Showing papers in "Journal of Hypertension in 2013"

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: Because of new evidence on several diagnostic and therapeutic aspects of hypertension, the present guidelines differ in many respects from the previous ones. Some of the most important differences are listed below: 1. Epidemiological data on hypertension and BP control in Europe. 2. Strengthening of the prognostic value of home blood pressure monitoring (HBPM) and of its role for diagnosis and management of hypertension, next to ambulatory blood pressure monitoring (ABPM). 3. Update of the prognostic significance of night-time BP, white-coat hypertension and masked hypertension. 4. Re-emphasis on integration of BP, cardiovascular (CV) risk factors, asymptomatic organ damage (OD) and clinical complications for total CV risk assessment. 5. Update of the prognostic significance of asymptomatic OD, including heart, blood vessels, kidney, eye and brain. 6. Reconsideration of the risk of overweight and target body mass index (BMI) in hypertension. 7. Hypertension in young people. 8. Initiation of antihypertensive treatment. More evidence-based criteria and no drug treatment of high normal BP. 9. Target BP for treatment. More evidence-based criteria and unified target systolic blood pressure (SBP) (<140 mmHg) in both higher and lower CV risk patients. 10. Liberal approach to initial monotherapy, without any all-ranking purpose. 11. Revised schema for priorital two-drug combinations. 12. New therapeutic algorithms for achieving target BP. 13. Extended section on therapeutic strategies in special conditions. 14. Revised recommendations on treatment of hypertension in the elderly. 15. Drug treatment of octogenarians. 16. Special attention to resistant hypertension and new treatment approaches. 17. Increased attention to OD-guided therapy. 18. New approaches to chronic management of hypertensive disease

European Society of Hypertension Position Paper on Ambulatory Blood Pressure Monitoring

Abstract: Ambulatory blood pressure monitoring (ABPM) is being used increasingly in both clinical practice and hypertension research. Although there are many guidelines that emphasize the indications for ABPM, there is no comprehensive guideline dealing with all aspects of the technique. It was agreed at a consensus meeting on ABPM in Milan in 2011 that the 34 attendees should prepare a comprehensive position paper on the scientific evidence for ABPM.This position paper considers the historical background, the advantages and limitations of ABPM, the threshold levels for practice, and the cost-effectiveness of the technique. It examines the need for selecting an appropriate device, the accuracy of devices, the additional information and indices that ABPM devices may provide, and the software requirements.At a practical level, the paper details the requirements for using ABPM in clinical practice, editing considerations, the number of measurements required, and the circumstances, such as obesity and arrhythmias, when particular care needs to be taken when using ABPM.The clinical indications for ABPM, among which white-coat phenomena, masked hypertension, and nocturnal hypertension appear to be prominent, are outlined in detail along with special considerations that apply in certain clinical circumstances, such as childhood, the elderly and pregnancy, and in cardiovascular illness, examples being stroke and chronic renal disease, and the place of home measurement of blood pressure in relation to ABPM is appraised.The role of ABPM in research circumstances, such as pharmacological trials and in the prediction of outcome in epidemiological studies is examined and finally the implementation of ABPM in practice is considered in relation to the issue of reimbursement in different countries, the provision of the technique by primary care practices, hospital clinics and pharmacies, and the growing role of registries of ABPM in many countries.

2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension.

Abstract: 1. INTRODUCTION1.1 PrinciplesThe 2013 European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines continue to adhere to some fundamental principles that inspired the 2003 and 2007 guidelines, namely to base recommendations on properly conducted studies identified from an ext

Resistant hypertension? Assessment of adherence by toxicological urine analysis.

Abstract: Objective:Uncontrolled hypertension under antihypertensive multidrug regimen is not necessarily always true resistance. Incomplete adherence is one of several possible causes of uncontrolled hypertension. Nonadherence remains largely unrecognized and is falsely interpreted as treatment resistance, a

Clinical usefulness and cost effectiveness of home blood pressure telemonitoring: meta-analysis of randomized controlled studies.

Abstract: Objective:To systematically review data from randomized controlled studies on the effectiveness of home blood pressure telemonitoring (HBPT) versus usual care with respect to improvement of BP control, healthcare resources utilization and costs, patient's quality of life and adverse events.Methods:E

Antihypertensive classes, cognitive decline and incidence of dementia: a network meta-analysis.

Abstract: Objectives:Prevention of cognitive decline and dementia with blood pressure lowering treatments has shown inconsistent results. We compared the effects of different classes of antihypertensive drugs on the incidence of dementia, and on cognitive function.Methods:We conducted a systematic review and

The association between psoriasis and hypertension: a systematic review and meta-analysis of observational studies.

Abstract: Population-based observational studies have suggested a relationship between psoriasis and hypertension. We performed a systematic review and meta-analysis to better understand the association between psoriasis and hypertension. We systematically searched MEDLINE, EMBASE, and the Cochrane Central Register from 1 January 1980 to 1 January 2012. Two authors independently assessed trial eligibility and quality. We applied the Meta-Analysis of Observational Studies in Epidemiology guidelines in the conduct of this study. We identified 24 observational studies with a total of approximately 2.7 million study participants fulfilling our inclusion criteria. Among them, 309 469 were patients with psoriasis. On the basis of random effects modeling of case-control and cross-sectional studies, the odds ratio (OR) for hypertension among patients with psoriasis was 1.58 [95% confidence interval (CI) 1.42-1.76] compared with the controls. The OR for hypertension among patients with mild psoriasis was 1.30 (95% CI 1.15-1.47) and the OR for hypertension among patients with severe psoriasis was 1.49 (95% CI 1.20-1.86) compared with the controls. Two cohort studies examining incidence of hypertension found that psoriasis was associated with a hazard ratio of 1.09 (95% CI 1.05-1.14) and 1.17 (95% CI 1.06-1.30) for development of hypertension. In a subgroup analysis, patients with psoriatic arthritis also had an increased prevalence of hypertension (OR 2.07, 95% CI 1.41-3.04). Psoriasis and psoriatic arthritis are associated with greater prevalence of hypertension. Patients with severe psoriasis have greater odds of hypertension than those with mild psoriasis.

A new approach to improve the specificity of flow-mediated dilation for indicating endothelial function in cardiovascular research.

Abstract: Flow-mediated dilation (FMD) is a noninvasive indicator of endothelial function and is routinely expressed as the percentage change in arterial diameter (FMD%) from a resting baseline (Dbase) to a postischemic peak (Dpeak). This expression is equivalent to the ratio of Dpeak/Dbase and is, therefore, dependent on important statistical assumptions, which have never been analysed in the context of FMD%. We aimed to investigate these assumptions, via a comparison of FMD between samples of children and adults, as well as to explore other approaches to scaling diameter change for Dbase. We found that FMD% did not scale accurately for interindividual differences in Dbase but, as expected, overestimated endothelial function for low Dbase and vice versa. We argue that this imprecise scaling of FMD% is predictable, not explained by physiology and is probably common. This problem is resolved by applying scaling principles, whereby the difference in diameter is the outcome and Dbase is a covariate in a logarithmic-linked generalized linear model. A specific allometric expression of FMD can be derived and we found this to be Dpeak/Dbase rather than a simple ratio in our particular dataset. We found that sample differences in endothelial function were inaccurate with FMD% versus our new allometric approach, and that FMD% misclassified participants into 'high' and 'low'cohorts, which has implications for prognostic-type studies. We conclude that the general use of FMD% could have led to biased comparisons of different conditions and/or populations in past studies. Our new approach to scaling FMD is flexible for different datasets and is not based on the current assumption that a percentage change is appropriate in all circumstances.

Early vascular ageing in translation: from laboratory investigations to clinical applications in cardiovascular prevention.

Abstract: The ageing of the vascular tree is a fundamental reflection of biological ageing in general and a determinant of organ function. In the arterial wall this is characterized by a reduction in the elastin content, as well as by an increased content of collagen and its cross-linkages, leading to increased arterial stiffness and elevated central as well as brachial blood pressure, accompanied by increased SBP variability. In recent years a better understanding of these processes have led to the proposal of a condition named early vascular ageing (EVA) in patients with increased arterial stiffness for their age and sex. This is a condition that could increase cardiovascular risk and is associated with various degrees of cognitive dysfunction, as well as other features of biological ageing. This brief review aims to give an update on EVA and how the concept can be used in clinical practice.

Endurance exercise beneficially affects ambulatory blood pressure: a systematic review and meta-analysis.

Abstract: Exercise is widely recommended as one of the key preventive lifestyle changes to reduce the risk of hypertension and to manage high blood pressure (BP), but individual studies investigating the effect of exercise on ambulatory BP have remained inconclusive. Therefore, the primary purpose of this systematic review and meta-analysis was to determine the effect of aerobic endurance training on daytime and night-time BP in healthy adults. A systematic literature search was conducted using PubMed and Cochrane Controlled Clinical trial registry from their inception to May 2012. Randomized controlled trials of at least 4 weeks investigating the effects of aerobic endurance training on ambulatory BP in healthy adults were included. Inverse weighted random effects models were used for analyses, with data reported as weighted means and 95% confidence limits. We included 15 randomized controlled trials, involving 17 study groups and 633 participants (394 exercise participants and 239 control participants). Overall, endurance training induced a significant reduction in daytime SBP [-3.2 mmHg, 95% confidence interval (CI), -5.0 to-1.3] and daytime DBP (-2.7 mmHg, 95% CI, -3.9 to -1.5). No effect was observed on night-time BP. The findings from this meta-analysis suggest that aerobic endurance exercise significantly decreases daytime, but not night-time, ambulatory BP.

Blood pressure levels and brain volume reduction: a systematic review and meta-analysis

Abstract: Objective High blood pressure (BP) levels may be associated with brain volume reduction and may contribute to brain atrophy in key brain regions involved in cognition and susceptible to neurodegeneration in Alzheimer's disease. The purpose of this work was to systematically review and quantitatively synthesize the association of BP levels with brain volume reduction in humans. Methods An English Medline, Cochrane Library and PsycINFO search was conducted in June 2012 using the Medical Subject Heading terms 'Blood pressure', 'Hypertension', 'Brain mapping' and 'Brain atrophy'. Results Of the 609 screened abstracts, 28 studies (4.6%) were included in the qualitative analysis. Twenty-six studies (92.9%) showed a significant association of higher BP levels and/or hypertension with total and/or regional brain volume reduction, the frontal and temporal lobes being particularly affected. In addition, four other studies reported an association between lower BP levels and brain volume reduction. Due to the heterogeneity of methodology and outcomes, random-effects meta-analyses of the mean difference of brain volume could be performed on only seven studies, with a total of 709 cases with hypertension and 1001 controls without hypertension. The findings showed no between-group difference regarding the whole-gray matter volume (summary mean difference = 2.42 cm [95% confidence interval (CI): -2.13 to 6.96]). Conversely, cases with hypertension exhibited lower hippocampus volume compared with controls [summary mean difference = -0.10 cm (95% CI: -0.17 to -0.02)]. Conclusion These findings provide evidence that high BP levels lead to brain volume reduction, specifically in hippocampus, and may be an important factor that contributes to neurodegeneration in Alzheimer's disease.

Precise assessment of noncompliance with the antihypertensive therapy in patients with resistant hypertension using toxicological serum analysis.

Abstract: Background:The aim of our study was to assess the prevalence of pseudo-resistance caused by noncompliance with treatment among patients with severe resistant hypertension and to analyze the contributing factors.Method:Three hundred and thirty-nine patients (195 men) with resistant essential hyperten

Chronic resveratrol consumption improves brachial flow-mediated dilatation in healthy obese adults.

Abstract: Background: We have previously demonstrated acute dose-dependent increases of flow-mediated dilatation (FMD) in the brachial artery after resveratrol consumption in mildly hypertensive, overweight/obese adults. Resveratrol supplementation has also been shown to increase cerebral blood flow acutely, without affecting cognition. Objectives: To evaluate the effects of chronic resveratrol supplementation on both FMD and cognitive performance. Method: Twenty-eight obese but otherwise healthy adults (BMI: 33.3±0.6kg/m 2) were randomized to take a single 75 mg capsule of trans-resveratrol (Resvida) or placebo daily for 6 weeks each in a double-blind crossover supplementation trial. Blood pressure, arterial compliance, FMD, and performance on the Stroop Color-Word Test were assessed at the end of each 6-week intervention period while fasted and at least 18 h after taking the last daily capsule. An additional capsule of the same supplement was then taken. FMD assessment was repeated 1 h later. Results: Chronic resveratrol supplementation for 6 weeks was well tolerated and resulted in a 23% increase in FMD compared with placebo (P = 0.021, paired t-test). The extent of increase correlated negatively with baseline FMD (r= -0.47, P=0.01). A single dose of resveratrol (75 mg) following chronic resveratrol supplementation resulted in a 35% greater acute FMD response than the equivalent placebo supplementation. These FMD improvements remained significant after adjusting for baseline FMD. Blood pressure, arterial compliance, and all components of the Stroop Color-Word Test were unaffected by chronic resveratrol supplementation. Conclusion: Daily resveratrol consumption was well tolerated and has the potential to maintain healthy circulatory function in obese adults.

Prevalence, awareness and risk factors of hypertension in a large cohort of Iranian adult population.

Abstract: Background There is considerable variation in hypertension prevalence and awareness, and their correlates, across different geographic locations and ethnic groups. We performed this cross-sectional analysis on data from the Golestan Cohort Study (GCS).

Low dose spironolactone reduces blood pressure in patients with resistant hypertension and type 2 diabetes mellitus: a double blind randomized clinical trial

Abstract: Background:The increased risk of cardiovascular morbidity and mortality associated with arterial hypertension is particularly pronounced in patients with type 2 diabetes mellitus. Blood pressure control is, therefore, decisively important but often not sufficiently achieved.Objective:The primary obj

High Dietary Sodium Intake Impairs Endothelium-Dependent Dilation in Healthy Salt-Resistant Humans

Abstract: Background:Excess dietary sodium has been linked to the development of hypertension and other cardiovascular diseases. In humans, the effects of sodium consumption on endothelial function have not been separated from the effects on blood pressure. The present study was designed to determine if dieta

Prevalence, awareness, treatment and control of hypertension among slum dwellers in Nairobi, Kenya.

Abstract: AIMS: This study aims to assess the prevalence, awareness, treatment, and control of hypertension in two major slums in Nairobi, Kenya. METHODS: We use data from a cross-sectional population-based survey, conducted in 2008-2009, involving a random sample of 5190 (2794 men and 2396 women) adults aged 18 years and older resident in both slums. RESULTS: Overall, the prevalence (weighted by sampling and response rates) of hypertension (SBP ≥140 mmHg and/or DBP ≥90 mmHg and/or antihypertensive medication) was 12.3% (12.7% in women and 12.0% in men). The overall level of awareness (having been previously informed of hypertensive status by a health professional) among hypertensives was 19.5% (30.7% in women and 10.8% in men). About 47% (44.9% in women and 50.9% in men) of those who were aware of being hypertensive reported being on antihypertensive treatment in the 1 year preceding the survey. Among those who reported being on treatment, only 21.5% (14.4% in women and 35.7% in men) had their hypertension controlled to levels below 140/90 mmHg. Hypertension control among all hypertensives was below 3%. CONCLUSION: Our findings suggest that hypertension is common in the slums, but the rates of awareness, treatment, and control are low. However, once people are aware of their hypertension, most seek treatment. This indicates that the best gains in treatment can be made when awareness is raised. Overall, there is urgent need to implement strategies that improve prevention, detection, and access to effective treatment in these neglected populations.

Central artery stiffness, neuropsychological function, and cerebral perfusion in sedentary and endurance-trained middle-aged adults

Abstract: BACKGROUND Midlife vascular disease risk is a strong risk factor for late-life dementia. Central arterial stiffness, a hallmark of vascular aging, is associated with accelerated brain aging and cognitive decline. Habitual aerobic exercise is an effective lifestyle strategy to reduce central arterial stiffness and is related to lower risk of cognitive impairment. OBJECTIVE To determine the associations among cardiopulmonary fitness, neuropsychological function, central arterial stiffness, and cerebral perfusion in the sedentary and endurance-trained middle-aged adults. METHODS Twenty-six sedentary and 32 endurance-trained middle-aged adults were measured for maximal oxygen consumption, central arterial stiffness determined by aortic pulse wave velocity and carotid ultrasound, neuropsychological function, and regional cerebral blood flow assessed by MRI. RESULTS There were no group differences in age, sex, ethnicity, education, blood pressure, and carotid intima-media wall thickness (all P>0.05). Neuropsychological performance and occipitoparietal perfusion were greater, and central arterial stiffness was lower in endurance-trained individuals than in sedentary individuals (all P<0.05). Greater cardiopulmonary fitness was related to better cognitive composite scores, including memory and attention-executive function (r=0.28-0.40, P<0.05). Lower carotid arterial stiffness was associated with better neuropsychological outcome independent of age, sex, and education (r=-0.32 to -0.35, P<0.05), and correlated with greater occipitoparietal blood flow (r= -0.37 to -0.51, P<0.05). CONCLUSION Lower carotid artery stiffness in endurance-trained adults is associated with better neuropsychological outcome and greater occipitoparietal perfusion.

Evaluation of the Vicorder, a novel cuff-based device for the noninvasive estimation of central blood pressure.

Abstract: Objectives: The Vicorder is a new brachial cuff-based device that estimates central blood pressure (cBP) using a brachial-to-aortic transfer function. The aim of this study was to evaluate cBP estimated by the Vicorder. Methods: During cardiac angiography, cBP estimated by the Vicorder and the SphygmoCor was evaluated against simultaneous invasive cBP in 50 patients. The two devices were also compared noninvasively in a separate group of 90 healthy individuals. Results: Central SBP (cSBP) obtained with each device satisfied the American Association for the Advancement of Medical Instrumentation accuracy criteria when peripheral waveforms were calibrated to invasive mean arterial

Spironolactone, eplerenone and the new aldosterone blockers in endocrine and primary hypertension.

Abstract: Mineralocorticoid receptor antagonists (MRAs) are commonly used to reduce blood pressure, left-ventricular hypertrophy, and urinary albumin excretion in patients with essential hypertension or primary aldosteronism. Effects of MRAs on hypertensive organ damage seem to occur beyond what is expected from the mere reduction of blood pressure. This suggests that activation of the mineralocorticoid receptor plays a central role in the development of cardiac and renal abnormalities in hypertensive patients. However, broad use of classic MRAs such as spironolactone has been limited by significant incidence of gynecomastia and other sex-related adverse effects. To overcome these problems, new aldosterone blockers have been developed with different strategies that include use of nonsteroidal MRAs and inhibition of aldosterone synthesis. Both strategies have been designed to avoid the steroid receptor cross-reactivity of classic MRAs that accounts for most adverse effects. Moreover, inhibition of aldosterone synthesis could have an additional benefit due to blockade of the mineralocorticoid receptor-independent pathways that might account for some of the untoward effects of aldosterone. The new aldosterone blockers are currently having extensive preclinical evaluation, and one of these compounds has passed phase 2 trials showing promising results in patients with primary hypertension and primary aldosteronism. This narrative review summarizes the knowledge on the use of classic MRAs in hypertension and covers the evidence currently available on new aldosterone blockers.

Guidelines on guidelines: focus on isolated systolic hypertension in youth.

Abstract: Current guidelines on isolated systolic hypertension (ISH) suggest the same treatment to patients of all ages Application of these guidelines in youth with ISH may not be appropriate, as presently no data show adverse outcome or benefit of drug therapy in this group Simple noninvasive tonometric techniques now enable physicians to measure the central aortic pressure waveform and amplification of the pressure pulse ISH in youth is usually caused by high amplification of the central pressure wave, whereas ISH in the elderly (>age 60) is attributable to aortic stiffening This is the only group with ISH shown to have an adverse prognosis and to warrant drug therapy

Brachial-ankle pulse wave velocity predicts the development of cardiovascular disease in a general Japanese population: the Hisayama Study.

Abstract: Objective:We examined the relationship between brachial-ankle pulse wave velocity and the development of cardiovascular disease in a general Japanese population.Methods:A total of 2916 community-dwelling Japanese individuals without history of cardiovascular disease aged at least 40 years were follo

Latin American consensus on hypertension in patients with diabetes type 2 and metabolic syndrome.

Abstract: The present document has been prepared by a group of experts, members of cardiology, endocrinology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although

Obesity phenotype and incident hypertension: a prospective community-based cohort study.

Abstract: OBJECTIVE The relationship betweens the healthy obese phenotype and the risk of cardiovascular events remains unclear. We prospectively investigated the association between the obesity phenotype and the incidence of hypertension. METHODS We studied 2352 participants, aged 40-69 years at baseline, with normal blood pressure (BP) from the Ansan cohort and the Ansung cohort of the Korean Genome Epidemiology Study. Participants were divided into six groups based on BMI and the metabolic syndrome (MetS) components: healthy (none of the five MetS components) normal weight (BMI <23 kg/m(2)), unhealthy (one or more MetS component) normal weight, healthy overweight (BMI 23-24.9 kg/m(2)), unhealthy overweight, healthy obesity (BMI ≥25 kg/m(2)), and unhealthy obesity. The incidence of hypertension was identified by biennial health examinations during the 8-year follow-up. RESULTS After adjusting for age, sex, cohort, physical activity, smoking, alcohol consumption, and family history of hypertension and cardiovascular diseases, an increased risk for hypertension in combined cohort was observed in the healthy obesity [hazard ratio (HR): 2.20, 95% confidence interval (CI):1.34-3.60], unhealthy overweight (HR: 1.47, 95% CI: 1.00-2.14), and unhealthy obesity (HR: 2.45, 95% CI: 1.79-3.37), compared with the healthy normal weight group. In each cohort, the healthy obesity was still associated with a higher incidence of hypertension (HR 2.20, 95% CI 1.11-4.36 for the Ansan cohort and HR 2.21, 95% CI 1.01-4.83 for the Ansung cohort). CONCLUSION These findings provide evidence that the metabolically healthy obese phenotype may not be a benign condition.

Carotid-femoral pulse wave velocity assessment using novel cuff-based techniques: comparison with tonometric measurement.

Abstract: BACKGROUND Carotid-femoral pulse wave velocity, a predictor of cardiovascular outcome, is conventionally measured using a tonometer sequentially placed upon the carotid and femoral arteries, gated using an electrocardiogram. Leg cuff detection of the femoral pulse removes the need for signal gating, reduces the time required for a single measurement, but gives different pulse wave velocity values to tonometric analysis. A novel algorithm to correct for the transit time and distance related to the additional femoral segment was applied to the cuff-based approach in this study. METHOD Eighty-eight individuals were recruited across four centres and carotid-femoral pulse wave velocity measured in triplicate using two operators with both a tonometer-based device and a device using an inflated thigh cuff with and without the use of the novel algorithm. Comparison was made by Bland-Altman and regression analysis. RESULTS The unadjusted cuff-based approach gave lower pulse wave velocity values than the tonometer-based approach (6.11 ± 1.27 and 7.02 ± 1.88 m/s, P < 0.001). With application of the algorithm, the cuff-based device gave similar pulse wave velocity values (7.04 ± 1.72 m/s) as the tonometer-based approach (P = 0.86). Analysis of covariance with age showed a difference between the tonometer and cuff-based methods (P < 0.001), with a dependence upon age (P = 0.004). The adjusted cuff-based method gave similar results to the tonometer-based method (P = 0.94), with no dependence upon age (P = 0.46). CONCLUSION This study provided validation of a cuff-based assessment of carotid-femoral pulse wave velocity against the universally accepted tonometric method. Adjusting the cuff-based method for the additional femoral segment measured gives results comparable to the tonometer-based method, for which the majority of population data exist to date.

Hypertension prevalence and Framingham risk score stratification in a large HIV-positive cohort in Uganda

Abstract: Background:To report the prevalence of hypertension and projected 10-year absolute risk of acute cardiovascular disease in a large prospectively followed cohort of HIV-positive youth and adults beginning antiretroviral therapy in sub-Saharan Africa.Methods:HIV-positive individuals seeking HIV treatm

Management of Hypertensive Emergencies

Abstract: Hypertension is a common problem encountered in everyday clinical practice. Patients with poorly controlled hypertension may present to the emergency room with “hypertensive emergency” - severely elevated blood pressure (>180/120 mmHg) associated with end organ damage, involving neurological, cardiovascular or renal systems. There is a paucity of literature regarding the preferred rate of decline of blood pressure, while treating these patients, as well as the appropriate medications to be used. Based on expert opinion and anecdotal data, it is recommended that the initial management should focus on promptly identifying impending or established end organ damage and decreasing the blood pressure by about 25% in the first 2 hours, except in aortic dissection where rapid lowering of blood pressure is recommended. This review provides a focused approach to the management of hypertensive emergencies.

Dual inhibition of the renin-angiotensin system in high-risk diabetes and risk for stroke and other outcomes: results of the ONTARGET trial.

Abstract: Background:A recent study suggested that addition of a direct renin inhibitor to either an angiotension-converting enzyme (ACE) inhibitor (ACEi) or an angiotensin receptor blocker (ARB) may increase stroke risk in people with diabetes and renal disease.Methods:We examined the effects of addition of

Tomato extract and the carotenoids lycopene and lutein improve endothelial function and attenuate inflammatory NF-κB signaling in endothelial cells.

Abstract: Objectives:In our previous research the antihypertensive properties of lycopene-containing tomato oleoresin have been revealed. The present study was aimed to assess if oleoresin interferes in the inflammatory signalling in endothelial cells, imitating reduction of inflammatory processes in the vess

Renal nerve ablation reduces augmentation index in patients with resistant hypertension.

Abstract: OBJECTIVE Renal denervation (RDN) has been demonstrated to reduce muscle sympathetic nerve activity (MSNA) and blood pressure (BP) in patients with resistant hypertension. Whether alterations of arterial stiffness may contribute to BP-lowering effects of RDN is unknown. METHODS We measured office BP and arterial stiffness using fingertip tonometry-derived augmentation index (EndoPAT2000) at baseline and at 3-month follow-up in 50 consecutive patients with resistant hypertension. Forty patients received RDN and 10 patients served as controls. MSNA was obtained in 20 RDN and 10 non-RDN patients. RESULTS Baseline BP averaged 170/92 ± 19/15 mmHg (RDN) and 171/93 ± 14/8 mmHg (non-RDN) despite the use of 4.9 ± 1.9 and 4.4 ± 2.0 antihypertensive drugs, respectively. RDN significantly reduced SBP (170 ± 19 vs. 154 ± 25 mmHg; P < 0.001) and DBP (92 ± 15 vs. 84 ± 16 mmHg; P<0.001), augmentation index (30.6 ± 23.8 vs. 22.7 ± 22.4%; P=0.002), AI@75 corrected for heart rate (22.4 ± 21.6 vs. 14.4 ± 20.7; P=0.002) and MSNA (80 ± 15 vs. 71 ± 18 bursts/100 heartbeats; P<0.01). Changes in AI@75 with RDN were unrelated to SBP (r=0.043; P = 0.79), and DBP (r = 0.092; P = 0.57) and MSNA changes (r = -0.17; P = 0.49). No changes in BP, augmentation index, AI@75 or MSNA were observed in the non-RDN group. CONCLUSION RDN results in a substantial and rapid reduction in augmentation index, which appears to be independent of BP and MSNA changes. These findings are indicative of a beneficial effect of RDN on arterial stiffness in patients with resistant hypertension and may contribute to the sustained BP-lowering effect of RDN.