The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

ABCD
: Appropriate Blood pressure Control in Diabetes
ABI
: ankle–brachial index
ABPM
: ambulatory blood pressure monitoring
ACCESS
: Acute Candesartan Cilexetil Therapy in Stroke Survival
ACCOMPLISH
: Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension
ACCORD
: Action to Control Cardiovascular Risk in Diabetes
ACE
: angiotensin-converting enzyme
ACTIVE I
: Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events
ADVANCE
: Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation
AHEAD
: Action for HEAlth in Diabetes
ALLHAT
: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack
ALTITUDE
: ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints
ANTIPAF
: ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation
APOLLO
: A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People
ARB
: angiotensin receptor blocker
ARIC
: Atherosclerosis Risk In Communities
ARR
: aldosterone renin ratio
ASCOT
: Anglo-Scandinavian Cardiac Outcomes Trial
ASCOT-LLA
: Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm
ASTRAL
: Angioplasty and STenting for Renal Artery Lesions
A-V
: atrioventricular
BB
: beta-blocker
BMI
: body mass index
BP
: blood pressure
BSA
: body surface area
CA
: calcium antagonist
CABG
: coronary artery bypass graft
CAPPP
: CAPtopril Prevention Project
CAPRAF
: CAndesartan in the Prevention of Relapsing Atrial Fibrillation
CHD
: coronary heart disease
CHHIPS
: Controlling Hypertension and Hypertension Immediately Post-Stroke
CKD
: chronic kidney disease
CKD-EPI
: Chronic Kidney Disease—EPIdemiology collaboration
CONVINCE
: Controlled ONset Verapamil INvestigation of CV Endpoints
CT
: computed tomography
CV
: cardiovascular
CVD
: cardiovascular disease
D
: diuretic
DASH
: Dietary Approaches to Stop Hypertension
DBP
: diastolic blood pressure
DCCT
: Diabetes Control and Complications Study
DIRECT
: DIabetic REtinopathy Candesartan Trials
DM
: diabetes mellitus
DPP-4
: dipeptidyl peptidase 4
EAS
: European Atherosclerosis Society
EASD
: European Association for the Study of Diabetes
ECG
: electrocardiogram
EF
: ejection fraction
eGFR
: estimated glomerular filtration rate
ELSA
: European Lacidipine Study on Atherosclerosis
ESC
: European Society of Cardiology
ESH
: European Society of Hypertension
ESRD
: end-stage renal disease
EXPLOR
: Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination
FDA
: U.S. Food and Drug Administration
FEVER
: Felodipine EVent Reduction study
GISSI-AF
: Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation
HbA1c
: glycated haemoglobin
HBPM
: home blood pressure monitoring
HOPE
: Heart Outcomes Prevention Evaluation
HOT
: Hypertension Optimal Treatment
HRT
: hormone replacement therapy
HT
: hypertension
HYVET
: HYpertension in the Very Elderly Trial
IMT
: intima-media thickness
I-PRESERVE
: Irbesartan in Heart Failure with Preserved Systolic Function
INTERHEART
: Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries
INVEST
: INternational VErapamil SR/T Trandolapril
ISH
: Isolated systolic hypertension
JNC
: Joint National Committee
JUPITER
: Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin
LAVi
: left atrial volume index
LIFE
: Losartan Intervention For Endpoint Reduction in Hypertensives
LV
: left ventricle/left ventricular
LVH
: left ventricular hypertrophy
LVM
: left ventricular mass
MDRD
: Modification of Diet in Renal Disease
MRFIT
: Multiple Risk Factor Intervention Trial
MRI
: magnetic resonance imaging
NORDIL
: The Nordic Diltiazem Intervention study
OC
: oral contraceptive
OD
: organ damage
ONTARGET
: ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial
PAD
: peripheral artery disease
PATHS
: Prevention And Treatment of Hypertension Study
PCI
: percutaneous coronary intervention
PPAR
: peroxisome proliferator-activated receptor
PREVEND
: Prevention of REnal and Vascular ENdstage Disease
PROFESS
: Prevention Regimen for Effectively Avoiding Secondary Strokes
PROGRESS
: Perindopril Protection Against Recurrent Stroke Study
PWV
: pulse wave velocity
QALY
: Quality adjusted life years
RAA
: renin-angiotensin-aldosterone
RAS
: renin-angiotensin system
RCT
: randomized controlled trials
RF
: risk factor
ROADMAP
: Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention
SBP
: systolic blood pressure
SCAST
: Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke
SCOPE
: Study on COgnition and Prognosis in the Elderly
SCORE
: Systematic COronary Risk Evaluation
SHEP
: Systolic Hypertension in the Elderly Program
STOP
: Swedish Trials in Old Patients with Hypertension
STOP-2
: The second Swedish Trial in Old Patients with Hypertension
SYSTCHINA
: SYSTolic Hypertension in the Elderly: Chinese trial
SYSTEUR
: SYSTolic Hypertension in Europe
TIA
: transient ischaemic attack
TOHP
: Trials Of Hypertension Prevention
TRANSCEND
: Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease
UKPDS
: United Kingdom Prospective Diabetes Study
VADT
: Veterans' Affairs Diabetes Trial
VALUE
: Valsartan Antihypertensive Long-term Use Evaluation
WHO
: World Health Organization

### 1.1 Principles

The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

/pdf/2013-esh-esc-guidelines-for-the-management-of-arterial-4ydvs5ifsx.pdf

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

This study evaluated a modified, timed version of the "Get-Up and Go" Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital (mean age 79.5 years). The patient is observed and timed while he rises from an arm chair, walks 3 meters, turns, walks back, and sits down again. The results indicate that the time score is (1) reliable (inter-rater and intra-rater); (2) correlates well with log-transformed scores on the Berg Balance Scale (r = -0.81), gait speed (r = -0.61) and Barthel Index of ADL (r = -0.78); and (3) appears to predict the patient's ability to go outside alone safely. These data suggest that the timed "Up & Go" test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time. The test is quick, requires no special equipment or training, and is easily included as part of the routine medical examination.

The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons

2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Section I: Disorders of Water, Elecrolytes, and Acid-Base IntroductionChapter 1 Diseases of Water Metabolism Sumit Kumar and Tomas Berl Physiology of the Renal Diluting and Concentrating Mechanisms Control of Water Balance and Serum Sodium Concentration Approach to the Hyponatremic Patient Approach to the Hypernateremic Patient Chapter 2 Disorders of Sodium Balance David H Ellison Normal Extracellular Fluid Volume Homeostatsis Mechanisms of Extracellular Fluid Volume Control Mechanisms of Sodium and Chloride Transport Along the Nephron Causes, Signs, and Symptoms of Extracellular Fluid Volume Expansion and Contraction Unifying Hypothesis of Renal Sodium Excretion Mechanisms of Extracellular Fluid Volume Expansion in Congestive Heart Failure Mechanisms of Extracellular Fluid Volume Expansion in Cirrhosis Mechanisms of Extracellular Fluid Volume Expansion in Nephrotic Syndrome Extracellular Fluid Volume Homeostasis in Chronic Renal Failure Chapter 3 Disorders of Potassium Metabolism Fredrick V Osorio and Stuart L Linas Overview of Potassium Pysiology Hypokalemia: Diagnostic Approach Hypokalemia: Clinical Manifestations Hypokalemia: Treatment Hyperkalemia: Diagnostic Approach Hyperkalemia: Clinical Manifestations Myperkalemia: Treatment Chapter 4 Divalent Cation Metabolism: Magnesium James T McCarthy and Rafiv Kumar Magnesium Distribution Intracellular Magnesium Metabolism Gastrointestinal Absorption of Magnesium Renal Handling of Magnesium Magnesium Depletion Chapter 5 Divalent Cation Metabolism: Calcium James T McCarthy and Rajiv Kumar Calcium Distribution Intracellular Calcium Metabolism Vitamin D and Parathyriod Hormone Actions Gastrointestinal Absorption of Calcium Renal Handling of Calcium Disturbances of Serum Calcium Secondary Hyperparathyroidsm Calcium and Vitamin D Preparations Chapter 6 Disorders of Acid-Base Balance Horacio J Androgue and Nicolaos E Madias Respiratory Acidosis Respiratory Alkalosis Metabolic Alkalosis Chapter 7 Disorders of Phosphate Balance Moshe Levi and Mordicai Popovtzer Renal Tubular Phosphate Reabsorption Hypophosphatemia/Hyperphosphatemia Section II: Acute Renal Failure Introduction Chapter 8 Acute renal Failure: Causes and Prognosis Fernando Liano Causes of Acute Renal Failure Epidemiology of Acute Renal Failure Hospital-Related Epidemiologic Data Prognosis Chapter 9 Renal Histopatology, Urine Cytology, and Cytopathology of Acute Renal Failure Lorraine C. Racusen and Cynthia C Nast Glomerular Diseases Vascular Diseases Interstitial Disease Tubular Diseases Chapter 10 Acute Renal Failure in the Transplanted Kidney Kim Solez and Lorraine C Racusen Acute Rejection Acute Tubule Necrosis Cyclosporine Toxicity Posttransplant Lymphoprolifertive Disorder Subclinical Rejection Thrombotic Microangiopathy Chapter 11 Renal Injury Due to Environmental Toxins, Drugs and Contrast Agents Marc E De Broe General Nephrotoxic Factors Aminoglycosides Amphotericin B Cyclosporine Lithium-Induced Acute Renal Faliure Inhibitors of the Renin-Angiotensin System Nonsteroidal Anti-inflammatory Drugs Contrast Medium-Associated Nephrotoxicity Chapter 12 Diagnostic Evaluation of the Patient with Acute Renal Faliure Brian G Dwinnell and Robert J Anderson Blood Urea Nitrogen, Creatinine, and Renal Failure Categorization of Causes of Acute Renal Failure Diagnostic Steps in Evaluating Acute Renal Failure Vascular Mechanisms Involved in Acute Renal Failure Acute Glomerulonephritis Interstitial Nephritis Acute Tubular Necrosis Nephrotoxin Acute Renal Failure Chapter 13 Pathophysiology of Ischemic Acute Renal Failure: Cytoskeletal Aspects Bruce A Molitoris and Robert Bacallao Chapter 14 Pathophysiology of Ischemic Acute Renal Failure Michael S Goligorsky and Wilfred Lieberthal Vasoactive Hormones Leukocytes in Acute Renal Failure Mechanisms of Cell Death: Necrosis and Apoptosis Chapter 15 Pathophysiology of Nephrotoxic Acute Renal Failure Rick G Schnellmann and Katrina J Kelly Clinical Significance of Toxincant-Medicated Acute Renal Failure Renal Cellular Responses to Toxicant Exposures Mechanisms of Toxicant-Medicated Cellular Injury Chapter 16 Acute Renal Failure: Cellular Features of Injury and Repair Kevin T Bush, Hiroyuki Sakurai, Tatsuo Tsukamoto, and Sanjay K Nigam The Ischemic Epithelial Cell Reassembly of the permeability Barrier The Endoplasmic Reticulum Stress Response in Ischemia Growth Factors and Morphogenesis Chapter 17 Molecular Responses and Growth Factors Steven B Miller and Babu J Padanilam Growth Factors in Acute Renal Failure Clinical use of Growth Factors in Acute Renal Failure Future Directions Chapter 18 Nutrition and Metabolism in Acute Renal Failure Wilfred Druml Metabolic Alterations in Acute Renal Failure Metabolic Impact of Renal Replacement Therapy Nutrition, Renal Function, and Recovery Desision Making, Patient Classification, and Nutritional Requirements Enteral Nutrition Parenteral Nutrition

Disorders of water, electrolytes, and acid-base . Acute renal failure

It is a truism that academic medicine has changed markedly over the last two decades. Academic institutions and their hospitals have become similar to large corporations operating increasingly on business principles. These changes and new accountabilities demanded by institutions of faculty, particularly clinicians, have created some new challenges and tensions for the academically inclined nephrologist. Clearly the decline in the physician-scientist over the past two decades is well chronicled. This change is worrisome because truly astounding advances in biomedical research have made the physician-scientist even …

/pdf/introduction-academic-nephrology-2008-2ank995z6s.pdf

Introduction: Academic Nephrology 2008

Protective effect of renal denervation (RD) and angiotensin II antagonism (AIIA) during hypotensive hemorrhage (HH) in prostaglandin (PG) depleted dogs

Publisher Summary Non-osmotic release of arginine-vasopressin (AVP) is present in conscious, adrenalectomized animals with either gluco- or mineralocorticoid deficiency. This chapter investigates whether the non-osmotic release of AVP has a vascular effect in the gluco- or mineralocorticoid-deficient state. Administration of a specific inhibitor of the hydroosmotic effect of AVP profoundly improves the capacity of mineralocorticoid- or glucocorticoid-deficient animals to excrete an acute water load. Using a sensitive and potent AVP vascular antagonist, a vascular role of endogenous AVP to maintain mean arterial pressure is observed in adrenal insufficiency in the conscious rat. The effect is more readily demonstrable in the mineralocorticoid- than the glucocorticoid-deficient state. Activation of the renin-angiotensin and sympathetic nervous systems in the mineralocorticoid deficient state also contributes to the maintenance of blood pressure. In the mineralocorticoid-deficient state, antagonism of the renin-angiotensin system or α-adrenergic blockade is associated with prolongation of the hypotensive effect of the AVP vascular antagonist. Thus, AVP, angiotensin II, and adrenergic stimulation all combine to support mean arterial pressure in the mineralocorticoid-deficient, conscious rat.

Vascular Effects of Arginine-Vasopressin, Angiotensin and Noradrenaline in Adrenal Insufficiency

Background
The National Institutes of Health (NIH) announced a revised, expanded definition of "clinical trial" in 2014 to improve trial identification and administrative compliance. Some stakeholders voiced concerns that the policy added administrative burden potentially slowing research progress.


Methods
This quasi-experimental study examined the difference-in-differences impact of the new NIH clinical trial definition policy on participant recruitment progress in grants funded by the National Institute of Mental Health (NIMH).


Results
132 funded clinical trial grants were identified. While more grants were identified as clinical trials under the revised definition, the difference-in-differences in recruitment progress before and after the policy change was not statistically significant.


Conclusions
The revised NIH clinical trial definition had no clear effect on recruitment progress in newly-identified NIMH-funded clinical trials as compared to traditionally-identified clinical trials. Concerns that administrative delays and burden could impact study progress may be alleviated by these initial results.

Robert W. Schrier

Papers

Disorders of water, electrolytes, and acid-base . Acute renal failure

Introduction: Academic Nephrology 2008

Protective effect of renal denervation (RD) and angiotensin II antagonism (AIIA) during hypotensive hemorrhage (HH) in prostaglandin (PG) depleted dogs

Vascular Effects of Arginine-Vasopressin, Angiotensin and Noradrenaline in Adrenal Insufficiency

Evaluating the Revised National Institutes of Health Clinical Trial Definition Impact on Recruitment Progress.