Roland E. Schmieder

Bio: Roland E. Schmieder is an academic researcher from University of Erlangen-Nuremberg. The author has contributed to research in topics: Blood pressure & Essential hypertension. The author has an hindex of 97, co-authored 717 publications receiving 78138 citations. Previous affiliations of Roland E. Schmieder include Complutense University of Madrid & University of Regensburg.

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 very effective therapeutic agents in the treatment of individuals with the metabolic syndrome.

Renal denervation: where do we stand and what is the relevance to the nephrologist?

Abstract: Catheter-based renal denervation to reduce high blood pressure (BP) has received well-deserved attention after a recent series of sham-controlled trials reported significant antihypertensive efficacy and very favourable tolerability and safety of the intervention. This emerging treatment option is of high relevance to nephrologists. Patients with chronic kidney disease (CKD) are at elevated risk of cardiovascular adverse events and often present with hypertension, which is very difficult to control with medication. Renal denervation promises a new tool to reduce BP and to prevent loss of renal function in this population. The current review considers the role of the kidney and neurohormonal activation in the development of hypertension and the rationale for renal denervation. The current state of the evidence for the effectiveness and tolerability of the procedure is considered from the nephrologists' perspective, with a focus on the potential future role of renal denervation in the management of CKD patients with hypertension.

L-arginine-induced vasodilation of the renal vasculature is not altered in hypertensive patients with type 2 diabetes.

Abstract: OBJECTIVE —Diabetes, arterial hypertension, hypercholesterolemia, and aging are associated with endothelial dysfunction in various vasculatures. Endothelium-dependent vasodilation of the renal vasculature cannot be easily assessed, but infusion of l-arginine, the substrate of endothelial nitric oxide synthase, leads to an increase in renal plasma flow (RPF) in humans. We have examined the effect of l-arginine infusion on renal hemodynamics in hypertensive patients with type 2 diabetes. RESEARCH DESIGN AND METHODS —Twenty-three elderly patients with type 2 diabetes (age, 65 ± 6 years; HbA 1c , 7.8 ± 1.6%) with coexisting arterial hypertension (158 ± 19/83 ± 11 mmHg) and elevated cholesterol levels (total cholesterol, 215 ± 33 mg/dl) were examined. These patients were compared with a young and healthy reference group ( n = 20; age, 26 ± 2 years). The effect of l-arginine infusion (100 mg/kg over 30 min) on RPF and glomerular filtration rate were measured using the constant input clearance technique with p -aminohippurate and inulin, respectively. RESULTS —l-Arginine infusion similarly influenced renal hemodynamics in patients and reference subjects: RPF increased by 7 ± 11 and 7 ± 11% in diabetic and reference subjects, respectively ( P = NS). Other parameters of renal hemodynamics such as glomerular filtration rate (5 ± 5 vs. 4 ± 4%) and filtration fraction (−1 ± 8 vs. −1 ± 9%) were not significantly different between diabetic and reference subjects, too. CONCLUSIONS —l-Arginine-induced vasodilation of the renal vasculature is not different between a group of hypertensive diabetic patients and a young, healthy reference group. These data were obtained using low-dose l-arginine infusion.

Changes in 24-Hour Patterns of Blood Pressure in Hypertension Following Renal Denervation Therapy.

Abstract: The hypertension paradox was described over 10 years ago to stress the growing incidence of hypertension despite the availability of safe, effective, and inexpensive drug therapies. Multiple factors contribute to the hypertension paradox, including lack of patient awareness and education, failure to adhere to prescribed lifestyle changes and prescribed drug regimens, aging societal demographics, and recent recommendations for lowered blood pressure goals. Hence, a rationale exists for procedural-based therapy options that could augment drug therapy regimens and help more patients achieve and sustain blood pressure goals. Percutaneous renal denervation has gained continued scientific and clinical interest due to its proven impact on autonomic function, likely because of both efferent and afferent mechanisms affecting the renal nerves. Clinical evidence suggests a strong association between renal denervation and reduced indices of sympathetic tone including muscle sympathetic nerve activity and renal norepinephrine spillover. Historically, surgical sympathetic denervation was shown to improve mortality, independent of its effect on blood pressure. In 2014, the randomized sham-controlled SYMPLICTY HTN-3 trial reported blood pressure drops in the renal denervation-treated group which were nearly matched by those in the sham control group. More recently however, 3 new multicenter, international, prospective, randomized, shamcontrolled clinical trials have demonstrated lower blood pressure after catheter-based renal denervation in uncontrolled hypertensive patients in both the presence and absence of concomitant drug therapy, confirming the biological proof of principle. These trials have rekindled scientific and clinical interest in the procedure and have also revealed interesting new insights into the 24-hour profile of blood pressure reduction associated with the therapy. This review highlights the 24-hour circadian pattern of blood pressure lowering after renal denervation and hypothesize how these effects might complement drug therapy. 24-Hour Blood Pressure Monitoring: Toward Perfect Control The advent of 24-hour ambulatory monitoring has allowed consideration of blood pressure as a continuous and dynamic circadian physiological signal, especially highlighting the unique blood pressure characteristics of the nighttime and early morning period. Thus, blood pressure control has been more meaningfully redefined relative to specific times of day (Figure 1). Circadian blood pressure variability is a direct reflection of the relative integrity of the autonomic nervous system which modulates its behavior. Multiple clinical trials have demonstrated that elevated nighttime blood pressure is more strongly associated with cardiovascular risk than daytime or office blood pressure. Furthermore, 24-hour blood pressure patterns distinguish between different hypertension phenotypes including white coat, masked and sustained hypertension as well as identifying abnormal nighttime dipping patterns. Recently, an analysis of the Spanish Ambulatory Blood Pressure registry with >60 000 patients enrolled, indicated that white-coat hypertension, defined by an out of office 24-hour ambulatory blood pressure lower than goal blood pressure and in-office blood pressure that was above goal in unmedicated patients, was associated with increased mortality, and that masked hypertension was associated with a greater risk of death than sustained hypertension. Indeed, out of office ambulatory (ABPM) or home blood pressure measurement is now recommended to confirm the diagnosis of hypertension and, in the case of home blood pressure measurement, to monitor therapy efficacy in both the United States and European Hypertension Guidelines. Despite these recommendations, ABPM monitoring is used relatively rarely in clinic to confirm the diagnosis of hypertension, even among patients treated by hypertension specialists. Likewise, only recently has ambulatory blood pressure become the focus end point for clinical trials. Ideal blood pressure control includes 24-hour control, adequate circadian rhythm, and appropriate

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

Abstract: 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.

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).

Abstract: 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 …

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).

Abstract: 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).