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	Prevalence and Diagnosis of Primary Aldosteronism Abstract  Primary aldosteronism (PA) is a common cause of arterial hypertension: in the PA Prevalence in Hypertensives (PAPY) Study, the prevalence of PA was 11.2% in consecutive referred hypertensive patients. When adrenal vein sampling (AVS) is available, two thirds of the cases can be attributed to a tumor and one third of cases are idiopathic; the opposite is seen when AVS is unavailable. Thus, AVS influences the relative prevalence rate of the main subtypes of PA. When adrenalectomy is undertaken based on AVS, almost 100% of patients are cured of hyperaldosteronism, one third are cured of hypertension, and 52% are markedly improved in terms of blood pressure control. Persistent hypertension can be predicted by a long history of hypertension and by the presence of exces... Detection and Treatment of Resistant Hypertension Abstract  The evaluation of patients with resistant hypertension should be directed toward confirming true treatment resistance, identifying the causes contributing to treatment resistance (including secondary causes of hypertension), and documenting target-organ damage. Treatment of resistant hypertension is aimed at reversing lifestyle factors contributing to treatment resistance, accurately diagnosing and appropriately treating secondary causes of hypertension, and effectively using multidrug regimens. Lifestyle changes, pharmacologic therapies, and nonpharmacologic therapies have all shown benefits in patients with resistant hypertension, but much additional knowledge is needed to better identify and treat these patients. Content Type Journal ArticleDOI 10.1007/s119... Systolic Pressure, Diastolic Pressure, or Pulse Pressure as a Cardiovascular Risk Factor in Renal Disease Abstract  Chronic kidney disease is a leading global health problem with an increasing prevalence. Hypertension is present in most patients with chronic kidney disease, and hypertension-related nephrosclerosis is a top cause of progressive renal damage and end-stage renal disease. Systolic blood pressure (BP) and pulse pressure, together with nocturnal BP, are the most important factors favoring the progression of renal failure. Consequently, strict control of BP and other cardiovascular risk factors is required, including an adequate degree of suppression of the renin-angiotensin system in every patient. Content Type Journal ArticleDOI 10.1007/s11906-010-0129-zAuthors José A. García-Donaire, Hypertension Unit, Hospital 12 de Octubre Av. Cordoba, s/n. 28041 Madrid Sp... Aldosterone in the Pathogenesis of Chronic Kidney Disease and Proteinuria Abstract  There has been much recent interest in the role of aldosterone as an independent contributor to the progression of chronic kidney disease. Despite treatment with agents such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, many studies have shown that there is incomplete blockade of the renin-angiotensin cascade evidenced by persistent or rising plasma aldosterone levels despite therapeutic renin-angiotensin blockade. This phenomenon is commonly referred to as ?aldosterone escape? and is thought to be one of the main contributors to chronic kidney disease progression despite conventional therapeutics. Animal models of the effects of exposure to exogenous aldosterone demonstrate the development of inflammation and fibrosis in both ... Hypertension Management and Microvascular Insulin Resistance in Diabetes Abstract  Type 2 diabetes is in essence a vascular disease and is frequently associated with hypertension, macrovascular events, and microvascular complications. Microvascular dysfunction, including impaired recruitment and capillary rarefaction, has been implicated in the pathogenesis of diabetic complications. Microvascular insulin resistance and renin-angiotensin system upregulation are present in diabetes, and each contributes to the development of hypertension and microvascular dysfunction. In the insulin-sensitive state, insulin increases microvascular perfusion by increasing endothelial nitric oxide production, but this effect is abolished by insulin resistance. Angiotensin II, acting via the type 1 receptors, induces inflammation and oxidative stress, leading to imp... Mineralocorticoid Receptor Antagonists and the Metabolic Syndrome Abstract  Key components of the metabolic syndrome (MetS), ie, obesity and insulin resistance, are associated with increased aldosterone production and mineralocorticoid receptor (MR) activation. Both MetS and hyperaldosteronism are proinflammatory and pro-oxidative states associated with cardiovascular disease. This review discusses emerging data that MR activation may contribute to abnormalities seen in MetS. In view of these data, MR antagonists may be beneficial in MetS, not only by controlling hypertension but also by reversing inflammation, oxidative stress, and defective insulin signaling at the cellular-molecular level. Clinical trials have demonstrated benefits of MR antagonists in heart failure, hypertension, and diabetic nephropathy, but additional trials are nee... The Metabolic Syndrome: How Do We Get There? Content Type Journal ArticleCategory Literature AlertDOI 10.1007/s11906-010-0128-0Authors Norman K. Hollenberg, Brigham and Women?s Hospital Departments of Medicine and Radiology, Harvard Medical School Mailstop PBB1-Rad Building, 15 Francis Street Boston MA 02115 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 (Source: Current Hypertension Reports) Targeting the Vasoprotective Axis of the Renin-Angiotensin System: A Novel Strategic Approach to Pulmonary Hypertensive Therapy Abstract  A decade has passed since the discovery of angiotensin-converting enzyme 2 (ACE2), a component of the ACE2?angiotensin (Ang)-(1-7)?Mas counterregulatory axis of the renin angiotensin system (RAS). ACE2 is considered an endogenous regulator of the vasoconstrictive, proliferative, fibrotic, and proinflammatory effects of the ACE?Ang II?angiotensin II type 1 receptor (AT1R) axis. Both animal and clinical studies have emerged to define a role for ACE2 in pulmonary arterial hypertension (PAH). There is scientific evidence supporting the concept that ACE2 maintains the RAS balance and plays a protective role in PAH. The activation of pulmonary ACE2 could influence the pathogenesis of PAH and serve as a novel therapeutic target in PAH. Current therapeutic strategi... Polypill: Lights and Shadows Abstract  The idea of packaging and formulating several drugs commonly used in cardiovascular disease prevention into a single polypill is appealing. It is believed that the polypill would have several advantages over the separate use of several medications, enhancing acceptability and long-term adherence, with lower cost and easier accessibility. However, there are few data available on the efficacy and safety of polypill preparations for preventive purposes. The Indian Polycap Study (TIPS) was the first to systematically test the clinical application of the polypill; it included ramipril, hydrochlorothiazide, atenolol, aspirin, and simvastatin. Blood pressure and LDL levels were effectively lowered and antiplatelet function was demonstrated, but the effect of simvastatin ... Endothelium-derived Vasoactive Factors and Hypertension: Possible Roles in Pathogenesis and as Treatment Targets Abstract  Endothelial cells regulate vascular tone by releasing various contracting and relaxing factors including nitric oxide (NO), arachidonic acid metabolites (derived from cyclooxygenases, lipoxygenases, and cytochrome P450 monooxygenases), reactive oxygen species, and vasoactive peptides. Additionally, another pathway associated with the hyperpolarization of the underlying smooth muscle cells plays a predominant role in resistance arteries. Endothelial dysfunction is a multifaceted disorder, which has been associated with hypertension of diverse etiologies, involving not only alterations of the L-arginine NO-synthase?soluble guanylyl cyclase pathway but also reduced endothelium-dependent hyperpolarizations and enhanced production of contracting factors, particularly... Drug Mechanisms to Help in Managing Resistant Hypertension in Obesity Abstract  Obesity is a major risk factor for the development of hypertension. Because the prevalence of obesity is increasing worldwide, the prevalence of obesity hypertension is also increasing. Importantly, hypertension in obesity is commonly complicated by dyslipidemia and type 2 diabetes mellitus and hence imposes a high cardiovascular disease risk. Furthermore, obesity is strongly associated with resistant hypertension. Activation of the sympathetic nervous system and the renin-angiotensin system, leading to renal sodium and water retention, links obesity with hypertension. There is also evidence for the release of factors by visceral adipose tissue promoting excessive aldosterone production, and a more central role of aldosterone in obesity hypertension is emerging. R... The ?J Curve? Problem Revisited: Old and New Findings Abstract  This paper critically addresses the issue of the ?J-curve? paradox?the finding described in studies performed about 30 years ago indicating that treatment-induced systolic blood pressure values below 120 or 125 mm Hg and diastolic blood pressure values below 75 mm Hg are characterized by an increase, rather than a reduction, in the incidence of coronary events. This paper focuses on four major subjects: 1) the benefits of a lower blood pressure target during treatment; 2) the historical background of the ?J-curve? phenomenon; 3) the evidence collected in recent clinical trials regarding the existence of a ?J-curve? in treated hypertensive patients; and 4) the recent recommendations by the Task Force Committee of the European S... ESCAPE: From Hypertension to Renal Failure Content Type Journal ArticleCategory CLINICAL TRIAL REPORTDOI 10.1007/s11906-010-0124-4Authors Helmy M. Siragy, University of Virginia Health Center Department of Medicine P.O. Box 801409 Charlottesville VA 22908 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 (Source: Current Hypertension Reports) Do the Blood Pressure Effects of Nonsteroidal Antiinflammatory Drugs Influence Cardiovascular Morbidity and Mortality? Abstract  There are many theories about why selective inhibitors of the second isoform of cyclooxygenase (COX-2) increase cardiovascular risk. Although torcetrapib raises blood pressure and cardiovascular risk, it has been difficult to prove such a link for COX-2 inhibitors in randomized clinical trials. This review shows a significant correlation in placebo-controlled trials between the five agents? elevations in blood pressures and their rate ratios for cardiovascular events. A larger body of evidence arises from randomized clinical trial comparisons of selective versus nonselective inhibitors of COX-2, but these results are heterogeneous for naproxen versus other traditional agents. The best current trial evidence comes from the centrally adjudicated placebo-controlled... Inflammation and Therapy for Hypertension Abstract  It is currently accepted that hypertension, atherosclerosis, and diabetes are disorders with subtle or overt activation of inflammatory mediators. Therefore, it has become increasingly important to ascertain whether current antihypertensive drug families have proinflammatory or anti-inflammatory actions that modify the outcomes of their hemodynamic effects on blood pressure. We review the current state of knowledge about the effects of the major classes of available antihypertensive agents on inflammation and speculate on the possible contribution of these effects to observations in clinical trials. We suggest that a strategy of drug development specifically addressing inflammation in hypertension may provide increased benefit in terms of target organ damage, and ... Antihypertensive Effects of Aspirin: What is the Evidence? Abstract  Nonsteroidal anti-inflammatory drugs are known to increase blood pressure and blunt the effect of antihypertensive drugs. Surprisingly, it has been suggested recently that aspirin lowers blood pressure and could be used for preventing hypertension. This review summarizes published data on the effects of aspirin on blood pressure. Trials suggesting that aspirin administered at bedtime lowers blood pressure are uncontrolled, unmasked, and potentially biased. They also conflict with cohort studies showing an 18% increase in the risk of hypertension among aspirin users. Fortunately, short-term use of aspirin does not seem to interfere with antihypertensive drugs. Regardless of its effect on blood pressure, low-dose aspirin effectively prevents cardiovascular events in... Vascular Effects of Antihypertensive Drug Therapy Abstract  Hypertension is associated with structural and functional alterations in the vasculature that lead to hemodynamic disturbances and target organ damage. The benefit of reducing blood pressure on risk reduction is well established. Antihypertensive drugs partially correct hypertensive vascular changes by a number of mechanisms, but their influence may vary in different vascular beds. Recently, combinations of drugs with complementary or synergistic effects have shown favorable effects on the vasculature; these combinations may contribute to risk reduction and improve outcomes in the future. Clinical trial evidence has shown an improvement in morbidity and mortality indicators that could be related to vascular effects of antihypertensive drugs, but this effect needs ... New Therapeutic Approaches to Resistant Hypertension Abstract  Resistant hypertension is a common and growing clinical problem characterized by failure to achieve target blood pressure levels despite adequate use of at least three antihypertensive agents. Although numerous safe and effective pharmacologic therapies are available to treat elevated blood pressure, novel therapeutic approaches are warranted to improve the management and prognosis of patients with resistant hypertension. In this context, several lines of research have generated promising results based on both novel pharmacologic and device-based approaches that may more effectively treat resistant hypertension and its adverse consequences in the future. Content Type Journal ArticleDOI 10.1007/s11906-010-0119-1Authors Markus P. Schlaich, Baker IDI Heart & Di... Renin System Blockade, the Eye, and the Kidney in Type 1 Diabetes Mellitus Content Type Journal ArticleCategory Literature AlertDOI 10.1007/s11906-010-0113-7Authors Norman K. Hollenberg, Harvard Medical School, Brigham and Women?s Hospital Departments of Medicine and Radiology Mailstop PBB1-Rad Building, 15 Francis Street Boston MA 02115 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 (Source: Current Hypertension Reports) The Prognostic Significance of Heart Rate for Cardiovascular Disease and Hypertension Abstract  Five decades ago, hypertension was a debated risk factor for the development of cardiovascular disease. After further studies and the introduction of antihypertensive medications, few, if any, have doubted the important role hypertension plays as a cardiovascular risk factor. Today, a growing body of evidence emphasizes the relationship between heart rate and hypertension, and heart rate and cardiovascular disease, which makes the measurement of heart rate an important component of the cardiovascular risk assessment. Current European guidelines for managing arterial hypertension recommend the measurement of heart rate for risk stratification, but there still are no recommendations for treatment. This review discusses the evidence for a relationship between heart r... Sleep Apnea and Cardiovascular Disease Abstract  Cardiovascular disease is still the leading cause of death in North America. To improve outcomes, it will likely be necessary to identify new potentially treatable conditions. Sleep apnea affects approximately 50% of patients with cardiovascular disease and is associated with increased cardiovascular risk. Continuous positive airway pressure is currently the treatment of choice and has many short-term favorable effects. The long-term benefits, however, remain elusive. Further, it may not be the ideal treatment for central sleep apnea, and the benefits of alternatives such adaptive servo-ventilation are currently being tested. Randomized controlled trials are now needed to determine whether treating sleep apnea will improve survival and reduce cardiovascular diseas... Renal Nerves in the Maintenance of Hypertension: A Potential Therapeutic Target Abstract  Renal sympathetic efferent and afferent nerves, which lie within and immediately adjacent to the wall of the renal arteries, contribute to the maintenance of hypertension. Because the causative factors of hypertension change over time, denervation of both efferent and afferent renal nerves should result in long-term attenuation of hypertension. The importance of the renal nerves in hypertensive patients can now be defined with the novel development of percutaneous, minimally invasive renal denervation from within the renal artery using radiofrequency energy as a therapeutic strategy. Studies thus far show that catheter-based renal denervation in patients with resistant essential hypertension lowers systolic blood pressure 27 mm Hg by 12 months, with... The Evolution of Renin-Angiotensin Blockade: Angiotensin-Converting Enzyme Inhibitors as the Starting Point Abstract  The renin-angiotensin system has been a target in the treatment of hypertension for close to three decades. Several medication classes that block specific aspects of this system have emerged as useful therapies, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and, most recently, direct renin inhibitors. There has been a natural history to the development of each of these three drug classes, starting with their use as antihypertensive agents; thereafter, in each case they have been employed as end-organ protective agents. To date, there has been scant evidence to favor angiotensin receptor blockers or direct renin inhibitors over angiotensin-converting enzyme inhibitors in treating hypertension or in affording end-organ protection... Synergistic Physician and Patient Behavioral Interventions as Management Strategy for Effective Population-Based Hypertension Control Content Type Journal ArticleCategory CLINICAL TRIAL REPORTDOI 10.1007/s11906-010-0111-9Authors Pei-an Betty Shih, University of California, San Diego, Center for Human Genetics and Genomics Department of Medicine Pharmaceutical Sciences Building (PSB), Room 4261, 9500 Gilman Drive La Jolla CA 92093 USADaniel T. O?Connor, University of California, San Diego, Center for Human Genetics and Genomics Department of Medicine Pharmaceutical Sciences Building (PSB), Room 4261, 9500 Gilman Drive La Jolla CA 92093 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 (Source: Current Hypertension Reports) The Obesity Paradox and Cardiovascular Disease This article reviews some recent publications that have studied this phenomenon as it relates to heart failure, coronary artery disease, peripheral arterial disease, kidney disease, and a cohort of patients undergoing nonbariatric surgery. Content Type Journal ArticleDOI 10.1007/s11906-010-0099-1Authors Stephen A. Morse, Louisiana State University Health Sciences Center Section of Nephrology 1542 Tulane Avenue New Orleans LA 70112 USARajat Gulati, Louisiana State University Health Sciences Center Section of Nephrology 1542 Tulane Avenue New Orleans LA 70112 USAEfrain Reisin, Louisiana State University Health Sciences Center Section of Nephrology 1542 Tulane Avenue New Orleans LA 70112 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 (Source:... Oxidative Stress and Vascular Function: Implications for Pharmacologic Treatments Abstract  Production of considerable amounts of reactive oxygen species (ROS) eventually leads to oxidative stress. A key role of oxidative stress is evident in the pathologic mechanisms of endothelial dysfunction and associated cardiovascular diseases. Vascular enzymes such as NADPH oxidases, xanthine oxidase, and uncoupled endothelial nitric oxide synthase are involved in the production of ROS. The question remains whether pharmacologic approaches can effectively combat the excessive ROS production in the vasculature. Interestingly, existing registered cardiovascular drugs can directly or indirectly act as antioxidants, thereby preventing the damaging effects of ROS. Moreover, new compounds targeting NADPH oxidases have been developed. Finally, food-derived compounds appe... Cytokine Abnormalities in the Etiology of the Cardiometabolic Syndrome Abstract  The cardiometabolic syndrome comprises a cluster of risk factors, including abdominal obesity, dyslipidemia, hypertension, insulin resistance/glucose intolerance, and proteinuria. This syndrome is due, in part, to the accumulation of visceral fat, which promotes synthesis of proinflammatory adipokines resulting in a visceral adipose tissue-specific increase in reactive oxygen species derived from NADPH oxidase. Adipose tissue oxidative stress results in the development of systemic oxidative stress and inflammation, which further lead to development of metabolic dyslipidemia, impaired glucose metabolism, renal disease, and hypertension. Importantly, visceral?not subcutaneous?fat is the significant source of the circulating adipokines that promote these systemic... A STITCH Saves Time and Lowers Blood Pressure Content Type Journal ArticleCategory CLINICAL TRIAL REPORTDOI 10.1007/s11906-010-0110-xAuthors Suzanne Oparil, University of Alabama at Birmingham School of Medicine 1530 3rd Avenue South, ZRB 1034 Birmingham AL 35294 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 (Source: Current Hypertension Reports) Angiotensin-Converting Enzyme 2: Central Regulator for Cardiovascular Function Abstract  Angiotensin-converting enzyme 2 (ACE2) is a new component of the renin-angiotensin system (RAS). Accumulating evidence shows that ACE2 provides protective effects in peripheral tissues and has great potential for the treatment of RAS-related diseases. The role of ACE2 in the central nervous system is not well established. However, in recent years, much more progress has been made on the studies of this carboxypeptidase in the central regulation of blood pressure and cardiovascular function in general. It has been shown that brain ACE2 interacts with the other components of the RAS (ACE, angiotensin II, and angiotensin II type 1 receptor), protects baroreflex and autonomic function, stimulates nitric oxide release, reduces oxidative stress, and prevents the develop... Obstructive Sleep Apnea and Hypertension Abstract  Obstructive sleep apnea (OSA) and hypertension commonly coexist. Observational studies indicate that untreated OSA is associated with an increased risk of prevalent hypertension, whereas prospective studies of normotensive cohorts suggest that OSA may increase the risk of incident hypertension. Randomized evaluations of continuous positive airway pressure (CPAP) indicate an overall modest effect on blood pressure. However, these studies do indicate a wide variation in the blood pressure effects of CPAP, with some patients, on an individual basis, manifesting a large antihypertensive benefit. OSA is particularly common in patients with resistant hypertension. The reason for this high prevalence of OSA is not fully explained, but data from our laboratory suggest tha... Erratum to: Literature Alert Content Type Journal ArticleCategory ErratumDOI 10.1007/s11906-010-0090-xAuthors Bernice M. Wissler, 400 Market St., Suite 700 Philadelphia PA 19106 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 (Source: Current Hypertension Reports) Baroreflex Stimulation in Antihypertensive Treatment Abstract  Hypertension is a leading cause of morbidity and mortality worldwide. Despite the development of new medications, an alarmingly high proportion of patients are not reaching their target blood pressure goals, so nonpharmacologic therapies have been attracting more interest. Chronic baroreceptor stimulation of the carotid sinus has been shown to reduce blood pressure by inhibiting the sympathetic nervous system, particularly the renal sympathetic tone. This finding has led to the development of implantable carotid sinus stimulators, which have now been studied in both animals and humans, as a means for treating chronic hypertension. The enthusiasm for this modality has led to ongoing studies, which will provide more information on its safety and efficacy in patients... INVESTing in Hypertension Content Type Journal ArticleCategory Clinical Trial ReportDOI 10.1007/s11906-010-0101-yAuthors Robert M. Carey, University of Virginia Health System P.O. Box 801414 Charlottesville VA 22908-1414 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 (Source: Current Hypertension Reports) The Role of High-Fructose Corn Syrup in Metabolic Syndrome and Hypertension Abstract  Obesity and related diseases are an important and growing health concern in the United States and around the world. Soft drinks and other sugar-sweetened beverages are now the primary sources of added sugars in Americans? diets. The metabolic syndrome is a cluster of common pathologies, including abdominal obesity linked to an excess of visceral fat, fatty liver, insulin resistance, hyperinsulinemia, dyslipidemia, and hypertension. Trends in all of these alterations are related to the consumption of dietary fructose and the introduction of high-fructose corn syrup (HFCS) as a sweetener in soft drinks and other foods. Experimental and clinical evidence suggests a progressive association between HFCS consumption, obesity, and the other injury processes. However, e... ASTRALogy: Unrealistic Expectations? Content Type Journal ArticleCategory CLINICAL TRIAL REPORTDOI 10.1007/s11906-010-0109-3Authors Peter W. de Leeuw, University Hospital Maastricht Department of Medicine PO Box 5800 6202 AZ Maastricht The Netherlands Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 (Source: Current Hypertension Reports) Midkine Regulation of the Renin-Angiotensin System Abstract  Hypertension and chronic kidney disease are often associated. The pathogenesis of these diseases involves the renin-angiotensin system. We have recently reported that the growth factor midkine is a novel regulator of the renin-angiotensin system. Midkine is a heparin-binding growth factor so far implicated in neuronal differentiation, neuroprotection, cardioprotection, inflammation, and cancer development. In a mouse model of chronic kidney disease induced by 5/6 nephrectomy, midkine is produced in the lung and in turn upregulates angiotensin-converting enzyme expression. Hypertension associated with 5/6 nephrectomy is not observed in midkine-deficient mice. Conversely, supplemental administration of midkine to the deficient mice induces hypertension. This review ... Modulation of Pressure-Natriuresis by Renal Medullary Reactive Oxygen Species and Nitric Oxide Abstract  The renal pressure-natriuresis mechanism is the dominant controller of body fluid balance and long-term arterial pressure. In recent years, it has become clear that the balance of reactive oxygen and nitrogen species within the renal medullary region is a key determinant of the set point of the renal pressure-natriuresis curve. The development of renal medullary oxidative stress causes dysfunction of the pressure-natriuresis mechanism and contributes to the development of hypertension in numerous disease models. The purpose of this review is to point out the known mechanisms within the renal medulla through which reactive oxygen and nitrogen species modulate the pressure-natriuresis response and to update the reader on recent advances in this field. Content T... Medical Complexity and Hypertension Management Content Type Journal ArticleCategory Literature AlertDOI 10.1007/s11906-010-0089-3Authors Norman K. Hollenberg, Harvard Medical School, Brigham and Women?s Hospital Departments of Medicine and Radiology Mailstop PBB1-Rad Building, 15 Francis Street Boston MA 02115 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 (Source: Current Hypertension Reports) Oxidative Stress and Hypertension: Current Concepts Abstract  Hypertension is a major contributor to the development of renal failure, cardiovascular disease, and stroke. These pathologies are associated with vascular functional and structural changes including endothelial dysfunction, altered contractility, and vascular remodeling. Central to these phenomena is oxidative stress. Factors that activate pro-oxidant enzymes, such as NADPH oxidase, remain poorly defined, but likely involve angiotensin II, mechanical stretch, and inflammatory cytokines. Reactive oxygen species influence vascular, renal, and cardiac function and structure by modulating cell growth, contraction/dilatation, and inflammatory responses via redox-dependent signaling pathways. Compelling data from molecular and cellular experiments, together with animal... Uric Acid as a Factor in the Metabolic Syndrome Abstract  Hyperuricemia is a prevalent finding in patients presenting metabolic syndrome, although its clinical meaning is still controversial and often underestimated. Men and women have different serum urate levels at all ages, and the impact of hyperuricemia in cardiovascular and renal outcomes is generally associated with a worse prognosis in women. Recent studies also have called attention to another perspective on hyperuricemia, indicating that it may be not only a consequence of insulin resistance states but also a significant predictor of the development of metabolic syndrome. This review discusses recent evidence related to the clinical significance of hyperuricemia in both sexes and the potential benefits of lowering serum uric acid levels. Content Type Journa... Central Adiposity, Systemic Inflammation, and the Metabolic Syndrome Abstract  Metabolic syndrome (MetS) is a constellation of metabolic derangements and underlying factors that significantly increases the risk for developing type 2 diabetes and cardiovascular diseases. MetS is a low-grade inflammatory condition, with systemic inflammation and inflammation of central abdominal fat as contributors. Systemic inflammation in MetS is thought to involve C-reactive protein and some proinflammatory cytokines; the nuclear factor-?B pathway also is believed to play a role. Inflammation of central adipose tissue leads to adipokine production, followed by secretion of adipokines into the general circulation to contribute to the overall inflammatory condition. The molecular mechanisms that contribute to this inflammation are still somewhat unclear, but... The Benefit of the Mediterranean-Style Diet in Patients with Newly Diagnosed Diabetes Content Type Journal ArticleCategory Clinical Trial ReportDOI 10.1007/s11906-010-0102-xAuthors Efrain Reisin, Section of Nephrology and Hypertension Department of Medicine 1542 Tulane Avenue New Orleans LA 70002 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 (Source: Current Hypertension Reports) Regression of Small Resistance Artery Structural Alterations in Hypertension by Appropriate Antihypertensive Treatment Abstract  Regardless of the mechanisms that initiate the rise of blood pressure, the development of structural changes in the systemic vasculature is the end result of established hypertension. Indices of small resistance artery structure, such as the ratio of tunica media to internal lumen, may have a strong prognostic significance in hypertensive patients, over and above all other known cardiovascular risk factors. Hence, the regression of vascular alterations seems to be an appealing goal for antihypertensive treatment. Different antihypertensive drugs may have different effects on vascular structure. Complete normalization of small resistance artery structure was demonstrated in hypertensive patients after long-term and effective antihypertensive therapy with angiotensi... Sodium Sensitivity of Blood Pressure in Chinese Populations This study indicated that approximately 39% of Chinese adults were sodium-sensitive. Sodium sensitivity was more common in women and in persons who were older and had higher usual blood pressure. Sodium sensitivity was also more common in individuals with higher responses to a cold pressor test and in individuals with the metabolic syndrome. Genetic factors may play an important role in determining sodium sensitivity in the Chinese population. A better understanding of the genetic and environmental determinants of sodium sensitivity has important public health and clinical implications. Content Type Journal ArticleDOI 10.1007/s11906-009-0088-4Authors Jing Chen, Tulane University School of Medicine Department of Medicine 1430 Tulane Avenue, SL45 New Orleans LA 70112 USA Jo... Carotid Baroreflex Activation: Past, Present, and Future Abstract  Electrical activation of the carotid baroreceptor system is an attractive therapy for the treatment of resistant hypertension. In the past, several attempts were made to directly activate the baroreceptor system in humans, but the method had to be restricted to a few selected patients. Adverse effects, the need for better electrical devices and better surgical techniques, and the lack of knowledge about long-term effects has greatly hampered developments in this area for many years. Recently, a new and promising device was evaluated in a multicenter feasibility trial, which showed a clinically and statistically significant reduction in office systolic blood pressure (>20 mm Hg). This reduction could be sustained for at least 2 years with an acceptable ... Recent Advances in Genetics of the Spontaneously Hypertensive Rat Abstract  The spontaneously hypertensive rat (SHR) is the most widely used animal model of essential hypertension and associated metabolic disturbances. Multiple quantitative trait loci associated with hemodynamic and metabolic parameters have been mapped in the SHR. Recently, it has become possible to identify some of the specific quantitative trait gene (QTG) variants that underlie quantitative trait loci linked to complex cardiovascular and metabolic traits in SHR related strains. Recombinant inbred strains derived from SHR and Brown Norway progenitors, together with SHR congenic and transgenic strains, have proven useful for establishing the identity of several QTGs in SHR models. It is anticipated that the combined use of linkage analyses and gene expression profiles, ... Darusentan in Resistant Hypertension: Lost in Translation Content Type Journal ArticleCategory Clinical Trial ReportDOI 10.1007/s11906-009-0081-yAuthors Frank Enseleit, University Hospital Zurich Cardiovascular Center Cardiology Rämistrasse 100 8091 Zürich SwitzerlandFrank Ruschitzka, University Hospital Zurich Cardiovascular Center Cardiology Rämistrasse 100 8091 Zürich Switzerland Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 (Source: Current Hypertension Reports) Genome-Wide Association Studies: Contribution of Genomics to Understanding Blood Pressure and Essential Hypertension This article gives a short introduction to GWAS and summarizes the current findings for blood pressure and hypertension. Content Type Journal ArticleDOI 10.1007/s11906-009-0086-6Authors Georg B. Ehret, Johns Hopkins University Center for Complex Disease Genomics, McKusick-Nathans Institute of Genetic Medicine 733 N. Broadway Baltimore MD 21205 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 (Source: Current Hypertension Reports) Chronic Psychosocial Stress and Hypertension Abstract  Genetic and behavioral factors do not fully explain the development of hypertension, and there is increasing evidence suggesting that psychosocial factors may also play an important role. Exposure to chronic stress has been hypothesized as a risk factor for hypertension, and occupational stress, stressful aspects of the social environment, and low socioeconomic status have each been studied extensively. The study of discrimination is a more recent and rapidly growing area of investigation and may also help to explain the well-known racial disparities in hypertension. Research regarding mechanisms underlying stress effects on hypertension has largely focused on cardiovascular reactivity, but delayed recovery to the pre-stress level is increasingly being evaluated a... Anti-VEGF Therapies and Blood Pressure: More Than Meets the Eye Abstract  ?Wet? (also called neovascular) age-related macular degeneration (AMD) is a chronic progressive disease characterized by leakage of fluid or blood from choroidal neovascularization. It remains the leading cause of blindness in the developed world. Vascular endothelial growth factor (VEGF), which plays a key role in the pathogenesis of retinal neovascularization and vessel leakage leading to central vision loss, has emerged as a potential target in the treatment of wet AMD. Importantly, large-scale clinical trials have demonstrated that intravitreal VEGF antagonism prevents vision loss and may even improve visual acuity in patients with neovascular AMD. Because VEGF and its downstream mediator nitric oxide have a well-established cardioprotective role, however, ... Literature Alert Abstract  The beneficial effects of flavonoid consumption on cardiovascular risk are supported by mechanistic and epidemiologic evidence. We aimed to systematically review the effectiveness of different flavonoid subclasses and flavonoid-rich food sources on cardiovascular disease (CVD) and risk factors?ie, lipoproteins, blood pressure, and flow-mediated dilatation (FMD). Methods included a structured search strategy on MEDLINE, EMBASE, and Cochrane databases; formal inclusion or exclusion, data extraction, and validity assessment; and meta-analysis. One hundred thirty-three trials were included. No randomized controlled trial studied effects on CVD morbidity or mortality. Significant heterogeneity confirmed differential effects between flavonoid subclasses and foods. Choc... Novel Mechanisms for the Control of Renin Synthesis and Release Abstract  Renin is the key regulated step in the enzymatic cascade that leads to angiotensin generation and the control of blood pressure and fluid/electrolyte homeostasis. In the adult unstressed animal, renin is synthesized and released by renal juxtaglomerular cells. However, when homeostasis is threatened, the number of cells that express and release renin increases and extends beyond the juxtaglomerular area; the result is an increase in circulating renin and the reestablishment of homeostasis. The increase in the number of renin cells, a process termed recruitment, is achieved by dedifferentiation and re-expression of renin in cells derived from the renin lineage. The mechanisms that regulate the related processes of reacquisition of the renin phenotype, renin synthesi... Can Antihypertensive Treatment Reverse Large-Artery Stiffening? Abstract  In some controlled therapeutic trials for hypertension, a selective reduction of systolic blood pressure has been obtained with long-term treatment. The greatest effects on cardiovascular outcomes stem from a decrease of central blood pressure through a significant reduction of arterial stiffness, wave reflections, or both. Until now, all protocols have used angiotensin II blockade, mainly through angiotensin-converting enzyme inhibition. Cardiovascular outcomes have been significantly improved when compared with controls, but most of them have been treated with beta blockers. Such ?de-stiffening? therapies are important to consider and require additional trials. Content Type Journal ArticleDOI 10.1007/s11906-009-0085-7Authors Michel E. Safar, Centre de Di... Renal Sympathetic Nerve Ablation: The New Frontier in the Treatment of Hypertension Abstract  The sympathetic nervous system plays an important role in circulatory and metabolic control and has clearly been established as a major contributor to the development of hypertension, as elevated sympathetic nerve activity initiates and sustains the elevation of blood pressure. Increased sympathetic outflow to the heart, resulting in increased cardiac output and neurally mediated vasoconstriction of peripheral blood vessels, is an obvious example of a neural pathophysiologic pathway leading to elevated blood pressure. The consequences of increased sympathetic outflow to the kidneys, perhaps most important in this context, are sodium and water retention, increased renin release, and alterations of renal blood flow?effects that contribute substantially to both acu... Control of hypertension in pregnancy Abstract  The hypertensive disorders of pregnancy are a leading cause of maternal mortality and morbidity. Complications are not limited to preeclampsia but also complicate both preexisting hypertension and isolated gestational hypertension. Blood pressure (BP) management is important but is only one aspect of management of the hypertensive disorders of pregnancy, which may be caused or exacerbated by underlying uteroplacental mismatch between maternal supply and fetal demand. BP treatment thresholds and goals vary in international guidelines, largely reflecting differences in opinion rather than differences in published data. Because of short-term maternal risks, there is consensus that BP should be treated when sustained at greater than or equal to 160 to 170 mm Hg systol... Myocardial remodeling in low-renin hypertension: Molecular pathways to cellular injury in relative aldosteronism Abstract  The pathologic hypertrophy of hypertensive heart disease is related to the quality, not the quantity, of myocardium; the presence of fibrosis is inevitably linked to structural and functional insufficiencies with increased cardiovascular risk. Elevations in plasma aldosterone that are inappropriate relative to dietary sodium, or relative aldosteronism, are accompanied by suppressed plasma renin activity, elevation in arterial pressure, and dyshomeostasis of divalent cations. The accompanying hypocalcemia, hypomagnesemia, and hypozincemia of aldosteronism contribute to the appearance of secondary hyperparathyroidism. Parathyroid hormone-mediated intracellular calcium overloading of cardiac myocytes and mitochondria leads to the induction of oxidative stress and mole... Seek and destroy: The ubiquitin-proteasome system in cardiac disease Abstract  The ubiquitin-proteasome system (UPS) is a major proteolytic system that regulates the degradation of intracellular proteins in the heart. The UPS regulates the turnover of misfolded and damaged proteins, in addition to numerous cellular processes, by affecting the stability of short-lived proteins such as transcription factors and cell signaling pathways. The UPS is tightly regulated by the specificity of ubiquitin ligases that recognize specific substrates and direct the addition of ubiquitin, targeting the substrates for degradation by the 26S proteasome. An increasing number of cardiac ubiquitin ligases have been identified, and the number of substrates each one is known to recognize also has increased, expanding their roles. Although mainly cardioprotective r... All things considered-including glucose control in the ICU Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11906-009-0066-xAuthors Thomas R. Lux, The University of Texas Houston Medical School Department of Internal Medicine, Division of General Medicine Houston USAHeinrich Taegtmeyer, The University of Texas Houston Medical School Department of Internal Medicine, Division of Cardiology Houston USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 6 / December, 2009 (Source: Current Hypertension Reports) Activation of the ubiquitin-proteasome system in doxorubicin cardiomyopathy Abstract  Doxorubicin (Dox) is a very potent anticancer agent, but its use is limited by its dose-dependent, irreversible cardiotoxicity. Despite intensive research efforts, the mechanism of Dox cardiotoxicity remains poorly understood, so very limited means are available for its prevention or effective management. Recent studies have revealed that a therapeutic dose of Dox can activate proteolysis in cardiomyocytes that is mediated by the ubiquitin-proteasome system (UPS), and that the UPS-mediated degradation of a number of pivotal cardiac transcription factors and/or survival factors is enhanced by Dox treatment. These findings suggest that Dox-induced UPS activation may represent a new mechanism underlying Dox cardiotoxicity. Notably, recent experimental studies suggest... Direct renin inhibition: An update Abstract  Aliskiren, the first orally effective direct renin inhibitor, is an effective antihypertensive agent with distinctive properties including placebo-like tolerability, pharmacologic effects that persist after drug discontinuation, and a unique mechanism of action. When combined with agents that inhibit the reninangiotensin-aldosterone system (RAAS), such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or ?-blockers, additional blood pressure reduction reflects more complete RAAS blockade. Concern that marked elevation in plasma renin concentration following aliskiren administration might lead to RAAS-induced paradoxical blood pressure increases appears unfounded, based upon analyses of patients participating in clinical trials. Studies i... Cardiomyocyte autophagy: Remodeling, repairing, and reconstructing the heart Abstract  Autophagy is an evolutionarily conserved catabolic pathway of lysosome-dependent turnover of damaged proteins and organelles. When nutrients are in short supply, bulk removal of cytoplasmic components by autophagy replenishes depleted energy stores, a process critical for maintaining cellular homeostasis. However, prolonged activation of autophagic pathways can result in cell death. Longstanding evidence has linked the stimulation of lysosomal pathways to pathologic cardiac remodeling and a number of cardiac diseases, including heart failure and ischemia. Only recently, however, has work begun to parse cytoprotective autophagy from autophagy that contributes to disease pathogenesis. Current thinking suggests that the effects of autophagy exist on a continuum, with... Recommendations for global hypertension monitoring and prevention Abstract  In recent years, cardiovascular diseases (CVDs) have been recognized as the most common cause of death in the world, accounting for 30% of all mortality, with a growing burden in developing countries. In 2000, it was estimated that 26% of the world?s adult population (972 million individuals) had prevalent hypertension, a key risk factor for CVD, and this number is expected to increase to 29% (1.56 billion) by 2025. CVDs place a heavy burden on society and overall economic activity; they are ranked third in disability-adjusted life years lost. We now have a comprehensive understanding of the basic lifestyle modifications that decrease risk of hypertension and its associated sequelae, however, and it is clear that only modest lifestyle changes would be required t... WNK kinases and blood pressure control This article reviews current knowledge of the role of these proteins in ion homeostasis and volume control. Content Type Journal ArticleDOI 10.1007/s11906-009-0072-zAuthors Staci L. DeatonSamarpita SenguptaMelanie H. Cobb, University of Texas Southwestern Medical Center Department of Pharmacology 6001 Forest Park Road Dallas TX 75390 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 6 / December, 2009 (Source: Current Hypertension Reports) Trends in hypertension treatment in diabetes Abstract  This review discusses current concepts and future trends in the optimal control of elevated blood pressure and hypertension in persons with diabetes, specifically type 2 diabetes mellitus. Although the primary management for persons with type 2 diabetes mellitus, especially with lower levels of blood pressure elevation, is modification or reversal of adverse lifestyles, including weight management and increased physical activity, pharmacologic antihypertensive treatment is usually necessary to optimally control cardiovascular and renal risks. Therapies that modulate the renin-angiotensin-aldosterone system may be beneficial in reducing associated cardiovascular and renal diseases, but control of elevated blood pressure remains an essential target of any antihypert... Aldosterone and cardiovascular risk Abstract  Through its classic effects on sodium and potassium homeostasis, aldosterone, when produced in excess, is associated with the development of hypertension and hence with higher cardiovascular and renal risk. In recent years, experimental and epidemiologic data have suggested that aldosterone also may be linked to high cardiovascular risk independently of its effects on blood pressure. Thus, aldosterone has been associated with obesity and metabolic syndrome in selected populations, and these associations may further contribute to the higher cardiovascular risk of subjects with elevated aldosterone levels. Moreover, aldosterone has been reported to promote inflammation, oxidative stress, and fibrosis in a number of tissues. Clinical evidence indicates that patients ... Literature alert Content Type Journal ArticleDOI 10.1007/s11906-009-0067-9 Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 6 / December, 2009 (Source: Current Hypertension Reports) Outcomes of antiproteinuric RAAS blockade: High-dose compared with dual therapy Abstract  Proteinuria is both a marker and a mediator of progressive renal damage; higher levels are associated with greater cardiovascular and renal risk. At normal and low levels of proteinuria (in the microalbuminuria range), the rate of hard renal events (dialysis and doubling of creatinine) is much lower than the mortality rate. At higher levels of proteinuria, the renal event rate surpasses the mortality rate. In the overt nephropathy range (proteinuria > 0.5 g/L), patients who achieve lower proteinuria with therapy have improved hard renal outcomes, but this result has not been demonstrated in the microalbuminuria range. For patients with more severe overt nephropathy, there is a basic rationale for additional blockade of the renin-angiotensin-aldosterone system (... Blood pressure level and kidney disease progression: Do we really need to go to 130/80 mm Hg? Abstract  Current guidelines recommend a blood pressure goal of less than 130/80 mm Hg in patients with chronic kidney disease. Considerable epidemiologic observational data, post hoc analyses of clinical trials, and meta-analyses support this goal, particularly in patients with proteinuria. Although prospective clinical trials have not shown a clear benefit, recent data indicate that a longer duration of follow-up may be needed to assess the effects of different blood pressure goals. While we await the results of several ongoing and planned studies in this area, the current recommendations of a blood pressure goal less than 130/80 mm Hg appear reasonable. Content Type Journal ArticleDOI 10.1007/s11906-009-0060-3Authors Bassam G. Abu JawdehMahboob Rahman, University Hos... Hypertension in children and adolescents: An approach to management of complex hyper tension in pediatric patients Abstract  Although primary (essential) hypertension is detectable in childhood, secondary causes of hypertension must be considered in evaluating and managing hypertension in children and adolescents. Very young children and children with severe hypertension may have an underlying cause of the hypertension. Interventions to control elevated blood pressure (BP) are clinically important for all children with high BP. Nonpharmacologic approaches are recommended for all asymptomatic children with hypertension and prehypertension. Some children and adolescents will require pharmacologic therapy to control BP and to optimize organ protection. Recent advancements in pediatric clinical trials of antihypertensive agents have provided data on BP-lowering effects and safety in childre... Hypertension in patients with chronic kidney disease Abstract  Hypertension is very common in patients with chronic kidney disease (CKD); it causes early loss of kidney function and accelerated cardiovascular morbidity and mortality. African American patients with hypertension and genetic disposition are at an even higher risk for renal disease and ultimately renal failure. Hypertensive patients with CKD should aim for stringent blood pressure (BP) control (target < 130/80 mm Hg) requiring more than one drug with renin-angiotensin-aldosterone system blockade as a component of therapy targeting both hyper tension and proteinuria. Management of hypertension in the dialysis population should focus on ambulatory measurements of BP and the use of longer-acting antihypertensive drugs, with their dosage and timing adjusted accord... Home blood pressure monitoring to manage hypertension in patients with nephropathy: The time has arrived Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11906-009-0063-0Authors George Bakris, 5841 South Maryland Avenue, MC 1027 Chicago IL 60637 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 5 / October, 2009 (Source: Current Hypertension Reports) Hypertension guidelines and chronic kidney disease: Physicians, please follow directions Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11906-009-0064-zAuthors George Bakris, 5841 South Maryland Avenue, MC 1027 Chicago IL 60637 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 5 / October, 2009 (Source: Current Hypertension Reports) Hypertension: Issues in control and resistance Abstract  Hypertension remains uncontrolled in more than 50% of treated patients. Barriers to hypertension control include those that are patient-related, physician-related, and related to the health system. Identification of uncontrolled hypertension, pseudoresistant hypertension, and resistant hypertension require thoughtful attention to accurate blood pressure measurement, lifestyle factors, evaluation for secondary causes of hypertension, and proper treatment. Recent guidelines emphasize the importance of aggressive treatment and referral to hypertension specialists for patients with resistant hypertension, defined as blood pressure that remains above goal despite the use of three appropriate anti hypertensive agents. Content Type Journal ArticleDOI 10.1007/s11906-009... Effect of blood pressure lowering on markers of kidney disease progression Abstract  Hypertension remains a common comorbidity and cause of chronic kidney disease (CKD). As the number of patients with CKD grows, so does the need to identify modifiable risk factors for CKD progression. Data on slowing progression of CKD or preventing end-stage renal disease with aggressive blood pressure control have not yielded definitive conclusions regarding ideal blood pressure targets. Shifting the focus of antihypertensive therapy to alternative markers of end-organ damage, specifically proteinuria, has yielded some promise in preventing the progression of CKD. Nevertheless, proteinuria and decline in estimated GFR may represent an irreversible degree of injury to the kidney that limits the impact of any therapy. The identification and use of novel markers of... Treatment of hypertensive urgencies and emergencies Abstract  Although systemic hypertension is a common clinical condition, hypertensive emergencies are unusual in clinical practice. There are some situations, however, that qualify as hypertensive emergencies or urgencies. It is important, therefore, to diagnose these acute conditions, in which immediate treatment of hypertension is indicated. The diagnosis of hypertensive emergencies depends on consideration of the clinical manifestations as well as the absolute level of blood pressure. Manifestations of hypertensive emergencies can be quite profound, but they vary depending on the target organ that is affected. Thus, an accurate clinical diagnosis is necessary to render appropriate therapy. Fortunately, effective drug therapy is available to lower the blood pressure quick... Blood pressure control in the elderly: Can you have too much of a good thing? Abstract  Hypertension (especially systolic hypertension) is very common in older persons. Systolic hypertension occurs because large conduit arteries become stiffer with age. Strong evidence from randomized trials suggests that treating systolic blood pressures initially higher than 160 mm Hg is extremely beneficial, and a recent trial extended this conclusion to healthy persons over 80 years of age. However, the only trial that has directly tested the use of more aggressive treatment goals (< 140 mm Hg) in the elderly did not show benefit in those older than 75. Risks of overtreating hypertension for the elderly include falls and orthostatic hypotension, and the most compromised older persons may be the most likely to experience adverse effects. Our current state of kn... Dual renin-angiotensin system blockade in the ONTARGET study: Clinically relevant risk for the kidney? Abstract  Inhibition of the renin-angiotensin system contributes to reductions in proteinuria and in progression of chronic kidney disease. Indeed, monotherapy with either an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) has been shown to decrease proteinuria and slow the decline of chronic kidney disease, but incompletely. Therefore, there is increasing interest in whether combination strategies will provide more complete blockade of the renin-angiotensin system, which may translate into superior renoprotective and cardioprotective effects compared with either agent alone. There have been several reports on combination strategies. However, the recent report of the Ongoing Telmisartan Alone and in Combination with Ramipril Global End... Should albuminuria be a focus of antihypertensive therapy goals? Abstract  Albuminuria has been recognized as a risk marker for both chronic kidney disease and cardiovascular disease in large observational cohorts. In addition, post hoc analyses of many large randomized trials have found a positive relationship between albu minuria and adverse renal and cardiovascular outcomes, leading some to suggest that albuminuria may be a potential therapeutic target for antihypertensive treatment. However, direct clinical evidence linking albuminuria reduction to reduction in adverse renal and cardiovascular events is scarce. This paper reviews the evidence in the current literature to address whether albuminuria can be used as a credible predictor of risk for chronic kidney disease and cardiovascular disease and also reviews the clinical trial evi... Literature alert Content Type Journal ArticleDOI 10.1007/s11906-009-0065-y Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 5 / October, 2009 (Source: Current Hypertension Reports) Therapeutic approaches to diastolic dysfunction Abstract  Progressive abnormalities of passive stiffness or active relaxation of the myocardium that impair ventricular filling during diastole may be an important contributor to the development of heart failure in patients with preserved ejection fraction. In this review, we discuss the epidemiology and pathophysiology of diastolic dysfunction and heart failure with preserved ejection fraction, highlighting potential therapeutic approaches and exploring the limited available evidence base for improving clinical outcomes in patients with these challenging entities. Content Type Journal ArticleDOI 10.1007/s11906-009-0048-zAuthors Rajesh JanardhananAkshay S. DesaiScott D. Solomon, Brigham and Women?s Hospital Cardiovascular Division 75 Francis Street Boston MA 02115 USA ... The role of peroxisome proliferator-activated receptor ? in blood pressure regulation Abstract  Peroxisome proliferator-activated receptor-? (PPAR?) is a member of the nuclear hormone receptor superfamily. It is expressed in adipocytes, immune cells, and cardiovascular cells that include cardiomyocytes, endothelial cells, and smooth muscle cells. PPAR? plays a role in regulating cellular anti-inflammatory responses and is a mediator of insulin sensitization induced by thiazolidinediones, which also can reduce elevated blood pressure both clinically and experimentally. As a result, research regarding the role of PPAR? in blood pressure homeostasis is ongoing. Recent studies have demonstrated that increases or decreases in blood pressure phenotype may be PPAR?-dependent and involve a number of different signaling pathways. Furthermore, studies using PPAR?.. Antihypertensive treatment and stroke prevention: From recent meta-analyses to the PRoFESS trial This article examines the cerebrovascular protection provided by antihypertensive drug treatment in the light of the results of recent meta-analyses and of the findings of the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial. Content Type Journal ArticleDOI 10.1007/s11906-009-0045-2Authors Guido Grassi, Ospedale San Gerardo Clinica Medica Via Pergolesi 33 20052 Monza (Milan) ItalyFosca Quarti-TrevanoRaffaella Dell?OroGiuseppe Mancia Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 4 / August, 2009 (Source: Current Hypertension Reports) Management of hypertension in hemodialysis patients Abstract  Hypertension is very common in patients with chronic kidney disease and is present in most patients with end-stage renal disease (ESRD). Hypertension is largely responsible for premature cardiovascular disease in dialysis patients. The pathophysiology of hypertension in ESRD is complex, and multiple mechanisms are likely involved in blood pressure dysregulation in patients on hemodialysis. Some of these patients demonstrate resistant hypertension. Aggressive control of hypertension in ESRD/dialysis is mandatory. Generally, nonpharmacologic treatments are not enough to achieve the goal blood pressure levels in dialysis patients. Multiple antihypertensive drugs are often necessary. Drugs that block the reninangiotensin system offer a number of advantages for patient... Hypertension, dementia, and antihypertensive treatment: Implications for the very elderly Abstract  A wealth of longitudinal epidemiologic evidence links high blood pressure or hypertension to cognitive decline and incident dementia. Some (but not all) studies have suggested that antihypertensive treatment is beneficial, reducing risk of decline and dementia. There are plausible mechanisms to support the possibility that hypertension may increase the risk of dementia. There is also evidence suggesting that the two dementia types thought to be most common, Alzheimer?s disease and vascular dementia, have overlapping risk factors. Seven placebo-controlled trials of antihypertensive treatment have assessed cognitive function, incident dementia, or both, with mixed outcomes. The Hypertension in the Very Elderly Trial (HYVET), despite showing reductions in mortality... Antihypertensive drugs and central blood pressure Abstract  Recent evidence suggests that central blood pressure is a more important determinant of cardiovascular risk than brachial pressure. Interestingly, antihypertensive drugs exert different effects on brachial and central pressure. Traditional ?-blockers, such as atenolol, appear to have an adverse impact on central pressure, despite lowering brachial pressure. This may help to explain the results of recent large outcome studies using atenolol. Further research is required to clarify whether other antihypertensive agents lower central pressure beyond the effects observed on brachial pressure. Content Type Journal ArticleDOI 10.1007/s11906-009-0043-4Authors Carmel M. McEniery, University of Cambridge, Addenbrooke?s Hospital Clinical Pharmacology Unit Box 110 Camb... Treatment of hypertension in patients with peripheral arterial disease: An update Abstract  Hypertension is a known risk factor for cardiovascular events, and recent data have pointed to peripheral arterial disease (PAD) as another strong risk factor; together, they cause a surprisingly high total risk. This review deals with the clinical management of this dangerous association. The ankle-brachial index helps in the diagnosis of PAD and the estimation of risk. To control risk, lifestyle adaptation is essential. There is no consensus on a first choice of antihypertensive drug. Arguments favor angiotensin-converting enzyme inhibitors, but most patients require several antihypertensive drugs to reach goal pressure (140/90 mm Hg or lower). Moreover, to control the risk of PAD, antiplatelet drugs, antihypertensive drugs, and statins are recommended. Conte... Choosing the ideal drug for hypertension after ischemic stroke This article reviews the studies assessing the efficacy of each agent class in secondary stroke prevention. The comparison of studies and agents is often difficult because of differences in achieved blood pressures and in the exact agents and combinations of agents that are used. Meta-analysis has attempted to resolve some of these difficulties by using meta-regression modeling to predict ?expected? risk reduction given an achieved blood pressure. The resultant ability to give a value to ?blood pressure-independent? effects is questioned. The effect of reducing blood pressure far outweighs any other effect in reducing stroke risk, and the agent that has been shown to be most consistently equal or superior to any agent compared with it has been amlodipine, a calcium-channel bl... ACCOMPLISH the goal: Hypertension and beyond Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11906-009-0050-5Authors Helmy M. Siragy, University of Virginia School of Medicine the Department of Medicine and Hypertension Center Charlottesville Virginia USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 4 / August, 2009 (Source: Current Hypertension Reports) The SANDS Randomized Trial Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11906-009-0052-3Authors Thomas D. Giles, Tulane University School of Medicine the Department of Medicine, Section of Cardiology New Orleans USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 4 / August, 2009 (Source: Current Hypertension Reports) The potential role of the angiotensin subtype 2 receptor in cardiovascular protection Abstract  Advances in our knowledge of the renin-angiotensin system have led to better understanding of the mechanisms contributing to the development of cardiovascular, renal, and metabolic disorders. Similarly, the discovery of new components of this system offers opportunities to develop new therapeutic tools to manage these diseases. Angiotensin subtype 2 (AT2) receptor represents one of those components with the potential for improving cardiovascular protection. Current knowledge suggests that the AT2 receptor antagonizes the effects of the angiotensin subtype 1 receptor. AT2 receptor activation is linked to vasodilation, nitric oxide production, and antiproliferative and anti-inflammatory effects. The role of the AT2 receptor in inducing natriuresis, inhibiting renin ... Literature alert Content Type Journal ArticleDOI 10.1007/s11906-009-0051-4 Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 4 / August, 2009 (Source: Current Hypertension Reports) Antihypertensive drugs with anti-inflammatory properties are more effective in treating postmenopausal hypertensive women Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11906-009-0029-2Authors Kathleen H. Berecek Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 3 / June, 2009 (Source: Current Hypertension Reports) Sympathoadrenal mechanisms in the pathogenesis of sleep apnea-related hypertension Abstract  Obstructive sleep apnea-hypopnea (OSAH) is regarded as an increasingly common cause of sustained hypertension. The vast majority of mechanistic studies linking these entities have focused on the role of sympathoactivation. This review therefore addresses this purported mechanism by highlighting studies conducted in the past 5 years that speak to OSAH-related changes in sympathoregulation, independent of obesity, as well as the intervening players and pathways that may be relevant to such changes. Finally, studies with a focus on changes in sympathoregulation induced by continuous positive airway pressure (CPAP) therapy are discussed. Taken together, these findings strengthen the claim that the sympathoadrenal pressor system is essential for the development of the ... Left ventricular hypertrophy and renin-angiotensin system blockade Abstract  The renin-angiotensin system (RAS), an important control system for blood pressure and intravascular volume, also causes left ventricular hypertrophy (LVH) and fibrosis. The main causal mechanism is the increase in blood pressure, which leads to increased left ventricular wall stress; however, aldosterone release from the adrenals and (more controversially) the direct action of angiotensin II on the cardiomyocytes also play a role. Large clinical trials evaluating the blockade of the RAS with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers have demonstrated an ability to prevent progression and induce regression of left ventricular mass, thereby reducing the significant and independent cardiovascular risk conferred by LVH. Regression of l... Central blood pressure, arterial stiffness, and wave reflection: New targets of treatment in essential hypertension Abstract  Central blood pressure is dependent on the stiffness of large arteries and pulse wave reflection. These parameters are very important in the development of hypertensive target organ disease. Moreover, recent clinical studies have shown their independent predictive value for cardiovascular morbidity and mortality. Therefore, 2007 guidelines for the management of hypertension inserted the evaluation of central arterial stiffness as an important component for assessing total cardiovascular risk. Differences in the way various antihypertensive drugs affect arterial stiffness and central hemodynamics may explain the greater cardiovascular protection provided by newer drugs (eg, renin-angiotensin system blockers or calcium channel blockers) independent of peripheral blo... The role of cardiac autonomic function in hypertension and cardiovascular disease Abstract  Autonomic nervous system abnormality, clinically manifested as a hyperkinetic circulation characterized by elevations in heart rate, blood pressure, plasma norepinephrine levels, and cardiac output, has been repeatedly demonstrated in hypertension. Increased release of norepinephrine from the brain has also been described in hypertension, and increased sympathetic activity has been demonstrated using spectral analysis of heart rate variability, particularly in the early stage of hypertension and in white-coat hypertension. Studies performed with microneurographic assessment also have found a marked increase in muscle sympathetic nervous activity in subjects with both borderline and established hypertension. A transition from the early hyperkinetic state to a high-... Central mineralocorticoid receptors, sympathetic activity, and hypertension This article reviews some of the recent advances in this area, particularly mechanisms by which the mineralocorticoid receptor maintains selectivity for its ligand within the central nervous system, its role in salt appetite, and the possibility of local production of corticosteroids. In addition, the links between central mineralocorticoid receptor activation, stress, sympathetic activity, and hypertension are discussed. Content Type Journal ArticleDOI 10.1007/s11906-009-0039-0Authors Frances McManusScott M. MacKenzieE. Marie Freel, University of Glasgow BHF Glasgow Cardiovascular Research Centre 126 University Place Glasgow G12 8TA UK Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Numb... The macrocirculation and microcirculation of hypertension Abstract  Changes in vascular structure that accompany hypertension may contribute to hypertensive end-organ damage. Both the macrovascular and microvascular levels should be considered, as interactions between them are believed to be critically important. Regarding the macrocirculation, the article first reviews basic concepts of vascular biomechanics, such as arterial compliance, arterial distensibility, and stress-strain relationships of arterial wall material, and then reviews how hypertension affects the properties of conduit arteries, particularly examining evidence that it accelerates the progressive stiffening that normally occurs with advancing age. High arterial stiffness may increase central systolic and pulse pressure by two different mechanisms: 1) Abnormally h... The role of the sympathetic nervous system in obesity-related hypertension Abstract  Obesity is recognized as a major health problem throughout the world. Excess weight is a major cause of increased blood pressure in most patients with essential hypertension and greatly increases the risk for diabetes, cardiovascular diseases, and end-stage renal disease. Although the mechanisms by which obesity raises blood pressure are not completely understood, increased renal sodium reabsorption, impaired pressure natriuresis, and volume expansion appear to play important roles. Several potential mechanisms have been suggested to contribute to altered kidney function and hypertension in obesity, including activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system, as well as physical compression of the kidneys, especially when vi... Differential diagnosis of primary aldosteronism subtypes This article reviews the strategies to correctly identify PA subtypes, underlining the central role of adrenal vein sampling. Content Type Journal ArticleDOI 10.1007/s11906-009-0038-1Authors Paolo Mulatero, AOU San Giovanni Battista Division of Internal Medicine and Hypertension Via Genova 3 10126 Torino ItalyChiara BertelloAndrea VerhovezDenis RossatoGiuseppe GiraudoGiulio MengozziGiorgio LimeruttiEleonora AvenattiDavide TizzaniFranco Veglio Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 3 / June, 2009 (Source: Current Hypertension Reports) Literature alert Content Type Journal ArticleDOI 10.1007/s11906-009-0040-7 Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 3 / June, 2009 (Source: Current Hypertension Reports) Hypertension and the bradykinin system Abstract  The blood pressure-lowering property of the brady kinin system has been documented for more than eight decades. The bradykinin system is involved in the mediation and modulation of the vasoconstrictor renin-angiotensin system and the vasodilators prostaglandin, prostacyclin, and nitric oxide in regulating sodium water balance, renal and cardiac hemodynamics, and blood pressure. Reduced activity of the bradykinin system has been observed in various hypertensive situations in both clinical and experimental models of hypertension. Antihypertensive properties of the angiotensin-converting enzyme or kininase II inhibitors are primarily mediated via the bradykinin-releasing pathway, which may also cause regression of left ventricular hypertrophy in hypertensive situatio... The crumbling of dual renin-angiotensin system blockade Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11906-009-0028-3Authors Franz H. Messerli Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 3 / June, 2009 (Source: Current Hypertension Reports) Strategies for managing perioperative hypertension This article reviews perioperative hypertension emergencies/urgencies and various approaches for management. Content Type Journal ArticleDOI 10.1007/s11906-009-0031-8Authors Ronak G. DesaiMuhammad MuntazarMichael E. Goldberg, Cooper University Hospital, UMDNJ/Robert Wood Johnson Medical School Department of Anesthesiology Camden Campus Camden NJ 08103 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 3 / June, 2009 (Source: Current Hypertension Reports) Ethnic, gender, and age-related differences in patients with the metabolic syndrome Abstract  The metabolic syndrome is a clustering of cardiovascular risk factors and is associated with an increased risk of developing diabetes, cardiovascular disease, and kidney disease. Epidemiologic studies have demonstrated differences in prevalence by age, gender, and ethnicity. The prevalence of the metabolic syndrome increases with age through the sixth decade of life among men and seventh decade among women. Most, but not all, studies reported a higher prevalence of the metabolic syndrome among women compared with men. Although the metabolic syndrome is more common among Mexican Americans compared with non-Hispanic whites and blacks, among men the metabolic syndrome is more common among non-Hispanic whites than non-Hispanic blacks; the reverse is true among women. ... Albuminuria: What can we expect from the determination of nonimmunoreactive albumin? Abstract  Albuminuria is an early marker for diabetic nephropathy in patients with diabetes, and has a clear place in patient care. It also predicts cardiovascular events and mortality in diabetic patients and in the general population, and is slowly becoming accepted in population screening for cardiovascular disease and chronic kidney disease. Recently, investigators found that a considerable amount of albumin in urine is nonimmunoreactive and that classic immunochemical assays do not properly measure all albumin in urine. Assays that detect immunoreactive plus nonimmunoreactive albumin may better predict development of diabetic nephropathy, cardiovascular events, and mortality than assays that only detect immunoreactive albumin. Proof of the existence of nonimmunoreactiv... Aortic stiffness, kidney disease, and renal transplantation Abstract  In subjects with chronic kidney disease (CKD), treatment of high systolic blood pressure is a key element in preventing disease progression and the occurrence of cardiovascular (CV) events. This relationship between the large arterial system and kidney function was demonstrated in different renal populations. In subjects with mild to severe renal insufficiency, increased aortic stiffness and reduced creatinine clearance are closely related and are independent of traditional CV risk factors. In renal transplant patients, aortic stiffness is significantly increased irrespective of donor type. Donor age and/or acute rejection contribute independently to the increased stiffness. In the presence of renal dysfunction, an increase in systemic pulse pressure frequently ma... Effect of excessive salt intake: Role of plasma sodium Abstract  Sodium chloride is a normal and necessary constituent of food and the main cause for the rise in arterial pressure that occurs with age. Changes in dietary salt intake can cause changes in plasma sodium. Even a small increase has been shown to be harmful, for example, by increasing left ventricular mass, thickening and narrowing resistance arteries, and stiffening endothelial cells. Therefore, it is possible that an increase in plasma sodium is an important pressor mechanism. This review discusses the role of dietary sodium and plasma sodium, with a special focus on their impact on the endothelial cell. Content Type Journal ArticleDOI 10.1007/s11906-009-0018-5Authors Stefan ReuterEckhart BüssemakerMartin HausbergHermann PavenstädtUta Hillebrand, Medizinische ... ONTARGET: Does dual blockade of the renin-angiotensin system provide more effective cardiovascular and renal protection in patients at high cardiovascular risk? Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11906-009-0017-6Authors Jean-Michel HalimiAlbert Mimran Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 2 / April, 2009 (Source: Current Hypertension Reports) Intensified inhibition of renin-angiotensin system: A way to improve renal protection? Abstract  Several large, randomized, multicenter studies in diabetic and nondiabetic patients with chronic proteinuric nephropathies have clearly demonstrated that angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARB) are able to reduce urinary protein excretion and retard renal disease progression. However, the number of patients who reach end-stage renal failure is still considerable and there is a great need to identify therapies that can arrest evolution of kidney damage. Maximizing renin-angiotensin system (RAS) blockade through combined ACE inhibitor and ARB therapy has been shown to further increase antiproteinuric and nephroprotective effects of each drug class. However, in order to slow to the greatest extent progression of renal... The intracellular renin-angiotensin system in the heart We describe the physiology of the intracellular RAS, potential pathologic roles of intracellular Ang II, and the relevance of the intracellular system in view of recent clinical trials involving various RAS inhibitors. Content Type Journal ArticleDOI 10.1007/s11906-009-0020-yAuthors Rajesh KumarVivek P. SinghKenneth M. Baker, 1901 South First Street, Building 205 Temple TX 76504 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 2 / April, 2009 (Source: Current Hypertension Reports) Literature alert Content Type Journal ArticleDOI 10.1007/s11906-009-0015-8 Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 2 / April, 2009 (Source: Current Hypertension Reports) Weight loss maintenance: An excellent approach to control hypertension but a difficult goal to reach Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11906-009-0016-7Authors Efrain Reisin Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 2 / April, 2009 (Source: Current Hypertension Reports) Ambulatory blood pressure monitoring in childhood and adult obesity Abstract  Body mass and body fat are known modulators of blood pressure (BP) measured by clinic sphygmomanometry. However, the ambulatory BP-monitoring characteristics unique to obesity have not been widely studied. We reviewed the literature on ambulatory BP monitoring for links between measures of body adiposity in lean and overweight children and adults and various BP measures obtained by ambulatory monitoring. Collectively, the findings suggest significant associations of adiposity with ambulatory BP and heart rate, sleep-related BP dipping, and the white-coat phenomenon. Content Type Journal ArticleDOI 10.1007/s11906-009-0024-7Authors Iddo Z. Ben-DovMichael Bursztyn, Hadassah-Hebrew University Medical Center Department of Internal Medicine, Hypertension Unit Mount S... The role of statins in the treatment of the metabolic syndrome Abstract  The metabolic syndrome is a cluster of cardiometabolic risk factors associated with higher risk for atherosclerotic cardiovascular (CV) disease and diabetes. Its prevalence is about 20% to 30% among adults worldwide and is increasing. The primary goal is reduction of CV risk through lifestyle changes and drug therapy if required. Post hoc analyses of prospective trials showed the benefit of lowering low-density lipoprotein (LDL) cholesterol in patients with the metabolic syndrome. Statin therapy exerts beneficial effects not only by lowering LDL cholesterol but also via its so-called pleiotropic effects. These effects seem particularly important for reducing risk of CV disease in patients with the metabolic syndrome. Thus, evidence is accumulating that statins are... Update on the metabolic syndrome: Hypertension Abstract  The presence of the metabolic syndrome identifies an individual at increased risk for diabetes, cardiovascular disease, and early mortality. However, the increased risk may vary by the absence or presence of hypertension. Current guidelines for the management of high blood pressure in the metabolic syndrome emphasize lifestyle modification as a first-line strategy. Pharmacologic treatment of elevated blood pressure in the metabolic syndrome may be necessary in the presence of other cardiovascular risk factors or to achieve adequate blood pressure control. Currently, there is no consensus as to which antihypertensive therapy should be used to treat hypertension in patients with the metabolic syndrome; it remains unclear whether achieving tight blood pressure contro... The metabolic syndrome: Insulin resistance Abstract  Insulin resistance is the most accepted unifying theory explaining the pathophysiology of the metabolic syndrome. However, epidemiologic studies indicate that a substantial proportion of patients with the metabolic syndrome do not have evidence of insulin resistance, and the correlation between insulin resistance and individual components of the syndrome is weak to moderate. Insulin resistance may play an important role in the development of hyperglycemia and dyslipidemia, which can further aggravate insulin resistance. The implication of insulin resistance in hypertension appears to be less strong than its role in causing hyperglycemia and dyslipidemia. Obesity may be another pathogenic factor in the metabolic syndrome that may help initiate or worsen insulin res... Stress-induced sodium retention and hypertension: A review and hypothesis Abstract  Hypertension?an important health problem in industrialized nations?is particularly significant in blacks and obese individuals, in whom it is hypothesized to result from impaired renal sodium regulation. We reviewed studies that identified individuals with impaired sodium regulation by examining the natriuretic response to mental stress. A significant percentage of black and obese individuals retain or have a diminished natriuretic response to mental stress despite increased blood pressure (BP). This contributes a volume component to the normal resistance-mediated BP increase, and BP remains elevated after the stressor ceases until the volume expansion diminishes. The stress exposes these individuals to greater cardiovascular load. This response pattern has be... Heme oxygenase and renal disease Abstract  The cellular content of heme, derived from the breakdown of heme proteins, is regulated via the heme oxygenase (HO) enzyme system. HO catalyzes the rate-limiting step in heme degradation resulting in the formation of iron, carbon monoxide, and biliverdin. Recent studies have focused on the biologic effects of product(s) of this reaction, which have important antioxidant, antiapoptotic, anti-inflammatory, and cytoprotective properties. Two isoforms of the HO enzyme have been described: an inducible isoform (HO-1) and a constitutively expressed isoform (HO-2). Induction of HO-1 occurs as a beneficial response to several injurious stimuli and has been implicated in many clinically relevant disease states including sepsis, hypertension, atherosclerosis, and acute lung... Baroreflex device therapy in the treatment of hypertension Abstract  Despite therapy with multiple optimally dosed medications, hypertension remains poorly controlled in a sizeable number of people worldwide. This has spurred interest in exploring other pharmacologic and nonpharmacologic options for treatment. The carotid baroreceptors are important in regulating blood pressure in chronic hypertension by centrally mediated sympathoinhibitory effects and other effects. This has led to renewed interest in treating hypertension by electrically stimulating the carotid baroreceptors. Although this concept was first studied several decades ago, modern technology and better understanding of physiology have finally allowed the development of a feasible treatment option. Ongoing trials are finding significant and sustained reductions in blo... The role of incretins in cardiovascular control Abstract  Glucagon-like peptide-1 (GLP-1) is an incretin secreted in response to nutrient ingestion. Understanding the incretin effect on diabetes pathophysiology has led to development of a new class of agents termed incretin mimetics. Exenatide is the first GLP-1 agonist approved to treat type 2 diabetes mellitus (T2DM). Clinical studies have demonstrated exenatide?s efficacy in improving glycemic control, often coupled with weight loss. Studies are investigating the potential cardiovascular benefits of GLP-1 agonists. Blood pressure, cholesterol levels, C-reactive protein, and insulin resistance may improve in patients treated with exenatide. The direct effect of GLP-1 on cardiac myocytes and vascular smooth muscle has been an active area of investigation. Infusions of... Weighing in on blood pressure Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11906-009-0003-zAuthors Arya M. Sharma Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 1 / February, 2009 (Source: Current Hypertension Reports) The BEAUTIFUL study: Is heart rate reduction a new therapeutic principle? Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11906-009-0009-6Authors Frank EnseleitFrank T. Ruschitzka Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 1 / February, 2009 (Source: Current Hypertension Reports) ONTARGET: How much RAS inhibition is enough? Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11906-009-0002-0Authors Alan B. Weder Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 1 / February, 2009 (Source: Current Hypertension Reports) Literature alert Content Type Journal ArticleDOI 10.1007/s11906-009-0001-1 Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 1 / February, 2009 (Source: Current Hypertension Reports) A review of the role of atrial natriuretic peptide gene polymorphisms in hypertension and its sequelae This report provides a comprehensive review of studies exploring NPPA polymorphisms in relation to hypertension and hypertension-related outcomes. Content Type Journal ArticleDOI 10.1007/s11906-009-0008-7Authors Amy I. Lynch, University of Minnesota Medical School Department of Laboratory Medicine and Pathology Mayo Mail Code 609, 420 Delaware Street SE Minneapolis MN 55455 USASteven A. ClaasDonna K. Arnett Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 1 / February, 2009 (Source: Current Hypertension Reports) Hypertension in women Abstract  Systolic blood pressure is higher in African American and Hispanic women older than 60 and in white women older than 70 than it is in men. Coupled with their longer survival, elderly women have higher hypertension prevalence rates, particularly for isolated systolic hypertension. Hemodynamic characteristics differ by sex for premenopausal women and age-matched men, but these differences lessen after menopause. This transition may result from hormonal or metabolic alterations, including weight gain and tissue adiposity, which are common after menopause. Clinical trials enrolling large numbers of women support the benefits of treatment to reduce cardiovascular events and mortality. The trend to enroll subjects with several comorbidities and thereby increase event ra... Non-pressure-related effects of dietary sodium Abstract  After the demonstration of a positive correlation between sodium intake and arterial pressure in large population studies, the effect of short-term reduction in sodium intake demonstrated the efficacy of this nonpharmacologic therapy. In addition, a positive relation between urinary sodium (the most reliable estimate of salt intake) and left ventricular hypertrophy was found; and in recent years it was shown that cardiovascular morbidity clearly progressed with increasing sodium intake, despite one contradictory study. The role of non-pressure-related effects of dietary sodium is discussed in order to bring more arguments for a large-scale attempt to reduce sodium intake by 30% to 50%. Content Type Journal ArticleDOI 10.1007/s11906-009-0004-yAuthors Guilhem du... Vascular insulin resistance: A potential link between cardiovascular and metabolic diseases This article reviews experimental and clinical data elucidating the physiologic and pathophysiologic role of insulin in the vasculature and the mechanisms contributing to the development of vascular and metabolic diseases. Content Type Journal ArticleDOI 10.1007/s11906-009-0010-0Authors Ivonne Hernandez SchulmanMing-Sheng Zhou, University of Miami Miller School of Medicine, Veterans Affairs Medical Center, Nephrology-Hypertension Section Vascular Biology Institute 1201 Northwest 16th Street, Room A-1009 Miami FL 33125 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 11 Journal Issue Volume 11, Number 1 / February, 2009 (Source: Current Hypertension Reports) Angiotensin vaccination: What is the prospect of success? Abstract  Over many decades, several attempts have been made to treat hypertension using a vaccination strategy to inhibit the renin-angiotensin system. Renin vaccination successfully inhibited renin activity and reduced blood pressure in animal models, but caused autoimmune disease of the kidney. By contrast, most previous studies of angiotensin vaccination failed to reduce blood pressure in animal models, despite producing high titers of antibodies that prevented the pressor response to exogenous angiotensins. Angiotensin vaccination is being revisited as a strategy for treating hypertension, in the hope that new conjugates of angiotensin I and angiotensin II will produce antibodies of sufficient titer and affinity to reduce blood pressure in patients with hypertension. A... The hypertension peril: Lessons from CETP inhibitors Abstract  Pharmacologic inhibitors of the cholesteryl ester transfer protein (CETP) are capable of increasing HDL cholesterol by 50% to 100% in humans. Despite intriguing antiatherogenic effects of CETP inhibition in animal models of atherosclerosis, the Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events trial investigators observed an excess of cardiovascular and noncardiovascular morbidity and mortality associated with the use of the CETP inhibitor torcetrapib. This review summarizes available clinical and experimental data about potential underlying mechanisms. Content Type Journal ArticleDOI 10.1007/s11906-009-0014-9Authors Matthias Hermann, University Hospital Zürich Department of Cardiology Ramistrasse 100 CH-8091 Zürich Sw... Renal protective effect of renin inhibition Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11906-008-0088-9Authors Theodore A. Kotchen Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 10 Journal Issue Volume 10, Number 6 / December, 2008 (Source: Current Hypertension Reports) Perioperative control of hypertension: When will it adversely affect perioperative outcome? Abstract  Much has been published about the impact of treatment on adverse outcomes in patients with cardiovascular diseases. Hypertension is an extremely common condition affecting a significant percentage of the world population. Although care guidelines exist for the medical patient with raised blood pressure, there are no accepted guidelines for the preoperative evaluation and perioperative care of the patient with hypertension who undergoes noncardiac surgery. Of particular importance are defining at-risk groups of patients, and the indications for cancellation to treat and hence reduce this risk. This review examines the interactions between hypertension, drug therapies, anesthesia, and adverse outcomes in these patients. Recommendations for identifying patients at gr... Endothelin antagonist for the treatment of resistant hypertension Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11906-008-0080-4Authors Steven A. Atlas Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 10 Journal Issue Volume 10, Number 6 / December, 2008 (Source: Current Hypertension Reports) Leptin and mechanisms of endothelial dysfunction and cardiovascular disease This report reviews pertinent literature on leptin-mediated endothelial dysfunction, leptin-mediated sympathetic activation, and leptin as a significant perivascular adipose-derived factor. Content Type Journal ArticleDOI 10.1007/s11906-008-0082-2Authors Jarrod D. Knudson, Baylor College of Medicine Department of Pediatrics One Baylor Plaza Houston TX 77030 USAGregory A. PayneLéna BorbouseJohnathan D. Tune Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 10 Journal Issue Volume 10, Number 6 / December, 2008 (Source: Current Hypertension Reports) Aliskiren combined with losartan: Thor?s hammer or Sigurd?s sword? Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11906-008-0081-3Authors Thomas R. LuxHeinrich Taegtmeyer Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 10 Journal Issue Volume 10, Number 6 / December, 2008 (Source: Current Hypertension Reports) Impaired cardiac function in leptin-deficient mice This article briefly reviews leptin?s physiologic role in cardiomyocyte structure and function and how leptin deficiency or disrupted signaling may trigger cardiac functional and morphologic abnormalities. Content Type Journal ArticleDOI 10.1007/s11906-008-0084-0Authors Jun Ren, Fourth Military Medical University Department of Physiology Xi?an ChinaHeng Ma Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 10 Journal Issue Volume 10, Number 6 / December, 2008 (Source: Current Hypertension Reports) The PAT family of lipid droplet proteins in heart and vascular cells Abstract  Cytoplasmic lipid droplets (LDs) are organelles in which cells store neutral lipids for use as an energy source in times of need, but they also play important roles in the regulation of key metabolic processes. Although LDs are essential for normal cell function, excess accumulation of intracellular lipid is associated with several metabolic diseases, including obesity, type 2 diabetes, and atherosclerosis. The function of LDs is regulated by their associated proteins, including the members of the PAT family: perilipin, adipophilin/adipose differentiation-related protein, tail-interacting protein 47, S3-12, and OXPAT/myocardial LD protein/lipid-storage droplet protein 5. In this review we discuss the PAT proteins in two cardiovascular contexts: 1) in the atheroscl... Cardiomyocyte apoptosis in animal models of obesity This article critically reviews studies conducted in animal models of obesity that have expanded our understanding of the mechanisms of cardiomyocyte apoptosis and their role in various obesity-associated cardiovascular diseases. Content Type Journal ArticleDOI 10.1007/s11906-008-0085-zAuthors Premal S. TrivediLili A. Barouch, Johns Hopkins University Division of Cardiology 720 Rutland Avenue, Ross 1050 Baltimore MD 21205 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 10 Journal Issue Volume 10, Number 6 / December, 2008 (Source: Current Hypertension Reports) Mediators of sympathetic activation in metabolic syndrome obesity Abstract  The metabolic syndrome represents a major public health burden because of its high prevalence in the general population and its association with cardiovascular disease and type 2 diabetes. Accumulated evidence based on biochemical, neurophysiologic, and indirect measurements of autonomic activity indicate that visceral obesity and the metabolic syndrome are associated with enhanced sympathetic neural drive and vagal impairment. The mechanisms linking metabolic syndrome with sympathetic activation are complex and not completely understood, and cause-effect relationships need further clarification from prospective trials. Components of the metabolic syndrome that may directly or indirectly enhance sympathetic drive include hyperinsulinemia, leptin, nonesterified fat... Aldosterone and CKD in metabolic syndrome Content Type Journal ArticleCategory Invited CommentaryDOI 10.1007/s11906-008-0078-yAuthors Toshiro Fujita, University of Tokyo Department of Nephrology and Endocrinology 7-3-1 Hongo, Bunkyo-ku Tokyo 113-8655 Japan Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 10 Journal Issue Volume 10, Number 6 / December, 2008 (Source: Current Hypertension Reports) Treating hypertension prevents heart failure Content Type Journal ArticleCategory Invited CommentaryDOI 10.1007/s11906-008-0079-xAuthors M. Gary Nicholls, University of Otago-Christchurch, Christchurch Hospital Department of Medicine PO Box 4345 Christchurch New Zealand Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 10 Journal Issue Volume 10, Number 6 / December, 2008 (Source: Current Hypertension Reports) Resistant hypertension and hyperaldosteronism Abstract  Resistant hypertension is defined as blood pressure that remains uncontrolled in spite of ? 3 antihypertensive medications at effective doses, ideally including a diuretic. Although exact prevalence is unknown, clinical trials suggest that 20% to 30% of study participants are resistant. Hyperaldosteronism, obesity, refractory volume expansion, and obstructive sleep apnea are common findings in resistant hypertension patients. Multiple studies indicate that primary aldosteronism (PA) is common (? 20%) in patients with resistant hypertension. Screening for PA is recommended for most patients with resistant hypertension, ideally by measurement of 24-hour urinary aldosterone excretion, or by the plasma aldosterone/plasma renin activity ratio. Successful treatment ... Genetic determinants of hypertension: An update Abstract  Hypertension represents a global public health burden. In addition to the rarer Mendelian forms of hypertension, classic genetic studies have documented a significant heritable component to the most common form, essential hypertension (EH). Extensive efforts are under way to elucidate the genetic basis of this disease. Recently, a new form of Mendelian hypertension has been identified, pharmacogenetic association studies in hypertensive patients have identified novel gene-by-drug interactions, and the first genome-wide association studies of EH have been published. New findings in consomic and congenic rat models also offer new clues to the genetic architecture of this complex phenotype. In this review, the authors summarize and evaluate the most recent findings r... Vaccination: A novel strategy for inhibiting the renin-angiotensin-aldosterone system Abstract  Immunologic approaches to renin-angiotensin-aldosterone system (RAAS) inhibition have been studied for more than 50 years. In animal models, vaccination against renin was effective but resulted in fatal autoimmune renal disease; vaccines directed at small peptides including angiotensin I and II and a segment of the AT1 receptor reduced blood pressure (BP) without causing autoimmune disease. In humans, angiotensin I vaccination did not reduce BP. More promising is the AngQb vaccine, which uses an immunization technology involving conjugation of angiotensin II to virus-like particles. In a phase 2 trial, hypertensive patients vaccinated with 300 ?g showed a difference of 9.0/4.0 mm Hg from baseline in mean daytime ambulatory BP after 14 weeks (P = 0.015 for systolic... Effect of angiotensin II type 1 receptor blockers in patients with self-monitored morning hypertension Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11906-008-0087-xAuthors George MansourJanette Mansour Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 10 Journal Issue Volume 10, Number 6 / December, 2008 (Source: Current Hypertension Reports) Insulin resistance and blood pressure Abstract  Insulin resistance, cardiometabolic syndrome, and hypertension are common health problems with significant consequences for individuals and society. The pathogenesis of these disorders is complex and not fully understood. In this article we review the current knowledge about the effects of lifestyle modification and pharmacologic antihypertensive agents on insulin resistance and hypertension. Content Type Journal ArticleDOI 10.1007/s11906-008-0059-1Authors Sonya AddisonSameer StasMelvin R. HaydenJames R. Sowers, University of Missouri School of Medicine, D109 HSC Diabetes Center, One Hospital Drive, Harry S. Truman VA Medical Center Diabetes and Cardiovascular Center Columbia MO 65212 USA Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN... Treating prehypertension: A review of the evidence Abstract  Although the term ?prehypertension? has been challenged by some, its use to define people with systolic blood pressure (BP) between 120 and 139 mm Hg and/or diastolic pressures between 80 and 89 mm Hg has gained general acceptance. The category includes as many people as the number who have hypertension, defined as blood pressure of 140/90 or above. Such people are clearly at an increased risk of cardiovascular damage compared with people with BPs below 120/80 mm Hg. The major unresolved issue is the appropriate management of such patients. Two trials have attempted to document the value of short-term drug therapy to prevent the progression of BP to overt hypertension, but no outcome studies are currently available. Content Type Journal ArticleDOI 10.1007/s1... ONTARGET for hypertension or not? Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11906-008-0056-4Authors Thomas D. Giles Journal Current Hypertension ReportsOnline ISSN 1534-3111Print ISSN 1522-6417 Journal Volume Volume 10 Journal Issue Volume 10, Number 4 / August, 2008 (Source: Current Hypertension Reports) Advances in the understanding of eclampsia Abstract  Preeclampsia, a serious hypertensive complication of pregnancy characterized by new-onset hypertension and proteinuria after midpregnancy, is a multisystem disorder that often involves the central nervous system. Neurologic signs and symptoms include hyperreflexia, headaches, visual disturbance, seizures, and cerebral hemorrhage. Eclampsia?new-onset seizures in the setting of preeclampsia?usually occurs before or within 48 hours of delivery, but can present as late as 1 month postpartum (late postpartum eclampsia). Magnesium sulfate is the drug of choice to prevent and treat eclampsia, a recommendation validated through large, randomized, and placebo-controlled trials. This review describes the pathogenesis, clinical features, and treatment of eclampsia, focus...

hypertension and massage guide

Can Massage Help Hypertension

We know that hypertension is a condition that occurs when a person’s blood pressure has elevated too high. There are actually various different levels of hypertension and it is a condition that can occur in children or adults, although it is much more prominent in people over the age of thirty-five. Hypertension can be incredibly dangerous to a person’s health, and is a major risk factor for heart disease, stroke, kidney disease and even dementia.

It is important for people to realize that it is extremely important to realize that the higher blood pressure you have, the higher the risk of heart and stroke.

Hypertension and Massage

The relaxation caused by massage here is caused by central and peripheral components of oxygen consumption being altered and a resulting decrease in cardiac output. These studies also show that people who have been diagnosed with hypertension who used the hypertension and massage method of treatment for five weeks experienced significantly lowered blood pressure, less hostile behavior, less depression and lower urinary hormone levels.

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A Bioavailability Study Comparing Treprostinil Diethanolamine Oral Tablets and Oral Solution in Healthy Volunteers
Condition: Pulmonary Arterial Hypertension Intervention: Drug: treprostinil diethanolamine Sponsor: United Therapeutics Not yet recruiting - verified July 2010
A Study to Test the Effects of Riociguat in Patients With Pulmonary Hypertension Associated With Left Ventricular Diastolic Dysfunction
Conditions: Hypertension, Pulmonary; Ventricular Dysfunction, Left Interventions: Drug: Riociguat (BAY63-2521); Drug: Riociguat (BAY63-2521); Drug: Riociguat (BAY63-2521); Drug: Placebo Sponsor: Bayer Recruiting - verified July 2010

few different options available when it comes to the treatment of hypertension, but hypertension and massage is quickly becoming one of the most popular. The hypertension and massage treatment is extremely effective because it helps to soothe and relax the patient, which in turn helps to lower their blood pressure.

Various studies have been conduced which have gone to prove that hypertension and massage can be helpful, even in the most serious of cases. This is for a number of reasons but for one because the goal of treating hypertension is to reduce the risk of serious complications, such as heart disease and stroke. Massage is helpful because it is a safe and all natural way to calm and relax the body, thereby reducing blood pressure.

Massage is also a good choice because it can be used no matter what the patient’s age. The medical benefits of massage therapy are gradually gaining more recognition from health practitioners around the world, and people are slowly beginning to realize the advantages it has to offer even for serious health conditions.

If massage is not even your doctor may recommend further treatment, namely prescription medication. Avapro Oral is one of the most commonly used medications for hypertension, and it is a drug which helps with blood pressure reduction and as a result helps prevent strokes, heart attacks, and kidney problems. Caduet Oral is another drug for hypertension, one which contains a calcium channel blocker, amlodipine, and a statin, atorvastatin.

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Hypertension is a condition that occurs when blood exerts too much pressure on the inner walls of the blood vessels which is also known as high blood pressure. Read more...

Can Massage Help Hypertension
We know that hypertension is a condition that occurs when a person’s blood pressure has elevated too high. There are actually various different levels of hypertension and it is a condition that Read more...