2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)
Paul A. James,Suzanne Oparil,Barry L. Carter,William C. Cushman,Cheryl Dennison-Himmelfarb,Joel Handler,Daniel T. Lackland,Michael L. LeFevre,Thomas D. MacKenzie,Olugbenga Ogedegbe,Sidney C. Smith,Laura P. Svetkey,Sandra J. Taler,Raymond R. Townsend,Jackson T. Wright,Andrew S. Narva,Eduardo Ortiz +16 more
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Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.Abstract:
Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.read more
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The impact of hypertension on chronic kidney disease and end-stage renal disease is greater in men than women: a systematic review and meta-analysis.
TL;DR: Sex differences in onset, duration, and severity of some risk factors, such as albuminuria, diabetes, cardiovascular disease, obesity, and socioeconomic status, may explain part of the excess risk in men.
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Nonfunctioning adrenal incidentaloma: A novel predictive factor for metabolic syndrome.
Emanuela Mello Ribeiro Cavalari,Marcela Pessoa de Paula,Mariana Arruda,Nathália Carraro,Arthur Martins,Kamila de Souza,Maria Célia Nunes Coelho,Nathalie Anne de Oliveira e Silva de Morais,Aline Barbosa Moraes,Leonardo Vieira Neto +9 more
TL;DR: Although metabolic syndrome has been studied in patients with autonomous cortisol secretion, there are limited data for those with nonfunctioning adrenal incidentaloma (NFAI).
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Dietary interventions to improve outcomes in chronic kidney disease
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TL;DR: Dietary interventions are underused as kidney protection strategies and clinicians must become aware of their potential utility in the management of CKD patients, as further studies better define how to best use these dietary interventions for kidney protection.
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Optimisation of treatment with lenvatinib in radioactive iodine-refractory differentiated thyroid cancer
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High-Sensitivity Troponin T and Cardiovascular Events in Systolic Blood Pressure Categories Atherosclerosis Risk in Communities Study
Yashashwi Pokharel,Wensheng Sun,James A. de Lemos,George E. Taffet,Salim S. Virani,Chiadi E Ndumele,Thomas H. Mosley,Ron C. Hoogeveen,Josef Coresh,Jacqueline D. Wright,Gerardo Heiss,Eric Boerwinkle,Biykem Bozkurt,Scott D. Solomon,Christie M. Ballantyne,Vijay Nambi +15 more
TL;DR: In this paper, the authors assessed whether troponin T measured using high-sensitivity assay was associated with cardiovascular disease within systolic blood pressure (SBP) categories in 11 191 Atherosclerosis Risk in Communities study participants.
References
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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.
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Giuseppe Mancia,Guy De Backer,Anna F. Dominiczak,Renata Cifkova,Robert Fagard,Giuseppe Germanò,Guido Grassi,Anthony M. Heagerty,Sverre E. Kjeldsen,Stéphane Laurent,Krzysztof Narkiewicz,Luis M. Ruilope,Andrzej Rynkiewicz,Roland E. Schmieder,Harry A.J. Struijker Boudier,Alberto Zanchetti +15 more
TL;DR: 2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the management of Arterspertension of the European Society ofhypertension (ESH) and of theEuropean Society of Cardiology (ESC).
Journal ArticleDOI
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)
Giuseppe Mancia,Robert Fagard,Krzysztof Narkiewicz,Josep Redon,Alberto Zanchetti,Michael Böhm,Thierry Christiaens,Renata Cifkova,Guy De Backer,Anna Dominiczak,Maurizio Galderisi,Diederick E. Grobbee,Tiny Jaarsma,Paulus Kirchhof,Sverre E. Kjeldsen,Stephane Laurent,Athanasios J. Manolis,Peter M. Nilsson,Luis M. Ruilope,Roland E. Schmieder,Per Anton Sirnes,Peter Sleight,Margus Viigimaa,Bernard Waeber,Faiez Zannad +24 more
TL;DR: 2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the management of Arterspertension of the European Society ofhypertension (ESH) and of theEuropean Society of Cardiology (ESC).
Journal ArticleDOI
Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy
Barry M. Brenner,Mark E. Cooper,Dick de Zeeuw,William F. Keane,William E. Mitch,Hans-Henrik Parving,Giuseppe Remuzzi,Steven M. Snapinn,Zhonxin Zhang,Shahnaz Shahinfar +9 more
TL;DR: Losartan conferred significant renal benefits in patients with type 2 diabetes and nephropathy, and it was generally well tolerated.
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