Antihypertensive Requirements Research Articles

PREVALENCE OF HYPERTENSION IN LOW FLUX VERSUS HIGH FLUX MODALITIES OF MAINTENANCE HEMODIALYSIS - A COMPARATIVE STUDY

Background:Hypertension is common in patients on dialysis. Hemodialysis dialyzer membrane may me either High-flux or Low-flux type and biocompatibility of membranes also may be less or more in both these types. There has been no study comparing the control of hypertension across these Low and High-flux modalities with use of same Ultrapure water and same High biocompatible membrane for both the modalities. Methods: Pre-dialytic BP has been recorded one hour before starting and Post-dialytic BP two hours after finishing Hemodialysis. Intra-dialytic BP has been measured at every 30 minutes interval. All BP recordings have been done for all patients for five hemodialysis sessions and recordings are compared. Number of antihypertensive drugs required in each group have been compared. Fluid overload causing hypertension have been excluded by excluding Intra-Dialytic Weight Gain more than 4.5%. Results:While comparing Pre-dialytic, Intra-dialytic and Post-dialytic BP across Low and High-flux modalities, the p value obtained in each of the case was greater than 0.05, and requirement of antihypertensive drugs and Intra-Dialytic Weight Gain also have no significant difference across these Low and High-flux modalities. Conclusions:It has been concluded from this study that both the Low flux and High flux modalities of hemodialysis are equally efficacious in terms of BP control when same Ultrapure water and High biocompatible membrane is used, and there is no difference in requirement of antihypertensive drugs and Intra-Dialytic Weight Gain across these two modalities.

A PREDICTIVE TOOL FOR FORECASTING ANTI-HYPERTENSION MEDICATION REQUIREMENTS IN LOW- AND MIDDLE-INCOME COUNTRIES

Objective: To develop a mathematical tool for estimating medication requirement that would improve the uninterrupted supply of medications for large-scale hypertension control programs in low- and middle-income countries. Design and method: In a steady state, annual drug procurement forecasts can simply replicate the previous year's consumption. For a new or rapidly growing hypertension control program, however, forecasting drug requirement requires consideration of not only patients currently on medication, but also rates of new patient registration and drop-out. To forecast antihypertensive drug requirements, a simple mathematical tool was developed based on the morbidity method, requiring minimal inputs and assumptions. The tool hinges on use of a standard step-wise treatment protocol which uses specific medications and doses and considers hypertension prevalence, number of existing patients, expected new monthly enrollments, proportion of patients with controlled blood pressure at each protocol step, and expected loss-to-follow up over time. Outputs include forecasted quantities of specific medications for any specific time period and associated budgets. The tool provides flexibility for correction of projected requirements based on programmatic data, thus making the estimation more accurate. Results: The tool was implemented in an Indian hypertension control program starting with a priori assumptions and refined iteratively as program data became available. It was customised for use in specific Indian states based on their treatment protocol, population size and primary health care coverage. The monthly drug requirement projected by the tool helped to quantify drug volumes for periodic procurement, and to overcome shortages observed in some areas in first year of the program. More than 10 states in India have adopted this tool for procurement and budget planning. Conclusions: This simple, pragmatic antihypertension drug forecasting tool can help ensure prudent resource allocation in hypertension control programs and facilitate reliable delivery of medications for patients in low- and middle-income countries. This tool can also quantify the financial implications of alternative treatment protocols, inform protocol design, and be adapted to other chronic disease control programs.

Efficacy of percutaneous renal revascularization in resistant hypertension patients

Background: Renovascular hypertension is one of the most common potentially curable types of secondary hypertension. Medical therapy alone does not inhibit the progressive loss of renal function. The aim of the present study was to evaluate the efficacy of percutaneous renal revascularization in resistant hypertension patients. Methods: Forty-two patients aged ≥ 45 years with resistant hypertension having renal artery stenosis (>50% luminal narrowing assessed by quantitative renal angiography) undergoing percutaneous transluminal renal angioplasty (PTRA) were included in the study. The primary outcome measures were a response of blood pressure (BP) and the requirement of the number of hypertensive drugs, whereas the secondary outcome measure was to study the correlation of renal vein renin levels (RVRLs) with postrenal angioplasty BP response. Chi-square/Fisher's exact test and unpaired t-test were used to compare qualitative and quantitative variables, respectively. A paired t-test was used for intragroup comparison. Results: The mean systolic BP at 6-month follow-up (159.5 mmHg) was significantly less as compared to baseline (181.3 mmHg) (P = 0.0001). The mean diastolic BP at 6-month follow-up (94.4 mmHg) was significantly less as compared to baseline (106.5 mmHg) (P = 0.0001). The mean number of antihypertensive drugs used at the baseline and 6-month follow-up was 3.4 and 1.8, respectively, which was statistically significant (P = 0.001). There was no significant correlation of RVRL with postrenal angioplasty BP response. Conclusions: In patients with resistant hypertension, PTRA improved BP control and reduced the requirement of antihypertensive drugs.

Furosemide in postpartum management of severe preeclampsia: A randomized controlled trial

ABSTRACTBackground: Hypertension in the postpartum period is a common phenomenon and is often a cause for concern. Following delivery, fluid that has been sequestered in the extravascular space is mobilized, producing a large auto-infusion of fluid from the extravascular to the intravascular compartment. As a result of this fluid mobilization process, there is an increase in central venous pressure and pulmonary capillary wedge pressure, which might favor the development of pulmonary edema. Thus, diuretics logically might be a better choice as antihypertensive medication in such a scenario.Methods: A total of 108 antenatal women diagnosed with having severe preeclampsia, with two high blood pressure recordings of ≥150/100 mm of Hg in the postpartum period within the first 24 hours of delivery, were enrolled in the study. These patients were randomly divided into two groups (Group A: furosemide 20 mg OD + nifedipine & Group B: nifedipine alone). Main outcome measures studied were reduction in systolic, diastolic, and mean arterial blood pressures, requirement of additional antihypertensive drugs to control blood pressure, duration of hospital stay, and antihypertensive requirement at discharge.Results: Both groups were comparable for distribution of age and parity and presence of imminent symptoms and eclampsia. There was no significant difference in mean systolic, diastolic, and mean arterial pressures (MAPs) between both the groups at admission. Mean gestational age at delivery was 36 weeks in both the groups. Requirement of additional antihypertensive was significantly higher in women in group B (26.0% vs. 8.0%, p = 0.017). Duration of hospital and postpartum stay and the use of antihypertensive at discharge were similar in both the groupsConclusion: In conclusion, the use of a short course of furosemide along with nifedipine significantly reduces the need of additional antihypertensive in severe preeclamptic women with postpartum hypertension when compared to women who received nifedipine alone.

V11-05 LAPAROENDOSCOPIC SINGLE-SITE (LESS) VARICOCELECTOMY USING INDOCYANINE GREEN FLUORESCENCE (ICG) ANGIOGRAPHY

INTRODUCTION AND OBJECTIVES: Since the first laparoscopic adrenalectomy described by Gagner et al in 1992, it has become the approach of election, been safe and effective. Castillo et al presented by first time in the Spanish literature a serial cases of primary aldosteronism caused by adenomas where he performed partial laparoscopic resections with favorable conclusions. METHODS: This is a case of a 44 years old male with secondary hypertension caused by primary aldosteronism by bilateral adrenal masses (Conn Syndrome) 19 mm right y 23 mm left side. Without achieving medical control of hypertension, the resection of both adrenal masses was decided, after laterality functional studies went no conclusive, to be performed in a single procedure. RESULTS: A transperitoneal approach is performed. We started with the right side: the patient is positioned in the left lateral flank position. Pneumoperitoneum using open technique, opening of the retroperitoneal space, identification and dissection of the adrenal gland, identification, dissection and resection of right adrenal tumor. Hemostasis with the bipolar grasper. The patient is re-positioned in the right lateral flank position. Pneumoperitoneum using open technique. The line of Toldt is incised and the colon retracted medially, the spleen and tail of pancreas are also mobilized cephalad and medially, identification of the adrenal tumor in the anterior inner edge of the gland and the enucleation of adrenal adenoma is performed The Operative time was 190 minutes with minimal bleeding. The patient was discharge in the 3rd postoperative day without any incidents. Less requirement of anti-hypertensive drugs since the postoperative time was reported. The pathology reported bilateral adrenal adenomas 3.5cm left and right 2.5cm side. The tests one month after surgery showed normal potassium. The hypertension was controlled with fewer drugs, without requirement of corticosteroid therapy. In our center we have performed in the last 10 years 38 laparoscopic adrenalectomy, 27 with benign results, been our most frequently found pheochromocytoma. CONCLUSIONS: The laparoscopic adrenal tumor resection (partial adrenalectomy or enucleation) could be considered the procedure of choice in cases of accessible tumors with bilateral tumors or single gland. This is our first case of laparoscopic bilateral adrenal tumor resection in one surgical time. The procedure coursed without complications and favorable clinic results.

Balloon angioplasty, with and without stenting, versus medical therapy for hypertensive patients with renal artery stenosis.

Atherosclerotic renal artery stenosis is the most common cause of secondary hypertension. Balloon angioplasty with stenting is widely used for the treatment of hypertensive patients with renal artery stenosis but the effectiveness of this procedure in treating hypertension, improving renal function and preventing adverse cardiovascular and renal events remains uncertain. This is an update, to include the results of recent, important large trials, of a review first published in 2003. To compare the effectiveness of balloon angioplasty (with and without stenting) with medical therapy for the treatment of atherosclerotic renal artery stenosis in patients with hypertension. The following outcomes were compared: blood pressure control, renal function, frequency of cardiovascular and renal adverse events, presence or absence of restenosis of the renal artery, side effects of medical therapy, numbers and defined daily doses of antihypertensive drugs. For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched May 2014) and CENTRAL (2014, Issue 4). Bibliographies were also reviewed and trial authors were contacted for more information. Randomised controlled trials (RCTs) comparing balloon angioplasty with medical therapy in hypertensive patients with haemodynamically significant renal artery stenosis (greater than 50% reduction in luminal diameter) and with a minimum follow-up of six months. Data were extracted independently on trial design, participants, interventions and outcome measures. A formal meta-analysis was completed to assess the effect on blood pressure, renal function and cardiovascular and renal adverse events. Peto's odds ratios (ORs) and corresponding 95% confidence intervals (CI) for dichotomous outcomes and mean differences (MD) and corresponding 95% CIs for continuous variables were calculated. Eight RCTs involving 2222 participants with renal artery stenosis were included in the review. The overall quality of evidence included in this review was moderate. Limited pooling of results was possible due to the variable presentation of some of the trial outcomes. Meta-analysis of the four studies reporting change in diastolic blood pressure (BP) found a small improvement in diastolic BP in the angioplasty group (MD -2.00 mmHg; 95% CI -3.72 to -0.27) whilst the meta-analysis of the five studies reporting change in systolic BP did not find any evidence of significant improvement (MD -1.07 mmHg; 95% CI -3.45 to 1.30). There was no significant effect on renal function as measured by serum creatinine (MD -7.99 µmol/L; 95% CI -22.6 to 6.62). Meta-analysis of the three studies that reported the mean number of antihypertensive drugs found a small decrease in antihypertensive drug requirements for the angioplasty group (MD -0.18; 95% CI -0.34 to -0.03). Repeat angiography was only performed on a small number of participants in a single trial and it was therefore not possible to comment on restenosis of the renal artery following balloon angioplasty. Based on the results of the seven studies that reported cardiovascular and renal clinical outcomes there were no differences in cardiovascular (OR 0.91; 95% CI 0.75 to 1.11) or renal adverse events (OR 1.02; 95% CI 0.75 to 1.38) between the angioplasty and medical treatment groups. A small number of procedural complications of balloon angioplasty were reported (haematoma at the site of catheter insertion (6.5%), femoral artery pseudoaneurysm (0.7%), renal artery or kidney perforation or dissection (2.5%) as well as peri-procedural deaths (0.4%)). No side effects of medical therapy were reported. The available data are insufficient to conclude that revascularisation in the form of balloon angioplasty, with or without stenting, is superior to medical therapy for the treatment of atherosclerotic renal artery stenosis in patients with hypertension. However, balloon angioplasty results in a small improvement in diastolic blood pressure and a small reduction in antihypertensive drug requirements. Balloon angioplasty appears safe and results in similar numbers of cardiovascular and renal adverse events to medical therapy.

Effect of laparoscopic Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus with hypertension: A randomized controlled trial

AimsThe aim of this study was to evaluate the effect of laparoscopic Roux-en-Y gastric bypass (RYGB) surgery compared with usual care with and without Exenatide therapy in obese people with type 2 diabetes mellitus (T2DM) and hypertension. Methods108 obese T2DM with hypertension were enrolled and randomly allocated to usual care (group A), usual care plus Exenatide (group B), and RYGB surgery (group C). Demographic characteristics, metabolic parameters and cardiac structure/function along with inflammatory cytokines were measured and compared before and after 12 months. ResultsAt 12 months, diabetes remission had occurred in no patients in groups A and B versus 90% in group C, and there was a significant decrease in requirement of antihypertensive drugs in group C compared with groups A and B (P<0.05). Other parameters (body mass index, hemoglobin A1c, homeostasis model assessment of insulin resistance, lipids), inflammation index (high sensitivity C-reactive protein, tumor necrosis factor-α, high molecular weight adiponectin) and cardiac structure (left ventricular mass index) were significantly improved in groups B and C, but patients in group C had the greatest degree of improvement (P<0.05). ConclusionRYGB surgery improves a number of parameters including cardiovascular function in obese hypertensive people with T2DM. This is likely to be due to, at least in part, an improvement in the abnormal metabolic panel and to reduced inflammation.

Timing and Selection for Renal Revascularization in an Era of Negative Trials: What to Do?

Management of atherosclerotic renal artery stenosis has become more complex with advances in both medical therapy and endovascular procedures. Results from recent trials fail to demonstrate major benefits of endovascular stenting in addition to optimal medical therapy. The general applicability of these results to many patients is limited by short-term follow-up and selection biases in recruitment. Many patients at highest risk were excluded from these studies and some were included with trivial lesions. Identification of patients with hemodynamically significant lesions remains a challenge and has led to more stringent criteria for Doppler ultrasound, measurement of translesional gradients and quantitative angiography. Although many patients can now be managed with medical therapy, it should be recognized that long-term reduction in antihypertensive drug requirements and recovery of kidney function are limited to those undergoing renal revascularization. As with any major vascular lesion, follow-up for disease stability and/or progression is essential. The ambiguity of present trial data may lead some to overlook selected subgroups that would benefit from restoring renal blood supply through revascularization. Further studies to more precisely identify kidneys that can recover function and/or are beyond meaningful recovery are essential. Considering the comorbid risks for the atherosclerotic population, it will remain imperative for clinicians to consider the hazards, costs and benefits carefully for each patient to determine the role and timing for both medical therapy and revascularization.

Obesity and hypertension.

There is a close association of obesity with hypertension through mechanisms not now understood. Hypertension occurs frequently in industrialized societies where weight gain with advancing years is a common feature and is rare in primitive societies where weight and age are negatively correlated. Hemodynamically, obesity is characterized by an expanded blood volume and increased cardiac output. Hypertension results if/when systemic vascular resistance fails to decrease as cardiac output increases. When calorie restriction leads to weight loss, both blood volume and cardiac output decrease; when the blood pressure falls, this is because peripheral resistance is unchanged. Weight-loss programs are helpful for the obese hypertensive because when hypertension is mild, blood pressure often (but not always) normalizes. Also, weight loss has been shown to decrease antihypertensive drug requirements. Interest in obesity-associated hypertension focuses on hyperinsulinemia/insulin resistance as causative factors. Although the evidence is tempting, it is far from conclusive and it seems likely that the mechanism of this type of hypertension is as multifactorial as those of other types.

Pharmacokinetic-Pharmacodynamic Modeling of Antihypertensive Drugs: From Basic Research to Clinical Practice

Knowledge of pharmacokinetic-pharmacodynamic (PK/PD) properties of antihypertensive drugs may optimize drug therapy of hypertension. PK/PD modeling of antihypertensive drugs in both basic and clinical research could contribute to drug development and clinical practice in several aspects, including a profound evaluation of the efficacy and safety of investigational antihypertensive agents, enhancement of preclinical information during the development process, identification of factors that contribute to drug response variability, by allowing a rapid identification of poor or nonresponders and by helping to determine optimal antihypertensive drug and dose requirements in each hypertensive patient. Although a concentration-response relationship for antihypertensive agents was found in normotensive and hypertensive patients, there are some limitations in PK/PD modeling of antihypertensive drugs in the clinical setting, including application of inadequate pharmacodynamic models and the inability to study large doses of antihypertensive drugs in order to determine the complete pharmacodynamic range of their antihypertensive effect. Most limitations in the clinical study of PK/PD models of antihypertensive drugs are not present in basic research, and therefore study of PK/PD models in laboratory animals could be of interest. The aim of the present review is to describe the current knowledge of PK/PD modeling of antihypertensive drugs in basic and clinical research and its future applications. Keywords: Antihypertensive drugs, pharmacokinetic-pharmacodynamic modeling, drug development, clinical practice, dose optimization

Detection of Occult Renovascular Disease in Unexplained Chronic Kidney Disease

Atherosclerotic renal artery stenosis (RAS) is a recognized cause of renal impairment. RAS is often overlooked in unexplained chronic kidney disease (CKD). A retrospective analysis of renal angiograms was performed to determine the prevalence of occult renovascular disease in 64 (M:F, 46:18; ages 21-81 years [median 60 years]) patients with unexplained CKD. Twelve patients had diabetes mellitus (type II: 11) and 43 were smokers. Median serum creatinine was 5.2 mg/dl (range 1.5-10.6 mg/dl). Group A included patients with unexplained CKD and with no risk factors for RAS and Group B had patients with increased risk for RAS. A narrowing of the renal vessel, main artery or branch, by >50% on renal arteriography was used as diagnostic criteria for RAS. 31/64 patients had positive angiographic findings. Thirteen patients had unilateral RAS, 9 had bilateral RAS, 5 had unilateral stenosis with occlusion on the opposite side, 3 had unilateral occlusion and 1 had a solitary kidney with RAS. 19/34 (54%) in Group A and 12/30 (40%) in Group B had a positive renal angiogram. In 10 patients with a rise in serum creatinine on recent introduction of ACE inhibition, 2 had evidence of RAS on renal arteriography. Eleven patients underwent angioplasty and 2 reconstructive surgeries. In 4 patients, blood pressure control improved and anti-hypertensive drug requirements were reduced, whilst renal replacement therapy was postponed in 4, by 2-24 months. In 18 patients, the lesions were not amenable to angioplasty or reconstructive surgery. Four patients did not benefit in any form with intervention. Occult atheromatous renal vascular disease is a common, not readily predictable and potentially correctable etiology of unexplained CKD.

Effects of a lifestyle programme on ambulatory blood pressure and drug dosage in treated hypertensive patients: a randomized controlled trial

To assess effects of multifactorial lifestyle modification on antihypertensive drug needs in treated hypertensive individuals. Randomized controlled trial. Research studies unit. Overweight hypertensive patients, receiving one or two antihypertensive drugs, were recruited by advertising, and allocated randomly to a usual care group (controls; n = 118) or a lifestyle modification group (programme group; n = 123). A 4-month programme of weight loss, a low-sodium 'Dietary Approaches to Stop Hypertension'-type diet with added fish, physical activity and moderation of alcohol intake. After 4 months, if mean 24-h ambulatory blood pressure (ABP) was less than 135/85 mmHg, antihypertensive drugs were withdrawn over 4 weeks and long-term home blood pressure monitoring was begun. Antihypertensive drug requirements, ABP, weight, waist girth at 4 months and 1-year follow-up. Ninety control group and 102 programme group participants completed the study. Mean 24-h ABP changed after 4 months by -1.0/-0.3 +/- 0.5/0.4 mmHg in controls and -4.1/-2.1 +/- 0.7/0.5 mmHg with the lifestyle programme (P < 0.01). At follow-up, changes in the two groups were not significantly different (4.1/1.3 +/- 1.1/1.0 mmHg in controls; 2.5/-0.1 +/- 1.1/0.8 mmHg in the programme group; P = 0.73). At 4 months, drug withdrawal differed significantly between the groups (P = 0.038) in men (control 44%; programme 66%) but not in women (65 and 64%, respectively; P = 0.964). At follow-up, sex-related differences were not significant, and 41% in the control group and 43% in the programme group maintained drug-withdrawal status. With the programme, net weight loss was 3.3 kg (P < 0.001) at 4 months and 3.0 kg (P < 0.001) at follow-up; respective net decreases in waist girth were 3.3 cm (P < 0.001) and 3.5 cm (P < 0.001). A 4-month multifactorial lifestyle modification in patients with treated hypertension reduced blood pressure in the short-term. Decreased central obesity persisted 1 year later and could reduce overall cardiovascular risk.

Left ventricular mass and hemodynamic overload in normotensive hemodialysis patients

It remains uncertain whether the hemodynamic parameters are important determinants of left ventricular mass (LVM) in normotensive chronic hemodialysis (NTHD) patients, as has been found in their hypertensive counterparts. Forty NTHD patients (mean age, 53.7 +/- 14.4 years; male/female, 18/22) without the requirement of antihypertensive drugs for at least six months were studied. Controls were 41 hypertensive hemodialysis patients (HTHD) and 46 normotensive subjects with normal renal function (NTNR). The influence of anthropometrics, cardiovascular structure and function, and volume status on LVM (by two-dimensional echocardiography) was analyzed by steps of multiple linear regression. As compared with the NTNR and NTHD group, the HTHD group had obvious pressure and volume/flow overload, and greater LV wall thickness, chamber size and mass. In contrast, NTHD subjects had similar blood pressure, large artery function, LV chamber size and stroke volume as the NTNR subjects. However, the NTHD patients still had greater wall thickness and LVM, along with greater cardiac output, lower total peripheral resistance and lower end-systolic meridional stress to volume ratio (ESSV) than the NTNR group. LVM in the NTHD group was significantly positively related to averaged systolic blood pressure (SBPavg), body surface area, extracellular fluid (ECF), carotid intima-media thickness (IMT), aortic pulse wave velocity (PWV), and negatively related to ESSV and Kt/V. The independent significant noncardiac structural determinants of LVM in NTHD subjects were ESSV, SBPavg, PWV and SV (model r2 = 0.617, P < 0.001). The NTHD patients, without significant pressure and volume overload, still had increased LVM that was partially explained by the persistent flow overload and subclinical LV dysfunction.

HYPERRENINEMIA ASSOCIATED PROLONGED AORTO-RENAL TRANSIT TIMES IN HYPERTENSIVE RENAL TRANSPLANT RECIPIENTS.

656 Hypertension after renal transplantation is associated with a hyperreninemic state. The major causes of hypertension include renin secretion from native diseased kidneys, immunosuppressive drugs, allograft rejections and transplant renal artery stenosis. Renal allograft perfusion could be reduced due to the presence of renal artery thrombosis/stenosis or as a result of allograft rejection. Aorto-renal transit times (ARTT) have been used as a marker of renal perfusion and vascular resistance in native kidneys. The effect of hypertension, if any, on renal allograft perfusion has not been studied. We prospectively evaluated 10 patients with post renal transplant hypertension and 11 normotensive renal transplant recipients with normal allograft functions. Hypertensive patients with renal insufficiency (serum creatinine >1.5 mg%) underwent an allograft biopsy before inclusion in the study. They were excluded if the biopsy showed evidence of acute or chronic rejection. Tc99m DTPA renal transplant scans were done and dynamic studies were acquired on the computer every second for 1 minute and time activity curves generated. The ARTTs were calculated from the graphs obtained as the time to transplant peak minus the time to aortic peak. The mean ARTTs in normotensive controls were 4.3±0.9 seconds as compared to 5.9±1.5 seconds in patients with post-transplant hypertension (p<0.01). There was no significant difference in the ARTTs in patients receiving cyclosporine (4.9±1.0 seconds) as compared to those not receiving the drug (5.2±1.8 seconds, p>0.05). The basal plasma renin activity (normal 0.2-2.8 ng/ml/hr) in hypertensives (25.6±13.9 ng/ml/hr) was significantly higher than normotensive controls (7.4±5.6 ng/ml/hr, p<0.05). There was no significant correlation in the degree of prolongation of ARTTs with elevation of plasma renin activity when hypertensive recipients (r=0.846) were compared against normotensive controls (r=0.967, p>0.05). Transplant renal artery stenosis was excluded on color doppler in 6 and on angiography in 4 hypertensive patients. Three of these 4 patients had reduction in antihypertensive drug requirements after bilateral native kidney nephrectomies. We conclude that aorto-renal transit times are prolonged in severely hypertensive renal transplant recipients with otherwise normal graft functions. This appears to be a result of hyper-reninema due to persistent renin secretion from native diseased kidneys.

The Characteristics of Blood Pressure Control in Chronic Renal Failure Patients Treated with Peritoneal Dialysis

Background and Methods: In order to evaluate characteristics and modulatory factors of blood pressure in peritoneal dialysis(PD), studies were conducted on the 69 patients who had underwent peritoneal equilibration test(PET). Results: The results were as follows; 1) All patients received an antihypertensive drug before PD, but, 15 of 69 patients successfully quit taking the antihypertensive drug after peritoneal dialysis. 2) During peritoneal dialysis, mean arterial pressure(MAP) was significantly decreased for the first 3 months, and this lasted for 1 year, and antihypertensive drug requirements were significantly decreased continuously up to 9 months(p to , p, to , p to , p

A trial of oral magnesium supplementation in renal transplant recipients receiving cyclosporine

WE undertook a single blinded crossover trial of oral magnesium supplementation in 15 hypomagnesemic renal transplant patients. The study was designed to determine (1) to what extent chronic oral magnesium supplementation would increase serum magnesium in this population; (2) whether magnesium supplementation would reduce blood pressure, lessen antihypertensive drug requirements, and/or improve lipid profiles; (3) the significance of side effects from the cathartic effects of magnesium compounds; and (4) the changes in renal magnesium excretion and serum electrolytes associated with magnesium therapy.

N003 Life-style modifications reduce blood pressure and antihypertensive drug requirements

N003 Life-style modifications reduce blood pressure and antihypertensive drug requirements

Effect of Continuous Ambulatory Peritoneal Dialysis on Blood Pressure Control

To assess the efficacy of blood pressure control in continuous ambulatory peritoneal dialysis (CAPD), blood pressure was examined sequentially in 63 CAPD patients transferred from hemodialysis (HD), and in 97 patients started de novo on CAPD (NEW), over periods ranging from 3 to 63 months. Blood pressure changes were related to changes in body weight, hematocrit, and treatment with recombinant human erythropoietin (rHu-EPO), as well as to changes in antihypertensive drug requirements. Both groups of patients showed an immediate improvement in blood pressure control at 1 month, as manifested by an absolute decrease in blood pressure in HD patients (-4.3% +/- 2.1% [SEM], P < 0.05) and by a decrease in antihypertensive drug requirements in NEW patients (from 78% to 43.3%). This early improvement in blood pressure appeared to be volume-related, as reflected by changes in body weight. Both groups showed an additional decrement in blood pressure at approximately 6 months (-7.8% +/- 2.6% [SEM], P < 0.05, HD group; -3.4% +/- 2.4% [SEM], P < 0.05, NEW group). Treatment of anemia with rHu-EPO in 22 of the CAPD patients had no effect on blood pressure. CAPD thus appears to be more effective than HD in controlling blood pressure.

126. A controlled study of the effects of aerobic exercise on the antihypertensive drug requirements of essential hypertensive patients

126. A controlled study of the effects of aerobic exercise on the antihypertensive drug requirements of essential hypertensive patients

Obesity and Hypertension

There is a close association of obesity with hypertension through mechanisms not now understood. Hypertension occurs frequently in industrialized societies where weight gain with advancing years is a common feature and is rare in primitive societies where weight and age are negatively correlated. Hemodynamically, obesity is characterized by an expanded blood volume and increased cardiac output. Hypertension results if/when systemic vascular resistance fails to decrease as cardiac output increases. When calorie restriction leads to weight loss, both blood volume and cardiac output decrease; when the blood pressure falls, this is because peripheral resistance is unchanged. Weight-loss programs are helpful for the obese hypertensive because when hypertension is mild, blood pressure often (but not always) normalizes. Also, weight loss has been shown to decrease antihypertensive drug requirements. Interest in obesity-associated hypertension focuses on hyperinsulinemia/insulin resistance as causative factors. Although the evidence is tempting, it is far from conclusive and it seems likely that the mechanism of this type of hypertension is as multifactorial as those of other types.