Author
Suzanne Oparil
Other affiliations: Michigan State University, Oregon Health & Science University, National Institutes of Health ...read more
Bio: Suzanne Oparil is an academic researcher from University of Alabama at Birmingham. The author has contributed to research in topics: Blood pressure & Angiotensin II. The author has an hindex of 106, co-authored 885 publications receiving 113983 citations. Previous affiliations of Suzanne Oparil include Michigan State University & Oregon Health & Science University.
Papers published on a yearly basis
Papers
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TL;DR: Interest in studying the fundamental biology of the raas has burgeoned, and recent findings may help to elucidate the ultimate therapeutic role of direct renin inhibitors.
Abstract: Vol. 9 no. 9 sEpTEmbEr 2007 706 The availability of an effective orally active direct renin inhibitor is a milestone in the long journey of scientists and clinicians interested in exploring how the renin-angiotensin-aldosterone system (raas) works and in exploiting this new knowledge for the possible benefit of patients. The developers of the new direct renin inhibitor should be commended on their perseverance. The search for such a compound had gone on for at least 3 decades, with little success. Everything involved in the development of this drug had to be studied in primates at great cost and with some questions regarding applicability to humans. The direct renin inhibitor that has just been approved by the us food and Drug administration has many positive attributes: placebo-like tolerability at clinically recommended doses (although the game is in the early innings, and problems could emerge later), additive efficacy with most other antihypertensive drug classes, and a long duration of action, which is important for patients who skip doses. This persistence of effect correlates with good 24-hour blood pressure (bp) control, which may result in target organ protection. only randomized controlled trials will tell for sure. Having a direct renin inhibitor is also important because it gives the clinician and the patient an additional choice for therapy. some patients cannot or will not tolerate presently available antihypertensive agents in doses and combinations sufficient to achieve adequate bp control. While the new direct renin inhibitor produces only modest bp reduction when administered as monotherapy, it lowers bp further when combined with antihypertensive agents from most other classes. it is intriguing that this additional bp lowering occurs even when the renin inhibitor is combined with the maximal recommended dose of a downstream raas blocker, specifically, an angiotensin ii receptor blocker (arb). Whether this means that neither the renin inhibitor nor the arb alone fully shuts down the raas cascade or that the renin inhibitor acts by mechanisms in addition to shutting down angiotensin ii production is unknown and is actively being studied. There is also an important bedside-to-bench aspect of having this agent available for clinical use: interest in studying the fundamental biology of the raas has burgeoned, and recent findings may help to elucidate the ultimate therapeutic role of direct renin inhibitors. inhibition of renin activity reduces angiotensin generation, resulting in loss of the normal angiotensin-mediated feedback inhibition of renin synthesis and release. Thus, in hypertensive patients receiving aliskiren treatment, circulating levels of renin and its catalytically inactive precursor prorenin, which circulates in 10to 100-fold excess of active renin, are actually elevated, while renin activity is suppressed. Conventional wisdom dictates that these elevated plasma renin and prorenin levels are without biologic significance, since renin has no function beyond its catalytic activity (ie, angiotensin generation). recent findings have challenged that concept. some observations suggest that human prorenin is potentially biologically active and can have vasculotoxic effects. C o m m e n t a r y
2 citations
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TL;DR: Evidence from randomized controlled trials of antihypertensive treatment and of secondary stroke prevention support the thesis that, independent of mean systolic BP, treatments that effect the greatest reduction in BP variability are associated with the greatest reductions in risk.
Abstract: of future research. Commentary by Dr. Tony Heagerty critically reviewed the implications and limitations of BP variability assessment for future guidelines and clinical practice and outlined recommendations for future research. Dr. Rothwell drew on his experience in the Stroke Prevention Research Unit at Oxford to emphasize the striking relationship between BP variability and stroke. He showed that within individual visit-to-visit variability in systolic BP (SBP) is increased in cohorts at high risk of stroke, i.e., those with established cerebrovascular disease, or previous transient ischemic attack (TIA) or stroke, is reproducible within individuals over time, and is a powerful predictor of stroke independently of mean SBP (3,10–15). Evidence from randomized controlled trials of antihypertensive treatment and of secondary stroke prevention, including the Anglo-Scandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm (ASCOT-BPLA) (16), the Medical Research Council (MRC) trial of the treatment of hypertension in older adults (17 ) and the UK-TIA trial (18 ) support the thesis that, independent of mean systolic BP, treatments that effect the greatest reduction in BP variability are associated with the greatest reductions in risk. ASCOT-BPLA reported that a calcium channel blocker (CCB, amlodipine) based regimen was more effective in preventing stroke and coronary events than expected, based on change in mean BP, and more effective compared to a beta blocker (BB, atenolol) based regimen; and that this differential effect was independent of changes in other measured vascular risk factors during follow-up (16,19). Within individual visit-to-visit variability in clinic SBP, diastolic BP (DBP) and pulse pressure (PP) were expressed as the standard deviation (SD) and coeffi cient of variation Blood Pressure. 2010; 19: 209–211
2 citations
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TL;DR: Self-assessment of BP is rather extensive in Turkey by the use of a variety of both automatic arm as well as wrist devices and there is a greater proportion of masked hypertensive patients among high-risk diabetics with microalbuminuria as compared with low-risk hypertensives, which by itself may be an argument in favour of an increased use of out-of-office BP measurements.
Abstract: Blood pressure (BP) assessment and evaluation is becoming more complex and for many practicing physicians it is increasingly a numbers game where the rules keep changing. Conventionally, high BP is interpreted as increased clinic systolic and/or diastolic pressure. However, high pressures with or without increased clinic systolic or diastolic values may also be assessed by ambulatory or home measurements, where the actual mmHg normal values often differ from the clinic values. In isolated office hypertension the clinic BP values are higher, while in the masked hypertensives, only the out-of-office values are increased. There is accumulating evidence that any form of high BP is dangerous if not properly controlled (1,2). Although the weight of the evidence differs, the future risk for stroke, heart attack, congestive heart failure or kidney damage is increased, whether or not it is the clinic, ambulatory or home BP that is elevated. In the present issue of Blood Pressure, Dilek and coworkers (3) show that self-assessment of BP is rather extensive in Turkey by the use of a variety of both automatic arm as well as wrist devices. The different devices were assessed against a conventional mercury manometer and checked whether readings were within 4 mmHg of the reference mercury sphygmomanometer. Surprisingly, about 60% of the automatic manometers and about 80% of the wrist devices were judged inaccurate by this comparison. In addition to the equipment-related errors, in the real setting there are also observer-, technique-, environmentaland patient-related factors that may contribute to the potential lack of accuracy in devices for home BP assessment. Thus, with an increasing use of home devices by patients for self-assessment, there will be an increasing need for patient education and training, in addition to information on which devices are recommended as well as regular check-up and calibration of devices used at home by patients. This is an area where we currently have insufficient knowledge, since we lack large pieces of information from the real world on the practical outcome and reliability of out-of-office devices when used by common patients over extended periods. In an earlier study, Gasowski et al. (4) assessed patient-related factors during use of ambulatory and home devices by metabolic syndrome patients. In their patient cohort with excess cardiovascular (CV) risk, the relative accuracy of office, home and ambulatory BP measurements was clearly unsatisfactory. In particular, there was a deviation of home measurements in a dose-dependent fashion, which correlated with the intensity of the metabolic syndrome. Thus, in such patients at excess CV risk, there seems to be an even greater need for standardized measurement and equipment protocols when assessing BP readings and treatment efficacy. Also, earlier studies (5) indicate that there may be a greater proportion of masked hypertensive patients among high-risk diabetics with microalbuminuria as compared with low-risk hypertensives, which by itself may be an argument in favour of an increased use of out-of-office BP measurements. Additionally, Márquez Contreras et al. (6) demonstrated in the Spanish HICAP study that a high proportion of hypertensive patients in primary care present with a high CV global risk. Also, CV risk factor control, especially among patients at higher CV global risk, was clearly insufficient in their cohort. Blood Pressure. 2008; 17: 5–6
2 citations
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TL;DR: The severity of OSA may contribute to RfHTN status in men but not women, and OSA severity was associated with sex, but not hypertension phenotype.
Abstract: OBJECTIVES Obstructive sleep apnea (OSA) is associated with treatment-resistant hypertension (RHTN) and may contribute to refractory hypertension (RfHTN). The objective of the current study was to test the hypothesis that patients with RfHTN have more severe OSA compared with patients with controlled RHTN. METHODS Patients (n = 187) referred to the University of Alabama at Birmingham Hypertension Clinic for evaluation and treatment of RHTN, defined as uncontrolled blood pressure (BP) (SBP ≥ 130 mmHg or DBP ≥ 80 mmHg) despite the use of at least three antihypertensive medications including a diuretic, were enrolled following completion of at least three follow-up clinic visits. RfHTN was defined as uncontrolled high BP despite treatment with five or more antihypertensive agents of different classes, including a long-acting thiazide-type diuretic and a mineralocorticoid receptor antagonist. Following enrollment, all patients (n = 130) completed 24-h ambulatory BP measurement and overnight diagnostic polysomnography during normal nightly use of continuous positive airway pressure. Analyses examined the severity of OSA and related sleep characteristics among patients with RfHTN versus controlled RHTN. RESULTS Of the 130 evaluated patients, 37 (28.5%) had RfHTN and 93 (71.5%) had controlled RHTN. In unadjusted analyses, there was not a significant difference in OSA severity, oxygen saturation, or hypoxemia time in patients with RfHTN versus controlled RHTN (P > 0.05). Men with RfHTN had more severe OSA compared with men with controlled RHTN (P = 0.044). In adjusted analyses, OSA severity was associated with sex (P < 0.0001), but not hypertension phenotype (P = 0.17). CONCLUSION The severity of OSA may contribute to RfHTN status in men but not women.
2 citations
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TL;DR: There is, I think, something ethereal about i —the square root of minus one, which seems an odd beast at that time—an intruder hovering on the edge of reality.
Abstract: There is, I think, something ethereal about i —the square root of minus one. I remember first hearing about it at school. It seemed an odd beast at that time—an intruder hovering on the edge of reality.
Usually familiarity dulls this sense of the bizarre, but in the case of i it was the reverse: over the years the sense of its surreal nature intensified. It seemed that it was impossible to write mathematics that described the real world in …
33,785 citations
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Boston University1, Rush University Medical Center2, University of Tennessee Health Science Center3, University of Michigan4, University at Buffalo5, University of Mississippi6, University of Miami7, University of Alabama at Birmingham8, Case Western Reserve University9, National Institutes of Health10
TL;DR: The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated, and empathy builds trust and is a potent motivator.
Abstract: "The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure" provides a new guideline
for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of
more than 140 mm Hg is a much more important cardiovascular disease
(CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75
mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive
at 55 years of age have a 90% lifetime risk for developing hypertension; (3)
Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80
to 89 mm Hg should be considered as prehypertensive and require health-promoting
lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should
be used in drug treatment for most patients with uncomplicated hypertension,
either alone or combined with drugs from other classes. Certain high-risk
conditions are compelling indications for the initial use of other antihypertensive
drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor
blockers, β-blockers, calcium channel blockers); (5) Most patients with
hypertension will require 2 or more antihypertensive medications to achieve
goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes
or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal
BP, consideration should be given to initiating therapy with 2 agents, 1 of
which usually should be a thiazide-type diuretic; and (7) The most effective
therapy prescribed by the most careful clinician will control hypertension
only if patients are motivated. Motivation improves when patients have positive
experiences with and trust in the clinician. Empathy builds trust and is a
potent motivator. Finally, in presenting these guidelines, the committee recognizes
that the responsible physician's judgment remains paramount.
24,988 citations
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TL;DR: In those older than age 50, systolic blood pressure of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP, and hypertension will be controlled only if patients are motivated to stay on their treatment plan.
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.
14,975 citations
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TL;DR: In this article, a randomized controlled trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly people was presented. But the authors did not discuss the effect of the combination therapy in patients living with systolic hypertension.
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 …
14,173 citations
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TL;DR: Authors/Task Force Members: Piotr Ponikowski* (Chairperson) (Poland), Adriaan A. Voors* (Co-Chair person) (The Netherlands), Stefan D. Anker (Germany), Héctor Bueno (Spain), John G. F. Cleland (UK), Andrew J. S. Coats (UK)
13,400 citations