Effective Blood Pressure Control Research Articles

401 Cardiovascular Indices Measured by a Noninvasive Doppler Ultrasonography Cardiac Output Monitor in Patients With Stage 2 Hypertension

Study Objective: Hypertensive patients either have increased systemic vascular resistance or increased cardiac output, or both. The exact prevalence of these pathophysiological derangements, and their relative contribution to hypertension, are not known. Study Objectives: To use a noninvasive Doppler ultrasonography cardiac output monitor to measure haemodynamic parameters and determine the relative derangements of cardiac output and systemic vascular resistance in emergency department patients with Stage 2 hypertension. Methods: Patients aged 18 years or above who attended the emergency department (ED) with systolic blood pressure> 160 or diastolic blood pressure >100 in 2 or more measurements at least 20 minutes apart were included. Research assistants collected demographic and clinical data and measured the cardiac output and systemic vascular resistance of these patients with a noninvasive Doppler ultrasonography cardiac output monitor. Patients were followed up within 2 weeks. Those who did not have documented increased blood pressure (Stage 2) in 2 or more different occasions were excluded. The patients' body surface area (BSA) was calculated to obtain the cardiac index (CI) and the systemic vascular resistance index (SVRI); where CI = cardiac output/BSA and SVRI = systemic vascular resistance/BSA. Results: Forty-nine patients were included. Mean age (+/− SD) was 66.5 +/− 12.5 years and 59.2% were females. 7 (14.3%) had either high cardiac output or high CI; 41(83.7%) had either high systemic vascular resistance or high SVRI; one had normal haemodynamics; 18 (36.7%) had either low cardiac output or low CI; and 3 (6.1%) had low SVRI. The prevalence of haemodynamic derangement subtypes was as follows: 4 (8.2%) with systemic vascular resistance normal, cardiac output high; 39 (79.5%) with systemic vascular resistance high, cardiac output normal; 4 (8.2%) with systemic vascular resistance and cardiac output normal; 2 (4.1%) with systemic vascular resistance high, cardiac output low. Conclusion: In ED patients with Stage 2 hypertension, about 80% have increased systemic vascular resistance. If clinicians choose anti-hypertensive therapy aiming at reducing systemic vascular resistance, it may result in a much higher likelihood of effective blood pressure control.

Arterial hypertension: sociodemographic profile and comorbidities of patients from northwest Paraná State, Southern Brazil

The systemic arterial hypertension (SAH) currently a major public health problem, presents high medical and socioeconomic costs, and occurs concurrently with other diseases, of infectious origin or not. This study aimed to describe the sociodemographic profile of hypertensive patients with or without co-morbidities assisted in a health reference centre in a municipality of the northwest of the Parana State, Southern Brazil. We gathered data from 250 medical records, concerning age, gender, race, marital status, educational level, professional duties, place of origin, reasons for seeking the services, occurrences of co- morbidities, and duration of systemic arterial hypertension. SAH occurred more often in the age group of 60-69 years old. The female gender was significantly different from the male. We observed the predominance of married (60.0%), Caucasian (76.0%), with fundamental level of education (54.4%), housewife (39.6%), living in neighborhood towns (58.0%), born in other regions than the Southern Brazil and have seek the service mainly for reasons not related to hypertension (p < 0.05). Cardiopathy of diverse etiology, Diabetes mellitus, Chagas disease and acute myocardial heart attack were identified in 98 patients (39.2%). Long-standing SAH was observed on 65.2% of the patients. The knowledge of the profile of the hypertensives, and principal associated diseases allows directing health actions in order to optimize resources, and make effective control of blood pressure and co-morbidities, including alternative intervention approaches to increase life expectation of patients.

486 DIFFICULTIES FACED IN CONTROLLING HYPERTENSION IN COMMUNITY LEVEL

Hypertension is a global problem and a major risk factor for cardiovascular diseases. 12% of Bangladeshi people are suffering for Hypertension, 7% of deaths in Bangladesh are accounted for by HTN-related diseases, which is equivalent to 9.6 million people after the age of 25 or above1. Effective control of blood pressure is on average 11%. This is due to socioeconomic factors, including: lack of education, high illiteracy rates, low income and difficulty in physician access. This has lead overall to late HTN detection and lack of compliance in HTN control through pharmacotherapy and lifestyle changes. Traditional risk for HTN in Bangladesh include high rates of smoking, sedentary behavior, and the dietary profile, including low consumption of fruits and vegetables. Interestingly, salt consumption is markedly high in the Bangladesh population – a mean of 17 mg/day per person. This is due to in part to excess addition of salt to food, high intake of salted dried fish and the high saline content of water in coastal areas of Bangladesh. These challenges to HTN control particular to Bangladesh are expected to greatly increase the incidence of CVD morbidity and mortality in Bangladesh as the population grows and urbanizes. Thus, mitigation of HTN prevalence in Bangladesh at the community level through HTN control advocacy and intervention by physicians and other health care providers must play a greater role to reduce the high social burden perpetuated by HTN in Bangladesh. Reference: Bangladesh NCD Risk Factor Survey 2010.

Nutraceuticals for Blood Pressure Control in Patients with High-Normal or Grade 1 Hypertension

Current hypertension management guidelines do not recommend drug treatment in subjects with blood pressure (BP) in the high-normal range due to the risk of side effects of the currently available antihypertensive agents that overcomes the possible benefit. Nutraceuticals are free from relevant side effects and could be a valuable strategy for the treatment of these patients. The objective of this study was to compare the efficacy of two nutraceutical compositions given by the combination of policosanol, red yeast rice extract, berberine, folic acid and coenzyme Q(10) with or without Orthosiphon stamineus in lowering the BP and lipid profile. Thirty patients with grade 1 essential hypertension and low cardiovascular risk were analysed. At the end of a run-in period, patients were divided into two study arms and assigned to receive the nutraceutical combination with and without Orthosiphon stamineus. All participants underwent 24-hour ambulatory BP monitoring at the end of the run-in period and of the 4-week treatment with each of the two different nutraceutical combinations. In patients treated with Orthosiphon stamineus a significant reduction of mean 24-hour systolic and diastolic BP levels compared with baseline values was registered and the smoothness index calculated for systolic and diastolic BP showed a more reliable and homogeneous effect on BP over 24 hours. In contrast, nutraceutical treatment without Orthosiphon stamineus was not associated with a significant reduction of BP. Our results show that the addition of Orthosiphon stamineus to the combination of nutraceuticals confers an antihypertensive effect that allows a surprisingly effective 24-hour BP control in hypertensive patients.

Abstract 222: Valsartan at a Sub-therapeutic Dose Ameliorates Myocardial Autophagy Overactivated in Renovascular Hypertension (RVH)

Objective: Excessive autophagy (degradation of intracellular structures) characterizes cardiomyocyte injury in hypertensive heart disease. The effect of Angiotensin II receptor blocker Valsartan on RVH-induced myocardial autophagy remains unexplored. Method: Twenty-one domestic pigs (50-60 Kg) were randomized into 3 groups: RVH, RVH+Valsartan, and Control (n=7 each), and observed for 10 wks. Valsartan (320mg/d PO) was administered for 4 wks starting at 6 wks of RVH. After 10 wks, myocardial fibrosis was examined by trichrome staining, and inflammation by M1 macrophage (M1 Ø, CD163+/iNOS+) staining and TNF-α expression (immunoblotting). Autophagy was examined for Atg 12-Atg 5, Beclin-1 and its inhibitor mTOR. Result: At 6 wks, MAP was higher in both RVH and RVH+Valsartan compared to Control (147.6 ±14.0 and 139.1±11.2 vs. 105.9±11.4 mmHg, respectively, P&lt;0.05). At 10 wks, Valsartan did not decrease MAP compared to RVH (P=0.31), Both Beclin-1 and Atg 12-Atg 15 expressions that were elevated in RVH (P&lt;0.05 vs. Control), indicating increased autophagy, were restored by Valsartan (Figure). Valsartan restored a compensatory increase in mTOR expression in RVH, and ameliorated myocardial fibrosis, M1 Ø, and TNF-α expression (Figure). Conclusion: Valsartan decreased myocardial autophagy, fibrosis and inflammation in pigs with RVH, independent of effective blood pressure control. Valsartan has novel pleiotropic effects on turnover of cellular structures in RVH-induced myocardial damage.

Left Ventricular Mass Index as a Predictor of New-Onset Microalbuminuria in Hypertensive Subjects: A Prospective Study

We aimed to investigate the predictive role of left ventricular mass and its reduction on the development of new-onset microalbuminuria (MA) in newly diagnosed hypertensive patients. A total of 207 nondiabetic, normoalbuminuric patients without clinical organ damage (aged 50.8 ± 10.1 years, 132 male, 84 smokers) with baseline office blood pressure (BP) 148/96 mm Hg were followed for a mean period of 3.3 ± 1.3 years. At baseline and last follow-up visit, all patients underwent office and 24-h ambulatory BP monitoring, albumin to creatinine ratio (ACR) determination, and echocardiographic assessment of left ventricular mass index (LVMI). All patients were treated with antihypertensive therapy during the follow-up period. We defined MA as ACR between 20 and 300 mg/g for men and 30-300 mg/g for women, effective BP control as office BP <140/90 mm Hg in ≥75% of total number of visits, and LVMI reduction as the decline of LVMI at end-follow-up of ≥15% with respect to the baseline value. Between baseline and last follow-up visit, LVMI decreased by 6.84 ± 21.5 g/m(2) (P < 0.01); 64.3% (n = 133) of participants achieved BP control during the follow-up period. Of the total population, 5.8% (n = 12) developed MA during follow-up. Cox-regression analysis, after adjustment for clinical variables, revealed that increase of LVMI by 1 s.d. (23.3 g/m(2)) conferred a 15% increased risk of new-onset MA, while LVMI reduction and BP control were both associated with almost 100% reduced risk of MA development. LVMI and its reduction were qualified as predictors of new-onset MA in newly diagnosed hypertensive patients, beyond BP control.

Safety and Efficacy of Aliskiren/Amlodipine/Hydrochlorothiazide Triple Combination in Patients With Moderate to Severe Hypertension: A 54‐Week, Open‐Label Study

Combination antihypertensive therapies are recommended to attain blood pressure (BP) targets especially in high-risk patients in whom rapid and pronounced BP control is essential. This 28- to 54-week, open-label, multicenter study evaluated the safety and efficacy of a triple combination, aliskiren with amlodipine and hydrochlorothiazide (HCTZ), in patients with moderate to severe hypertension. Following a washout period of up to 4 weeks, patients received aliskiren/HCTZ 300/12.5 mg for 1 week, followed by add-on amlodipine 5 mg for 1 week. Thereafter, the doses of amlodipine and HCTZ were doubled. The first 206 of 564 patients who completed 28 weeks of study continued for an additional 26 weeks. Safety was assessed by recording all adverse events. Efficacy variables included changes in BP from baseline to endpoint and BP control rate. Of 564 patients, 493 completed the study. Peripheral edema (9.4%), headache (5.7%), nasopharyngitis (4.1%), and bronchitis (3.7%) were reported frequently. Clinically significant reductions in mean sitting systolic BP/mean sitting diastolic BP from baseline (-34.2/-20.3 mm Hg and -37.3/-21.8 mm Hg at weeks 28 and 54, respectively) were observed. Corresponding BP control rates were 69.1% and 77.1%. The aliskiren/amlodipine/HCTZ combination in patients with moderate to severe hypertension was well tolerated and provided clinically significant BP reductions and effective BP control.

Blood Pressure Control in Italian Essential Hypertensives Treated by General Practitioners

Adequate control of blood pressure (BP) is limited worldwide. This has serious consequences for public health because in hypertensive patients, uncontrolled BP is associated with a higher incidence of cardiovascular events, particularly stroke. The aim of this study was to investigate BP control in a cohort of treated patients with diagnosed hypertension, who were under general practitioner care in Italy. Data were collected by 2,643 physicians on 8,572 individual Italian patients. Office BP was measured 5 min after seating each patient and then 3-5 min later. For each patient, data such as medical history of patients, physical examination data, antihypertensive drug usage, and self-BP measurement frequency were obtained. Male prevalence was 48.4%, and mean age was 64.3 ± 10.5 years. Based on the second measurement, BP control (<140/90 mm Hg) was observed in 33.5% of all patients (34.2% in men and 33.4% in women). BP control was much lower for systolic BP than for diastolic BP (35.9 vs. 61.3%, P < 0.0001); moreover, BP control was much more common in patients who were engaged in self-BP measurement (61.2 vs. 38.8%, P < 0.0001). A stricter BP control recommended by the guidelines of the European Society of Hypertension (ESH) and European Society of Cardiology (ESC) (<130/80 mm Hg) was observed in only 5.5% of diabetic patients. In treated Italian hypertensives effective BP control remains uncommon largely due to the failure to appropriately reduce the systolic BP. The stricter values recommended by the ESH/ESC guidelines for diabetic patients are achieved only by a small fraction of hypertensive diabetic population.

OS014. Which first-line drug to control severe hypertension in pregnancy? A pilot study

Severe hypertension is a common complication in pregnancy-associated hypertensive disorders and there is no clear consensus on which first-line antihypertensive drug to use in this setting. To determine the efficacy and safety of four antihypertensive drugs (two intravenous and two oral) in pregnant women with severe hypertension. Pilot prospective randomised study. pregnant women with a gestational age >24weeks and admitted in the Obstetrics Department with severe hypertension defined as systolic blood pressure (SBP) ⩾165mmHg and/or diastolic blood pressure (DBP) ⩾105mmHg. The women were randomised in 4 groups to receive:-20mg intravenous labetalol;-5mg intravenous hydralazine;-10mg oral nifedipine tablets ;-10mg sublingual nifedipine. Treatment was repeated every 20mn until target SBP and DBP were reached (⩽150/⩽95mmHg). The primary endpoint was the time needed to achieve effective blood pressure control. Treatment failure was defined as the unability to reach the target BP within one hour. After giving informed consent, 41 pregnant women admitted with severe hypertension were randomised. Mean age was 35 years (SD 3.5), 65% were nulliparous and mean SBP and DBP at admission were 176 (SD 16) and 105 (SD 12)mmHg, respectively. Success to achieve target BP was reached in all patients within the oral 10mg nifedipine group (11 patients), in all but one patients with the 10mg sublingual group (12 patients), and only in 5 out of 9 patients and 6 out of 9 patients within the labetalol and hydralazine groups. They were only one hypotension (defined as SBP <120mmHg) in the two groups with intravenous drugs and 3 and 5 in the oral and sublingual nifedipine groups. These results indicate that oral nifedipine seems more effective than intravenous labetalol or hydralazine to reach BP control in pregnant patients with severe hypertension. A large scale randomized trial comparing oral nifedipine versus these commonly used intravenous antihypertensive drugs should be implemented in order to determine whether oral nifedipine is a more effective treatment in this population.

Epidemiology and Management of Hypertension in the Hispanic Population

Hispanics are the fastest growing ethnic minority in the USA. Among Hispanics, lack of hypertension awareness and lack of effective blood pressure (BP) control are problematic, as are higher incidence rates of hypertension-related co-morbidities compared with non-Hispanic populations. Moreover, there are currently no hypertension treatment guidelines that address the unique characteristics of this ethnic group. This article discusses ethnic differences in hypertension and cardiovascular risk factors and reviews the literature on the efficacy of antihypertensive agents in Hispanic patients, with a focus on the role of renin-angiotensinaldosterone system (RAAS) inhibition in the management of hypertension in these patients. Hypertension in Hispanic patients can be challenging to manage, in part because this population has a higher prevalence of obesity, diabetes, and metabolic syndrome compared with non-Hispanic whites. The presence of these comorbidities suggests that RAAS-inhibitor-based therapies may be particularly beneficial in this population. However, few studies have evaluated the efficacy of antihypertensive treatments in Hispanic patients. Two outcomes studies in hypertensive patients have shown the benefits of treating Hispanic patients with antihypertensive therapy and included RAAS inhibitors as part of the treatment regimen. In addition, BP-lowering trials have shown the antihypertensive efficacy of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and direct renin inhibitors, although data on the latter are more limited. Additional studies are needed to more thoroughly evaluate the effects of RAAS inhibitors (and other drug classes) on outcomes and BP lowering in the Hispanic hypertensive population.

Fixed combination of lercanidipine and enalapril in the management of hypertension: focus on patient preference and adherence

Hypertension is one of the most important and widespread risk factors for the development of cardiovascular disease. Once, combination therapy was traditionally reserved as a third-line or fourth-line approach in the management of hypertension. However, several major intervention trials in high-risk patient populations have shown that an average of 2–4 antihypertensive agents are required to achieve effective blood pressure control. Combination treatment should be considered as a first choice in patients at high cardiovascular risk and in individuals for whom blood pressure is markedly above the hypertension threshold (eg, more than 20 mmHg systolic or 10 mmHg diastolic), or when milder degrees of blood pressure elevation are associated with multiple risk factors, subclinical organ damage, diabetes, renal failure, or associated cardiovascular disease. A number of clinical trials have demonstrated that a fixed combination of lercanidipine and enalapril has better efficacy and tolerability than monotherapy with either agents. The fixed-dose formulation of lercanidipine–enalapril was well tolerated in all clinical trials, with an adverse event rate similar to that of the component drugs as monotherapy. The advantages of combination therapy include improved adherence to therapy and minimization of blood pressure variability. In addition, combining two antihypertensive agents with different mechanisms of action may provide greater protection against major cardiovascular events and the development of end-organ damage.

Blood Pressure Control and Antihypertensive Treatment

Several lines of evidence show that blood pressure (BP) control in treated hypertensive patients is largely unsatisfactory and that this depends on a variety of factors, such as the poor patient's compliance, insufficient use of combination drug treatment as well as true difficulties in achieving well controlled BP. This review article will be focused on the main features of BP control by discussing the data obtained in clinical trials as well as the results available in clinical practice. The paper will also discuss the possible factors responsible for these findings as well as the favourable outcome on cardiovascular risk profile of an effective control of elevated BP. The possible approaches for controlling elevated BP values will be highlighted.

Psychosomatik und arterielle Hypertonie - Love it or leave it?

Over the last two decades modern psychosomatic research has found multiple evidence for an impact of psychosocial factors on the control of arterial blood pressure as well as the development of arterial hypertension. This narrative review focuses first on the current stress concept and factors that influence the degree of blood pressure change following a psychosocial stressor. Second, relevant psychosocial factors associated with blood pressure are presented such as marital status, social support, socioeconomic status and work conditions. In addition, the influence of personality and cognition on blood pressure will be discussed. The second part focuses on the outcome of cognitive-behavioral therapies and relaxation techniques as a means to effectively control blood pressure. In conclusion, there is now good evidence showing that psychosocial factors and stressors may increase blood pressure. The working environment, the socioeconomic status as well as aspects of personality and cognitive factors like rumination may also impact blood pressure with to an extent that is clinically relevant. With respect to therapeutic options, cognitive-behavioral interventions, combined with relaxation techniques all fitting the needs of the individual patient best can offer a clinically meaningful contribution of an effective blood pressure control.

ADSORB: A Prospective Randomised Study on the Efficacy of Endovascular Grafting vs. Best Medical Treatment in Uncomplicated Acute Dissection of the Descending Aorta

Many of the arterial lesions that vascular surgeons treat are on the decline, and those that currently are may soon be offered more effective drug therapy. In contrast, dissections of the aorta are increasing and are likely to represent a significant future workload and challenge for vascular surgeons. Traditionally acute Stanford type B dissections of the aorta were managed by a variety of specialists, often cardiologists. Vascular surgeons only became involved where peripheral ischaemia supervened. Dake demonstrated the feasibility of placing endovascular stentgrafts in to dissected aortas. 1 This approach appeared to offer an attractive alternative to traditional open surgical approaches for complicated aortic dissection which carried high rates of complications. 2 Consequently stent-grafts have been used increasingly in this group of patients. 3 Early efforts to reduce mortality from acute type B dissection demonstrated that effective blood pressure control in the early stages reduced mortality. Medical therapy did not necessarily prevent long-term aortic related complications. The INSTEAD Trial attempted to answer the question whether there was any benefit from placing a stent-graft in type B aortic dissection in the subacute phase (2e52 weeks). 4 There was no reduction in aortic related mortality 2 years after the initial dissection but preliminary data from INSTEAD suggests that stent-grafting might be protective in the longer term (5 years). The next question is whether there would be any additional benefit (or harm) from stenting patients within the first 2 weeks of their initial uncomplicated type B dissection? There remains scope for improvement in the 10% in-hospital mortality when treated with medical therapy. 5 It is possible that stenting might reduce mortality. However, concerns remain (due in part to a lack of data) that stenting within the first 2 weeks may be associated with significant risks even when the aortic dissection is uncomplicated. It is for these reasons that we have been following the development of the ADSORB trial keenly since its inception in 2002. Recruitmenthasbeenslow,suggestingalackofclinicalequipoiseand the change of power calculation is regrettable but seems realistic if the triallists are to complete their study. It is a pity that the trial will not have the power to demonstrate significant differences in the more robustclinicalendpoints (aortic relatedorall-causemortality). It is not clear whether the primary trial composite endpoint of a variety of aortic related events (false lumen thrombosis, aortic dilatation >5 mm, aortic rupture) at 1-year will be a clinically relevant one for patients. In the INSTEAD Trial 20% of patients managed non-operativelyachievedfalselumenthrombosis.Itisquite possible that this group of patients receiving early stent-grafting in the ADSORBtrialmightnotderiveanybenefitatall(andmaybeharmed).

Beyond blood pressure: evidence for cardiovascular, cerebrovascular, and renal protective effects of renin–angiotensin system blockers

For patients with hypertension, effective control of blood pressure (BP) reduces cardiovascular (CV), and renal risk. Antihypertensive agents that offer benefits that extend beyond those associated with BP reduction alone, to include tissue protective effects and effects on the vasculature, may be of benefit for many patients with increased CV risk due to comorbidities or prior history of CV events. Renin-angiotensin system (RAS) blockers [angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs)] are guideline-recognized, highly effective antihypertensive agents that exert their BP-lowering action through different mechanisms at different levels of the RAS. Large-scale clinical studies suggest that small, between-treatment differences in BP lowering do not account for observed outcome differences between RAS blockers and other antihypertensive agents. Analysis of data from seminal clinical studies and meta-analyses identify that, controlling for effects on BP control, RAS blockers may be more effective than calcium channel blockers (CCBs) in reducing risk of myocardial infarction and congestive heart failure; ARBs may be more effective than either ACEIs or β blockers in stroke prevention; CCBs may be more effective than RAS blockers in stroke prevention; and ARBs may be more effective than β blockers in reducing left ventricular hypertrophy. This review considers the rationale and evidence for benefits of RAS blockade beyond BP lowering, and highlights the differences between ARBs and ACEIs, and between agents within these drug classes.

The Role of ARBs Alone or with HCTZ in the Treatment of Hypertension and Prevention of Cardiovascular and Renal Complications

Background: Hypertension (HTN) management guidelines stress the importance of effective blood pressure (BP) control to prevent progression to adverse cardiovascular (CV) and renal outcomes. Objective: To review the efficacy of different angiotensin II receptor blocking agents (ARBs) as monotherapy or in combination therapy as antihypertensive agents and their effects on renal and CV outcomes beyond BP control. Methods: The emerging use of ARBs was reviewed from the current literature (1997–2010). Results: Evidence from clinical trials indicates that most patients will need > 1 agent to achieve their BP goal. First-line combination therapy is becoming increasingly accepted as standard, especially in patients with moderate to severe HTN, as combination therapy not only allows patients to benefit from additive or synergistic properties of drugs with complementary mechanisms of action, but also improves patient compliance and offers better tolerability Furthermore, because HTN is a key risk factor for vascular disease, it is becoming clear that additional beneficial effects, such as cardio– and renoprotection, should also be considered when choosing antihypertensive agents, or combinations, for treatment. Angiotensin receptor blockers as a class of antihypertensive agents are noted for their efficacy and good tolerability in combination with other agents, especially diuretics. Irbesartan/hydrochlorothiazide (HCTZ) treatment resulted in a reduction of 27.1 and 14.6 mm Hg in systolic BP (SBP) and diastolic BP (DBP), respectively. Combination treatment of losartan, olmesartan, telmisartan, valsartan, and HCTZ all achieved significant reductions in SBP/DBP compared with monotherapy regimens. Conclusions: Early use of ARB/HCTZ combination therapy achieves critical decrease in BP and is an effective treatment for patients with moderate to severe HTN. Angiotensin receptor blockers also have renal– and CV–protective properties in conjunction with their antihypertensive effects, providing additional benefit to patients who at risk of vascular disease.

Can strict volume control be the key for treatment and prevention of posterior reversible encephalopathy syndrome in hemodialysis patients?

Posterior reversible encephalopathy syndrome (PRES) is a rare but if diagnosed late an irreversible disease. The majority of the patients present with severe hypertension, and effective blood pressure control is the mainstay of therapy. In this case report, we present three cases with PRES, treated successfully with strict volume control policy and propose that strict volume control policy may be a key element for the treatment of PRES.

An observational study to evaluate factors responsible and actions taken for hypertensive patients who are not at blood pressure goal: i-target Goal Study

To evaluate the percentage of hypertensive patients who could achieve target blood pressure (TBP) according to the guidelines in the context of recommended measures and the factors responsible for failure. A total of 589 hypertensive patients (59.0% female; mean age: 57.7 ± 10.4 years) were assessed twice for TBP achievement based on 2007 ESH/ESC guidelines and the investigators' view, in addition to the recommended measures and possible causes of failure in hypertension management in this national multi-center (n = 99), non-interventional observational study. Only 29.5% of the patients at the first visit and 46.8% at the second visit achieved the TBP levels specified by the guidelines. However, the investigators' evaluation indicated a higher achievement rate at the first (43.5%) as well as the second (69.1%) visit when compared with the guideline-based assessments (P < 0.001). The primary reasons identified by the investigators for the failure to reach TBP were non-compliance with dietary recommendations (61.6%) at the first visit and non-compliance with treatment (63.92%) at the second visit. Recommendations for lifestyle were the most commonly identified treatment plan by the investigators at both visits (62.9% and 66.1%, respectively). Although more patients achieved the TBP levels specified by the guidelines for the second visit compared with the first, effective blood pressure control was achieved only in 29.5% of our patients. Interestingly, the investigators had a more optimistic view about their patients' control of hypertension, which may have contributed to a poor achievement of TBP.

Association of retinal microvascular caliber with blood pressure levels

Background. The most common ophthalmologic manifestation of hypertension is hypertensive retinopathy. Our study was designed to evaluate the factors that determine retinal vessel caliber in hypertensive subjects. Methods. During a 6-month period, retinal photographs were taken of participants during a routine yearly check-up. The photographs were evaluated by an ophthalmologist and the diameters of the individual retinal vessels were measured and summarized by a computer program. Data including patient's medical history, physical examination and laboratory evaluations were collected. The findings of the ophthalmologic examinations were analyzed with respect to the relevant systemic data. Results. We evaluated 285 subjects (43 women) with an average age of 62 ± 9 years (range 33–87). Hypertension was reported in 204 (71.6%) subjects and diabetes mellitus in 60 subjects (21%). The arteriolar calibers were inversely related to age (R = − 017; p = 0.01). Retinal arteriolar and venular calibers were wider in smokers and in subjects with dyslipidemia. History of hypertension was not associated with any vascular changes. However, retinal arteriolar caliber was inversely related to blood pressure levels. Diuretic treatment was associated with narrow retinal venular caliber. Conclusion. The association between different cardiovascular risk factors and hypertensive retinopathy is complex. Effective blood pressure control has a beneficial effect on the vascular changes in the retina.

Olmesartan medoxomil combined with hydrochlorothiazide improves 24-hour blood pressure control in moderate-to-severe hypertension

Background:Twenty-four-hour ambulatory blood pressure monitoring (ABPM) has been shown to be more reliable than conventional measurements for hypertension assessment and the associated increased risk of cardiovascular events. Olmesartan/hydrochlorothiazide combination therapy has demonstrated increased blood pressure lowering over 24 hours compared with the component monotherapies. This prespecified pooled analysis of data from two trials investigated the effects of olmesartan/hydrochlorothiazide combination therapy and olmesartan monotherapy on 24-hour blood pressure control in patients with moderate-to-severe hypertension.Methods:After 8 weeks’ open-label olmesartan 40 mg monotherapy, uncontrolled patients (mean trough seated blood pressure 90–115/140–180 mmHg and 24-hour mean ambulatory diastolic blood pressure ≥80 mmHg with ≥30% of daytime ambulatory diastolic blood pressure readings >85 mmHg) were randomised to 8 weeks’ double-blind treatment with olmesartan 40 mg or olmesartan/hydrochlorothiazide 20/12.5, 40/12.5 or 40/25 mg (Study 1) or olmesartan/hydrochlorothiazide 20/25 or 40/25 mg (Study 2). This prespecified analysis of ambulatory blood pressure was performed on patients from the full analysis set of pooled studies 1 and 2, restricted to patients who provided at least one valid ABPM measurement at baseline.Results:After 8 weeks’ double-blind treatment, reductions in 24-hour, daytime and night-time blood pressure from baseline were observed for all treatment groups. These reductions were dose-dependent, with olmesartan/hydrochlorothiazide 40/25 mg demonstrating the greatest reductions in 24-hour blood pressure from baseline to Week 16 versus olmesartan monotherapy: −14.0/−8.8 vs −2.7/−2.0 mmHg, respectively; p < 0.0001.Conclusions:Adding hydrochlorothiazide to olmesartan provides more effective 24-hour blood pressure control versus olmesartan monotherapy in patients with moderate-to-severe hypertension.Clinical trial registration:Trial registration: ClinicalTrials.gov identifier: NCT00430508.Trial registration: ClinicalTrials.gov identifier: NCT00430950.