MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'The Journal of Clinical Hypertension' source. Wed, 08 Feb 2012 09:33:01 +0100 http://www.medworm.com/index.php?rid=5628429&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00589.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5628429 Thu, 26 Jan 2012 14:20:46 +0100 5628429 http://www.medworm.com/index.php?rid=5628432&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00579.x This report describes the process to date and hopefully will stimulate conversations about mechanisms to encourage similar collaboration within other communities. (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5628432 Tue, 24 Jan 2012 05:00:00 +0100 5628432 http://www.medworm.com/index.php?rid=5628431&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00581.x The association between within‐visit variability of systolic blood pressure (SBP) and diastolic blood pressure (DBP) and all‐cause and cardiovascular (CVD) mortality was examined using the Third National Health and Nutrition Survey (n=15,317). Three SBP and DBP readings were taken by physicians during a single medical evaluation. Within‐visit variability for each participant was defined using the standard deviation of SBP and DBP across these measurements. Mortality was assessed over 14 years (n=3848 and n=1684 deaths from all causes and CVD, respectively). After age, sex, and race‐ethnicity adjustment, the hazard ratios (95% confidence intervals) for all‐cause mortality associated with the 4 highest quintiles of within‐visit standard deviation of SBP (2.00–2.99 mm Hg, 3.00... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5628431 Tue, 24 Jan 2012 05:00:00 +0100 5628431 http://www.medworm.com/index.php?rid=5628430&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00588.x Most patients with hypertension require combination therapy in order to achieve blood pressure (BP) goals. This 40‐week open‐label extension of the 12‐week double‐blind Triple Therapy With Olmesartan Medoxomil, Amlodipine, and Hydrochlorothiazide in Hypertensive Patients Study (TRINITY) evaluated the efficacy and safety of triple‐combination treatments with olmesartan medoxomil, amlodipine besylate, and hydrochlorothiazide (OM/AML/HCTZ) in 2112 participants with moderate to severe hypertension. Following 2 weeks of initial treatment with OM 40/AML 5/HCTZ 12.5 mg, participants not achieving BP goal were titrated to OM 40/AML 5/HCTZ 25 mg or OM 40/AML 10/HCTZ 12.5 mg on a randomized basis. At week 16, participants who did not achieve BP goal were further titrated to OM 40/A... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5628430 Tue, 24 Jan 2012 05:00:00 +0100 5628430 http://www.medworm.com/index.php?rid=5608651&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00578.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5608651 Thu, 19 Jan 2012 05:00:00 +0100 5608651 http://www.medworm.com/index.php?rid=5608650&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00580.x Peripheral arterial disease (PAD) is a subclinical marker of coronary artery disease and identifies asymptomatic individuals at high risk for cardiovascular disease (CVD) events. The metabolic syndrome (MetS) is a constellation of clinical factors that increases the risk of developing diabetes and CVD. The authors’ objectives were to estimate the prevalence of MetS in patients with PAD and to determine the prevalence of PAD in the population of asymptomatic US adults 40 years and older with MetS. The authors analyzed data from 3 National Health and Nutrition Examination Surveys (NHANES, 1999–2004). Prevalence of MetS as defined by the Third Report of the Adult Treatment Panel criteria and prevalence of associated cardiac risk factors were determined in 5376 asymptomatic participants 40... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5608650 Thu, 19 Jan 2012 05:00:00 +0100 5608650 http://www.medworm.com/index.php?rid=5608649&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00582.x The authors analyzed HealthStyles surveys 2005 and 2008 combined to assess the prevalence of regular home blood pressure monitor (HBPM) use among hypertensive adults. All data were self‐reported. The authors calculated odds ratios (ORs) of regular HBPM use and relative percent change (RPC) in the use of HBPM between the 2 survey years. There were 3739 (32.6%) hypertensives in the 2 survey years combined. Based on the self‐reported data, the proportion of hypertensives who regularly used an HBPM was 43.2%. Male sex, age, race/ethnicity, household income, and education were all associated with differences in the prevalence of regular HBPM use. Patients 65 years and older (OR, 2.38; 95% confidence interval [CI], 1.49–3.81) were significantly more likely to be regular HBPM users than t... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5608649 Thu, 19 Jan 2012 05:00:00 +0100 5608649 http://www.medworm.com/index.php?rid=5608653&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00576.x J Clin Hypertens (Greenwich). 2012;14:121–132. ©2012 Wiley Periodicals, Inc.The combination of a lipid‐lowering diet and scientifically proven nutraceutical supplements has the ability to significantly reduce low‐density lipoprotein (LDL) cholesterol, increase LDL particle size, decrease LDL particle number, lower trigylcerides and very LDL levels, and increase total and high‐density lipoprotein 2b cholesterol. In addition, inflammation, oxidative stress, and immune responses are decreased. In several prospective clinical trials, coronary heart disease and cardiovascular disease have been reduced with many nutraceutical supplements. This nutritional and nutraceutical supplement treatment is a valid alternative for patients who are intolerant to statins, cannot take other drugs for... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5608653 Tue, 17 Jan 2012 05:00:00 +0100 5608653 http://www.medworm.com/index.php?rid=5608652&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00577.x J Clin Hypertens (Greenwich). 2012;14:78–84. ©2012 Wiley Periodicals, Inc.The Observational Study on Cognitive Function and SBP Reduction (OSCAR) provided opportunities to examine the influence of eprosartan on trends in cognitive performance in a large population of patients with difficult‐to‐treat hypertension (DTTH). A total of 4649 patients diagnosed retrospectively with DTTH, defined as systolic/diastolic blood pressure (SBP/DBP) ≥140/90 mm Hg despite use of at least 3 antihypertensive drugs during the month preceding the baseline visit comprised the intention‐to‐treat (ITT) cohort. The patients were given eprosartan‐based antihypertension therapy (EBT; 600 mg/d). Blood pressure and cognitive function parameters included significant (P<.001) differences for DTTH ... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5608652 Tue, 17 Jan 2012 05:00:00 +0100 5608652 http://www.medworm.com/index.php?rid=5559807&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00571.x J Clin Hypertens (Greenwich).****;**:**–**. ©2011 Wiley Periodicals, Inc.Transient ischemic attack (TIA) is currently defined as a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia without infarction. TIA is an important risk factor for stroke and other major vascular events. Risk factors for TIA or stroke need to be addressed effectively to reduce the risk for stroke in patients who have had a TIA. Aspirin (ASA) significantly reduces the risk for stroke when given after a TIA, stroke, or myocardial infarction in a dose of 50 mg/d to 325 mg/d. The role of ASA in the primary prevention of TIA or stroke, however, is less well‐substantiated. Clopidogrel may be used in the secondary prevention of TIA or stroke, but its antiplatelet eff... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5559807 Wed, 04 Jan 2012 05:00:00 +0100 5559807 http://www.medworm.com/index.php?rid=5559806&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00574.x J Clin Hypertens (Greenwich).****;**:**–**. ©2011 Wiley Periodicals, Inc.It is unknown what role uric acid (UA) may play in the increasing rates of cardiovascular disease (CVD) among Alaska Eskimos. UA is associated with both hypertension (HTN) and chronic kidney disease (CKD). The authors analyzed 1078 Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) participants. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine measures using the Modification of Diet in Renal Disease equation. CKD was defined by an eGFR of <60 mL/min/1.73 m2. The authors adjusted for age, sex, education, diabetes, hypertension (or eGFR), obesity, lipids, and smoking status; 7% (n=75) had prevalent CKD. eGFR decreased with increasing tertiles of serum UA (P<.001)... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5559806 Wed, 04 Jan 2012 05:00:00 +0100 5559806 http://www.medworm.com/index.php?rid=5619961&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00586.x Self blood pressure measurement (SBPM) improves the overall management of hypertension provided it is implemented with methodologic care. This concerns especially the accuracy and technical requirements of blood pressure (BP) measuring devices that should be validated according to internationally accepted protocols. The use of memory‐equipped automatic home monitors is strongly recommended because they reduce observer bias, avoid patients’ misreporting, and allow fully automatic analysis by software. For current use, simple software should be worked out that allow for analysis of readings in an objective manner. Miscuffing is also a frequent source of measurement error in obese arms when oscillometric devices are used. Modern automatic devices can overcome this problem because of speci... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5619961 Sun, 01 Jan 2012 05:00:00 +0100 5619961 http://www.medworm.com/index.php?rid=5608648&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00584.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5608648 Sun, 01 Jan 2012 05:00:00 +0100 5608648 http://www.medworm.com/index.php?rid=5581374&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00585.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5581374 Sun, 01 Jan 2012 05:00:00 +0100 5581374 http://www.medworm.com/index.php?rid=5559809&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00587.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5559809 Sun, 01 Jan 2012 05:00:00 +0100 5559809 http://www.medworm.com/index.php?rid=5559808&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00546.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5559808 Sun, 01 Jan 2012 05:00:00 +0100 5559808 http://www.medworm.com/index.php?rid=5559805&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00575.x J Clin Hypertens (Greenwich).****;**:**–**. ©2011 Wiley Periodicals, Inc.The prevalence of hypertension in the United States has grown dramatically in recent years. Thiazide diuretics have played a major role in the rising rate of blood pressure (BP) control. Accompanying this has been the appearance of adverse drug events, including hospitalizations associated with thiazide‐associated hyponatremia (HTAH). Hyponatremia is a common yet often overlooked side effect of this drug class. Identification of HTAH risk factors may aid in creating strategies to prevent hospitalizations. This is a retrospective, case‐controlled study of 10,805 patients (1802 cases, 9003 controls) examining HTAH risk factors within a group‐model integrated‐care organization. Multivariate analysis revealed t... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5559805 Sun, 01 Jan 2012 05:00:00 +0100 5559805 http://www.medworm.com/index.php?rid=5524496&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00569.x The authors hypothesized that carvedilol controlled‐release plus lisinopril combination therapy (C+L) would increase endothelial function and decrease oxidative stress to a greater extent than hydrochlorothiazide plus lisinopril combination therapy (H+L) in obese patients with hypertension. Twenty‐five abdominally obese patients (aged 54.4±7.3 years; 14 women) with hypertension/prehypertension were enrolled in a 7‐month (two 3‐month treatment periods separated by a 1‐month washout), randomized, double‐blind, controlled, crossover clinical trial comparing C+L vs H+L. Endothelial function, measured by digital reactive hyperemic index (RHI), circulating oxidized low‐density lipoprotein (oxLDL), 8‐isoprostane, and asymmetric dimethylarginine (ADMA) were obtained at baseline, p... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5524496 Mon, 19 Dec 2011 05:00:00 +0100 5524496 http://www.medworm.com/index.php?rid=5486702&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00564.x Furosemide is the diuretic of choice for the treatment of hypertension in chronic kidney disease but the adaptative changes in the distal nephron may decrease its efficacy. Hydrochlorothiazide is not believed to be efficient in this setting. In a randomized, double‐blind, cross‐over trial, 23 patients with hypertension and stage 4 or 5 chronic kidney disease received long‐acting furosemide (60 mg) and hydrochlorothiazide (25 mg) for 3 months and then both diuretics for 3 months. Sodium and chloride fractional excretions were measured after 3 months of each diuretic and then after their association. A trend towards an increase in the fractional excretion of sodium and chloride was observed with furosemide and hydrochlorothiazide (P=not significant). The association of the tw... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5486702 Fri, 09 Dec 2011 05:00:00 +0100 5486702 http://www.medworm.com/index.php?rid=5486701&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00568.x A randomized, double‐blind, active‐controlled, multicenter trial assigned 32,804 participants aged 55 years and older with hypertension and ≥1 other coronary heart disease risk factors to receive chlorthalidone (n=15,002), amlodipine (n=8898), or lisinopril (n=8904) for 4 to 8 years, when double‐blinded therapy was discontinued. Passive surveillance continued for a total follow‐up of 8 to 13 years using national administrative databases to ascertain deaths and hospitalizations. During the post‐trial period, fatal outcomes and nonfatal outcomes were available for 98% and 65% of participants, respectively, due to lack of access to administrative databases for the remainder. This paper assesses whether mortality and morbidity differences persisted or new differences develope... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5486701 Fri, 09 Dec 2011 05:00:00 +0100 5486701 http://www.medworm.com/index.php?rid=5486700&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00572.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5486700 Fri, 09 Dec 2011 05:00:00 +0100 5486700 http://www.medworm.com/index.php?rid=5486704&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00565.x This study indicates that increased WC and WHR may be early premetabolic syndrome markers in obese individuals and should warrant aggressive risk factor reduction therapy to prevent future development of related cardiovascular conditions. (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5486704 Wed, 07 Dec 2011 05:00:00 +0100 5486704 http://www.medworm.com/index.php?rid=5486703&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00567.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5486703 Wed, 07 Dec 2011 05:00:00 +0100 5486703 http://www.medworm.com/index.php?rid=5524495&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00570.x J Clin Hypertens (Greenwich). 2011;00:00–00. ©2011 Wiley Periodicals, Inc.Both impaired glucose tolerance and diabetes are associated with substantially increased prevalence of hypertension, cardiovascular and renal disease. The goal for hypertension treatment in diabetic patients is in evolution, because of recent clinical trials. For example, the results of the recent Action to Control Cardiovascular Risk in Diabetes—BP Arm (ACCORD BP) trial failed to show an additional benefit on cardiovascular event reduction at a mean systolic BP of 119 mm Hg. A post hoc analysis of 6,400 patients with type 2 diabetes from the International Verapamil‐Trandolapril Study (INVEST) also failed to show additional cardiovascular risk reduction among patients who achieved a BP <130/80 mm Hg... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5524495 Thu, 01 Dec 2011 05:00:00 +0100 5524495 http://www.medworm.com/index.php?rid=5486699&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00573.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5486699 Thu, 01 Dec 2011 05:00:00 +0100 5486699 http://www.medworm.com/index.php?rid=5476420&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2010.00583.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5476420 Thu, 01 Dec 2011 05:00:00 +0100 5476420 http://www.medworm.com/index.php?rid=5476419&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00563.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5476419 Thu, 01 Dec 2011 05:00:00 +0100 5476419 http://www.medworm.com/index.php?rid=5468951&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00560.x This study investigated associations between inflammatory markers, MS, and incident HF in a population with a high prevalence of diabetes, obesity, and MS. The cohort consisted of 3098 American Indians without prevalent cardiovascular disease who had C‐reactive protein (CRP) and fibrinogen measured at the Strong Heart Study phase II examination. Independent associations between inflammatory markers, MS, and HF were analyzed by Cox hazard models. During a mean follow‐up of 11 years, 218 participants developed HF. After the adjustment for cardiovascular risk factors, fibrinogen, (hazard ratio [HR], 1.36; 95% confidence interval [CI], 1.15–1.59) but not CRP (HR, 1.25; 95% CI, 0.97–1.32) remained a significant HF predictor. In individuals without diabetes, concomitant presence of MS ... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5468951 Thu, 01 Dec 2011 05:00:00 +0100 5468951 http://www.medworm.com/index.php?rid=5468950&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00566.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5468950 Thu, 01 Dec 2011 05:00:00 +0100 5468950 http://www.medworm.com/index.php?rid=5421935&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00557.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5421935 Fri, 18 Nov 2011 05:00:00 +0100 5421935 http://www.medworm.com/index.php?rid=5407778&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00556.x J Clin Hypertens (Greenwich).Among patients with resistant hypertension (RHTN), there are those whose blood pressure (BP) remains uncontrolled in spite of maximal medical therapy. This retrospective analysis aims to characterize these patients with refractory hypertension. Refractory hypertension was defined as BP that remained uncontrolled after ≥3 visits to a hypertension clinic within a minimum 6‐month follow‐up period. Of the 304 patients referred for RHTN, 29 (9.5%) remained refractory to treatment. Patients with refractory hypertension and those with controlled RHTN had similar aldosterone levels and plasma renin activity (PRA). Patients with refractory hypertension had higher baseline BP (175±23/97±15 mm Hg vs 158±25/89±15 mm Hg; P=.001/.005) and heart rate, and hi... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5407778 Tue, 15 Nov 2011 05:00:00 +0100 5407778 http://www.medworm.com/index.php?rid=5407776&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00561.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5407776 Tue, 15 Nov 2011 05:00:00 +0100 5407776 http://www.medworm.com/index.php?rid=5407779&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00547.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5407779 Mon, 14 Nov 2011 05:00:00 +0100 5407779 http://www.medworm.com/index.php?rid=5400651&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00552.x Patients with stage 2 hypertension and diabetes are at high cardiovascular risk and require large blood pressure (BP) reductions to reach treatment goals. This randomized double‐blind study compared aliskiren/hydrochlorothiazide (HCTZ) combination therapy with amlodipine monotherapy in 860 patients with mean sitting systolic BP (msSBP) ≥160 mm Hg to <200 mm Hg and type 2 diabetes. Patients received either once‐daily aliskiren/HCTZ 150/12.5 mg or amlodipine 5 mg for 1 week then force‐titrated to double the doses for 7 weeks. Baseline BP was 167.7/91.4 mm Hg. At week 8 end point, aliskiren/HCTZ provided significantly greater reductions in msSBP than amlodipine (28.8 mm Hg vs 26.2 mm Hg; P<.05). Mean sitting diastolic BP reductions were similar with aliskiren... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5400651 Fri, 11 Nov 2011 05:00:00 +0100 5400651 http://www.medworm.com/index.php?rid=5400650&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00553.x Hypertension is a major cardiovascular (CV) risk factor, but several other common conditions, including chronic obstructive pulmonary disease (COPD), osteoporosis, and peripheral arterial disease (PAD), have been shown to independently increase the risk of CV events and death. The physiological basis for an increased CV risk in those conditions probably lies in the augmentations of oxidative stress, endothelial dysfunction, systemic inflammation, and arterial stiffness, which all are also hallmarks of hypertension. β‐Blockers have been used for the treatment of hypertension for more than 40 years, but a number of meta‐analyses have demonstrated that treatment with these agents may be associated with an increased risk of CV events and mortality. However, the majority of primary preve... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5400650 Fri, 11 Nov 2011 05:00:00 +0100 5400650 http://www.medworm.com/index.php?rid=5400649&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00554.x Anti‐inflammatory and pain therapies have been associated with blood pressure (BP) destabilization. Hence, the effects on BP of sumatriptan/naproxen sodium in fixed‐dose combination, sumatriptan 85 mg, and naproxen sodium 500 mg administered intermittently for the acute treatment of migraine attacks were assessed. Patients with migraine with or without aura and no history of hypertension were randomized to sumatriptan/naproxen sodium (n=135), sumatriptan (n=136), or naproxen sodium (n=136) to treat migraine attacks for 6 months in a double‐blind, parallel‐group trial. Following a treated migraine attack, patients performed 2 consecutive days of self‐measured BPs beginning ≥24 hours after the last dose of study medication and transmitted them by a transtelephonic modem. Th... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5400649 Fri, 11 Nov 2011 05:00:00 +0100 5400649 http://www.medworm.com/index.php?rid=5386354&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00545.x J Clin Hypertens (Greenwich). ****; **:**–**.Environmental temperatures are inversely related to BP; however, the effects of short‐term temperature changes within a 24‐hour period and measured with high accuracy at the personal level have not been described. Fifty‐one nonsmoking patients living in the Detroit area had up to 5 consecutive days of 24‐hour personal‐level environmental temperature (PET) monitoring along with daily cardiovascular measurements, including BP, performed mostly between 5 pm and 7 pm during summer and/or winter periods. The associations between hour‐long mean PET levels during the previous 24 hours with the outcomes were assessed by linear mixed models. Accounting for demographics, environmental factors, and monitoring compliance, systolic and di... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5386354 Mon, 07 Nov 2011 05:00:00 +0100 5386354 http://www.medworm.com/index.php?rid=5386353&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00548.x High cystatin C levels among patients without clinically recognized chronic kidney disease (CKD) may identify patients who are at preclinical stages of CKD. Higher body mass index (BMI) has been found to be associated with increased risk of CKD. However, the association between BMI and high cystatin C levels is not clear. The authors examined participants older than 20 years from the National Health and Nutrition Examination Survey 1999 to 2002 (N=2583, 50.2% women). BMI was categorized as <25 kg/m2, 25–29.9 kg/m2, and ≥30 kg/m2. Main outcome was high cystatin C (>1 mg/dL) among patients without clinically recognized CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2 or microalbuminuria). Higher BMI was positively associated with high cystatin C, indepe... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5386353 Mon, 07 Nov 2011 05:00:00 +0100 5386353 http://www.medworm.com/index.php?rid=5386352&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00549.x Blood pressure (BP) characteristics, such as central aortic pressure and arterial stiffness, independently predict cardiovascular events. The effects of pharmacologically dissimilar β‐blockers on these properties have not been fully elucidated. Patients with essential hypertension and without significant concomitant cardiovascular disease were randomly assigned to controlled‐release carvedilol, force‐titrated to 80 mg (n=22), or atenolol, force‐titrated to 100 mg (n=19); each was given once daily for 4 weeks. Baseline characteristics were similar. At the end of week 4, atenolol and carvedilol reduced central and brachial systolic and diastolic BP to a similar extent. Central augmentation index was increased in atenolol‐treated patients but not carvedilol‐treated patients... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5386352 Mon, 07 Nov 2011 05:00:00 +0100 5386352 http://www.medworm.com/index.php?rid=5386351&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00550.x This meta‐analysis compares health care resource use costs, adherence, and persistence between groups of patients taking antihypertensives as single‐pill combinations (SPCs) vs free‐equivalent components (FEC) based on a structured review of published studies. The search yielded 12 retrospective database studies included in analyses. The mean difference in combined total annual all‐cause and hypertension‐related health care costs was $1357 (95% confidence interval [CI], $778–$1935) lower in favor of SPC than FEC groups. Adherence, measured as the mean difference in medication possession ratio, was estimated to be 8% higher for patients naive to prior antihypertensives and 14% higher for nonnaive SPC patients compared with corresponding FEC patients. Persistence in the SPC group... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5386351 Mon, 07 Nov 2011 05:00:00 +0100 5386351 http://www.medworm.com/index.php?rid=5468949&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00559.x The objective of this study was to determine whether a videoconference‐based telehealth network can increase hypertension management knowledge and self‐assessed competency among primary care providers (PCPs) working in urban Federally Qualified Health Centers (FQHCs). We created a telehealth network among 6 urban FQHCs and our institution to support a 12‐session educational program designed to teach state‐of‐the‐art hypertension management. Each 1‐hour session included a brief lecture by a university‐based hypertension specialist, case presentations by PCPs, and interactive discussions among the specialist and PCPs. Twelve PCPs (9 intervention and 3 controls) were surveyed at baseline and immediately following the curriculum. The mean number of correct answers on the 26‐i... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5468949 Tue, 01 Nov 2011 04:00:00 +0100 5468949 http://www.medworm.com/index.php?rid=5457515&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00542.x J Clin Hypertens (Greenwich).Team‐based care is one of the key components of the patient‐centered medical home. Studies have consistently demonstrated that teams involving pharmacists or nurses in patient management can significantly improve blood pressure control. These findings have been demonstrated in several meta‐analyses and systematic reviews. These reviews have generally found that team‐based care can reduce systolic blood pressure by 4–10 mm Hg over usual care. However, these reviews have also concluded that many of the studies had various limitations and that additional research should be conducted. The present state of the art review paper will highlight newer studies, many of which were funded by the National Institutes of Health. Newer strategies involve telephone an... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5457515 Tue, 01 Nov 2011 04:00:00 +0100 5457515 http://www.medworm.com/index.php?rid=5421934&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00558.x The authors’ objective was to gain a better understanding of minority patients’ beliefs about hypertension and to use this understanding to develop a model to explain gaps in communication between patients and clinicians. Eighty‐eight hypertensive black and Latino adults from 4 inner‐city primary care clinics participated in focus groups to elucidate views on hypertension. Participants believed that hypertension was a serious illness in need of treatment. Participants’ diverged from the medical model in their beliefs about the time‐course of hypertension (believed hypertension was intermittent); causes of hypertension (believed stress, racism, pollution, and poverty were the important causes); symptoms of hypertension (believed hypertension was primarily present when symptomati... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5421934 Tue, 01 Nov 2011 04:00:00 +0100 5421934 http://www.medworm.com/index.php?rid=5407775&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00562.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5407775 Tue, 01 Nov 2011 04:00:00 +0100 5407775 http://www.medworm.com/index.php?rid=5400648&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00555.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5400648 Tue, 01 Nov 2011 04:00:00 +0100 5400648 http://www.medworm.com/index.php?rid=5386356&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2010.00312_2.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5386356 Tue, 01 Nov 2011 04:00:00 +0100 5386356 http://www.medworm.com/index.php?rid=5386355&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2010.00312_1.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5386355 Tue, 01 Nov 2011 04:00:00 +0100 5386355 http://www.medworm.com/index.php?rid=5386350&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00551.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5386350 Tue, 01 Nov 2011 04:00:00 +0100 5386350 http://www.medworm.com/index.php?rid=5360280&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00536.x J Clin Hypertens (Greenwich).Interruption of the renin‐angiotensin‐aldosterone system (RAAS) cascade with angiotensin‐converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or more recently direct renin inhibitors (DRIs) is a safe and effective antihypertensive strategy that is in routine clinical use. The clinical utility of these agents in cardiorenal end‐organ protection is increasingly being recognized. Although both ACE inhibitors and ARBs demonstrate substantial benefit in patients with cardiovascular and/or renal disease, considerable evidence indicates that they only partially suppress the RAAS pathway due to feedback upregulation of plasma renin activity. With the goal of providing more comprehensive RAAS blockade, combination ACE inhibitor/ARB therapy h... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5360280 Fri, 28 Oct 2011 04:00:00 +0100 5360280 http://www.medworm.com/index.php?rid=5335561&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00539.x J Clin Hypertens (Greenwich).The authors examined the comparative effectiveness of 4 angiotensin receptor blockers (ARBs) in patients with hypertension using a large electronic medical record database. Analysis of covariance and logistic multivariate regression models were used to estimate the blood pressure (BP) outcomes of 73,012 patients during 13 months of treatment with olmesartan, losartan, valsartan, and irbesartan. Results were adjusted by baseline BP, starting dose, year, age, sex, race, body mass index, comorbid conditions, and concomitant medications of patients. All ARBs led to sustained reductions in BP, but with significant differences in the magnitude of BP reduction. Raw mean systolic BP/diastolic BP reductions with losartan, valsartan, irbesartan, and olmesartan were 9.3... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5335561 Tue, 18 Oct 2011 04:00:00 +0100 5335561 http://www.medworm.com/index.php?rid=5360279&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00544.x J Clin Hypertens (Greenwich).This 12‐week, multicenter, randomized, double‐blinded, 4‐arm study in 440 patients with moderate to severe hypertension compared ambulatory blood pressure (ABP) responses with a triple‐combination regimen (olmesartan medoxomil [OM] 40 mg, amlodipine besylate [AML] 10 mg, and hydrochlorothiazide [HCTZ] 25 mg) and its component dual‐combination regimens at similar doses. At week 12, the triple combination resulted in a greater reduction in mean 24‐hour systolic and diastolic blood pressure (−30.3/−18.0 mm Hg) compared with the 3 dual‐combination regimens (OM 40 mg/AML 10 mg: −23.5/−13.9, OM 40 mg/HCTZ 25 mg: −23.9/−14.5, and AML 10 mg/HCTZ 25 mg: −18.5 mm Hg/−10.7 mm Hg; P<.0001 each). Greater efficacy was also... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5360279 Sat, 01 Oct 2011 04:00:00 +0100 5360279 http://www.medworm.com/index.php?rid=5335560&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00543.x J Clin Hypertens (Greenwich).Blood pressure (BP) is affected by many environmental factors including ambient temperature, altitude, latitude, noise, and air pollutants. Given their pervasiveness, it is plausible that such factors may also have an impact on hypertension prevalence and control rates. Health care providers should be aware that the environment can play a significant role in altering BP. Although not among the established modifiable risk factors (eg, obesity) for hypertension, reducing exposures when pertinent should be considered to prevent or control hypertension. The authors provide a concise review of the evidence linking diverse environmental factors with BP and suggest an approach for incorporating this knowledge into clinical practice. The authors propose using the term ... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5335560 Sat, 01 Oct 2011 04:00:00 +0100 5335560 http://www.medworm.com/index.php?rid=5260544&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00532.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5260544 Mon, 26 Sep 2011 04:00:00 +0100 5260544 http://www.medworm.com/index.php?rid=5260543&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00534.x J Clin Hypertens (Greenwich).Effective control of hypertension and the other cardiovascular risk factors has been dependent on primary medical care as provided by family practitioners and internists. The progressive reduction in availability of primary care for adult populations in the United States threatens the likelihood of better control of the risk factors and potential loss of opportunity for prevention of cardiovascular disease. Recent progress has been made in the use of home blood pressure monitoring for improvement in classification of risk for hypertensive patients. Several studies establish the feasibility of home pressure monitoring combined with telemedicine for improving control of hypertension. Some studies have explored the role of self‐care for adjustment of medication,... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5260543 Mon, 26 Sep 2011 04:00:00 +0100 5260543 http://www.medworm.com/index.php?rid=5260542&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00537.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5260542 Mon, 26 Sep 2011 04:00:00 +0100 5260542 http://www.medworm.com/index.php?rid=5260541&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00541.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5260541 Mon, 26 Sep 2011 04:00:00 +0100 5260541 http://www.medworm.com/index.php?rid=5260540&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00533.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5260540 Mon, 26 Sep 2011 04:00:00 +0100 5260540 http://www.medworm.com/index.php?rid=5183919&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00529.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5183919 Thu, 01 Sep 2011 23:00:00 +0100 5183919 http://www.medworm.com/index.php?rid=5260539&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00538.x J Clin Hypertens (Greenwich).Magnesium intake of 500 mg/d to 1000 mg/d may reduce blood pressure (BP) as much as 5.6/2.8 mm Hg. However, clinical studies have a wide range of BP reduction, with some showing no change in BP. The combination of increased intake of magnesium and potassium coupled with reduced sodium intake is more effective in reducing BP than single mineral intake and is often as effective as one antihypertensive drug in treating hypertension. Reducing intracellular sodium and calcium while increasing intracellular magnesium and potassium improves BP response. Magnesium also increases the effectiveness of all antihypertensive drug classes. It remains to be conclusively proven that cardiovascular disease such as coronary heart disease, ischemic stroke, and cardiac arr... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5260539 Thu, 01 Sep 2011 04:00:00 +0100 5260539 http://www.medworm.com/index.php?rid=5237152&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00535.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5237152 Thu, 01 Sep 2011 04:00:00 +0100 5237152 http://www.medworm.com/index.php?rid=5225361&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00528.x J Clin Hypertens (Greenwich).Electronic medical records (EMRs) allow for real‐time access to blood pressure (BP) information on a population basis and improve identification and treatment of individuals with hypertension. Despite the potential uses of the data available from EMRs, relatively little research has examined the reliability of this data. To address this gap, the authors examined the reliability of BP taken at primary care visits and recorded in an EMR with those taken at a research study visit at which standard protocols were used to measure BP among all adults as well as by sex and age. Systolic BP (SBP) averaged 3.7 (17.3) points and diastolic BP (DBP) was 2.8 (10.6) points lower in the EMR than in the study visit across age and sex groups, with all differences statisticall... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5225361 Thu, 01 Sep 2011 04:00:00 +0100 5225361 http://www.medworm.com/index.php?rid=5196265&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00531.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5196265 Wed, 31 Aug 2011 23:00:00 +0100 5196265 http://www.medworm.com/index.php?rid=5161561&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00523.x Although the beneficial effects of lowering salt intake in hypertensive patients are widely appreciated, the impact of promoting dietary salt restriction for blood pressure (BP) reduction at the population level remains controversial. The authors used 24‐hour ambulatory BP monitoring to characterize the determinants of systolic BP (SBP) response to low‐salt intake in a large, relatively healthy Amish population. Patients received a high‐ and low‐sodium diet for 6 days each, separated by a 6‐ to 14‐day washout period. Variance component analysis was used to assess the association of several variables with SBP response to low‐salt diet. Mean SBP was 0.7±5.8 mm Hg and 1.3±6.1 mm Hg lower on the low‐salt compared with the high‐salt diet during daytime (P=.008) and n... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5161561 Tue, 23 Aug 2011 23:00:00 +0100 5161561 http://www.medworm.com/index.php?rid=5161560&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00525.x The association between blood pressure (BP) and cognitive functioning in the elderly is still under debate. Theoretically, high BP could either prevent or enhance cognitive impairment. The authors assessed the changes that took place in BP and cognitive functioning over 6 years. A total of 318 noninstitutional elderly (81% of the survivors) were re‐evaluated. BP was measured and a cognitive test was performed. Elderly patients who had higher systolic BP (SBP) and scored lower on the Mini‐Mental State Examination (MMSE) at baseline were less likely to survive. At follow‐up, the proportion of patients with normal or normalized BP by treatment increased. Considerable changes in SBP were observed. Most cognitive functions declined during follow‐up; however, decline in SBP was associa... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5161560 Tue, 23 Aug 2011 23:00:00 +0100 5161560 http://www.medworm.com/index.php?rid=5161559&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00526.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5161559 Tue, 23 Aug 2011 23:00:00 +0100 5161559 http://www.medworm.com/index.php?rid=5131999&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00520.x Despite the increased risk of myocardial infarction, aortic dissection, and arrhythmias in patients with hypertension who use cocaine, the hemodynamic and arrhythmogenic effects of cocaine use have not been well characterized in this population. The authors hypothesized that patients with hypertension demonstrate extreme, transient changes in arterial pressures as well as new arrhythmic activity during cocaine use. Ambulatory blood pressures, heart rates, and electrocardiograms (AECGs) were recorded for 48 hours in 10 patients with a history of hypertension who smoke cocaine. Active cocaine use was identified through patient diaries and manual activation of the blood pressure cuff. Of the 10 patients studied (6 men, 7 African Americans, age 49±8 years), 8 were taking antihypertensive me... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5131999 Mon, 15 Aug 2011 23:00:00 +0100 5131999 http://www.medworm.com/index.php?rid=5131998&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00521.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5131998 Mon, 15 Aug 2011 23:00:00 +0100 5131998 http://www.medworm.com/index.php?rid=5109324&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00515.x Key Points and Practical Recommendations• β‐Blockers are appropriate treatment for patients with hypertension and those who have concomitant ischemic heart disease, heart failure, obstructive cardiomyopathy, or certain arrhythmias.• β‐Blockers can be used in combination with other antihypertensive drugs to achieve maximal blood pressure control. Labetalol can be used in hypertensive emergencies and urgencies.• β‐Blockers may be useful in patients having hyperkinetic circulation (palpitations, tachycardia, hypertension, and anxiety), migraine headache, and essential tremor.• β‐Blockers are highly heterogeneous with respect to various pharmacologic effects: degree of intrinsic sympathomimetic activity, membrane‐stabilizing activity, β1 selectivity, α1‐adrene... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5109324 Sun, 07 Aug 2011 23:00:00 +0100 5109324 http://www.medworm.com/index.php?rid=5096971&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00510.x J Clin Hypertens (Greenwich).Key Points and Practical Recommendations• α Antagonists lower blood pressure by selectively blocking post‐synaptic α1‐adrenoreceptors, which antagonizes catecholamine‐induced constriction of the arterial and venous vascular beds.• α1‐Adrenoreceptor antagonists are not indicated for initial, first‐line antihypertensive therapy; however, they can be added to most other antihypertensive drug classes in—preferably diuretic‐containing—drug regimens.• When used over time, these agents cause expansion of the extracellular fluid and plasma volumes that typically manifests as weight gain and an attenuation of the blood pressure–lowering efficacy in persons who are consuming usual amounts of dietary sodium.• Utilization of α1‐adren... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5096971 Wed, 03 Aug 2011 23:00:00 +0100 5096971 http://www.medworm.com/index.php?rid=5096970&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00516.x The authors measured the percentage of children aged 6 through 17 whose blood pressure (BP) was not measured during recent nonemergency clinical examination and assessed the relative importance of health, ability‐to‐pay, language, and race‐ethnic factors in determining whether BP was measured. Using a pooled dataset from the Medical Expenditure Panel Survey (MEPS) for 2006 and 2007, the authors calculated the percentage of children whose BP was not measured using a sample of children aged 6 through 17 and constructed a logistic regression model to estimate the relative importance of health, economic, and social factors in the examiner’s decision to measure BP. A total of 28.9% of children did not have their BP measured. Within this unmeasured group, 31% had a family history of hype... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5096970 Wed, 03 Aug 2011 23:00:00 +0100 5096970 http://www.medworm.com/index.php?rid=5183918&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00530.x The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) was a randomized placebo‐controlled trial which clearly demonstrated that perindopril‐based blood pressure (BP)–lowering treatment is one of the most effective and generalizable strategies for secondary prevention of stroke. Beneficial effects of BP lowering were observed on recurrent stroke, other cardiovascular events, disability, dependency, and cognitive function across a variety of subgroups defined by age, sex, geographical region, body mass index, diabetes, atrial fibrillation, chronic kidney disease, and baseline BP levels. Once patients with stroke have stabilized, all patients should receive BP‐lowering therapy irrespective of their BP levels. On the basis of recommendations from current international gu... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5183918 Sun, 31 Jul 2011 23:00:00 +0100 5183918 http://www.medworm.com/index.php?rid=5161558&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00524.x This article will review the evidence behind some available nondrug interventions for the treatment of hypertension. (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5161558 Sun, 31 Jul 2011 23:00:00 +0100 5161558 http://www.medworm.com/index.php?rid=5131997&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00522.x Recently, the authors experienced four patients who had refractory hypertension and neurovascular compression of the rostral ventrolateral medulla (RVLM). One of them, a 49‐year‐old woman, had undergone continuous intravenous drip injections of calcium channel blockers and β‐blockers for more than 3 years because of severe and refractory hypertension. The patients had undergone microvascular decompression (MVD) of the RVLM, and the changes in blood pressure (BP) and sympathetic nerve activities were recorded. In these patients, BP decreased to the normal range without any antihypertensive drugs 2 to 3 months after MVD. The tibial sympathetic nerve activities under resting and stress conditions significantly decreased, and plasma levels of norepinephrine, urinary levels of adrena... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5131997 Sun, 31 Jul 2011 23:00:00 +0100 5131997 http://www.medworm.com/index.php?rid=5109323&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00511.x J Clin Hypertens (Greenwich).Key Points and Practical Recommendations• Mineralocorticoid receptor (MR) antagonists (aldosterone blockers) provide effective antihypertensive treatment, especially in low‐renin and salt‐sensitive forms of hypertension, including resistant hypertension.• Newer, more selective MR antagonists (eg, eplerenone) have fewer of the progestational and antiandrogenic effects than spironolactone, enhancing tolerability and potentially improving adherence to therapy.• MR antagonists provide an additional benefit in the treatment of heart failure when combined with angiotensin‐converting enzyme inhibitors, digoxin, and loop diuretics.• Other potassium‐sparing diuretics (amiloride or triamterene) are generally prescribed for essential hypertension a... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5109323 Sun, 31 Jul 2011 23:00:00 +0100 5109323 http://www.medworm.com/index.php?rid=5096969&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00519.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5096969 Sun, 31 Jul 2011 23:00:00 +0100 5096969 http://www.medworm.com/index.php?rid=5088340&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00527_2.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5088340 Sun, 31 Jul 2011 23:00:00 +0100 5088340 http://www.medworm.com/index.php?rid=5088339&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00527_1.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5088339 Sun, 31 Jul 2011 23:00:00 +0100 5088339 http://www.medworm.com/index.php?rid=5070216&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00503.x J Clin Hypertens (Greenwich).Serum calcium levels have been shown to be associated with cardiovascular disease (CVD); however, it is not clear whether serum calcium levels are related to hypertension, a risk factor for CVD. The authors examined the association between serum calcium and hypertension in a representative sample of US adults. A cross‐sectional study of 12,405 third National Health and Nutrition Examination Survey participants 20 years and older was conducted. Serum total and ionized calcium levels were analyzed as quartiles. The main outcome of interest was hypertension (n=3437), defined as self‐reported use of antihypertensive medication and/or systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Elevated serum total calcium levels were ... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5070216 Tue, 26 Jul 2011 23:00:00 +0100 5070216 http://www.medworm.com/index.php?rid=5070215&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00504.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5070215 Tue, 26 Jul 2011 23:00:00 +0100 5070215 http://www.medworm.com/index.php?rid=5070214&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00505.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5070214 Tue, 26 Jul 2011 23:00:00 +0100 5070214 http://www.medworm.com/index.php?rid=5070213&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00506.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5070213 Tue, 26 Jul 2011 23:00:00 +0100 5070213 http://www.medworm.com/index.php?rid=5070212&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00512.x Key Points and Practical Recommendations• Although chlorthalidone and hydrochlorothiazide are structurally similar, they are very different pharmacokinetically, with chlorthalidone having both an extremely long half‐life (approximately 40 to 60 hours) and a large volume of distribution, with gradual elimination from the plasma compartment by tubular secretion.• Furosemide usage, the most widely used diuretic in the loop diuretic class, can be complicated by extremely erratic absorption, with a bioavailability range of 12% to 112%.• Chlorthalidone, at a dose of 25 mg, is comparatively more potent than 50 mg of hydrochlorothiazide, particularly as related to overnight blood pressure reduction.• In ALLHAT, there was no difference among chlorthalidone, amlodipine, lisin... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5070212 Tue, 26 Jul 2011 23:00:00 +0100 5070212 http://www.medworm.com/index.php?rid=5070211&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00513.x J Clin Hypertens (Greenwich).Key Points and Practical Recommendations• Calcium channel blockers, which dilate arteries by reducing calcium flux into cells, effectively lower blood pressure, especially in combination with other drugs, and some formulations of agents of this class are approved for treating angina or cardiac dysrhythmias.• Calcium channel blockers reduce blood pressure across all patient groups, regardless of sex, race/ethnicity, age, and dietary sodium intake.• Nondihydropyridine calcium channel blockers are more negatively chronotropic and inotropic than the dihydropyridine subclass, which is important for patients with cardiac dysrhythmias or who need β‐blockers.• Extensive experience in comparative randomized trials indicates that an initial calcium ant... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5070211 Tue, 26 Jul 2011 23:00:00 +0100 5070211 http://www.medworm.com/index.php?rid=5070210&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00514.x J Clin Hypertens (Greenwich).Key Points and Practical Recommendations• Aliskiren, the sole oral renin inhibitor approved by the US Food and Drug Administration, is indicated for the treatment of hypertension, either as monotherapy or in combination, with reductions in blood pressure similar to other agents.• Early evidence suggests that aliskiren confers additional benefit in patients with diabetic nephropathy. Data are not yet available to determine whether protection will extend to cardiovascular disease.• No initial dosage adjustment is required in elderly patients or for patients with mild to severe renal impairment; however, clinical experience is limited in patients with significant renal impairment, and with renal artery stenosis.• It appears rational to combine alis... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5070210 Tue, 26 Jul 2011 23:00:00 +0100 5070210 http://www.medworm.com/index.php?rid=5039393&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00484.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5039393 Sun, 17 Jul 2011 23:00:00 +0100 5039393 http://www.medworm.com/index.php?rid=5039392&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00507.x J Clin Hypertens (Greenwich).Key Points and Practical Recommendations• Hydralazine and minoxidil act by dilating resistance arterioles, thus reducing peripheral resistance, with no dilating effect on the venous side of the circulation.• There is a baroreflex‐mediated venoconstriction, resulting in an increase in venous return to the heart, along with a direct catecholamine‐mediated positive inotropic and chronotropic stimulation of the heart.• Hydralazine therapy is usually combined with a sympathetic inhibitor to prevent expression of this reflex, as well as with a diuretic agent to prevent sodium retention caused by reduction in renal perfusion pressure.• Hydralazine is indicated in the long‐term therapy of essential hypertension, in the short‐term therapy of preg... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5039392 Sun, 17 Jul 2011 23:00:00 +0100 5039392 http://www.medworm.com/index.php?rid=5039391&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00508.x J Clin Hypertens (Greenwich).Key Points and Recommendations• In addition to hypertension, angiotensin‐converting enzyme inhibitors are indicated for treatment of patients at high risk for coronary artery disease, after myocardial infarction, with dilated cardiomypathy, or with chronic kidney disease.• The most familiar angiotensin‐converting enzyme subtype, angiotensin‐converting enzyme‐1 (kininase II), cleaves the vasoconstrictor octapeptide angiotensin II from its inactive decapeptide precursor, angiotensin I, while simultaneously inactivating the vasodilator bradykinin.• Biochemical pathways within and around the renin‐angiotensin system are highly species‐specific; there is little evidence that “angiotensin‐converting enzyme bypass pathways” have major cli... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5039391 Sun, 17 Jul 2011 23:00:00 +0100 5039391 http://www.medworm.com/index.php?rid=5030371&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00490.x J Clin Hypertens (Greenwich).Type 2 diabetes mellitus (T2DM) is characterized by progressively worsening hyperglycemia that leads to microvascular and macrovascular complications. Optimal management of T2DM aims to simultaneously control hyperglycemia, hypertension, and dyslipidemia to reduce the overall risk. However, a large proportion of patients in clinical practice do not reach treatment targets. Some of the obstacles to achieving treatment targets include high medication costs, costs associated with health insurance, poor patient adherence to medication, patient fear of potential adverse effects, improper patient education, and failure by health care providers to appropriately initiate or intensify therapy (clinical inertia). Possible causes of clinical inertia include the influence ... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5030371 Wed, 13 Jul 2011 23:00:00 +0100 5030371 http://www.medworm.com/index.php?rid=5030370&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00492.x This study compared the efficacy and safety of combination angiotensin‐receptor blocker (ARB)/calcium‐channel blocker (CCB) with hydrochlorothiazide (valsartan/amlodipine/HCTZ 160/5/25 mg) vs maximal available combination doses of an ARB with HCTZ (losartan/HCTZ 100/25 mg) in the management of stage 2 hypertension. After 1 to 2 weeks of antihypertensive drug washout, patients with a mean sitting systolic blood pressure (MSSBP) of ≥160 mm Hg and <200 mm Hg were randomized to valsartan/amlodipine 160/5 mg (n=241) or losartan 100 mg (n=247). At week 3, HCTZ 25 mg was added to both treatments. The primary end point, reduction in MSSBP from baseline to week 6, was significantly greater in the valsartan/amlodipine group than in the losartan group (least‐squares [... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5030370 Wed, 13 Jul 2011 23:00:00 +0100 5030370 http://www.medworm.com/index.php?rid=5030369&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00495.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5030369 Wed, 13 Jul 2011 23:00:00 +0100 5030369 http://www.medworm.com/index.php?rid=5030368&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00496.x J Clin Hypertens (Greenwich).The purpose of the study was to investigate blood pressure (BP) distribution, prevalence of hypertension, and correlation between BP and body mass index (BMI) in 9‐ to 10‐year‐old Icelandic children. Two manual and two automated BP measurements were performed in 1071 Icelandic children. Children with elevated BP underwent a second BP screening, and a third screening was performed if the BP was elevated at the second visit. Hypertension was defined as BP ≥95th percentile at all three visits. White‐coat hypertension was diagnosed in hypertensive children with normal 24‐hour ambulatory BP. Of 970 children with complete data, 489 were girls (50.4%). The mean BP was 111/63 mm Hg in girls and 112/64 mm Hg in boys (P<.001). The prevalence of elevate... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5030368 Wed, 13 Jul 2011 23:00:00 +0100 5030368 http://www.medworm.com/index.php?rid=5030367&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00497.x J Clin Hypertens (Greenwich).Patients’ knowledge concerning high blood pressure (HBP) is a useful outcome measure in HBP education programs. However, valid and easy‐to‐use HBP knowledge assessment tools are scarce. The purpose of the study was to validate the HBP Knowledge Test (HKT) in two independent samples of Korean Americans with HBP (N=885). A total of 61% of the sample were women with a mean age of about 61 years (standard deviation=11.0) and 44% reported some college education or greater. Psychometric and item response theory analyses identified 21 items that fit a unidimensional model to form the HKT. Internal consistency was acceptable, with Cronbach’s α=0.70. Construct validity testing revealed that patients with controlled BP had significantly higher HKT scores than ... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5030367 Wed, 13 Jul 2011 23:00:00 +0100 5030367 http://www.medworm.com/index.php?rid=5030366&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00498.x J Clin Hypertens (Greenwich).This 16‐week trial investigated the efficacy and safety of single‐pill valsartan/hydrochlorothiazide (HCTZ) vs the individual components in patients 70 years and older with systolic hypertension. Patients were randomized to valsartan/HCTZ 160/12.5 mg (n=128), HCTZ 12.5 mg (n=128), or valsartan 160 mg (n=128) for 4 weeks. Patients whose blood pressure (BP) was ≥140/90 mm Hg at weeks 4, 8, or 12 were up‐titrated to a maximum of valsartan/HCTZ 320/25 mg. Week 4 systolic BP reduction (primary efficacy outcome) was greater with valsartan/HCTZ than valsartan (−17.3 mm Hg vs −8.6 mm Hg, P <.0001) but only marginally greater than HCTZ (−13.6 mm Hg, P =.096). Median time to BP control was shorter with valsartan/HCTZ (4 ... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5030366 Wed, 13 Jul 2011 23:00:00 +0100 5030366 http://www.medworm.com/index.php?rid=5030365&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00499.x J Clin Hypertens (Greenwich).The authors evaluated the blood pressure (BP)–lowering effects of combination valsartan/hydrochlorothiazide (HCTZ) vs amlodipine/HCTZ in a 16‐week, double‐blind, randomized, forced‐titration study and ambulatory BP monitoring (ABPM) substudy involving centrally obese hypertensive patients 40 years and older. Patients were started on valsartan/HCTZ 160/12.5 mg or HCTZ 12.5 mg monotherapy, force‐titrated at week 4 to valsartan/HCTZ 320/25 mg and HCTZ 25 mg, respectively. The HCTZ group initiated amlodipine 5 mg at week 8 and 10 mg at week 12. A subset of patients had 24‐hour ABPM at baseline and weeks 8 and 16. At week 16 in the intent‐to‐treat population (n=401), valsartan/HCTZ and amlodipine/HCTZ lowered office systolic BP (−30.6... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5030365 Wed, 13 Jul 2011 23:00:00 +0100 5030365 http://www.medworm.com/index.php?rid=5030364&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00494.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5030364 Wed, 13 Jul 2011 23:00:00 +0100 5030364 http://www.medworm.com/index.php?rid=5030363&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00500.x J Clin Hypertens (Greenwich).Sleep is a contributing factor to optimal health and vitality. However, to date, no national study has evaluated the simultaneous relationship between sleep disorders, quality, and duration with hypertension. Using data from National Health and Nutrition Examination Survey (NHANES) (2005 to 2008), hypertension was defined by current use of antihypertensive medication or systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Self‐reported sleep disorders and duration were categorized from a single household interview question, and sleep quality was determined from several questions on sleeping habits. The prevalence of hypertension was 30.2% and 7.5%, and 33.0% and 52.1% reported having sleep disorders, short sleep, and poor sleep,... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5030363 Wed, 13 Jul 2011 23:00:00 +0100 5030363 http://www.medworm.com/index.php?rid=5030362&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00501.x J Clin Hypertens (Greenwich).The authors investigated whether high‐density lipoprotein (HDL) cholesterol plays a role in arterial stiffening and left diastolic dysfunction in essential hypertension. Carotid arterial stiffness parameter and left ventricular (LV) diastolic function index were evaluated in 217 patients with essential hypertension. The correlations of dyslipidemia, especially low HDL cholesterol, to LV diastolic function and arterial stiffness were investigated in these patients. Arterial stiffness parameter increased with the increasing of E/Em (LV diastolic function index: the ratio of transmitral peak velocity of early filling to peak early diastolic motion velocity of mitral annulus) (r=0.26, P<.01). In univariate regression analysis, HDL cholesterol was inversely ass... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5030362 Wed, 13 Jul 2011 23:00:00 +0100 5030362 http://www.medworm.com/index.php?rid=5020636&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00489.x J Clin Hypertens (Greenwich).Mercury has a high affinity for sulfhydryl groups, inactivating numerous enzymatic reactions, amino acids, and sulfur‐containing antioxidants (N‐acetyl‐L‐cysteine, alpha‐lipoic acid, L‐glutathione), with subsequent decreased oxidant defense and increased oxidative stress. Mercury binds to metallothionein and substitute for zinc, copper, and other trace metals, reducing the effectiveness of metalloenzymes. Mercury induces mitochondrial dysfunction with reduction in adenosine triphosphate, depletion of glutathione, and increased lipid peroxidation. Increased oxidative stress and reduced oxidative defense are common. Selenium and fish containing omega‐3 fatty acids antagonize mercury toxicity. The overall vascular effects of mercury include increased... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5020636 Sun, 10 Jul 2011 23:00:00 +0100 5020636 http://www.medworm.com/index.php?rid=5020635&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00491.x J Clin Hypertens (Greenwich).The Hypertension Initiative began in 1999 to help transition South Carolina from a leader in cardiovascular disease (CVD) to a model of heart and vascular health. Goals were to reduce heart disease and stroke by 50% by promoting healthy lifestyles and access to effective care and medications. Continuing medical education was used to train providers, encourage physicians to become American Society of Hypertension (ASH)–certified hypertension specialists and recruit practices into the community‐based practice network (CBPN). Practice data audit with provider specific feedback is a key quality improvement tool. With ASH support, the CBPN has grown to 197 practices with approximately 1.6 million patients (approximately 700,000 hypertensives). Clinical data ar... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5020635 Sun, 10 Jul 2011 23:00:00 +0100 5020635 http://www.medworm.com/index.php?rid=5070209&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00518.x J Clin Hypertens (Greenwich).Key Points and Practical Recommendations• The angiotensin receptor blockers are highly effective antihypertensive agents that are also particularly well tolerated.• There are no major differences in efficacy or other clinical characteristics among older drugs in this class, although some of the newer agents may more effectively reduce blood pressure than older agents.• Major randomized clinical trials have demonstrated that angiotensin receptor blockers provide significant outcomes benefits in conditions such as diabetic nephropathy, chronic heart failure or heart failure following myocardial infarction, hypertension with left ventricular hypertrophy and in patients whose histories of previous events or complicated diabetes puts them at high cardiov... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5070209 Thu, 30 Jun 2011 23:00:00 +0100 5070209 http://www.medworm.com/index.php?rid=5039395&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00517_2.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5039395 Thu, 30 Jun 2011 23:00:00 +0100 5039395 http://www.medworm.com/index.php?rid=5039394&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00517_1.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5039394 Thu, 30 Jun 2011 23:00:00 +0100 5039394 http://www.medworm.com/index.php?rid=5039390&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00509.x J Clin Hypertens (Greenwich).Key Points• Central sympatholytic drugs reduce blood pressure mainly by stimulating central α2‐adrenergic receptors in the brainstem centers, thereby reducing sympathetic nerve activity and neuronal release of norepinephrine to the heart and peripheral circulation.• This class of drugs, however, is currently used mainly as fourth‐line (or beyond) drug therapy for hypertension because of side effects of drowsiness, fatigue, and dry mouth.• Rebound hypertension is also another major concern in certain drugs with a short half‐life, particularly in patients who are nonadherent to the regimen. Therefore, their use on a “PRN” basis for treatment of blood pressure surge in the absence of symptoms or acute target complications should also be avoi... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5039390 Thu, 30 Jun 2011 23:00:00 +0100 5039390 http://www.medworm.com/index.php?rid=4977630&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00477.x This study was composed of a largely urban African American cohort of hypertensive patients. This was a prospective, 4‐arm, randomized controlled trial designed to evaluate the comparative effectiveness of both physician and patient education (PPE), patient education only (PAE), and physician education only (PHE) vs usual care (UC). Hypertension specialists gave a series of didactic lectures to the physicians, while a nurse educator performed the patient education. The mean adjusted difference in systolic blood pressure (SBP) from baseline in the PPE group was an average reduction of 12 mm Hg (95% confidence interval [CI], −4.5 to −19.4) at 6‐months, followed by average reductions of 4.6 mm Hg (6.9 to −16.12) in the PAE group, 4.1 mm Hg (3.4 to −11.7) in the PHE gro... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4977630 Mon, 27 Jun 2011 23:00:00 +0100 4977630 http://www.medworm.com/index.php?rid=4970266&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00476.x J Clin Hypertens (Greenwich).Hypertensive emergencies (HEs) are frequently accompanied with the release of cardiac troponin I (cTnI); however, determinants and clinical significance of cTnI elevation are largely unknown. A retrospective analysis was performed on patients (n=567) with a diagnosis of HE admitted to two tertiary care centers that primarily serve an inner‐city population. Data on demographics, clinical variables, and cTnI were collected through chart review. Using regression analyses, predictors of cTnI elevation were studied and the impact of cTnI on all‐cause mortality (data obtained through the Social Security Death Index) was determined. cTnI elevation was observed in 186 (32.3%) admissions with a mean peak cTnI level of 4.06±14.6 ng/mL. Predictors of cTnI were age,... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4970266 Sun, 26 Jun 2011 23:00:00 +0100 4970266 http://www.medworm.com/index.php?rid=4970265&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00480.x J Clin Hypertens (Greenwich).Failure of blood pressure (BP) to decline appropriately overnight (nondipping) is associated with increased risk. This may be due to inappropriately raised supine central BP and this study’s first aim was to examine this hypothesis. Secondly, aortic stiffness, central hemodynamics, and left ventricular (LV) mass were measured as other possible mechanisms of higher risk. Brachial and central BP (supine and seated), aortic stiffness, central hemodynamics, and LV dimensions were measured in 95 patients with hypertension (mean age 62±8 standard deviation). Central hemodynamics were recorded by combined radial tonometry and 3‐dimensional echocardiography. Seated brachial and central systolic BP (SBP) were similar between dippers (n=52) and nondippers (n=43). Ho... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4970265 Sun, 26 Jun 2011 23:00:00 +0100 4970265 http://www.medworm.com/index.php?rid=4970264&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00485.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4970264 Sun, 26 Jun 2011 23:00:00 +0100 4970264 http://www.medworm.com/index.php?rid=4970263&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00487.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4970263 Sun, 26 Jun 2011 23:00:00 +0100 4970263 http://www.medworm.com/index.php?rid=4946503&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00481.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4946503 Sun, 19 Jun 2011 23:00:00 +0100 4946503 http://www.medworm.com/index.php?rid=4946502&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00482.x J Clin Hypertens (Greenwich).Azilsartan medoxomil (AZL‐M) is a unique angiotensin II receptor blocker (ARB) under development for the treatment of hypertension. To compare this ARB with another in the class, the authors studied the effects of AZL‐M and valsartan (VAL) in 984 patients with primary hypertension in a randomized, double‐blind, multicenter study using ambulatory and clinic blood pressure (BP) measurements. The primary end point was change from baseline in 24‐hour mean ambulatory systolic BP following 24 weeks of treatment. Hierarchical analysis testing for noninferiority was followed by superiority testing of AZL‐M (80 mg then 40 mg) vs VAL. The mean age of participants was 58 years, 52% were men, and 15% were black. Baseline 24‐hour mean systolic BP was similar... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4946502 Sun, 19 Jun 2011 23:00:00 +0100 4946502 http://www.medworm.com/index.php?rid=4946501&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00483.x J Clin Hypertens (Greenwich).Initial multiple drug therapy for hypertension achieves greater and quicker reductions and higher blood pressure (BP) control rates than monotherapy. This 8‐week, prospective, multicenter, randomized, double‐blind study compared the efficacy and safety of the initial combination of aliskiren/amlodipine with amlodipine monotherapy in African Americans with stage 2 hypertension. After a 1‐ to 4‐week washout, patients received aliskiren/amlodipine 150/5 mg or amlodipine 5 mg for 1 week and then were force‐titrated to aliskiren/amlodipine 300/10 mg or amlodipine 10 mg for 7 weeks. At week 8, greater reductions in mean sitting systolic BP were obtained with aliskiren/amlodipine (n=220) than with amlodipine (n=223) (least squares mean change [st... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4946501 Sun, 19 Jun 2011 23:00:00 +0100 4946501 http://www.medworm.com/index.php?rid=5030361&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00502.x J Clin Hypertens (Greenwich).This post hoc analysis assessed the efficacy and tolerability of valsartan for the treatment of hypertension in obese vs non‐obese children and adolescents. After a 1‐week antihypertensive washout period, 142 obese and 119 non‐obese hypertensive children and adolescents aged 6 to 16 years were randomized to 2 weeks of once‐daily treatment with valsartan 10 to 20 mg, 40 to 80 mg, or 80 to 160 mg, followed by re‐randomization to either valsartan or placebo for an additional 2 weeks. Patients could continue to receive valsartan during an optional 52‐week, open‐label extension. Valsartan resulted in statistically significant (P<.05) and clinically relevant reductions in mean sitting blood pressure (BP), ranging from approximately 7/4 mm H... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5030361 Tue, 31 May 2011 23:00:00 +0100 5030361 http://www.medworm.com/index.php?rid=5020634&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00493.x J Clin Hypertens (Greenwich).Cerebral microangiopathy is a cause of cognitive impairment and indicates high risk for clinically overt cerebrovascular disease. It develops in patients with or without hypertension, and different pathologies may play a supporting role. In this pilot study, the authors aimed to elucidate risk factors contributing to the deleterious action of hypertension on cerebral small vessels. A cross‐sectional study in 42 patients with treatment‐resistant hypertension was performed. Microangiopathy was investigated by cerebral magnetic resonance imaging (MRI). Determinants were identified by clinical investigation, computed tomography, intima‐media thickness and pulse wave velocity measurement, and urinary albumin excretion. Nineteen of 42 patients had cerebral micr... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=5020634 Tue, 31 May 2011 23:00:00 +0100 5020634 http://www.medworm.com/index.php?rid=4977629&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00478.x J Clin Hypertens (Greenwich). ****;**:**–**.Hypertension is prevalent in the United States and remains uncontrolled. The primary objective of the study was to determine the effect of once‐daily dosing of a combination therapy for blood pressure (BP) and dyslipidemia using home BP monitoring on reaching clinical BP and the effect of daily dosing of combination therapy on reaching lipid goals. The study was conducted in middle‐aged, indigent, African Americans who had high‐risk, resistant hypertension and dyslipidemia. Patients were randomly assigned to either the home and clinic BP group or usual care group and were followed for 6 months. The average BPs for each group were compared and used to titrate the study drug appropriately. Both groups achieved significant declines in BP, ... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4977629 Tue, 31 May 2011 23:00:00 +0100 4977629 http://www.medworm.com/index.php?rid=4970262&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00479.x J Clin Hypertens (Greenwich).This paper reports the results of a clinical investigation to determine the sustainability of intervention effects to lower blood pressure (BP) that were obtained through a short‐term education via home telemonitoring of BP and regular counseling by bilingual nurses during 1 year. A total of 359 middle‐aged (40–64 years) Korean immigrants completed a 15‐month intervention that consisted of 6‐week behavioral education followed by home telemonitoring of BP and bilingual nurse telephone counseling for 12 months. The final analysis revealed a sharp increase in BP control rates sustained for more than 12 months. At baseline, only 30% of the sample achieved BP control (<140/90 mm Hg). After the initial education period (approximately 3 mont... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4970262 Tue, 31 May 2011 23:00:00 +0100 4970262 http://www.medworm.com/index.php?rid=4946500&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00486.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4946500 Tue, 31 May 2011 23:00:00 +0100 4946500 http://www.medworm.com/index.php?rid=4936820&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00475.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4936820 Tue, 31 May 2011 23:00:00 +0100 4936820 http://www.medworm.com/index.php?rid=4913545&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00488.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4913545 Tue, 31 May 2011 23:00:00 +0100 4913545 http://www.medworm.com/index.php?rid=4913544&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00470.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4913544 Tue, 31 May 2011 23:00:00 +0100 4913544 http://www.medworm.com/index.php?rid=4864054&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00474.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4864054 Sat, 30 Apr 2011 23:00:00 +0100 4864054 http://www.medworm.com/index.php?rid=4782468&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00473_2.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4782468 Sat, 30 Apr 2011 23:00:00 +0100 4782468 http://www.medworm.com/index.php?rid=4782467&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00473_1.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4782467 Sat, 30 Apr 2011 23:00:00 +0100 4782467 http://www.medworm.com/index.php?rid=4782466&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00466.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4782466 Sat, 30 Apr 2011 23:00:00 +0100 4782466 http://www.medworm.com/index.php?rid=4735992&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00464.x J Clin Hypertens (Greenwich).The authors analyzed data on 9950 participants taking antihypertensive medications in the nationwide Reasons for Geographic and Racial Differences in Stroke (REGARDS) study to determine the association between medication adherence and incident stroke symptoms. Medication adherence was assessed using a validated 4‐item self‐report scale and participants were categorized into 4 groups (scores of 0, 1, 2, and 3 or 4, with higher scores indicating worse adherence). The incidence of 6 stroke symptoms (sudden weakness on one side of the body, numbness, painless loss of vision in one or both eyes, loss of half vision, losing the ability to understand people, and losing the ability to express oneself verbally or in writing) was assessed via telephone interviews eve... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4735992 Thu, 21 Apr 2011 23:00:00 +0100 4735992 http://www.medworm.com/index.php?rid=4735991&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00465.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4735991 Thu, 21 Apr 2011 23:00:00 +0100 4735991 http://www.medworm.com/index.php?rid=4735990&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00468.x J Clin Hypertens (Greenwich).An 8‐week, randomized, double‐blind, controlled study with single‐pill combinations of telmisartan 40 mg or 80 mg/amlodipine 5 mg (T40/A5 or T80/A5) vs monotherapy with amlodipine 5 mg or 10 mg (A10) in 1097 patients with uncontrolled hypertension (diastolic blood pressure [BP] ≥90 mm Hg). T40/A5 and T80/A5 resulted in significantly greater (P<.0001) reductions in seated trough systolic/diastolic BP vs A5 (−7.4 mm Hg/−3.6 mm Hg; −8.8 mm Hg/−4.9 mm Hg) and a significantly greater (P<.001) proportion of patients achieving systolic/diastolic BP goal rate (60.0%/56.7%; 65.7%/63.8%) vs A5 (39.2%/42.0%). Superior BP reductions were also seen with T40‐T80/A5 vs A10, with BP goal rates at least as high as with A10; however, the... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4735990 Thu, 21 Apr 2011 23:00:00 +0100 4735990 http://www.medworm.com/index.php?rid=4735989&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00469.x This study evaluated its effectiveness in reducing patients’ blood pressure for the sessions occurring from 2003 to 2007. Using the Hypertension Initiative Database, 8183 patients of CME providers (CME patients) were paired with controls and changes in blood pressure, provider visits, prescription months, and the proportion of patients with blood pressure <140/90 mm Hg before and after the intervention date were estimated. In the 2‐year period before training and the 2‐year period afterwards, CME patients’ systolic blood pressure decreased by 1.99 mm Hg and diastolic blood pressure decreased by 1.49 mm Hg. The CME patients displayed an increase in provider visits but no statistically significant change in prescription months. Restricting the analysis to the subsample... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4735989 Thu, 21 Apr 2011 23:00:00 +0100 4735989 http://www.medworm.com/index.php?rid=4735995&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00463.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4735995 Wed, 20 Apr 2011 23:00:00 +0100 4735995 http://www.medworm.com/index.php?rid=4735994&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00467.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4735994 Wed, 20 Apr 2011 23:00:00 +0100 4735994 http://www.medworm.com/index.php?rid=4735993&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00471.x J Clin Hypertens (Greenwich).Hypertension is associated with increased left ventricular mass (LVM) and carotid intima‐media thickness (cIMT), which predict cardiovascular (CV) events in adults. Whether target organ damage is found in pre‐hypertensive youth is not known. The authors measured body mass index, blood pressure, fasting glucose, insulin, lipids and C‐reactive protein, LVM/height2.7 (LVM index), diastolic function, cIMT, carotid stiffness, augmentation index, brachial artery distensibility, and pulse wave velocity (PWV) in 723 patients aged 10 to 23 years (29% with type 2 diabetes mellitus). Patients were stratified by blood pressure level (normotensive: 531, pre‐hypertensive: 65, hypertensive: 127). Adiposity and CV risk factors worsened across blood pressure group. Th... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4735993 Wed, 20 Apr 2011 23:00:00 +0100 4735993 http://www.medworm.com/index.php?rid=4735988&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00470.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4735988 Thu, 31 Mar 2011 23:00:00 +0100 4735988 http://www.medworm.com/index.php?rid=4686270&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00472_2.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686270 Thu, 31 Mar 2011 23:00:00 +0100 4686270 http://www.medworm.com/index.php?rid=4686269&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00472_1.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686269 Thu, 31 Mar 2011 23:00:00 +0100 4686269 http://www.medworm.com/index.php?rid=4686268&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00442.x Treatment of blood pressure in the patient with diabetes remains a challenge. While data extrapolated from many trials seemed to imply that lower blood pressures leads to more favorable cardiovascular outcomes, this paper reviews newer trials designed to treat to blood pressure targets below 130/80 mmHg in patients with long term established diabetes, which showed that this goal may prove more harmful than helpful. In clinical practice this may be less relevant due to the fact that less than half of patients are even at the goal of 130/80. The interaction between glucose control and blood pressure control are also discussed, emphasizing the importance of multifactorial treatment. J Clin Hypertens (Greenwich). 2011;13:314–318. © 2011 Wiley Periodicals, Inc. (Source: The Journal of Clin... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686268 Thu, 31 Mar 2011 23:00:00 +0100 4686268 http://www.medworm.com/index.php?rid=4686267&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00431.x Cardiovascular disease (CVD) remains the main cause of mortality and morbidity in patients with diabetes. Prevention of CVD in diabetes involves a multifactorial approach that aims to treat the cluster of risk factors including hyperglycemia, dyslipidemia, obesity, hypertension, and hypercoagulation associated with this condition. Antiplatelets reduce the prothrombotic environment in diabetes, but complications of this therapeutic approach include a general risk of bleeding, specifically intracranial hemorrhage, the risk of which increases in the presence of hypertension. Current guidelines recommend the use of antiplatelet agents after tight control of blood pressure, which, in clinical practice, is not always possible. In this review, the evidence for antiplatelet use in diabetes with pa... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686267 Thu, 31 Mar 2011 23:00:00 +0100 4686267 http://www.medworm.com/index.php?rid=4686266&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00450.x Many small studies with varied surrogate end points and numerous preclinical data have suggested the likelihood of there being specific benefits that exceed simple blood pressure control with drug classes such as angiotensin‐converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers, which may be particularly relevant to the patient with diabetes and hypertension. Large clinical trials, however, have provided only token support for this idea. Likewise, meta‐analyses that have incorporated varied clinical trials, albeit with somewhat heterogeneous data, have not been particularly forthcoming in their support of this concept. In the patient with diabetes and hypertension, tight blood pressure control, more so than using a specific drug class, is the most im... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686266 Thu, 31 Mar 2011 23:00:00 +0100 4686266 http://www.medworm.com/index.php?rid=4686265&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00454.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686265 Thu, 31 Mar 2011 23:00:00 +0100 4686265 http://www.medworm.com/index.php?rid=4686264&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00447.x There are more clinical trials investigating angiotensin receptor blockers (ARBs) in diabetes than any other drug class, ranging from early “prevention” trials to the treatment of individuals with advanced organ damage. In its earliest manifestations, visceral adiposity predisposes to hypertension and hyperglycemia (metabolic syndrome). In these individuals, ARB therapy delays the progression to chronic hypertension and may also delay the progression to overt diabetes. Based on the increased cardiovascular disease risk of the metabolic syndrome, which is similar to stage 1 hypertension, both lifestyle modification and ARB therapy are justifiable. ARB therapy has also been found to delay the onset of microalbuminuria and retinopathy. In established diabetic nephropathy, ARB therapy is r... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686264 Thu, 31 Mar 2011 23:00:00 +0100 4686264 http://www.medworm.com/index.php?rid=4686263&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00448.x Hypertension is common in patients with diabetes mellitus and is a main cause of renal and cardiovascular complications. There has been recent controversy on what should be considered the optimal blood pressure goal and the optimal antihypertensive agent. It has become apparent that one blood pressure does not fit all in diabetic patients. Major confounders are preexisting cardiovascular disease and presence or absence of proteinuric kidney disease. In proteinuric diabetic nephropathy, renin‐angiotensin system blockade is clearly indicated, but monotherapy is practically always insufficient to achieve target blood pressure values. J Clin Hypertens (Greenwich). 2011;13:285–289. © 2011 Wiley Periodicals, Inc. (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686263 Thu, 31 Mar 2011 23:00:00 +0100 4686263 http://www.medworm.com/index.php?rid=4686262&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00440.x Hypertensive disorders of pregnancy (HDP), including pre‐existing hypertension, gestational hypertension, and preeclampsia, further complicate already high‐risk pregnancies in women with diabetes mellitus (DM). Women with both pre‐existing and gestational diabetes are at increased risk for HDP, leading to higher maternal and fetal morbidity. Further, particularly in diabetic women and women with a history of gestational diabetes, HDP significantly increases the risk for future cardiovascular events. For clinicians, women with hypertension and diabetes during pregnancy pose a management challenge. Specifically, preconception management should stress strict control of glycemia, blood pressure, and prevention of diabetic complications, specifically nephropathy, which specifically increa... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686262 Thu, 31 Mar 2011 23:00:00 +0100 4686262 http://www.medworm.com/index.php?rid=4686261&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00451.x Patients with prediabetes have impaired fasting glucose, impaired glucose tolerance, and the metabolic syndrome. They have similar coronary heart disease risk rates as patients with type 2 diabetes. Goals and agents for blood pressure and lipid management should be the same for patients with prediabetes as those for patients with overt diabetes. Multiple antihypertensive agents are likely necessary for normotension. Aggressive statin usage is the first‐line lipid therapy and concomitant fibrate and nicotinic acid usage should be reserved for failures in primary prevention. J Clin Hypertens (Greenwich). 2011;13:270–274. © 2011 Wiley Periodicals, Inc. (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686261 Thu, 31 Mar 2011 23:00:00 +0100 4686261 http://www.medworm.com/index.php?rid=4686260&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00441.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686260 Thu, 31 Mar 2011 23:00:00 +0100 4686260 http://www.medworm.com/index.php?rid=4686259&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00429.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686259 Thu, 31 Mar 2011 23:00:00 +0100 4686259 http://www.medworm.com/index.php?rid=4686258&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2010.00415.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686258 Thu, 31 Mar 2011 23:00:00 +0100 4686258 http://www.medworm.com/index.php?rid=4686257&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00430.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686257 Thu, 31 Mar 2011 23:00:00 +0100 4686257 http://www.medworm.com/index.php?rid=4686256&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00446.x The authors concisely review the main clinical issues arising in the management of the hypertensive patient with type 2 diabetes, in whom chronic kidney disease is prevalent and heralds increased cardiovascular morbidity and mortality. Special attention is paid to the clinical meaning, relevance and limits of albumin excretion and glomerular filtration rate, the two widely used markers of reduced kidney function during the course of chronic diseases like diabetes and hypertension. The main therapeutic strategies involving blood pressure and glycemic control, treatment of dyslipidemia and improvement of lifestyle are discussed from the viewpoint of a general practitioner dealing with the clinical complexity of these patients. J Clin Hypertens (Greenwich). 2011;13:252–257. © 2011 Wiley Pe... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686256 Thu, 31 Mar 2011 23:00:00 +0100 4686256 http://www.medworm.com/index.php?rid=4686255&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00434.x Up to 75% of adults with diabetes also have hypertension, and patients with hypertension alone often show evidence of insulin resistance. Thus, hypertension and diabetes are common, intertwined conditions that share a significant overlap in underlying risk factors (including ethnicity, familial, dyslipidemia, and lifestyle determinants) and complications. These complications include microvascular and macrovascular disorders. The macrovascular complications, which are well recognized in patients with longstanding diabetes or hypertension, include coronary artery disease, myocardial infarction, stroke, congestive heart failure, and peripheral vascular disease. Although microvascular complications (retinopathy, nephropathy, and neuropathy) are conventionally linked to hyperglycemia, studies h... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686255 Thu, 31 Mar 2011 23:00:00 +0100 4686255 http://www.medworm.com/index.php?rid=4686254&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00439.x Insulin resistance plays a major role in the pathogenesis and clinical course of patients with type 2 diabetes (2DM) and essential hypertension. However, the syndromes differ in prevalence of insulin resistance, and associated insulin secretory response. Essentially all patients with type 2 diabetes are insulin resistant, whereas only approximately 50% of those with essential hypertension are insulin resistant. Furthermore, 2DM develops when the pancreatic β‐cell can no longer maintain the degree of compensatory hyperinsulinemia needed to prevent hyperglycemia. In contrast, the compensatory hyperinsulinemia that prevents most insulin resistant individuals from developing 2DM acts on normally insulin sensitive tissues in a manner that predisposes to the development of essential hypertens... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686254 Thu, 31 Mar 2011 23:00:00 +0100 4686254 http://www.medworm.com/index.php?rid=4686253&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00449.x Activation of the renin‐angiotensin‐aldosterone system (RAAS) is the primary etiologic event in the development of hypertension in people with diabetes mellitus. Modulation of the RAAS has been shown to slow the progression and even cause regression of the microvascular and macrovascular complications associated with diabetes mellitus. Early pharmacotherapy with agents that decrease RAAS activation in the adipose tissue have had a dramatic impact on the prevalence of diabetes related complications. Recent data show that preventing the development of “angry fat” can prevent not just hypertension but also type 2 diabetes mellitus and its associated complications. This review updates what is known about angry fat and the role of RAAS inhibition in preventing the metabolic sequelae of ... The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686253 Thu, 31 Mar 2011 23:00:00 +0100 4686253 http://www.medworm.com/index.php?rid=4686252&cid=s_38737_7_f&fid=38737&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1751-7176.2011.00453.x (Source: The Journal of Clinical Hypertension) The Journal of Clinical Hypertension journals http://www.medworm.com/rss/comments.php?id=4686252 Thu, 31 Mar 2011 23:00:00 +0100 4686252