Hypertension is a silent killer. Indians are racially predisposed to cardiovascular disease and the increasing burden of hypertension has only added to the problem. Economic constraints and the allure of additional benefits without adverse effects have made lifestyle modifications an attractive proposition in developing and developed countries alike. Blood pressure ...

If the recommendations of Joint National Committee 7 are implemented, the incidence of heart failure should continue to decline. These recommendations are designed not only to reduce the incidence of heart failure but also prevent other target end-organ damage and reduce overall cardiovascular morbidity and mortality. The emphasis of these ...

Hypertension is a common condition affecting one in four adults. It is a leading cause of cardiovascular morbidity and mortality and appropriate treatment strategies that are both clinically and cost effective are key to the management of this condition. Recent guidelines have focused on addressing total cardiovascular risk and recommended ...

Treating hypertension reduces the rates of myocardial infarction, stroke, and renal disease; however, clinical trial experience suggests that monotherapy is not likely to be successful for achieving goal blood pressure (BP) levels in many hypertensive patients. In multiple recent clinical trials including various subsets of hypertensive patients, the achievement of ...

Therapeutic strategies in resistant hypertension include adding another drug or changing drugs in search for a better synergic combination. Most patients, however, receive all of their drugs in a single morning dose. We have evaluated the impact on the circadian pattern of blood pressure on modifying the time of treatment ...

BACKGROUND: The changes of blood pressure in patients undergoing cataract procedure are not well studied. The blood pressures of cataract patients often become uncontrolled intraoperatively causing the procedure to be postponed. Intraoperative rise in blood pressure has been associated with ocular complications such as suprachoroidal haemorrhage and can be fatal ...

Hypertension is a major public health problem, being one of the leading causes of death and disability worldwide and a major risk factor for cardiovascular disease. The renin-angiotensin-aldosterone system plays an important role in volume homeostasis and blood pressure regulation, and is a target for several groups of pharmaceutical agents. ...

INTRODUCTION: Calcium antagonists are very effective drugs, recommended as first-line therapy in hypertension. However, their large use in clinical practice is often limited by a high incidence of peripheral oedema. Calcium antagonists of the third generation, such as lercanidipine, have been shown to be as effective as first- and second-generation ...

Now that many options for treating hypertension are available and the studies of their use have proliferated, selecting a specific antihypertensive agent for a specific condition often receives an inordinate amount of attention from physicians. Controlling the blood pressure per se should be our primary concern ("dinner"), while choosing agents ...

Diuretics are tools of considerable therapeutic importance. First, they effectively reduce blood pressure, while at the same time decreasing the morbidity and mortality associated with hypertension. Diuretics are currently recommended as first-line therapy for the treatment of hypertension. In addition, they remain an important component of heart failure therapy, in ...

Patients with chronic kidney disease progress to end stage renal disease and about 86% are diagnosed hypertensives. Hypertension is a risk factor for cardiovascular disease which is the main cause of morbidity and mortality in the dialysis population. Pre and post-dialysis blood pressure values of < 140/90 mmHg are recommended ...

More than 1 medication is required in many hypertensive patients to reach blood pressure (BP) goals, and initial treatment with 2 agents has been recommended for patients whose BP level is >20/10 mm Hg above target. Diuretics reduce BP levels and the incidence of target organ complications and together with ...

BACKGROUND: Evidence-based guidelines for the management of hypertension are now well established. Studies have shown that more than 60% of patients with hypertension will require two or more drugs to achieve current treatment targets. DISCUSSION: Combination therapy is recommended as first-line treatment by the JNC-7 guidelines for patients with a ...

Intravenous antihypertensive agents are used in clinical situations in which the immediate, precise control of blood pressure is a clinical necessity. Clevidipine is a new, vascular-selective, dihyrdopyridine Ca(2+) channel blocker, which exerts its hemodynamic effects through selective arterial vasodilation without effects on the venous circulation. Because it is a potent ...

Recently, the use of combination therapy with a calcium channel blocker (CCB) and an angiotensin II receptor blocker (ARB) has been rapidly increasing. Although this combination therapy is accepted as a standard treatment hypertension, there have been few large-scale, multicenter studies examining its safety and efficacy. The present study was ...

The role of beta-blockers in uncomplicated hypertension has been challenged recently. Compared with other antihypertensives, beta-blockers are less effective for preventing cardiovascular events in patients with uncomplicated hypertension. Moreover, a recent meta-analysis of placebo-controlled clinical trials concluded that atenolol is not more efficacious than placebo for preventing cardiovascular events in ...

AIM: Clinical trials have proved that angiotensin receptor blockers (ARB) are more effective than other antihypertensive agents in reducing left ventricular hypertrophy (LVH); however, information about the efficacy of ARB on LVH regression in daily medical practice is scarce. The aim of the SARA study was to investigate the effect ...

OBJECTIVE: The purpose of the study was to assess the efficiency of a goal-oriented therapeutic strategy in lowering blood pressure and reducing the need for antihypertensive medications in 168 patients undergoing long-term hemodialysis. METHODS: Patients were managed initially by achieving optimal dry weight. After reduction of the dry weight, patients ...

OBJECTIVES: To investigate the efficacy of laparoscopic nephrectomy for the management of hypertension associated with a unilateral poorly functioning kidney in adults and the role of some variables in the prediction of its outcome in the management of nephrogenic hypertension. METHODS: We conducted this study on 22 hypertensive patients with ...

OBJECTIVES: Our primary objective was to determine the incidence of AEs of antihypertensive drugs in a cohort of outpatients attending a specialized clinic. The secondary objectives were to determine the incidence of AEs by classes of blood-pressure-lowering drugs used in monotherapy and to identify risk factors for the occurrence of ...

BACKGROUND: Although guidelines now recommend polytherapy to achieve blood pressure targets, little is know about which antihypertensive drugs are combined in clinical practice. OBJECTIVE: To examine current practices for the coprescribing of antihypertensive agents. METHODS: A population-based cohort study was performed using linked administrative databases on all Ontario residents 66 ...

High blood pressure represents one of the leading risk factors for the development of stroke and its recurrence. This explains why blood pressure control is a major objective of antihypertensive treatment, both in primary and secondary prevention of this cerebrovascular disease. This paper reviews the evidence provided by randomized clinical ...

Effective treatment of high blood pressure levels represents a key strategy for reducing global cardiovascular risk. Other factors, beyond blood pressure control, however, appear to be of potential relevance in reducing the risk related to hypertension. Recent clinical trials have demonstrated that those pharmacological agents that counteract the renin-angiotensin system ...

OBJECTIVE: To describe the knowledge of hypertensive patients, in Kassala, eastern Sudan, about the disease, in relation to its control. DESIGN: Cross-sectional study. SETTING: Kassala Teaching Hospital, Kassala, Eastern Sudan. SUBJECTS: Patients with hypertension attending referred outpatient medical clinic. MAIN OUTCOME MEASURES: Blood pressure, control status and hypertension knowledge score. ...

PURPOSE OF REVIEW: We examined the role of blood pressure-lowering compared with class-specific properties of antihypertensive drugs in cardiovascular prevention. RECENT FINDINGS: We reviewed recently published trials and meta-regression analyses. SUMMARY: From 150,000 to 180,000 randomized patients followed up from 3 to 5 years were required to demonstrate a 10-15% ...

Despite data on the importance of blood pressure control in preventing cardiovascular and cerebrovascular events, only 34% of hypertensive patients have their blood pressure under control. The National Council on Patient Information and Education has estimated that the compliance rate is just over 30% for chronic conditions like hypertension. Polypharmacy ...

In patients with diabetes mellitus, hypertension is an important risk factor for cardiovascular and renal events, including macro and microvascular complications such as nephropathy. The risks are reduced when blood pressure is decreased, regardless of the treatment regimen, and intensive regimens have been found to offer greater protection than less ...

As for other critically ill diseases, two key factors may markedly improved morbidity and mortality of acute heart failure syndromes (AHFS): early initiation of treatment and tailored therapy. Early initiation aims to stop the negative cascade of heart dysfunction. Tailored therapy should be based on the level of systolic blood ...

OBJECTIVES: ADVANCE (Action in Diabetes and Vascular Disease - PreterAx and DiamicroN MR Controlled Evaluation) is a large-scale clinical trial designed to investigate the benefits of blood pressure lowering and intensive glucose control in patients with type 2 diabetes mellitus. METHODS AND PARTICIPANTS: ADVANCE is a 2 x 2 factorial ...

The objective of our study was to explore physician and patient attitudes regarding hypertension management. One hundred forty-five primary care providers and 189 patients with hypertension at 6 Veterans Administration clinics completed a hypertension survey. Fifty-one percent of patients were at their blood pressure goal, 58% were on guideline-concordant therapy, ...

In patients with diabetes mellitus, hypertension is an important risk factor for cardiovascular and renal events, including macro and microvascular complications such as nephropathy. The risks are reduced when blood pressure is decreased, regardless of the treatment regimen, and intensive regimens have been found to offer greater protection than less ...

Hypertension remains uncontrolled in the majority of treated patients, especially those with multiple cardiovascular risk factors. This was demonstrated by a French study that showed that 70% of treated hypertensive patients are not controlled to the target level of 140/90 mmHg. This proportion reached 84% in hypertensive patients with diabetes ...

Controversy surrounds the acceptance of hypertension as an independent risk factor for anaesthesia. In an attempt to identify variables that are associated with increased haemodynamic instability during surgery, the blood pressure profiles of 128 patients were analysed. The two variables that contributed most to the instability were pre-operative control of ...

Hypertension remains uncontrolled in the majority of treated patients, especially those with multiple cardiovascular risk factors. This was demonstrated by a French study that showed that 70% of treated hypertensive patients are not controlled to the target level of 140/90 mmHg. This proportion reached 84% in hypertensive patients with diabetes ...

Achieving blood pressure targets in hypertension can be challenging. Often, patients require multiple medications to reach these targets. The Canadian Hypertension Education Program has updated its past recommendations to reflect current knowledge regarding effective antihypertensive combinations. Evidence for the use of specific drug combinations in achieving blood pressure targets has ...

Subjects with high normal blood pressure are at high risk of developing hypertension. Thus, the criteria of the Canadian Hypertension Education Program for diagnosis of hypertension and recommendations for follow-up now recommend that patients with high normal blood pressure (130 mmHg to 139 mmHg systolic and/or 85 mmHg to 89 ...

The present paper summarizes and highlights key messages of the 2007 Canadian Hypertension Education Program recommendations for the management and diagnosis of hypertension. This is the eighth annual update. Important new messages in the 2007 Canadian Hypertension Education Program recommendations emphasize the need for assessing adults with high normal blood ...

OBJECTIVE: To provide updated, evidence-based recommendations for the prevention and management of hypertension in adults. OPTIONS AND OUTCOMES: For lifestyle and pharmacological interventions, evidence was reviewed from randomized controlled trials and systematic reviews of trials. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. However, for lifestyle ...

<sec><st>Aims</st> We estimated what the improved treatment of high blood pressure with anithypertensive drug therapy has contributed to U.S. public health, in terms of reductions in excess premature deaths from cardiovascular disease, myocardial infarctions, and strokes. </sec> <sec><st>Methods and Results</st> Using national survey data to estimate blood pressures in the ...

STUDY OBJECTIVE: Recommendations for the treatment of emergency department (ED) patients with asymptomatic severely elevated blood pressure advise assessment for occult, acute hypertensive target-organ damage. This study determines the prevalence of unanticipated, clinically meaningful test abnormalities in ED patients with asymptomatic severely elevated blood pressure. METHODS: This was a prospective ...

Vardenafil is a selective phosphodiesterase-5 inhibitor approved for the treatment of erectile dysfunction. It was found to be effective in a high percentage of patients and a broad spectrum of underlying conditions. It potentiates the increase in intracellular cGMP in the corpora cavernosa in response to sexual stimuli, resulting in ...

A large proportion of patients with hypertension require a second blood pressure-lowering drug to reach blood pressure control. None of the major clinical trials of blood pressure drugs have compared, in a random fashion, the efficacy of the second drug in the prevention of hard outcomes and only one large ...

Hypertension is a medical condition commonly seen in the outpatient setting. Primary care providers should be aware that asymptomatic hypertension, despite the degree of elevation, is rarely an emergency. Based on consensus guidelines from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and the ...

Hypertension is a high-prevalence disease that may affect several organs. In recent years, data have accumulated indicating that angiotensin II receptor blockers (ARBs) may have a supplementary effect beyond lowering blood pressure. The aim of this review is to evaluate the impact of ARBs on the most important complications of ...

Hypertensive emergencies are characterized by acute blood pressure elevations and potential for end organ damage. The critical care nurse must understand the pathophysiology to appreciate the therapeutic management and complications associated with the devastating clinical event. Stroke, renal damage and failure, retinopathy, aortic dissection, and encephalopathy are among the sequelae ...

Hypertension is a growing public health problem worldwide. Only 37% of American hypertensives currently have their blood pressures controlled. Hypertension is traditionally diagnosed in the medical office, but both home and ambulatory blood pressure monitoring can help. Lifestyle modifications are recommended for everyone who has higher than "normal" blood pressure ...

METHODS: We have conducted an open observational study of the use of spironolactone 25-50 mg in the management of patients with resistant hypertension. This drug was recommended in 133 patients who were already receiving an angiotensin-blocking drug in addition to other therapies. RESULTS: Of these, three defaulted from follow-up and ...

Heterogeneity of treatment effects (HTE) is a measure of the variations in individual treatment response to the same agent across a population. Hypertension affords an appropriate model for investigators of HTE. Use of blood pressure measurement guidelines and consistent techniques help to reduce the potential variability associated with clinician measurements. ...

Despite recognition that hypertension is a major risk factor for cardiovascular events and mortality, blood pressure control rates remain low in the US population. Reflecting clinical trial results, hypertension management guidelines assert the clinical benefit of achieving current blood pressure goals and indicate that most patients will require 2 or ...

BACKGROUND: Although there are effective ways of treating hypertension, only a minority of all hypertensive people reach target blood pressure levels. This may be a function of how patients and physicians put measured values into context when they decide if the blood pressure is well controlled or too high. METHODOLOGY: ...