Hypertension Experts Research Articles

Sleep Disorders, Obesity, Hypertension, and Cardiovascular Risk.

The pandemic of obesity is associated with parallel epidemics of sleep disorders, diabetes, hypertension, and cardiovascular disease (CVD), that is, the primary cause of morbidity and mortality among adults [1]. Sleep disorders generally go unrecognized and undiagnosed and appear to play a major role in the interrelationships between obesity, diabetes, hypertension, and cardiovascular disease [2–4]. Accumulating evidence from cross-sectional as well as longitudinal studies by various groups, including ours, indicates close interrelationships among sleep disorders and diabetes, hypertension, and CVD including stroke, coronary artery disease, and heart failure, particularly among minority populations and women [2–5]. Postulated mechanisms or mediators of interrelationships between sleep disorders and CVD include oxidative stress, increased inflammation, increased uric acid endothelial dysfunction, dyslipidemia, and hypercoagulability, which are common underlying CVD risk factors among individuals with metabolic syndrome [6–8]. Furthermore, the cost of undiagnosed sleep disorders appears to be exceedingly high, prompting the American Academy of Sleep Medicine to recommend screening for at-risk individuals [9, 10]. This is quite important giving the mounting evidence of decreased CVD risk and improved cardiometabolic functions with treatment of sleep disorders, particularly among patients with sleep apnea [9]. In this special issue, we assembled a group of world-renowned editors with complementary expertise in sleep medicine, hypertension, diabetes, obesity, and cardiovascular disease to lead this initiative. Commensurate with level of expertise of the editorial team, we were able to attract important papers from established investigators from all over the world. Judging from the accepted papers for this special issue, we surmise that they are both topical and timely and they are likely to have a significant impact on the field. The issue covers a wide range of topics, from dietary interventions, in the form of low glycemic index food and its effectiveness in lowering blood pressure to factors associated with medication nonadherence among hypertensives in two African countries: Ghana and Nigeria. Another important topic covered is the implications of renal denervation, a rather novel and increasingly studied potential therapy for hypertension, in patients with sleep apnea. An interesting topic also examined in a research paper indicated that in Black American working nonday time shift are more likely to report hypertension, especially with short sleep duration. This article opens further questions for investigations including those examining the underlying mechanisms for these findings. This special issue also included an epidemiologic assessment for the prehypertension and hypertension in two countries in Sub-Saharan Africa. This study assessed predictors of various stages of hypertension including obesity and educational levels in these vulnerable populations. Another closely related article from Africa among people with hypertension assessed the subtypes of hypertension in different light including controlled hypertension, isolated systolic hypertension, and isolated diastolic hypertension as well as systolic-diastolic hypertension as they relate to obesity. This is quite important since different subtypes confer various degrees of risk. For example, among Blacks and/or people with diabetes systolic hypertension is predominant and is associated with high CVD risk factors including microalbuminuria, insulin resistance, postural hypertension, salt sensitivity, and volume expansion. Characterization of subtypes of hypertension not only opens the doors for further investigations of research questions, but also helps strategize in terms of treatment such as the utilization of low salt diet, diuretics, and agents that inhibit the renin angiotensin aldosterone function (RAAS), such as Angiotensin Converting Enzyme (ACE) Inhibitors and the Angiotensin Receptor Blockers (ARBs). Finally, the interrelationships between sleep disorders and CVD are explained and illustrated in a well-written review article included in this issue that highlights the most recent findings and insights in this highly complex topic, providing the readers with food for thought that will hopefully generate testable and clinically important hypotheses. Samy I. McFarlane Olugbenga Ogedegbe Amgad N. Makaryus Charles Agyemang Girardin Jean-Louis

Knowledge and attitude of general practitioners regarding diagnosis and treatment of hypertension in a Nigerian city

Background: Hypertension is highly prevalent in sub-Saharan Africa, underlying many of the fatal and non-fatal cardiovascular events. Objectives: To examine the level of knowledge of primary care physicians in urban Nigeria, as regards to hypertension. Participants: A cross-sectional survey of general medical practitioners in Lagos, Nigeria was undertaken in the months of July and August 2011 using self-administered semi-structured questionnaires. Results: There were 74 respondents, 59.5% of whom were men and the bulk of the subjects, 41.9% were in the 30-39 years age range. Duration since graduation of 0-5 years, 56.8% and ≥21 years, 17.6% had the highest respondents. The bulk of the respondents, 90.5% were aware of the existence of guidelines on hypertension but 35.1% were not familiar with the details of any guideline. Majority, 97.3% agreed to the usefulness of guidelines and 93.2% correctly identified cut-off values for hypertension. All but one agreed to the need of referral of complicated cases to hypertension experts and would recommend lifestyle modification for all. About 44.6% of respondents generally attended 5 or more continuing professional development (CPD) per year. Conclusion: Awareness of the existence of guidelines on hypertension and attendance at CPD programs is quite high among general medical practitioners in urban Nigeria. Knowledge of the details of these guidelines however is not as high. Focus on hypertension guidelines in most of the CPDs is recommended considering the public health importance of hypertension.

Pulmonary hypertension and the right ventricle-thinking outside the box (Third International Right Heart Failure Summit, part 1).

The Third International Right Heart Failure Summit (Boston, MA) convened a group of international clinical and scientific experts in pulmonary vascular disease and right heart disease to explore cutting-edge developments in the mechanisms and clinical management of right-sided cardiovascular disease. The symposium was organized into three distinct sessions, the first of which was titled "Pulmonary Hypertension and the Right Ventricle-Thinking outside the Box" and will be the focus of this review. Three internationally renowned experts in pulmonary hypertension and right heart disease-Drs. Stuart Rich, Sean Gaine, and Harm Bogaard-each delivered provocative lectures. The first lecture, by Dr. Rich, was titled "Current Classification for Pulmonary Hypertension-Why Are We Ignoring the Structural Basis of the Disease?" Rich focused on the current classification system of pulmonary hypertension and provided a unique historical perspective. He also addressed the need to evolve the prevailing conceptual framework of our approach to pulmonary vascular diseases and right ventricular dysfunction, including the future design of pulmonary hypertension clinical trials. Dr. Gaine delivered the second lecture, titled "Treatment Algorithm for Pulmonary Hypertension: Tunnel Vision of our Current Approach." Gaine emphasized the tripartite model of pulmonary hypertension management, namely, supportive measures, pharmacologic therapy, and rescue therapy. Specifically, he detailed how each of these entities is changing as our understanding of the unmet needs in the field of pulmonary hypertension is becoming increasingly apparent. Finally, Dr. Bogaard provided a lecture titled "Treating Right Heart Failure: Why Does the Art of Medicine Lead the Science?" Bogaard provided a stimulating review of cutting-edge translational research of right ventricular function and dysfunction. In particular, he described a variety of molecular and cellular changes that occur in the hypertrophied right ventricle and contrasted those changes that may be adaptive from those that are maladaptive and may be potential therapeutic targets.

Excellence and Notable Achievement Awards From the World Hypertension League: A Call for 2015 Nominations

Excellence and Notable Achievement Awards From the World Hypertension League: A Call for 2015 Nominations

The heterogeneity of clinical practice patterns among an international cohort of pulmonary arterial hypertension experts.

The extent to which pulmonary arterial hypertension (PAH) experts share common practice patterns that are in alignment with published expert consensus recommendations is unknown. Our objective was to characterize the clinical management strategies used by an international cohort of self-identified PAH experts. A 32-item questionnaire composed mainly of rank order or Likert scale questions was distributed via the Internet (August 5, 2013, through January 20, 2014) to four international pulmonary vascular disease organizations. The survey respondents (N = 105) were field experts reporting 11.6 ± 8.7 years of PAH experience. Likert scale responses (1 = disagree, 7 = agree) were 3.0-5.0, indicating a disparity in opinions, for 78% of questions. Respondent (dis)agreement scores were 4.4 ± 2.2 for use of expert recommendations to determine catheterization timing in PAH. For PAH patients without cardiogenic shock or known vasoreactivity status, the most and least preferred first-line therapies (1 = most preferred, 5 = least preferred) were phosphodiesterase type 5 inhibitors (PDE-Vi) and subcutaneous prostacyclin analogues, respectively (1.4 ± 0.8 vs. 4.0 ± 1.1; P < 0.05). Compared with US-practicing clinicians (N = 46), non-US-practicing clinicians (N = 57) favored collaboration between cardiology and pulmonary medicine for clinical decision making (1 = disagree, 7 = agree; 3.1 ± 2.2 vs. 4.8 ± 2.2; P < 0.0001) and PDE-Vi (6.5% vs. 22.4%) as first-line therapy for PAH patients with cardiogenic shock but were less likely to perform vasoreactivity testing in patients with lung disease-induced pulmonary hypertension (4.3 ± 2.1 vs. 2.2 ± 1.6; P < 0.0001). In conclusion, practice patterns among PAH experts diverge from consensus recommendations and differ by practice location, suggesting that opportunity may exist to improve care quality for this highly morbid cardiopulmonary disease.

Chronic thromboembolic pulmonary hypertension: Time delay from onset of symtoms to diagnosis and clinical condition at diagnosis

Chronic-thromboembolic pulmonary hypertension (CTEPH) is a serious complication of acute pulmonary embolism (PE). In untreated patients prognosis is poor. It depends on WHO-functional class. A delay from onset of symptoms and diagnosis can lead to a further worsening of prognosis. A pulmonary endarterectomy is the treatment of choice. We aimed to evaluate the time delay from onset of symptoms to diagnosis and the WHO-functional class at primary diagnosis in patients with CTEPH. Retrospective analysis of data from 70 monocentrically registered patients (48 women, 22 men, mean age 66,2 years ± 13,8 years) with confirmed CTEPH from the pulmonary hypertension expert center Missionsärztliche Klinik. Diagnostic work-up was performed according to the current guidelines. Mean delay from onset of symptoms to diagnosis of CTEPH was 18 ± 26 months. Time delay was only slightly shorter in patients with a history of PE (n = 56; 81 %) than in patients without a history of PE (n = 13; 19 %): 16,9 ± 23,8 vs. 23,5 ± 36,9 months. Time delay was higher in patients who received vasoactive medication before the first contact with a PH expert center and in patients who were classified as technically not suitable for a thrombendarterectomy. 38 patients with a history of acute PE did not have a period without symptoms. In 18 patients symptoms had transiently gone after PE. More than 70 % presented in WHO functional class III or IV. Time delay between onset of symptoms and diagnosis of CTEPH and referral to a PH expert center is long and the majority of patients presented in WHO-functional class III or IV. Prognosis is poor in untreated patients and getting worse with a higher WHO-functional class. For this reason, and because CTEPH can be cured by a pulmonary endarterectomy, each patient with suspected PH should be referred to a PH expert center to exclude CTEPH.

Hypertension Expert System with C5.0 Algorithm and Fuzzy Logic

Hypertension Expert System with C5.0 Algorithm and Fuzzy Logic

Prevention and control of hypertension: developing a global agenda.

This review demonstrates the need for enhancing strategic approaches to the prevention and control of hypertension, a global health issue. An epidemic of chronic noncommunicable diseases is threatening national healthcare systems' sustainability and the economy of many countries. Increased blood pressure is the leading risk for premature death and disability and accounts for approximately 10% of healthcare spending. Four of nine recent United Nations' targets for reducing chronic noncommunicable diseases relate directly or indirectly to hypertension. The expanded chronic care model provides a comprehensive framework for developing hypertension prevention and control strategies. The model addresses the roles of healthy public policy, healthy living environments, healthy communities, reorientation of health services delivery toward management of chronic illness, support for improving clinical decisions, enhanced skills of people to prevent and self-manage chronic disease, partnerships of stakeholders and information systems to track the impact of interventions and identify care 'gaps'. The authors advocate that hypertension organizations can lead aspects of hypertension strategy development and implementation. Prevention and control of hypertension requires a strategic approach that could have a central role for hypertension experts and the hypertension community.

Eligibility for Renal Denervation

Based on the SYMPLICITY studies and CE (Conformité Européenne) certification, renal denervation is currently applied as a novel treatment of resistant hypertension in Europe. However, information on the proportion of patients with resistant hypertension qualifying for renal denervation after a thorough work-up and treatment adjustment remains scarce. The aim of this study was to investigate the proportion of patients eligible for renal denervation and the reasons for noneligibility at 11 expert centers participating in the European Network COordinating Research on renal Denervation in treatment-resistant hypertension (ENCOReD). The analysis included 731 patients. Age averaged 61.6 years, office blood pressure at screening was 177/96 mm Hg, and the number of blood pressure–lowering drugs taken was 4.1. Specialists referred 75.6% of patients. The proportion of patients eligible for renal denervation according to the SYMPLICITY HTN-2 criteria and each center’s criteria was 42.5% (95% confidence interval, 38.0%–47.0%) and 39.7% (36.2%–43.2%), respectively. The main reasons of noneligibility were normalization of blood pressure after treatment adjustment (46.9%), unsuitable renal arterial anatomy (17.0%), and previously undetected secondary causes of hypertension (11.1%). In conclusion, after careful screening and treatment adjustment at hypertension expert centers, only ≈40% of patients referred for renal denervation, mostly by specialists, were eligible for the procedure. The most frequent cause of ineligibility (approximately half of cases) was blood pressure normalization after treatment adjustment by a hypertension specialist. Our findings highlight that hypertension centers with a record in clinical experience and research should remain the gatekeepers before renal denervation is considered.

Clinical Implications

HomeHypertensionVol. 63, No. 6Clinical Implications Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBClinical Implications Originally published1 Jun 2014https://doi.org/10.1161/HYPERTENSIONAHA.114.03613Hypertension. 2014;63:1137Eligibility for Renal Denervation (page 1319)Based on the SYMPLICITY studies and Conformité Européenne certification, renal denervation is currently applied as a novel treatment of resistant hypertension in Europe. However, information on the proportion of patients with resistant hypertension qualifying for renal denervation after a thorough workup and treatment adjustment remains scarce. This issue of Hypertension includes a study that aimed to investigate the proportion of patients eligible for renal denervation and the reasons for noneligibility at 11 expert centers participating in the European Network COordinating Research on renal Denervation in treatment-resistant hypertension (ENCOReD). The analysis included 731 patients. After careful screening and treatment adjustment at hypertension expert centers, only ≈40% of patients referred for renal denervation, mostly by specialists, were eligible for the procedure. The main reasons of noneligibility were normalization of blood pressure after treatment adjustment (46.9%), unsuitable renal arterial anatomy (17.0%), and previously undetected secondary causes of hypertension (11.1%). Our findings highlight that hypertension centers with a record in clinical experience and research should remain the gatekeepers before renal denervation is considered. Moreover, assuming that renal denervation would be efficacious in a large number of patients with a variety of conditions may be overly optimistic. This groundless belief might well explain why SYMPLICITY HTN-3 failed to reach its primary end point for efficacy.Download figureDownload PowerPointEstrogen Receptor-β and Intracranial Aneurysm Rupture (page 1339)Clinical observations suggest that postmenopausal women have a higher incidence of aneurysmal subarachnoid hemorrhage than premenopausal women. In addition, hormone replacement regimens that contain estrogen seem to reduce the risk for subarachnoid hemorrhage in postmenopausal women. These clinical observations led to the hypothesis that estrogen may protect against the development of intracranial aneurysm rupture (subarachnoid hemorrhage) in postmenopausal women. In this issue of Hypertension, Tada et al sought to establish the causal relationship between estrogen treatment and the prevention of aneurysmal rupture in postmenopausal mice. They used a mouse model of intracranial aneurysm. This model recapitulates the key features of human intracranial aneurysms, including spontaneous rupture. In ovariectomized female mice, estrogen significantly reduced the rupture rates. The protective effect of estrogen seemed to occur through the activation of estrogen receptor-β, a predominant subtype of estrogen receptor in human intracranial aneurysms and cerebral arteries. Estrogen’s unwanted effects are often attributed to its agonistic activity without tissue specificity. Selective estrogen receptor modulators can exert agonistic or antagonistic actions on estrogen receptor subtypes in a tissue-specific fashion. Findings from this study may become the basis for testing selective estrogen receptor modulators with a favorable tissue and receptor subtype specificity profile for the prevention of the growth and rupture of intracranial aneurysms in humans, particularly in postmenopausal women.Download figureDownload PowerPointCardiometabolic Risk at 5 Years (page 1326)The time immediately before and after birth may be a sensitive period related to programming cardiometabolic risk. The present prospective study, performed in children born at term after a noncomplicated pregnancy, shows that birth weight and postnatal weight gain exert independent influences on cardiometabolic parameters at 5 years of age. Although birth weight influenced the metabolic parameters, insulin levels, homeostatic model assessment index, and postnatal weight gain influenced both metabolic parameters and blood pressure values. Throughout the study, systolic blood pressure was related to weight gain, and at 5 years the heaviest children had the highest systolic blood pressure. Moreover, the highest values of insulin, homeostatic model assessment index, and triglycerides were related to both weight gain and current weight. Interestingly, small for gestational age children had the highest values of fasting insulin and homeostatic model assessment index and the lowest high-density lipoprotein. Therefore, it stands to reason that subjects smaller at birth who gain more weight have more risk for metabolic alterations, a fingerprint of early subtle adaptations in the glucose-insulin metabolism. Furthermore, a clustering of higher blood pressure values, insulin levels, and uric acid levels has been observed early in life, indicating the potential for increased cardiometabolic risk later on. This information provides a window of opportunity for intervention to avoid an unbalanced weight gain and to reduce the potential increment of cardiometabolic risk later in life.Download figureDownload PowerPoint Previous Back to top Next FiguresReferencesRelatedDetails June 2014Vol 63, Issue 6 Advertisement Article InformationMetrics © 2014 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.114.03613 Originally publishedJune 1, 2014 PDF download Advertisement

Assessing the Trustworthiness of the Guideline for Management of High Blood Pressure in Adults

The article by James and colleagues1 published in JAMA contains the long-awaited guideline for hypertension issued by the panel members appointed by the National Heart, Lung, and Blood Institute (NHLBI) to the Eighth Joint National Committee (JNC 8). In the past decade, the effect of guidelines on clinical practice has increased because organizations that develop quality measures and make coverage decisions depend on guideline developers to uncover the best evidence and make specific recommendations. Because guidelines matter more, critics have questioned the processes that professional associations have used to develop guidelines. The title of the 2011 Institute of Medicine (IOM) report on quality standards for practice guidelines, Clinical Practice Guidelines We Can Trust,2 captures current concerns. Despite the efforts of the expert panel that developed the new guideline for management of hypertension, some aspects of the external review process may undermine public confidence. The NHLBI convened the JNC 8 panel in 2008. The panel decided to adhere to the standards set by the IOM study committee2 instead of following the practices of earlier JNC panels. The JNC 7 committee produced a comprehensive overview of the management of hypertension. The committee did not commission systematic reviews of the evidence. The report did not state the extent and quality of the evidence for many topics, so that the logical connection between the evidence and some recommendations was not clear. The report described conflicts of interest for committee members but did not say whether members recused themselves from voting when they had a conflict.3 As part of the guideline development process, the present hypertension guideline panel commissioned a systematic review of randomized trial evidence, evaluated the evidence, made recommendations, indicated the level of evidence supporting those recommendations, reported conflicts of interest, and recused conflicted panel members from voting. Because of these changes, this guideline adheres much more closely to the IOM standards than the JNC 7 guideline. The external review process began when the panel submitted the draft guideline to the NHLBI. According to James et al,1 the NHLBI submitted the guideline to 16 federal agencies and to 20 reviewers, all of whom were experts in hypertension. In addition, individual reviewers were expert in cardiology, nephrology, primary care, pharmacology, research (including clinical trials), biostatistics, and other related fields. The authors report that they received responses from 16 individual reviewers and 5 reviewers from federal agencies. The panel revised the guideline, completing its work in June 2013, just as the NHLBI announced that it was turning the guideline development process over to the American Heart Association and the American College of Cardiology, which jointly sponsor a respected guidelines program.4 Rather than submit the hypertension guideline for review by these organizations, the panel members submitted the guideline to JAMA, where it underwent both internal and external peer review. Thus, physicians and other readers are confronted with an important report that, although it has undergone extensive review, has not been evaluated by the specialty societies that the NHLBI designated to take responsibility for the guidelines program. The panel’s departure from usual practice leads to 4 questions. First, what are the key elements of trustworthiness in a guideline? Second, how does this guideline measure up? Third, what is the role of expert review of guidelines? Fourth, what is the pathway to guidelines that the public can trust?

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

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

Analysis of Recent Papers in Hypertension Treatment of Hypertension in the Setting of Acute Intracerebral Hemorrhage: Still No Clear Answer on the Best BP Level to Intervene or What BP Goal to Achieve

Whether or not and how aggressively to treat elevated blood pressure (BP) in the face of acute intracerebral hemorrhage (ICH) have been questions stroke neurologists and hypertension experts have been debating for decades. Even in patients without a known history of hypertension, BP tends to elevate after ICH. This effect is thought to be primarily an adaptive response to increased intracerebral pressure (ICP), although other mechanisms may also be involved. Whether elevated BP after acute ICH is simply a marker of increased ICP and a poor prognosis or is a potential target for intervention is unknown. Certainly, increased BP might lead to a greater risk of hematoma expansion and poor outcome, but lowering BP with antihypertensive medication in the face of increased ICP might also be associated with decreased cerebral perfusion and a greater likelihood of ischemia. Current guidelines from the American Stroke Association (ASA) published in 2010 1 suggest aggressively treating BP in patients with acute ICH with intravenous antihypertensive agents if:

Safety Recommendations for Administering Intravenous Prostacyclins in the Hospital

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

Ambulatory Blood Pressure Measurement

The Working Group on Blood Pressure Monitoring of the European Society of Hypertension (ESH) published recommendations for blood pressure (BP) measurement in 20031 and a guideline for home BP measurement in 2008.2 Ambulatory BP monitoring (ABPM) has become a subject of considerable scientific interest with >10 000 articles listed on PubMed in 2012. In 2001, the Center for Medicare and Medicaid Services in the United States approved ABPM for reimbursement for the identification of subjects with white-coat hypertension,3 and in 2011, the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom recommended that ABPM should be offered as a cost-effective technique to all people suspected of having hypertension.4 One of the first meetings to examine the potential of ABPM was held in Ghent in 1978,5 and since then the ESH Working Group on Blood Pressure Monitoring has held several consensus conferences, the most recent being in Milan in 2011. The technique was comprehensively reviewed and, arising from this meeting, a position article was drafted incorporating the opinions of 34 international experts in hypertension and BP measurement.6 During the drafting of this article, it became apparent, first, that the large literature on ABPM was in need of assessment but that drafting a systematic review on this topic would be a difficult task, given the very large number of studies dealing with ABPM, and second, that even among experts, there was differing opinion on certain basic aspects of ABPM, such as the definition of white-coat and masked hypertension. In this article, we highlight these areas of potential controversy, not as an indictment of expert opinion but rather to illuminate aspects of the technique in need of clarification, and perhaps, as importantly, in need of further research. Most devices available for ABPM have been validated …

GW24-e1143 A Network platform for hypertension originated from innovation, applied to practice

ObjectivesTo make a breakthrough in medical care, and establish "a network platform for hypertension", so as to explore its function in preventing and treating hypertension.MethodsTo establish "a network platform for...

World Health Day

Each year, World Health Day celebrates the formation of the World Health Organization. In 2013, the theme is hypertension, and on April 4 there will be a media release from the World Health Organization (http://www.who.int/ world-healthday/en/). The WHO intends to focus attention on “the causes and consequences of hypertension, the need for people to have healthy behaviours to prevent hypertension, the need for regular blood pressure checks, and the need for governments to create healthy environments that would assist in preventing hypertension.” Increased blood pressure is recognized by the WHO as the leading risk for death and disability worldwide. An estimated 9.4 million deaths annually and 7% of all disability are caused by increased blood pressure. The World Hypertension League supports the efforts of the WHO to bring attention to hypertension and requests national hypertension organizations and experts utilize the World Health Day to advocate for actions to prevent and control hypertension. In addition, the World Hypertension League through its national member leagues and societies promote public awareness of hypertension through World Hypertension Day, annually, on May 17th. The World Hypertension League reminds all that:

KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for Management of Blood Pressure in CKD

In response to the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) guideline for blood pressure management in patients with chronic kidney disease not on dialysis, the National Kidney Foundation organized a group of US experts in hypertension and transplant nephrology to review the recommendations and comment on their relevancy in the context of current US clinical practice and concerns. The overriding message was the dearth of clinical trial evidence to provide strong evidence-based recommendations. For patients with CKD with normal to mildly increased albuminuria, goal blood pressure has been relaxed to ≤140/90 mm Hg for both diabetic and nondiabetic patients. In contrast, KDIGO continues to recommend goal blood pressure ≤130/80 mm Hg for patients with chronic kidney disease with moderately or severely increased albuminuria and for all renal transplant recipients regardless of the presence of proteinuria, without supporting data. The expert panel thought the KDIGO recommendations were generally reasonable but lacking in sufficient evidence support and that additional studies are greatly needed.

OMG, a Kid is Coming!: Preparing Community Hospice and Palliative Care Providers to Care for Children (TH337)

a life-limiting condition. In addition, the multidisciplinary panel of palliative care and pulmonary hypertension experts will discuss their combined experience caring for patients nearing and at the end of life. These experiences will also include de-escalating advanced therapies such as continuous prostacylins at the end of life. The speakers will discuss common barriers at end of life for pulmonary hypertension patients and provide some potential ways to overcome these hurdles. The session will draw upon a combination of lecture and case examples to highlight these important teaching points.

Expert consensus for performing right heart catheterisation for suspected pulmonary arterial hypertension in systemic sclerosis: a Delphi consensus study with cluster analysis

ObjectiveTo establish an expert consensus on which criteria are the most appropriate in clinical practice to refer patients with systemic sclerosis (SSc) for right heart catheterisation (RHC) when pulmonary hypertension...