Endothelin-1 exerts vasoactive, pro-inflammatory, hypertrophic, and profibrotic properties on the heart, kidney, and blood vessels. Hence, endothelin-receptor antagonists hold the potential to reduce blood pressure and to prevent complications of hypertension, atherosclerosis, and diabetes through blood pressure-independent effects on cardiovascular growth, inflammation, and fibrosis. These potentially important effects of endothelin ...

Hypertensive emergencies are life-threatening conditions because their course is complicated with acute target organ damage. They can present with neurological, renal, cardiovascular, microangiopathic hemolytic anemia, and obstetric complications. After diagnosis, they require the immediate reduction of blood pressure (in <1 hour) with intravenous drugs such as sodium nitroprusside, administered in ...

Arterial blood pressure is a major determinant of renal and cardiovascular outcomes in diabetic nephropathy. There is a proportional relationship between the systolic blood pressure and renal and mortality outcomes. Decreasing the diastolic pressure does not significantly decrease these outcomes. Irrespective of the magnitude of pretreatment systolic hypertension in the ...

This article discusses seven issues in the management of hypertension in diabetic patients, namely the importance of blood pressure control, optimal blood pressure control levels, the importance of blocking the renin-angiotensin system, the inevi-tability of combination anti-hypertensive therapy, drug choices, the diabetogenic effects of high dose thiazide diuretics and beta-blockers ...

The microcirculation largely determines peripheral vascular resistance and substantially contributes to arterial hypertension. In both human arterial hypertension and animal models of hypertension, genetic, fetal and other mechanisms associated with hypertension can reduce the formation and number of microvessels (i.e. parallel-connected arterioles and capillaries). Impaired formation of microvessels (impaired angiogenesis) ...

Among the general heart failure (HF) population, over half have diastolic HF (DHF). The proportion of DHF increases with age, from 46% in patients younger than 45 years to 59% in patients older than 85 years. The diagnosis of DHF is made by the combination of signs and symptoms of ...

The choice of vasopressors to treat vasodilatory shock after cardiac surgery is a matter of controversy. We have systematically reviewed the literature and found that the data are insufficient to guide choice of agent. However, we found sufficient evidence that when a target blood pressure can not be achieved with ...

For half a century, controlled hypotension has been used to reduce bleeding and the need for blood transfusions, and provide a satisfactory bloodless surgical field. It has been indicated in oromaxillofacial surgery (mandibular osteotomy, facial repair), endoscopic sinus or middle ear microsurgery, spinal surgery and other neurosurgery (aneurysm), major orthopaedic ...

AIM: The purpose of this study was to assess the prevalence and severity of hypertension in a dental hygiene clinic and evaluate factors related to the disease. METHODS AND MATERIALS: Records of 615 patients, treated by dental hygiene students during 2003, were reviewed. Data collected included systolic and diastolic blood ...

Hypertension (persistent diastolic blood pressure of 90 mm Hg or higher and systolic blood pressure 140 mm Hg or higher) affects 20% of the world's adult population, and increases the risk of cardiovascular disease, end stage renal disease, and retinopathy. METHODS AND OUTCOMES: We conducted a systematic review and aimed ...

PURPOSE: A study was conducted to characterize the prevalence of hypertension in patients with diabetes mellitus and the percentage of patients with diabetes and hypertension who achieved a targeted blood pressure goal (<135/80 mm Hg). METHODS: A retrospective, cross-sectional study was conducted in an ambulatory care clinic. Eligible patients were ...

Aliskiren is a potent, highly specific renin inhibitor with better oral bioavailability than earlier renin inhibitors and a long plasma half-life that makes it suitable for once-daily dosing. The efficacy and safety of aliskiren in treating hypertension has been studied in clinical trials both as monotherapy, comparing it with existing ...

Resistant hypertension is defined as failure to achieve goal blood pressure despite adherence to 3 different antihypertensive medications, one of which must be a diuretic. True resistant hypertension must be distinguished by apparent resistant hypertension, of which an important cause is medication nonadherence, which can be recognized through a variety ...

Hypertension is a major cause and contributor to stroke, heart and kidney disease. Despite the development of an arsenal of medication to treat hypertension over the past half-century, adequate treatment continues to be a major problem in the United States. The Third National Health and Nutrition Examination Survey (NHANES-III) shows ...

Nesiritide is a recombinant form of human B-type natriuretic peptide, a naturally occurring endogenous hormone released by cardiac ventricles in response to an increase in ventricular wall stress. Its use in the treatment of acute decompensated heart failure (ADHF) has been evaluated in a series of randomised controlled clinical trials. ...

Effective blood pressure control with a large arsenal of conventional antihypertensive drugs, such as diuretics, beta-adrenergic blockers, and calcium channel blockers, significantly reduce the morbidity and mortality associated with cardiovascular disease. However, blood pressure control with these drugs does not reduce cardiovascular disease risks to the levels in normotensive persons. ...

BACKGROUND: Diuretics are a common intervention in critically ill patients with acute kidney injury (AKI). However, there is no information that describes the practice patterns of diuretic use by clinicians. METHODS: Multinational, multicenter survey of intensive care and nephrology clinicians that utilized an 18-question self-reported questionnaire. RESULTS: The survey generated ...

The presence of proteinuria is a well-known risk factor for both the progression of renal disease and cardiovascular morbidity and mortality, and decreases in urine protein excretion level were associated with a slower decrease in renal function and decrease in risk of cardiovascular events. Increased blood pressure has a major ...

The management of hypertension continues to pose important challenges. Recent developments have established the importance of more rigorous blood pressure control in the community. In the perioperative setting, hypertension has long been recognised as undesirable, although the adverse impact of high blood pressure on the acute risks of elective surgery ...

Information Technology (IT) enables health care providers to manage patients with chronic conditions through identification, follow up and administration of specific interventions. In our setting, we developed a surveillance system for chronic diseases. The aim of this study was to show its efficacy on monitoring blood pressure throughout a cluster ...

Since most cases of hypertension are managed in family practice, estimates of the prevalence, treatment, and control in the primary care population are needed to adequately address the burden of hypertension in Canada as it has in other countries. The authors used a large primary care research database to determine ...

High blood pressure (BP) is the major cardiovascular risk factor and the main cause of death around the world. Control of blood pressure reduces the high mortality associated with hypertension and the most recent guidelines recommend reducing arterial BP values below 140/90 mmHg for all hypertensive patients (130/80 in diabetics) ...

INTRODUCTION: Patients with sepsis suffer high morbidity and mortality. We sought to conduct a systematic review of the literature to evaluate the association between hemodynamic goals of therapy and patient outcomes. METHODS: We conducted a comprehensive search of the literature to systematically review hemodynamic goals used in clinical trials in ...

Detection of hypertension and blood pressure control are critically important for reducing the risk of heart attacks and strokes. We analyzed the trends in the prevalence, awareness, treatment, and control of hypertension in the United States in the period 1999-2004. We used the National Health and Nutrition Examination Survey 1999-2004 ...

Recent analyses suggest that about 67-68% of men with hypertension have some degree of erectile dysfunction (ED). With about 25 million men in the US with hypertension, substantial numbers of hypertension-related ED exist that tend to be of a more severe nature than the general population. Men with ED are ...

BACKGROUND: Control of blood pressure remains suboptimal worldwide. High rates of undiagnosed and untreated hypertensive patients raise the need of searching for the basis of this situation among prescribing physicians. AIM: To evaluate the awareness of medical residents and practicing physicians in Jordan about the treatment of high blood pressure ...

Approximately one-third of the adult population has hypertension. Large-scale clinical trials have convincingly demonstrated that the treatment of isolated systolic and systolic/diastolic hypertension reduces rates of total mortality, cardiovascular mortality, and stroke in older adults, yet control of systolic hypertension remains poor. This article reviews systolic blood pressure as a ...

OBJECTIVE: Hypertension increases micro- and macrovascular complications of diabetes. The goal for blood pressure is <130/80 mmHg. In primary care, however, blood pressure in many patients exceeds this goal. In this study, we evaluated the clinical decision-making process when a patient with diabetes presents with elevated blood pressure. RESEARCH DESIGN ...

Optimal blood pressure control (<130/80 mm Hg) in patients with chronic kidney disease (CKD), despite being the main objective of conservative therapy, is rarely achieved in clinical practice. A major area of improvement is the correction of the extracellular volume expansion. This goal can be reached by means of dietary ...

The primary care physician should treat the patient's underlying disease and his/her blood pressure (achieve an absolute reduction in blood pressure). This two-prolonged strategy saves lives and attenuates the progression of chronic disease. This philosophy of tailoring a patient's medications is supported by the National Kidney Foundation, AHA, ACC, and ...

Cardiovascular disease, the leading cause of death in the United States and other developed societies, can be managed with intensive risk factor modification, including treatment of hypertension and dyslipidemia. Evidence for reduction of cardiovascular morbidity and mortality is summarized in evidence-based guidelines, primarily for hypertension in the Seventh Report of ...

Hypertension-induced target organ damage (TOD), is one of the leading causes of morbidity and mortality. Reactive oxygen species (ROS) play an important role in the pathogenesis and development of hypertension. It has been suggested that hypertension-induced TOD is related to the level of oxidative stress, but is in part independent ...

The systolic hypertension in Europe (Syst-Eur) trial has been the only trial that has suggested a protective effect of antihypertensive treatment on incidence of dementia. It is unclear whether this protective effect has been caused by the blood pressure lowering effect of the calcium antagonist nitrendipine or by the calcium ...

Essential hypertension is a heterogeneous multifactorial syndrome associated with a high cardiovascular risk. A multiple choice of antihypertensive drugs is available; however, a high individual variability to the antihypertensive therapy is still responsible for a modest reduction of the CV risk and not satisfactory control of blood pressure levels. The ...

Systemic hypertension is a major global problem contributing to enormous disease burden, premature morbidity and mortality. A substantial majority of hypertensive patients require long-term drug therapy for appropriate blood pressure control. Although there are many classes of antihypertensive drugs for clinical use, calcium channel blockers (CCBs) have a special role ...

Patients with congestive heart failure (CHF) resistant to conventional treatment have a poor prognosis. Extracorporeal ultrafiltration (UF) appears to be the therapy of choice for short-term management of such patients with severe fluid overload, whereas peritoneal dialysis (PD) may be the therapy of choice for the long-term treatment. Fluid removal ...

About 50 million people in the United States have hypertension. Many epidemiologists feels it is the number one public health problem in developed countries. Although asymptomatic early on, untreated hypertension leads to cardiovascular disease, strokes, renal failure, and blindness. Dentists no doubt treat patients with hypertension and its sequelae in ...

The purpose of this study was to compare several diltiazem-based antihypertensive drug combinations and assess the usefulness of home blood pressure monitoring in the evaluation of the efficacy of combination pharmacotherapy. Sixteen general practitioners recruited hypertensive subjects uncontrolled on diltiazem monotherapy, who were randomized to receive eight weeks of add-on ...

Hypertension management is both routine and a challenge. Updated guidelines emphasize the need to achieve increasingly stringent blood pressure goals to reduce cardiovascular morbidity and mortality; however, the blood pressure of many patients who have been diagnosed with hypertension is not well controlled. Treating prehypertension nonpharmacologically may preempt the progression ...

An elevated arterial pressure is probably the most important public health problem. The prevalence of hypertension depends on both the racial composition of the population studied and the criteria used to define the condition. Patients with hypertension die prematurely, the most common cause of death is heart disease, stroke, and ...

BACKGROUND: Even with optimal blood pressure control, organ protection may also depend on the selected therapeutic regime. Angiotensin-converting enzyme inhibitors have been shown to provide excellent organ protection in hypertension, and may show dose-dependent protective effects. Adrenergic alpha blockers have been associated with an increased rate of heart failure in ...

Negative emotions have been linked to increases in blood pressure, but relations between positive emotion and blood pressure have not been investigated. Our aim was to test the hypothesis that high positive emotion would be associated with lower blood pressure in older adults. A cross-sectional study included 2564 Mexican Americans ...

This article reviews the history and current status of an innovative nonpharmacological approach for the treatment of resistant hypertension - chronic electrical activation of the afferent limb of the carotid baroreflex. Recent studies in both normotensive and hypertensive canine models have unambiguously demonstrated sustained and clinically relevant reductions in arterial ...

STUDY OBJECTIVE: To assess the effectiveness of a pharmacist-managed service in improving hypertension control among patients with coronary artery disease. DESIGN: Prospective cohort study. Setting. Health maintenance organization. PATIENTS: Three hundred seventy-six patients with uncontrolled hypertension and coronary artery disease. INTERVENTION: Pharmacist-managed, physician-supervised population-management approach to optimize evidence-based drug management. ...

Portopulmonary hypertension (PPHT) is defined as precapillary pulmonary hypertension accompanied by hepatic disease or portal hypertension. Pulmonary hypertension results from excessive pulmonary vascular remodeling and vasoconstriction. These histological alterations have been indistinguishable from those of other forms of pulmonary arterial hypertension. Factors involved in the pathogenesis of PPHT include volume ...

PURPOSE OF REVIEW: Stroke represents the most devastating cardiovascular disease in the Western world, accounting for approximately 700,000 cases each year, including 500,000 first attacks and 200,000 recurrent episodes. High blood pressure is the most relevant modifiable risk factor for developing stroke. RECENT FINDINGS: In hypertensive patients, especially those with ...

PURPOSE OF REVIEW: Blood pressure variability, a quantitative index for the spontaneous variation in blood pressure, has been proposed as a risk factor for end-organ damage and to determine the efficacy of hypertension treatment. RECENT FINDINGS: Animal studies indicate that blood pressure variability is as important as blood pressure level ...

Hypertension management is a common reason for visits to primary care physicians. One third of patients with hypertension do not have controlled blood pressure, and may present to the physician's office with hypertensive urgencies or emergencies. How to define severely elevated blood pressure, appropriate triage, and the clinical evaluation of ...

Lowering blood pressure is the most effective treatment method to ensure a reduction in the total risk for cardiovascular morbidity and mortality. The renin-angiotensin system plays an important role in volume homeostasis and blood pressure regulation and is a target for several groups of pharmaceutical agents. Angiotensin II receptor blockers ...

Recent progress in antihypertensive therapy has widened the selection of drugs, and large clinical trials have attracted attention to newer classes of antihypertensives. Consequently, the use of diuretics as antihypertensive agents has been relatively reduced, particularly since the newer drugs are associated with fewer adverse metabolic reactions. However, diuretics have ...