Controversies In Hypertension Research Articles

Dietary Sodium Reduction Is Best for Reducing Blood Pressure: Controversies in Hypertension.

Dietary Sodium Reduction Is Best for Reducing Blood Pressure: Controversies in Hypertension.

Response to Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension - Con Side of the Argument.

HomeHypertensionVol. 79, No. 8Response to Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension - Con Side of the Argument No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextResponse to Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension - Con Side of the Argument Alan P. Jacobsen, Myles McKittrick, Natalie Daya, Mahmoud Al Rifai and John W. McEvoy Alan P. JacobsenAlan P. Jacobsen https://orcid.org/0000-0003-0587-8333 Search for more papers by this author , Myles McKittrickMyles McKittrick Search for more papers by this author , Natalie DayaNatalie Daya https://orcid.org/0000-0002-2257-0480 Search for more papers by this author , Mahmoud Al RifaiMahmoud Al Rifai https://orcid.org/0000-0002-6933-790X Search for more papers by this author and John W. McEvoyJohn W. McEvoy https://orcid.org/0000-0001-6530-5479 Search for more papers by this author Originally published13 Jul 2022https://doi.org/10.1161/HYPERTENSIONAHA.122.19492Hypertension. 2022;79:1570"Response to Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension - Con Side of the Argument." Hypertension, 79(8), p. 1570 Previous Back to top Next FiguresReferencesRelatedDetails August 2022Vol 79, Issue 8 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.122.19492PMID: 35861746 Originally publishedJuly 13, 2022 PDF download Advertisement SubjectsHigh Blood PressureHypertension

Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension-Con Side of the Argument.

HomeHypertensionVol. 79, No. 8Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension—Con Side of the Argument No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toNo AccessArticle CommentaryRequest AccessFull TextIsolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension—Con Side of the Argument Alan P. Jacobsen, Myles McKittrick, Natalie Daya, Mahmoud Al Rifai and John W. McEvoy Alan P. JacobsenAlan P. Jacobsen https://orcid.org/0000-0003-0587-8333 Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (A.P.J., J.W.M.). *A.P. Jacobsen and M. McKittrick contributed equally. Search for more papers by this author , Myles McKittrickMyles McKittrick National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway (M.M., J.W.M.). *A.P. Jacobsen and M. McKittrick contributed equally. Search for more papers by this author , Natalie DayaNatalie Daya https://orcid.org/0000-0002-2257-0480 Welch Center for Prevention, Epidemiology and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (N.D.). Search for more papers by this author , Mahmoud Al RifaiMahmoud Al Rifai https://orcid.org/0000-0002-6933-790X Section of Cardiology, Baylor College of Medicine, Houston, TX (M.A.R.). Search for more papers by this author and John W. McEvoyJohn W. McEvoy Correspondence to: John W. McEvoy, National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Moyola Lane, Galway, Ireland. Email E-mail Address: [email protected] https://orcid.org/0000-0001-6530-5479 Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (A.P.J., J.W.M.). National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway (M.M., J.W.M.). Search for more papers by this author Originally published13 Jul 2022https://doi.org/10.1161/HYPERTENSIONAHA.122.18458Hypertension. 2022;79:1571–1578Footnotes*A.P. Jacobsen and M. McKittrick contributed equally.For Sources of Funding and Disclosures, see page 1577.Correspondence to: John W. McEvoy, National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Moyola Lane, Galway, Ireland. Email johnwilliam.[email protected]ie

Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension - Pro Side of the Argument.

Isolated diastolic hypertension (IDH), defined as diastolic blood pressure in the hypertensive range but systolic blood pressure not in the hypertensive range, is not uncommon (<20%) among adults with hypertension. IDH often manifests in concurrence with other cardiovascular risk factors. Individuals with IDH tend to have lower awareness of their hypertension compared with those with both systolic and diastolic hypertension. IDH appears to be a largely underrated risk factor for cardiovascular disease events, which may be explained by inconsistent association of IDH with cardiovascular disease events. The inconsistency suggests that IDH is heterogeneous. One size does not seem to fit all in the clinical management of individuals with IDH. Rather than treating IDH as a monolithic low-risk condition, detailed phenotyping in the context of individual comprehensive cardiovascular risk would seem to be most useful to assess an individual's expected net benefit from therapy. In this review, we highlight that the clinical relevance of IDH differs by individual clinical characteristics, and elucidate groups of individuals with IDH that should be wary of cardiovascular disease risks.

Response to Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension - Con Side of the Argument.

HomeHypertensionVol. 79, No. 8Response to Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension - Con Side of the Argument No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toNo AccessArticle CommentaryRequest AccessFull TextResponse to Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension - Con Side of the Argument Yuichiro Yano, Hyeon Chang Kim, Hokyou Lee, Nazar Azahar, Sabrina Ahmed, Kaori Kitaoka, Hidehiro Kaneko, Fujimi Kawai, Atsushi Mizuno and Anthony J. Viera Yuichiro YanoYuichiro Yano https://orcid.org/0000-0002-2565-7290 Search for more papers by this author , Hyeon Chang KimHyeon Chang Kim https://orcid.org/0000-0001-7867-1240 Search for more papers by this author , Hokyou LeeHokyou Lee https://orcid.org/0000-0002-5034-8422 Search for more papers by this author , Nazar AzaharNazar Azahar Search for more papers by this author , Sabrina AhmedSabrina Ahmed https://orcid.org/0000-0001-6256-1389 Search for more papers by this author , Kaori KitaokaKaori Kitaoka Search for more papers by this author , Hidehiro KanekoHidehiro Kaneko https://orcid.org/0000-0003-2553-6170 Search for more papers by this author , Fujimi KawaiFujimi Kawai Search for more papers by this author , Atsushi MizunoAtsushi Mizuno https://orcid.org/0000-0002-7596-7633 Search for more papers by this author and Anthony J. VieraAnthony J. Viera Search for more papers by this author Originally published13 Jul 2022https://doi.org/10.1161/HYPERTENSIONAHA.122.19493Hypertension. 2022;79:1579"Response to Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension - Con Side of the Argument." Hypertension, 79(8), p. 1579 Previous Back to top Next FiguresReferencesRelatedDetails August 2022Vol 79, Issue 8Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.122.19493PMID: 35861747 Originally publishedJuly 13, 2022 PDF download Advertisement

Lowering Nighttime Blood Pressure With Bedtime Dosing of Antihypertensive Medications: Controversies in Hypertension - Con Side of the Argument.

Lowering Nighttime Blood Pressure With Bedtime Dosing of Antihypertensive Medications: Controversies in Hypertension - Con Side of the Argument.

Correction to: Starting Antihypertensive Drug Treatment With Combination Therapy: Controversies in Hypertension - Con Side of the Argument.

Correction to: Starting Antihypertensive Drug Treatment With Combination Therapy: Controversies in Hypertension - Con Side of the Argument.

Correction to: Starting Antihypertensive Drug Treatment With Combination Therapy: Controversies in Hypertension - Pro Side of the Argument.

Correction to: Starting Antihypertensive Drug Treatment With Combination Therapy: Controversies in Hypertension - Pro Side of the Argument.

Starting Antihypertensive Drug Treatment With Combination Therapy

Starting Antihypertensive Drug Treatment With Combination Therapy

Controversies in hypertension: is lower blood pressure always better?

Cardiovascular disease risk is continuously related to BP over the range of about 115/75 to 185/115 mmHg, yet all clinical guidelines use arbitrary cutoffs to determine acceptable antihypertensive therapy. There is substantial conflict in the results of clinical trials with respect to how low the most appropriate BP threshold should be to reduce CVD and renal risk. This divergence should not be surprising given the intrinsic differences in circulatory anatomy and physiology among the heart, brain, vessels, and kidney. In the real world, however, discreet BP targets or even ranges may be a tolerable practical necessity as long as it is recognized that any arbitrary threshold in a continuous relationship can serve as both a stimulus and a barrier to effective treatment. Overall, it may be necessary to assess risk differentially by organ or disease process; lower systolic pressure is most beneficial in preventing recurrent stroke and heart failure episodes, benefits on kidney function and ischemic heart disease are less demonstrable for a variety of scientific and experimental design reasons. It may also be a good time for practice guideline writers and individual physicians to re-evaluate the benefits of lower BP targets.

Hypertension

We are happy to report continued progress during the past year in achieving the goals outlined previously for Hypertension .1 The readership of the journal has been further expanded; the quality and impact of the published original research continue to increase; the review process appears to be fairly efficient and (we hope you agree) effective in selecting the best papers in the field; and Hypertension provides an important vehicle for disseminating clinically important information and for achieving the mission of the American Heart Association (AHA) and its scientific councils. The main credit for this progress goes to you, as authors, editorial board members, reviewers, and readers, for your support of Hypertension and for your excellent scientific contributions. In this report we summarize a few statistics and new initiatives and provide a brief perspective on what we can, and should, do better. Figure 1 shows the steady increase in article submissions during the past 5 years. These data do not include submissions for the Proceedings of the AHA Council for High Blood Pressure Research, the Inter-American Society of Hypertension, or the International Workshop on Structure and Function of Large Arteries, which include an additional 160 articles for 2007. Figure 1. Number of article submissions for original scientific contributions for January 1, 2002, to December 31, 2007. These data do not include 160 articles for the Proceedings of the Council for High Blood Pressure Research, Inter-American Society of Hypertension, and the International Workshop on Structure and Function of Large Arteries. Articles were submitted from 65 countries. The top 5 countries and their percentages of the total number of articles submitted are shown in Figure 2. Figure 2. The top 10 countries and their percentages of the total submitted articles for 2007. Approximately 58% of articles submitted in 2007 were clinical …

Prenatal Influences and Endothelial Dysfunction

Hypertension during pregnancy when associated with new-onset proteinuria is termed “preeclampsia.”1,2 Preeclampsia is thought to initiate with improper remodeling of the uterine spiral arteries leading to reduced placental/fetal perfusion and subsequent extensive dysfunction of the maternal vascular endothelium.1,2 Reduced placental perfusion, however, may not always result in preeclampsia.1 Additionally, reduced placental perfusion may not necessarily reflect an imbalance between nutrient delivery and the metabolic needs of the fetus. Nonetheless, based on the fact that low placental perfusion is not always associated with preeclampsia, Roberts and Gammill1 proposed that the maternal response to reduced placental perfusion requires interaction with pre-existing maternal factors. Maternal factors that may contribute to increased maternal susceptibility to reduced placental perfusion and development of preeclampsia or hypertensive disorders of pregnancy include genetic, behavioral, and environmental factors.1 Numerous studies indicate that a genetic component may contribute to increased risk for preeclampsia and hypertensive disorders of pregnancy.1,3,4 Women and men born to a woman with preeclampsia are at greater risk for developing, or fathering, a preeclamptic pregnancy, suggesting transmission of a fetal gene for increased susceptibility to preeclampsia.3,4 However, this susceptibility is greater in women than in men, suggesting passage of maternal susceptibility …

Clinical Advisory Statement. Importance of systolic blood pressure in older Americans.

This clinical advisory statement from the Coordinating Committee of the National High Blood Pressure Education Program is intended to advance and clarify the recommendations of the Sixth Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI, 1997).1 The advisory addresses several interrelated issues about blood pressure (BP) that affect people approaching the later decades of life. On the basis of the wealth of currently available evidence, the committee now recommends a major paradigm shift in urging that systolic BP become the major criterion for diagnosis, staging, and therapeutic management of hypertension, particularly in middle-aged and older Americans. Several lines of strong evidence support the initiative to emphasize systolic BP. Pathophysiologically, there are strong associations among aging, increased stiffness of large arteries, increased systolic BP, increased pulse pressure, and the prevalence of cardiac and vascular disease. Epidemiologically, isolated systolic hypertension is the most common form of hypertension and is present in approximately two thirds of hypertensive individuals >60 years of age. Diagnostically, classification and staging of hypertension are more precise when systolic rather than diastolic BP is used as the principal criterion. Risk stratification for major complications of hypertension (stroke, myocardial infarction, heart failure, and kidney failure) is actually confounded by the use of diastolic BP; in older people with systolic hypertension, diastolic BP is inversely related to cardiovascular risk. Clinical benefits of treatment of isolated systolic hypertension include reductions in stroke, myocardial infarction, heart failure, kidney failure, and overall cardiovascular disease morbidity and mortality. Currently, only 1 in 4 Americans with hypertension falls below JNC VI–recommended values of 140/90 mm Hg in uncomplicated hypertension or 130/85 mm Hg in individuals with kidney disease or diabetes. Hypertension control rates are poorest in older people, primarily as a result of inadequate …

Controversies in Nephrology and Hypertension

To understand the controversies that are inherent to a discipline is to understand the discipline itself. A consequence of this truism is that any collection of essays designed to articulate the controversial aspects of modern nephrology should be useful if the resultant book is thoughtfully planned and diligently constructed. Dr Robert G. Narins has done just that in his book in Nephrology and Hypertension . A compilation of essays arranged in point-counterpoint fashion, this book comprises five sections: Social, Economic, and Ethical and End-Stage Renal Disease, Controversies in Hypertension, Controversies in Diagnosing Renal-Metabolic Disorders, Controversies in Treating Renal-Electrolyte Disorders, and Controversies in Physiology and Pathophysiology. Its 48 essayists include nephrologists, urologic surgeons, and a pathologist. All nephrologists should read the summary of the legislative and regulatory history of the End-Stage Renal Disease Program and the discussion of the economic models for the delivery of dialytic therapy. The presentation of