Journal ArticleDOI
Strict blood-pressure control and progression of renal failure in children.
Antonella Trivelli,Stefano Picca,Mieczysław Litwin,Amira Peco-Antic,Sara Testa,Sevinç Emre,Alberto Caldas-Afonso,Patrick Niaudet,Aysin Bakkaloglu,Giovanni Montini,Ann-Margret Wingen,Peter Sallay,Nikola Jeck,Ulla Berg,Salim Caliskan,Simone Wygoda,Katharina Hohbach-Hohenfellner,Jiri Dusek,Tomasz Urasiński,Klaus Arbeiter,Thomas Neu,Jutta Gellermann,Michel Fischbach,Kristina Möller,Marianne Wigger,Licia Peruzzi,Otto Mehls,Franz Schaefer +27 more
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TLDR
Investigation of the long-term renoprotective effect of intensified blood-pressure control among children who were receiving a fixed high dose of an angiotensin-converting-enzyme (ACE) inhibitor revealed a substantial benefit with respect to renal function among children with chronic kidney disease.Abstract:
Background Although inhibition of the renin–angiotensin system delays the progression of renal failure in adults with chronic kidney disease, the blood-pressure target for optimal renal protection is controversial. We assessed the long-term renoprotective effect of intensified blood-pressure control among children who were receiving a fixed high dose of an angiotensin-converting–enzyme (ACE) inhibitor. Methods After a 6-month run-in period, 385 children, 3 to 18 years of age, with chronic kidney disease (glomerular filtration rate of 15 to 80 ml per minute per 1.73 m 2 of body-surface area) received ramipril at a dose of 6 mg per square meter of bodysurface area per day. Patients were randomly assigned to intensified blood-pressure control (with a target 24-hour mean arterial pressure below the 50th percentile) or conventional blood-pressure control (mean arterial pressure in the 50th to 95th percentile), achieved by the addition of antihypertensive therapy that does not target the renin–angiotensin system; patients were followed for 5 years. The primary end point was the time to a decline of 50% in the glomerular filtration rate or progression to end-stage renal disease. Secondary end points included changes in blood pressure, glomerular filtration rate, and urinary protein excretion. Results A total of 29.9% of the patients in the group that received intensified blood-pressure control reached the primary end point, as assessed by means of a Kaplan– Meier analysis, as compared with 41.7% in the group that received conventional blood-pressure control (hazard ratio, 0.65; confidence interval, 0.44 to 0.94; P = 0.02). The two groups did not differ significantly with respect to the type or incidence of adverse events or the cumulative rates of withdrawal from the study (28.0% vs. 26.5%). Proteinuria gradually rebounded during ongoing ACE inhibition after an initial 50% decrease, despite persistently good blood-pressure control. Achievement of blood-pressure targets and a decrease in proteinuria were significant independent predictors of delayed progression of renal disease. Conclusions Intensified blood-pressure control, with target 24-hour blood-pressure levels in the low range of normal, confers a substantial benefit with respect to renal function among children with chronic kidney disease. Reappearance of proteinuria after initial successful pharmacologic blood-pressure control is common among children who are receiving long-term ACE inhibition. (ClinicalTrials.gov number, NCT00221845.)read more
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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 F. Dominiczak,Maurizio Galderisi,Diederick E. Grobbee,Tiny Jaarsma,Paulus Kirchhof,Sverre E. Kjeldsen,Stéphane Laurent,Athanasios J. Manolis,Peter M. Nilsson,Luis M. Ruilope,Roland E. Schmieder,Per Anton Sirnes,Peter Sleight,Margus Viigimaa,Bernard Waeber,Faiez Zannad,Michel Burnier,Ettore Ambrosioni,Mark Caufield,Antonio Coca,Michael H. Olsen,Costas Tsioufis,Philippe van de Borne,José Luis Zamorano,Stephan Achenbach,Helmut Baumgartner,Jeroen J. Bax,Héctor Bueno,Veronica Dean,Christi Deaton,Çetin Erol,Roberto Ferrari,David Hasdai,Arno W. Hoes,Juhani Knuuti,Philippe Kolh,Patrizio Lancellotti,Aleš Linhart,Petros Nihoyannopoulos,Massimo F Piepoli,Piotr Ponikowski,Juan Tamargo,Michal Tendera,Adam Torbicki,William Wijns,Stephan Windecker,Denis Clement,Thierry C. Gillebert,Enrico Agabiti Rosei,Stefan D. Anker,Johann Bauersachs,Jana Brguljan Hitij,Mark J. Caulfield,Marc De Buyzere,Sabina De Geest,Geneviève Derumeaux,Serap Erdine,Csaba Farsang,Christian Funck-Brentano,Vjekoslav Gerc,Giuseppe Germanò,Stephan Gielen,Herman Haller,Jens Jordan,Thomas Kahan,Michel Komajda,Dragan Lovic,Heiko Mahrholdt,Jan Östergren,Gianfranco Parati,Joep Perk,Jorge Polónia,Bogdan A. Popescu,Zeljko Reiner,Lars Rydén,Yuriy Sirenko,Alice Stanton,Harry A.J. Struijker-Boudier,Charalambos Vlachopoulos,Massimo Volpe,David A. Wood +89 more
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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Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents.
Joseph T. Flynn,David C. Kaelber,Carissa M. Baker-Smith,Douglas L. Blowey,Aaron E. Carroll,Stephen R. Daniels,Sarah D. de Ferranti,Janis M. Dionne,Bonita Falkner,Susan K. Flinn,Samuel S. Gidding,Celeste Goodwin,Michael G. Leu,Makia Powers,Corinna J. Rea,Joshua Samuels,Madeline Simasek,Vidhu V Thaker,Elaine M. Urbina,Subcommittee On Screening +19 more
TL;DR: These pediatric hypertension guidelines are an update to the 2004 report and include revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy.
Journal ArticleDOI
The contribution of chronic kidney disease to the global burden of major noncommunicable diseases
TL;DR: Interventions targeting CKD, particularly to reduce urine protein excretion, are efficacious, cost-effective methods of improving cardiovascular and renal outcomes, especially when applied to high-risk groups and Integration of these approaches within NCD programs could minimize the need for renal replacement therapy.
Journal ArticleDOI
The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019)
Satoshi Umemura,Hisatomi Arima,Shuji Arima,Kei Asayama,Yasuaki Dohi,Yoshitaka Hirooka,Takeshi Horio,Satoshi Hoshide,Shunya Ikeda,Toshihiko Ishimitsu,Masaaki Ito,Sadayoshi Ito,Yoshio Iwashima,Hisashi Kai,Kei Kamide,Yoshihiko Kanno,Naoki Kashihara,Yuhei Kawano,Toru Kikuchi,Kazuo Kitamura,Takanari Kitazono,Katsuhiko Kohara,Masataka Kudo,Hiroo Kumagai,Kiyoshi Matsumura,Hideo Matsuura,Katsuyuki Miura,Masashi Mukoyama,Satoko Nakamura,Takayoshi Ohkubo,Yusuke Ohya,Takafumi Okura,Hiromi Rakugi,Shigeyuki Saitoh,Hirotaka Shibata,Tatsuo Shimosawa,Hiromichi Suzuki,Shori Takahashi,Kouichi Tamura,Hirofumi Tomiyama,Takuya Tsuchihashi,Shinichiro Ueda,Yoshinari Uehara,Hidenori Urata,Nobuhito Hirawa +44 more
TL;DR: The story of the life and times of Toshihiko Umemura and his family in the years leading up to and including his death.
Journal ArticleDOI
2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents
Empar Lurbe,Enrico Agabiti-Rosei,J. Kennedy Cruickshank,Anna F. Dominiczak,Serap Erdine,Asle Hirth,Cecilia Invitti,Mieczysław Litwin,Giuseppe Mancia,Dénes Páll,Wolfgang Rascher,Josep Redon,Franz Schaefer,Tomáš Seeman,Manish D. Sinha,Stella Stabouli,Nicholas J. A. Webb,Elke Wühl,Alberto Zanchetti +18 more
TL;DR: The recommendations of the present document represent the best clinical wisdom upon which physicians, nurses and families should base their decisions and should encourage public policy makers to develop a global effort to improve identification and treatment of high blood pressure among children and adolescents.
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The Use of Plasma Creatinine Concentration for Estimating Glomerular Filtration Rate in Infants, Children, and Adolescents
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