in the median age of 45.9 +/- 23 years. 22 patients out of those had 2nd stage essential hypertension, while the other 8 had 3rd stage. The control group consisted of 30 patients, 20 male and 10 female, in the median age of 45.1 + 1.3 years. 4 patients had 3rd stage essential hypertension, 26 patients had 2nd stage. The both groups were clinically comparable by the character and severity of the main disease, the carried out surgery (open cholecystectomy) and the qualification of surgeons. Results of the research showed, that low flow monoanesthesia with xenon abruptly eradicated the unfavourable consequences of induction of anesthesia (3-5 mg/kg of sodium thiopental or 2-2.5 mg/kg of propofol) and had a positive effect on the parameters of central hemodynamics of patients with essential hypertension. Xenon anesthesia, compared to nitrous oxide, rapidly stabilized the parameters of blood pressure and heart rate and can be recommended as a method of choice in patients with essential hypertension and compromised myocarium. Nitrous oxide with bolus of regular fentanyl doses doesn't reliable anesthesiological protection during open cholecystectomy and shows signs of toxicity. PMID:21692217

  7. [Assessment of cardiovascular risk in hypertensive patients: comparison among scores].

    PubMed

    Del Colle, Sara; Rabbia, Franco; Mulatero, Paolo; Veglio, Franco

    2004-09-01

    At present, a correct and thorough risk evaluation represents the best prognostic and therapeutic approach for hypertensive patients. Recent European and American guidelines recommend a global stratification of the cardiovascular risk of hypertensive patients, based on the evaluation of risk factors, organ damage, and the clinical conditions associated with hypertension. A similar approach uses numerical risk scores that transform the percentage risk, calculated from large populations, into absolute values. These scores have been calculated by different research groups and scientific organizations with the aim of better defining the real risk of a given population over time. Many of these risk scores have been conceived by American and European scientific groups on the basis of the epidemiology of different risk variables in the respective populations; in general, north American hypertensives are exposed to a higher cardiovascular risk compared to Europeans and some European countries have a higher risk than others. The present review underlines the pivotal role of a correct risk evaluation of hypertension as reported in the guidelines. We briefly analyze the principal studies on risk scores: we compare the advantages and disadvantages of the different scores, as well as the similarities and differences, in order to demonstrate not only their utility, but also the possible equivalence of the different parameters considered. PMID:15568607

  8. Intracranial Hypertension in Children without Papilledema.

    PubMed

    Chelse, Ana B; Epstein, Leon G

    2015-08-01

    Researchers at Nationwide Children's Hospital studied the frequency of intracranial hypertension without papilledema in children followed in a multispecialty pediatric intracranial hypertension clinic. PMID:26933598

  9. [Chronotherapy in arterial hypertension].

    PubMed

    Bendersky, M

    2015-01-01

    The blood pressure profile in most normo- and hypertensive subjects are currently known, as well as the impact their changes induced on the cardio- and cerebrovascular risk. Ambulatory blood pressure monitoring (ABPM) has contributed greatly to the knowledge of this parameter. It to correct the schedule of drug administration (chronotherapy) with changes in any component of the BP profile that have better correlation with risk. These include the nocturnal decrease and the morning BP surge. Investigations in this direction are still scarce, and multicenter studies need to be conducted that can answer the true preventive impact of such modifications. PMID:26180036

  10. Sexual function in hypertensive patients receiving treatment

    PubMed Central

    Reffelmann, Thorsten; Kloner, Robert A

    2006-01-01

    In many forms of erectile dysfunction (ED), cardiovascular risk factors, in particular arterial hypertension, seem to be extremely common. While causes for ED are related to a broad spectrum of diseases, a generalized vascular process seems to be the underlying mechanism in many patients, which in a large portion of clinical cases involves endothelial dysfunction, ie, inadequate vasodilation in response to endothelium-dependent stimuli, both in the systemic vasculature and the penile arteries. Due to this close association of cardiovascular disease and ED, patients with ED should be evaluated as to whether they may suffer from cardiovascular risk factors including hypertension, cardiovascular disease or silent myocardial ischemia. On the other hand, cardiovascular patients, seeking treatment of ED, must be evaluated in order to decide whether treatment of ED or sexual activity can be recommended without significantly increased cardiac risk. The guideline from the first and second Princeton Consensus Conference may be applied in this context. While consequent treatment of cardiovascular risk factors should be accomplished in these patients, many antihypertensive drugs may worsen sexual function as a drug specific side-effect. Importantly, effective treatment for arterial hypertension should not be discontinued as hypertension itself may contribute to altered sexual functioning; to the contrary, alternative antihypertensive regimes should be administered with individually tailored drug regimes with minimal side-effects on sexual function. When phosphodiesterase-5 inhibitors, such as sildenafil, tadalafil and vardenafil, are prescribed to hypertensive patients on antihypertensive drugs, these combinations of antihypertensive drugs and phosphodiesterase 5 are usually well tolerated, provided there is a baseline blood pressure of at least 90/60 mmHg. However, there are two exceptions: nitric oxide donors and α-adrenoceptor blockers. Any drug serving as a nitric oxide

  11. The Immune System in Hypertension

    ERIC Educational Resources Information Center

    Trott, Daniel W.; Harrison, David G.

    2014-01-01

    While hypertension has predominantly been attributed to perturbations of the vasculature, kidney, and central nervous system, research for almost 50 yr has shown that the immune system also contributes to this disease. Inflammatory cells accumulate in the kidneys and vasculature of humans and experimental animals with hypertension and likely…

  12. Exercise hypertension: an adverse prognosis?

    PubMed

    Smith, Ryan G; Rubin, Stanley A; Ellestad, Myrvin H

    2009-01-01

    We sought to clarify the prognostic importance of an "exaggerated" or "hypertensive" systolic blood pressure response to exercise during an exercise test. Studies evaluating the prognosis for cardiovascular events and cardiovascular mortality in those with hypertension during exercise testing were systematically reviewed. Fourteen studies were identified. Six studies were of healthy volunteers or hypertensives. Eight studies were in subjects with known or suspected heart disease. Without established heart disease, exercise hypertension predicted cardiovascular events and cardiovascular death. However, two of the six studies included a multivariate analysis; both demonstrated no independent association. Studies in subjects with known or suspected heart disease demonstrated that exercise hypertension predicted fewer cardiac events and lesser mortality or, after multivariate adjustment, no associated risk. In a healthy population, a higher exercise blood pressure may indicate hypertension or prehypertension, instead of normal vascular function, and an associated long-term adverse prognosis. In a population with a high burden of heart disease, the highest risk subjects with the most extensive cardiac disease may not be capable of generating pressure or workload to allow the manifestation of exercise systolic hypertension. By comparison, therefore, those with exercise hypertension have a better prognosis. PMID:20409979

  13. Endocrine hypertension – Cushing's syndrome

    PubMed Central

    Singh, Yashpal; Kotwal, Narendra; Menon, A. S.

    2011-01-01

    Hypertension is a major and frequent comorbid finding of Cushing's syndrome. This review discusses the etiology and pathophysiology of hypertension in Cushing's syndrome, while suggesting methods of management of this condition. It also provides an overview of diagnosis and management strategies in this disease. PMID:22145133

  14. Mental health in hypertension: assessing symptoms of anxiety, depression and stress on anti-hypertensive medication adherence

    PubMed Central

    2014-01-01

    Background Patients with chronic conditions like hypertension may experience many negative emotions which increase their risk for the development of mental health disorders particularly anxiety and depression. For Ghanaian patients with hypertension, the interaction between hypertension and symptoms of anxiety, depression and stress remains largely unexplored. To fill this knowledge gap, the study sought to ascertain the prevalence and role of these negative emotions on anti-hypertensive medication adherence while taking into account patients’ belief systems. Methods The hospital-based cross-sectional study involving 400 hypertensive patients was conducted in two tertiary hospitals in Ghana. Data were gathered on patient’s socio-demographic characteristics, anxiety, depression and stress symptoms, spiritual beliefs, and medication adherence. Results Hypertensive patients experienced symptoms of anxiety (56%), stress (20%) and depression (4%). As a coping mechanism, a significant relation was observed between spiritual beliefs and anxiety (x2 = 13.352, p = 0.010), depression (x2 = 6.205, p = 0.045) and stress (x2 = 14.833, p = 0.001). Stress among patients increased their likelihood of medication non-adherence [odds ratio (OR) = 2.42 (95% CI 1.06 – 5.5), p = 0.035]. Conclusion The study has demonstrated the need for clinicians to pay attention to negative emotions and their role in medication non-adherence. The recommendation is that attention should be directed toward the use of spirituality as a possible mechanism by which negative emotions could be managed among hypertensive patients. PMID:24987456

  15. HyperCare: a prototype of an active database for compliance with essential hypertension therapy guidelines.

    PubMed Central

    Caironi, P. V.; Portoni, L.; Combi, C.; Pinciroli, F.; Ceri, S.

    1997-01-01

    HyperCare is a prototype of a decision support system for essential hypertension care management. The medical knowledge implemented in HyperCare derives from the guidelines for the management of mild hypertension of the World Health Organization/International Society of Hypertension, and from the recommendations of the United States Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. HyperCare has been implemented using Chimera, an active database language developed at the Politecnico di Milano. HyperCare proves the possibility to use active database systems in developing a medical data-intensive application where inferential elaboration of moderate complexity is required. PMID:9357634

  16. Hypertensive heart disease

    MedlinePlus

    ... are those who are overweight or obese, and African Americans. Your health care provider may recommend more frequent screenings based on your blood pressure levels and other health ... your provider. Carefully control diabetes and high cholesterol.

  17. Expert consensus on the treatment of hypertension with chinese patent medicines.

    PubMed

    Wang, Li Ying; Chan, Kam Wa; Yuwen, Ya; Shi, Nan Nan; Han, Xue Jie; Lu, Aiping

    2013-01-01

    Objectives. This study was aimed to determine the therapeutic principle and identify Chinese Patent Medicine (CPM) with corresponding indications for hypertension treatment. Methods. Three rounds of Delphi survey were mailed among 40 cardiovascular integrative medicine specialists. Items with agreement of more than 80% respondents were included in the consensus. Results. According to majority of the panelists, CPM is suitable for most hypertensive patients and should be used according to traditional Chinese medicine pattern classification. CPM could be used alone for grade 1 hypertension and could be used in combination with Western biomedicine (WM) for both grade 2 and grade 3 hypertension. It is recommended that less than two CPMs are used simultaneously. For the treatment of grade 2 and 3 hypertension, CPM and WM should be taken separately. Recommended CPMs included Tianma Gouteng granule, Qiju Dihuang capsule, Jinkui Shenqi pill, Yinxingye tablet, Niuhuang Jiangya pill and Banxia Tianma pill. The indications of 4 CPMs were specified with symptoms related to TCM pattern classification by the experts. Conclusions. An expert consensus on CMP application was formed for the treatment of hypertension in the form of integrative medicine. A flow of IM hypertension management was proposed based on the results of the survey. PMID:23662141

  18. Inflammatory cytokines in pulmonary hypertension

    PubMed Central

    2014-01-01

    Pulmonary hypertension is an “umbrella term” used for a spectrum of entities resulting in an elevation of the pulmonary arterial pressure. Clinical symptoms include dyspnea and fatigue which in the absence of adequate therapeutic intervention may lead to progressive right heart failure and death. The pathogenesis of pulmonary hypertension is characterized by three major processes including vasoconstriction, vascular remodeling and microthrombotic events. In addition accumulating evidence point to a cytokine driven inflammatory process as a major contributor to the development of pulmonary hypertension. This review summarizes the latest clinical and experimental developments in inflammation associated with pulmonary hypertension with special focus on Interleukin-6, and its role in vascular remodeling in pulmonary hypertension. PMID:24739042

  19. Hypertension in children and adolescents.

    PubMed

    Mitsnefes, Mark M

    2006-06-01

    Hypertension is one of the most common health problems in the United States and a powerful independent risk factor for cardiovascular and renal disease. Until recently, the incidence of persistent hypertension in children has been low, with a range of 1% to 3%. Recent data indicate that over the last decade, however, average blood pressure levels have risen substantially among American children. Obesity and other lifestyle factors, such as physical inactivity and increased intake of high-calorie, high-salt foods, are thought to be responsible for this trend. Hypertension in children is currently recognized as an important health issue. There is increasing evidence that hypertension has its antecedents during childhood, because adult blood pressure often correlates with childhood blood pressure. Hypertension in children also is viewed as a significant risk factor for the development of cardiovascular disease in adulthood. PMID:16716793

  20. Homocysteine and essential hypertension.

    PubMed

    Rodrigo, Ramón; Passalacqua, Walter; Araya, Julia; Orellana, Myriam; Rivera, Gonzalo

    2003-12-01

    The authors examine the available clinical and experimental data supporting the view that homocysteine, an alternative risk factor of cardiovascular disease, may play a role in the pathogenesis of essential hypertension. The mechanism of this disease has not been elucidated, but it may be related to impairment of vascular endothelial and smooth muscle cell function. Therefore, the occurrence of endothelial dysfunction could contribute to alterations of the endothelium-dependent vasomotor regulation. Elevated homocysteinemia diminishes the vasodilation by nitric oxide, increases oxidative stress, stimulates the proliferation of vascular smooth muscle cells, and alters the elastic properties of the vascular wall. Thus, homocysteine contributes to elevate the blood pressure. Also it is known that elevated plasma levels of homocysteine could lead to oxidant injury to the endothelium. The correction of elevated homocysteinemia by administration of vitamins B12 and B6 plus folic acid, could be a useful adjuvant therapy of hypertension. However, further controlled randomized trials are necessary to establish the efficacy and tolerability of these potentially therapeutic agents. PMID:14615465

  1. β-Blockers in hypertension: studies and meta-analyses over the years.

    PubMed

    Larochelle, Pierre; Tobe, Sheldon W; Lacourcière, Yves

    2014-05-01

    β-Blockers are among the most commonly used medications in the treatment of hypertension. However, 45 years after their initial indication for that treatment, their place in the treatment of hypertensive patients is under evaluation and their usefulness has been questioned based on evidence from meta-analyses of clinical trials. The β-blocker class consists of various agents with diverse pharmacokinetic and pharmacodynamic properties including lipo- and hydrophilicity, duration of action, intrinsic sympathomimetic activity, vasodilation, and metabolism linked to genetic polymorphisms. Because of their various properties, some β-blockers are indicated for cardiovascular conditions such as angina, rate control of atrial fibrillation, chronic heart failure, and after myocardial infarction, and other indications such as migraine and essential tremor. There have been more than 17 large trials influencing the recommendations on the use of these agents in the treatment of hypertension. The results of these trials initially led to the widespread recommendation for the use of β-blockers in the management of hypertension. However, the recent multiple meta-analyses using these trials have raised a controversy on their place in that treatment. The Canadian Hypertension Education Program recommendations have included β-blockers as a first-line treatment option for patients younger than 60 years of age based on the evidence from these large trials, and this has been supported by 2 of the meta-analyses. This article reviews these studies to help clinicians better understand the role of β-blockers in managing hypertension. PMID:24750978

  2. The contribution of the ACCOMPLISH trial to the treatment of stage 2 hypertension.

    PubMed

    Byrd, James Brian; Bakris, George; Jamerson, Kenneth

    2014-03-01

    The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommended a thiazide-like diuretic, alone or in combination with other antihypertensive drug classes, as initial therapy for hypertension. JNC 7, however, did not specify preferred combinations. The Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial was completed five years after the JNC 7 and demonstrated a 20 % advantage in cardiovascular risk reduction when blood pressure was lowered using the single-pill combination of benazepril-amlodipine compared to benazepril-hydrochlorothiazide (Jamerson et al. 359(23):2417-28 [1]). This new and significant finding provided compelling evidence that the long-standing preference for diuretics as initial therapy could be refuted, but it may also be relevant to the lower-than-expected reduction in coronary disease related events (compared to stroke) observed for decades prior to the ACCOMPLISH approach to therapy. The JNC 8 panel members recently published their recommendations, and while the group did not recommend benazepril-hydrochlorothiazide over other combinations, they did highlight the findings of ACCOMPLISH, rating the primary ACCOMPLISH paper as "good." The American Society of Hypertension position paper and the European Hypertension Society guidelines endorse such combinations as a first-line agent for patients with stage 2 hypertension. We review the current position of ACCOMPLISH in the guidelines regarding treatment of stage 2 hypertension. PMID:24474031

  3. Recommendation Knowledge Discovery

    NASA Astrophysics Data System (ADS)

    McSherry, David; Stretch, Christopher

    Recently we presented a novel approach to the discovery of recommendation rules from a product case base that take account of all features of a recommended product, including those with respect to which the user's preferences are unknown. In this paper, we investigate the potential role of default preferences in the discovery of recommendation rules. As we show in the domain of digital cameras, the potential benefits include a dramatic reduction in the effective length of the discovered rules and increased coverage of queries representing the user's personal preferences. Another important finding of the research presented is that in a recommender system that takes account of default preferences, many of the products in the case base may never be recommended.

  4. Weight control in the management of hypertension. World Hypertension League.

    PubMed Central

    1989-01-01

    This article, which includes a brief description of the mechanisms and some epidemiological findings in obesity and high blood pressure, sums up present knowledge on a complex subject and provides guidance to medical practitioners on the management of obese hypertensive patients. Weight reduction, together with drug therapy in severe and moderate hypertension, and other non-pharmacological methods and continuing observation in mild hypertension are the essential measures to be applied. In addition to the lowering of blood pressure, weight loss offers several other metabolic and haemodynamic benefits. PMID:2670295

  5. Statement on pregnancy in pulmonary hypertension from the Pulmonary Vascular Research Institute

    PubMed Central

    Kiely, David G.; Cockrill, Barbara A.; Safdar, Zeenat; Wilson, Victoria J.; Al Hazmi, Manal; Preston, Ioana R.; MacLean, Mandy R.; Lahm, Tim

    2015-01-01

    Abstract Pregnancy outcomes in patients with pulmonary hypertension remain poor despite advanced therapies. Although consensus guidelines recommend against pregnancy in pulmonary hypertension, it may nonetheless occasionally occur. This guideline document sought to discuss the state of knowledge of pregnancy effects on pulmonary vascular disease and to define usual practice in avoidance of pregnancy and pregnancy management. This guideline is based on systematic review of peer-reviewed, published literature identified with MEDLINE. The strength of the literature was graded, and when it was inadequate to support high-level recommendations, consensus-based recommendations were formed according to prespecified criteria. There was no literature that met standards for high-level recommendations for pregnancy management in pulmonary hypertension. We drafted 38 consensus-based recommendations on pregnancy avoidance and management. Further, we identified the current state of knowledge on the effects of sex hormones during pregnancy on the pulmonary vasculature and right heart and suggested areas for future study. There is currently limited evidence-based knowledge about both the basic molecular effects of sex hormones and pregnancy on the pulmonary vasculature and the best practices in contraception and pregnancy management in pulmonary hypertension. We have drafted 38 consensus-based recommendations to guide clinicians in these challenging topics, but further research is needed in this area to define best practices and improve patient outcomes. PMID:26401246

  6. Understanding Perceptions and Practices for Zambian Adults in Western Province at Risk for Hypertension: An Exploratory Descriptive Study

    PubMed Central

    Oelke, Nelly D.; Rush, Kathy L.; Goma, Fastone M.; Barker, Jessica; Marck, Patricia; Pedersen, Chloe

    2016-01-01

    Hypertension is an important public health issue in Zambia. Despite the need for early detection, treatment, and ongoing monitoring, there is little documented research on hypertension in Zambia. The study aims were to: 1) better understand risk factors for hypertension in urban and rural communities in Mongu and Limulunga Districts, Western Province; 2) identify current health practices for hypertension and prevention in these communities; and 3) explore intersections between culture and hypertension perceptions and practices for study participants. A mixed methods approach was used; 203 adults completed surveys including demographics, anthropometric measures, blood pressure (BP), physicial activity, diet, and salt intake at five health check stations. Two focus groups were conducted with rural and urban community members to better understand their perspectives on hypertension. The prevalence of hypertension was 32.8% for survey participants. A further 24.6% had pre-hypertension. The mean total weight of salt added to food was nearly double the WHO recommendation with women adding significantly more salt to food than men. Significant differences in waist circumference were observed between men and women with men at low risk and women at substantialy high risk. In focus groups, participants cited westernized diets, lack of physical activity, stress, psychological factors, and urbanization as causative factors for hypertension. Participants lacked understanding of BP medications, healthy lifestyles, adherence to treatment, and ongoing monitoring. Focus group participants mentioned challenges in obtaining treatment for hypertension and desired to be active contributors in creating solutions. They recommended that government priorize hypertension initiatives that increase access to health education to reduce risk, enhance early detection, and support lifestyle changes and medication adherence. Our findings suggest that policy-makers need to engage communities more

  7. Evaluation of Prothrombin Time and Activated Partial Thromboplastin Time in Hypertensive Patients Attending a Tertiary Hospital in Calabar, Nigeria

    PubMed Central

    Nnenna Adaeze, Nnamani; Uchenna Emeribe, Anthony; Abdullahi Nasiru, Idris; Babayo, Adamu; Uko, Emmanuel K.

    2014-01-01

    Introduction. Several biomedical findings have established the effects of hypertension on haemostasis and roles of blood coagulation products in the clinical course of hypertension. Methods. This cross-sectional study aimed at determining effects of hypertension on prothrombin time (PT) and activated partial thromboplastin time (APTT) in hypertensive patients in comparison with normotensive subjects attending a tertiary hospital in Calabar. Forty-two (42) hypertensive patients and thirty-nine (39) normotensive control subjects were investigated for PT and APTT using Quick one-stage methods. Results. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) correlated positively with APTT (r = 0.3072, r = 0.4988; P < 0.05) in hypertensive patients. DBP, SBP, PT, and APTT were significantly higher in hypertensive patients when compared to normotensive subjects (P < 0.05). DBP correlated negatively with duration of illness (r = −0.3097; P < 0.05) in hypertensive patients and positively with age of normotensive subjects (r = 0.3523; P < 0.05). Conclusion. The results obtained indicated that measurements of PT and APTT may serve as indices for evaluating hemostatic abnormalities in hypertensive patients and guide for antihypertensive therapy. However, to have better understanding of hemostatic activities in hypertension, it is recommended to conduct D-dimer, platelet factors, and protein assays. PMID:25477963

  8. Hypertension: empirical evidence and implications in 2014

    PubMed Central

    Makridakis, Spyros; DiNicolantonio, James J

    2014-01-01

    High blood pressure (HBP) or hypertension (HTN) is one of the leading causes of cardiovascular (CV) morbidity and mortality throughout the world. Despite this fact, there is widespread agreement that the treatment of HBP, over the last half century, has been a great achievement. However, after the release of the new Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure-8 (JNC-8) guidelines, there have been heated debates with regard to what are the most evidence-based blood pressure goals. While JNC-8 claims that the goal blood pressure for otherwise healthy patients with mild hypertension (systolic blood pressure ≥140–159 mm Hg and diastolic blood pressure ≥90–99 mm Hg) should be <140/90 mm Hg; a recent Cochrane meta-analysis is in direct conflict with these recommendations. Indeed, a 2012 Cochrane meta-analysis indicated that there is no evidence that treating otherwise healthy mild hypertension patients with antihypertensive therapy will reduce CV events or mortality. Additionally, the Cochrane meta-analysis showed that antihypertensive therapy was associated with a significant increase in withdrawal due to adverse events. Thus, the current evidence in the literature does not support the goals set by the JNC-8 guidelines. In this review we discussed the strengths and limitations of both lines of evidence and why it takes an evidence-based medication to reduce CV events/mortality (eg, how a goal blood pressure is achieved is more important than getting to the goal). As medications inherently cause side effects and come at a cost to the patient, the practice of evidence-based medicine becomes exceedingly important. Although the majority of HTN studies claim great advantages by lowering HBP, this review finds severe conflicts in the findings among the various HTN studies, as well as serious epistemological, methodological and statistical problems that cast doubt to such claims. PMID:25332797

  9. Hypertension: empirical evidence and implications in 2014.

    PubMed

    Makridakis, Spyros; DiNicolantonio, James J

    2014-01-01

    High blood pressure (HBP) or hypertension (HTN) is one of the leading causes of cardiovascular (CV) morbidity and mortality throughout the world. Despite this fact, there is widespread agreement that the treatment of HBP, over the last half century, has been a great achievement. However, after the release of the new Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure-8 (JNC-8) guidelines, there have been heated debates with regard to what are the most evidence-based blood pressure goals. While JNC-8 claims that the goal blood pressure for otherwise healthy patients with mild hypertension (systolic blood pressure ≥140-159 mm Hg and diastolic blood pressure ≥90-99 mm Hg) should be <140/90 mm Hg; a recent Cochrane meta-analysis is in direct conflict with these recommendations. Indeed, a 2012 Cochrane meta-analysis indicated that there is no evidence that treating otherwise healthy mild hypertension patients with antihypertensive therapy will reduce CV events or mortality. Additionally, the Cochrane meta-analysis showed that antihypertensive therapy was associated with a significant increase in withdrawal due to adverse events. Thus, the current evidence in the literature does not support the goals set by the JNC-8 guidelines. In this review we discussed the strengths and limitations of both lines of evidence and why it takes an evidence-based medication to reduce CV events/mortality (eg, how a goal blood pressure is achieved is more important than getting to the goal). As medications inherently cause side effects and come at a cost to the patient, the practice of evidence-based medicine becomes exceedingly important. Although the majority of HTN studies claim great advantages by lowering HBP, this review finds severe conflicts in the findings among the various HTN studies, as well as serious epistemological, methodological and statistical problems that cast doubt to such claims. PMID:25332797

  10. 2015 guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the management of hypertension.

    PubMed

    Chiang, Chern-En; Wang, Tzung-Dau; Ueng, Kwo-Chang; Lin, Tsung-Hsien; Yeh, Hung-I; Chen, Chung-Yin; Wu, Yih-Jer; Tsai, Wei-Chuan; Chao, Ting-Hsing; Chen, Chen-Huan; Chu, Pao-Hsien; Chao, Chia-Lun; Liu, Ping-Yen; Sung, Shih-Hsien; Cheng, Hao-Min; Wang, Kang-Ling; Li, Yi-Heng; Chiang, Fu-Tien; Chen, Jyh-Hong; Chen, Wen-Jone; Yeh, San-Jou; Lin, Shing-Jong

    2015-01-01

    targets are <140/90 mmHg for all other patient groups, except for patients ≥80 years of age in whom a BP target of <150/90 mmHg would be optimal. For the management of hypertension, we proposed a treatment algorithm, starting with life style modification (LSM) including S-ABCDE (Sodium restriction, Alcohol limitation, Body weight reduction, Cigarette smoke cessation, Diet adaptation, and Exercise adoption). We emphasized a low-salt strategy instead of a no-salt strategy, and that excessively aggressive sodium restriction to <2.0 gram/day may be harmful. When drug therapy is considered, a strategy called "PROCEED" was suggested (Previous experience, Risk factors, Organ damage, Contraindications or unfavorable conditions, Expert's or doctor's judgment, Expenses or cost, and Delivery and compliance issue). To predict drug effects in lowering BP, we proposed the "Rule of 10" and "Rule of 5". With a standard dose of any one of the 5 major classes of anti-hypertensive agents, one can anticipate approximately a 10-mmHg decrease in systolic BP (SBP) (Rule of 10) and a 5-mmHg decrease in diastolic BP (DBP) (Rule of 5). When doses of the same drug are doubled, there is only a 2-mmHg incremental decrease in SBP and a 1-mmHg incremental decrease in DBP. Preferably, when 2 drugs with different mechanisms are to be taken together, the decrease in BP is the sum of the decrease of the individual agents (approximately 20 mmHg in SBP and 10 mmHg in DBP). Early combination therapy, especially single-pill combination (SPC), is recommended. When patient's initial treatment cannot get BP to targeted goals, we have proposed an adjustment algorithm, "AT GOALs" (Adherence, Timing of administration, Greater doses, Other classes of drugs, Alternative combination or SPC, and LSM + Laboratory tests). Treatment of hypertension in special conditions, including treatment of resistant hypertension, hypertension in women, and perioperative management of hypertension, were also mentioned. The

  11. Hypertension in Patients with Cancer

    PubMed Central

    de Souza, Vinicius Barbosa; Silva, Eduardo Nani; Ribeiro, Mario Luiz; Martins, Wolney de Andrade

    2015-01-01

    There is a known association between chemotherapy and radiotherapy for treatment of cancer patients and development or worsening of hypertension. The aim of this article is to review this association. A literature search was conducted for articles reporting this association on the databases PubMed, SciELO and LILACS between 1993 and 2013. There was a high coprevalence of hypertension and cancer, since both diseases share the same risk factors, such as sedentary lifestyle, obesity, smoking, unhealthy diet and alcohol abuse. The use of chemotherapy and adjuvant drugs effective in the treatment of cancer increased the survival rate of these patients and, consequently, increased the incidence of hypertension. We described the association between the use of angiogenesis inhibitors (bevacizumab, sorafenib and sunitinib), corticosteroids, erythropoietin and non-steroidal anti-inflammatory drugs with the development of hypertension. We also described the relationship between hypertension and carotid baroreceptor injury secondary to cervical radiotherapy. Morbidity and mortality increased in patients with cancer and hypertension without proper antihypertensive treatment. We concluded that there is need for early diagnosis, effective monitoring and treatment strategies for hypertension in cancer patients in order to reduce cardiovascular morbidity and mortality. PMID:25742420

  12. Dermatoglyphics in hypertension: a review.

    PubMed

    Wijerathne, Buddhika T B; Meier, Robert J; Agampodi, Thilini C; Agampodi, Suneth B

    2015-01-01

    Hypertension is a major contributor to the global burden of disease and mortality. A major medical advancement would be a better means to ascertain which persons are at higher risk for becoming hypertensive beforehand. To that end, there have been a number of studies showing that certain dermatoglyphic markers are associated with hypertension. This association could be explained if the risk toward developing hypertension later on in life is somehow connected with fetal development of dermatoglyphics. It would be highly valuable from a clinical standpoint if this conjecture could be substantiated since dermatoglyphic markers could then be used for screening out individuals who might be at an elevated risk of becoming hypertensive. The aim of this review was to search for and appraise available studies that pertain to the association between hypertension and dermatoglyphics.A systematic literature search conducted using articles from MEDLINE (PubMed), Trip, Cochran, Google scholar, and gray literature until December 2014. Of the 37 relevant publications, 17 were included in the review. The review performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement.This review showed a fairly consistent finding of an increased frequency of whorl patterns along with a higher mean total ridge count in digital dermatoglyphic results in hypertensive samples compared to controls. However, it was imperative to discuss several limitations found in the studies that could make this association as yet unsettled. PMID:26265377

  13. New Standards for Diagnosing Hypertension Are Met with Skepticism | Poster

    Cancer.gov

    Members of the Eighth Joint National Committee recently released new standards for treating hypertension, also referred to as high blood pressure (BP). The new standards do not recommend treatment changes for individuals under 60 years of age. However, treatment changes were recommended for people over the age of 60 who do not have conditions such as diabetes or chronic kidney disease (CKD), but whose BP numbers are 150/90 or higher. This BP threshold is up from the previously recommended threshold of 140/90. The panel also recommended that for people over 60 years of age who have diabetes or CKD, treatment should begin when BP is 140/90, which is an increase from 130/80. Treatment may involve lifestyle changes and/or medication to bring the BP numbers into a healthy range.

  14. New Standards for Diagnosing Hypertension Are Met with Skepticism | Poster

    Cancer.gov

    Members of the Eighth Joint National Committee recently released new standards for treating hypertension, also referred to as high blood pressure (BP). The new standards do not recommend treatment changes for individuals under 60 years of age. However, treatment changes were recommended for people over the age of 60 who do not have conditions such as diabetes or chronic kidney disease (CKD), but whose BP numbers are 150/90 or higher. This BP threshold is up from the previously recommended threshold of 140/90. The panel also recommended that for people over 60 years of age who have diabetes or CKD, treatment should begin when BP is 140/90, which is an increase from 130/80. Treatment may involve lifestyle changes and/or medication to bring the BP numbers into a healthy range.

  15. In the clinic: hypertension.

    PubMed

    Weir, Matthew R

    2014-12-01

    This issue provides a clinical overview of Hypertension focusing on prevention, diagnosis, treatment, practice improvement, and patient information. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of science writers and physician writers. Editorial consultants from ACP Smart Medicine and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult http://smartmedicine.acponline.org, http://mksap.acponline.org, and other resources referenced in each issue of In the Clinic. PMID:25437425

  16. Treatment of pulmonary hypertension

    PubMed Central

    Patel, Rajendrakumar; Aronow, Wilbert S.; Patel, Laxeshkumar; Gandhi, Kaushang; Desai, Harit; Kaul, Dhiraj; Sahgal, Sumir P.

    2012-01-01

    Summary Pulmonary arterial hypertension (PAH) is a chronic progressive disease of the pulmonary vasculature characterized by elevated pulmonary arterial pressure and secondary right ventricular failure. PAH is considered a life-threatening condition unless treated. This article provides a comprehensive review of controlled and uncontrolled trials to define the risk-benefit for different therapeutic options of this clinical disorder. Relevant published articles were identified through searches of the National Center for Biotechnology PubMed database. All therapeutic measures for PAH were discussed. Six drugs have been approved in the United States for the treatment of PAH. Extensive medical advancement has been achieved in treatment of PAH. However, none of the approved therapies have shown ability to cure the disease. New research should be performed to develop promising new therapies. PMID:22460104

  17. Recent clinical and translational advances in pediatric hypertension.

    PubMed

    Falkner, Bonita

    2015-05-01

    Epidemiological reports describe a child population increase in BP level and an increase in prevalence of hypertension, that is largely, but not entirely, driven by a concurrent increase in childhood obesity. Given current estimates, ≈10% of adolescents have hypertension or prehypertension. In addition to obesity, dietary salt intake and waist circumference, a marker of visceral obesity, are found to be independently associated with the rise in BP among children and adolescents. Dietary salt intake in urban children is well above recommended levels largely because of consumption of processed and fast foods. Childhood exposures, such as stress,52 salt, and fructose, as well as lifestyles, including food sources, sleep patterns, and reductions in physical activity may have a role in obesity-high BP associations. In addition, clinical and translational evidence is mounting that intrauterine exposures alter can effect changes in fetal development that have an enduring effect on cardiovascular and metabolic function later in life. These effects can be detected even in children who are products of a term otherwise normal pregnancy. Hypertension in childhood has been defined statistically (BP ≥ 95th percentile) because of lack of outcome data that links a BP level with heightened risk for future cardiovascular events. Therefore, primary hypertension had been considered a risk factor for later hypertension in adulthood. Intermediate markers of TOD, including cardiac hypertrophy, vascular stiffness, and increases in cIMT, are detectable in adolescents with primary hypertension. Evidence that vascular injury is present in the early phase of hypertension and even in prehypertension warrants consideration on the current definition of pediatric hypertension. With further studies on TOD and other risk factors in addition to high BP, it may be possible to shift from a statistical definition to a definition of childhood hypertension that is evidence based. Preventing or

  18. Updated treatment algorithm of pulmonary arterial hypertension.

    PubMed

    Galiè, Nazzareno; Corris, Paul A; Frost, Adaani; Girgis, Reda E; Granton, John; Jing, Zhi Cheng; Klepetko, Walter; McGoon, Michael D; McLaughlin, Vallerie V; Preston, Ioana R; Rubin, Lewis J; Sandoval, Julio; Seeger, Werner; Keogh, Anne

    2013-12-24

    The demands on a pulmonary arterial hypertension (PAH) treatment algorithm are multiple and in some ways conflicting. The treatment algorithm usually includes different types of recommendations with varying degrees of scientific evidence. In addition, the algorithm is required to be comprehensive but not too complex, informative yet simple and straightforward. The type of information in the treatment algorithm are heterogeneous including clinical, hemodynamic, medical, interventional, pharmacological and regulatory recommendations. Stakeholders (or users) including physicians from various specialties and with variable expertise in PAH, nurses, patients and patients' associations, healthcare providers, regulatory agencies and industry are often interested in the PAH treatment algorithm for different reasons. These are the considerable challenges faced when proposing appropriate updates to the current evidence-based treatment algorithm.The current treatment algorithm may be divided into 3 main areas: 1) general measures, supportive therapy, referral strategy, acute vasoreactivity testing and chronic treatment with calcium channel blockers; 2) initial therapy with approved PAH drugs; and 3) clinical response to the initial therapy, combination therapy, balloon atrial septostomy, and lung transplantation. All three sections will be revisited highlighting information newly available in the past 5 years and proposing updates where appropriate. The European Society of Cardiology grades of recommendation and levels of evidence will be adopted to rank the proposed treatments. PMID:24355643

  19. Sick But Unaware: Hypertension in Indonesia.

    PubMed

    Sohn, Kitae

    2015-01-01

    Discrepancies between self-reported and measured hypertension pose a great risk to health because they prevent timely treatment. Analyzing the Indonesian Family Life Survey, we compared self-reported and measured hypertension to assess the extent of the misclassification of hypertension. Building on this, we estimated factors related to self-reported and measured hypertension. Our results show that different factors were involved in each case, suggesting that they are two different phenomena. More importantly, we estimated factors that increased awareness of hypertension and found that visiting a health facility was a very effective way of increasing awareness of hypertension among hypertensive patients. PMID:26652684

  20. Hyperuricemia, Cardiovascular Disease, and Hypertension

    PubMed Central

    Kuwabara, Masanari

    2016-01-01

    In recent years, there has been an increase in the prevalence of hyperuricemia, and the latter has attracted attention as an adult lifestyle-associated disease, together with hypertension, diabetes, and dyslipidemia. Although hyperuricemia is known to be an independent risk factor for hypertension, whether it is an independent risk factor for cardiovascular disease remains controversial. Recently, some small-scale interventional studies on antihyperuricemic medications showed that the latter improved angina symptoms and prevented cardiovascular disease. Here, we will mainly explain the cause of hyperuricemia and the associations between hyperuricemia, hypertension, and cardiovascular disease based on the latest published evidence. PMID:27195245

  1. Collateral Pathways in Portal Hypertension

    PubMed Central

    Sharma, Malay; Rameshbabu, Chittapuram S.

    2012-01-01

    Presence of portosystemic collateral veins (PSCV) is common in portal hypertension due to cirrhosis. Physiologically, normal portosystemic anastomoses exist which exhibit hepatofugal flow. With the development of portal hypertension, transmission of backpressure leads to increased flow in these patent normal portosystemic anastomoses. In extrahepatic portal vein obstruction collateral circulation develops in a hepatopetal direction and portoportal pathways are frequently found. The objective of this review is to illustrate the various PSCV and portoportal collateral vein pathways pertinent to portal hypertension in liver cirrhosis and EHPVO. PMID:25755456

  2. Precursors of Hypertension: A Review

    PubMed Central

    Thomas, John; Neser, William B.; Thomas, Johniene; Semenya, Kofi; Green, Donald R.

    1983-01-01

    Recent advances in hypertension therapy have been remarkable; however, much less is known about those precursors that facilitate preventive and early intervention measures. This review of the literature indicates that relevant precursors are early elevated casual systolic blood pressures, positive family history, and obesity in females. Additional predisposing or enhancing factors point to high sodium ingestion, heavy smoking, and high socioecologic stress. Evidence for a high-risk hypertensive personality is not conclusive. There is a paucity of longitudinal data on hypertension in the black population. PMID:6864814

  3. The results of a survey of physicians about the Japanese Society of Hypertension Guidelines for the Management of Hypertension 2014 and its clinical use.

    PubMed

    Mogi, Masaki; Hasebe, Naoyuki; Horiuchi, Masatsugu; Shimamoto, Kazuaki; Umemura, Satoshi

    2016-09-01

    The current study investigated physicians' awareness and use of the Japanese Society of Hypertension Guidelines for the Management of Hypertension 2014 (JSH2014) and is based on the results of a survey performed by the Publicity and Advertisement Committee of JSH. A questionnaire was used to survey physicians' awareness of the JSH2014, their recommended target blood pressure for hypertensive patients with complications and their use of antihypertensive drugs. Physicians who downloaded a PDF version of JSH2014 during the 6 months after its publication (April-September 2014) were asked to complete an online questionnaire. Of the 7872 respondents, 91% were aware of the JSH and complied partially, mostly or completely with it in their practice. With reference to hypertensive patients, ∼70% of physicians who completed the questionnaire recommended a target blood pressure (BP) of 140/90 mm Hg for an office BP value, and 40% recommended 135/85 mm Hg for a home BP value. Physicians recommended target BP levels of 130/80 mm Hg for patients with diabetes or chronic kidney disease (50-63% of physician surveyed) and for elderly patients with diabetes or kidney disease (45-55% of respondents), whereas they recommended 140/90 mm Hg for elderly patients with low cardiovascular disease risk (56-60% of physician surveyed) and for patients with chronic-phase stroke (40-47% of respondents). The most commonly prescribed combination of antihypertensive drugs was angiotensin receptor blocker (ARB) with calcium channel blocker. In addition, physicians' first choice of drug for patients with diabetes or chronic kidney disease was most often ARB. Overall, the survey results showed that the new recommendations from the JSH2014 accurately reflect daily clinical practices for hypertension management used by Japanese physicians. PMID:27169398

  4. [Management of resistant hypertension. Expert consensus statement from the French Society of Hypertension, an affiliate of the French Society of Cardiology].

    PubMed

    Denolle, Thierry; Chamontin, Bernard; Doll, Gérard; Fauvel, Jean-Pierre; Girerd, Xavier; Herpin, Daniel; Vaïsse, Bernard; Villeneuve, Frédéric; Halimi, Jean-Michel

    2014-12-01

    To improve the management of resistant hypertension, the French Society of Hypertension, an affiliate of the French Society of Cardiology, has published a set of eleven recommendations. The primary objective is to provide the most up-to-date information, based on the strongest scientific rationale and which is easily applicable to daily clinical practice for health professionals working within the French health system. Resistant hypertension is defined as uncontrolled blood pressure (BP) both on office measurements and confirmed by out-of-office measurements despite a therapeutic strategy comprising appropriate lifestyle and dietary measures and the concurrent use of three antihypertensive agents including a thiazide diuretic, a renin-angiotensin system blocker (ARB or ACEI) and a calcium channel blocker, for at least four weeks, at optimal doses. Treatment compliance must be closely monitored, as most factors that are likely to affect treatment resistance (excessive dietary salt intake, alcohol, depression and drug interactions, or vasopressors). If the diagnosis of resistant hypertension is confirmed, the patient should be referred to a hypertension specialist to screen for potential target organ damage and secondary causes of hypertension. The recommended treatment regimen is a combination therapy comprising four treatment classes, including spironolactone (12.5 to 25mg/day). In the event of a contraindication or a non-response to spironolactone, or if adverse effects occur, a β-blocker, an α-blocker, or a centrally acting antihypertensive drug should be prescribed. Because renal denervation is still undergoing assessment for the treatment of hypertension, this technique should only be prescribed by a specialist hypertension clinic. PMID:25459067

  5. [Differences between the 2013 and 2014 hypertension guidelines.: Position of the Central American and Caribbean Society for Hypertension and Cardiovascular Prevention].

    PubMed

    Morales-Salinas, Alberto; Wyss, Fernando; Coca, Antonio; Ramírez, Agustín J; Valdez, Osiris; Valerio, Luis F

    2015-03-01

    Between the end of 2013 and the beginning of 2014 the most internationally influential hypertension guidelines were published. Although there are no major differences between them, there are discrepancies that can have an impact on treatment and prognosis for individuals with hypertension. This article analyzes the main controversial elements in the guides and presents the recommendations of the Sociedad Centroamericana y del Caribe de Hipertensión y Prevención Cardiovascular (Caribbean Society for Hypertension and Cardiovascular Prevention). The main differences are found a) in the categorization of prehypertension, b) in the use of global cardiovascular risk in the decision to begin antihypertensive treatment, c) in the validity of beta-blockers as first-line drugs in treating uncomplicated hypertension, and d) the increase in the therapeutic goal of maintaining values between < 140/90 and < 150/90 mmHg in patients over 60 years of age with no history of diabetes or chronic kidney disease. All the factors in favor of and against accepting each of these four controversial criteria are analyzed critically and the observations made by the Society are included. The conclusion is that there are pros and cons for all controversial elements in the hypertension guides. However, the weight of the evidence and clinical judgment favor subdividing prehypertension into stages I and II, seeking a therapeutic goal of maintaining systolic blood pressure below 140 mmHg in all the hypertensive patients under 80 years of age, retaining beta-blockers as first-line drugs in uncomplicated hypertension, and not delaying the start of drug treatment for hypertension stage I with low global cardiovascular risk. Finally, seven recommendations by the Society based on the analysis are included. PMID:25988254

  6. [Pulmonary arterial hypertension: changing approaches to management].

    PubMed

    Sidorenko, B A; Preobrazhenskiĭ, D V; Batyraliev, T A; Belenkov, Iu N

    2011-01-01

    The review is devoted to different aspects of pulmonary arterial hypertension (PAH); new classification of PAH is published in 2010. There are idiopathic PAH and PAH associated with other diseases. Current guidelines recommend to treat PAH only after the verification of diagnosis with right heart catheterization and acute tests with vasodilators. Patients-reactors should be treated with calcium antagonists. The following drugs related to one of three categories should be used in PAH: (1) prostanoids (epoprostenol, iloprost et al.); (2) blockers of endothelin receptors (bosentan, ambrisentan, sitaxsentan); (3) phosphodiesterase 5 type inhibitors (sildenafil, tadalafil et al.) In majority of cases the combined treatment is used, usually the combination of bosentan and sildenafil is used. PMID:21626809

  7. Surgical treatment of pulmonary hypertension: Lung transplantation

    PubMed Central

    Long, Jason; Russo, Mark J.; Muller, Charlie; Vigneswaran, Wickii T.

    2011-01-01

    Pulmonary hypertension (PH) is a serious and progressive disorder that results in right ventricular dysfunction that lead to subsequent right heart failure and death. When untreated the median survival for these patients is 2.8 years. Over the past decade advances in disease specific medical therapy considerably changed the natural history. This is reflected in a threefold decrease in the number of patients undergoing lung transplantation for PH which used to be main stay of treatment. Despite the successful development of medical therapy lung transplant still remains the gold standard for patients who fail medical therapy. Referral for lung transplant is recommended when patients have a less than 2-3 years of predicted survival or in NYHA class III or IV. Both single and bilateral lung transplants have been successfully performed for PH but outcome analyses and survival comparisons generally favor a bilateral lung transplant. PMID:22140622

  8. Updated Lightning Safety Recommendations.

    ERIC Educational Resources Information Center

    Vavrek, R. James; Holle, Ronald L.; Lopez, Raul E.

    1999-01-01

    Summarizes the recommendations of the Lightning Safety Group (LSG), which was first convened during the 1998 American Meteorological Society Conference. Findings outline appropriate actions under various circumstances when lightning threatens. (WRM)

  9. Suitability of antiplatelet therapy in hypertensive patients.

    PubMed

    Martínez-Orozco, M J; Perseguer-Torregrosa, Z; Gil-Guillén, V F; Palazón-Bru, A; Orozco-Beltran, D; Carratalá-Munuera, C

    2015-01-01

    Antiplatelet therapy (AT) is indicated in hypertensive patients with increased cardiovascular risk. The literature about the adequate or inadequate prescription of AT is scarce. We conducted a prospective descriptive study to quantify therapeutic inertia and non-guideline-recommended prescription (NGRP) of AT (aspirinor clopidogrel or both), and to assess associated factors, calculating the adjusted odds ratios (ORs) from multivariate models. In 2007-2009, 712 primary health-care hypertensive patients in a Spanish region were enrolled. Inertia was defined as the lack of an AT prescription, despite being indicated by guidelines, whereas NGRP was defined as AT prescription when there was no guideline recommendation. We also recorded cardiovascular variables. Inertia and NGRP were quantified for primary and secondary prevention. Of 108 patients in secondary prevention, 53 had inertia (49.1%, 95% confidence interval (CI): 39.6-58.5%). Associated profile: female (OR=0.460, P=0.091), no dyslipidemia (OR=0.393, P=0.048), no coronary heart disease (OR=0.215, P=0.001) and high diastolic blood pressure (OR=1.076, P=0.016). In primary prevention, NGRP was present in 69 of 595 patients (11.6%, 95% CI: 9.0-14.2%). Associated profile: male (OR=1.610, P=0.089), smoking (OR=2.055, P=0.045), dyslipidemia (OR=3.227, P<0.001) and diabetes (OR=2.795, P<0.001). Although certain factors were clearly associated with these phenomena much still remains to be learnt. PMID:24694801

  10. New Insulin Delivery Recommendations.

    PubMed

    Frid, Anders H; Kreugel, Gillian; Grassi, Giorgio; Halimi, Serge; Hicks, Debbie; Hirsch, Laurence J; Smith, Mike J; Wellhoener, Regine; Bode, Bruce W; Hirsch, Irl B; Kalra, Sanjay; Ji, Linong; Strauss, Kenneth W

    2016-09-01

    Many primary care professionals manage injection or infusion therapies in patients with diabetes. Few published guidelines have been available to help such professionals and their patients manage these therapies. Herein, we present new, practical, and comprehensive recommendations for diabetes injections and infusions. These recommendations were informed by a large international survey of current practice and were written and vetted by 183 diabetes experts from 54 countries at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Rome, Italy, in 2015. Recommendations are organized around the themes of anatomy, physiology, pathology, psychology, and technology. Key among the recommendations are that the shortest needles (currently the 4-mm pen and 6-mm syringe needles) are safe, effective, and less painful and should be the first-line choice in all patient categories; intramuscular injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result; lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, and, therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them; effective long-term therapy with insulin is critically dependent on addressing psychological hurdles upstream, even before insulin has been started; inappropriate disposal of used sharps poses a risk of infection with blood-borne pathogens; and mitigation is possible with proper training, effective disposal strategies, and the use of safety devices. Adherence to these new recommendations should lead to more effective therapies, improved outcomes, and lower costs for patients with diabetes. PMID:27594187

  11. Social Tagging Recommender Systems

    NASA Astrophysics Data System (ADS)

    Marinho, Leandro Balby; Nanopoulos, Alexandros; Schmidt-Thieme, Lars; Jäschke, Robert; Hotho, Andreas; Stumme, Gerd; Symeonidis, Panagiotis

    The new generation of Web applications known as (STS) is successfully established and poised for continued growth. STS are open and inherently social; features that have been proven to encourage participation. But while STS bring new opportunities, they revive old problems, such as information overload. Recommender Systems are well known applications for increasing the level of relevant content over the "noise" that continuously grows as more and more content becomes available online. In STS however, we face new challenges. Users are interested in finding not only content, but also tags and even other users. Moreover, while traditional recommender systems usually operate over 2-way data arrays, STS data is represented as a third-order tensor or a hypergraph with hyperedges denoting (user, resource, tag) triples. In this chapter, we survey the most recent and state-of-the-art work about a whole new generation of recommender systems built to serve STS.We describe (a) novel facets of recommenders for STS, such as user, resource, and tag recommenders, (b) new approaches and algorithms for dealing with the ternary nature of STS data, and (c) recommender systems deployed in real world STS. Moreover, a concise comparison between existing works is presented, through which we identify and point out new research directions.

  12. Sex differences in primary hypertension

    PubMed Central

    2012-01-01

    Men have higher blood pressure than women through much of life regardless of race and ethnicity. This is a robust and highly conserved sex difference that it is also observed across species including dogs, rats, mice and chickens and it is found in induced, genetic and transgenic animal models of hypertension. Not only do the differences between the ovarian and testicular hormonal milieu contribute to this sexual dimorphism in blood pressure, the sex chromosomes also play a role in and of themselves. This review primarily focuses on epidemiological studies of blood pressure in men and women and experimental models of hypertension in both sexes. Gaps in current knowledge regarding what underlie male-female differences in blood pressure control are discussed. Elucidating the mechanisms underlying sex differences in hypertension may lead to the development of anti-hypertensives tailored to one's sex and ultimately to improved therapeutic strategies for treating this disease and preventing its devastating consequences. PMID:22417477

  13. Intracranial Hypertension: Medication and Surgery

    MedlinePlus

    ... http://www.ihrfoundation.org/hypertension/info/C172 Surgery Optic Nerve Fenestration When sight is at risk and drug therapy has been unsuccessful, an optic nerve fenestration (also called an optic nerve sheath ...

  14. [Personality characteristics of hypertensive patients].

    PubMed

    Kubej, P; Korán, M

    1989-02-01

    Essential hypertension, as well-known specialists believe, is due both to genetic and external environment factors. Apart from the steadily growing complexity of social life and various important life events, high-risk factors may also be seen in a certain way of behaviour and man's psychophysiological reactivity. Recent literature on this topic informs about some common characteristics found in the behaviour of hypertensive persons, for example: anxiety in social contacts, suppressed hostility, manifestations of perfectionism, suppression of emotions, exaggerated behavioral adaptability and defensive attitudes to stress stimuli. In accordance with literary data, the control group of hypertensive patients (N = 89) gave evidence of some identical characteristics. Their knowledge permits to carry out more specific attempts at influencing hypertension in a non-pharmacological way. PMID:2720750

  15. Controversies Among the Hypertension Guidelines.

    PubMed

    Ripley, Toni L; Baumert, Mary

    2016-02-01

    Hypertension affects 80 million people in the United States. It remains poorly controlled, with only 54% of diagnosed patients treated to blood pressure targets. Hypertension management is complex in part due to the volume of antihypertensive agents, variable patient needs and responses, and inconsistent design and outcomes from clinical trials. Therefore, trustworthy clinical practice guidelines have a key role in hypertension management. The United States experienced a 10-year gap in publication of hypertension guidelines, followed by multiple guideline publications in 2013. These guidelines led to more controversy than clarity, as there was discordance among them. This review summarizes the guidelines and clinical statements influencing the current debate in order to facilitate appropriate application. PMID:26668216

  16. A case of hypertensive urgency.

    PubMed

    Baum, Laurence

    2016-08-01

    A 41-year-old male Nepalese soldier presented to the primary care medical centre with a 1-week history of fatigue and muscle aches following a trip to Nepal. His BP was 164/98 but was otherwise normal. Four days later he presented with new symptoms of sweating and palpitations and a BP of 200/127 whereupon he was admitted to hospital with the diagnosis of hypertensive crisis. Appropriate investigation and initial management were undertaken, and he was discharged after 12 h on antihypertensive treatment. This case highlights the risk of hypertensive crisis in both diagnosed and silent hypertensive disease, and the review highlights the presentations, initial investigation and different management of hypertensive crisis. PMID:26002343

  17. Systemic hypertension and its management.

    PubMed

    Henik, R A

    1997-11-01

    The pathophysiology of hypertension in dogs and cats, the methods available to monitor blood pressure, and the signs and treatment of hypertension are reviewed. Clinical signs of hypertension are usually referable to target organ damage, most notably in ophthalmic, renal, and cardiovascular tissues, which have a rich arteriolar supply. Blood pressure should be measured in any animal with renal disease, hyperthyroidism, hyperadrenocorticism, retinal detachment or hemorrhage, hyphema, or echocardiographically determined cardiac hypertrophy. All cats with acquired cardiac murmur should also be evaluated for hypertension. Antihypertensive medication should be administered if the indirect blood pressure in cats is consistently over 170/100 mmHg, or if the indirect blood pressure in dogs is greater than 180/100 mmHg. PMID:9348634

  18. [Resistant hypertension : What is it?].

    PubMed

    Luft, F C

    2015-03-01

    When blood pressure is poorly controlled despite treatment with a diuretic and two antihypertensive drugs at adequate doses, the hypertension is termed resistant. The prevalence of resistant hypertension is increasing. Once pseudo-resistance due to poor compliance, secondary forms of hypertension, and massive salt consumption have been excluded, some authorities maintain that blood pressure can be invariably lowered using minoxidil or mineralocorticoid receptor blockade. I also adhered to this belief until we encountered a patient who despite treatment with seven antihypertensive agents, electrical carotid sinus stimulation, and catheter-based renal denervation continued to exhibit extraordinarily high blood pressure values. I am now convinced that resistant hypertension does indeed exist. The prevalence of such patients can be substantially reduced by means of a thorough history and physical examination, determining drug serum concentrations, and excluding secondary causes. PMID:25668441

  19. A Practical Approach to Hypertension

    PubMed Central

    Dodek, Arthur; Wilkins, Graeme

    1976-01-01

    At least ten percent of the adult population has hypertension. Detection and effective treatment of hypertension are imperative in order to prevent the cardiovascular consequences. Effective antihypertensive treatment reduces morbidity and mortality. Weight reduction and sodium restriction are important fundamentals, and diuretics are the cornerstone of drug therapy. In order to increase patient compliance, treatment should be simple and drugs given twice daily wherever possible. PMID:20469276

  20. Hypertension in the emergency department.

    PubMed

    Jackson, R E

    1988-05-01

    Hypertensive emergencies are now rare and are recognized by the deleterious effect on end-organs. Prompt, efficacious treatment is critical, and the current drug of choice for most episodes is sodium nitroprusside. Hypertensive urgencies are more common than are emergencies, and are distinguished by diastolic pressures greater than 115 mm Hg without end-organ dysfunction. Although there are many efficacious agents, one excellent choice is nifedipine. PMID:3280299

  1. The Novelty of the 2015 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension.

    PubMed

    Cheng, Hao-Min; Chiang, Chern-En; Chen, Chen-Huan

    2015-05-01

    hypertensive patients, including the approach to a more accurate diagnosis, treatment and adjustment algorithm, and evidence-based recommendations. PMID:26587455

  2. The hidden epidemic of hypertension.

    PubMed

    Grenfell, Robert; Lee, Rebecca; Stavreski, Bill; Page, Karen

    2014-04-01

    The majority of cardiovascular disease (CVD) is caused by risk factors that can be controlled, treated or modified. In terms of attributable deaths, the leading cardiovascular disease risk factor is hypertension. The Australian Health Survey results showed some startling figures-4.6 million adult Australians are hypertensive (>140/90 mmHg). Further, a fifth of the adult population experience hypertension, with more than two out of three not attaining blood pressure target levels. This is despite an estimated cost of $1 billion per annum spent on managing hypertension. It is now well recognised that the level of risk for coronary heart disease is linked to an individual's risk profile. Results indicate that many Australians have multiple risk factors, including hypertension. It could be considered that these numbers provide a proxy indicator of secondary prevention failure. Considerable attention needs to be given to the assessment of the combined risk of those with hypertension enabling effective management of identified, modifiable risk factors. We look forward to presenting the absolute risk profiles when the Australian Health Survey biometric results are released. PMID:24468162

  3. Contemporary practice patterns in the management of newly diagnosed hypertension

    PubMed Central

    McAlister, F A; Teo, K K; Lewanczuk, R Z; Wells, G; Montague, T J

    1997-01-01

    OBJECTIVE: To determine what proportion of patients with hypertension are managed in accordance with guidelines established by the Canadian Hypertension Society. DESIGN: Retrospective medical record review. SETTING: Outpatients seen in primary care offices and internal medicine referral clinics in Edmonton. PATIENTS: All 969 adults who presented with a new diagnosis of essential hypertension from Sept. 1, 1993, to Dec. 31, 1995. OUTCOME MEASURES: Initial laboratory tests performed, advice concerning nonpharmacologic treatment given, antihypertensive drugs prescribed and any contraindications to thiazide diuretics or beta-adrenergic blocking agents documented. RESULTS: The mean age of the 969 patients in the sample was 52.5 years; 129 (13%) of the patients were older than 70 years of age; and 500 (52%) were women. Most of the patients (704, 73%) had mild or moderate diastolic hypertension. In the 617 patients who underwent laboratory tests related to hypertension, the creatinine level was determined in 466 (76%), the cholesterol level in 372 (60%), a urinalysis was conducted in 378 (61%), the serum potassium level was checked in 343 (56%), the sodium level in 323 (52%) and an electrocardiogram was performed in 303 (49%). Liver function tests, which are not recommended in the guidelines, were performed in 338 patients (55%). Although there were differences in prescribing among physicians in the 711 patients given first-line therapy, most (238, 34%) were prescribed angiotensin-converting-enzyme (ACE) inhibitors. Lifestyle modification, without drug therapy, was suggested for 180 (25%) of the patients. Although the guidelines recommend their use for first-line drug therapy, only 82 patients (12%) were given beta-adrenergic blocking agents and only 75 (11%) were given thiazide diuretics. Of the patients who were prescribed an antihypertensive other than a thiazide or beta-adrenergic blocking agent as first-line drug therapy, only 161 (43%) had a documented

  4. Baroreflex stimulation: A novel treatment option for resistant hypertension

    PubMed Central

    Navaneethan, Sankar D; Lohmeier, Thomas E.; Bisognano, John D

    2013-01-01

    Hypertension is a major public health problem in both developing and developed countries. Despite the increasing awareness of hypertension and its implications among patients and the treating physicians, the prevalence of resistant hypertension remains high and expected to increase. Many patients fail to reach their target blood pressure despite the wide availability of several antihypertensive agents and the continued recommendation of dietary and lifestyle modifications. Stimulation of the carotid sinus results in lowering of blood pressure by initiating the baroreflex and, in so doing, reducing sympathetic tone and increasing renal excretory function, in part, by exerting inhibitory effects on renin secretion. . Recent evidence from experimental studies suggests that the baroreflex may be more important in the setting of chronic hypertension than originally believed. In early phase clinical trials that did not include control arms, implantation of a baroreflex stimulator yielded a sustained decrease in blood pressure. An ongoing larger clinical trial with appropriate control arms is further exploring the safety and efficacy of the device. This article describes the history and potential mechanisms of action of this device including its extensive pre-clinical development and movement to human clinical trials. PMID:20409946

  5. The Medieval Origins of the Concept of Hypertension

    PubMed Central

    Heydari, Mojtaba; Dalfardi, Behnam; Golzari, Samad E. J.; Habibi, Hamzeh; Zarshenas, Mohammad Mehdi

    2014-01-01

    Despite the well-known history of hypertension research in the modern era, like many other cardiovascular concepts, main points in the medieval concept of this disease and its early management methods remain obscure. This article attempts to make a brief review on the medieval origin of the concept of this disease from the Hidayat of Al-Akhawayni (?-983 AD). This article has reviewed the chapter of “Fi al-Imtela” (About the Fullness) from the Hidβyat al-Muta’allimin fi al-Tibb (The Students' Handbook of Medicine) of Al-Akhawayni. The definition, symptoms and treatments presented for the Imtela are compared with the current knowledge on hypertension. Akhawayni believed that Imtela could result from the excessive amount of blood within the blood vessels. It can manifest with symptoms including the presence of a pulsus magnus, sleepiness, weakness, dyspnea, facial blushing, engorgement of the vessels, thick urine, vascular rupture, and hemorrhagic stroke. He also suggested some ways to manage al-Imtela'. These include recommendations of changes in lifestyle (staying away from anger and sexual intercourse) and dietary program for patients (avoiding the consumption of wine, meat, and pastries, reducing the volume of food in a meal, maintaining a low-energy diet and the dietary usage of spinach and vinegar). Al-Akhawayni's description of “Imtela,” despite of its numerous differences with current knowledge of hypertension, can be considered as medieval origin of the concept of hypertension. PMID:25538828

  6. The medieval origins of the concept of hypertension.

    PubMed

    Heydari, Mojtaba; Dalfardi, Behnam; Golzari, Samad E J; Habibi, Hamzeh; Zarshenas, Mohammad Mehdi

    2014-07-01

    Despite the well-known history of hypertension research in the modern era, like many other cardiovascular concepts, main points in the medieval concept of this disease and its early management methods remain obscure. This article attempts to make a brief review on the medieval origin of the concept of this disease from the Hidayat of Al-Akhawayni (?-983 AD). This article has reviewed the chapter of "Fi al-Imtela" (About the Fullness) from the Hidβyat al-Muta'allimin fi al-Tibb (The Students' Handbook of Medicine) of Al-Akhawayni. The definition, symptoms and treatments presented for the Imtela are compared with the current knowledge on hypertension. Akhawayni believed that Imtela could result from the excessive amount of blood within the blood vessels. It can manifest with symptoms including the presence of a pulsus magnus, sleepiness, weakness, dyspnea, facial blushing, engorgement of the vessels, thick urine, vascular rupture, and hemorrhagic stroke. He also suggested some ways to manage al-Imtela'. These include recommendations of changes in lifestyle (staying away from anger and sexual intercourse) and dietary program for patients (avoiding the consumption of wine, meat, and pastries, reducing the volume of food in a meal, maintaining a low-energy diet and the dietary usage of spinach and vinegar). Al-Akhawayni's description of "Imtela," despite of its numerous differences with current knowledge of hypertension, can be considered as medieval origin of the concept of hypertension. PMID:25538828

  7. Distributed Deliberative Recommender Systems

    NASA Astrophysics Data System (ADS)

    Recio-García, Juan A.; Díaz-Agudo, Belén; González-Sanz, Sergio; Sanchez, Lara Quijano

    Case-Based Reasoning (CBR) is one of most successful applied AI technologies of recent years. Although many CBR systems reason locally on a previous experience base to solve new problems, in this paper we focus on distributed retrieval processes working on a network of collaborating CBR systems. In such systems, each node in a network of CBR agents collaborates, arguments and counterarguments its local results with other nodes to improve the performance of the system's global response. We describe D2ISCO: a framework to design and implement deliberative and collaborative CBR systems that is integrated as a part of jcolibritwo an established framework in the CBR community. We apply D2ISCO to one particular simplified type of CBR systems: recommender systems. We perform a first case study for a collaborative music recommender system and present the results of an experiment of the accuracy of the system results using a fuzzy version of the argumentation system AMAL and a network topology based on a social network. Besides individual recommendation we also discuss how D2ISCO can be used to improve recommendations to groups and we present a second case of study based on the movie recommendation domain with heterogeneous groups according to the group personality composition and a group topology based on a social network.

  8. [Postpartum pulmonary hypertension].

    PubMed

    Escalante, Juan Pablo; Diez, Ana; Figueroa Casas, Marcelo; Lasave, Alejandro; Cursack, Guillermo; Poy, Carlos; Rodríguez, María Soledad; Galuppo, Marcela; Zapata, Gerardo

    2015-01-01

    Pulmonary hypertension (PH) in pregnancy is a rare disorder that carries a high risk to mother and child, and as such, it is considered a contraindication to becoming pregnant. However, there are few published reports related to the diagnosis of this condition after delivery. We describe three PH cases diagnosed after their normal pregnancies and deliveries. Although the causes are unknown, several mechanisms such as hypercoagulation, placental hypoxia or amniotic fluid embolism have been considered as possible causes. It is difficult to define whether a PH diagnosed in the postpartum period, relates to an earlier asymptomatic PH period that was triggered by the physiological stress of labor or if it is a recently acquired condition. Despite the lack of data to support the absence of PH previous to pregnancy in our three patients, lack of events during this period, asymptomatic and normal deliveries, lead us to believe that they did not suffer this disease prior to pregnancy; considering that high hemodynamic demands impair a ventricle with little reserve, and its subsequent appearance at time of delivery. PMID:25637900

  9. Developmental programming and hypertension

    PubMed Central

    Nuyt, Anne Monique; Alexander, Barbara T.

    2009-01-01

    Purpose of review There is a growing body of evidence linking adverse events or exposures during early life and adult-onset diseases. After important epidemiological studies from many parts of the world, research now focuses on mechanisms of organ dysfunction and on refining the understanding of the interaction between common elements of adverse perinatal conditions, such as nutrition, oxidants, and toxins exposures. This review will focus on advances in our comprehension of developmental programming of hypertension. Recent findings Recent studies have unraveled important mechanisms of oligonephronia and impaired renal function, altered vascular function and structure as well as sympathetic regulation of the cardiovascular system. Furthermore, interactions between prenatal insults and postnatal conditions are the subject of intensive research. Prematurity vs. intrauterine growth restriction modulate differently programming of high blood pressure. Along with antenatal exposure to glucocorticoids and imbalanced nutrition, a critical role for perinatal oxidative stress is emerging. Summary While the complexity of the interactions between antenatal and postnatal influences on adult blood pressure is increasingly recognized, the importance of postnatal life in (positively) modulating developmental programming offers the hope of a critical window of opportunity to reverse programming and prevent or reduce related adult-onset diseases. PMID:19434052

  10. Management of Acute Hypertensive Response in Patients With Ischemic Stroke.

    PubMed

    AlSibai, Ahmad; Qureshi, Adnan I

    2016-07-01

    High blood pressure (BP) >140/90 mm Hg is seen in 75% of patients with acute ischemic stroke and in 80% of patients with acute intracerebral hemorrhages and is independently associated with poor functional outcome. While BP reduction in patients with chronic hypertension remains one of the most important factors in primary and secondary stroke prevention, the proper management strategy for acute hypertensive response within the first 72 hours of acute ischemic stroke has been a matter of debate. Recent guidelines recommend clinical trials to ascertain whether antihypertensive therapy in the acute phase of stroke is beneficial. This review summarizes the current data on acute hypertensive response or elevated BP management during the first 72 hours after an acute ischemic stroke. Based on the potential deleterious effect of lowering BP observed in some clinical trials in patients with acute ischemic stroke and because of the lack of convincing evidence to support acute BP lowering in those situations, aggressive BP reduction in patients presenting with acute ischemic stroke is currently not recommended. While the early use of angiotensin receptor antagonists may help reduce cardiovascular events, this benefit is not necessarily related to BP reduction. PMID:27366297

  11. Order Theoretical Semantic Recommendation

    SciTech Connect

    Joslyn, Cliff A.; Hogan, Emilie A.; Paulson, Patrick R.; Peterson, Elena S.; Stephan, Eric G.; Thomas, Dennis G.

    2013-07-23

    Mathematical concepts of order and ordering relations play multiple roles in semantic technologies. Discrete totally ordered data characterize both input streams and top-k rank-ordered recommendations and query output, while temporal attributes establish numerical total orders, either over time points or in the more complex case of startend temporal intervals. But also of note are the fully partially ordered data, including both lattices and non-lattices, which actually dominate the semantic strcuture of ontological systems. Scalar semantic similarities over partially-ordered semantic data are traditionally used to return rank-ordered recommendations, but these require complementation with true metrics available over partially ordered sets. In this paper we report on our work in the foundations of partial order measurement in ontologies, with application to top-k semantic recommendation in workflows.

  12. Space Station Software Recommendations

    NASA Technical Reports Server (NTRS)

    Voigt, S. (Editor)

    1985-01-01

    Four panels of invited experts and NASA representatives focused on the following topics: software management, software development environment, languages, and software standards. Each panel deliberated in private, held two open sessions with audience participation, and developed recommendations for the NASA Space Station Program. The major thrusts of the recommendations were as follows: (1) The software management plan should establish policies, responsibilities, and decision points for software acquisition; (2) NASA should furnish a uniform modular software support environment and require its use for all space station software acquired (or developed); (3) The language Ada should be selected for space station software, and NASA should begin to address issues related to the effective use of Ada; and (4) The space station software standards should be selected (based upon existing standards where possible), and an organization should be identified to promulgate and enforce them. These and related recommendations are described in detail in the conference proceedings.

  13. Personalized Movie Recommendation

    NASA Astrophysics Data System (ADS)

    Lekakos, George; Charami, Matina; Caravelas, Petros

    This article proposes a movie recommender system, named MoRe, which follows a hybrid approach that combines content-based and collaborative filtering. MoR's performance is empirically evaluated upon the predictive accuracy of the algorithms as well as other important indicators such as the percentage of items that the system can actually predict (called prediction coverage) and the time required for generating predictions. The remainder of this article is organized as follows. The next section is devoted to the fundamental background of recommender systems describing the main recommendation techniques along with their advantages and limitations. Right after, we illustrate the MoRe system overview and in the section following, we describe in detail the algorithms implemented. The empirical evaluation results are then presented, while the final section provides a discussion about conclusions and future research.

  14. Evaluating Recommendation Systems

    NASA Astrophysics Data System (ADS)

    Shani, Guy; Gunawardana, Asela

    Recommender systems are now popular both commercially and in the research community, where many approaches have been suggested for providing recommendations. In many cases a system designer that wishes to employ a recommendation system must choose between a set of candidate approaches. A first step towards selecting an appropriate algorithm is to decide which properties of the application to focus upon when making this choice. Indeed, recommendation systems have a variety of properties that may affect user experience, such as accuracy, robustness, scalability, and so forth. In this paper we discuss how to compare recommenders based on a set of properties that are relevant for the application. We focus on comparative studies, where a few algorithms are compared using some evaluation metric, rather than absolute benchmarking of algorithms. We describe experimental settings appropriate for making choices between algorithms. We review three types of experiments, starting with an offline setting, where recommendation approaches are compared without user interaction, then reviewing user studies, where a small group of subjects experiment with the system and report on the experience, and finally describe large scale online experiments, where real user populations interact with the system. In each of these cases we describe types of questions that can be answered, and suggest protocols for experimentation. We also discuss how to draw trustworthy conclusions from the conducted experiments. We then review a large set of properties, and explain how to evaluate systems given relevant properties. We also survey a large set of evaluation metrics in the context of the properties that they evaluate.

  15. Perioperative management of pulmonary hypertension during lung transplantation (a lesson for other anaesthesia settings).

    PubMed

    Rabanal, J M; Real, M I; Williams, M

    2014-10-01

    Patients with pulmonary hypertension are some of the most challenging for an anaesthesiologist to manage. Pulmonary hypertension in patients undergoing surgical procedures is associated with high morbidity and mortality due to right ventricular failure, arrhythmias and ischaemia leading to haemodynamic instability. Lung transplantation is the only therapeutic option for end-stage lung disease. Patients undergoing lung transplantation present a variety of challenges for anaesthesia team, but pulmonary hypertension remains the most important. The purpose of this article is to review the anaesthetic management of pulmonary hypertension during lung transplantation, with particular emphasis on the choice of anaesthesia, pulmonary vasodilator therapy, inotropic and vasopressor therapy, and the most recent intraoperative monitoring recommendations to optimize patient care. PMID:25156939

  16. Hypertensive patients in primary health care: access, connection and care involved in spontaneous demands.

    PubMed

    Girão, Ana Lívia Araújo; Freitas, Consuelo Helena Aires de

    2016-06-01

    Objective To assess the impacts of inclusion of care for spontaneous demands in the treatment of hypertensive patients in primary health care. Methods Third generation qualitative assessment survey conducted with 16 workers in a Primary Care Health Unit (PHCU) of the city of Fortaleza, state of Ceara, in the period between July and September of 2015. To collect data, systematic field observation and semi-structured interviews were used, and the stages of thematic content analysis were adopted for data analysis. Results Participants revealed that access, connection and care are fundamental to the treatment of hypertension. However, they said that the introduction of free access for spontaneous demands compromised the flow of care in the hypertension programs. Conclusion A dichotomy between the practice of care recommended by health policies and the one existing in the reality of PHCUs was shown, causing evident losses to the care of hypertensive patients in primary care. PMID:27253602

  17. New therapies for arterial hypertension.

    PubMed

    Pagliaro, Beniamino; Santolamazza, Caterina; Rubattu, Speranza; Volpe, Massimo

    2016-03-01

    Arterial hypertension is the most common chronic disease in developed countries and it is the leading risk factor for stroke, ischemic heart disease, congestive heart failure, chronic renal failure and peripheral artery disease. Its prevalence appears to be about 30-45% of the general population. Recent European guidelines estimate that up to 15-20% of the hypertensive patients are not controlled on a dual antihypertensive combination and they require three or more different antihypertensive drug classes to achieve adequate blood pressure control. The guidelines confirmed that diuretics, beta-blockers, calcium-channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are suitable for the initiation and maintenance of antihypertensive treatment, either as monotherapy or in combination therapy. Very few antihypertensive agents have reached the market over the last few years, but no new therapeutic class has really emerged. The long-term adherence to cardiovascular drugs is still low in both primary and secondary prevention of cardiovascular diseases. In particular, the issue of compliance is persistently high in hypertension, despite the fixed-dose combination therapy. As a consequence, a cohort of high-risk hypertensive population, represented by patients affected by refractory and resistant hypertension, can be identified. Therefore, the need of controlling BP in high-risk patients may be addressed, in part, by the development of new drugs, devices and procedures that are designed to treat hypertension and comorbidities. In this review we will comprehensively discuss the current literature on recent therapeutic advances in hypertension, including both medical therapy and interventional procedures. PMID:26730462

  18. Comprehensive management of hypertensive emergencies and urgencies.

    PubMed

    Mansoor, George A; Frishman, William H

    2002-01-01

    Despite advances in chronic hypertension management, hypertensive emergencies and urgencies remain as serious complications. Much of this relates to poor compliance with effective antihypertensive management. Hypertensive emergencies and urgencies can also be seen as the initial manifestations of hypertension in pregnancy and in the perioperative period. Multiple classes of intravenous antihypertensive drugs are available to treat hypertensive emergencies, and specific agents may have an advantage in a given clinical situation. Orally active agents are used to treat hypertensive urgencies, and include clonidine, angiotensin-converting enzyme inhibitors, and labetalol. Most patients respond to drug therapy, but problems may arise related to a rapid normalization of blood pressure. PMID:12441013

  19. Beliefs of Health Care Providers, Lay Health Care Providers and Lay Persons in Nigeria Regarding Hypertension. A Systematic Mixed Studies Review

    PubMed Central

    Akinlua, James Tosin; Meakin, Richard; Fadahunsi, Philip; Freemantle, Nick

    2016-01-01

    Background Hypertension is a major health risk factor for mortality globally, resulting in about 13% of deaths worldwide. In Nigeria, the high burden of hypertension remains an issue for urgent attention. The control of hypertension, among other factors, is strongly determined by personal beliefs about the illness and recommended treatment. Objective The aim of this review is to systematically synthesize available data from all types of studies on beliefs of the Nigerian populace about hypertension Methods We searched the following electronic databases; Medline, EMBase, PsycInfo, AMED from their inception till date for all relevant articles. A modified Kleinman’s explanatory model for hypertension was used as a framework for extraction of data on beliefs about hypertension. Results The search yielded a total of 3,794 hits from which 16 relevant studies (2 qualitative, 11 quantitative and 3 mixed methods studies) met the inclusion criteria for the review. Overall, most health care providers (HCPs) believe that stress is a major cause of hypertension. Furthermore, reported cut-off point for uncomplicated hypertension differed widely among HCPs. Lay Health Care Providers such as Patent Medicine Vendors’ beliefs about hypertension seem to be relatively similar to health care professionals in areas of risk factors for hypertension, course of hypertension and methods of treatment. Among Lay persons, misconception about hypertension was quite high. Although some Nigerians believed that life style habits such as alcohol intake, exercise levels, cigarette smoking were risk factors for developing hypertension, there was discordance between belief and practice of control of risk factors. However, beliefs across numerous ethnic groups and settings (urban/rural) in Nigeria have not been explored. Conclusion In order to achieve control of hypertension in Nigeria, interventions should be informed, among other factors, by adequate knowledge of beliefs regarding hypertension

  20. A quality improvement plan for hypertension control: the INCOTECA Project (INterventions for COntrol of hyperTEnsion in CAtalonia)

    PubMed Central

    Vallès-Fernandez, Roser; Rosell-Murphy, Magdalena; Correcher-Aventin, Olga; Mengual-Martínez, Lucas; Aznar-Martínez, Núria; Prieto-De Lamo, Gemma; Franzi-Sisó, Alícia; Puig-Manresa, Jordi; Ma Bonet-Simó, Josep

    2009-01-01

    Background Different studies have shown insufficient blood pressure (BP) control in hypertensive patients. Multiple factors influence hypertension management, and the quality of primary care is one of them. We decided therefore to evaluate the effectiveness of a quality improvement plan directed at professionals of Primary Health Care Teams (PHCT) with the aim to achieve a better control of hypertension. The hypothesis of the study is that the implementation of a quality improvement plan will improve the control of hypertension. The primary aim of this study will be to evaluate the effectiveness of this plan. Methods and design Design: multicentric study quasi-experimental before – after with control group. The non-randomised allocation of the intervention will be done at PHCT level. Setting: 18 PHCT in the Barcelona province (Spain). Sample: all patients with a diagnosis of hypertension (population based study). Exclusion criteria: patients with a diagnosis of hypertension made later than 01/01/2006 and patients younger than 18 years. Intervention: a quality improvement plan, which targets primary health care professionals and includes educational sessions, feedback to health professionals, audit and implementation of recommended clinical practice guidelines for the management of hypertensive patients. Measurements: age, sex, associated co-morbidity (diabetes mellitus type I and II, heart failure and renal failure). The following variables will be recorded: BP measurement, cardiovascular risk and antihypertensive drugs used. Results will be measured before the start of the intervention and twelve months after the start of the study. Dependent variable: prevalence of hypertensive patients with poor BP control. Analysis: Chi-square test and Student's t-test will be used to measure the association between independent qualitative and quantitative variables, respectively. Non-parametric tests will be used for the analysis of non-normally distributed variables

  1. Hypertension treatment in the Asia-Pacific: the role of and treatment strategies with nebivolol

    PubMed Central

    Kim, Cheol-Ho; Abelardo, Nelson; Buranakitjaroen, Peera; Krittayaphong, Rungroj; Lim, Chin Hock; Park, Sung-Ha; Pham, Nguyen Vinh; Rogelio, Gregorio; Wong, Bernard; Low, Lip Ping

    2016-01-01

    Hypertension is a common disease, and hypertensive patients are at increased risk of cardiovascular events. The prevalence and socioeconomic burden of hypertension in the Asia-Pacific region are predicted to increase in the coming decades. Effective blood pressure lowering reduces overall cardiovascular morbidity and mortality in patients, yet doubt has been raised regarding the use of (mainly older generation) β-blockers as initial therapy in hypertension. Consequently, several international treatment guidelines do not recommend β-blockers for the treatment of hypertension. However, in contrast to first-generation and second-generation β-blockers, the third-generation, vasodilating β-blocker nebivolol has a considerably better metabolic, haemodynamic and side effect profile. In addition to providing effective blood pressure control similar to other β-blockers and drugs from other antihypertensive classes, nebivolol exerts a dual mechanism for increasing the bioavailability of the naturally occurring vasodilator nitric oxide. The clinical benefits and significance of enhancing nitric oxide levels in hypertensive patients have been shown in direct comparisons of nebivolol with other β-blockers. While β-blockers generally provide comparable blood pressure reductions, only nebivolol demonstrated enhanced vasodilation and blood flow by increasing the expression of endothelial nitric oxide synthase and therefore increasing nitric oxide release from the endothelium. In contrast to other β-blockers, therefore, it has been suggested that nebivolol has beneficial effects in several hypertensive subgroups due to its vasodilating properties. Considering the existing data, it may be timely for treatment guidelines to recommend third-generation vasodilating β-blockers as a first-line option for the pharmacotherapy of hypertension. PMID:27326226

  2. [Diagnostic and treatment of hypertensive cerebellar hematomas].

    PubMed

    Krylov, V V; Dash'ian, V G; Murashko, A A; Burov, S A

    2009-01-01

    Authors analyzed the results of treatment of 56 patients with hypertensive cerebellar hemorrhages (volume 0,5-41 cm3). Brain stem symptoms were found in 45 (80%) of patients. The dislocation of brain stem was observed in 38 (68%) cases, occlusive hydrocephaly - in 22 (39%), intraventricular hemorrhage - in 26 (46%). Severity of state depended on character of disease course, presence of stem symptoms, awakening level, volume and localization of cerebellar hematoma, development of intraventricular hemorrhage, occlusive hydrocephaly and dislocation of brain stem. Thirty-six patients were operated. After the neurosurgical intervention, 22 (61%) patients were discharged without or with the minimal neurological deficit, 1 (3%) with marked disability and 13 (36%) patients died. In conclusion, the removal of hematoma is recommended in dislocation of brain stem and disturbance of consiousnes: the ventricular drainage - in occlusive hydrocephaly developed as a consequence of hemotamponade of IV ventricular. The surgical treatment is not recommended to patients with cerebellar hematomas with the volume less than 7 cm3. PMID:19491806

  3. When to Recommend Intervention.

    ERIC Educational Resources Information Center

    Olswang, Lesley B.; Bain, Barbara A.

    1991-01-01

    This article reviews the critical issues that influence whether a child with language impairments can benefit from intervention. It recommends three procedures (profiling, dynamic assessment, and tracking/monitoring) as tools for helping speech-language pathologists make informed decisions about intervention. (Author/JDD)

  4. Concluding Comments and Recommendations

    ERIC Educational Resources Information Center

    Carson, Russell L.; Landers, Rian Q.; Blankenship, Bonnie Tjeerdsma

    2010-01-01

    Using the expertise from the academy interest areas of the National Association for Sport and Physical Education, the 2010 All-Academy Symposium and this feature set out to discern the promises and pitfalls of youth sport specialization. This final article offers a few conclusions and recommendations based on the multidisciplinary perspectives and…

  5. CASE's ESEA Reauthorization Recommendations

    ERIC Educational Resources Information Center

    Council of Administrators of Special Education (NJ1), 2011

    2011-01-01

    This paper presents the recommendations by the Council of Administrators of Special Education, Inc. (CASE) for the reauthorization of the Elementary and Secondary Education Act (ESEA). CASE is a non-profit professional organization which provides leadership and support to approximately 5,000 members by influencing policies and practices to improve…

  6. CETA: Assessment and Recommendations.

    ERIC Educational Resources Information Center

    National Academy of Sciences - National Research Council, Washington, DC. Committee on Evaluation of Employment and Training Programs.

    This document presents the principal findings and recommendations of a study conducted by the Committee on Evaluation of Employment and Training Program to assess the impact of CETA (Comprehensive Employment and Training Act) on manpower programs. This report is divided into two parts. Part 1 provides an overview of CETA's history, summarizes…

  7. Assessment: DEC Recommended Practices.

    ERIC Educational Resources Information Center

    Neisworth, John T.

    This paper lists practices recommended by the Division for Early Childhood for assessment in early intervention and early childhood special education (EI/ECSE) programs for infants and young children with special needs and their families. Introductory text examines the role of assessment, materials and procedures used, and assessment principles,…

  8. Recommendations for Alternative Credit.

    ERIC Educational Resources Information Center

    Lenderman, Ed; And Others

    Following a review of the mathematics topics taught in accounting, electronics, auto, food and clothing, and metals courses at Linn-Benton Community College, Albany, Oregon, recommendations were made to grant one semester of mathematics credit for completing a two-year sequence of these courses. The other required semester of mathematics should be…

  9. Writing Letters of Recommendation

    ERIC Educational Resources Information Center

    Withers, Jennie

    2009-01-01

    The purpose of this essay is to instruct teachers how to write a letter of recommendation for their students. It includes when to say no, what the student needs to provide the teacher and how to write a strong letter. I am a teacher with sixteen years experience and therefore have written many letters for students. This instructional essay will…

  10. Recommendations for Neophyte Innovators.

    ERIC Educational Resources Information Center

    Gilman, Peter J.

    1979-01-01

    The study recorded the origin, development, and implementation of the physical facilities, organizational structure, and program of Chamisa Elementary School, Los Alamos, New Mexico. Recommendations made pertain to administrative and public support, physical facilities, faculty selection, innovating on a limited scale, curriculum development, team…

  11. Hyperthyroidism and pulmonary hypertension.

    PubMed

    Marvisi, M; Brianti, M; Marani, G; Del Borello, R; Bortesi, M L; Guariglia, A

    2002-04-01

    In recent years, many authors have described several cases revealing an association between hyperthyroidism and pulmonary hypertension (PH). This observational study was designed to evaluate the incidence of PH in hyperthyroidism and was set in a department of internal medicine and pulmonary diseases with an out-patients department of endocrinology. Thirty-four patients, 25 women and nine men, with a mean age of 38 +/- 15 SD years participated. Twenty had Graves' disease and 14 had a nodular goitre. The patients were divided into two equally matched groups: those with a recently diagnosed hyperthyroidism, taking no drugs (group 1; n = 17) and those in a euthyroid state taking methimazole (group 2; n= 17). Transthoracic Doppler echocardiography was performed and systolic pulmonary artery pressurements of (PAPs) was determined by the tricuspid regurgitation method using the Bernoulli equation. Measurements of triiodothyronine, tetraiodothyronine, free thyroxine (Ft4), thyroid-stimulating hormone (TSH) and antithyroglobulin and antimicrosomal antibodies were also taken. We found a mild PH in seven patients of group 1 and in none of group 2. The mean +/- SD systolic pulmonaryartery pressurewas 28.88 +/- 6.41 in group 1 and 22.53 +/- 1.84 ingroup 2 (P<0.0001). A correlation was found between the TSH value and PAPs (r = -082;P < 0.001) and Ft4 and PAPs (r = 0 85; P < 0.001) in group 1. These findings indicate the presence of a frequent association between PH and hyperthyroidism. We suggest that hyperthyroidism be included in the differential diagnosis of PH. PMID:11999999

  12. Development of Hypertension Management Mobile Application based on Clinical Practice Guidelines.

    PubMed

    Kang, H; Park, H A

    2015-01-01

    This study aims to develop and evaluate a mobile application for hypertension management based on Clinical Practice Guidelines. The application was developed according to Web-Roadmap methodology. In planning phase, we defined the tasks and product of each phase, selected clinical practice guidelines and extracted intervention items for hypertension management. In analysis phase, we analysed intervention items and made data dictionary, rules, use-case diagram, hypertension management ontology and tailored recommendations for the application. In design phase, we developed an entity-relations diagram, algorithm, and user interface and coded them in the implementation phase. In evaluation phase, first, the knowledge-base was evaluated for its accuracy by experts and they proposed three more detailed recommendations, which were added to the application. Second, mobile heuristics were evaluated. The evaluators pointed out 33 usability-related problems on mobile heuristics items. Out of these, three problems were solved by reflecting evaluators' comments. PMID:25991219

  13. Heat stress proteins in hypertension

    SciTech Connect

    Malo, D.; Tremblay, J.; Pang, S.C.; Schlager, G.; Hamet, P.

    1986-03-05

    It has been described that spontaneously hypertensive rats (SHR) are more sensitive to an acute environmental heat stress and that cultured cardiomyocytes from neonatal SHR are demonstrated to be more thermosensitive. In addition, chronically heat exposed spontaneously hypertensive mice leads to a decrease of blood pressure in these animals. Heat shock is known to induce the synthesis of a new set of proteins (HSP) in every cell tested. This ubiquitous response seems to be involved in the induction of a thermotolerant state. The synthesis of 70K HSP was observed in lymphocytes isolated from the spleen of chronically heated mice. They used lymphocytes, previously isolated on a ficoll gradient, to evaluate the HSP induction in normotensive (WKY) and hypertensive (SHR) rats. The heat shock was induced by exposing the lymphocytes at 46/sup 0/C during 5 min in a hot water bath. The cells were then labeled with (/sup 75/Se)-methionine, washed, homogenized and separated on 5-30% SDS-polyacrylamide gel. Preliminary results suggest an abnormal pattern of induction of 70K and 90K HSP in hypertension. Heat sensitivity, thermotolerance and expression of HSP may, thus, be related to hypertension.

  14. [Dyslipidemia and hypertension].

    PubMed

    Alvirde-García, Ulices

    2016-09-01

    Most of the recent observational studies have failed to find an association between dairy intake and increased risk of cardiovascular disease, coronary heart disease and stroke, regardless of milk fat content. The purpose of this review is to examine the published research on the relationship between milk products containing milk fat and cardiovascular health. Despite their saturated fat content, there is no clear evidence of an association between dairy intake and an increased risk of cardiovascular disease (CVD). Consequently, the current dietary recommendations to restrict saturated fat should be assessed for every case. PMID:27603889

  15. Applicability of the current hypertension guidelines in Latin America.

    PubMed

    Alcocer, Luis; Meaney, Eduardo; Hernandez-Hernandez, Hector

    2015-08-01

    Recent research has focused on the development of evidence-based guidelines that are intended to regulate the conduct of physicians in the diagnosis and control of hypertension, with the goal of achieving greater effectiveness and equity at the lowest possible cost. In Latin America, guidelines are available for the management of hypertension at three levels: national, regional and international. The national and regional Latin American and Caribbean (LAC) guidelines are in fact adaptations of the international guidelines. The potential benefit of applying guidelines developed in other regions to local healthcare decision making is that it will enable decision makers to take advantage of existing analyses and transfer or adapt them to their local contexts. However, this adaptation precludes the assessment of their generalizability and potential transferability. In addition, this region is characterized by wide socioeconomic differences between its inhabitants, both among and within nations. Therefore, new guidelines for the LAC region must include recommendations that are common to all hypertensive patients in the region. Moreover, we advocate the inclusion of a specific section that makes comprehensive recommendations and provides strategies for implementation according to the socioeconomic conditions of particular groups. In addition to developing guidelines that are truly applicable to the LAC region, it seems sensible to consider information that is specific to this region. Furthermore, developing evidence-based guidelines is not enough to affect positively the burden of disease caused by hypertension. Therefore, professional programs are required for the implementation of such guidelines as well as the auditing of their results. Achieving these ambitious goals will require collaborative efforts by many groups including policymakers, international organizations, healthcare providers, universities and society. PMID:26088410

  16. Who Is at Risk for Pulmonary Hypertension?

    MedlinePlus

    ... exact number of people who have pulmonary hypertension (PH) isn't known. Group 1 pulmonary arterial hypertension ( ... have group 1 PAH tend to be overweight . PH that occurs with another disease or condition is ...

  17. Infantile Renovascular Hypertension with Failure to Thrive.

    PubMed

    Phillips, Amanda R; Eliason, Jonathan L; Stanley, James C; Coleman, Dawn M

    2016-05-01

    Severe hypertension in infancy is a rare cause of failure to thrive. The successful surgical management of this disease in an infant having refractory renovascular hypertension and growth failure is reported. PMID:26965798

  18. An Update on Inpatient Hypertension Management.

    PubMed

    Axon, R Neal; Turner, Mason; Buckley, Ryan

    2015-11-01

    Hypertension is highly prevalent affecting nearly one third of the US adult population. Though generally approached as an outpatient disorder, elevated blood pressure is observed in a majority of hospitalized patients. The spectrum of hypertensive disease ranges from patients with hypertensive emergency including markedly elevated blood pressure and associated end-organ damage to asymptomatic patients with minimally elevated pressures of unclear significance. It is important to note that current evidence-based hypertension guidelines do not specifically address inpatient hypertension. This narrative review focuses primarily on best practices for diagnosing and managing nonemergent hypertension in the inpatient setting. We describe examples of common hypertensive syndromes, provide suggestions for optimal post-acute management, and point to evidence-based or consensus guidelines where available. In addition, we describe a practical approach to managing asymptomatic elevated blood pressure observed in the inpatient setting. Finally, arranging effective care transitions to ensure optimal ongoing hypertension management is appropriate in all cases. PMID:26362300

  19. Pressure Points: Preventing and Controlling Hypertension

    MedlinePlus

    ... Issue Past Issues Pressure Points: Preventing and Controlling Hypertension Past Issues / Summer 2006 Table of Contents For ... diagnosed with high blood pressure." Aditional Information On Hypertension MedlinePlus: High blood pressure: http://www.nlm.nih. ...

  20. Microarray analysis in pulmonary hypertension

    PubMed Central

    Hoffmann, Julia; Wilhelm, Jochen; Olschewski, Andrea

    2016-01-01

    Microarrays are a powerful and effective tool that allows the detection of genome-wide gene expression differences between controls and disease conditions. They have been broadly applied to investigate the pathobiology of diverse forms of pulmonary hypertension, namely group 1, including patients with idiopathic pulmonary arterial hypertension, and group 3, including pulmonary hypertension associated with chronic lung diseases such as chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis. To date, numerous human microarray studies have been conducted to analyse global (lung homogenate samples), compartment-specific (laser capture microdissection), cell type-specific (isolated primary cells) and circulating cell (peripheral blood) expression profiles. Combined, they provide important information on development, progression and the end-stage disease. In the future, system biology approaches, expression of noncoding RNAs that regulate coding RNAs, and direct comparison between animal models and human disease might be of importance. PMID:27076594

  1. QT dispersion in adult hypertensives.

    PubMed Central

    Sani, Isa Muhammad; Solomon, Danbauchi Sulei; Imhogene, Oyati Albert; Ahmad, Alhassan Muhammad; Bala, Garko Sani

    2006-01-01

    Increased QT dispersion is associated with sudden cardiac death in congestive cardiac failure, hypertrophic cardiomyopathy and following myocardial infarction. Patients with hypertension--in particular, those with left ventricular hypertrophy (LVH)--are also at greater risk of sudden cardiac death. We examined whether QT dispersion, which is easily obtained from a routine ECG, correlates with LVH. One-hundred untreated patients with systemic hypertension and 78 normotensives had QT dispersion measured manually from a surface 12-lead electrocardiogram and two-dimensional echocardiography performed to measure interventricular septal thickness, posterior wall thickness and left ventricular internal diameter. Office blood pressure was also recorded. Multivariate analysis demonstrated significant relationships between QT dispersion and office systolic blood pressure, and left ventricular mass index. Manual measurement of QT dispersion might be a simple, noninvasive screening procedure to identify those hypertensives at greatest risk of sudden cardiac death in a third-world country. PMID:16623077

  2. Microarray analysis in pulmonary hypertension.

    PubMed

    Hoffmann, Julia; Wilhelm, Jochen; Olschewski, Andrea; Kwapiszewska, Grazyna

    2016-07-01

    Microarrays are a powerful and effective tool that allows the detection of genome-wide gene expression differences between controls and disease conditions. They have been broadly applied to investigate the pathobiology of diverse forms of pulmonary hypertension, namely group 1, including patients with idiopathic pulmonary arterial hypertension, and group 3, including pulmonary hypertension associated with chronic lung diseases such as chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis. To date, numerous human microarray studies have been conducted to analyse global (lung homogenate samples), compartment-specific (laser capture microdissection), cell type-specific (isolated primary cells) and circulating cell (peripheral blood) expression profiles. Combined, they provide important information on development, progression and the end-stage disease. In the future, system biology approaches, expression of noncoding RNAs that regulate coding RNAs, and direct comparison between animal models and human disease might be of importance. PMID:27076594

  3. Schistosomiasis-associated pulmonary hypertension

    PubMed Central

    Mocumbi, Ana Olga H.; Kim, Nick H.; Mandel, Jess

    2014-01-01

    Abstract Schistosomiasis, a parasite-borne disease, is highly prevalent in Africa and Asia; it is estimated that close to 20 million people worldwide have a severe form of the disease. The chronic form can affect the gastrointestinal system and lead to hepatosplenic disease, and it may cause cardiopulmonary complications, including pulmonary hypertension. The exact pathogenesis of schistosomiasis-associated pulmonary hypertension (Sch-PH) remains unclear, although several mechanisms, including parasitic arterial embolization, pulmonary arteriopathy, and portopulmonary hypertension–like pathophysiology, have been suggested. The immunopathology of the disease is also unclear, although there are similarities with the immunology of idiopathic pulmonary arterial hypertension (PAH). Finally, the treatment of Sch-PH has not been well studied. There is some evidence on treating the underlying infection, with unclear effect on Sch-PH, and advanced PAH therapies are now being suggested, but more studies are needed to confirm their efficacy. PMID:25610596

  4. Refeeding hypertension in dietary obesity

    SciTech Connect

    Ernsberger, P.; Nelson, D.O. )

    1988-01-01

    A novel model of nutritionally induced hypertension in the rat is described. Dietary obesity was produced by providing sweet milk in addition to regular chow, which elicited a 52% increase in caloric intake. Despite 54% greater body weight gain and 139% heavier retroperitoneal fat pads, 120 days of overfeeding failed to increase systolic pressure in the conscious state or mean arterial pressure under urethan anesthesia. In contrast, mild hypertension developed in intermittantly fasted obese animals. The first 4-day supplemented fast was initiated 4 wk after the introduction of sweet milk, when the animals were 47 g overweight relative to chow-fed controls. Thereafter, 4 days of starvation were alternated with 2 wk of refeeding for a total of 4 cycles. A rapid fall in systolic blood pressure accompanied the onset of supplemented fasting and was maintained thereafter. With refeeding, blood pressure rose precipitously, despite poststarvation anorexia. Blood pressure tended to rise slightly over the remainder of the realimentation period. After the 4th supplemented fast, hypertension was sustained during 30 days of refeeding. Cumulative caloric intake in starved-refed rats fell within 2% of that in chow-fed controls. Refeeding hypertension appeared to be due to increased sympathetic nervous activity, since (1) cardiac {beta}-adrenergic receptors were downregulated, as indicated by a 40% decrease in the maximum binding of ({sup 3}H)dihydroalpranolol; and (2) the decrease in heart rate as a result of {beta}-blockade was enhanced. Refeeding hypertension in the dietary obese rat may be a potential animal model for some forms of human obesity-related hypertension.

  5. Hypertension management in 2002: where have we been? where might we be going?

    PubMed

    Hansson, Lennart

    2002-10-01

    The term "blood pressure" was coined almost 300 years ago by the man who first measured it, the Reverend Stephen Hales of England. However, our understanding of the pathogenesis and consequences of hypertension, as well as the available treatments for it, have remained greatly limited and inadequate until only the past 30 years. Starting in 1977, reports from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of Hypertension (JNC) have provided regular updates on developments in hypertension management, and have set guidelines for the diagnosis and treatment of hypertension. More than 20 years ago, the JNC stratified blood pressure (BP) levels into categories of mild, moderate, and severe (later renamed stages 1, 2, and 3, respectively). A stepped-care approach to hypertension therapy was originally recommended. With each revised JNC report, there was a reduction in target BP and a growing recognition of the importance of high-normal BP and isolated systolic hypertension. The sixth and most current report of the Joint National Committee, JNC VI, emphasizes treatment of comorbidities of hypertension, sets a lower BP goal (<130/85 mm Hg) for high-risk patients-eg, those with diabetes or renal disease-than for those with uncomplicated hypertension (<140/90 mm Hg), and places a greater emphasis on disease prevention. For the future, the current trend toward lower BP goals suggests that more effective and better tolerated antihypertensive therapies will be needed. Multiple antihypertensive agents used concomitantly will likely be needed to control elevated levels of BP in the majority of hypertensive patients. PMID:12383590

  6. A Mobile App for Hypertension Management Based on Clinical Practice Guidelines: Development and Deployment

    PubMed Central

    Kang, Hannah

    2016-01-01

    Background Hypertension is a chronic and lifestyle-related disease that requires continuous preventive care. Although there are many evidence-based clinical practice guidelines (CPGs) for hypertension management, applying them to daily management can be difficult for patients with hypertension. A mobile app, based on CPGs, could help patients with hypertension manage their disease. Objective To develop a mobile app for hypertension management based on CPGs and evaluate its effectiveness in patients with hypertension with respect to perceived usefulness, user satisfaction, and medication adherence. Methods The hypertension management app (HMA) was developed according to the Web-Roadmap methodology, which includes planning, analysis, design, implementation, and evaluation phases. The HMA was provided to individuals (N=38) with hypertension. Medication adherence was measured before and after using the HMA for 4 weeks. The perceived usefulness and user satisfaction were surveyed in the patients who completed the medication adherence survey. Results Of the 38 study participants, 29 (76%) participated in medical adherence assessment. Medication adherence, as measured by the Modified Morisky Scale, was significantly improved in these patients after they had used the HMA (P=.001). The perceived usefulness score was 3.7 out of 5. The user satisfaction scores, with respect to using the HMA for blood pressure recording, medication recording, data sending, alerting, recommending, and educating about medication were 4.3, 3.8, 3.1, 3.2, 3.4, and 3.8 out of 5, respectively, in the 19 patients. Conclusions This study showed that a mobile app for hypertension management based on CPGs is effective at improving medication adherence. PMID:26839283

  7. Risk Factors in Adolescent Hypertension.

    PubMed

    Ewald, D Rose; Haldeman PhD, Lauren A

    2016-01-01

    Hypertension is a complex and multifaceted disease, with many contributing factors. While diet and nutrition are important influences, the confounding effects of overweight and obesity, metabolic and genetic factors, racial and ethnic predispositions, socioeconomic status, cultural influences, growth rate, and pubertal stage have even more influence and make diagnosis quite challenging. The prevalence of hypertension in adolescents far exceeds the numbers who have been diagnosed; studies have found that 75% or more go undiagnosed. This literature review summarizes the challenges of blood pressure classification in adolescents, discusses the impact of these confounding influences, and identifies actions that will improve diagnosis and treatment outcomes. PMID:27335997

  8. Risk Factors in Adolescent Hypertension

    PubMed Central

    Ewald, D. Rose; Haldeman, Lauren A.

    2016-01-01

    Hypertension is a complex and multifaceted disease, with many contributing factors. While diet and nutrition are important influences, the confounding effects of overweight and obesity, metabolic and genetic factors, racial and ethnic predispositions, socioeconomic status, cultural influences, growth rate, and pubertal stage have even more influence and make diagnosis quite challenging. The prevalence of hypertension in adolescents far exceeds the numbers who have been diagnosed; studies have found that 75% or more go undiagnosed. This literature review summarizes the challenges of blood pressure classification in adolescents, discusses the impact of these confounding influences, and identifies actions that will improve diagnosis and treatment outcomes. PMID:27335997

  9. Determinants of Adherence to Treatment in Hypertensive Patients of African Descent and the Role of Culturally Appropriate Education

    PubMed Central

    Meinema, Jennita G.; van Dijk, Nynke; Beune, Erik J. A. J.; Jaarsma, Debbie A. D. C.; van Weert, Henk C. P. M.; Haafkens, Joke A.

    2015-01-01

    Background In Western countries, better knowledge about patient-related determinants of treatment adherence (medication and lifestyle) is needed to improve treatment adherence and outcomes among hypertensive ethnic minority patients of African descent. Objective To identify patient-related determinants of adherence to lifestyle and medication recommendations among hypertensive African Surinamese and Ghanaian patients with suboptimal treatment results (SBP≥140) living in the Netherlands and how culturally appropriate hypertension education (CAHE) influenced those determinants. Methods This study analysed data of 139 patients who participated in the CAHE trial. Univariate logistic regression analysis was used to measure the association between patient-related determinants (medication self-efficacy, beliefs about medication and hypertension, social support, and satisfaction with care) and treatment adherence. We also tested whether CAHE influenced the determinants. Results Medication self-efficacy and social support were associated with medication adherence at baseline. At six months, more medication self-efficacy and fewer concerns about medication use were associated with improved medication adherence. Self-efficacy was also associated with adherence to lifestyle recommendations at baseline. CAHE influenced patients’ illness perceptions by creating more understanding of hypertension, its chronic character, and more concerns about the associated risks. Conclusion In this high-risk population, health care providers can support medication adherence by paying attention to patients’ medication self-efficacy, the concerns they may have about medication use and patients’ perceptions on hypertension. The CAHE intervention improved patients’ perception on hypertension. PMID:26267453

  10. [Treatment algorithm for pulmonary arterial hypertension].

    PubMed

    Hoeper, Marius M

    2005-06-01

    During the last decade, we have witnessed substantial improvements in the therapeutic options for pulmonary arterial hypertension (PAH), including true innovations targeting some of the mechanisms involved in the pathogenesis of this devastating disease. Intravenous epoprostenol was the first drug to improve symptoms and survival of patients with PAH. Novel prostanoids including subcutaneous treprostinil and inhaled iloprost also have beneficial effects in many patients, although their long-term efficacy is less well known. Among the newer treatments for PAH, endothelin receptor antagonists and phosphodiesterase type 5 inhibitors have reshaped clinical practice. The endothelin receptor antagonist bosentan has been approved in many parts of the world and most current guidelines recommend this drug as first-line treatment for PAH. Novel endothelin receptor antagonists such as sitaxsentan and ambrisentan are currently being investigated. The phosphodiesterase type 5 inhibitor sildenafil is also being intensively studied in patients with pulmonary hypertension, and most of the available data look promising, although approval for PAH is still pending. Other phosphodiesterase type 5 inhibitors have not yet undergone extensive study in PAH. However, PAH is a complex disorder and targeting a single pathway cannot be expected to be uniformly successful. Thus, combining substances with different modes of action is expected to improve symptoms, hemodynamics and survival in PAH patients, although combination therapy has yet to undergo the scrutiny of large randomized clinical trials.Based on the available data, several guidelines for the diagnostic and therapeutic approach to PAH have been published recently. These guidelines have incorporated treatment algorithms, which, fortunately, are virtually identical. The present review article summarizes the current guidelines to the management of patients with PAH. PMID:15965810

  11. Pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: pathophysiology.

    PubMed

    Humbert, M

    2010-03-01

    Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are two of the key subgroups of pulmonary hypertension. They are characterised by different risk factors. PAH can be associated with mutations in the gene encoding bone morphogenetic protein receptor type II (BMPR2), HIV infection, congenital heart disease, connective tissue disease (such as systemic sclerosis), and exposure to particular drugs and toxins including fenfluramine derivatives. In contrast, CTEPH can be associated with anti-phospholipid antibodies, splenectomy and the presence of a ventriculo-atrial shunt or an infected pacemaker. The first-line therapies used to treat PAH and CTEPH also differ. While medical therapy tends to be used for patients with PAH, pulmonary endarterectomy is the treatment of choice for patients with CTEPH. However, there are possible common mechanisms behind the two diseases, including endothelial cell dysfunction and distal pulmonary artery remodelling. Further research into these similarities is needed to assist the development of targeted pharmacological therapies for patients with inoperable CTEPH and patients who have persistent pulmonary hypertension after endarterectomy. PMID:20956167

  12. Renovascular hypertension: Pathophysiology, diagnosis, and treatment

    SciTech Connect

    Glorioso, N.; Laragh, J.H.; Rappelli, A.

    1987-01-01

    This book contains 42 selections. Some of the titles are: Clinical Pharmacology of Two Synthetic Atrial Natriuretics Peptides; Reflex Control of Renin Release in Normotensive and Hypertensive Humans; Renal Blood flow in Renovascular Hypertension; and Radioisotopic Studies in Renovascular Hypertension Before and After Surgery or Percutaneous Transluminal Renal Angioplasty.

  13. Pharmacologic Therapy for Pulmonary Arterial Hypertension in Adults

    PubMed Central

    Taichman, Darren B.; Chung, Lorinda; Klinger, James R.; Lewis, Sandra; Mandel, Jess; Palevsky, Harold I.; Rich, Stuart; Sood, Namita; Rosenzweig, Erika B.; Trow, Terence K.; Yung, Rex; Elliott, C. Gregory; Badesch, David B.

    2014-01-01

    OBJECTIVE: Choices of pharmacologic therapies for pulmonary arterial hypertension (PAH) are ideally guided by high-level evidence. The objective of this guideline is to provide clinicians advice regarding pharmacologic therapy for adult patients with PAH as informed by available evidence. METHODS: This guideline was based on systematic reviews of English language evidence published between 1990 and November 2013, identified using the MEDLINE and Cochrane Library databases. The strength of available evidence was graded using the Grades of Recommendations, Assessment, Development, and Evaluation methodology. Guideline recommendations, or consensus statements when available evidence was insufficient to support recommendations, were developed using a modified Delphi technique to achieve consensus. RESULTS: Available evidence is limited in its ability to support high-level recommendations. Therefore, we drafted consensus statements to address many clinical questions regarding pharmacotherapy for patients with PAH. A total of 79 recommendations or consensus statements were adopted and graded. CONCLUSIONS: Clinical decisions regarding pharmacotherapy for PAH should be guided by high-level recommendations when sufficient evidence is available. Absent higher level evidence, consensus statements based upon available information must be used. Further studies are needed to address the gaps in available knowledge regarding optimal pharmacotherapy for PAH. PMID:24937180

  14. Safety recommendations for administering intravenous prostacyclins in the hospital.

    PubMed

    Kingman, Martha S; Chin, Kelly

    2013-10-01

    Prostacyclins are a high-risk category of continuous intravenous infusions increasingly used in hospitals to treat advanced pulmonary arterial hypertension, a rare condition characterized by vasoconstriction and vascular proliferation of the pulmonary arteries. Prostacyclins are given in doses of nanograms per kilogram per minute and have a narrow therapeutic dosing range for each patient. Sudden increases or decreases in dose can be life threatening. Previous studies revealed errors in the administration of these high-risk infusions, which in some instances led to serious adverse events, including death. The literature was reviewed for safety measures in administration of high-risk intravenous medications and input was obtained from leading experts in pulmonary arterial hypertension to create a set of safety recommendations for infusion of prostacyclins. PMID:24085826

  15. Optimal blood pressure targets in 2014 - Does the guideline recommendation match the evidence base?

    PubMed

    Alviar, C L; Bangalore, S; Messerli, F H

    2015-01-01

    Various scientific societies have recently published practice guidelines for the diagnosis and management of arterial hypertension with no clear consensus on a blood pressure target. This article reviews those recommendations and critically examines if they are based on sound evidence. PMID:26179968

  16. Matching Recommendation Technologies and Domains

    NASA Astrophysics Data System (ADS)

    Burke, Robin; Ramezani, Maryam

    Recommender systems form an extremely diverse body of technologies and approaches. The chapter aims to assist researchers and developers to identify the recommendation technologies that are most likely to be applicable to different domains of recommendation. Unlike other taxonomies of recommender systems, our approach is centered on the question of knowledge: what knowledge does a recommender system need in order to function, and where does that knowledge come from? Different recommendation domains (books vs condominiums, for example) provide different opportunities for the gathering and application of knowledge. These considerations give rise to a mapping between domain characteristics and recommendation technologies.

  17. [PREDICTORS OF RESISTANT ARTERIAL HYPERTENSION].

    PubMed

    Lazutkina, A Y; Gorbunov, V V

    2016-01-01

    The paper reports results of 6 year prospective observation of 7959 members of locomotive crews engaged at the Transbaikal Railways. The study aimed to estimate the probability and time of development of resistant arterial hypertension under effect of predictors of this disease. The data obtained are of value for diagnostic, prophylactic, and therapeutic practice. PMID:27522725

  18. Carbamazepine-induced hypertension: A rare case

    PubMed Central

    Kharb, Preeti; Mittal, Niti; Gupta, Mahesh C.

    2015-01-01

    A 74-year-old female with trigeminal neuralgia developed hypertension after the initiation of carbamazepine therapy. The time sequence of start of the suspected drug and onset of hypertension are consistent with the diagnosis. The hypertension did not resolve with antihypertensive therapy or dose reduction of carbamazepine. Patient recovered after the carbamazepine therapy was discontinued. The positive rechallenge and positive dechallenge showed association of carbamazepine therapy with hypertension as its adverse effect. This is a rare case that we report of carbamazepine-induced hypertension and this report may act as alerting mechanism to the health care professionals especially neurologists. PMID:26816475

  19. Cardiovascular magnetic resonance in systemic hypertension

    PubMed Central

    2012-01-01

    Systemic hypertension is a highly prevalent potentially modifiable cardiovascular risk factor. Imaging plays an important role in the diagnosis of underlying causes for hypertension, in assessing cardiovascular complications of hypertension, and in understanding the pathophysiology of the disease process. Cardiovascular magnetic resonance (CMR) provides accurate and reproducible measures of ventricular volumes, mass, function and haemodynamics as well as uniquely allowing tissue characterization of diffuse and focal fibrosis. In addition, CMR is well suited for exclusion of common secondary causes for hypertension. We review the current and emerging clinical and research applications of CMR in hypertension. PMID:22559053

  20. Reconciling Multiple Hypertension Guidelines to Promote Effective Clinical Practice.

    PubMed

    Salvo, Marissa; White, C Michael

    2014-06-20

    The new Joint National Committee 8 (JNC-8) blood pressure guidelines were recently published, and there are some major changes from JNC-7. There are also differences between JNC-8 and hypertension guidelines created by major organizations in North America and around the world published from 2013 to the present. In the face of conflicting evidence, it is difficult for practicing clinicians to reconcile these differences and to incorporate new guidance into their practice. This commentary will identify similarities and differences between guidelines, provide some literature context in the areas of differing recommendations, and then provide advice to enhance patient care. PMID:24951309

  1. Panel summary of recommendations

    NASA Technical Reports Server (NTRS)

    Dunbar, Bonnie J.; Coleman, Martin E.; Mitchell, Kenneth L.

    1990-01-01

    The following Space Station internal contamination topics were addressed: past flight experience (Skylab and Spacelab missions); present flight activities (Spacelabs and Soviet Space Station Mir); future activities (materials science and life science experiments); Space Station capabilities (PPMS, FMS, ECLSS, and U.S. Laboratory overview); manned systems/crew safety; internal contamination detection; contamination control - stowage and handling; and contamination control - waste gas processing. Space Station design assumptions are discussed. Issues and concerns are discussed as they relate to (1) policy and management, (2) subsystem design, (3) experiment design, and (4) internal contamination detection and control. The recommendations generated are summarized.

  2. Personalized professional content recommendation

    DOEpatents

    Xu, Songhua

    2015-10-27

    A personalized content recommendation system includes a client interface configured to automatically monitor a user's information data stream transmitted on the Internet. A hybrid contextual behavioral and collaborative personal interest inference engine resident to a non-transient media generates automatic predictions about the interests of individual users of the system. A database server retains the user's personal interest profile based on a plurality of monitored information. The system also includes a server programmed to filter items in an incoming information stream with the personal interest profile and is further programmed to identify only those items of the incoming information stream that substantially match the personal interest profile.

  3. Purinergic dysregulation in pulmonary hypertension.

    PubMed

    Visovatti, Scott H; Hyman, Matthew C; Goonewardena, Sascha N; Anyanwu, Anuli C; Kanthi, Yogendra; Robichaud, Patrick; Wang, Jintao; Petrovic-Djergovic, Danica; Rattan, Rahul; Burant, Charles F; Pinsky, David J

    2016-07-01

    Despite the fact that nucleotides and adenosine help regulate vascular tone through purinergic signaling pathways, little is known regarding their contributions to the pathobiology of pulmonary arterial hypertension, a condition characterized by elevated pulmonary vascular resistance and remodeling. Even less is known about the potential role that alterations in CD39 (ENTPD1), the ectonucleotidase responsible for the conversion of the nucleotides ATP and ADP to AMP, may play in pulmonary arterial hypertension. In this study we identified decreased CD39 expression on the pulmonary endothelium of patients with idiopathic pulmonary arterial hypertension. We next determined the effects of CD39 gene deletion in mice exposed to normoxia or normobaric hypoxia (10% oxygen). Compared with controls, hypoxic CD39(-/-) mice were found to have a markedly elevated ATP-to-adenosine ratio, higher pulmonary arterial pressures, more right ventricular hypertrophy, more arterial medial hypertrophy, and a pro-thrombotic phenotype. In addition, hypoxic CD39(-/-) mice exhibited a marked increase in lung P2X1 receptors. Systemic reconstitution of ATPase and ADPase enzymatic activities through continuous administration of apyrase decreased pulmonary arterial pressures in hypoxic CD39(-/-) mice to levels found in hypoxic CD39(+/+) controls. Treatment with NF279, a potent and selective P2X1 receptor antagonist, lowered pulmonary arterial pressures even further. Our study is the first to implicate decreased CD39 and resultant alterations in circulating purinergic signaling ligands and cognate receptors in the pathobiology of pulmonary arterial hypertension. Reconstitution and receptor blocking experiments suggest that phosphohydrolysis of purinergic nucleotide tri- and diphosphates, or blocking of the P2X1 receptor could serve as treatment for pulmonary arterial hypertension. PMID:27208163

  4. HNF1 AND HYPERTENSIVE NEPHROPATHY

    PubMed Central

    Dmitrieva, Renata I.; Hinojos, Cruz A.; Boerwinkle, Eric; Braun, Michael C.; Fornage, Myriam; Doris, Peter A.

    2009-01-01

    Hypertension in SHR is associated with renal redox stress and we hypothesized that nephropathy arises in SHR-A3 from altered capacity to mitigate redox stress compared with nephropathy-resistant SHR lines. We measured renal expression of redox genes in distinct lines of the spontaneously hypertensive rat (SHR-A3, SHR-B2, SHR-C) and the normotensive WKY strain. The SHR lines differ in either resisting (SHR-B2, SHR-C) or experiencing hypertensive nephropathy (SHR-A3). Immediately prior to the emergence of hypertensive renal injury expression of redox genes in SHR-A3 was profoundly altered compared with the injury-resistant SHR lines and WKY. This change appeared to arise in anti-oxidant genes where 16 of 28 were expressed at 34.3% of the level in the reference strain (WKY). No such change was observed in the injury-resistant SHR lines. We analyzed occurrence of transcription factor matrices (TFM) in the promoters of the down-regulated antioxidant genes. In these genes, the HNF1 TFM was found to be nearly twice as likely to be present and the overall frequency of HNF1 sites was nearly 5 times higher, compared with HNF1 TFMs in anti-oxidant genes that were not down-regulated. We identified 35 other (non-redox) renal genes regulated by HNF1. These were also significantly down-regulated in SHR-A3, but not in SHR-B2 or SHR-C. Finally, expression of genes that comprise HNF1 (Tcf1, Tcf2 and Dcoh) was also down-regulated in SHR-A3. The present experiments uncover a major change in transcriptional control by HNF1 that affects redox and other genes and precedes emergence of hypertensive renal injury. PMID:18443232

  5. Magnetic Resonance Imaging in Pediatric Pulmonary Hypertension

    PubMed Central

    Olgunturk, Rana; Cevik, Ayhan; Terlemez, Semiha; Kacar, Emre; Oner, Yusuf Ali

    2015-01-01

    The present study aims to determine the efficacy and reliability of cardiovascular magnetic resonance imaging in establishing the diagnosis and prognosis of pulmonary hypertension in children. This is a retrospective comparison of 25 children with pulmonary hypertension and a control group comprising 19 healthy children. The diagnosis of pulmonary hypertension was made when the mean pulmonary artery pressure was ≥25 mmHg by catheter angiography. The children with pulmonary hypertension had significantly lower body mass indices than did the healthy children (P=0.048). In addition, the children with pulmonary hypertension had significantly larger main pulmonary artery diameters and ascending aortic diameters (both P=0.001) but statistically similar ratios of main pulmonary artery diameter-to-ascending aortic diameter. If the main pulmonary artery diameter was ≥25 mm, pediatric pulmonary hypertension was diagnosed with 72% sensitivity and 84% specificity. In the event that the ratio of main pulmonary artery diameter-to-ascending aorta diameter was ≥1, pediatric pulmonary hypertension was diagnosed with 60% sensitivity and 53% specificity. When compared with children who had New York Heart Association functional class II pulmonary hypertension, the children with functional class III pulmonary hypertension had significantly larger main (P=0.046), right (P=0.036), and left (P=0.003) pulmonary arteries. Cardiovascular magnetic resonance imaging is useful in the diagnosis of children with pulmonary hypertension. Pediatric pulmonary hypertension can be diagnosed with high sensitivity and specificity when the main pulmonary artery diameter measures ≥25 mm. PMID:26175631

  6. Magnetic resonance imaging in pediatric pulmonary hypertension.

    PubMed

    Pektas, Ayhan; Olgunturk, Rana; Cevik, Ayhan; Terlemez, Semiha; Kacar, Emre; Oner, Yusuf Ali

    2015-06-01

    The present study aims to determine the efficacy and reliability of cardiovascular magnetic resonance imaging in establishing the diagnosis and prognosis of pulmonary hypertension in children. This is a retrospective comparison of 25 children with pulmonary hypertension and a control group comprising 19 healthy children. The diagnosis of pulmonary hypertension was made when the mean pulmonary artery pressure was ≥25 mmHg by catheter angiography. The children with pulmonary hypertension had significantly lower body mass indices than did the healthy children (P=0.048). In addition, the children with pulmonary hypertension had significantly larger main pulmonary artery diameters and ascending aortic diameters (both P=0.001) but statistically similar ratios of main pulmonary artery diameter-to-ascending aortic diameter. If the main pulmonary artery diameter was ≥25 mm, pediatric pulmonary hypertension was diagnosed with 72% sensitivity and 84% specificity. In the event that the ratio of main pulmonary artery diameter-to-ascending aorta diameter was ≥1, pediatric pulmonary hypertension was diagnosed with 60% sensitivity and 53% specificity. When compared with children who had New York Heart Association functional class II pulmonary hypertension, the children with functional class III pulmonary hypertension had significantly larger main (P=0.046), right (P=0.036), and left (P=0.003) pulmonary arteries. Cardiovascular magnetic resonance imaging is useful in the diagnosis of children with pulmonary hypertension. Pediatric pulmonary hypertension can be diagnosed with high sensitivity and specificity when the main pulmonary artery diameter measures ≥25 mm. PMID:26175631

  7. The persisting gender gap in hypertension management and control in Germany: 1998 and 2008-2011.

    PubMed

    Sarganas, Giselle; Neuhauser, Hannelore K

    2016-06-01

    Hypertension is a major risk factor for cardiovascular morbidity; therefore, its control is very important. International Guidelines recommend the same hypertension management in men and women; however, studies suggest that management of hypertension differs. This study explores gender-age disparities in the management and control of hypertension in Germany in 1998 and 2008-2011. Data from the German Health Examination Surveys (GNHIES98 1998, n=7124 and DEGS1 2008-2011, n=7988, age 18-79 years), including standardized blood pressure measurements and Anatomical Therapeutic Chemical medication codes, were analyzed by gender and two age groups. For 1998 and 2008-2011 in Germany, the gender gap in hypertension management persisted without significant changes. Hypertensive men in 2008-2011 had lower awareness of their condition (78.3 vs. 86.8%), less treatment for hypertension (65.3 vs. 79.2%), less control of hypertension (45.4 vs. 57.5%) and less treatment among those aware of their condition (83.9 vs. 91.5%) than did women. These gender differences were greater in younger compared with older adults (18-54 years vs. 55-79 years). No gender differences were observed in control of hypertension among those treated in 1998; however, subsequent improvement was less in younger men compared with the other age-gender groups, leading to a new gender gap in 18-54-year olds (women 84.8%, men 63.9%). Younger women used more β-blockers and less angiotensin-converting enzyme inhibitors (ACEI) than younger men. Factors positively associated with control among those treated for hypertension in the younger group were being a woman, using β-blockers or using ACEI, or angiotensin-receptor blockers. In the older group, diabetes was negatively associated with control of hypertension, whereas having cardiovascular comorbidities was positively associated. Gender disparities in hypertension management and control still exist in Germany but may be masked because they are age-dependent. PMID

  8. The diagnosis and management of hypertensive crises.

    PubMed

    Varon, J; Marik, P E

    2000-07-01

    Severe hypertension is a common clinical problem in the United States, encountered in various clinical settings. Although various terms have been applied to severe hypertension, such as hypertensive crises, emergencies, or urgencies, they are all characterized by acute elevations in BP that may be associated with end-organ damage (hypertensive crisis). The immediate reduction of BP is only required in patients with acute end-organ damage. Hypertension associated with cerebral infarction or intracerebral hemorrhage only rarely requires treatment. While nitroprusside is commonly used to treat severe hypertension, it is an extremely toxic drug that should only be used in rare circumstances. Furthermore, the short-acting calcium channel blocker nifedipine is associated with significant morbidity and should be avoided. Today, a wide range of pharmacologic alternatives are available to the practitioner to control severe hypertension. This article reviews some of the current concepts and common misconceptions in the management of patients with acutely elevated BP. PMID:10893382

  9. Sex-specific differences in cardiovascular risk factors and blood pressure control in hypertensive patients.

    PubMed

    Tziomalos, Konstantinos; Giampatzis, Vasilios; Baltatzi, Maria; Efthymiou, Elias; Psianou, Konstantia; Papastergiou, Natalia; Magkou, Dimitra; Bougatsa, Vagia; Savopoulos, Christos; Hatzitolios, Apostolos I

    2014-04-01

    Cardiovascular disease (CVD) and cardiovascular risk factors are frequently undertreated in women. However, it is unclear whether the prevalence of additional cardiovascular risk factors and the total cardiovascular risk differ between hypertensive men and women. There are also limited data regarding rates of blood pressure control in the two sexes outside the United States. The authors aimed to compare the cardiovascular risk profile between sexes. A total of 1810 hypertensive patients (40.4% men, age 56.5±13.5 years) attending the hypertension outpatient clinic of our department were studied. Men were more frequently smokers than women and were more heavy smokers than the latter. Serum high-density lipoprotein cholesterol levels were lower and serum triglyceride levels were higher in men. On the other hand, abdominal obesity and chronic kidney disease were more prevalent in women. The estimated cardiovascular risk was higher in men than in women but the prevalence of established CVD did not differ between the sexes. The percentage of patients with controlled hypertension and the number of antihypertensive medications were similar in men and women. In conclusion, hypertensive men have more adverse cardiovascular risk factor profile and greater estimated cardiovascular risk than women. However, the prevalence of established CVD does not differ between sexes. These findings further reinforce current guidelines that recommend that management of hypertension and of other cardiovascular risk factors should be as aggressive in women as in men in order to prevent cardiovascular events. PMID:24621371

  10. Hypertension in rural communities in Delta State, Nigeria: Prevalence, risk factors and barriers to health care

    PubMed Central

    Ncama, Busisiwe P.; Sartorius, Benn

    2015-01-01

    Introduction Hypertension is a global health challenge and its prevalence is increasing rapidly amongst adults in many African countries. Some studies on the prevalence and risk factors of hypertension have been conducted in Nigeria, but none within Delta State. We assessed the prevalence of hypertension and associated risk factors amongst adults in three villages in the Ibusa community in Delta State, Nigeria. Method Homesteads were randomly selected and all consenting adults (≥ 18 years of age) were recruited for this cross-sectional study (134 individuals: 48 men, 86 women). Sociodemographic data and anthropometric measurements (weight, height and abdominal circumference) were recorded. Diagnosis of hypertension was based on blood pressure ≥ 140/90 mmHg. Result Hypertension prevalence in this rural community was 44%. Results from one village (Ogboli: 82%) and ethnic group (Ibo: 50%) were significantly higher than in others in the same variable category. Multivariate logistic regression analysis suggested increasing age, increasing body mass index and high salt intake as prominent risk factors for hypertension. Lack of funds and equipment shortage in clinics were most often reported as barriers to health care. Conclusion A nutritional education programme to promote low-cholesterol and low-salt diets is recommended to specifically target people in higher-risk areas and of higher-risk ethnicity. Local barriers to accessing health care need to be addressed. PMID:26842522

  11. High prevalence of hypertension among an ethnic group in Sudan: implications for prevention.

    PubMed

    Noor, Sufian K; Elsugud, Nada A; Bushara, Sarra O; Elmadhoun, Wadie M; Ahmed, Mohamed H

    2016-04-01

    Objective Hypertension is an emerging non-communicable disease in developing countries. Due to its silent nature and serious complications, active screening is essential in order to prevent complications. For instance, premature mortality from cardiovascular diseases could be prevented by the effective control of hypertension. The aim of this study was to determine the prevalence of undiagnosed hypertension among Nuba ethnic group living in Atbara city, north Sudan and to identify the associated risk factors. Subject and methods All consenting 500 adults from Nuba tribe who live in El Wihda District, Atbara were included. Blood pressure (BP) and body mass index were measured. Standard interviewing procedures were used to record medical history, socio-demographic data, and lifestyle characteristics. Results Among the 500 participants, females were 364 (72.8%) and males were 136 (27.2%). The overall prevalence of undiagnosed hypertension was 49.4% (30.8% stage 1 hypertension and 18.6% stage 2 hypertension). In addition, 41% of the population was having prehypertension. The significant risk factors for high BP were: male sex, age above 45 years, overweight, illiteracy, and alcohol consumption. Conclusion Undiagnosed high BP is very common among Nuba ethnic group; therefore, active screening and early management are recommended to prevent complications. PMID:26738696

  12. Ambulatory Blood Pressure Monitoring (ABPM) as the reference standard for diagnosis of hypertension and assessment of vascular risk in adults.

    PubMed

    Hermida, Ramón C; Smolensky, Michael H; Ayala, Diana E; Portaluppi, Francesco

    2015-01-01

    New information has become available since the ISC, AAMCC, and SECAC released their first extensive guidedelines to improve the diagnosis and treatment of adult arterial hypertension. A critical assessment of evidence and a comparison of what international guidelines now propose are the basis for the following statements, which update the recommendations first issued in 2013. Office blood pressure (BP) measurements should no longer be considered to be the "gold standard" for the diagnosis of hypertension and assessment of cardiovascular risk. Relying on office BP, even when supplemented with at-home wake-time self-measurements, to identify high-risk individuals, disregarding circadian BP patterning and asleep BP level, leads to potential misclassification of 50% of all evaluated persons. Accordingly, ambulatory BP monitoring is the recommended reference standard for the diagnosis of true hypertension and accurate assessment of cardiovascular risk in all adults ≥18 yrs of age, regardless of whether office BP is normal or elevated. Asleep systolic BP mean is the most significant independent predictor of cardiovascular events. The sleep-time relative SBP decline adds prognostic value to the statistical model that already includes the asleep systolic BP mean and corrected for relevant confounding variables. Accordingly, the asleep systolic BP mean is the recommended protocol to diagnose hypertension, assess cardiovascular risk, and predict cardiovascular event-free interval. In men, and in the absence of compelling clinical conditions, reference thresholds for diagnosing hypertension are 120/70 mmHg for the asleep systolic/diastolic BP means derived from ambulatory BP monitoring. However, in women, in the absence of complicating co-morbidities, the same thresholds are lower by 10/5 mmHg, i.e., 110/65 mmHg for the asleep means. In high-risk patients, including those diagnosed with diabetes or chronic kidney disease, and/or those having experienced past

  13. Increasing complexity: which drug class to choose for treatment of hypertension in the elderly?

    PubMed

    Kaiser, Edelgard Anna; Lotze, Ulrich; Schäfer, Hans Hendrik

    2014-01-01

    Treatment of hypertension in the elderly is expected to become more complex in the coming decades. Based on the current landscape of clinical trials, guideline recommendations remain inconclusive. The present review discusses the latest evidence derived from studies available in 2013 and investigates optimal blood pressure (BP) and preferred treatment substances. Three common archetypes are discussed that hamper the treatment of hypertension in the very elderly. In addition, this paper presents the current recommendations of the NICE 2011, JNC7 2013-update, ESH/ESC 2013, CHEP 2013, JNC8 and ASH/ISH guidelines for elderly patients. Advantages of the six main substance classes, namely diuretics, beta-blockers (BBs), calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and direct renin inhibitors (DRIs) are discussed. Medical and economic implications of drug administration in the very elderly are presented. Avoidance of treatment-related adverse effects has become increasingly relevant. Current substance classes are equally effective, with similar effects on cardiovascular outcomes. Selection of substances should therefore also be based on collateral advantages of drugs that extend beyond BP reduction. The combination of ACEIs and diuretics appears to be favorable in managing systolic/diastolic hypertension. Diuretics are a preferred and cheap combination drug, and the combination with CCBs is recommended for patients with isolated systolic hypertension. ACEIs and CCBs are favorable for patients with dementia, while CCBs and ARBs imply substantial cost savings due to high adherence. PMID:24711696

  14. Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension

    PubMed Central

    Biecker, Erwin

    2013-01-01

    Gastrointestinal bleeding related to portal hypertension is a serious complication in patients with liver cirrhosis. Most patients bleed from esophageal or gastric varices, but bleeding from ectopic varices or portal hypertensive gastropathy is also possible. The management of acute bleeding has changed over the last years. Patients are managed with a combination of endoscopic and pharmacologic treatment. The endoscopic treatment of choice for esophageal variceal bleeding is variceal band ligation. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the time point of endoscopy. The first-line treatment for primary prophylaxis of esophageal variceal bleeding is nonselective beta blockers. Pharmacologic therapy is recommended for most patients; band ligation is an alternative in patients with contraindications for or intolerability of beta blockers. Treatment options for secondary prophylaxis include variceal band ligation, beta blockers, a combination of nitrates and beta blockers, and combination of band ligation and pharmacologic treatment. A clear superiority of one treatment over the other has not been shown. Bleeding from portal hypertensive gastropathy or ectopic varices is less common. Treatment options include beta blocker therapy, injection therapy, and interventional radiology. PMID:27335828

  15. [Consensus on Systemic Arterial Hypertension In México].

    PubMed

    Rosas-Peralta, Martín; Palomo-Piñón, Silvia; Borrayo-Sánchez, Gabriela; Madrid-Miller, Alejandra; Almeida-Gutiérrez, Eduardo; Galván-Oseguera, Héctor; Magaña-Serrano, José Antonio; Saturno-Chiu, Guillermo; Ramírez-Arias, Erick; Santos-Martínez, Efrén; Díaz-Díaz, Enrique; Salgado-Pastor, Selene Janette; Morales-Mora, Gerardo; Medina-Concebida, Luz Elena; Mejía-Rodríguez, Oliva; Pérez-Ruiz, Claudia Elsa; Chapa-Mejía, Luis Raúl; Álvarez-Aguilar, Cleto; Pérez-Rodríguez, Gilberto; Castro-Martínez, María Guadalupe; López-Bárcena, Joaquín; Paniagua-Sierra, José Ramón

    2016-01-01

    This Consenso Nacional de Hipertensión Arterial Sistémica (National Consensus on Systemic Arterial Hypertension) brings together experiences and joint work of 79 specialists who have been in contact with the patient affected by systemic arterial hypertension. All concepts here presented were outlined on the basis of the real world practice of Mexican hypertensive population. The consensus was developed under strict methodological guidelines. The Delphi technique was applied in two rounds for the development of an appropriate statistical analysis of the concepts exposed by all the specialists, who posed key questions, later developed by the panel of experts of the Hospital de Cardiología, and specialists from the Centro Médico Nacional. Several angles of this illness are shown: detection, diagnosis, pathophysiology, classification, treatment and prevention. The evidence analysis was carried out using PRISMA method. More than 600 articles were reviewed, leaving only the most representative in the references. This document concludes with practical and useful recommendations for the three levels of health care of our country. PMID:27284844

  16. [Hypertensive crises in patients with arterial hypertension in ambulatory treatment].

    PubMed

    Gomes Guedes, Nirla; Chaves Costa, Francisca Bertilia; Moreira, Rafaella Pessoa; Moreira, Tahissa Frota; Soares Chavess, Emilia; de Araújo, Thelma Leite

    2005-06-01

    This study assessed the sociodemographic characteristics and the characteristics of therapeutic adhesion of 27 bearers of arterial hypertension undergoing ambulatorial treatment who had hypertensive urgencies crises or emergencies in the city of Fortaleza in the period between October of 2002 and May of 2003. The majority were women, between 50 and 60-years old, with little formal education, treatment time shorter than 5 years and time of diagnosis varying from 5 to 10 years. The use of medicine was the treatment that was most mentioned, followed by the reduction of the consumption of salt and attendance to medical appointments. However, attending the appointments and receiving orientation did not seem to change their behavior, since most of the patients that were interviewed practiced no physical exercises and demonstrated little knowledge of the illness, for they attributed the rise of the arterial pressure to emotional factors. PMID:16060305

  17. Wind Farm Recommendation Report

    SciTech Connect

    John Reisenauer

    2011-05-01

    On April 21, 2011, an Idaho National Laboratory (INL) Land Use Committee meeting was convened to develop a wind farm recommendation for the Executive Council and a list of proposed actions for proceeding with the recommendation. In terms of land use, the INL Land Use Committee unanimously agrees that Site 6 is the preferred location of the alternatives presented for an INL wind farm. However, further studies and resolution to questions raised (stated in this report) by the INL Land Use Committee are needed for the preferred location. Studies include, but are not limited to, wind viability (6 months), bats (2 years), and the visual impact of the wind farm. In addition, cultural resource surveys and consultation (1 month) and the National Environmental Policy Act process (9 to 12 months) need to be completed. Furthermore, there is no documented evidence of developers expressing interest in constructing a small wind farm on INL, nor a specific list of expectations or concessions for which a developer might expect INL to cover the cost. To date, INL assumes the National Environmental Policy Act activities will be paid for by the Department of Energy and INL (the environmental assessment has only received partial funding). However, other concessions also may be expected by developers such as roads, fencing, power line installation, tie-ins to substations, annual maintenance, snow removal, access control, down-time, and remediation. These types of concessions have not been documented, as a request, from a developer and INL has not identified the short and long-term cost liabilities for such concessions should a developer expect INL to cover these costs. INL has not identified a go-no-go funding level or the priority this Wind Farm Project might have with respect to other nuclear-related projects, should the wind farm remain an unfunded mandate. The Land Use Committee recommends Legal be consulted to determine what, if any, liabilities exist with the Wind Farm Project and

  18. [Regional management of arterial hypertension in France. Report of a survey of general practitioners].

    PubMed

    Chamontin, B; Lang, T; Vaisse, B; Nicodeme, R; Antoine, M P; Lazorthes, M L; Gallois, H; Poggi, L

    2001-08-01

    A survey was conducted in 14 regional samples of general practitioners (GPs) included in Gallup-up poll. 2,423 GPs contributed to the study and had to include all patients > 18 years old over a period of one week. Patients were considered hypertensives if the mean of two recorded BP measurements was > or = 140/90 mmHg and/or < 140/90 mmHg if they were under antihypertensive treatment. Hypertensives were considered as controlled if there BP levels were overall < 140/90 mmHg under treatment. The risk factors associated with hypertension were collected in order to evaluate the cardiovascular risk, according to 1999 ISH-OMS recommendations. 156,470 patients recruited by 2423 GPs were included in the study representing 14 different French regions: Ile-de-France I (1), Ile-de-France II (2), Ile-de-France-Pays-de-la-Loire (3), Bretagne (4), Normandie-Picardie (5), Nord-Pas-de-Calais (6), Alsace-Lorraine (7), Bourgogne-Franche Comté (8), Rhônes-Alpes (9), Provence-Côte d'Azur (10), Languedoc-Provence (11), Limousin-Auvergne (12), Midi-Pyrénées (13), Aquitaine (14). Among 70,073 hypertensives, 23,054 had never received antihypertensive treatment, and 32,059 (47%) had a high or a very high cardiovascular risk. 67% of hypertensives (47,019) were treated, and 32.8% of treated hypertensives (15,422) had a BP < 140/90 mmHg. The study illustrated few differences in prevalence and control of hypertension in the different French regions: BP control at the 140/90 mmHg threshold vary from 28.5 to 36.6% among treated hypertensives and % of patients at high cardiovascular risk from 42.1% (South-France) to 49.7% (East-France). PMID:11575211

  19. Hypertensive urgency: an important aetiology of rebound hypertension.

    PubMed

    Malaty, John; Malaty, Irene A

    2014-01-01

    A 46-year-old African-American man with a history of hypertension, end-stage kidney disease (on haemodialysis) and previous cocaine misuse presented to the emergency room with a sudden onset of severe headache and diaphoresis without other neurological or cardiovascular signs/symptoms. He checked his blood pressure at home and found it to be 230/130. It did not improve despite taking two serial doses of oral clonidine 0.3 mg. Evaluation with head CT and lumbar puncture demonstrated no acute intracranial process, such as subarachnoid haemorrhage. These symptoms started after he took Libido-Max, an over-the-counter supplement for erectile dysfunction. This supplement includes yohimbine, an α-2 antagonist, which counteracts the effects of oral clonidine, one of his routine antihypertensive medications. This led to rebound hypertension and made his hypertensive urgency resistant to oral clonidine. He was successfully treated with intravenous labetalol and his symptoms quickly resolved after lowering of his blood pressure. PMID:25336552

  20. Music Search and Recommendation

    NASA Astrophysics Data System (ADS)

    Brandenburg, Karlheinz; Dittmar, Christian; Gruhne, Matthias; Abeßer, Jakob; Lukashevich, Hanna; Dunker, Peter; Gärtner, Daniel; Wolter, Kay; Grossmann, Holger

    In the last ten years, our ways to listen to music have drastically changed: In earlier times, we went to record stores or had to use low bit-rate audio coding to get some music and to store it on PCs. Nowadays, millions of songs are within reach via on-line distributors. Some music lovers already got terabytes of music on their hard disc. Users are now no longer desparate to get music, but to select, to find the music they love. A number of technologies has been developed to adress these new requirements. There are techniques to identify music and ways to search for music. Recommendation today is a hot topic as well as organizing music into playlists.

  1. Clinical Recommendation: Labial Adhesions.

    PubMed

    Bacon, Janice L; Romano, Mary E; Quint, Elisabeth H

    2015-10-01

    Labial adhesions, also known as labial agglutination, are a common finding in prepubertal adolescents. They are defined as fusion of the labia minora in the midline or are termed vulvar adhesions when they occur below the labia minora (inner labia). Patients are often asymptomatic but might present with genitourinary complaints. The decision for treatment is based on symptoms. The mainstay of treatment in asymptomatic patients is conservative, with careful attention to vulvar hygiene and reassurance to parents. In symptomatic patients, topical treatment with estrogen and/or steroid cream is often curative. Less often, corrective surgery is necessary. Recurrence is common until a patient goes through puberty. These recommendations are intended for pediatric and gynecologic health care providers who care for pediatric and adolescent girls to facilitate diagnosis and treatment. PMID:26162697

  2. IRIS Product Recommendations

    NASA Technical Reports Server (NTRS)

    Short, David A.

    2000-01-01

    This report presents the Applied Meteorology Unit's (AMU) evaluation of SIGMET Inc.'s Integrated Radar Information System (IRIS) Product Generator and recommendations for products emphasizing lightning and microburst tools. The IRIS Product Generator processes radar reflectivity data from the Weather Surveillance Radar, model 74C (WSR-74C), located on Patrick Air Force Base. The IRIS System was upgraded from version 6.12 to version 7.05 in late December 1999. A statistical analysis of atmospheric temperature variability over the Cape Canaveral Air Force Station (CCAFS) Weather Station provided guidance for the configuration of radar products that provide information on the mixed-phase (liquid and ice) region of clouds, between 0 C and -20 C. Mixed-phase processes at these temperatures are physically linked to electrification and the genesis of severe weather within convectively generated clouds. Day-to-day variations in the atmospheric temperature profile are of sufficient magnitude to warrant periodic reconfiguration of radar products intended for the interpretation of lightning and microburst potential of convectively generated clouds. The AMU also examined the radar volume-scan strategy to determine the scales of vertical gaps within the altitude range of the 0 C to -20 C isotherms over the Kennedy Space Center (KSC)/CCAFS area. This report present's two objective strategies for designing volume scans and proposes a modified scan strategy that reduces the average vertical gap by 37% as a means for improving radar observations of cloud characteristics in the critical 0 C to -20 C layer. The AMU recommends a total of 18 products, including 11 products that require use of the IRIS programming language and the IRIS User Product Insert feature. Included is a cell trends product and display, modeled after the WSR-88D cell trends display in use by the National Weather Service.

  3. [Clinical guidelines for detection, prevention, diagnosis and treatment of systemic arterial hypertension in Mexico (2008)].

    PubMed

    Rosas, Martín; Pastelín, Gustavo; Vargas-Alarcón, Gilberto; Martínez-Reding, Jesús; Lomelí, Catalina; Mendoza-González, Celso; Lorenzo, José Antonio; Méndez, Arturo; Franco, Martha; Sánchez-Lozada, Laura Gabriela; Verdejo, Juan; Sánchez, Noé; Ruiz, Rocío; Férez-Santander, Sergio Mario; Attie, Fause

    2008-01-01

    The multidisciplinary Institutional Committee of experts in Systemic Arterial Hypertension from the National Institute of Cardiology "Ignacio Chávez" presents its update (2008) of "Guidelines and Recommendations" for the early detection, control, treatment and prevention of Hypertension. The boarding tries to be simple and realistic for all that physicians whom have to face the hypertensive population in their clinical practice. The information is based in the most recent scientific evidence. These guides are principally directed to hypertensive population of emergent countries like Mexico. It is emphasized preventive health measures, the importance of the no pharmacological actions, such as good nutrition, exercise and changes in life style, (which ideally it must begin from very early ages). "We suggest that the changes in the style of life must be vigorous, continuous and systematized, with a real reinforcing by part of all the organisms related to the health education for all population (federal and private social organisms). It is the most important way to confront and prevent this pandemic of chronic diseases". In this new edition the authors amplifies the information and importance on the matter. The preventive cardiology must contribute in multidisciplinary entailment. Based mainly on national data and the international scientific publications, we developed our own system of classification and risk stratification for the carrying people with hypertension, Called HTM (Arterial Hypertension in Mexico) index. Its principal of purpose this index is to keep in mind that the current approach of hypertension must be always multidisciplinary. The institutional committee of experts reviewed with rigorous methodology under the principles of the evidence-based medicine, both, national and international medical literature, with the purpose of adapting the concepts and guidelines for a better control and treatment of hypertension in Mexico. This work group recognizes

  4. Emergency Management of Hypertension in Children

    PubMed Central

    Singh, Dinesh; Akingbola, Olugbenga; Yosypiv, Ihor; El-Dahr, Samir

    2012-01-01

    Systemic arterial hypertension in children has traditionally been thought to be secondary in origin. Increased incidence of risk factors like obesity, sedentary life-styles, and faulty dietary habits has led to increased prevalence of the primary arterial hypertension (PAH), particularly in adolescent age children. PAH has become a global epidemic worldwide imposing huge economic constraint on health care. Sudden acute increase in systolic and diastolic blood pressure can lead to hypertensive crisis. While it generally pertains to secondary hypertension, occurrence of hypertensive crisis in PAH is however rare in children. Hypertensive crisis has been further subclassified depending on presence or absence of end-organ damage into hypertensive emergency or urgency. Both hypertensive emergencies and urgencies are known to cause significant morbidity and mortality. Increasing awareness among the physicians, targeted at investigation of the pathophysiology of hypertension and its complications, better screening methods, generation, and implementation of novel treatment modalities will impact overall outcomes. In this paper, we discuss the etiology, pathogenesis, and management of hypertensive crisis in children. An extensive database search using keywords was done to obtain the information. PMID:22577545

  5. Public Health, Hypertension, and the Emergency Department.

    PubMed

    Brody, Aaron; Janke, Alex; Sharma, Vineet; Levy, Phillip

    2016-06-01

    Hypertension (HTN) is the most common cardiovascular disease worldwide and is associated with severe long-term morbidity when not treated appropriately. Despite this, blood pressure (BP) control remains suboptimal, particularly among underserved populations and those who rely on emergency departments (EDs) as a source of primary care. ED providers encounter patients with severely elevated BP daily, and yet adherence to minimal standards of BP reassessment and referral to outpatient medical care, as recommended by the American College of Emergency Physicians, is limited. Barriers such as provider knowledge deficits, resource constraints, and negative attitudes towards patients who utilize EDs for nonurgent complaints are compounded by perceptions of HTN as a condition that can only be addressed in a primary care setting to contribute to this. Efforts to reduce this gap must go beyond government mandates to address systemic issues including access to care and payment models to encourage health promotion. Additionally, individual physician behavior can be shifted through targeted education, financial incentives, and the accumulation of high-quality evidence to encourage more proactive approaches to the management of uncontrolled HTN in the ED. PMID:27165429

  6. The healthcare burden of hypertension in Asia

    PubMed Central

    Jin, Chun-Na; Yu, Cheuk-Man; Sun, Jing-Ping; Fang, Fang; Wen, Yong-Na; Liu, Ming; Lee, Alex Pui-Wai

    2013-01-01

    As the leading global risk for mortality, hypertension (HT) is a common healthcare problem in the world. The total number of patients with HT is likely to grow in the next few decades as the population age and the prevalence of obesity and diabetes increase. HT, as a major modifiable risk factor for cardiovascular disease, results in more deaths than any other risk factors, including diabetes and cigarette smoking. High prevalence, inadequate awareness, suboptimal treatment and low rate of achieving guideline-recommended target blood pressure control are key factors leading to severe cardiovascular complications that impose a heavy socioeconomic burden, especially in developing countries. Asia is the world's largest and most populous continent with approximately 4.3 billion people, hosting 60% of the world’s current human population, and has a high growth rate. Asia differs very widely from the West with regard to ethnic groups, cultures, environments, economics, historical ties and government systems. Therefore, the purpose of this review is to comprehensively summarise the epidemiology, treatment practice and the status of control of HT in different Asian countries in order to guide the future prevention and management in this part of the world. PMID:27326143

  7. When and how to recommend 'alternative approaches' in the management of high blood pressure.

    PubMed

    Brook, Robert D; Jackson, Elizabeth A; Giorgini, Paolo; McGowan, Cheri L

    2015-06-01

    Several nonpharmacologic therapies, such as sodium restriction and weight loss, have been promoted by hypertension guidelines based on the trial evidence supporting their capacity to lower blood pressure. However, many patients may not respond or be able to adhere to these nonpharmacologic treatments. Despite numerous formal diet and lifestyle recommendations, the prevalence of hypertension continues to grow worldwide. As such, additional approaches are needed to help combat this public health epidemic. In this review, we outline the evidence supporting the efficacy of a number of alternative approaches for blood pressure lowering. On the basis of the recommendations by a recent American Heart Association scientific statement, we also provide guidance on when and how to implement these methods in clinical practice. The available evidence supports several approaches, including Transcendental Meditation, device-guided slow breathing, and aerobic, resistance, and isometric exercises. Nonetheless, many questions remain, and future recommendations for using alternative approaches will need to be updated as new trials are published. PMID:25644320

  8. Treatment of pediatric pulmonary hypertension

    PubMed Central

    Hawkins, Amy; Tulloh, Robert

    2009-01-01

    Pulmonary hypertension was once thought to be a rare condition and only managed in specialized centers. Now however, with the advent of echocardiography, it is found in many clinical scenarios, in the neonate with chronic lung disease, in the acute setting in the intensive care unit, in connective tissue disease and in cardiology pre- and postoperatively. We have a better understanding of the pathological process and have a range of medication which is starting to be able to palliate this previously fatal condition. This review describes the areas that are known in this condition and those that are less familiar. The basic physiology behind pulmonary hypertension and pulmonary vascular disease is explained. The histopathologic process and the various diagnostic tools are described and are followed by the current and future therapy at our disposal. PMID:19554091

  9. Pulmonary Hypertension: Types and Treatments

    PubMed Central

    Rose-Jones, Lisa J; Mclaughlin, Vallerie V

    2015-01-01

    Pulmonary arterial hypertension (PAH) is a panvasculopathy that affects the distal pulmonary arteries and leads to restricted blood flow. This increased afterload leads to adaptive mechanisms of the right ventricle, with eventual failure once it can no longer compensate. Pulmonary hypertension from associated conditions, most importantly left heart disease, i.e. heart failure, can also lead to the same sequela. Patients often experience early vague symptoms of dyspnea and exercise intolerance, and thus PH can elude clinicians until right heart failure symptoms predominate. Evidence-based treatment options with pulmo-nary vasodilators are available for those with PAH and should be employed early. It is essential that patients be accurately categorized by their etiology of PH, as treatment strategies differ, and can potentially be dangerous if employed in the wrong clinical scenario. PMID:24251459

  10. Hypertensive emergencies: diagnosis and management.

    PubMed

    Phillips, Robert A; Greenblatt, Jonathan; Krakoff, Lawrence R

    2002-01-01

    The treatment of hypertension is preventive medicine. This principle applies in the emergency room as well as the clinic. However, there are crucial contrasts between these two care settings related to specific goals of management for real emergencies and nonemergency conditions. In the emergency room, rapid triage is necessary to separate those who can safely be sent home for future clinic assessment from those who require immediate interventions including short stays in 24-hour observation units or hospitalization for more serious problems. This review focuses on decisions related to hypertension management in the emergency room and over brief periods of observation and treatment. Strategy is supported by evidence-based considerations whenever possible. Where outcome studies are not available, we rely on the rationale derived from relevant clinical research. PMID:12138413

  11. [Abdominal bruit associated with hypertension].

    PubMed

    Fontseré, N; Bonet, J; Bonal, J; Romero, R

    2004-01-01

    First cause of secondary hypertension is renovascular hypertension which presents abdominal bruit in 16 to 20% of cases. This clinical sign is also associated with other vascular disease of the abdomen such as celiac trunk stenosis and/or aneurysms located on the pancreaticoduodenal or gastroduodenal arcs level, with little representation among aneurysm. They usually appear on a context of digestive complications like neoplasias, chronic pancreatitis or gastric obstructions possibly with obstructive icterus, hemorrhage and acute abdomen episodes. Its presentation in other contexts is rare and constitutes a diagnostic challenge. Diagnosis is made by abdominal arteriography which is the best method because you can locate the problem as well as intervene therapeutically with embolization of the aneurysme. We would like to emphasize the importance of a quick diagnosis due to the risk of rupture and the high morbi-mortality associated. PMID:15219082

  12. Endoscopic Management of Portal Hypertension

    PubMed Central

    Al-Busafi, Said A.; Ghali, Peter; Wong, Philip; Deschenes, Marc

    2012-01-01

    Cirrhosis is the leading cause of portal hypertension worldwide, with the development of bleeding gastroesophageal varices being one of the most life-threatening consequences. Endoscopy plays an indispensible role in the diagnosis, staging, and prophylactic or active management of varices. With the expected future refinements in endoscopic technology, capsule endoscopy may one day replace traditional gastroscopy as a diagnostic modality, whereas endoscopic ultrasound may more precisely guide interventional therapy for gastric varices. PMID:22830037

  13. [Neonatal intermittent hypoxia and hypertension].

    PubMed

    Sukhova, G K; Nozdrachev, A D; Gozal, D

    2009-01-01

    Obstructive apnea during sleep is accompanied by intermittent hypoxia (IH) leading to hypertension and other cardiovascular disturbances. A comparative evaluation of long-term effects of the neonatal IH on the cardiovascular function was performed in normotensive Sprague-Dawley and spontaneously hypertensive rats (SHR). The newborn rats were placed for 30 days to conditions of IH (8 and 21% O2, alternating every 90 s for 12 h/day). Control groups of rats were constantly kept in normoxia. By 6 months, in the spontaneously hypertensive rats submitted to IH at the period of wakefulness there was a statistically significant increase (as compared with control) of the systolic (correspondingly 185.8 +/- 1.7 and 169.9 +/- 1.4 mm Hg, p < 0.01) and diastolic pressure (correspondingly 96.2 +/- 4.9 and 86.0 +/- 2.6 mm Hg, p < 0.01). During sleep, the systolic and diastolic pressure in these rats was higher than in control animals by 10 mm Hg (p < 0.01) and 12 mm Hg (p < 0.01), its decrease during sleep being absent. SHR submitted to IH had an increase in low- to the high-frequency power ratio of the heart rate variability from 0.9 +/- 0.15 to 1.5 +/- 0.17, which indicates a shift of the sympatho-parasympathetic balance in this group towards predominance of the sympathetic component. In the Sprague-Dawley rats submitted to neonatal hypoxia, the above changes were not pronounced. These peculiarities of the hypertensive rats allow establishing connection of the genetic factor with the sympathetic mechanism providing long-term consequences of the neonatal IH for the cardiovascular control in these rats. PMID:19435263

  14. Inhaled Therapies for Pulmonary Hypertension.

    PubMed

    Hill, Nicholas S; Preston, Ioana R; Roberts, Kari E

    2015-06-01

    The inhaled route has a number of attractive features for treatment of pulmonary hypertension, including delivery of drug directly to the target organ, thus enhancing pulmonary specificity and reducing systemic adverse effects. It can also improve ventilation/perfusion matching by dilating vessels supplying ventilated regions, thus improving gas exchange. Furthermore, it can achieve higher local drug concentrations at a lower overall dose, potentially reducing drug cost. Accordingly, a number of inhaled agents have been developed to treat pulmonary hypertension. Most in current use are prostacyclins, including epoprostenol, which has been cleared for intravenous applications but is used off-label in acute care settings as a continuously nebulized medication. Aerosolized iloprost and treprostinil are both prostacyclins that have been cleared by the FDA to treat pulmonary arterial hypertension (PAH). Both require frequent administration (6 and 4 times daily, respectively), and both have a tendency to cause airway symptoms, including cough and wheeze, which can lead to intolerance. These agents cannot be used to substitute for the infused routes of prostacyclin because they do not permit delivery of medication at high doses. Inhaled nitric oxide (INO) is cleared for the treatment of primary pulmonary hypertension in newborns. It is also used off-label to test acute vasoreactivity in PAH during right-heart catheterization and to treat acute right-heart failure in hospitalized patients. In addition, some studies on long-term application of INO either have been recently completed with results pending or are under consideration. In the future, because of its inherent advantages in targeting the lung, the inhaled route is likely to be tested using a variety of small molecules that show promise as PAH therapies. PMID:26070575

  15. Vascular smooth muscle in hypertension.

    PubMed

    Winquist, R J; Webb, R C; Bohr, D F

    1982-06-01

    The cause of the elevated arterial pressure in most forms of hypertension is an increase in total peripheral resistance. This brief review is directed toward an assessment of recent investigations contributing information about the factors responsible for this increased vascular resistance. Structural abnormalities in the vasculature that characterize the hypertensive process are 1) changes in the vascular media, 2) rarefication of the resistance vessels, and 3) lesions of the intimal vascular surface. These abnormalities are mainly the result of an adaptive process and are secondary to the increase in wall stress and/or to pathological damage to cellular components in the vessel wall. Functional alterations in the vascular smooth muscle are described as changes in agonist-smooth muscle interaction or plasma membrane permeability. These types of changes appear to play a primary, initiating role in the elevation of vascular resistance of hypertension. These alterations are not the result of an increase in wall stress and they often precede the development of high blood pressure. The functional changes are initiated by abnormal function of neurogenic, humoral, and/or myogenic changes that alter vascular smooth muscle activity. PMID:6282652

  16. Epigenetic Modifications in Essential Hypertension

    PubMed Central

    Wise, Ingrid A.; Charchar, Fadi J.

    2016-01-01

    Essential hypertension (EH) is a complex, polygenic condition with no single causative agent. Despite advances in our understanding of the pathophysiology of EH, hypertension remains one of the world’s leading public health problems. Furthermore, there is increasing evidence that epigenetic modifications are as important as genetic predisposition in the development of EH. Indeed, a complex and interactive genetic and environmental system exists to determine an individual’s risk of EH. Epigenetics refers to all heritable changes to the regulation of gene expression as well as chromatin remodelling, without involvement of nucleotide sequence changes. Epigenetic modification is recognized as an essential process in biology, but is now being investigated for its role in the development of specific pathologic conditions, including EH. Epigenetic research will provide insights into the pathogenesis of blood pressure regulation that cannot be explained by classic Mendelian inheritance. This review concentrates on epigenetic modifications to DNA structure, including the influence of non-coding RNAs on hypertension development. PMID:27023534

  17. Reporting of Adherence to Healthy Lifestyle Behaviors among Hypertensive Adults in the 50 States and the District of Columbia, 2013

    PubMed Central

    Fang, Jing; Moore, Latetia; Loustalot, Fleetwood; Yang, Quanhe; Ayala, Carma

    2016-01-01

    Achieving and maintaining a healthy lifestyle is an important part of hypertension management. The purpose of this study was to assess US state-level prevalence of adherence to healthy lifestyle behaviors among those with self-reported hypertension. Using 2013 data from the Behavioral Risk Factor Surveillance System, a state-based telephone survey, we examined the adherence to 5 healthy lifestyle behaviors related to hypertension management: having a “normal” weight, not smoking, avoiding or limiting alcohol intake, consuming the recommended amount of fruits and vegetables, and engaging in the recommended amount of physical activity. We estimated age-standardized percentages of each healthy lifestyle behavior overall and by state, as well as prevalence of all 5 healthy lifestyle behaviors. Overall, the prevalence of healthy lifestyle behaviors varied widely among those with self-reported hypertension: 20.5% had a normal weight, 82.3% did not smoke, 94.1% reported no or limited alcohol intake, 14.1% consumed the recommended amounts of fruits or vegetables, and 46.6% engaged in the recommended amount of physical activity. Overall, only 1.7% of adults with self-reported hypertension reported all 5 healthy lifestyle behaviors, with significant variation by state. Age-standardized prevalence of individuals reporting all 5 healthy lifestyle behaviors ranged from 0.3% in Louisiana to 3.8% in the District of Columbia. In conclusion, adherence to healthy lifestyle behaviors varied among those with hypertension; fewer than 2% reported meeting current recommendations and standards when assessed collectively. Disparities were observed by demographic and descriptive characteristics, including geography. PMID:26851000

  18. Focus on prevention, diagnosis and treatment of hypertension in children and adolescents

    PubMed Central

    2013-01-01

    The European Society of Hypertension has recently published its recommendations on prevention, diagnosis and treatment of high blood pressure in children and adolescents. Taking this contribution as a starting point the Study Group of Hypertension of the Italian Society of Pediatrics together with the Italian Society of Hypertension has conducted a reappraisal of the most recent literature on this subject. The present review does not claim to be an exhaustive description of hypertension in the pediatric population but intends to provide Pediatricians with practical and updated indications in order to guide them in this often unappreciated problem. This document pays particular attention to the primary hypertension which represents a growing problem in children and adolescents. Subjects at elevated risk of hypertension are those overweight, with low birth weight and presenting a family history of hypertension. However, also children who do not present these risk factors may have elevated blood pressure levels. In pediatric age diagnosis of hypertension or high normal blood pressure is made with repeated office blood pressure measurements that show values exceeding the reference values. Blood pressure should be monitored at least once a year with adequate methods and instrumentation and the observed values have to be interpreted according to the most updated nomograms that are adjusted for children’s gender, age and height. Currently other available methods such as ambulatory blood pressure monitoring and home blood pressure measurement are not yet adequately validated for use as diagnostic instruments. To diagnose primary hypertension it is necessary to exclude secondary forms. The probability of facing a secondary form of hypertension is inversely proportional to the child’s age and directly proportional to blood pressure levels. Medical history, clinical data and blood tests may guide the differential diagnosis of primary versus secondary forms. The prevention

  19. Current concepts in combination therapy for the treatment of hypertension: combined calcium channel blockers and RAAS inhibitors

    PubMed Central

    Rubio-Guerra, Alberto F; Castro-Serna, David; Barrera, Cesar I Elizalde; Ramos-Brizuela, Luz M

    2009-01-01

    Recent guidelines for the management of hypertension recommend target blood pressures <140/90 mmHg in hypertensive patients, or <130/80 mmHg in subjects with diabetes, chronic kidney disease, or coronary artery disease. Despite the availability and efficacy of antihypertensive drugs, most hypertensive patients do not reach the recommended treatment targets with monotherapy, making combination therapy necessary to achieve the therapeutic goal. Combination therapy with 2 or more agents is the most effective method for achieving strict blood pressure goals. Fixed-dose combination simplifies treatment, reduces costs, and improves adherence. There are many drug choices for combination therapy, but few data are available about the efficacy and safety of some specific combinations. Combination therapy of calcium antagonists and inhibitors of the renin-angiotensin-aldosterone system (RAAS) are efficacious and safe, and have been considered rational by both the JNC 7 and the 2007 European Society of Hypertension – European Society of Cardiology guidelines for the management of arterial hypertension. The aim of this review is to discuss some relevant issues about the use of combinations with calcium channel blockers and RAAS inhibitors in the treatment of hypertension. PMID:21949615

  20. Resistant Hypertension Workup and Approach to Treatment

    PubMed Central

    Makris, Anastasios; Seferou, Maria; Papadopoulos, Dimitris P.

    2011-01-01

    Resistant hypertension is defined as blood pressure above the patient's goal despite the use of 3 or more antihypertensive agents from different classes at optimal doses, one of which should ideally be a diuretic. Evaluation of patients with resistive hypertension should first confirm that they have true resistant hypertension by ruling out or correcting factors associated with pseudoresistance such as white coat hypertension, suboptimal blood pressure measurement technique, poor adherence to prescribed medication, suboptimal dosing of antihypertensive agents or inappropriate combinations, the white coat effect, and clinical inertia. Management includes lifestyle and dietary modification, elimination of medications contributing to resistance, and evaluation of potential secondary causes of hypertension. Pharmacological treatment should be tailored to the patient's profile and focus on the causative pathway of resistance. Patients with uncontrolled hypertension despite receiving an optimal therapy are candidates for newer interventional therapies such as carotid baroreceptor stimulation and renal denervation. PMID:21234416

  1. Managing Hypertension in the Newborn Infants

    PubMed Central

    Nickavar, Azar; Assadi, Farahnak

    2014-01-01

    Hypertension in newborn infants, particularly those requiring intensive care, is becoming increasingly recognized, with prevalence of 0.2-3%. Recent studies have established normative tables for blood pressure (BP) in both term and pre-term infants based on the gestational age, postnatal age, gender, weight and height, identifying the neonates at increased risk for early-onset cardiovascular disease. Common causes of neonatal hypertension include thromboembolic complications secondary to umbilical artery catheterization, congenital renal structural malformation, renovascular disease, aortic coarctation, as well as acute kidney injury and certain medications. A careful diagnostic evaluation should lead to identification of the underlying cause of hypertension in most infants. Treatment options should be tailored to the severity; and underlying cause of hypertension, including intravenous and/or oral therapy. This review summarizes recent work in these areas, focusing on optimal BP measurement, definition, evaluation and management of hypertension as well as advances in drug therapy of neonatal hypertension. PMID:24791189

  2. Current diagnosis and management of hypertensive emergency.

    PubMed

    Haas, Andrew R; Marik, Paul E

    2006-01-01

    The appropriate and timely evaluation and treatment of patients with severely elevated blood pressure is essential to avoid serious adverse outcomes. Most importantly, the distinction between a hypertensive emergency (crisis) and urgency needs to be made. A sudden elevation in systolic (SBP) and/or diastolic blood pressure (DBP) that is associated with acute end organ damage (cardiovascular, cerebrovascular, or renal) is defined as a hypertensive crisis or emergency. In contrast, acute elevation in SBP and/or DBP not associated with evidence of end organ damage is defined as hypertensive urgency. In patients with a hypertensive emergency, blood pressure control should be attained as expeditiously as possible with parenteral medications to prevent ongoing and potentially permanent end organ damage. In contrast, with hypertensive urgency, blood pressure control can be achieved with the use of oral medications within 24-48 hours. This paper reviews the management of hypertensive emergencies. PMID:17150051

  3. Pharmacologic treatment of hypertensive disorders during pregnancy.

    PubMed

    Yankowitz, Jerome

    2004-01-01

    Pregnancy complicated by hypertension is a common problem faced by clinicians. It can lead to substantial maternal and/or fetal/neonatal morbidity and mortality. There are a variety of medications that can be used during pregnancy either for treatment of significant chronic hypertension or in cases of acute severe hypertension. Most antihypertensive drugs have been shown to be safe for use in pregnancy. A variety of medications are available to treat more severe hypertension, although the use of pharmacologic therapy to treat mild chronic hypertension during pregnancy has not been supported in the literature. The data are more limited concerning drugs that would be used in the event of hypertensive emergencies or in an intensive care setting; however, in such a situation, maternal health and life become paramount and, despite lack of good studies, appropriate treatment should be rendered. PMID:15478474

  4. [Diagnosis and treatment of ocular hypertension].

    PubMed

    Sun, Y Y; Chen, W W; Wang, N L

    2016-07-01

    Ocular hypertension is popular among people, with a prevalence of 3% to 10% in those older than 40 years old. Without proper intervention, over 10% of the patients with ocular hypertension would develop glaucoma in the following 5 to 10 years. Glaucoma has become one of the leading causes of blindness all over the world, which makes it essential for us to pay enough attention to the prevention and treatment of ocular hypertension. However, it is not cost-effective to treat all the patients with ocular hypertension. Certain side effects may also be caused with long-term medical treatment. Therefore, it is of great importance for ophthalmologists to identify the right time and use appropriate therapeutic methods. To introduce the knowledge of ocular hypertension, the definition, epidemiology, diagnosis, risk factors and treatment of ocular hypertension are reviewed in this article. (Chin J Ophthalmol, 2016, 52: 542-546). PMID:27531115

  5. Renin in differential diagnosis of hypertension.

    NASA Technical Reports Server (NTRS)

    Oparil, S.; Haber, E.

    1971-01-01

    Renin is a proteolytic enzyme secreted by the kidney. Techniques for the direct measurement of renin content of human blood are not available at the present time. Two of the best known causes of remediable hypertension can be diagnosed from abnormalities in renin activity and aldosterone production. In renovascular hypertension, renin secretion is increased because of impaired glomerular perfusion. The renin activity assay, when applied in a carefully controlled fashion, is a useful screening test for treatable causes of hypertension.

  6. Hypertension in Cardiovascular and Kidney Disease

    PubMed Central

    Botdorf, Joshua; Chaudhary, Kunal; Whaley-Connell, Adam

    2011-01-01

    The relationship between hypertension and chronic kidney disease (CKD) is bidirectional in nature and, generally, management strategies for cardiovascular risk reduction also attenuate progression of CKD. Prevalent hypertension increases with diminishing kidney function, and the management strategy changes with level of kidney function. In this review, we will examine the evidence for management of hypertension, as a modifiable risk factor for cardiovascular disease in CKD, and the impact of this management on progression of CKD. PMID:22096454

  7. Assessment of antioxidant enzyme activities in erythrocytes of pre-hypertensive and hypertensive women

    PubMed Central

    Amirkhizi, Farshad; Siassi, Fereydoun; Djalali, Mahmoud; Foroushani, Abbas Rahimi

    2010-01-01

    BACKGROUND: Few studies that have investigated hypertension have considered a state of oxidative stress that can contribute to the development of atherosclerosis and other hypertension induced organ damage. The aim of this study was to investigate whether pre-hypertension and hypertension status is associated with activities of erythrocyte antioxidant enzymes in a random sample of cardiovascular disease-free women. METHODS: In this case-control study, 53 pre-hypertensive women, 32 hypertensive women and 75 healthy controls were included. General information was gathered using questionnaires and face-to-face interviews. Blood pressure and anthropometric measurements were measured for each subject. Venous blood samples were drawn from subjects and plasma was separated. Activities of erythrocyte antioxidant enzymes were also evaluated by measuring activities of copper zinc-superoxide dismutase (CuZn-SOD), glutathione peroxidase (GPX) and catalase (CAT) in selected subjects. RESULTS: Fifty-three (33.1%) and 32 (20%) participants were pre-hypertensive and hypertensive, respectively. The hypertensive and pre-hypertensive women had lower CuZn-SOD (p < 0.001) and GPX (p < 0.01) activities compared to normotensives. Furthermore, hypertensive women had lower CAT activity compared to pre-hypertensive and normotensive women (p < 0.001). Moreover, significant differences were also observed between hypertensive and pre-hypertensive women in erythrocyte CAT activity (p < 0.01). CONCLUSIONS: The present findings show that activities of erythrocyte antioxidant enzymes decrease in pre-hypertensive and hypertensive women, which may eventually lead to atherosclerosis and other high blood pressure related health problems. PMID:21526095

  8. Oral vasodilator therapy in patients with moderate to severe portopulmonary hypertension as a bridge to liver transplantation.

    PubMed

    Raevens, Sarah; De Pauw, Michel; Reyntjens, Koen; Geerts, Anja; Verhelst, Xavier; Berrevoet, Frederik; Rogiers, Xavier; Troisi, Roberto I; Van Vlierberghe, Hans; Colle, Isabelle

    2013-04-01

    Portopulmonary hypertension (POPH) is a part of group 1 pulmonary hypertension (pulmonary hypertension associated with portal hypertension). Liver transplantation (LTx) may be curative, but is usually restricted to patients with mild-to-moderate POPH. The presence of severe POPH may be a contraindication to transplantation because of the elevated risk of peritransplantation and post-transplantation morbidity and mortality. This report describes a series of seven patients with onset of moderate (two patients) or severe (five patients) POPH before LTx, of whom six were treated with oral vasodilator therapy for POPH. Although previous studies recommend aggressive parenteral prostacyclin therapy (epoprostenol), we describe the opportunity to treat cases of severe POPH with an oral phosphodiesterase type 5 inhibitor (sildenafil) and/or an endothelin receptor antagonist (bosentan/ambrisentan) as a bridge to successful LTx in selected patients. PMID:23242127

  9. Evidence-Based Chinese Medicine for Hypertension

    PubMed Central

    Wang, Jie; Xiong, Xingjiang

    2013-01-01

    Hypertension is an important worldwide public -health challenge with high mortality and disability. Due to the limitations and concerns with current available hypertension treatments, many hypertensive patients, especially in Asia, have turned to Chinese medicine (CM). Although hypertension is not a CM term, physicians who practice CM in China attempt to treat the disease using CM principles. A variety of approaches for treating hypertension have been taken in CM. For seeking the best evidence of CM in making decisions for hypertensive patients, a number of clinical studies have been conducted in China, which has paved the evidence-based way. After literature searching and analyzing, it appeared that CM was effective for hypertension in clinical use, such as Chinese herbal medicine, acupuncture, moxibustion, cupping, qigong, and Tai Chi. However, due to the poor quality of primary studies, clinical evidence is still weak. The potential benefits and safety of CM for hypertension still need to be confirmed in the future with well-designed RCTs of more persuasive primary endpoints and high-quality SRs. Evidence-based Chinese medicine for hypertension still has a long way to go. PMID:23861720

  10. Treatment of hypertension in the emergency department.

    PubMed

    Baumann, Brigitte M; Cline, David M; Pimenta, Eduardo

    2011-01-01

    This review updates concepts of hypertension evaluation and management in patients presenting to the emergency department. It outlines the current challenges faced by emergency physicians in the identification and management of hypertensive patients: In spite of published emergency care guidelines, identification and referral rates remain low in patients presenting to the emergency department with moderate blood pressure (BP) elevations. In patients with severely elevated BP, the evaluation for acute end organ damage remains inconsistent and is symptom-based. Using current consensus guidelines, this review provides an algorithm for the management of the hypertensive emergency department patient. The final section of this review outlines management strategies for specific hypertensive emergencies. PMID:21719370

  11. Evidence-based chinese medicine for hypertension.

    PubMed

    Wang, Jie; Xiong, Xingjiang

    2013-01-01

    Hypertension is an important worldwide public -health challenge with high mortality and disability. Due to the limitations and concerns with current available hypertension treatments, many hypertensive patients, especially in Asia, have turned to Chinese medicine (CM). Although hypertension is not a CM term, physicians who practice CM in China attempt to treat the disease using CM principles. A variety of approaches for treating hypertension have been taken in CM. For seeking the best evidence of CM in making decisions for hypertensive patients, a number of clinical studies have been conducted in China, which has paved the evidence-based way. After literature searching and analyzing, it appeared that CM was effective for hypertension in clinical use, such as Chinese herbal medicine, acupuncture, moxibustion, cupping, qigong, and Tai Chi. However, due to the poor quality of primary studies, clinical evidence is still weak. The potential benefits and safety of CM for hypertension still need to be confirmed in the future with well-designed RCTs of more persuasive primary endpoints and high-quality SRs. Evidence-based Chinese medicine for hypertension still has a long way to go. PMID:23861720

  12. Contrast stress echocardiography in hypertensive heart disease

    PubMed Central

    2011-01-01

    Hypertension is associated with atherosclerosis and cardiac and vascular structural and functional changes. Myocardial ischemia may arise in hypertension independent of coronary artery disease through an interaction between several pathophysiological mechanisms, including left ventricular hypertrophy, increased arterial stiffness and reduced coronary flow reserve associated with microvascular disease and endothelial dysfunction. The present case report demonstrates how contrast stress echocardiography can be used to diagnose myocardial ischemia in a hypertensive patient with angina pectoris but without significant obstructive coronary artery disease. The myocardial ischemia was due to severe resistant hypertension complicated with concentric left ventricular hypertrophy and increased arterial stiffness. PMID:22093163

  13. Dental management of patients with hypertension.

    PubMed

    Bavitz, J Bruce

    2006-10-01

    About 50 million people in the United States have hypertension. Many epidemiologists feels it is the number one public health problem in developed countries. Although asymptomatic early on, untreated hypertension leads to cardiovascular disease, strokes, renal failure, and blindness. Dentists no doubt treat patients with hypertension and its sequelae in their practice. This article summarizes the current thinking on the diagnosis and treatment of this condition, emphasizing dental implications. The article presents common oral and systemic side effects of antihypertensive medications, and discusses how dentists can help treat hypertension through the fabrication of devices useful in reducing obstructive sleep apnea. PMID:17000273

  14. Nerve conduction velocity in hypertensive patients.

    PubMed

    Halar, E M; Stewart, D T; Venkatesh, B; Chrissian, S A

    1978-01-01

    Due to conflicting reports in the literature regarding nerve conduction velocities (NCVs) in hypertensives, peroneal and sural NCVs and facial nerve conduction latencies were studied in 30 hypertensives and in 30 controls. An improved technique of NCV measurement was used. Twenty-one of the hypertensives were retested after five weeks, and five of them were tested for motor and sensory NCVs of the median nerve during a short period of partial occlusion of blood flow in the arm. No changes were found that could be related to blood pressure, duration of hypertension, eyeground changes, or partial restriction of blood flow. PMID:619818

  15. Hypertension crisis in the emergency department.

    PubMed

    Johnson, Wallace; Nguyen, My-Le; Patel, Ronak

    2012-11-01

    Hypertensive crises, which include hypertensive emergencies and urgencies, are frequently encountered in the emergency department, and require immediate attention as they can lead to irreversible end-organ damage. Normal blood pressure (BP) regulation is altered during acute rises in BP, leading to end-organ damage. Multiple organs can be injured. Special considerations should be given to hypertensive pregnant patients and patients with postoperative hypertension. Treatment should be individualized to each patient based on the type and extent of end-organ damage, degree of BP elevation, and the specific side effects that each medication could have on a patient's preexisting comorbidities. PMID:23102030

  16. [Recommendations for neonatal transport].

    PubMed

    Moreno Hernando, J; Thió Lluch, M; Salguero García, E; Rite Gracia, S; Fernández Lorenzo, J R; Echaniz Urcelay, I; Botet Mussons, F; Herranz Carrillo, G; Sánchez Luna, M

    2013-08-01

    During pregnancy, it is not always possible to identify maternal or foetal risk factors. Infants requiring specialised medical care are not always born in centres providing intensive care and will need to be transferred to a referral centre where intensive care can be provided. Therefore Neonatal Transport needs to be considered as part of the organisation of perinatal health care. The aim of Neonatal Transport is to transfer a newborn infant requiring intensive care to a centre where specialised resources and experience can be provided for the appropriate assessment and continuing treatment of a sick newborn infant. Intrauterine transfer is the ideal mode of transport when the birth of an infant with risk factors is diagnosed. Unfortunately, not all problems can be detected in advance with enough time to safely transfer a pregnant woman. Around 30- 50% of risk factors will be diagnosed during labour or soon after birth. Therefore, it is important to have the knowledge and resources to resuscitate and stabilise a newborn infant, as well as a specialised neonatal transport system. With this specialised transport it is possible to transfer newly born infants with the same level of care that they would receive if they had been born in a referral hospital, without increasing their risks or affecting the wellbeing of the newborn. The Standards Committee of the Spanish Society of Neonatology reviewed and updated recommendations for intrauterine transport and indications for neonatal transfer. They also reviewed organisational and logistic factors involved with performing neonatal transport. The Committee review included the type of personnel who should be involved; communication between referral and receiving hospitals; documentation; mode of transport; equipment to stabilise newly born infants; management during transfer, and admission at the referral hospital. PMID:23434016

  17. Prevalence and correlation of hypertension among adult population in Bahir Dar city, northwest Ethiopia: a community based cross-sectional study

    PubMed Central

    Anteneh, Zelalem Alamrew; Yalew, Worku Awoke; Abitew, Dereje Birhanu

    2015-01-01

    Background Hypertension is one of the most common causes of premature death and morbidity and has a major impact on health care costs. It is an important public health challenge to both developed and developing countries. The aim of this study was to determine the magnitude and correlates of hypertension. Methods A community-based cross-sectional study was conducted in June 2014 among 681 adult residents of Bahir Dar city using multistage sampling techniques. An interview-administrated questionnaire and physical measurements such as blood pressure (BP), weight, height, and waist and hip circumferences were employed to collect the data. The data were coded, entered, and analyzed with SPSS version 16 software package. Results A total of 678 responses were included in the analysis resulting in a response rate of 99.6%. The findings declared that 17.6%, 19.8%, and 2.2% of respondents were prehypertension, hypertension stage I, and hypertension stage II, respectively, on screening test. The overall prevalence of hypertension (systolic BP ≥140 mmHg, or diastolic BP ≥90 mmHg, or known hypertensive patient taking medications) was 25.1%. According to the multivariate logistic regression analysis, age; having ever smoked cigarette; number of hours spent walking/cycling per day; number of hours spent watching TV per day; history of diabetes; adding salt to food in addition to the normal amount that is added to the food during cooking; and body mass index were statistically significant predictors of hypertension. Conclusion One out of every four respondents of the study had hypertension, and more than one out of three cases of hypertension (38.8%) did not know that they had the hypertension; 17.6% of the respondents were in prehypertension stage, which adds to overall future risk of hypertension. Therefore, mass screening for hypertension, health education to prevent substance use, regular exercise, reducing salt consumption, and life style modifications are recommended

  18. APASL and AASLD Consensus Guidelines on Imaging Diagnosis of Hepatocellular Carcinoma: A Review

    PubMed Central

    Tan, Cher Heng; Low, Su-Chong Albert; Thng, Choon Hua

    2011-01-01

    Consensus guidelines for radiological diagnosis of hepatocellular carcinoma (HCC) have been drafted by several large international working groups. This article reviews the similarities and differences between the most recent guidelines proposed by the American Association for Study of Liver Diseases and the Asian Pacific Association for the Study of the Liver. Current evidence for the various imaging modalities for diagnosis of HCC and their relevance to the consensus guidelines are reviewed. PMID:22007313

  19. Management of the hypertensive patient with elevated heart rate: Statement of the Second Consensus Conference endorsed by the European Society of Hypertension.

    PubMed

    Palatini, Paolo; Rosei, Enrico Agabiti; Casiglia, Edoardo; Chalmers, John; Ferrari, Roberto; Grassi, Guido; Inoue, Teruo; Jelakovic, Bojan; Jensen, Magnus T; Julius, Stevo; Kjeldsen, Sverre E; Mancia, Giuseppe; Parati, Gianfranco; Pauletto, Paolo; Stella, Andrea; Zanchetti, Alberto

    2016-05-01

    In June 2015, a panel of experts gathered in a consensus conference to plan updating recommendations on the management of the hypertensive patient with elevated heart rate (HR), previously released in 2006. The issues examined during that meeting and further discussed by the participants during the following months involved the assessment of HR, the relevance of HR as a cardiovascular risk factor, the definition of tachycardia and the treatment of the hypertensive patient with high HR. For the measurement of resting HR the panel experts recommended that scientific investigations focusing on HR should report information on length of resting period before measurement, information about temperature and environment, method of measurement, duration of measurement, number of readings, time interval between measurements, body position and type of observer. According to the panellists there is convincing evidence that HR is an important risk factor for cardiovascular disease and they suggest to routinely include HR measurement in the assessment of the hypertensive patient. Regarding the definition of tachycardia, the panellists acknowledged that in the absence of convincing data any threshold used to define tachycardia is arbitrary. Similarly, as there are no outcome studies of HR lowering in tachycardia hypertension, the panellists could not make practical therapeutic suggestions for the management of such patients. However, the experts remarked that absence of evidence does not mean evidence against the importance of tachycardia as a risk factor for cardiovascular disease and that long-term exposure to a potentially important risk factor may impair the patient's prognosis. The main aims of the present document are to alert researchers and physicians about the importance of measuring HR in hypertensive patients, and to stimulate research to clarify unresolved issues. PMID:26982382

  20. Recommendations for observational studies of comorbidity in multiple sclerosis

    PubMed Central

    Miller, Aaron; Sormani, Maria Pia; Thompson, Alan; Waubant, Emmanuelle; Trojano, Maria; O'Connor, Paul; Fiest, Kirsten; Reider, Nadia; Reingold, Stephen; Cohen, Jeffrey A.

    2016-01-01

    Objective: To reach consensus about the most relevant comorbidities to study in multiple sclerosis (MS) with respect to incidence, prevalence, and effect on outcomes; review datasets that may support studies of comorbidity in MS; and identify MS outcomes that should be prioritized in such studies. Methods: We held an international workshop to meet these objectives, informed by a systematic review of the incidence and prevalence of comorbidity in MS, and an international survey regarding research priorities for comorbidity. Results: We recommend establishing age- and sex-specific incidence and prevalence estimates for 5 comorbidities (depression, anxiety, hypertension, hyperlipidemia, and diabetes); evaluating the effect of 7 comorbidities (depression, anxiety, hypertension, diabetes, hyperlipidemia, chronic lung disease, and autoimmune diseases) on disability, quality of life, brain atrophy and other imaging parameters, health care utilization, employment, and mortality, including age, sex, race/ethnicity, socioeconomic status, and disease duration as potential confounders; harmonizing study designs across jurisdictions; and conducting such studies worldwide. Ultimately, clinical trials of treating comorbidity in MS are needed. Conclusion: Our recommendations will help address knowledge gaps regarding the incidence, prevalence, and effect of comorbidity on outcomes in MS. PMID:26865523

  1. Hypertensive crisis during pregnancy and postpartum period.

    PubMed

    Too, Gloria T; Hill, James B

    2013-08-01

    Hypertension affects 10% of pregnancies, many with underlying chronic hypertension, and approximately 1-2% will undergo a hypertensive crisis at some point during their lives. Hypertensive crisis includes hypertensive urgency and emergency; the American College of Obstetricians and Gynecologists describes a hypertensive emergency in pregnancy as persistent (lasting 15 min or more), acute-onset, severe hypertension, defined as systolic BP greater than 160 mmHg or diastolic BP >110 mmHg in the setting of pre-eclampsia or eclampsia. Pregnancy may be complicated by hypertensive crisis, with lower blood pressure threshold for end-organ damage than non-pregnant patients. Maternal assessment should include a thorough history. Fetal assessment should include heart rate tracing, ultrasound for growth and amniotic assessment, and Doppler evaluation if growth restriction is suspected. Initial management of hypertensive emergency (systolic BP >160 mmHg or diastolic BP >110 mmHg in the setting of pre-eclampsia or eclampsia) generally includes the rapid reduction of blood pressure through the use of intravenous antihypertensive medications, with goal systolic blood pressure between 140 mmHg and 150 mmHg and diastolic pressure between 90 mmHg and 100 mmHg. First-line intravenous drugs include labetalol and hydralazine, but other agents may be used, including esmolol, nicardipine, nifedipine, and, as a last resort, sodium nitroprusside. Among patients with hypertensive urgency, slower blood pressure reduction can be provided with oral agents. The objective of this article is to review the current understanding, diagnosis, and management of hypertensive crisis during pregnancy and the postpartum period. PMID:23916027

  2. Clinical Outcome of Hypertensive Uveitis

    PubMed Central

    Lewkowicz, Deborah; Willermain, François; Relvas, Lia Judice; Makhoul, Dorine; Janssens, Sarah; Janssens, Xavier; Caspers, Laure

    2015-01-01

    Purpose. To review the clinical outcome of patients with hypertensive uveitis. Methods. Retrospective review of uveitis patients with elevated intraocular pressure (IOP) > 25 mmHg and >1-year follow-up. Data are uveitis type, etiology, viral (VU) and nonviral uveitis (NVU), IOP, and medical and/or surgical treatment. Results. In 61 patients, IOP values are first 32.9 mmHg (SD: 9.0), highest 36.6 mmHg (SD: 9.9), 3 months after the first episode 19.54 mmHg (SD: 9.16), and end of follow-up 15.5 mmHg (SD: 6.24). Patients with VU (n = 25) were older (50.6 y/35.7 y, p = 0.014) and had more unilateral disease (100%/72.22%  p = 0.004) than those with NVU (n = 36). Thirty patients (49.2%) had an elevated IOP before topical corticosteroid treatment. Patients with viral uveitis might have higher first elevated IOP (36.0/27.5 mmHg, p = 0,008) and maximal IOP (40.28/34.06 mmHg, p = 0.0148) but this was not significant when limited to the measurements before the use of topical corticosteroids (p = 0.260 and 0.160). Glaucoma occurred in 15 patients (24.59%) and was suspected in 11 (18.03%) without difference in viral and nonviral groups (p = 0.774). Conclusion. Patients with VU were older and had more unilateral hypertensive uveitis. Glaucoma frequently complicates hypertensive uveitis. Half of the patients had an elevated IOP before topical corticosteroid treatment. PMID:26504598

  3. Evidence for exercise training in the management of hypertension in adults

    PubMed Central

    Ghadieh, Alexandra S.; Saab, Basem

    2015-01-01

    Abstract Objective To provide recommendations on exercise training as part of the management of hypertension in adults. Quality of evidence Evidence was found through a systematic search of PubMed, MEDLINE, EMBASE, Agency for Healthcare Research and Quality evidence-based reports, Bandolier, Clinical Evidence, the Institute for Clinical Systems Improvement guidelines, the National Guideline Clearinghouse database, UpToDate, and the Cochrane Database of Systematic Reviews (part of Ovid Evidence Based Medicine Reviews) for articles published from January 1973 to September 2013. Study types were limited to meta-analyses, randomized controlled trials, clinical trials, and reviews. Main message Exercise exerts an anti-inflammatory action through the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, and has direct effects on blood pressure. The resulting physiologic effects are classified as acute, postexercise, and chronic. Current treatment guidelines emphasize the role of nonpharmacologic interventions, including physical activity, in the management of mild to moderate hypertension. Conclusion Moderate intensity aerobic exercise has been proven to prevent hypertension and to help in the management of stage 1 hypertension. Dynamic resistance exercises, if done properly, contribute to lowering both systolic and diastolic blood pressures. There is insufficient evidence about the safety and efficacy of isometric resistance training to recommend it. PMID:25927108

  4. Hypertension and concomitant diseases: a guide for evidence-based therapy.

    PubMed Central

    Retta, Tamrat M.; Randall, Otelio S.

    2004-01-01

    Hypertension remains one of the leading causes of morbidity and mortality in the United States. Numerous antihypertensive agents are available today, and most hypertensive patients suffer from concomitant diseases/conditions. Many of these diseases/conditions require appropriate selection of antihypertensive agents. It gets quite complex to pick the initial and additional antihypertensive agents that are simultaneously beneficial in the management of these comorbidities. The authors believe this guide will assist physicians in picking the right agent to achieve goal blood pressure recommended by the Joint National Committee (JNC). In this paper, the introduction section briefly outlines some aspects of the pathophysiology of hypertension. This is followed by subsections that identify commonly encountered diseases/conditions that coexist with hypertension, and a list of antihypertensive drugs to be used for these conditions in the order of preference. The suggested choices are based on evidence from clinical trials, for the most part, and in some cases based on mechanisms of action of the drugs. The list of choices is then followed by concise explanations or rationale, including citations for the clinical trials or other relevant sources. Such a systematic approach and use of a handy flow chart would enhance appropriate blood pressure control and patient compliance and, hopefully, make a little dent in the rate of hypertension-related cardiovascular morbidity and mortality. PMID:15101665

  5. [Strategies for effective control of arterial hypertension in Spain. Consensus document].

    PubMed

    Coca, A; Aranda, P; Bertomeu, V; Bonet, A; Esmatjes, E; Guillén, F; Hernández-Moreno, J; Llisterri, J L; Marín-Iranzo, R; Megía, C; Rodríguez-Mañas, L; Suárez, C

    2006-11-01

    Blood pressure (BP) control is inadequate among treated hypertensive patients in Spain. Control rates are lower than 40% of all treated patients and the cause of this problem is multifactorial. Despite the fact that possible solutions to this problem have been repeatedly suggested by expert groups along the last 10 years, BP control rates are still low. This fact have a negative impact on cardiovascular morbidity and mortality of patients with hypertension. The aim of the present document has been to achieve a consensus on effective specific measures in order to improve hypertension control rates in Spain. These measures involve health care professionals (physicians, nurses, pharmaceutics), health care authorities and patients. The document summarizes the consensus conference of several scientific societies involved in cardiovascular medicine in five group of measures: a) improvement of the methodology of office BP measurement; b) improvement of compliance to treatment by patients; c) clarification of pressure targets to be achieved in hypertensive patients; d) optimization of life style modifications and pharmacological treatment of hypertension; and e) continuous medical education. The document emphasize life style changes as a crucial aspect to be implemented in all patients. These changes have a beneficial impact on pressure reduction, contribute to a better control of associated cardiovascular risk factors, and increase the effectiveness of antihypertensive drugs. Health care professionals should base their clinical practice on the recommendations of guidelines in order to modify their therapeutic attitudes in patients whose targets have not been achieved. PMID:17129520

  6. Hypertension and prehypertension among adolescents in secondary schools in Enugu, South East Nigeria

    PubMed Central

    2013-01-01

    Background Hypertension is a prevalent cardiovascular disease risk factor among blacks and adolescent hypertension can progress into adulthood. Objective To determine the prevalence of hypertension and prehypertension among secondary school adolescents in Enugu South East Nigeria. Methodology A study of 2694 adolescents aged 10-18 years in Enugu metropolis was carried out. Socio-demographic profile anthropometric and blood pressure readings were obtained. Derived measurements such as Prehypertension, hypertension and BMI were obtained. Results The results showed that the mean systolic blood pressure and diastolic blood pressure for males were 106.66+ 11.80 mmHg and 70.25 + 7.34 mmHg respectively. The mean SBP and DBP for females were 109.83+ 11.66 mmHg and 72.23 + 8.26 mmHg respectively (p < 0.01). Blood pressure was found to increase with age. Prevalence of hypertension and prehypertension was 5.4% and 17.3% respectively with a higher rate in females (6.9%) than males (3.8%). Prevalence of prehypertension among males and females were 14.3% and 20.1% respectively. The prevalence of obesity was 1.9%. Conclusion Modifiable risk factors exist among adolescents. Early lifestyle modification and a strengthened school health are recommended. PMID:24180427

  7. Arrhythmias in pulmonary arterial hypertension.

    PubMed

    Rajdev, Archana; Garan, Hasan; Biviano, Angelo

    2012-01-01

    Cardiac arrhythmias are important contributors to morbidity and mortality in patients with pulmonary arterial hypertension (PAH). Such patients manifest a substrate resulting from altered autonomics, repolarization abnormalities, and ischemia. Supraventricular arrhythmias such as atrial fibrillation and flutter are associated with worsened outcomes, and maintenance of sinus rhythm is a goal. Sudden death is a relatively common issue, though the contribution of malignant ventricular arrhythmias versus bradyarrhythmias differs from non-PAH patients. Congenital heart disease patients with PAH benefit from catheter ablation of medically refractory arrhythmias. Clinical studies of defibrillator/pacemaker therapy for primary prevention against sudden death in PAH patients are lacking. PMID:23009914

  8. Arrhythmias in Pulmonary Arterial Hypertension

    PubMed Central

    Rajdev, Archana; Garan, Hasan; Biviano, Angelo

    2013-01-01

    Cardiac arrhythmias are important contributors to morbidity and mortality in patients with pulmonary arterial hypertension (PAH). Such patients manifest a substrate resulting from altered autonomics, repolarization abnormalities, and ischemia. Supraventricular arrhythmias such as atrial fibrillation and flutter are associated with worsened outcomes, and maintenance of sinus rhythm is a goal. Sudden death is a relatively common issue, though the contribution of malignant ventricular arrhythmias versus bradyarrhythmias differs from non-PAH patients. Congenital heart disease patients with PAH benefit from catheter ablation of medically refractory arrhythmias. Clinical studies of defibrillator/pacemaker therapy for primary prevention against sudden death in PAH patients are lacking. PMID:23009914

  9. Hypertension and a missing kidney

    PubMed Central

    Raina, Rupesh; Gulani, Vikas; Mehta, Lina; Jacobs, Gretta H.; Joyce, Kelly; Ponsky, Todd A.; Kenagy, David N.

    2012-01-01

    Standard initial assessment via ultrasound of a 4-year-old girl with hypertension revealed the absence of one kidney. Instead of cross-sectional imaging of the retroperitoneal space, a functional (nuclear) study was performed. This revealed a malformed kidney within the chest. Though systemic levels of renin and aldosterone were not elevated, removal of the malformed kidney normalized the blood pressure. The presence of prominent smooth muscle nodules surrounding the arteries was seen in the malformed kidney. Initial attempts to avert surgery by pharmacologically reducing blood flow to the malformed kidney were unsuccessful. The review of the literature offers little evidence to support such a strategy. PMID:25874090

  10. Post splenectomy related pulmonary hypertension

    PubMed Central

    Palkar, Atul V; Agrawal, Abhinav; Verma, Sameer; Iftikhar, Asma; Miller, Edmund J; Talwar, Arunabh

    2015-01-01

    Splenectomy predisposes patients to a slew of infectious and non-infectious complications including pulmonary vascular disease. Patients are at increased risk for venous thromboembolic events due to various mechanisms that may lead to chronic thromboembolic pulmonary hypertension (CTEPH). The development of CTEPH and pulmonary vasculopathy after splenectomy involves complex pathophysiologic mechanisms, some of which remain unclear. This review attempts congregate the current evidence behind our understanding about the etio-pathogenesis of pulmonary vascular disease related to splenectomy and highlight the controversies that surround its management. PMID:26949600

  11. HYPERTENSIVE-ISCHEMIC LEG ULCERS

    PubMed Central

    Farber, Eugene M.; Schmidt, Otto E. L.

    1950-01-01

    Ischemic ulcers of the leg having characteristics different from those of ordinary leg ulcers have been observed in a small number of hypertensive patients, mostly women, during the past few years. Such ulcers are usually located above the ankle. They begin with a small area of purplish discoloration at the site of slight trauma, and progress to acutely tender ulceration. In studies of tissue removed from the margin and the base of an ulcer of this kind, obliterative arteriolar sclerotic changes, ischemic-appearing connective tissue and inflammatory changes were noted. Two additional cases are reported. ImagesFigure 1.Figure 2.Figure 3.Figure 4. PMID:15398887

  12. [Effect of calcium pantothenate on vitamin B6 and C correlation in patients with hypertension and ischemic heart disease].

    PubMed

    Kalkun, D P; Artaeva, L P

    1986-01-01

    The relationship between pyridoxin and ascorbic acid was studied in patients with essential hypertension and coronary heart disease and proved to be antagonistic. To correct negative interrelations it is recommended that each of these vitamins be administered in combination with calcium pantothenate which favours their better utilization in the patient's body. PMID:3765531

  13. Hypertension care at primary health care centers: a report from Abha, Saudi Arabia.

    PubMed

    Al-Homrany, Mohammed A; Khan, Mohd Yunus; Al-Khaldi, Yahia Mater; Al-Gelban, Khalid S; Al-Amri, Hasan Saed

    2008-11-01

    It is well known that effective management of hypertension reduces the incidence of myo-cardial infarction, stroke and vascular complications. The Ministry of Health, Kingdom of Saudi Arabia, introduced the Quality Assurance Guidelines with the hope to improve the management of hypertension in its centers. We conducted an audit of two Primary Health Care Centers namely, Al-Manhal (MPHCC) and Al-Numais (NPHCC), to evaluate how well hypertension was managened at these centers. A check list was derived from the Quality Assurance Manual to audit the process and to assess the health outcome. A retrospective study on a chosen sample of 120 files of hypertensive patients, out of 256 from both the Primary Health Care Centers was performed, during the last three months of the year 2000. Results showed that 61% of the patients were between 45-64 years of age, 56% were females, 85% were married, 54% were illiterate and 7.5% were smokers. A total of 92% of the patients had primary hypertension and 25% had a positive family history of hypertension. Beta-blockers were the most commonly used drugs in both the centers. Although the recording of the information was not perfect, there was no statistical difference in the socio-demongraphic data and also the means of the total score in both the centres. On the other hand, carrying out the important procedures for hypertensive patients was found to be better at MPHCC in comparison to NPHCC (p < 0.05). The commonly missed procedures were chest x-rays, electrolytes and ECG. Hypertension was well controlled in 63% of the patients, 58% were found to have obesity, 9% suffered from hypertension-related complications while almost 50% had good compliance to appointment in both the centers. Our study reveals that the process of hypertension care at the two Primary Health Care Centres in Aseer region was not in accordance with the recommended national standards. The reasons include lack of updating systems, recall system and provision of

  14. Portal hypertensive polyps, a new entity?

    PubMed

    Martín Domínguez, Verónica; Díaz Méndez, Ariel; Santander, Cecilio; García-Buey, Luisa

    2016-05-01

    We present a case of a 62 year old woman with history of liver cirrhosis secondary to autoimmune hepatitis, with portal hypertension and coagulopathy. Gastroscopy findings were a polypoid and polylobed lesions in the gastric antrum. These were removed and the pathological study described hyperplastic polyps with edema, vascular congestion and hyperplasia of smooth muscle, corresponding to "portal hypertensive polyps" (PHP). PMID:27188590

  15. Mechanisms of obesity-induced hypertension.

    PubMed

    Kotsis, Vasilios; Stabouli, Stella; Papakatsika, Sofia; Rizos, Zoe; Parati, Gianfranco

    2010-05-01

    The relationship between obesity and hypertension is well established both in children and adults. The mechanisms through which obesity directly causes hypertension are still an area of research. Activation of the sympathetic nervous system has been considered to have an important function in the pathogenesis of obesity-related hypertension. The arterial-pressure control mechanism of diuresis and natriuresis, according to the principle of infinite feedback gain, seems to be shifted toward higher blood-pressure levels in obese individuals. During the early phases of obesity, primary sodium retention exists as a result of increase in renal tubular reabsorption. Extracellular-fluid volume is expanded and the kidney-fluid apparatus is resetted to a hypertensive level, consistent with a model of hypertension because of volume overload. Plasma renin activity, angiotensinogen, angiotensin II and aldosterone values display significant increase during obesity. Insulin resistance and inflammation may promote an altered profile of vascular function and consequently hypertension. Leptin and other neuropeptides are possible links between obesity and the development of hypertension. Obesity should be considered as a chronic medical condition, which is likely to require long-term treatment. Understanding of the mechanisms associated with obesity-related hypertension is essential for successful treatment strategies. PMID:20442753

  16. Pulmonary Hypertension in Pregnancy: Critical Care Management

    PubMed Central

    Bassily-Marcus, Adel M.; Yuan, Carol; Oropello, John; Manasia, Anthony; Kohli-Seth, Roopa; Benjamin, Ernest

    2012-01-01

    Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30–56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Imaging workup may have undesirable radiation exposure. Pulmonary artery catheter remains the gold standard for diagnosing pulmonary hypertension, although its use in the intensive care unit for other conditions has slowly fallen out of favor. Goal-directed bedside echocardiogram and lung ultrasonography provide attractive alternatives. Basic principles of managing pulmonary hypertension with right ventricular failure are maintaining right ventricular function and reducing pulmonary vascular resistance. Fluid resuscitation and various vasopressors are used with caution. Pulmonary-hypertension-targeted therapies have been utilized in pregnant women with understanding of their safety profile. Mainstay therapy for pulmonary embolism is anticoagulation, and the treatment for amniotic fluid embolism remains supportive care. Multidisciplinary team approach is crucial to achieving successful outcomes in these difficult cases. PMID:22848817

  17. Measuring hypertension control: NCQA and beyond.

    PubMed

    Miller, Nancy Houston

    2003-08-01

    Using tools developed by NCQA, Rand, and other institutions, health plans and providers can take an aggressive stance toward managing hypertension. This effort has led to gains in blood pressure control in some populations, greater recognition of the importance of controlling hypertension, and increased attention to processes that promote higher-quality health care. PMID:12971593

  18. Hypertension. Part 1: How Exercise Helps.

    ERIC Educational Resources Information Center

    Tanji, Jeffrey L.

    1990-01-01

    Reviews possible mechanisms by which exercise lowers blood pressure and discusses research which indicates exercise is an effective therapy for hypertension. The article presents information to help physicians counsel hypertensive patients wanting to start an exercise program and examines the use of exercise testing to predict the onset of…

  19. Pulmonary hypertension in pregnancy: critical care management.

    PubMed

    Bassily-Marcus, Adel M; Yuan, Carol; Oropello, John; Manasia, Anthony; Kohli-Seth, Roopa; Benjamin, Ernest

    2012-01-01

    Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30-56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Imaging workup may have undesirable radiation exposure. Pulmonary artery catheter remains the gold standard for diagnosing pulmonary hypertension, although its use in the intensive care unit for other conditions has slowly fallen out of favor. Goal-directed bedside echocardiogram and lung ultrasonography provide attractive alternatives. Basic principles of managing pulmonary hypertension with right ventricular failure are maintaining right ventricular function and reducing pulmonary vascular resistance. Fluid resuscitation and various vasopressors are used with caution. Pulmonary-hypertension-targeted therapies have been utilized in pregnant women with understanding of their safety profile. Mainstay therapy for pulmonary embolism is anticoagulation, and the treatment for amniotic fluid embolism remains supportive care. Multidisciplinary team approach is crucial to achieving successful outcomes in these difficult cases. PMID:22848817

  20. Minority Barbers Screen Customers for Hypertension.

    ERIC Educational Resources Information Center

    Pepe, Margaret V.

    1989-01-01

    Offering hypertension screening within the Black community in a convenient, nonthreatening environment can aid in reduction of morbidity and mortality attributable to high blood pressure in Black men. This article describes a successful pilot program which used volunteer barbers to perform on-site hypertension screening for their customers. (IAH)

  1. Emergency and disaster preparedness for chronically ill patients: a review of recommendations

    PubMed Central

    Tomio, Jun; Sato, Hajime

    2014-01-01

    Recent disasters, especially those in developed countries, have highlighted the importance of disaster preparedness measures for chronic diseases. A number of surviving patients experienced the exacerbation of a chronic illness, such as hypertension, diabetes, cancer, and chronic respiratory diseases, due to disaster-related stress, interruption of care, or both; for some patients, these exacerbations resulted in death. Here, we review reports from recent disasters in developed countries and summarize the recommendations for disaster preparedness of chronically ill patients. A considerable number of recommendations based on the lessons learned from recent disasters have been developed, and they provide practical and essential steps to prevent treatment interruption during and after a disaster. To improve preparedness efforts, we suggest that health care providers should be aware of the following three suggestions: 1) recommendations should be evidence-based; 2) recommendations should contain consistent messages; and 3) recommendations should be feasible. PMID:27147882

  2. Emergency and disaster preparedness for chronically ill patients: a review of recommendations.

    PubMed

    Tomio, Jun; Sato, Hajime

    2014-01-01

    Recent disasters, especially those in developed countries, have highlighted the importance of disaster preparedness measures for chronic diseases. A number of surviving patients experienced the exacerbation of a chronic illness, such as hypertension, diabetes, cancer, and chronic respiratory diseases, due to disaster-related stress, interruption of care, or both; for some patients, these exacerbations resulted in death. Here, we review reports from recent disasters in developed countries and summarize the recommendations for disaster preparedness of chronically ill patients. A considerable number of recommendations based on the lessons learned from recent disasters have been developed, and they provide practical and essential steps to prevent treatment interruption during and after a disaster. To improve preparedness efforts, we suggest that health care providers should be aware of the following three suggestions: 1) recommendations should be evidence-based; 2) recommendations should contain consistent messages; and 3) recommendations should be feasible. PMID:27147882

  3. Meals served to hypertensive and cardiac inpatients in Jordan: comparison with WHO and NIH dietary guidelines.

    PubMed

    Bawadi, H A; Banks, A D; Tayyem, R F; ElKhoury, C

    2016-01-01

    This study aimed to evaluate the compliance of daily meals served to hypertensive and cardiac inpatients in Jordan according to WHO guidelines and the Therapeutic Lifestyle Changes (TLC) and Dietary Approach to Stop Hypertension (DASH) diets plans. Weekly cycle menus from the food service department of major hospitals in Jordan (n = 16) were analysed using ESHA Food Processor software to obtain data about macroand micronutrient contents and food groups represented. The results showed inappropriate amounts of several nutrients in the menus provided, along with a general noncompliance with the DASH, TLC and WHO guidelines. Meals had higher than recommended sodium content coupled with low potassium content. Fatty acid profiles were often outside the recommended ranges. Meals provided to cardiac inpatients in Jordan need to be revised to meet the guidelines specified for the health conditions of these patients. PMID:27117647

  4. The relationships of sleep apnea, hypertension, and resistant hypertension on chronic kidney disease.

    PubMed

    Chang, Chih-Ping; Li, Tsai-Chung; Hang, Liang-Wen; Liang, Shinn-Jye; Lin, Jen-Jyn; Chou, Che-Yi; Tsai, Jeffrey J P; Ko, Po-Yen; Chang, Chiz-Tzung

    2016-06-01

    Hypertension, blood pressure variation, and resistant hypertension have close relations to sleep apnea, which lead to target organ damage, including the kidney. The complex relationships between sleep apnea and blood pressure cause their interactions with chronic kidney disease ambiguous. The aim of the study was to elucidate the separate and joint effects of sleep apnea, hypertension, and resistant hypertension on chronic kidney disease. A cross-sectional study was done to see the associations of sleep apnea, hypertension, and resistant hypertension with chronic kidney disease in 998 subjects underwent overnight polysomnography without device-therapy or surgery for their sleep-disordered breathing. Multivariate logistic regression was used to analyze the severity of SA, hypertension stage, resistant hypertension, and their joint effects on CKD. The multivariable relative odds (95% CI) of chronic kidney disease for the aged (age ≥65 years), severe sleep apnea, stage III hypertension, and resistant hypertension were 3.96 (2.57-6.09) (P < 0.001), 2.28 (1.13-4.58) (P < 0.05), 3.55 (1.70-7.42) (P < 0.001), and 9.42 (4.22-21.02) (P < 0.001), respectively. In subgroups analysis, the multivariable relative odds ratio of chronic kidney disease was highest in patients with both resistant hypertension and severe sleep apnea [13.42 (4.74-38.03)] (P < 0.001). Severe sleep apnea, stage III hypertension, and resistant hypertension are independent risk factors for chronic kidney disease. Patients with both severe sleep apnea and resistant hypertension have the highest risks. PMID:27281098

  5. The relationships of sleep apnea, hypertension, and resistant hypertension on chronic kidney disease

    PubMed Central

    Chang, Chih-Ping; Li, Tsai-Chung; Hang, Liang-Wen; Liang, Shinn-Jye; Lin, Jen-Jyn; Chou, Che-Yi; Tsai, Jeffrey J.P.; Ko, Po-Yen; Chang, Chiz-Tzung

    2016-01-01

    Abstract Hypertension, blood pressure variation, and resistant hypertension have close relations to sleep apnea, which lead to target organ damage, including the kidney. The complex relationships between sleep apnea and blood pressure cause their interactions with chronic kidney disease ambiguous. The aim of the study was to elucidate the separate and joint effects of sleep apnea, hypertension, and resistant hypertension on chronic kidney disease. A cross-sectional study was done to see the associations of sleep apnea, hypertension, and resistant hypertension with chronic kidney disease in 998 subjects underwent overnight polysomnography without device-therapy or surgery for their sleep-disordered breathing. Multivariate logistic regression was used to analyze the severity of SA, hypertension stage, resistant hypertension, and their joint effects on CKD. The multivariable relative odds (95% CI) of chronic kidney disease for the aged (age ≥65 years), severe sleep apnea, stage III hypertension, and resistant hypertension were 3.96 (2.57–6.09) (P < 0.001), 2.28 (1.13–4.58) (P < 0.05), 3.55 (1.70–7.42) (P < 0.001), and 9.42 (4.22–21.02) (P < 0.001), respectively. In subgroups analysis, the multivariable relative odds ratio of chronic kidney disease was highest in patients with both resistant hypertension and severe sleep apnea [13.42 (4.74–38.03)] (P < 0.001). Severe sleep apnea, stage III hypertension, and resistant hypertension are independent risk factors for chronic kidney disease. Patients with both severe sleep apnea and resistant hypertension have the highest risks. PMID:27281098

  6. [Hypertension during pregnancy: the challenge continues].

    PubMed

    Rosas-Peralta, Martín; Borrayo-Sánchez, Gabriela; Madrid-Miller, Alejandra; Ramírez-Arias, Erick; Pérez-Rodríguez, Gilberto

    2016-01-01

    Hypertensive disorders of pregnancy affect approximately from 5 to 10 % of all pregnant women, and are the main contributors of maternal and neonatal morbidity and mortality worldwide. This group of disorders includes chronic hypertension, as well as the conditions that arise de novo in pregnancy: gestational hypertension and preeclampsia. This last group is believed to be part of the same continuum, but with arbitrary division. Research on the etiology of hypertension in pregnancy largely have focused on preeclampsia, with a majority of studies that explore any factor associated with pregnancy, e.g., the answers derived from the placenta or immunological reactions to tissue from the pregnancy or maternal constitutional factors, such as cardiovascular health and endothelial dysfunction. The basic foundations for the pathophysiology and progression of hypertensive pregnancy disorders, particularly preeclampsia, are reviewed in this paper. Therapeutic options for the treatment of preeclampsia are also explored. PMID:27284848

  7. [Radiographic assessment of pulmonary hypertension: Methodical aspects].

    PubMed

    Korobkova, I Z; Lazutkina, V K; Nizovtsova, L A; Riden, T V

    2015-01-01

    Pulmonary hypertension is a menacing complication of a number of diseases, which is responsible for high mortality rates and considerably poorer quality of life in a patient. The timely detection for pulmonary hypertension allows timely initiation of treatment, thus improvement in prognosis in the patient. Chest X-ray is the most commonly used radiographic technique for various causes. Physicians' awareness about the radiographic manifestations of pulmonary hypertension may contribute to the earlier detection of this severe disease. Owing to the natural contrast of reflected structures, a chest X-ray film gives a unique opportunity to assess pulmonary circulation vessels, to reveal the signs of pulmonary hypertension, and to estimate trends in the course of the disease. The paper details a procedure for analysis and the normal radiographic anatomy of pulmonary circulation vessels, gives the present classification of pulmonary hypertension, and sets forth its X-ray semiotics. PMID:26552229

  8. Hotel Housekeeping Work Influences on Hypertension Management

    PubMed Central

    Sanon, Marie-Anne

    2013-01-01

    Background Characteristics of hotel housekeeping work increase the risk for hypertension development. Little is known about the influences of such work on hypertension management. Methods For this qualitative study, 27 Haitian immigrant hotel housekeepers from Miami-Dade County, FL were interviewed. Interview transcripts were analyzed with the assistance of the Atlas. ti software for code and theme identification. Results Influences of hotel housekeeping work on hypertension management arose both at the individual and system levels. Factors at the individual level included co-worker dynamics and maintenance of transmigrant life. Factors at the system level included supervisory support, workload, work pace, and work hiring practices. No positive influences were reported for workload and hiring practices. Conclusions Workplace interventions may be beneficial for effective hypertension management among hotel housekeepers. These work influences must be considered when determining effective methods for hypertension management among hotel housekeepers. PMID:23775918

  9. DNA Damage and Pulmonary Hypertension

    PubMed Central

    Ranchoux, Benoît; Meloche, Jolyane; Paulin, Roxane; Boucherat, Olivier; Provencher, Steeve; Bonnet, Sébastien

    2016-01-01

    Pulmonary hypertension (PH) is defined by a mean pulmonary arterial pressure over 25 mmHg at rest and is diagnosed by right heart catheterization. Among the different groups of PH, pulmonary arterial hypertension (PAH) is characterized by a progressive obstruction of distal pulmonary arteries, related to endothelial cell dysfunction and vascular cell proliferation, which leads to an increased pulmonary vascular resistance, right ventricular hypertrophy, and right heart failure. Although the primary trigger of PAH remains unknown, oxidative stress and inflammation have been shown to play a key role in the development and progression of vascular remodeling. These factors are known to increase DNA damage that might favor the emergence of the proliferative and apoptosis-resistant phenotype observed in PAH vascular cells. High levels of DNA damage were reported to occur in PAH lungs and remodeled arteries as well as in animal models of PH. Moreover, recent studies have demonstrated that impaired DNA-response mechanisms may lead to an increased mutagen sensitivity in PAH patients. Finally, PAH was linked with decreased breast cancer 1 protein (BRCA1) and DNA topoisomerase 2-binding protein 1 (TopBP1) expression, both involved in maintaining genome integrity. This review aims to provide an overview of recent evidence of DNA damage and DNA repair deficiency and their implication in PAH pathogenesis. PMID:27338373

  10. Hepatopulmonary syndrome and portopulmonary hypertension.

    PubMed

    Hendrickse, Adrian; Azam, Fareed; Mandell, M Susan

    2007-04-01

    The incidence of pulmonary vascular disorders is significantly increased in patients with liver disease. Intrapulmonary shunting with hypoxemia in patients with liver disease is diagnosed as hepatopulmonary syndrome (HPS), whereas precapillary pulmonary vessel obliteration is identified as portopulmonary hypertension (PPHTN). Because the symptoms of liver disease can mimic those of pulmonary vascular disease, all patients with hepatic failure should be screened for these two diseases. Pulse oximetry effectively screens for hypoxemia associated with HPS, whereas an elevated right ventricular systolic pressure estimated by echocardiography identifies patients at risk of having PPHTN. Liver transplantation is the only effective medical therapy for HPS. However, those who have a resting arterial oxygenation less than 50 mm Hg or a shunt measured by scintigraphic perfusion greater than 20% have an unacceptably high mortality rate following surgery. Compared with HPS, there are more therapeutic options that can bridge patients with PPHTN to transplantation. Drugs used to manage idiopathic pulmonary hypertension have shown promise in the treatment of PPHTN. Prostanoids, endothelin receptor antagonists, and phosphodiesterase-5 inhibitors have improved transplant survival. Despite treatment, however, perioperative mortality for patients with PPHTN remains high. Even with successful transplantation, HPS and PPHTN can persist or develop de novo. Long-term follow-up and surveillance of liver transplant recipients is thus indicated to identify HPS and PPHTN following surgery. PMID:17484815

  11. Virgin Olive Oil and Hypertension.

    PubMed

    Lopez, Sergio; Bermudez, Beatriz; Montserrat-de la Paz, Sergio; Jaramillo, Sara; Abia, Rocio; Muriana, Francisco Jg

    2016-01-01

    The incidence of high blood pressure (BP) along with other cardiovascular (CV) risk factors on human health has been studied for many years. These studies have proven a link between unhealthy dietary habits and sedentary lifestyle with the onset of hypertension, which is a hallmark of CV and cerebrovascular diseases. The Mediterranean diet, declared by the UNESCO as an Intangible Cultural Heritage since 2013, is rich in vegetables, legumes, fruits and virgin olive oil. Thanks to its many beneficial effects, including those with regard to lowering BP, the Mediterranean diet may help people from modern countries to achieve a lower occurrence of CV disease. Data from human and animal studies have shown that the consumption of virgin olive oil shares most of the beneficial effects of the Mediterranean diet. Virgin olive oil is the only edible fat that can be consumed as a natural fruit product with no additives or preservatives, and contains a unique constellation of bioactive entities, namely oleic acid and minor constituents. In this review, we summarize what is known about the effects of virgin olive oil on hypertension. PMID:26775852

  12. DNA Damage and Pulmonary Hypertension.

    PubMed

    Ranchoux, Benoît; Meloche, Jolyane; Paulin, Roxane; Boucherat, Olivier; Provencher, Steeve; Bonnet, Sébastien

    2016-01-01

    Pulmonary hypertension (PH) is defined by a mean pulmonary arterial pressure over 25 mmHg at rest and is diagnosed by right heart catheterization. Among the different groups of PH, pulmonary arterial hypertension (PAH) is characterized by a progressive obstruction of distal pulmonary arteries, related to endothelial cell dysfunction and vascular cell proliferation, which leads to an increased pulmonary vascular resistance, right ventricular hypertrophy, and right heart failure. Although the primary trigger of PAH remains unknown, oxidative stress and inflammation have been shown to play a key role in the development and progression of vascular remodeling. These factors are known to increase DNA damage that might favor the emergence of the proliferative and apoptosis-resistant phenotype observed in PAH vascular cells. High levels of DNA damage were reported to occur in PAH lungs and remodeled arteries as well as in animal models of PH. Moreover, recent studies have demonstrated that impaired DNA-response mechanisms may lead to an increased mutagen sensitivity in PAH patients. Finally, PAH was linked with decreased breast cancer 1 protein (BRCA1) and DNA topoisomerase 2-binding protein 1 (TopBP1) expression, both involved in maintaining genome integrity. This review aims to provide an overview of recent evidence of DNA damage and DNA repair deficiency and their implication in PAH pathogenesis. PMID:27338373

  13. Context-Aware Recommender Systems

    NASA Astrophysics Data System (ADS)

    Adomavicius, Gediminas; Tuzhilin, Alexander

    The importance of contextual information has been recognized by researchers and practitioners in many disciplines, including e-commerce personalization, information retrieval, ubiquitous and mobile computing, data mining, marketing, and management. While a substantial amount of research has already been performed in the area of recommender systems, most existing approaches focus on recommending the most relevant items to users without taking into account any additional contextual information, such as time, location, or the company of other people (e.g., for watching movies or dining out). In this chapter we argue that relevant contextual information does matter in recommender systems and that it is important to take this information into account when providing recommendations. We discuss the general notion of context and how it can be modeled in recommender systems. Furthermore, we introduce three different algorithmic paradigms - contextual prefiltering, post-filtering, and modeling - for incorporating contextual information into the recommendation process, discuss the possibilities of combining several contextaware recommendation techniques into a single unifying approach, and provide a case study of one such combined approach. Finally, we present additional capabilities for context-aware recommenders and discuss important and promising directions for future research.

  14. Teacher Leadership: Federal Policy Recommendations

    ERIC Educational Resources Information Center

    Gran, Jackie; Young, Margaret; Broin, Alexandra

    2015-01-01

    This policy brief was developed specifically for federal policymakers, and builds upon the policy recommendations included in "Leading from Every Seat: Empowering Principals to Cultivate Teacher Leadership for School Improvement." The recommendations in this report include the following: (1) Uncover New Leadership Ideas and Seed…

  15. Guideline recommendations for heart complications in thalassemia major.

    PubMed

    Cogliandro, Tiziana; Derchi, Giorgio; Mancuso, Luigi; Mayer, M Carolina; Pannone, Bruno; Pepe, Alessia; Pili, Marcello; Bina, Patrizio; Cianciulli, Paolo; De Sanctis, Vincenzo; Maggio, Aurelio

    2008-05-01

    Thalassemia major is an inherited hemoglobin disorder resulting in a chronic hemolytic anemia. Transfusion therapy together with elevated gastrointestinal absorption of iron determines iron overload, which causes most of the mortality and morbidity associated with the disease. Heart complications represent the leading cause of mortality in this disease, although, because of an improvement in chelation treatment, an important and progressive increase of life expectancy mainly as a result of a reduction in mortality due to cardiac dysfunction has been demonstrated in recent years. Clinical pictures of heart damage range from the involvement of the ventricles to pulmonary hypertension or symptomatic ventricular or supra-ventricular arrhythmias. For this reason, the possibility of having specific recommendations is noteworthy. These recommendations outline the definition, the follow-up and the treatment of the main heart complications in this group of patients. The identification of topics and the nomination of the committee were made on behalf of the Society for the Study of Thalassemia and Hemoglobinopathies (SoSTE). The document obtained the auspices of ANMCO, SIC, SIRM and the Cardiovascular Magnetic Resonance Working Groups of the ANMCO, SIC and SIRM. All recommendations provided in this document have been performed according to the American Cardiology College (ACC) and American Heart Association (AHA) guidelines. Moreover, the recommendations were reviewed by two external referees before the definitive approval. PMID:18404006

  16. Hypertension

    MedlinePlus

    ... y Cuidadores Hormones and Health Journey Through the Endocrine System Endocrine Disrupting Chemicals (EDCs) Endocrine Glands and Types ... Women's Health Hormones and Health Journey Through the Endocrine System Endocrine Disrupting Chemicals (EDCs) Endocrine Glands and Types ...

  17. Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings

    PubMed Central

    Modesti, Pietro A.; Agostoni, Piergiuseppe; Agyemang, Charles; Basu, Sanjay; Benetos, Athanase; Cappuccio, Francesco P.; Ceriello, Antonio; Del Prato, Stefano; Kalyesubula, Robert; O’Brien, Eoin; Kilama, Michael O.; Perlini, Stefano; Picano, Eugenio; Reboldi, Gianpaolo; Remuzzi, Giuseppe; Stuckler, David; Twagirumukiza, Marc; Van Bortel, Luc M.; Watfa, Ghassan; Zhao, Dong; Parati, Gianfranco

    2014-01-01

    The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on ‘Hypertension and Cardiovascular risk in low resource settings’, which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs. PMID:24577410

  18. Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings.

    PubMed

    Modesti, Pietro A; Agostoni, Piergiuseppe; Agyemang, Charles; Basu, Sanjay; Benetos, Athanase; Cappuccio, Francesco P; Ceriello, Antonio; Del Prato, Stefano; Kalyesubula, Robert; O'Brien, Eoin; Kilama, Michael O; Perlini, Stefano; Picano, Eugenio; Reboldi, Gianpaolo; Remuzzi, Giuseppe; Stuckler, David; Twagirumukiza, Marc; Van Bortel, Luc M; Watfa, Ghassan; Zhao, Dong; Parati, Gianfranco

    2014-05-01

    The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on 'Hypertension and Cardiovascular risk in low resource settings', which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs. PMID:24577410

  19. Masked Hypertension and Incident Clinic Hypertension Among Blacks in the Jackson Heart Study.

    PubMed

    Abdalla, Marwah; Booth, John N; Seals, Samantha R; Spruill, Tanya M; Viera, Anthony J; Diaz, Keith M; Sims, Mario; Muntner, Paul; Shimbo, Daichi

    2016-07-01

    Masked hypertension, defined as nonelevated clinic blood pressure (BP) and elevated out-of-clinic BP may be an intermediary stage in the progression from normotension to hypertension. We examined the associations of out-of-clinic BP and masked hypertension using ambulatory BP monitoring with incident clinic hypertension in the Jackson Heart Study, a prospective cohort of blacks. Analyses included 317 participants with clinic BP <140/90 mm Hg, complete ambulatory BP monitoring, who were not taking antihypertensive medication at baseline in 2000 to 2004. Masked daytime hypertension was defined as mean daytime blood pressure ≥135/85 mm Hg, masked night-time hypertension as mean night-time BP ≥120/70 mm Hg, and masked 24-hour hypertension as mean 24-hour BP ≥130/80 mm Hg. Incident clinic hypertension, assessed at study visits in 2005 to 2008 and 2009 to 2012, was defined as the first visit with clinic systolic/diastolic BP ≥140/90 mm Hg or antihypertensive medication use. During a median follow-up of 8.1 years, there were 187 (59.0%) incident cases of clinic hypertension. Clinic hypertension developed in 79.2% and 42.2% of participants with and without any masked hypertension, 85.7% and 50.4% with and without masked daytime hypertension, 79.9% and 43.7% with and without masked night-time hypertension, and 85.7% and 48.2% with and without masked 24-hour hypertension, respectively. Multivariable-adjusted hazard ratios (95% confidence interval) of incident clinic hypertension for any masked hypertension and masked daytime, night-time, and 24-hour hypertension were 2.13 (1.51-3.02), 1.79 (1.24-2.60), 2.22 (1.58-3.12), and 1.91 (1.32-2.75), respectively. These findings suggest that ambulatory BP monitoring can identify blacks at increased risk for developing clinic hypertension. PMID:27185746

  20. Hypertension: which aspects of hypertension should we impact on and how?

    PubMed

    Zanchetti, Alberto; Waeber, Bernard

    2006-08-01

    Cardiovascular complications may, to a large extent, be prevented by lowering blood pressure in hypertensive patients. International recommendations currently stress the importance of reaching values of below 140/90 mmHg in each patient or even lower in the case of concomitant diabetes or renal impairment. It is currently considered crucial to control the systolic pressure as well as the diastolic pressure, in particular because the relationship between cardiovascular risk and blood pressure is closer for the systolic than the diastolic value. An increase in systolic pressure is in itself a sign of the stiffening of the arterial tree. In most patients, the target pressure may only be reached by combining several different antihypertensive agents. In the STRATHE Study, a greater antihypertensive efficacy, in particular on systolic pressure, was obtained by instituting treatment with a fixed low-dose combination of an angiotensin-converting enzyme inhibitor (perindopril) and a diuretic (indapamide), in comparison with other therapeutic strategies based on single-agent therapy. Fixed-dose antihypertensive combinations have now become a validated option for initiating antihypertensive treatment. PMID:16936532

  1. Massage therapy for essential hypertension: a systematic review.

    PubMed

    Xiong, X J; Li, S J; Zhang, Y Q

    2015-03-01

    Massage, an ancient Chinese healing art, is widely practiced for symptom relief in hypertensive patients with anxiety, depression, headache, vertigo, chronic pain in neck, shoulder and back. A large number of case series and clinical trials have been published. However, it is still unclear whether massage can be recommended as an effective therapy for essential hypertension (EH). We estimated the current clinical evidence of massage for EH. Articles published before 10 December 2013 were searched using Cochrane Library, PubMed, EMBASE, Chinese Scientific Journal Database (VIP), Chinese Biomedical Literature Database, Wanfang data and Chinese National Knowledge Infrastructure. Randomized controlled trials comparing massage with any type of control intervention were included. Trials testing massage combined with antihypertensive drugs versus antihypertensive drugs were included as well. Meta-analysis was performed on the effects on blood pressure (BP). Twenty-four articles involving 1962 patients with EH were selected. Methodological quality of most trials was evaluated as generally low. Meta-analyses demonstrated that massage combined with antihypertensive drugs may be more effective than antihypertensive drugs alone in lowering both systolic BP (SBP; mean difference (MD): -6.92 (-10.05, -3.80); P<0.0001) and diastolic BP (MD: -3.63 (-6.18, -1.09); P=0.005); massage appears beneficial for reducing SBP (MD: -3.47 (-5.39, -1.56); P=0.0004) for hypertensive patients as compared with antihypertensive drugs. Safety of massage is still unclear. There is some encouraging evidence of massage for EH. However, because of poor methodological quality, the evidence remains weak. Rigorously designed trials are needed to validate the use of massage in future. PMID:24990417

  2. GUT MICROBIOTA DYSBIOSIS IS LINKED TO HYPERTENSION

    PubMed Central

    Yang, Tao; Santisteban, Monica M.; Rodriguez, Vermali; Li, Eric; Ahmari, Niousha; Carvajal, Jessica Marulanda; Zadeh, Mojgan; Gong, Minghao; Qi, Yanfei; Zubcevic, Jasenka; Sahay, Bikash; Pepine, Carl J.; Raizada, Mohan K.; Mohamadzadeh, Mansour

    2015-01-01

    Emerging evidence suggests that gut microbiota is critical in the maintenance of physiological homeostasis. The present study was designed to test the hypothesis that dysbiosis in gut microbiota is associated with hypertension since genetic, environmental, and dietary factors profoundly influence both gut microbiota and blood pressure. Bacterial DNA from fecal samples of two rat models of hypertension and a small cohort of patients was used for bacterial genomic analysis. We observed a significant decrease in microbial richness, diversity, and evenness in the spontaneously hypertensive rat, in addition to an increased Firmicutes to Bacteroidetes ratio. These changes were accompanied with decreases in acetate- and butyrate-producing bacteria. Additionally, the microbiota of a small cohort of human hypertension patients was found to follow a similar dysbiotic pattern, as it was less rich and diverse than that of control subjects. Similar changes in gut microbiota were observed in the chronic angiotensin II infusion rat model, most notably decreased microbial richness and an increased Firmicutes to Bacteroidetes ratio. In this model, we evaluated the efficacy of oral minocycline in restoring gut microbiota. In addition to attenuating high blood pressure, minocycline was able to rebalance the dysbiotic hypertension gut microbiota by reducing the Firmicutes to Bacteroidetes ratio. These observations demonstrate that high BP is associated with gut microbiota dysbiosis, both in animal and human hypertension. They suggest that dietary intervention to correct gut microbiota could be an innovative nutritional therapeutic strategy for hypertension. PMID:25870193

  3. Perspective on hypertension in the elderly.

    PubMed Central

    Whitcomb, B.; Byyny, R. L.

    1990-01-01

    More than half of elderly men and women have hypertension, leading to a significant risk of increased morbidity and mortality. The cause of hypertension in this age group is unknown. Left ventricular hypertrophy is frequently present, often associated with diastolic dysfunction. Systolic hypertension in the elderly increases the risk of cardiovascular disease, but there are no good data to show that the treatment of isolated systolic hypertension reduces the morbidity or mortality. Good evidence indicates that antihypertensive treatment in this group decreases cardiovascular morbidity and mortality up to age 80, so most elderly hypertensive patients should be treated. An empiric trial of nonpharmacologic therapy can be initiated in those with mild hypertension and no cardiovascular disease, but most patients will require drug therapy. Most elderly hypertensive patients have accompanying illnesses for which they may or may not be taking medications. Some antihypertensive drugs exacerbate coexisting diseases while others augment treatment regimens. Similarly, drugs may interact in a beneficial or adverse way. Finally, drug metabolism is altered by age, leading to problems with toxicity or diminished efficacy. The choice of medication should be based on all such considerations, including the cost and convenience of the drugs available. PMID:2190414

  4. Gut dysbiosis is linked to hypertension.

    PubMed

    Yang, Tao; Santisteban, Monica M; Rodriguez, Vermali; Li, Eric; Ahmari, Niousha; Carvajal, Jessica Marulanda; Zadeh, Mojgan; Gong, Minghao; Qi, Yanfei; Zubcevic, Jasenka; Sahay, Bikash; Pepine, Carl J; Raizada, Mohan K; Mohamadzadeh, Mansour

    2015-06-01

    Emerging evidence suggests that gut microbiota is critical in the maintenance of physiological homeostasis. This study was designed to test the hypothesis that dysbiosis in gut microbiota is associated with hypertension because genetic, environmental, and dietary factors profoundly influence both gut microbiota and blood pressure. Bacterial DNA from fecal samples of 2 rat models of hypertension and a small cohort of patients was used for bacterial genomic analysis. We observed a significant decrease in microbial richness, diversity, and evenness in the spontaneously hypertensive rat, in addition to an increased Firmicutes/Bacteroidetes ratio. These changes were accompanied by decreases in acetate- and butyrate-producing bacteria. In addition, the microbiota of a small cohort of human hypertensive patients was found to follow a similar dysbiotic pattern, as it was less rich and diverse than that of control subjects. Similar changes in gut microbiota were observed in the chronic angiotensin II infusion rat model, most notably decreased microbial richness and an increased Firmicutes/Bacteroidetes ratio. In this model, we evaluated the efficacy of oral minocycline in restoring gut microbiota. In addition to attenuating high blood pressure, minocycline was able to rebalance the dysbiotic hypertension gut microbiota by reducing the Firmicutes/Bacteroidetes ratio. These observations demonstrate that high blood pressure is associated with gut microbiota dysbiosis, both in animal and human hypertension. They suggest that dietary intervention to correct gut microbiota could be an innovative nutritional therapeutic strategy for hypertension. PMID:25870193

  5. [Rare forms of hypertension : From pheochromocytoma to vasculitis].

    PubMed

    Haller, H; Limbourg, F; Schmidt, B M; Menne, J

    2015-03-01

    Secondary hypertension affects only 5-10 % of hypertensive patients. Screening is expensive and time-consuming and should be performed only in patients for whom there is a high clinical suspicion of secondary hypertension. Clinical signs of secondary forms of hypertension are new-onset hypertension in patients without other risk factors (i.e., family history, obesity, etc.), sudden increase of blood pressure (BP) in a previously stable patient, increased BP in prepubertal children, resistant hypertension, and severe hypertension or hypertensive emergencies. In adults, renal parenchymal and vascular diseases as well as obstructive sleep apnea are the most common causes of secondary hypertension. Medication-induced hypertension and non-adherence to medication have to be ruled out. Of the endocrine causes associated with hypertension, primary aldosteronism is the most common. Other endocrine causes of hypertension such as thyroid disease (hypo- or hyperthyroidism), hypercortisolism (Cushing's syndrome), hyperparathyroidism, and pheochromocytoma are rare. Monogenetic forms of hypertension are mostly of tubular origin and associated with alterations in mineralocorticoid handling or signaling. Rare causes of hypertension also include inflammatory vascular disease. Acute forms of vasculitis may present as "malignant" hypertension with associated thrombotic microangiopathy and organ damage/failure. It is important to diagnose these rare forms of hypertension in order to prevent acute organ damage in these patients or unnecessary invasive treatment strategies. PMID:25700646

  6. Hypertension and chronic kidney disease in Turkey.

    PubMed

    Sengul, Sule; Erdem, Yunus; Batuman, Vecihi; Erturk, Sehsuvar

    2013-12-01

    Worldwide, both hypertension and chronic kidney disease are major public health problems, due to their epidemic proportions and their association with high cardiovascular mortality. In 2003, the first Prevalence, awareness, treatment, and control of hypertension in Turkey (the PatenT) study was conducted in a nationally representative population (n=4910) by the Turkish Society of Hypertension and Renal Diseases, and showed that overall age- and sex-adjusted prevalence of hypertension in Turkey was 31.8%. The PatenT study also reported that overall awareness (40.7%), treatment (31.1%), and control rates (8.1%) of hypertension were strikingly low. Only 20.7% of the patients who were aware of their hypertension and receiving treatment had their blood pressure controlled to <140/90 mm Hg. In the Chronic Renal Disease in Turkey (CREDIT) study (n=10,748), the overall prevalence of chronic kidney (including all stages) disease was 15.7% and increased with advancing age. In the same population, the prevalence of hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome were reported as 32.7%, 12.7%, 76.3%, 20.1%, and 31.3%, respectively. The prevalence and awareness of hypertension in CREDIT population was 32.7% and 48.6%, respectively. According to the data obtained from national surveys, the prevalence of hypertension and chronic kidney disease in Turkey is alarmingly high. To improve prevention, early diagnosis, and treatment of these major public health problems, appropriate health strategies should be implemented by the government, together with medical societies, non-governmental organizations, industry, health-care providers, and academia. PMID:25019009

  7. Hypertension in a Brazilian urban slum population.

    PubMed

    Unger, Alon; Felzemburgh, Ridalva D M; Snyder, Robert E; Ribeiro, Guilherme S; Mohr, Sharif; Costa, Vinícius B A; Melendez, Astrid X T O; Reis, Renato B; Santana, Francisco S; Riley, Lee W; Reis, Mitermayer G; Ko, Albert I

    2015-06-01

    Low- and middle-income countries account for the majority of hypertension disease burden. However, little is known about the distribution of this illness within subpopulations of these countries, particularly among those who live in urban informal settlements. A cross-sectional hypertension survey was conducted in 2003 among 5649 adult residents of a slum settlement in the city of Salvador, Brazil. Hypertension was defined as either an elevated arterial systolic (≥140 mmHg) or diastolic (≥90 mmHg) blood pressure. Sex-specific multivariable models of systolic blood pressure were constructed to identify factors associated with elevated blood pressure. The prevalence of hypertension in the population 18 years and older was 21% (1162/5649). Men had 1.2 times the risk of hypertension compared with women (95% confidence intervals (CI), 1.05, 1.36). Increasing age and lack of any schooling, particularly for women, were also significantly associated with elevated blood pressure (p < 0.05). There was also a direct association between men who were black and an elevated blood pressure. Among those who were hypertensive, 65.5% were aware of their condition, and only 36.3% of those aware were actively using anti-hypertensive medications. Men were less likely to be aware of their diagnosis or to use medications (p < 0.01 for both) than women. The prevalence of hypertension in this slum community was lower than reported frequencies in the non-slum population of Brazil and Salvador, yet both disease awareness and treatment frequency were low. Further research on hypertension and other chronic non-communicable diseases in slum populations is urgently needed to guide prevention and treatment efforts in this growing population. PMID:25920334

  8. Recent trends in pulmonary arterial hypertension

    PubMed Central

    Natarajan, Rajagopalan

    2011-01-01

    Pulmonary hypertension is a serious and unrelenting pulmonary vascular disorder that affects the functional quality of patients and significantly decreases their life span. If diagnosed early, with the number of new therapeutic options that are available, a better quality of life can be provided for a protracted length of time. It is likely that the available treatment will change the natural course of the disease and perhaps prolong survival. As symptoms are often subtle in the early stages of the disease it is imperative that physicians are aware of the manifestations of this condition. A thorough investigation of patients suspected of this condition is essential so that appropriate treatment can be initiated promptly. The routine workup of a patient suspected to have pulmonary hypertension could easily be carried out in any well-equipped peripheral hospital in many affluent and advanced countries. However, it must be mentioned that in some less advanced countries the necessary work up can only be done in major teaching hospitals. Both pulmonologists and cardiologists should be aware of the pathophysiology of pulmonary arterial hypertension, the workup and the treatment options that are available. Patients with refractory pulmonary hypertension should be referred to these research centers for enrolment into any ongoing drug trials as well as for evaluation for heart–lung, single lung, or double lung transplantation. This paper is primarily aimed at pulmonologists and cardiologists taking care of these patients. Unless indicated otherwise this paper mainly deals with WHO group 1 pulmonary hypertension which is designated pulmonary arterial hypertension. Extensive review of the literature spanning the last 30 years was made through Medline using titles such as primary pulmonary hypertension, pulmonary arterial hypertension, secondary pulmonary hypertension, and pulmonary vascular diseases. PMID:21654985

  9. Haplotypes of angiotensinogen in essential hypertension.

    PubMed Central

    Jeunemaitre, X; Inoue, I; Williams, C; Charru, A; Tichet, J; Powers, M; Sharma, A M; Gimenez-Roqueplo, A P; Hata, A; Corvol, P; Lalouel, J M

    1997-01-01

    The M235T polymorphism of the angiotensinogen gene (AGT) has been associated with essential and pregnancy-induced hypertension. Generation of haplotypes can help to resolve whether the T235 allele itself predisposes to the development of hypertension or acts as a marker of an unknown causal molecular variant. We identified 10 diallelic polymorphisms at the AGT locus and genotyped both a series of 477 probands of hypertensive families and 364 controls, all French Caucasians, as well as a series of 92 hypertensives and 122 controls from Japan. Despite a large ethnic difference in gene frequency, a significant association of T235 with hypertension was observed both in Cancasians (.46 vs. .38, P = .004) and in Japanese (.91 vs. .76, P = .002). In both groups, the G-->A substitution located at position -6 upstream of the initial transcription site occurred at the same frequency and in complete linkage disequilibrium with the T235 allele. No other polymorphism was found to be consistently associated with hypertension. Five informative haplotypes subdividing the T235 allele were generated. Whereas two of them were associated with hypertension in Caucasians, none of these two haplotypes (H3 and H4) reached statistical significance in Japanese. The analysis of the AGT-GT repeat revealed marked linkage disequilibriums between each of the diallelic polymorphisms and some (GT)n alleles, with similar patterns in the two populations. The strong disequilibrium between M235 and (GT)16 explained the increased frequency of that particular allele in French controls compared with hypertensives (.42 vs. .36, P < .01). The haplotype combining the M235T and G-6A polymorphisms appears as the ancestral allele of the human AGT gene and as the one associated with hypertension. PMID:9199566

  10. Ada training evaluation and recommendation

    NASA Technical Reports Server (NTRS)

    Murphy, Robert; Stark, Michael

    1987-01-01

    This paper documents the Ada training experiences and recommendations of the Gamma Ray Observatory dynamics simulator Ada development team. A two month Ada training program for software developers is recommended which stresses the importance of teaching design methodologies early, as well as the use of certain training aids such as videotaped lectures and computer-aided instruction. Furthermore, a separate training program for managers is recommended, so that they may gain a better understanding of modified review products and resource allocation associated with Ada projects.

  11. Pulmonary hypertension complicating multiple myeloma

    PubMed Central

    Mark, Tomer M.; Niesvizky, Ruben; Sobol, Irina

    2015-01-01

    Abstract Pulmonary hypertension (PH) is an infrequently reported complication of multiple myeloma (MM). PH has been more commonly associated with amyloidosis, myeloproliferative diseases, and the POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) syndrome. PH in MM is typically mild to moderate and may be secondary to a variety of conditions, which include left ventricular dysfunction, high-output cardiac failure, chronic kidney disease, treatment-related toxicities, and precapillary involvement. We describe 3 patients with MM and severe PH. Each patient underwent right heart catheterization. All patients demonstrated elevated pulmonary pressures, transpulmonary gradients, and pulmonary vascular resistance. Each patient was ultimately treated with pulmonary vasodilator therapy with improvement in cardiopulmonary symptoms. Additional studies are needed to define the prevalence, prognosis, and pathogenesis of PH in this complex population and to help clarify who may benefit from targeted PH therapy. PMID:26401262

  12. Pulmonary hypertension in antiphospholipid syndrome.

    PubMed

    Zuily, Stéphane; Wahl, Denis

    2015-01-01

    Pulmonary hypertension (PH) is a rare but life-threatening condition in antiphospholipid syndrome (APS) patients with or without systemic lupus erythematosus (SLE). The definition of PH is based on hemodynamic parameters estimated by transthoracic echocardiography (TTE) and confirmed by right heart catheterization (RHC). New evidence suggests that antiphospholipid antibodies (aPL) in SLE patients increase the risk of PH; however, studies yield conflicting results. Hypotheses regarding the impact of aPL on PH include large vessel and microvascular thrombosis, and endothelial remodeling. Natural history of PH is progressive worsening mainly due to recurrent pulmonary embolism. The management in APS patients includes anticoagulation; patients undergoing pulmonary endarterectomy need to be closely monitored because of an increased risk of thrombotic complications. PMID:25604574

  13. Pulmonary hypertension complicating pulmonary sarcoidosis.

    PubMed

    Huitema, M P; Grutters, J C; Rensing, B J W M; Reesink, H J; Post, M C

    2016-06-01

    Pulmonary hypertension (PH) is a severe complication of sarcoidosis, with an unknown prevalence. The aetiology is multifactorial, and the exact mechanism of PH in the individual patient is often difficult to establish. The diagnostic work-up and treatment of PH in sarcoidosis is complex, and should therefore be determined by a multidisciplinary expert team in a specialised centre. It is still a major challenge to identify sarcoidosis patients at risk for developing PH. There is no validated algorithm when to refer a patient suspected for PH, and PH analysis itself is difficult. Until present, there is no established therapy for PH in sarcoidosis. Besides optimal treatment for sarcoidosis, case series evaluating new therapeutic options involving PH-targeted therapy are arising for a subgroup of patients. This review summarises the current knowledge regarding the aetiology, diagnosis and possible treatment options for PH in sarcoidosis. PMID:27194118

  14. Hypertension and the ischaemic myocardium.

    PubMed

    Fox, K M; Levy, R D; Mockus, L; Wright, C

    1987-08-01

    Hypertension and ischaemic heart disease often co-exist. Recent studies, using ambulatory ST-segment and haemodynamic monitoring, have shown that myocardial ischaemia may not necessarily be accompanied by angina pectoris. Unless transient myocardial ischaemia is actively sought it may, therefore, be missed and this may have important prognostic and therapeutic implications. Studies investigating the use of beta-blockers, calcium antagonists and nitrates in angina pectoris have shown that these agents have an equal effect on painless as opposed to painful myocardial ischaemia. While there are no currently completed studies demonstrating the prognostic implication of silent ischaemia in stable angina, it is well known that approximately one-quarter of all myocardial infarctions occur without chest pain. Recent investigation in unstable angina showed that silent ischaemia was an important predictor of future coronary events. PMID:3312524

  15. Anticoagulation in Pulmonary Arterial Hypertension.

    PubMed

    Robinson, Jeffrey C; Pugliese, Steven C; Fox, Daniel L; Badesch, David B

    2016-06-01

    Pulmonary arterial hypertension (PAH) is characterized by molecular and pathologic alteration to the pulmonary circulation, resulting in increased pulmonary vascular resistance, right ventricular failure, and eventual death. Pharmacologic treatment of PAH consists of use of a multitude of pulmonary vasodilators, sometimes in combination. PAH has been associated with increased thrombosis and disrupted coagulation and fibrinolysis, making anticoagulation an attractive and frequently employed therapeutic modality. Observational studies have provided some insight into the therapeutic potential of anticoagulation in idiopathic PAH, but there is a distinct lack of well-controlled prospective trials. Due to the conflicting evidence, there is a large amount of heterogeneity in the application of therapeutic anticoagulation in PAH and further well-controlled prospective trials are needed to clarify its role in treating PAH. PMID:27137522

  16. Pulmonary hypertension complicating multiple myeloma.

    PubMed

    Krishnan, Udhay; Mark, Tomer M; Niesvizky, Ruben; Sobol, Irina

    2015-09-01

    Pulmonary hypertension (PH) is an infrequently reported complication of multiple myeloma (MM). PH has been more commonly associated with amyloidosis, myeloproliferative diseases, and the POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) syndrome. PH in MM is typically mild to moderate and may be secondary to a variety of conditions, which include left ventricular dysfunction, high-output cardiac failure, chronic kidney disease, treatment-related toxicities, and precapillary involvement. We describe 3 patients with MM and severe PH. Each patient underwent right heart catheterization. All patients demonstrated elevated pulmonary pressures, transpulmonary gradients, and pulmonary vascular resistance. Each patient was ultimately treated with pulmonary vasodilator therapy with improvement in cardiopulmonary symptoms. Additional studies are needed to define the prevalence, prognosis, and pathogenesis of PH in this complex population and to help clarify who may benefit from targeted PH therapy. PMID:26401262

  17. The Comparative Efficacy and Safety of the Angiotensin Receptor Blockers in the Management of Hypertension and Other Cardiovascular Diseases

    PubMed Central

    Abraham, Hazel Mae A.; White, C. Michael; White, William B.

    2014-01-01

    All national guidelines for the management of hypertension recommend angiotensin receptor blockers (ARBs) as an initial or add-on antihypertensive therapy. The 8 available ARBs have variable clinical efficacy when used for control of hypertension. Additive blood pressure (BP) lowering effects have been demonstrated when ARBs are combined with thiazide diuretics or dihydropyridine calcium channel blockers, augmenting hypertension control. Furthermore, therapeutic use of ARBs goes beyond their antihypertensive effects with evidence-based benefits in heart failure and diabetic renal disease particularly among ACE inhibitor intolerant patients. On the other hand, combining renin-angiotensin system blocking agents, a formerly common practice among medical subspecialists focusing on the management of hypertension, have ceased to do so as there is not only evidence of cardiovascular benefit, but modest evidence of harm, particularly with regard to renal dysfunction. The ARBs are very well tolerated as monotherapy as well as in combination with other anti-hypertensive medications that improve adherence to therapy and have become a mainstay in the treatment of stage 1 and 2 hypertension. PMID:25416320

  18. Erectile Dysfunction Among Male Hypertensives in a Tertiary Health Facility in South-West Nigeria

    PubMed Central

    Fafiolu, Akinbode Samuel; Adebayo, Ayodeji Matthew; Akande, Temilola Olufunmi; Akinboboye, Olubankole Olutosin

    2015-01-01

    : 2.9; 95% CI: 1.38–6.53; p = 0.006) were 3 times each more likely to have erectile dysfunction compared with those aged ≤ 45 years. Conclusion: This study revealed that erectile dysfunction was prevalent in both hypertensive and normotensive population studied and that this was significantly worse with increasing age. A higher proportion of hypertensives compared to normotensives had erectile dysfunction. We recommend that all men presenting to a physician should have routine evaluation for ED so as to recognise it early and reduce its effects. PMID:25560353

  19. Essential Hypertension: Cardiovascular Response to Breath Hold Combined with Exercise.

    PubMed

    Hoffmann, U; Urban, P; Koschate, J; Drescher, U; Pfister, R; Michels, G

    2015-07-01

    Essential hypertension (EH) is a widespread disease and might be prevalent in apnea divers and master athletes. Little is known about the influence of EH and the antihypertensive drugs (AHD) on cardiovascular reactions to combined breath hold (BH) and exercise. In this pilot study, healthy divers (HCON) were compared with treated hypertensive divers with regard to heart rate (HR) and mean blood-pressure (MAP) responses to BH, exercise and the combination of both. Ten subjects with EH and ten healthy divers were tested. 3 different 20 s stimuli were applied: BH combined with 30 W or 150 W and 150 W without BH. The time-charts during the stress intervals and during recovery were compared. Subjects treated with an angiotensin-converting enzyme (ACE) inhibitor showed higher changes for MAP values if breath hold was performed. HR responses were obviously changed if a β-blocker was part of the medication. One subject showed extreme MAP responses to all stimuli and conspicuous HR if BH was involved. The modulation of HR-/MAP-response in EH subjects depends on the mechanisms of antihypertensive agents. The combination of an ACE inhibitor and a β-blocker may give the best protection. It is recommended to include short apnea tests in the fitness-to-dive examination to individually predict potential endangerment. PMID:25875316

  20. Update on pulmonary hypertension complicating chronic obstructive pulmonary disease

    PubMed Central

    Jyothula, Soma; Safdar, Zeenat

    2009-01-01

    Pulmonary hypertension (PH) is the hemodynamic manifestation of various pathological processes that result in elevated pulmonary artery pressures (PAP). The National Institutes of Health Registry defined pulmonary arterial hypertension as the mean PAP of more than 25 mm Hg with a pulmonary capillary wedge pressure or left atrial pressure equal to or less than 15 mm Hg. This definition remains the currently accepted definition of PH that is used to define PH related to multiple clinical conditions including chronic obstructive pulmonary disease (COPD). The estimated US prevalence of COPD by the National Health Survey in 2002 in people aged >25 was 12.1 million. There is a lack of large population-based studies in COPD to document the correct prevalence of PH and outcome. The major cause of PH in COPD is hypoxemia leading to vascular remodeling. Echocardiogram is the initial screening tool of choice for PH. This simple noninvasive test can provide an estimate of right ventricular systolic and right atrial pressures. Right heart catheterization remains the gold standard to diagnose PH. It provides accurate measurement of mean PAP and pulmonary capillary wedge pressure. Oxygen therapy remains the cornerstone therapeutic for hypoxemia in COPD patients. Anecdotal reports suggest utility of PDE5-inhibitors and prostacyclin to treat COPD-related PH. Large randomized clinical trials are needed before the use of these drugs can be recommended. PMID:19802350

  1. Pulmonary arterial hypertension: a comparison between children and adults

    PubMed Central

    Barst, R.J.; Ertel, S.I.; Beghetti, M.; Ivy, D.D.

    2011-01-01

    The characteristics of pulmonary arterial hypertension (PAH), including pathology, symptoms, diagnosis and treatment are reviewed in children and adults. The histopathology seen in adults is also observed in children, although children have more medial hypertrophy at presentation. Both populations have vascular and endothelial dysfunction. Several unique disease states are present in children, as lung growth abnormalities contribute to pulmonary hypertension. Although both children and adults present at diagnosis with elevations in pulmonary vascular resistance and pulmonary artery pressure, children have less heart failure. Dyspnoea on exertion is the most frequent symptom in children and adults with PAH, but heart failure with oedema occurs more frequently in adults. However, in idiopathic PAH, syncope is more common in children. Haemodynamic assessment remains the gold standard for diagnosis, but the definition of vasoreactivity in adults may not apply to young children. Targeted PAH therapies approved for adults are associated with clinically meaningful effects in paediatric observational studies; children now survive as long as adults with current treatment guidelines. In conclusion, there are more similarities than differences in the characteristics of PAH in children and adults, resulting in guidelines recommending similar diagnostic and therapeutic algorithms in children (based on expert opinion) and adults (evidence-based). PMID:21357924

  2. [Chronic thromboembolic pulmonary hypertension--a position paper].

    PubMed

    Wilkens, H; Lang, I; Blankenburg, T; Grohé, C; Guth, S; Held, M; Klepetko, W; Konstantinides, S; Kramm, T; Krüger, U; Lankeit, M; Schäfers, H J; Seyfarth, H J; Mayer, E

    2014-12-01

    This position paper summarises current developments in chronic thromboembolic pulmonary hypertension (CTEPH) including diagnostic approaches and treatment options. Based on the guidelines of the task force of CTEPH experts at the 5th World Symposium on Pulmonary Hypertension in Nice 2013. Open questions arising during the treatment of patients with CTEPH are addressed. Patients with suspected CTEPH should undergo echocardiography and cardiopulmonary exercise testing. A ventilation/perfusion scan is the recommended imaging test for screening in the diagnostic algorithm for the evaluation of CTEPH. CTEPH-patients should be discussed in an expert center with an interdisciplinary team and an experienced PEA surgeon to decide the further treatment. Pulmonary endarterectomy (PEA) is the treatment of choice for patients with CTEPH. Medical therapy with PH-targeted medications for inoperable CTEPH and residual disease after PEA should only be initiated if evaluation reveals that the patient is no candidate for a PEA. Current data suggest that CTEPH patients treated with PEA have a better long-term survival rate and quality of life than patients treated with medical therapy. PMID:25084310

  3. Subclinical hypothyroidism causing hypertension in pregnancy.

    PubMed

    Ramtahal, Rishi; Dhanoo, Andrew

    2016-09-01

    This is a case of a 25-year-old primigravida who was referred to the hypertension specialist for elevated blood pressures. The patient had an elevated thyroid-stimulating hormone with normal free thyroxine (T4) levels and was positive for thyroid peroxidase antibodies resulting in a diagnosis of subclinical hypothyroidism. The patient was successfully treated with levothyroxine which normalized the blood pressure without the need for antihypertensive treatment. This case illustrates a cause of secondary hypertension that is not always considered in the differential diagnosis of a patient with hypertension in pregnancy. PMID:27506728

  4. Hemorheological abnormalities in human arterial hypertension

    NASA Astrophysics Data System (ADS)

    Lo Presti, Rosalia; Hopps, Eugenia; Caimi, Gregorio

    2014-05-01

    Blood rheology is impaired in hypertensive patients. The alteration involves blood and plasma viscosity, and the erythrocyte behaviour is often abnormal. The hemorheological pattern appears to be related to some pathophysiological mechanisms of hypertension and to organ damage, in particular left ventricular hypertrophy and myocardial ischemia. Abnormalities have been observed in erythrocyte membrane fluidity, explored by fluorescence spectroscopy and electron spin resonance. This may be relevant for red cell flow in microvessels and oxygen delivery to tissues. Although blood viscosity is not a direct target of antihypertensive therapy, the rheological properties of blood play a role in the pathophysiology of arterial hypertension and its vascular complications.

  5. Pulmonary hypertension and pregnancy: an overview.

    PubMed

    Gei, Alfredo; Montúfar-Rueda, Carlos

    2014-12-01

    Pulmonary hypertension is a syndrome infrequently associated with pregnancy. Despite advancements in therapy during the past 25 years and encouraging reports of improved outcomes, pulmonary arterial hypertension remains a devastating disease with a significantly reduced lifespan. This disorder should still be considered a contraindication to pregnancy. The decision of a patient to continue the pregnancy should be supported by an empathetic group of health care professionals who would optimize their treatment and hopefully their pregnancy outcomes and survival after delivery. We overview here different aspects of the diagnosis, evaluation, management, and counseling of patients suffering from pulmonary hypertension during pregnancy. PMID:25314091

  6. Spectrum of hypertensive emergencies in pregnancy.

    PubMed

    Henry, Charles S; Biedermann, Scott A; Campbell, Michel F; Guntupalli, Jayarama S

    2004-10-01

    Hypertension in pregnancy represents a spectrum of clinical entities, including pregnancy-induced hypertension (PIH), preeclampsia, eclampsia, and hemolysis, elevated liver enzyme levels, low platelet count syndrome. Although hypertension is a common denominator in this group of disorders, the pathogenesis, clinical features, and clinical course of these disorders is variable and somewhat distinct. Therapy must be tailored to the clinical entity and the patient. The incidence and prevalence of preeclampsia and eclampsia is decreasing worldwide. This decrease partly may be caused by the improved treatment of PIH and improved obstetrical services. PMID:15388197

  7. Amlodipine/ARB fixed-dose combinations for the treatment of hypertension: focus on amlodipine/olmesartan combination.

    PubMed

    Chrysant, Steven G

    2008-06-01

    The incidence of hypertension continues to increase worldwide and, according to recent estimates, its incidence is approximately 30% of the U.S. population. However, the control of blood pressure (BP) to recommended levels of < 140/90 mmHg for uncomplicated hypertension, recommended in the 7th Report of the Joint National Committee (JNC-7) on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, remains low at 36.8%. Because the level of BP is directly related to cardiovascular and stroke morbidity and mortality, aggressive treatment and control of hypertension are strongly indicated. Since monotherapy alone is not effective for the control of stage 2 hypertension, fixed-dose combination therapy with two complementary drugs has been recommended by the JNC-7 guidelines as initial therapy for subjects with diastolic BP > or = 100 mmHg and systolic BP > or = 160 mmHg. There are several fixed-dose combination preparations already available, each with its individual indications. The recently FDA-approved fixed-dose combinations of amlodipine with either olmesartan or valsartan are very effective in treating hypertension and are safe and well tolerated. In addition to reducing BP, these new fixed-dose combinations have also demonstrated significant reductions in the inciendence of edema associated with amlodipine monotherapy, which makes them more acceptable to patients. In addition, due to the metabolic neutrality of both component drugs, these preparations are preferable for the treatment of hypertensive patients with diabetes or the metabolic syndrome, in addition to other cardiovascular risk factors. PMID:18596998

  8. The evolving role of β-adrenergic receptor blockers in managing hypertension.

    PubMed

    Poirier, Luc; Lacourcière, Yves

    2012-05-01

    β-Adrenergic blocking agents (or β-blockers) have been widely used for the treatment of hypertension for the past 50 years, and continue to be recommended as a mainstay of therapy in many national guidelines. They have also been used in a variety of cardiovascular conditions commonly complicating hypertension, including angina pectoris, myocardial infarction (MI), acute and chronic heart failure, as well as conditions like essential tremor and migraine. Moreover, they have played a primary role in controlling blood pressure in patients with these specific comorbidities and in reducing cardiovascular risk with regard to the composite outcome of death, stroke, and MI among patients younger than 60 years of age. However, in patients 60 years of age or older, β-blockers were not associated with significantly lower rates of MI, heart failure or death, and demonstrated higher rates of stroke compared with other first-line therapies. Consequently, the Canadian Hypertension Education Program recommends the use of β-blockers as first-line therapy in hypertensive patients younger than 60 years of age but not for those age 60 and older, with the exception of patients with concomitant β-blocker-requiring cardiac diseases. Several reports suggest that the lack of consistent outcome data may relate to the use of traditional β-blockers such as atenolol and their ability only to reduce cardiac output, without beneficial effect on peripheral vascular resistance. The present report will describe the clinically relevant mechanisms of action of β-blockers, their pharmacological differences, their metabolic effects, and their usefulness in patients with hypertension. PMID:22595449

  9. The evaluation and treatment of endocrine forms of hypertension.

    PubMed

    Velasco, Alejandro; Vongpatanasin, Wanpen

    2014-09-01

    Endocrine hypertension is an important secondary form of hypertension, identified in between 5% and 10% of general hypertensive population. Primary aldosteronism is the most common cause of endocrine hypertension, accounting for 1%-10% in uncomplicated hypertension and 7%-20% in resistant hypertension. Other less common causes of endocrine hypertension include Cushing syndrome, pheochromocytoma, thyroid disorders, and hyperparathyroidism. Diagnosis requires a high index of suspicion and the use of appropriate screening tests based on clinical presentation. Failure to make proper diagnosis may lead to catastrophic complications or irreversible hypertensive target organ damage. Accordingly, patients who are suspected to have endocrine hypertension should be referred to endocrinologists or hypertension specialists who are familiar with management of the specific endocrine disorders. PMID:25119722

  10. Pantex lightning study recommendations report

    SciTech Connect

    Chen, K.C.; Merewether, K.O.

    1993-12-01

    A brief history of lightning protection at Pantex nuclear explosive areas (NEAs) is given. An assessment of current Pantex lightning protection at NEAs is summarized. Recommendations for further improvements in lightning protection are described.

  11. Recommended Immunizations for Adults 50+

    MedlinePlus

    ... page please turn Javascript on. Health Screenings and Immunizations Recommended Immunizations For Adults 50+ The content in this section ... out more, visit How Vaccines Prevent Disease . Vaccines, Vaccinations, and Immunizations Understanding the difference between vaccines, vaccinations, ...

  12. Macitentan (Opsumit) for the treatment of pulmonary arterial hypertension.

    PubMed

    Clarke, Megan; Walter, Claire; Agarwal, Richa; Kanwar, Manreet; Benza, Raymond L

    2014-07-01

    The endothelin pathway is a key pathway for the pathogenesis of pulmonary arterial hypertension (PAH). Antagonism of this pathway is recommended as initial therapy in low-risk patient with PAH to inhibit fibrosis, cell proliferation, and inflammation caused by endothelin. Prior to October 2013, ambrisentan, a selective ETA receptor antagonist and bosentan, a dual ETA/ETB antagonist, were the only currently available agents for PAH targeting the endothelin pathway. Based on the results of the SERAPHIN trial, macitentan (brand name Opsumit®), a new ETA/ETB antagonist, has been US FDA approved to delay disease progression and reduce hospitalizations for PAH. SERAPHIN is the first ERA trial to use an event-driven strategy with a composite primary end point of morbidity or mortality. Previous trials have focused on short-term outcomes, such as improved 6-min walk distance and WHO functional class. PMID:24851934

  13. Pulmonary Hypertension in the Era of Mechanical Circulatory Support.

    PubMed

    Krishnamurthy, Yamini; Cooper, Lauren B; Parikh, Kishan S; Felker, G Michael; Milano, Carmelo A; Rogers, Joseph G; Hernandez, Adrian F; Patel, Chetan B

    2016-01-01

    Left heart disease (LHD) represents the most common cause of pulmonary hypertension (PH), and is associated with worse prognosis compared with LHD without PH. In addition, PH due to LHD may prevent patients from receiving heart transplantation, because of risk of perioperative right ventricular failure. Current literature lacks comprehensive descriptions and management strategies of PH due to LHD. In this review, we summarize the literature that is available to highlight the definition, pathogenesis, and prognosis of PH due to LHD. Furthermore, we discuss the use of mechanical circulatory support (MCS) in this population. Finally, we provide recommendations regarding the management and reassessment of PH due to LHD in the specific context of MCS. PMID:27442856

  14. Optimising the management of pulmonary arterial hypertension patients: emergency treatments.

    PubMed

    Delcroix, M; Naeije, R

    2010-09-01

    Pulmonary arterial hypertension (PAH) is a rare and potentially fatal disease whose management is usually restricted to a few specialised centres. As patients do not necessarily live in the neighbourhood of these centres, daily care and emergencies have to be delegated to first and second lines. Treatment guidelines do not usually provide recommendations for acute emergency situations as evidence is scarce. This short review provides a description of our therapeutic protocols based on available data. A model of transmural organisation of care for PAH patients, currently applied in Belgium, is described. Thereafter, based on an analysis of the reasons of death in the PAH population, a review of the main emergencies is provided. Cardiac arrest and resuscitation, decompensated right heart failure, respiratory failure, arrhythmia, pericardial effusion, haemoptysis, surgery and drug-related adverse events will be discussed successively. Case reports showing the precariousness of PAH patients will enforce our thesis of the need for optimal patient management organisation. PMID:20956193

  15. Management of a child with pulmonary arterial hypertension presenting with systemic hypertension.

    PubMed

    Flores, Saul; Daily, Joshua; Pratap, Jayant Nick; Cash, Michelle C; Hirsch, Russel

    2016-02-01

    We describe the course and management of a 12-year-old girl with severe pulmonary arterial hypertension who initially presented with severe systemic hypertension. Successful therapy included pulmonary vasodilators and an atrial septostomy, while ensuring adequate maintenance of her systemic vascular resistance to maintain cardiac output. Clear understanding of the physiology and judicious medical management in patients with severe pulmonary arterial hypertension using extreme compensatory mechanisms is vitally important. PMID:26082002

  16. NUCLEAR DATA EVALUATIONS AND RECOMMENDATIONS

    SciTech Connect

    HOLDEN, N.E.

    2005-05-08

    The published scientific literature is scanned and periodically evaluated for neutron and non-neutron nuclear data and the resulting recommendations are published [1,2]. After the literature has been scanned and appropriate data collected, there are often problems with regard to the treatment of the various types of data during this evaluation process and with regard to the method by which the recommendations are drawn from the assessment of the collection of individual measurements. Some-problems with uncertainties are presented.

  17. Effectiveness of a program to improve hypertension screening in primary care.

    PubMed Central

    Aubin, M; Vézina, L; Fortin, J P; Bernard, P M

    1994-01-01

    OBJECTIVE: To evaluate the effectiveness of a program to improve hypertension screening practices in primary care. DESIGN: Retrospective quasi-experimental study. SETTING: Two hospital-based family medicine centres (FMCs). PATIENTS: In the study FMC, two study groups of randomly selected adult patients: 425 who visited the FMC before implementation of the screening improvement program (from Apr. 1, 1983, to Mar. 31, 1984) and 418 who visited it afterward (from Apr. 1, 1986, to Mar. 31, 1987). These patients were matched with 392 and 442 control patients respectively seen during the same time frames at the second FMC. INTERVENTIONS: Educational sessions for physicians to standardize blood pressure measurement and knowledge of the recommendations from the Canadian Hypertension Society on hypertension screening and diagnosis, and specific operational incentives to improve hypertension screening, including a reference guide placed in each physician's office, a coloured form for recording blood pressure measurements placed in every patient's chart and a follow-up and recall card file. MAIN OUTCOME MEASURE: Frequency of blood pressure measurements recorded in patient charts. RESULTS: The hypertension screening rate was 60% per year in the study group before program implementation and 79% in the study group afterward; the corresponding rates in the two control groups were 72% and 59% (p < 0.0001). Patients were more likely to be screened if they visited the physician for a periodic health examination than for other problems (e.g., psychosocial or dermatologic) and if they had a scheduled appointment rather than no appointment. Physician characteristics that were positive predictors of screening were low age, female sex and payment on a salary basis. CONCLUSION: Physician education and incentives are effective in improving hypertension screening practices in hospital-based FMCs without incurring additional costs or other use of resources. Further evaluation of such a

  18. Introduction on health recommender systems.

    PubMed

    Sanchez-Bocanegra, C L; Sanchez-Laguna, F; Sevillano, J L

    2015-01-01

    People are looking for appropriate health information which they are concerned about. The Internet is a great resource of this kind of information, but we have to be careful if we don't want to get harmful info. Health recommender systems are becoming a new wave for apt health information as systems suggest the best data according to the patients' needs.The main goals of health recommender systems are to retrieve trusted health information from the Internet, to analyse which is suitable for the user profile and select the best that can be recommended, to adapt their selection methods according to the knowledge domain and to learn from the best recommendations.A brief definition of recommender systems will be given and an explanation of how are they incorporated in the health sector. A description of the main elementary recommender methods as well as their most important problems will also be made. And, to finish, the state of the art will be described. PMID:25417084

  19. [The influence of citoflavin on molecular mechanisms of hypertensive encephalopathy development in patients with systolic arterial hypertension].

    PubMed

    Kartashova, E A; Romantsov, M G; Sarvilina, I V

    2014-01-01

    The molecular pharmacological effects of cytoflavin in patients with hypertensive encephalopathy (HE) and isolated systolic arterial hypertension (ISAH) have been investigated using the following methods: assessment of complaints, 24-hour arterial pressure monitoring, ultrasound diagnostics including echocardiography, measurement of lipid profiles and coagulograms, and molecular phenotyping by MALDI-TOF/TOF-MS. A combination of cytoflavin administration with standard therapy of HE and ISAH led to the most expressed return development of clinical symptoms, restoration of the hemodynamic, structural, and geometrical parameters of cardiovascular system, and normalization of the indices of lipid profiles and coagulograms in comparison to patients with HE and ISAH, which accepted only standard therapy. Molecular mechanisms of cytoflavin action have been revealed, which include control of the activity of cellular signaling pathways by means of intermolecular interactions. The optimized therapy of HE and ISAH is recommended for clinical application, which assumes a combined use of standard therapy and cytoflavin and provides a geroprotective action upon the cardiovascular system. PMID:25102730

  20. Idiopathic noncirrhotic portal hypertension: current perspectives.

    PubMed

    Riggio, Oliviero; Gioia, Stefania; Pentassuglio, Ilaria; Nicoletti, Valeria; Valente, Michele; d'Amati, Giulia

    2016-01-01

    The term idiopathic noncirrhotic portal hypertension (INCPH) has been recently proposed to replace terms, such as hepatoportal sclerosis, idiopathic portal hypertension, incomplete septal cirrhosis, and nodular regenerative hyperplasia, used to describe patients with a hepatic presinusoidal cause of portal hypertension of unknown etiology, characterized by features of portal hypertension (esophageal varices, nonmalignant ascites, porto-venous collaterals), splenomegaly, patent portal, and hepatic veins and no clinical and histological signs of cirrhosis. Physicians should learn to look for this condition in a number of clinical settings, including cryptogenic cirrhosis, a disease known to be associated with INCPH, drug administration, and even chronic alterations in liver function tests. Once INCPH is clinically suspected, liver histology becomes mandatory for the correct diagnosis. However, pathologists should be familiar with the histological features of INCPH, especially in cases in which histology is not only requested to exclude liver cirrhosis. PMID:27555800

  1. Management of hypertensive disorders in pregnancy.

    PubMed

    Moussa, Hind N; Arian, Sara E; Sibai, Baha M

    2014-07-01

    Hypertensive disorders are the most common medical complication of pregnancy, with an incidence of 5-10%, and a common cause of maternal mortality in the USA. Incidence of pre-eclampsia has increased by 25% in the past two decades. In addition to being among the lethal triad, there are likely up to 100 other women who experience 'near miss' significant maternal morbidity that stops short of death for every pre-eclampsia-related mortality. The purpose of this review is to present the new task force statement and novel definitions, as well as management approaches to each of the hypertensive disorders in pregnancy. The increased understanding of the pathophysiology of hypertension in pregnancy, as well as advances in medical therapy to minimize risks of fetal toxicity and teratogenicity, will improve our ability to prevent and treat hypertension in pregnancy. Fetal programming and fetal origins of adult disease theories extrapolate the benefit of such therapy to future generations. PMID:25259900

  2. Obesity-Induced Hypertension: Brain Signaling Pathways.

    PubMed

    do Carmo, Jussara M; da Silva, Alexandre A; Wang, Zhen; Fang, Taolin; Aberdein, Nicola; de Lara Rodriguez, Cecilia E P; Hall, John E

    2016-07-01

    Obesity greatly increases the risk for cardiovascular, metabolic, and renal diseases and is one of the most significant and preventable causes of increased blood pressure (BP) in patients with essential hypertension. This review highlights recent advances in our understanding of central nervous system (CNS) signaling pathways that contribute to the etiology and pathogenesis of obesity-induced hypertension. We discuss the role of excess adiposity and activation of the brain leptin-melanocortin system in causing increased sympathetic activity in obesity. In addition, we highlight other potential brain mechanisms by which increased weight gain modulates metabolic and cardiovascular functions. Unraveling the CNS mechanisms responsible for increased sympathetic activation and hypertension and how circulating hormones activate brain signaling pathways to control BP offer potentially important therapeutic targets for obesity and hypertension. PMID:27262997

  3. Renal denervation for resistant hypertension: no.

    PubMed

    Taddei, Stefano; Dal Canto, Elisa; Bruno, Rosa Maria

    2016-06-01

    In recent years, catheter-based radiofrequency denervation of the renal arteries (RDN) has emerged as a potential treatment for resistant hypertension. Though initial non-randomized and randomized small studies demonstrate large reductions in office blood pressure, RDN superiority to conventional treatment is not confirmed either by randomized controlled trials or by large international registries. Increasing evidence supports the hypothesis that a rational pharmacological therapeutic scheme is equally or more effective; this approach, together with an intervention aimed at increasing patient's compliance with treatment, might solve most of the cases of refractory hypertension. Thus, based on current evidence, renal denervation should not be routinely used to treat resistant hypertension. Though the possibility that RDN might be useful in other subsets of hypertensive patients exists, it has never been proven. Thus, its use should be limited to extreme situations, when all other possible treatments have failed. PMID:27001888

  4. Clinical review: The management of hypertensive crises

    PubMed Central

    Varon, Joseph; Marik, Paul E

    2003-01-01

    Hypertension is an extremely common clinical problem, affecting approximately 50 million people in the USA and approximately 1 billion individuals worldwide. Approximately 1% of these patients will develop acute elevations in blood pressure at some point in their lifetime. A number of terms have been applied to severe hypertension, including hypertensive crises, emergencies, and urgencies. By definition, acute elevations in blood pressure that are associated with end-organ damage are called hypertensive crises. Immediate reduction in blood pressure is required only in patients with acute end-organ damage. This article reviews current concepts, and common misconceptions and pitfalls in the diagnosis and management of patients with acutely elevated blood pressure. PMID:12974970

  5. [Drugs: an underestimated cause of arterial hypertension].

    PubMed

    Serveaux, Marianne; Burnier, Michel; Pruijm, Menno

    2014-09-10

    In Switzerland, as in other Occidental countries, the prevalence of arterial hypertension (AHT) in the adult population is around 30-40%. Among the causes of secondary AHT, drug induced hypertension is sometimes omitted. Many molecules can induce AHT or worsen it due to an interaction with anti hypertensive drugs. Among these, NSAIDs and anti depressants, widely prescribed, should be used with caution, particularly in patients at risk, namely: those with preexisting AHT, the elderly, or patients suffering from kidney disease, diabetes, and/or heart failure. Increases in blood pressure have also been described with anti-vascular endothelial growth factor (VEGF) drugs, used in the treatment of (metastatic) cancer. A thorough anamnesis of drugs, including over the counter ones, should be performed in every hypertensive patient, and can avoid cumbersome and unnecessary investigations and therapy. PMID:25322625

  6. Redox signaling in pathophysiology of hypertension

    PubMed Central

    2013-01-01

    Reactive oxygen species (ROS) are products of normal cellular metabolism and derive from various sources in different cellular compartments. Oxidative stress resultant from imbalance between ROS generation and antioxidant defense mechanisms is important in pathogenesis of cardiovascular diseases, such as hypertension, heart failure, atherosclerosis, diabetes, and cardiac hypertrophy. In this review we focus on hypertension and address sources of cellular ROS generation, mechanisms involved in regulation of radical homeostasis, superoxide dismutase isoforms in pathophysiology of hypertension; as well as radical intracellular signaling and phosphorylation processes in proteins of the affected cardiovascular tissues. Finally, we discuss the transcriptional factors involved in redox-sensitive gene transcription and antioxidant response, as well as their roles in hypertension. PMID:24047403

  7. Device-based Therapy for Hypertension.

    PubMed

    Ng, Fu L; Saxena, Manish; Mahfoud, Felix; Pathak, Atul; Lobo, Melvin D

    2016-08-01

    Hypertension continues to be a major contributor to global morbidity and mortality, fuelled by an abundance of patients with uncontrolled blood pressure despite the multitude of pharmacological options available. This may occur as a consequence of true resistant hypertension, through an inability to tolerate current pharmacological therapies, or non-adherence to antihypertensive medication. In recent years, there has been a rapid expansion of device-based therapies proposed as novel non-pharmacological approaches to treating resistant hypertension. In this review, we discuss seven novel devices-renal nerve denervation, baroreflex activation therapy, carotid body ablation, central iliac arteriovenous anastomosis, deep brain stimulation, median nerve stimulation, and vagal nerve stimulation. We highlight how the devices differ, the varying degrees of evidence available to date and upcoming trials. This review also considers the possible factors that may enable appropriate device selection for different hypertension phenotypes. PMID:27370788

  8. Idiopathic noncirrhotic portal hypertension: current perspectives

    PubMed Central

    Riggio, Oliviero; Gioia, Stefania; Pentassuglio, Ilaria; Nicoletti, Valeria; Valente, Michele; d’Amati, Giulia

    2016-01-01

    The term idiopathic noncirrhotic portal hypertension (INCPH) has been recently proposed to replace terms, such as hepatoportal sclerosis, idiopathic portal hypertension, incomplete septal cirrhosis, and nodular regenerative hyperplasia, used to describe patients with a hepatic presinusoidal cause of portal hypertension of unknown etiology, characterized by features of portal hypertension (esophageal varices, nonmalignant ascites, porto-venous collaterals), splenomegaly, patent portal, and hepatic veins and no clinical and histological signs of cirrhosis. Physicians should learn to look for this condition in a number of clinical settings, including cryptogenic cirrhosis, a disease known to be associated with INCPH, drug administration, and even chronic alterations in liver function tests. Once INCPH is clinically suspected, liver histology becomes mandatory for the correct diagnosis. However, pathologists should be familiar with the histological features of INCPH, especially in cases in which histology is not only requested to exclude liver cirrhosis. PMID:27555800

  9. Higher potato intake associated with hypertension risk.

    PubMed

    2016-06-29

    The aim of three US prospective longitudinal cohort studies was to determine whether a higher intake of baked or boiled potatoes, French fries or chips and mashed potatoes was associated with incidence of hypertension. PMID:27353785

  10. Blood pressure control in treated hypertensive patients: clinical performance of general practitioners.

    PubMed Central

    Frijling, B D; Spies, T H; Lobo, C M; Hulscher, M E; van Drenth, B B; Braspenning, J C; Prins, A; van der Wouden, J C; Grol, R P

    2001-01-01

    BACKGROUND: The blood pressure of many treated hypertensive patients remains above recommended target levels. This discrepancy may be related to general practitioners' (GPs') actions. AIM: To assess clinical performance of GPs in blood pressure control in treated hypertensive patients and to explore the influence of patient and GP characteristics on clinical performance. DESIGN OF STUDY: Cross-sectional study conducted on 195 GPs with invitations to participate made via bulletins and by letter. SETTING: One hundred and thirty-two practices in the southern half of The Netherlands from November 1996 to April 1997. METHOD: Performance criteria were selected from Dutch national hypertension guidelines for general practice. GPs completed self-report forms immediately after follow-up visits of hypertensive patients treated with antihypertensive medication. RESULTS: The GPs recorded 3526 follow-up visits. In 63% of these consultations the diastolic blood pressure (DBP) was 90 mmHg or above. The median performance rates of the GPs were less than 51% for most of the recommended actions, even at a DBP of > or = 100 mmHg. Performance of non-pharmacological actions increased gradually with increasing DBP; prescribing an increase in antihypertensive medication and making a follow-up appointment scheduled within six weeks rose steeply at a DBP of > or = 100 mmHg. Patient and GP characteristics contributed little to clinical performance. Action performance rates varied considerably between GPs. CONCLUSION: GPs seem to target their actions at a DBP of below 100 mmHg, whereas guidelines recommend targeting at a DBP of below 90 mmHg. PMID:11271892

  11. Mother-induced hypertension in familial dysautonomia.

    PubMed

    Norcliffe-Kaufmann, Lucy; Palma, Jose-Alberto; Kaufmann, Horacio

    2016-02-01

    Here we report the case of a patient with familial dysautonomia (a genetic form of afferent baroreflex failure), who had severe hypertension (230/149 mmHg) induced by the stress of his mother taking his blood pressure. His hypertension subsided when he learnt to measure his blood pressure without his mother's involvement. The case highlights how the reaction to maternal stress becomes amplified when catecholamine release is no longer under baroreflex control. PMID:26589199

  12. Infertility, Fertility Treatment, and Risk of Hypertension

    PubMed Central

    Farland, Leslie V; Grodstein, Francine; Srouji, Serene S; Forman, John P; Rich-Edwards, Janet; Chavarro, Jorge E; Missmer, Stacey A

    2015-01-01

    Objective To evaluate the association between infertility and fertility treatments on subsequent risk of hypertension. Design Cohort Study Setting Nurses’ Health Study II Patients 116,430 female nurses followed from 1993 to June 2011 as part of the Nurses' Health Study II cohort. Intervention None Main Outcome Measures Self-reported, physician diagnosed hypertension Results Compared to women who never reported infertility, infertile women were at no greater risk of hypertension (multi-variable adjusted relative risk (RR) = 1.01 95% confidence interval [0.94–1.07]). Infertility due to tubal disease was associated with a higher risk of hypertension (RR=1.15 [1.01–1.31]) but all other diagnoses were not associated with hypertension risk compared to women who did not report infertility (ovulatory disorder: RR=1.03 [0.94–1.13], cervical: RR=0.88 [0.70–1.10], male factor: RR= 1.05 [0.95–1.15], other reason: RR=1.02 [0.94–1.11], reason not found: RR=1.02 [0.95–1.10]). Among infertile women there were 5,070 cases of hypertension. No clear pattern between use of fertility treatment and hypertension was found among infertile women (Clomiphene: RR =0.97 [0.90–1.04], Gonadotropin alone: RR=0.97 [0.87–1.08], IUI: RR=0.86 [0.71–1.03], IVF: RR=0.86 [0.73–1.01]). Conclusion Among this relatively young cohort of women, there was no apparent increase in hypertension risk among infertile women or among women who underwent fertility treatment in the past. PMID:26049054

  13. Novel strategies for treatment of resistant hypertension.

    PubMed

    Judd, Eric K; Oparil, Suzanne

    2013-12-01

    Resistant hypertension, defined as blood pressure (BP) remaining above goal despite the use of 3 or more antihypertensive medications at maximally tolerated doses (one ideally being a diuretic) or BP that requires 4 or more agents to achieve control, occurs in a substantial proportion (>10%) of treated hypertensive patients. Refractory hypertension is a recently described subset of resistant hypertension that cannot be controlled with maximal medical therapy (⩾5 antihypertensive medications of different classes at maximal tolerated doses). Patients with resistant or refractory hypertension are at increased cardiovascular risk and comprise the target population for novel antihypertensive treatments. Device-based interventions, including carotid baroreceptor activation and renal denervation, reduce sympathetic nervous system activity and have effectively reduced BP in early clinical trials of resistant hypertension. Renal denervation interrupts afferent and efferent renal nerve signaling by delivering radiofrequency energy, other forms of energy, or norepinephrine-depleting pharmaceuticals through catheters in the renal arteries. Renal denervation has the advantage of not requiring general anesthesia, surgical intervention, or device implantation and has been evaluated extensively in observational proof-of-principle studies and larger randomized controlled trials. It has been shown to be safe and effective in reducing clinic BP, indices of sympathetic nervous system activity, and a variety of hypertension-related comorbidities. These include impaired glucose metabolism/insulin resistance, end-stage renal disease, obstructive sleep apnea, cardiac hypertrophy, heart failure, and cardiac arrhythmias. This article reviews the strengths, limitations, and future applications of novel device-based treatment, particularly renal denervation, for resistant hypertension and its comorbidities. PMID:25028641

  14. Physiologic Tailoring of Treatment in Resistant Hypertension

    PubMed Central

    Spence, J. David

    2010-01-01

    Resistant hypertension is a major opportunity for prevention of cardiovascular disease. Despite widespread dissemination of consensus guidelines, most patients are uncontrolled with approaches that assume that all patients are the same. Causes of resistant hypertension include 1) non-compliance 2) consumption of substances that aggravate hypertension (such as salt, alcohol, nonsteroidal anti-inflammatory drugs, licorice, decongestants) and 3) secondary hypertension. Selecting the appropriate therapy for a patient depends on finding the cause of the hypertension. Once rare causes have been eliminated (such as pheochromocytoma, licorice, adult coarctation of the aorta), the cause will usually be found by intelligent interpretation (in the light of medications then being taken) of plasma renin and aldosterone. If stimulated renin is low and the aldosterone is high, the problem is primary aldosteronism, and the best treatment is usually aldosterone antagonists (spironolactone or eplerenone; high-dose amiloride for men where eplerenone is not available). If the renin is high, with secondary hyperaldosteronism, the best treatment is angiotensin receptor blockers or aliskiren. If the renin and aldosterone are both low the problem is over-activity of renal sodium channels and the treatment is amiloride. This approach is particularly important in patients of African origin, who are more likely to have low-renin hypertension. PMID:21532778

  15. Developmental origins of obesity-related hypertension.

    PubMed

    Henry, Sarah L; Barzel, Benjamin; Wood-Bradley, Ryan J; Burke, Sandra L; Head, Geoffrey A; Armitage, James A

    2012-09-01

    1. In the past 30 years the prevalence of obesity and overweight have doubled. It is now estimated that globally over 500 million adults are obese and a further billion adults are overweight. Obesity is a cardiovascular risk factor and some studies suggest that up to 70% of cases of essential hypertension may be attributable, in part, to obesity. Increasingly, evidence supports a view that obesity-related hypertension may be driven by altered hypothalamic signalling, which results in inappropriately high appetite and sympathetic nerve activity to the kidney. 2. In addition to the adult risk factors for obesity and hypertension, the environment encountered in early life may 'programme' the development of obesity, hypertension and cardiovascular disease. In particular, maternal obesity or high dietary fat intake in pregnancy may induce changes in fetal growth trajectories and predispose individuals to develop obesity and related sequelae. 3. The mechanisms underlying the programming of obesity-related hypertension are becoming better understood. However, several issues require clarification, particularly with regard to the role of the placenta in transferring fatty acid to the fetal compartment, the impact of placental inflammation and cytokine production in obesity. 4. By understanding which factors are most associated with the development of obesity and hypertension in the offspring, we can focus therapeutic and behavioural interventions to most efficiently reduce the intergenerational propagation of the obesity cycle. PMID:21801195

  16. Pulmonary Hypertension in the Intensive Care Unit.

    PubMed

    Jentzer, Jacob C; Mathier, Michael A

    2016-07-01

    Pulmonary hypertension occurs as the result of disease processes increasing pressure within the pulmonary circulation, eventually leading to right ventricular failure. Patients may become critically ill from complications of pulmonary hypertension and right ventricular failure or may develop pulmonary hypertension as the result of critical illness. Diagnostic testing should evaluate for common causes such as left heart failure, hypoxemic lung disease and pulmonary embolism. Relatively few patients with pulmonary hypertension encountered in clinical practice require specific pharmacologic treatment of pulmonary hypertension targeting the pulmonary vasculature. Management of right ventricular failure involves optimization of preload, maintenance of systemic blood pressure and augmentation of inotropy to restore systemic perfusion. Selected patients may require pharmacologic therapy to reduce right ventricular afterload by directly targeting the pulmonary vasculature, but only after excluding elevated left heart filling pressures and confirming increased pulmonary vascular resistance. Critically-ill patients with pulmonary hypertension remain at high risk of adverse outcomes, requiring a diligent and thoughtful approach to diagnosis and treatment. PMID:25944777

  17. Intracranial hypertension: classification and patterns of evolution

    PubMed Central

    Iencean, SM

    2008-01-01

    Intracranial hypertension (ICH) was systematized in four categories according to its aetiology and pathogenic mechanisms: parenchymatous ICH with an intrinsic cerebral cause; vascular ICH, which has its aetiology in disorders of cerebral blood circulation; ICH caused by disorders of cerebro–spinal fluid dynamics and idiopathic ICH. The increase of intracranial pressure is the first to happen and then intracranial hypertension develops from this initial effect becoming symptomatic; it then acquires its individuality, surpassing the initial disease. The intracranial hypertension syndrome corresponds to the stage at which the increased intracranial pressure can be compensated and the acute form of intracranial hypertension is equivalent to a decompensated ICH syndrome. The decompensation of intracranial hypertension is a condition of instability and appears when the normal intrinsic ratio of intracranial pressure – time fluctuation is changed. The essential conditions for decompensation of intracranial hypertension are: the speed of intracranial pressure increase over normal values, the highest value of abnormal intracranial pressure and the duration of high ICP values. Medical objectives are preventing ICP from exceeding 20 mm Hg and maintaining a normal cerebral blood flow. The emergency therapy is the same for the acute form but each of the four forms of ICH has a specific therapy, according to the pathogenic mechanism and if possible to aetiology. PMID:20108456

  18. [Physical activity and public health: recommendations for exercise prescription].

    PubMed

    Mendes, Romeu; Sousa, Nelson; Barata, J L Themudo

    2011-01-01

    During the last half century scientific data have been accumulated, through epidemiological and clinical studies that clearly document the significant health benefits associated with regular physical activity. This paper will analyse the latest recommendations for prescribing exercise in all age groups in healthy subjects and to individuals with chronic non-communicable diseases such as overweight, obesity, diabetes, hypertension, atherosclerotic cardiovascular disease and cancer, that contribute to the leading causes of global mortality. A search in the Pubmed database was performed and were also searched the recommendations of the World Health Organization and scientific organizations in Portugal. Most health benefits occur with at least 150 minutes of aerobic exercise of moderate intensity, accumulated over the week, which can be split into periods of at least 10 minutes. Brisk walking seems to be the preferred aerobic exercise. Vigorous intensity aerobic exercise and resistance exercises for muscle strengthening, at least two days a week are also recommended. Children, youth, older adults and people with overweight have particular needs for physical activity. Additional benefits occur with increasing quantity and quality of physical activity through the proper manipulation of the exercise density (intensity, frequency and duration). However, some physical activity is better than none. The role of health professionals in prescribing appropriate exercise to their patients is fundamental to their involvement in increasing their physical activity levels and thus contributing to their health promotion and prevention and treatment of major non-communicable chronic diseases. PMID:22713198

  19. Setting thresholds to varying blood pressure monitoring intervals differentially affects risk estimates associated with white-coat and masked hypertension in the population.

    PubMed

    Asayama, Kei; Thijs, Lutgarde; Li, Yan; Gu, Yu-Mei; Hara, Azusa; Liu, Yan-Ping; Zhang, Zhenyu; Wei, Fang-Fei; Lujambio, Inés; Mena, Luis J; Boggia, José; Hansen, Tine W; Björklund-Bodegård, Kristina; Nomura, Kyoko; Ohkubo, Takayoshi; Jeppesen, Jørgen; Torp-Pedersen, Christian; Dolan, Eamon; Stolarz-Skrzypek, Katarzyna; Malyutina, Sofia; Casiglia, Edoardo; Nikitin, Yuri; Lind, Lars; Luzardo, Leonella; Kawecka-Jaszcz, Kalina; Sandoya, Edgardo; Filipovský, Jan; Maestre, Gladys E; Wang, Jiguang; Imai, Yutaka; Franklin, Stanley S; O'Brien, Eoin; Staessen, Jan A

    2014-11-01

    Outcome-driven recommendations about time intervals during which ambulatory blood pressure should be measured to diagnose white-coat or masked hypertension are lacking. We cross-classified 8237 untreated participants (mean age, 50.7 years; 48.4% women) enrolled in 12 population studies, using ≥140/≥90, ≥130/≥80, ≥135/≥85, and ≥120/≥70 mm Hg as hypertension thresholds for conventional, 24-hour, daytime, and nighttime blood pressure. White-coat hypertension was hypertension on conventional measurement with ambulatory normotension, the opposite condition being masked hypertension. Intervals used for classification of participants were daytime, nighttime, and 24 hours, first considered separately, and next combined as 24 hours plus daytime or plus nighttime, or plus both. Depending on time intervals chosen, white-coat and masked hypertension frequencies ranged from 6.3% to 12.5% and from 9.7% to 19.6%, respectively. During 91 046 person-years, 729 participants experienced a cardiovascular event. In multivariable analyses with normotension during all intervals of the day as reference, hazard ratios associated with white-coat hypertension progressively weakened considering daytime only (1.38; P=0.033), nighttime only (1.43; P=0.0074), 24 hours only (1.21; P=0.20), 24 hours plus daytime (1.24; P=0.18), 24 hours plus nighttime (1.15; P=0.39), and 24 hours plus daytime and nighttime (1.16; P=0.41). The hazard ratios comparing masked hypertension with normotension were all significant (P<0.0001), ranging from 1.76 to 2.03. In conclusion, identification of truly low-risk white-coat hypertension requires setting thresholds simultaneously to 24 hours, daytime, and nighttime blood pressure. Although any time interval suffices to diagnose masked hypertension, as proposed in current guidelines, full 24-hour recordings remain standard in clinical practice. PMID:25135185

  20. Setting Thresholds to Varying Blood Pressure Monitoring Intervals Differentially Affects Risk Estimates Associated With White-Coat and Masked Hypertension in the Population

    PubMed Central

    Asayama, Kei; Thijs, Lutgarde; Li, Yan; Gu, Yu-Mei; Hara, Azusa; Liu, Yan-Ping; Zhang, Zhenyu; Wei, Fang-Fei; Lujambio, Inés; Mena, Luis J.; Boggia, José; Hansen, Tine W.; Björklund-Bodegård, Kristina; Nomura, Kyoko; Ohkubo, Takayoshi; Jeppesen, Jørgen; Torp-Pedersen, Christian; Dolan, Eamon; Stolarz-Skrzypek, Katarzyna; Malyutina, Sofia; Casiglia, Edoardo; Nikitin, Yuri; Lind, Lars; Luzardo, Leonella; Kawecka-Jaszcz, Kalina; Sandoya, Edgardo; Filipovský, Jan; Maestre, Gladys E.; Wang, Jiguang; Imai, Yutaka; Franklin, Stanley S.; O’Brien, Eoin; Staessen, Jan A.

    2015-01-01

    Outcome-driven recommendations about time intervals during which ambulatory blood pressure should be measured to diagnose white-coat or masked hypertension are lacking. We cross-classified 8237 untreated participants (mean age, 50.7 years; 48.4% women) enrolled in 12 population studies, using ≥140/≥90, ≥130/≥80, ≥135/≥85, and ≥120/≥70 mm Hg as hypertension thresholds for conventional, 24-hour, daytime, and nighttime blood pressure. White-coat hypertension was hypertension on conventional measurement with ambulatory normotension, the opposite condition being masked hypertension. Intervals used for classification of participants were daytime, nighttime, and 24 hours, first considered separately, and next combined as 24 hours plus daytime or plus nighttime, or plus both. Depending on time intervals chosen, white-coat and masked hypertension frequencies ranged from 6.3% to 12.5% and from 9.7% to 19.6%, respectively. During 91 046 person-years, 729 participants experienced a cardiovascular event. In multivariable analyses with normotension during all intervals of the day as reference, hazard ratios associated with white-coat hypertension progressively weakened considering daytime only (1.38; P=0.033), nighttime only (1.43; P=0.0074), 24 hours only (1.21; P=0.20), 24 hours plus daytime (1.24; P=0.18), 24 hours plus nighttime (1.15; P=0.39), and 24 hours plus daytime and nighttime (1.16; P=0.41). The hazard ratios comparing masked hypertension with normotension were all significant (P<0.0001), ranging from 1.76 to 2.03. In conclusion, identification of truly low-risk white-coat hypertension requires setting thresholds simultaneously to 24 hours, daytime, and nighttime blood pressure. Although any time interval suffices to diagnose masked hypertension, as proposed in current guidelines, full 24-hour recordings remain standard in clinical practice. PMID:25135185

  1. Prevalence of Optimal Treatment Regimens in Patients with Apparent Treatment Resistant Hypertension Based on Office BP in a Community-Based Practice Network

    PubMed Central

    Egan, Brent M.; Zhao, Yumin; Li, Jiexiang; Brzezinski, W. Adam; Todoran, Thomas M.; Brook, Robert D.; Calhoun, David A.

    2013-01-01

    Hypertensive patients with clinic blood pressure (BP) uncontrolled on ≥3 antihypertensive medications, i.e., apparent treatment resistant hypertension (aTRH) comprise ~28%–30% of all uncontrolled patients in the U.S. However, the proportion receiving these medications in optimal doses is unknown; aTRH is used, since treatment adherence, BP measurement artifacts, and optimal therapy were not available in electronic record data from our >200 community-based clinics Outpatient QUuality Improvement Network (OQUIN). This study sought to define the proportion of uncontrolled hypertensives with aTRH on optimal regimens and clinical factors associated with optimal therapy. During 2007–2010, 468,877 hypertensive patients met inclusion criteria. BP <140/<90 defined control. Multivariable logistic regression was used to assess variables independently associated with ‘optimal therapy’ (prescription of diuretic and ≥2 other BP medications at ≥50% of maximum recommended hypertension doses). Among 468,877 hypertensives, 147,635 (31.5%) were uncontrolled; among uncontrolled hypertensives, 44,684 were prescribed ≥3 BP medications (30.3%) of which 22,189 (15.0%) were prescribed ‘optimal’ therapy. Clinical factors independently associated with optimal BP therapy included black race (OR 1.40 [95% CI 1.32–1.49]), chronic kidney disease (1.31 [1.25–1.38]) diabetes (1.30 [1.24–1.37]), and coronary heart disease risk equivalent status (1.29 [1.14–1.46]). Clinicians more often prescribe optimal therapy for aTRH when cardiovascular risk is greater and treatment goals lower. Approximately one in seven of all uncontrolled hypertensives and one in two with uncontrolled aTRH are prescribed ≥3 BP medications in optimal regimens. Prescribing more optimal pharmacotherapy, for uncontrolled hypertensives including aTRH, confirmed with out-of-office BP, could improve hypertension control. PMID:23918752

  2. Prevalence of optimal treatment regimens in patients with apparent treatment-resistant hypertension based on office blood pressure in a community-based practice network.

    PubMed

    Egan, Brent M; Zhao, Yumin; Li, Jiexiang; Brzezinski, W Adam; Todoran, Thomas M; Brook, Robert D; Calhoun, David A

    2013-10-01

    Hypertensive patients with clinical blood pressure (BP) uncontrolled on ≥3 antihypertensive medications (ie, apparent treatment-resistant hypertension [aTRH]) comprise ≈28% to 30% of all uncontrolled patients in the United States. However, the proportion receiving these medications in optimal doses is unknown; aTRH is used because treatment adherence and measurement artifacts were not available in electronic record data from our >200 community-based clinics Outpatient Quality Improvement Network. This study sought to define the proportion of uncontrolled hypertensives with aTRH on optimal regimens and clinical factors associated with optimal therapy. During 2007-2010, 468 877 hypertensive patients met inclusion criteria. BP <140/<90 mm Hg defined control. Multivariable logistic regression was used to assess variables independently associated with optimal therapy (prescription of diuretic and ≥2 other BP medications at ≥50% of maximum recommended hypertension doses). Among 468 877 hypertensives, 147 635 (31.5%) were uncontrolled; among uncontrolled hypertensives, 44 684 were prescribed ≥3 BP medications (30.3%), of whom 22 189 (15.0%) were prescribed optimal therapy. Clinical factors independently associated with optimal BP therapy included black race (odds ratio, 1.40 [95% confidence interval, 1.32-1.49]), chronic kidney disease (1.31 [1.25-1.38]), diabetes mellitus (1.30 [1.24-1.37]), and coronary heart disease risk equivalent status (1.29 [1.14-1.46]). Clinicians more often prescribe optimal therapy for aTRH when cardiovascular risk is greater and treatment goals lower. Approximately 1 in 7 of all uncontrolled hypertensives and 1 in 2 with uncontrolled aTRH are prescribed ≥3 BP medications in optimal regimens. Prescribing more optimal pharmacotherapy for uncontrolled hypertensives including aTRH, confirmed with out-of-office BP, could improve hypertension control. PMID:23918752

  3. Saudi guidelines on the diagnosis and treatment of pulmonary hypertension: 2014 updates.

    PubMed

    Idrees, Majdy M; Saleemi, Sarfraz; Azem, M Ali; Aldammas, Saleh; Alhazmi, Manal; Khan, Javid; Gari, Abdulgafour; Aldabbagh, Maha; Sakkijha, Husam; Aldalaan, Abdulla; Alnajashi, Khalid; Alhabeeb, Waleed; Nizami, Imran; Kouatli, Amjad; Chehab, May; Tamimi, Omar; Banjar, Hanaa; Kashour, Tarek; Lopes, Antonio; Minai, Omar; Hassoun, Paul; Pasha, Qadar; Mayer, Eckhard; Butrous, Ghazwan; Bhagavathula, Sastry; Ghio, Stefano; Swiston, John; Boueiz, Adel; Tonelli, Adriano; Levy, Robert D; Hoeper, Marius; Levy, Rober D

    2014-07-01

    The Saudi Association for Pulmonary Hypertension (previously called Saudi Advisory Group for Pulmonary Hypertension) has published the first Saudi Guidelines on Diagnosis and Treatment of Pulmonary Arterial Hypertension back in 2008.[1] That guideline was very detailed and extensive and reviewed most aspects of pulmonary hypertension (PH). One of the disadvantages of such detailed guidelines is the difficulty that some of the readers who just want to get a quick guidance or looking for a specific piece of information might face. All efforts were made to develop this guideline in an easy-to-read form, making it very handy and helpful to clinicians dealing with PH patients to select the best management strategies for the typical patient suffering from a specific condition. This Guideline was designed to provide recommendations for problems frequently encountered by practicing clinicians involved in management of PH. This publication targets mainly adult and pediatric PH-treating physicians, but can also be used by other physicians interested in PH. PMID:25076987

  4. Noninvasive identification of left-sided heart failure in a population suspected of pulmonary arterial hypertension.

    PubMed

    Jacobs, Wouter; Konings, Thelma C; Heymans, Martijn W; Boonstra, Anco; Bogaard, Harm Jan; van Rossum, Albert C; Vonk Noordegraaf, Anton

    2015-08-01

    Exclusion of pulmonary hypertension secondary to left-sided heart disease (left heart failure (LHF)) is pivotal in the diagnosis of pulmonary arterial hypertension (PAH). In case of doubt, invasive measurements are recommended. The aim of the present study was to investigate whether it is possible to diagnose LHF using noninvasive parameters in a population suspected of PAH.300 PAH and 80 LHF patients attended our pulmonary hypertension clinic before August 2010, and were used to build the predictive model. 79 PAH and 55 LHF patients attended our clinic from August 2010, and were used for prospective validation.A medical history of left heart disease, S deflection in V1 plus R deflection in V6 in millimetres on ECG, and left atrial dilation or left valvular heart disease that is worse than mild on echocardiography were independent predictors of LHF. The derived risk score system showed good predictive characteristics: R(2)=0.66 and area under the curve 0.93. In patients with a risk score ≥72, there is 100% certainty that the cause of pulmonary hypertension is LHF. Using this risk score system, the number of right heart catheterisations in LHF may be reduced by 20%.In a population referred under suspicion of PAH, a predictive model incorporating medical history, ECG and echocardiography data can diagnose LHF noninvasively in a substantial percentage of cases. PMID:25837029

  5. Saudi guidelines on the diagnosis and treatment of pulmonary hypertension: 2014 updates

    PubMed Central

    Idrees, Majdy M.; Saleemi, Sarfraz; Azem, M Ali; Aldammas, Saleh; Alhazmi, Manal; Khan, Javid; Gari, Abdulgafour; Aldabbagh, Maha; Sakkijha, Husam; Aldalaan, Abdulla; Alnajashi, Khalid; Alhabeeb, Waleed; Nizami, Imran; Kouatli, Amjad; Chehab, May; Tamimi, Omar; Banjar, Hanaa; Kashour, Tarek; Lopes, Antonio; Minai, Omar; Hassoun, Paul; Pasha, Qadar; Mayer, Eckhard; Butrous, Ghazwan; Bhagavathula, Sastry; Ghio, Stefano; Swiston, John; Boueiz, Adel; Tonelli, Adriano; Levy, Robert D.

    2014-01-01

    The Saudi Association for Pulmonary Hypertension (previously called Saudi Advisory Group for Pulmonary Hypertension) has published the first Saudi Guidelines on Diagnosis and Treatment of Pulmonary Arterial Hypertension back in 2008.[1] That guideline was very detailed and extensive and reviewed most aspects of pulmonary hypertension (PH). One of the disadvantages of such detailed guidelines is the difficulty that some of the readers who just want to get a quick guidance or looking for a specific piece of information might face. All efforts were made to develop this guideline in an easy-to-read form, making it very handy and helpful to clinicians dealing with PH patients to select the best management strategies for the typical patient suffering from a specific condition. This Guideline was designed to provide recommendations for problems frequently encountered by practicing clinicians involved in management of PH. This publication targets mainly adult and pediatric PH-treating physicians, but can also be used by other physicians interested in PH. PMID:25076987

  6. Common Secondary Causes of Resistant Hypertension and Rational for Treatment

    PubMed Central

    Faselis, Charles; Doumas, Michael; Papademetriou, Vasilios

    2011-01-01

    Resistant hypertension is defined as uncontrolled blood pressure despite the use of three antihypertensive drugs, including a diuretic, in optimal doses. Treatment resistance can be attributed to poor adherence to antihypertensive drugs, excessive salt intake, physician inertia, inappropriate or inadequate medication, and secondary hypertension. Drug-induced hypertension, obstructive sleep apnoea, primary aldosteronism, and chronic kidney disease represent the most common secondary causes of resistant hypertension. Several drugs can induce or exacerbate pre-existing hypertension, with non-steroidal anti-inflammatory drugs being the most common due to their wide use. Obstructive sleep apnoea and primary aldosteronism are frequently encountered in patients with resistant hypertension and require expert management. Hypertension is commonly found in patients with chronic kidney disease and is frequently resistant to treatment, while the management of renovascular hypertension remains controversial. A step-by-step approach of patients with resistant hypertension is proposed at the end of this review paper. PMID:21423678

  7. Recommended Practices in Thrust Measurements

    NASA Technical Reports Server (NTRS)

    Polk, James E.; Pancotti, Anthony; Haag, Thomas; King, Scott; Walker, Mitchell; Blakely, Joseph; Ziemer, John

    2013-01-01

    Accurate, direct measurement of thrust or impulse is one of the most critical elements of electric thruster characterization, and one of the most difficult measurements to make. The American Institute of Aeronautics and Astronautics has started an initiative to develop standards for many important measurement processes in electric propulsion, including thrust measurements. This paper summarizes recommended practices for the design, calibration, and operation of pendulum thrust stands, which are widely recognized as the best approach for measuring micro N- to mN-level thrust and micro Ns-level impulse bits. The fundamentals of pendulum thrust stand operation are reviewed, along with its implementation in hanging pendulum, inverted pendulum, and torsional balance configurations. Methods of calibration and recommendations for calibration processes are presented. Sources of error are identified and methods for data processing and uncertainty analysis are discussed. This review is intended to be the first step toward a recommended practices document to help the community produce high quality thrust measurements.

  8. Drugs induced pulmonary arterial hypertension.

    PubMed

    Seferian, Andrei; Chaumais, Marie-Camille; Savale, Laurent; Günther, Sven; Tubert-Bitter, Pascale; Humbert, Marc; Montani, David

    2013-09-01

    Pulmonary arterial hypertension (PAH) is a rare disorder characterized by progressive obliteration of the pulmonary microvasculature, resulting in elevated pulmonary vascular resistance and premature death. According to the current classification, PAH can be associated with exposure to certain drugs or toxins, particularly appetite suppressant drugs, such as aminorex, fenfluramine derivatives and benfluorex. These drugs have been confirmed to be risk factors for PAH and were withdrawn from the market. The supposed mechanism is an increase in serotonin levels, which was demonstrated to act as a growth factor for the pulmonary arterial smooth muscle cells. Amphetamines, phentermine and mazindol were less frequently used but are also considered as possible risk factors for PAH. Dasatinib, a dual Src/Abl kinase inhibitor, used in the treatment of chronic myelogenous leukaemia was associated with cases of severe PAH, in part reversible after its withdrawal. Recently several studies raised the potential endothelial dysfunction that could be induced by interferon, and few cases of PAH have been reported with interferon therapy. Other possible risk factors for PAH include: nasal decongestants, like phenylpropanolamine, dietary supplement - L-Tryptophan, selective serotonin reuptake inhibitors, pergolide and other drugs that could act on 5HT2B receptors. Interestingly, PAH remains a rare complication of these drugs, suggesting possible individual susceptibility and further studies are needed to identify patients at risk of drugs induced PAH. PMID:23972547

  9. Advances in Neonatal Pulmonary Hypertension.

    PubMed

    Steinhorn, Robin H

    2016-01-01

    Persistent pulmonary hypertension of the newborn (PPHN) is a surprisingly common event in the neonatal intensive care unit, and affects both term and preterm infants. Recent studies have begun to elucidate the maternal, fetal and genetic risk factors that trigger PPHN. There have been numerous therapeutic advances over the last decade. It is now appreciated that oxygen supplementation, particularly for the goal of pulmonary vasodilation, needs to be approached as a therapy that has risks and benefits. Administration of surfactant or inhaled nitric oxide (iNO) therapy at a lower acuity of illness can decrease the risk of extracorporeal membrane oxygenation/death, progression of disease and duration of hospital stay. Milrinone may have specific benefits as an 'inodilator', as prolonged exposure to iNO plus oxygen may activate phosphodiesterase (PDE) 3A. Additionally, sildenafil and hydrocortisone may benefit infants exposed to hyperoxia and oxidative stress. Continued investigation is likely to reveal new therapies such as citrulline and cinaciguat that will enhance NO synthase and soluble guanylate cyclase function. Continued laboratory and clinical investigation will be needed to optimize treatment and improve outcomes. PMID:27251312

  10. Iranian Pulmonary Arterial Hypertension Registry

    PubMed Central

    Fahimi, Fanak; Sharif-Kashani, Babak; Malek Mohammad, Majid; Saliminejad, Leila; Monjazebi, Fateme

    2015-01-01

    Background: Idiopathic pulmonary arterial hypertension (IPAH) is a fatal disorder with a prevalence of 8.6 per million. We introduce a registry website for IPAH and PAH patients ( www.IPAH.ir) for access and efficient delivery of government-aided and subsidized antihypertensive medications. Materials and Methods: The IPAH registry was opened in November 2009. Information of IPAH and PAH patients with a username and password were uploaded in the site. Data entry was possible only via the physicians and healthcare organizations via internet that were given a personalized username and password for entry. Following the patients’ profile submission, a scientific committee composed of a cardiologist and a pulmonologist who were selected by the Ministry of Health of Iran (MOH), evaluated the data. The eligibility of the patient to receive the medications was confirmed after evaluation. If the patient was eligible, 82% of the Bosentan cost was paid by MOH. Results: To date, one hundred and sixteen patients (82 females, 34 males) have been registered. The mean pulmonary artery pressure by right heart catheterization was 69.24±17 mmHg (ranging from 35 to 110 mmHg). Conclusion: The first online Iranian registry program for IPAH and PAH patients is believed to supply essential information for health care providers in the field. PMID:26528365

  11. New therapeutic agents for hypertension

    PubMed Central

    REID, JOHN L.

    1996-01-01

    1Over the last 40 years a range of therapeutic strategies has been introduced for the long term treatment of hypertension. 2Although safe effective agents are available a significant number of patients are unable or unwilling to take these drugs as long term treatment. 3Both insufficient efficacy and adverse effects justify the search for new antihypertensive strategies. 4Recent developments include orally active angiotensin (AT1) receptor antagonists (ARA) which appear to offer the benefits of prevention of angiotensin II effects without the adverse effects of bradykinin potentiation, such as cough, which limit the usefulness of angiotensin converting enzyme (ACE) inhibitors. 5Imidazoline receptor agonists offer the potential of centrally active antihypertensives without the adverse effects of sedation and dry mouth. Further clinical experience is necessary to confirm whether the clinical efficacy and good tolerability are confirmed with long term use. 6Both ARA and imidazoline preferring substances offer the bonus of a desirable haemodynamic profile in patients with heart failure and may open new therapeutic avenues in the management of cardiac failure. PMID:8807142

  12. Acute hypertensive crisis in pregnancy.

    PubMed

    Silver, H M

    1989-05-01

    Severe pre-eclampsia is a state of acute afterload increase where compensation may be total by use of the Frank-Starling mechanism and/or increased adrenergic drive, or may be uncompensated in a patient with limited or exhausted preload reserve. As such, we are presented with a diverse group of patients and antihypertensive therapy ideally should be individualized. In reality we are dealing with a complex situation because of the presence of the fetus raising concerns about direct effects on the fetus as well as on uteroplacental blood flow. This limits our choice of agents to those with extensive use in pregnancy except in complicated or resistant cases. For these reasons, hydralazine is the antihypertensive agent of choice for treatment of acute hypertensive emergencies in pregnancy. In the complicated case other agents such as sodium nitroprusside or nitroglycerin may be more appropriate and, in these cases, hemodynamic monitoring should be performed to allow not only greater safety, but also to tailor therapy to the individual hemodynamic profile. PMID:2649760

  13. Knowledge, Awareness and Self-Care Practices of Hypertension among Cardiac Hypertensive Patients

    PubMed Central

    Bilal, Muhammad; Haseeb, Abdul; Lashkerwala, Sehan Siraj; Zahid, Ibrahim; Siddiq, Khadijah; Saad, Muhammad; Dar, Mudassir Iqbal; Arshad, Mohammad Hussham; Shahnawaz, Waqas; Ahmed, Bilal; Yaqub, Aimen

    2016-01-01

    Introduction: The most prevalent form of hypertension is systolic blood pressure (SBP) and it is considered to be predisposing risk factor for cardiovascular disease. The objective of the study was to assess self-care practices, knowledge and awareness of hypertension, especially related to SBP among cardiac hypertensive patients. Methodology: A Cross sectional study was conducted on 664 cardiac hypertensive patients, which were selected by non-probability convenience sampling from cardiology outpatient department of three tertiary care hospitals. Face to face interviews were conducted using a pre designed questionnaire. Data was entered and analyzed by SPSS (V17). Results: 81.8%, did not know that hypertension is defined as high blood pressure. 97.1% of the sample population did not know that top measurement of blood pressure was referred to as systolic and only 25.0% correctly recognized normal systolic blood pressure to be less than 140mmHg. 7.4% of the patients consulted their doctor for hypertension once or twice in a month. Risk factor for high blood pressure most commonly identified by the participants was too much salt intake Conclusions: The results state that there is an inadequate general knowledge of hypertension among cardiac patients and they do not recognise the significance of elevated SBP levels. There is a need to initiate programs that create community awareness regarding long term complications of uncontrolled hypertension, particularly elevated SBP levels so that there is an improvement in self-care practices of the cardiacpatients. PMID:26383212

  14. Primary hypertension and special aspects of hypertension in older children and adolescents

    PubMed Central

    Ellis, Demetrius; Miyashita, Yosuke

    2011-01-01

    The prevalence of hypertension has increased at an accelerated rate in older children and adolescents. This has raised great concern about premature development of cardiovascular disease, which has major long-term health and financial implications. While obesity and sedentary habits largely explain this phenomenon, there are other social and cultural influences that may unmask genetic susceptibility to hypertension in the pediatric population. While it is essential to exclude numerous causes of secondary hypertension in every child, these disorders are not discussed in this review. Rather, the aim of this review is to familiarize pediatricians with casual and ambulatory blood pressure measurement, epidemiology, pathophysiology, and management of several common conditions that play a role in the development of hypertension in children and adolescents. Besides primary hypertension and obesity-related hypertension, emphasis is given to epidemiology, measurement of blood pressure, including ambulatory blood pressure monitoring, hypertension associated with drug use, teenage pregnancy, and video and computer games. Lastly, because pediatricians are increasingly confronted with special issues concerning the management of the hypertensive athlete, this topic is also addressed. PMID:24600275

  15. Primary hypertension and special aspects of hypertension in older children and adolescents.

    PubMed

    Ellis, Demetrius; Miyashita, Yosuke

    2011-01-01

    The prevalence of hypertension has increased at an accelerated rate in older children and adolescents. This has raised great concern about premature development of cardiovascular disease, which has major long-term health and financial implications. While obesity and sedentary habits largely explain this phenomenon, there are other social and cultural influences that may unmask genetic susceptibility to hypertension in the pediatric population. While it is essential to exclude numerous causes of secondary hypertension in every child, these disorders are not discussed in this review. Rather, the aim of this review is to familiarize pediatricians with casual and ambulatory blood pressure measurement, epidemiology, pathophysiology, and management of several common conditions that play a role in the development of hypertension in children and adolescents. Besides primary hypertension and obesity-related hypertension, emphasis is given to epidemiology, measurement of blood pressure, including ambulatory blood pressure monitoring, hypertension associated with drug use, teenage pregnancy, and video and computer games. Lastly, because pediatricians are increasingly confronted with special issues concerning the management of the hypertensive athlete, this topic is also addressed. PMID:24600275

  16. Action Recommendation for Cyber Resilience

    SciTech Connect

    Choudhury, Sutanay; Rodriguez, Luke R.; Curtis, Darren S.; Oler, Kiri J.; Nordquist, Peter L.; Chen, Pin-Yu; Ray, Indrajit

    2015-09-01

    This paper presents an unifying graph-based model for representing the infrastructure, behavior and missions of an enterprise. We describe how the model can be used to achieve resiliency against a wide class of failures and attacks. We introduce an algorithm for recommending resilience establishing actions based on dynamic updates to the models. Without loss of generality, we show the effectiveness of the algorithm for preserving latency based quality of service (QoS). Our models and the recommendation algorithms are implemented in a software framework that we seek to release as an open source framework for simulating resilient cyber systems.

  17. Prevalence of hypertension in type 2 diabetes mellitus: impact of the tightening definition of high blood pressure and association with confounding risk factors.

    PubMed

    Kabakov, Emma; Norymberg, Clara; Osher, Esther; Koffler, Michael; Tordjman, Karen; Greenman, Yona; Stern, Naftali

    2006-01-01

    The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) has recommended a downward shift in target blood pressure to <130/80 mm Hg in diabetic patients, thus operatively setting a new threshold level for the definition of hypertension at 130/80 mm Hg. The authors performed a retrospective chart analysis of 2227 type 2 diabetes patients treated in one hospital-based and two community-based clinics in central Israel to determine the prevalence of hypertension as a function of three diagnostic threshold levels. The prevalence of hypertension in this cohort was 60.2%, 76.5%, and 85.8% at blood pressure thresholds of 140/90, 130/85, and 130/80 mm Hg respectively. Hypertension prevalence increased with age, reaching a rate of 94.4% in patients aged 80 years or more when the cutoff value of 130/80 mm Hg was used. At this cutoff, 93.3% and 86.6% of patients with a body mass index over or under 30 kg/m(2), respectively, were diagnosed with hypertension. As hypertension appears to eventually afflict the vast majority of diabetic patients, the minority of subjects not developing hypertension emerges as a unique group, which potentially deserves further in-depth study. PMID:17679829

  18. Race, gender, class, sexuality (RGCS) and hypertension.

    PubMed

    Veenstra, Gerry

    2013-07-01

    Informed by intersectionality theory, a tradition that theorizes intersecting power relations of racism, patriarchy, classism and heterosexism, this paper investigates the degree to which race, gender, class and sexuality manifest distinct and interconnected associations with self-reported hypertension in nationally-representative survey data from Canada. Binary logistic regression is used to model the main effects of, and interactions between, race, gender, education, household income and sexual orientation on hypertension, controlling for age, using data from the 2003 Canadian Community Health Survey (n = 90,310). From a main effects ('additive') perspective, Black respondents, respondents with less than high school and poorer respondents were significantly more likely than White respondents, university-educated Canadians and wealthier Canadians, respectively, to report hypertension. However, the interactive models indicate that the additive models were poor predictors of hypertension for wealthy Black men, wealthy South Asian women, women with less than a high school diploma and wealthy bisexual respondents, who were more likely than expected to report hypertension, and for poor Black men, poor South Asian women, poor South Asian men and women with a university degree, who were less likely than expected to report hypertension. It appears that, with regard to blood pressure at least, Canadians experience the health effects of education differently by their genders and the health effects of income differently by their identities defined at the intersection of race and gender. This study provides empirical support for the intersectional approach to cardiovascular health inequalities by demonstrating that race, gender, class and sexuality cannot be disentangled from one another as predictors of hypertension. PMID:23726211

  19. A Novel Channelopathy in Pulmonary Arterial Hypertension

    PubMed Central

    Austin, Eric D.; Eyries, Mélanie; Sampson, Kevin S.; Soubrier, Florent; Germain, Marine; Trégouët, David-Alexandre; Borczuk, Alain; Rosenzweig, Erika Berman; Girerd, Barbara; Montani, David; Humbert, Marc; Loyd, James E.; Kass, Robert S.; Chung, Wendy K.

    2013-01-01

    BACKGROUND Pulmonary arterial hypertension is a devastating disease with high mortality. Familial cases of pulmonary arterial hypertension are usually characterized by autosomal dominant transmission with reduced penetrance, and some familial cases have unknown genetic causes. METHODS We studied a family in which multiple members had pulmonary arterial hypertension without identifiable mutations in any of the genes known to be associated with the disease, including BMPR2, ALK1, ENG, SMAD9, and CAV1. Three family members were studied with whole-exome sequencing. Additional patients with familial or idiopathic pulmonary arterial hypertension were screened for the mutations in the gene that was identified on whole-exome sequencing. All variants were expressed in COS-7 cells, and channel function was studied by means of patch-clamp analysis. RESULTS We identified a novel heterozygous missense variant c.608 G→A (G203D) in KCNK3 (the gene encoding potassium channel subfamily K, member 3) as a disease-causing candidate gene in the family. Five additional heterozygous missense variants in KCNK3 were independently identified in 92 unrelated patients with familial pulmonary arterial hypertension and 230 patients with idiopathic pulmonary arterial hypertension. We used in silico bioinformatic tools to predict that all six novel variants would be damaging. Electrophysiological studies of the channel indicated that all these missense mutations resulted in loss of function, and the reduction in the potassium-channel current was remedied by the application of the phospholipase inhibitor ONO-RS-082. CONCLUSIONS Our study identified the association of a novel gene, KCNK3, with familial and idiopathic pulmonary arterial hypertension. Mutations in this gene produced reduced potassium-channel current, which was successfully remedied by pharmacologic manipulation. (Funded by the National Institutes of Health.) PMID:23883380

  20. [Status of mild hypertension guidelines in Japan and abroad].

    PubMed

    Matsuoka, Hiroaki

    2008-08-01

    Historically patients with systolic blood pressure level 140 to 159 mmHg or diastolic blood pressure level 90 to 99 mmHg had been defined as mild hypertension. However, the word of mild hypertension is not used in recent guidelines, such as JNC 7 and ESH/ESC 2007, although it is still used in JSH2004 and BHS IV. Patients with mild hypertension in JSH2004 are diagnosed as high risk hypertension if these patients are complicated cardiovascular organ damage, cardiovascular disease, or diabetes mellitus etc. Personally, I think the word of mild hypertension should be changed to another word or applied to patients with low risk hypertension. PMID:18700542