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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TLDR
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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Effects of Blood Pressure Reduction in Mild Hypertension: A Systematic Review and Meta-analysis
Johan Sundström,Hisatomi Arima,Rod Jackson,Fiona Turnbull,Kazem Rahimi,John Chalmers,Mark Woodward,Bruce Neal +7 more
TL;DR: Blood pressure-lowering therapy is likely to prevent stroke and death in patients with uncomplicated grade 1 hypertension, and withdrawal from treatment due to adverse effects was more common in the active groups.
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TL;DR: If the same systematic improvement in all aspects of hypertension management continues until 2022, 80% of patients with treated hypertension will have controlled blood pressure levels with a potential annual saving of about 50,000 major cardiovascular events.
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Sex differences in coronary artery disease: Pathological observations
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Angiotensin Blockade in Late Autosomal Dominant Polycystic Kidney Disease
Vicente E. Torres,Kaleab Z. Abebe,Arlene B. Chapman,Robert W. Schrier,William E. Braun,Theodore I. Steinman,Franz T. Winklhofer,Godela Brosnahan,Peter G. Czarnecki,Marie C. Hogan,Dana C. Miskulin,Frederic F. Rahbari-Oskoui,Jared J. Grantham,Peter C. Harris,Michael F. Flessner,Charity G. Moore,Ronald D. Perrone +16 more
TL;DR: Monotherapy with an ACE inhibitor was associated with blood-pressure control in most patients with ADPKD and stage 3 chronic kidney disease and the addition of an ARB did not alter the decline in the estimated GFR.
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Natural history of pure autonomic failure: A United States prospective cohort.
Horacio Kaufmann,Lucy Norcliffe-Kaufmann,Jose-Alberto Palma,Italo Biaggioni,Phillip A. Low,Wolfgang Singer,David S. Goldstein,Amanda Peltier,Cyndia A Shibao,Christopher H. Gibbons,Roy Freeman,David Robertson +11 more
TL;DR: The clinical features and biomarkers that predict which patients with pure autonomic failure will develop Parkinson disease, dementia with Lewy bodies, or multiple system atrophy are defined.
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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