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Sun L, Chang YF, Wang YF, Xie QX, Ran XZ, Hu CY, Luo B, Ning B. Effect of Continuous Positive Airway Pressure on Blood Pressure in Patients with Resistant Hypertension and Obstructive Sleep Apnea: An Updated Meta-analysis. Curr Hypertens Rep 2024; 26:201-211. [PMID: 38460066 DOI: 10.1007/s11906-024-01294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 03/11/2024]
Abstract
PURPOSE OF REVIEW The effect of continuous positive airway pressure (CPAP) on resistant hypertension in patients at high risk with obstructive sleep apnea (OSA) needs further investigation. We aimed to determine the effect of CPAP on blood pressure in patients with resistant hypertension and OSA. Databases including PubMed, EMBASE, MEDLINE, the Cochrane Library, and CMB were searched. Data were pooled using a random-effects or fixed-effects model to derive weighted mean differences (WMDs) and 95% confidence intervals (CIs). RECENT FINDINGS A total of 12 trials and 718 participants were included. Compared with control, CPAP significantly reduced 24-h systolic blood pressure (SBP) (WMD: - 5.92 mmHg [ - 8.72, - 3.11]; P<0.001), 24-h diastolic blood pressure (DBP) (WMD: - 4.44 mmHg [- 6.26 , - 2.62]; P <0.001), daytime SBP (WMD: - 5.76 mmHg [ - 9.16, - 2.36]; P <0.001), daytime DBP (WMD: - 3.92 mmHg [- 5.55, - 2.30]; nighttime SBP (WMD: - 4.87 mmHg [ - 7.96 , - 1.78]; P = 0.002), and nighttime DBP (WMD: - 2.05 mmHg [- 2.99, - 1.11]; P<0.001) in patients with resistant hypertension and OSA. CPAP improved the blood pressure both in the short (<3 months) and long term (≥ 3 months). No significant impact on mean heart rate was noted (WMD: -2.76 beats per min [- 7.50, 1.97]; P = 0.25). CPAP treatment was associated with BP reduction in patients with resistant hypertension and OSA.
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Affiliation(s)
- Ling Sun
- Fuyang Tumor Hospital, Fuyang, China
| | - Ya-Fei Chang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Yun-Fei Wang
- The 90th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Hefei, Chine
| | | | | | - Chun-Yang Hu
- Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang, China
| | - Bin Luo
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.
| | - Bin Ning
- Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang, China.
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Lamirault G, Artifoni M, Daniel M, Barber-Chamoux N, Nantes University Hospital Working Group On Hypertension. Resistant Hypertension: Novel Insights. Curr Hypertens Rev 2019; 16:61-72. [PMID: 31622203 DOI: 10.2174/1573402115666191011111402] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 12/27/2022]
Abstract
Hypertension is the most common chronic disease and the leading risk factor for disability and premature deaths in the world, accounting for more than 9 million deaths annually. Resistant hypertension is a particularly severe form of hypertension. It was described 50 years ago and since then has been a very active field of research. This review aims at summarizing the most recent findings on resistant hypertension. The recent concepts of apparent- and true-resistant hypertension have stimulated a more precise definition of resistant hypertension taking into account not only the accuracy of blood pressure measurement and pharmacological class of prescribed drugs but also patient adherence to drugs and life-style recommendations. Recent epidemiological studies have reported a 10% prevalence of resistant hypertension among hypertensive subjects and demonstrated the high cardiovascular risk of these patients. In addition, these studies identified subgroups of patients with even higher morbidity and mortality risk, probably requiring a more aggressive medical management. In the meantime, guidelines provided more standardized clinical work-up to identify potentially reversible causes for resistant hypertension such as secondary hypertension. The debate is however still ongoing on which would be the optimal method(s) to screen for non-adherence to hypertension therapy, recognized as the major cause for (pseudo)-resistance to treatment. Recent randomized clinical trials have demonstrated the strong benefit of anti-aldosterone drugs (mostly spironolocatone) as fourth-line therapies in resistant hypertension whereas clinical trials with device-based therapies displayed contrasting results. New trials with improved devices and more carefully selected patients with resistant hypertension are ongoing.
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Affiliation(s)
- Guillaume Lamirault
- l'institut du Thorax, INSERM, CNRS, UNIV Nantes, Nantes, France.,l'institut du Thorax, CHU Nantes, Service de Cardiologie, Nantes, France
| | | | - Mélanie Daniel
- Clinical Pharmacology Centre (INSERM CIC1505), CHU Clermont-Ferrand, France
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Rapoport RM, Soleimani M. Mechanism of Thiazide Diuretic Arterial Pressure Reduction: The Search Continues. Front Pharmacol 2019; 10:815. [PMID: 31543812 PMCID: PMC6730501 DOI: 10.3389/fphar.2019.00815] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/24/2019] [Indexed: 12/21/2022] Open
Abstract
Thiazide diuretic (TZD)-mediated chronic reduction of arterial pressure is thought to occur through decreased total peripheral vascular resistance. Further, the decreased peripheral vascular resistance is accomplished through TZD activation of an extrarenal target, resulting in inhibition of vascular constriction. However, despite greater than five decades of investigation, little progress has been made into the identification of the TZD extrarenal target. Proposed mechanisms range from direct inhibition of constrictor and activation of relaxant signaling pathways in the vascular smooth muscle to indirect inhibition through decreased neurogenic and hormonal regulatory pathways. Surprisingly, particularly in view of this lack of progress, comprehensive reviews of the subject are absent. Moreover, even though it is well recognized that 1) several types of hypertension are insensitive to TZD reduction of arterial pressure and, further, TZD fail to reduce arterial pressure in normotensive subjects and animals, and 2) different mechanisms underlie acute and chronic TZD, findings derived from these models and parameters remain largely undifferentiated. This review 1) comprehensively describes findings associated with TZD reduction of arterial pressure; 2) differentiates between observations in TZD-sensitive and TZD-insensitive hypertension, normotensive subjects/animals, and acute and chronic effects of TZD; 3) critically evaluates proposed TZD extrarenal targets; 4) proposes guiding parameters for relevant investigations into extrarenal TZD target identification; and 5) proposes a working model for TZD chronic reduction of arterial pressure through vascular dilation.
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Affiliation(s)
- Robert M Rapoport
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Manoocher Soleimani
- Research Service, Veterans Affairs Medical Center, Cincinnati, OH, United States.,Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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4
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Gordin D, Fadl Elmula FEM, Andersson B, Gottsäter A, Elf J, Kahan T, Christensen KL, Vikatmaa P, Vikatmaa L, Bastholm Olesen T, Groop PH, Olsen MH, Tikkanen I. The effects of baroreflex activation therapy on blood pressure and sympathetic function in patients with refractory hypertension: the rationale and design of the Nordic BAT study. Blood Press 2017; 26:294-302. [PMID: 28595464 DOI: 10.1080/08037051.2017.1332477] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To explore the effects of baroreflex activation therapy (BAT) on hypertension in patients with treatment resistant or refractory hypertension. METHODS This investigator-initiated randomized, double-blind, 1:1 parallel-design clinical trial will include 100 patients with refractory hypertension from 6 tertiary referral hypertension centers in the Nordic countries. A Barostim Neo System will be implanted and after 1 month patients will be randomized to either BAT for 16 months or continuous pharmacotherapy (BAT off) for 8 months followed by BAT for 8 months. A second randomization will take place after 16 months to BAT or BAT off for 3 months. Eligible patients have a daytime systolic ambulatory blood pressure (ABPM) of ≥145 mm Hg, and/or a daytime diastolic ABPM of ≥95 mm Hg after witnessed drug intake (including ≥3 antihypertensive drugs, preferably including a diuretic). RESULTS The primary end point is the reduction in 24-hour systolic ABPM by BAT at 8 months, as compared to pharmacotherapy. Secondary and tertiary endpoints are effects of BAT on home and office blood pressures, measures of indices of cardiac and vascular structure and function during follow-up, and safety. CONCLUSIONS This academic initiative will increase the understanding of mechanisms and role of BAT in the refractory hypertension.
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Affiliation(s)
- Daniel Gordin
- a Helsinki Hypertension Centre of Excellence , University of Helsinki, Helsinki University Hospital , Helsinki , Finland.,b Abdominal Center Nephrology , University of Helsinki, Helsinki University Hospital , Helsinki , Finland.,c Folkhälsan Institute of Genetics , Folkhälsan Research Center, Biomedicum Helsinki , Helsinki , Finland
| | - Fadl Elmula M Fadl Elmula
- d Cardiovascular and Renal Research Centre, Department of Internal Medicine , Oslo University Hospital , Oslo , Norway
| | - Bert Andersson
- e Department of Molecular and Clinical Medicine , Göteborgs Universitet, Sahlgrenska sjukhuset , Göteborg , Sweden
| | - Anders Gottsäter
- f Department of Vascular Diseases, Malmö Hypertension Centre of Excellence , Lund University, Skåne University Hospital , Malmö, Sweden
| | - Johan Elf
- f Department of Vascular Diseases, Malmö Hypertension Centre of Excellence , Lund University, Skåne University Hospital , Malmö, Sweden
| | - Thomas Kahan
- g Department of Clinical Sciences, Division of Cardiovascular Medicine , Danderyd Hospital, Karolinska Institutet , Stockholm , Sweden
| | - Kent Lodberg Christensen
- h Blood Pressure Clinic, Department of Cardiology , University Hospital of Aarhus , Aarhus , Denmark
| | - Pirkka Vikatmaa
- i Abdominal Center, Vascular Surgery , Helsinki University Hospital , Helsinki , Finland
| | - Leena Vikatmaa
- j Department of Anesthesiology, Intensive Care and Pain Medicine , University of Helsinki, Helsinki University Hospital , Helsinki , Finland
| | - Thomas Bastholm Olesen
- k Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology , Odense University Hospital , Odense , Denmark
| | - Per-Henrik Groop
- a Helsinki Hypertension Centre of Excellence , University of Helsinki, Helsinki University Hospital , Helsinki , Finland.,b Abdominal Center Nephrology , University of Helsinki, Helsinki University Hospital , Helsinki , Finland.,c Folkhälsan Institute of Genetics , Folkhälsan Research Center, Biomedicum Helsinki , Helsinki , Finland.,l Baker IDI Heart and Diabetes Institute , Melbourne , VIC , Australia
| | - Michael Hecht Olsen
- m Department of Internal Medicine , Holbaek Hospital, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital , Odense , Denmark
| | - Ilkka Tikkanen
- a Helsinki Hypertension Centre of Excellence , University of Helsinki, Helsinki University Hospital , Helsinki , Finland.,b Abdominal Center Nephrology , University of Helsinki, Helsinki University Hospital , Helsinki , Finland.,n Minerva Institute for Medical Research , Helsinki , Finland
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Li P, Nader M, Arunagiri K, Papademetriou V. Device-Based Therapy for Drug-Resistant Hypertension: An Update. Curr Hypertens Rep 2016; 18:64. [PMID: 27402013 DOI: 10.1007/s11906-016-0671-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Drug-resistant hypertension (RH) remains a significant and common cardiovascular risk despite the availability of multiple potent antihypertensive medications. Uncontrolled resistant hypertension contributes substantially to excessive cardiovascular and renal morbidity and mortality. Clinical and experimental evidence suggest that sympathetic nervous system over-activity is the main culprit for the development and maintenance of drug-resistant hypertension. Both medical and interventional strategies, targeting the sympathetic over-activation, have been designed in patients with hypertension over the past few decades. Minimally invasive, catheter-based, renal sympathetic denervation (RDN) and carotid baroreceptor activation therapy (BAT) have been extensively evaluated in patients with RH in clinical trials. Current trial outcomes, though at times impressive, have been mostly uncontrolled trials in need of validation. Device-based therapy for drug-resistant hypertension has the potential to provide alternative treatment options to certain groups of patients who are refractory or intolerant to current antihypertensive medications. However, more research is needed to prove its efficacy in both animal models and in humans. In this article, we will review the evidence from recent renal denervation, carotid baroreceptor stimulation therapy, and newly emerged central arteriovenous anastomosis trials to pinpoint the weak links, and speculate on potential alternative approaches.
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Affiliation(s)
- Ping Li
- Washington Veterans Affairs Medical Center, 50 Irving Street, N.W., Washington, DC, 20422, USA
- Georgetown University Hospital, Washington, DC, USA
- George Washington University Hospital, Washington, DC, USA
| | - Mark Nader
- Georgetown University Hospital, Washington, DC, USA
| | | | - Vasilios Papademetriou
- Washington Veterans Affairs Medical Center, 50 Irving Street, N.W., Washington, DC, 20422, USA.
- Georgetown University Hospital, Washington, DC, USA.
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6
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Bloss CS, Wineinger NE, Peters M, Boeldt DL, Ariniello L, Kim JY, Sheard J, Komatireddy R, Barrett P, Topol EJ. A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors. PeerJ 2016; 4:e1554. [PMID: 26788432 PMCID: PMC4715435 DOI: 10.7717/peerj.1554] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 12/11/2015] [Indexed: 12/16/2022] Open
Abstract
Background. Mobile health and digital medicine technologies are becoming increasingly used by individuals with common, chronic diseases to monitor their health. Numerous devices, sensors, and apps are available to patients and consumers-some of which have been shown to lead to improved health management and health outcomes. However, no randomized controlled trials have been conducted which examine health care costs, and most have failed to provide study participants with a truly comprehensive monitoring system. Methods. We conducted a prospective randomized controlled trial of adults who had submitted a 2012 health insurance claim associated with hypertension, diabetes, and/or cardiac arrhythmia. The intervention involved receipt of one or more mobile devices that corresponded to their condition(s) (hypertension: Withings Blood Pressure Monitor; diabetes: Sanofi iBGStar Blood Glucose Meter; arrhythmia: AliveCor Mobile ECG) and an iPhone with linked tracking applications for a period of 6 months; the control group received a standard disease management program. Moreover, intervention study participants received access to an online health management system which provided participants detailed device tracking information over the course of the study. This was a monitoring system designed by leveraging collaborations with device manufacturers, a connected health leader, health care provider, and employee wellness program-making it both unique and inclusive. We hypothesized that health resource utilization with respect to health insurance claims may be influenced by the monitoring intervention. We also examined health-self management. Results & Conclusions. There was little evidence of differences in health care costs or utilization as a result of the intervention. Furthermore, we found evidence that the control and intervention groups were equivalent with respect to most health care utilization outcomes. This result suggests there are not large short-term increases or decreases in health care costs or utilization associated with monitoring chronic health conditions using mobile health or digital medicine technologies. Among secondary outcomes there was some evidence of improvement in health self-management which was characterized by a decrease in the propensity to view health status as due to chance factors in the intervention group.
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Affiliation(s)
- Cinnamon S. Bloss
- Scripps Translational Science Institute, La Jolla, California, United States
| | - Nathan E. Wineinger
- Scripps Translational Science Institute, La Jolla, California, United States
| | - Melissa Peters
- Scripps Translational Science Institute, La Jolla, California, United States
| | - Debra L. Boeldt
- Scripps Translational Science Institute, La Jolla, California, United States
| | - Lauren Ariniello
- Scripps Translational Science Institute, La Jolla, California, United States
| | - Ju Young Kim
- Department of Family Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Judith Sheard
- Scripps Translational Science Institute, La Jolla, California, United States
| | - Ravi Komatireddy
- Scripps Translational Science Institute, La Jolla, California, United States
| | - Paddy Barrett
- Scripps Translational Science Institute, La Jolla, California, United States
| | - Eric J. Topol
- Scripps Translational Science Institute, La Jolla, California, United States
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, United States
- Division of Cardiovascular Diseases, Scripps Health, San Diego
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Abstract
There has been a dramatic shift in the manner in which blood pressure (BP) is measured to provide far more comprehensive clinical information than that provided by a single set of office BP readings. Extensive clinical and epidemiological research shows an important role of ambulatory BP monitoring (ABPM) in the management of hypertensive patients. A 24-h BP profile helps to determine the absence of nocturnal dipping status and evaluate BP control in patients on antihypertensive therapy. The ability to detect white-coat or masked hypertension is enhanced by ambulatory BP monitoring. In 2001, the Center for Medicare and Medicaid Services approved ABPM for reimbursement for the identification of patients with white-coat hypertension. In 2011, the National Institute for Health and Clinical Excellence (NICE) in the UK published guidelines that recommended the routine use of ABPM in all patients suspected of having hypertension. The European Society of Hypertension (ESH) 2013 guidelines also support greater use of ABPM in clinical practice. While the advantages of ABPM are apparent from a clinical perspective, its use should be considered in relation to its cost, the complexity of data evaluation, as well as patient inconvenience. In this review, we evaluate the clinical importance of ABPM, highlighting its role in the current management of hypertension.
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Affiliation(s)
- William B White
- Division of Hypertension and Clinical Pharmacology, Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06032-3940, USA,
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Adams M, Bellone JM, Wright BM, Rutecki GW. Evaluation and Pharmacologic Approach to Patients with Resistant Hypertension. Postgrad Med 2015; 124:74-82. [DOI: 10.3810/pgm.2012.01.2520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Modolo R, de Faria AP, Almeida A, Moreno H. Resistant or Refractory Hypertension: Are They Different? Curr Hypertens Rep 2014; 16:485. [DOI: 10.1007/s11906-014-0485-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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10
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Effect of aldosterone antagonists on blood pressure in patients with resistant hypertension: a meta-analysis. J Hum Hypertens 2014; 29:159-66. [DOI: 10.1038/jhh.2014.64] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/14/2014] [Accepted: 06/30/2014] [Indexed: 11/09/2022]
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Varounis C, Katsi V, Kallikazaros IE, Tousoulis D, Stefanadis C, Parissis J, Lekakis J, Siristatidis C, Manolis AJ, Makris T. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: a systematic review and meta-analysis. Int J Cardiol 2014; 175:195-8. [PMID: 24841834 DOI: 10.1016/j.ijcard.2014.04.240] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 04/22/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Christos Varounis
- Department of Cardiology, Elena Venizelou Hospital, Athens, Greece; 2nd Department of Cardiology, Attikon University Hospital, Athens, Greece.
| | - Vasiliki Katsi
- Department of Cardiology, Elena Venizelou Hospital, Athens, Greece; Cardiology Department, Hippokration Hospital, Athens, Greece
| | | | | | | | - John Parissis
- 2nd Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - John Lekakis
- 2nd Department of Cardiology, Attikon University Hospital, Athens, Greece
| | | | | | - Thomas Makris
- Department of Cardiology, Elena Venizelou Hospital, Athens, Greece
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12
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Cost-effectiveness of Barostim therapy for the treatment of resistant hypertension in European settings. J Hypertens 2014; 32:681-92. [DOI: 10.1097/hjh.0000000000000071] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Yoshitomi Y, Kawanishi KI, Yamaguchi A, Sakurai SI, Minai K, Ishii T, Tarutani Y, Tsujibayashi T, Kaneki M, Saitou Y, Suwa S. Effectiveness of the direct renin inhibitor, aliskiren, in patients with resistant hypertension. Int Heart J 2013; 54:88-92. [PMID: 23676368 DOI: 10.1536/ihj.54.88] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Currently there is no consensus regarding which add-on therapy to use in resistant hypertension. We have conducted an open observational study of the use of aliskiren in resistant hypertensive patients. Forty-three patients with resistant hypertension were included in the study. The inclusion criteria were as follows: 1) office blood pressure (BP) > 140/90 mmHg despite treatment with at least three or more antihypertensive drugs; 2) no prior therapy with aliskiren; and 3) no renal insufficiency. Follow-up BP was determined at 1 and 3 months. Baseline BP was 153 ± 12/79 ± 12 mmHg. After 3 months, systolic BP (SBP) and diastolic BP (DBP) dropped significantly: 140 ± 19/73 ± 13 mmHg (P < 0.0001). Twenty-one patients (49%) had an office BP < 140/90 mmHg, and these patients were assigned to the good BP control group. Another 22 were placed into the poor BP control group. BP reductions from baseline in the good BP control group (SBP/ DBP: 19 ± 11/8 ± 7 mmHg) were larger than those in the poor BP control group (5 ± 15/3 ± 9 mmHg, P < 0.05). Mean BP (MBP) values at baseline, 1, and 3 months were higher in the poor BP control group. There was no significant difference in pulse pressure at baseline between the 2 groups. In multivariate analysis, only MBP at baseline correlated with lack of BP control. Aliskiren administration to resistant hypertensive patients was effective in reducing BP. The present findings suggest aliskiren may be useful as a fourth-line or fifth-line treatment added to other drugs in the treatment of resistant hypertension.
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Davis MI, Filion KB, Zhang D, Eisenberg MJ, Afilalo J, Schiffrin EL, Joyal D. Effectiveness of renal denervation therapy for resistant hypertension: a systematic review and meta-analysis. J Am Coll Cardiol 2013; 62:231-241. [PMID: 23644092 DOI: 10.1016/j.jacc.2013.04.010] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/18/2013] [Accepted: 04/07/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study sought to determine the current effectiveness and safety of sympathetic renal denervation (RDN) for resistant hypertension. BACKGROUND RDN is a novel approach that has been evaluated in multiple small studies. METHODS We performed a systematic review and meta-analysis of published studies evaluating the effect of RDN in patients with resistant hypertension. Studies were stratified according to controlled versus uncontrolled design and analyzed using random-effects meta-analysis models. RESULTS We identified 2 randomized controlled trials, 1 observational study with a control group, and 9 observational studies without a control group. In controlled studies, there was a reduction in mean systolic and diastolic blood pressure (BP) at 6 months of -28.9 mm Hg (95% confidence interval [CI]: -37.2 to -20.6 mm Hg) and -11.0 mm Hg (95% CI: -16.4 to -5.7 mm Hg), respectively, compared with medically treated patients (for both, p < 0.0001). In uncontrolled studies, there was a reduction in mean systolic and diastolic BP at 6 months of -25.0 mm Hg (95% CI: -29.9 to -20.1 mm Hg) and -10.0 mm Hg (95% CI: -12.5 to -7.5 mm Hg), respectively, compared with pre-RDN values (for both, p < 0.00001). There was no difference in the effect of RDN according to the 5 catheters employed. Reported procedural complications included 1 renal artery dissection and 4 femoral pseudoaneurysms. CONCLUSIONS RDN resulted in a substantial reduction in mean BP at 6 months in patients with resistant hypertension. The decrease in BP was similar irrespective of study design and type of catheter employed. Large randomized controlled trials with long-term follow-up are needed to confirm the sustained efficacy and safety of RDN.
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Affiliation(s)
- Mark I Davis
- Department of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Canada
| | - Kristian B Filion
- Division of Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada
| | - David Zhang
- Department of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Canada
| | - Mark J Eisenberg
- Department of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Canada; Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Jonathan Afilalo
- Department of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Canada; Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Ernesto L Schiffrin
- Department of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada
| | - Dominique Joyal
- Department of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Canada; Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada.
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Oliva RV, Bakris GL. Management of Hypertension in the Elderly Population. J Gerontol A Biol Sci Med Sci 2012; 67:1343-1351. [DOI: 10.1093/gerona/gls148] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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16
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White WB, Maraka S. Is it possible to manage hypertension and evaluate therapy without ambulatory blood pressure monitoring? Curr Hypertens Rep 2012; 14:366-73. [PMID: 22639014 DOI: 10.1007/s11906-012-0277-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the management of patients with hypertension, blood pressure (BP) has been traditionally measured in the physician's office. The contribution of ambulatory BP monitoring (ABPM) to the management of hypertensive patients has been increasingly recognized through clinical and epidemiological research. Ambulatory BP monitoring can enhance the ability to detect white-coat or masked hypertension, determine the absence of nocturnal dipping status, and evaluate BP control in patients on antihypertensive therapy. Recently, the United Kingdom National Clinical Guideline Centre published guidelines for the clinical management of primary hypertension in adults, recommending the routine use of ABPM to make the initial diagnosis of hypertension. While the advantages of ABPM are apparent from a clinical perspective, its use should be considered in relation to the cost of the equipment, data evaluation, and staff training as well as the possible inconvenience to the patient. In this review, we summarize the clinical importance of ABPM and discuss the current guidelines for establishing the diagnosis of hypertension.
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Affiliation(s)
- William B White
- Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06032-3940, USA.
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El Shamieh S, Visvikis-Siest S. Genetic biomarkers of hypertension and future challenges integrating epigenomics. Clin Chim Acta 2012; 414:259-65. [PMID: 23010416 DOI: 10.1016/j.cca.2012.09.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 09/10/2012] [Accepted: 09/16/2012] [Indexed: 12/15/2022]
Abstract
Essential hypertension is a multifactorial disease, considered to be one of the world's greatest public health problems. Despite recent, major, technical advances aiming to elucidate its genetic component, the discovered biomarkers up to now were reported to have only small effects, explaining consequently a tiny fraction of its phenotypic variance and resulting in a large proportion of missing heritability. Likewise, little evidence is available with regard to the epigenetic regulation of essential hypertension, since no robust biomarkers have yet been reported. In the current review, we discuss the main approaches used exclusively to study the genetics and epigenetics of essential hypertension, the biomarkers identified, their clinical utility and the difficulties to be overcome. Furthermore, we propose a new category of functional genetic-epigenetic biomarkers, eMethSNPs, and we provide their hypothetical gene expression profiles for a genetic functional regulation of hypertension via DNA methylation. Though believed to be infrequent, eMethSNPs could constitute a new category of mechanistically-based genetic biomarkers predisposing to essential hypertension.
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Affiliation(s)
- Said El Shamieh
- Université de Lorraine, Génétique Cardiovasculaire, EA-4373, Nancy 54000, France.
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Current world literature. Curr Opin Cardiol 2012; 27:441-54. [PMID: 22678411 DOI: 10.1097/hco.0b013e3283558773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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