Resistant Hypertension Management: Comparison of the 2017 American and 2018 European High Blood Pressure Guidelines

AbstractPurpose of ReviewTo compare European and American guidelines for the diagnosis, evaluation, and management of resistant hypertension.Recent FindingsResistant hypertension is defined as high blood pressure that remains above goal with the use of 3 or more antihypertensive agents, commonly a renin-angiotensin blocker (either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker), a long-acting calcium channel blocker, and thiazide or thiazide-like diuretic. Resistant hypertension is common, with a recent analysis indicating that it affects approximately 17 –19% of adult Americans with hypertension. Pseudocauses of apparent resistant hypertension, including inaccurate blood pressure measurement, white coat effect, undertreatment, and poor medication adherence, must be excluded in order to confirm true resistant hypertension. Evaluation of resistant h ypertension requires identifying and treating secondary causes of hypertension, including obstructive sleep apnea, primary aldosteronism, and renal artery stenosis. Treatment of resistant hypertension includes a combined use of lifestyle modification and prescription of effective multiple-drug combi nations. Preferential use of a long-acting thiazide-like diuretic, either chlorthalidone or indapamide, and a mineralocorticoid receptor blocker, most commonly spironolactone, is recommended if needed to achieve blood pressure control.SummaryAside for small exceptions, European and American guideline...
Source: Current Hypertension Reports - Category: Primary Care Source Type: research

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We examined the association of OSA with nighttime BP among African Americans who completed 24-hour ambulatory BP monitoring at Exam 1 (2000-2004) of the Jackson Heart Study (JHS) and subsequently participated in the JHS Sleep Study (2012-2016). Type 3 home sleep apnea testing was used to assess OSA measures, including respiratory event index (REI4%) and percent sleep time
Source: American Journal of Hypertension - Category: Cardiology Authors: Tags: Am J Hypertens Source Type: research
An 81-year-old man presented to the clinic for an annual general medical examination with insomnia and pruritus. His insomnia was associated with nocturnal leg restlessness, foot cramping, and pruritus of his feet. His cramping was not associated with activity and occurred mostly at night. He reported no fevers, weight loss, night sweats, numbness, skin lesions, or purulence. His medical history included obstructive sleep apnea (OSA) treated with continuous positive airway pressure therapy, hypertension, hyperlipidemia, gastroesophageal reflux disease, bilateral chronic onychomycosis of the toenails (recently completed tre...
Source: Mayo Clinic Proceedings - Category: Internal Medicine Authors: Tags: Residents ’ Clinic Source Type: research
CONCLUSION: Even though CIH did not cause abnormal pulmonary function or PH, early lung injury was detected at the molecular level in rats exposed to CIH. Treatment with Ad ameliorated the pulmonary injury by activating the SIRT3/SOD2 pathway, reducing ROS generation, and inhibiting ROS-associated lung cell apoptosis. PMID: 32458376 [PubMed - as supplied by publisher]
Source: Sleep and Breathing - Category: Sleep Medicine Authors: Tags: Sleep Breath Source Type: research
AbstractBackgroundObstructive sleep apnea syndrome (OSAS) is associated with a variety of systemic diseases. Among patients with chronic kidney diseases (CKD), the prevalence of OSAS is high. OSAS can induce progression of CKD. However, whether or not OSAS can cause renal damage in healthy people is not clear. Thus, the purpose of this meta-analysis was to elucidate whether or not there was an association between OSAS and early renal damage.MethodsPubMed, Embase Database, Cochrane Library, Web of Science, China National Knowledge Infrastructure, China Biology Medicine Database, Chinese Scientific Journals Database, and Wan...
Source: Sleep and Breathing - Category: Respiratory Medicine Source Type: research
Abstract BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is associated with a variety of systemic diseases. Among patients with chronic kidney diseases (CKD), the prevalence of OSAS is high. OSAS can induce progression of CKD. However, whether or not OSAS can cause renal damage in healthy people is not clear. Thus, the purpose of this meta-analysis was to elucidate whether or not there was an association between OSAS and early renal damage. METHODS: PubMed, Embase Database, Cochrane Library, Web of Science, China National Knowledge Infrastructure, China Biology Medicine Database, Chinese Scientific Journa...
Source: Sleep and Breathing - Category: Sleep Medicine Authors: Tags: Sleep Breath Source Type: research
Abstract Although excessive daytime sleepiness is commonly evaluated in clinical and research settings using the Epworth Sleepiness Scale, few studies have assessed the factors associated with its incidence in the general population. We prospectively investigated the predictors of incident and persistent excessive daytime sleepiness in 2,751 subjects (46.1% men, mean age 56.0 ± 9.8 years) from the CoLaus-PsyCoLaus population-based cohort (Lausanne, Switzerland) over 5 years. Participants completed the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index, and underwent a full c...
Source: Journal of Sleep Research - Category: Sleep Medicine Authors: Tags: J Sleep Res Source Type: research
ConclusionSmall artery disease is the most common stroke subtype associated with obstructive sleep apnea. Clinicians must vigilantly assess the presence of obstructive sleep apnea in ischemic stroke patients, especially in patients whose stroke is attributed to small artery disease.
Source: Neurological Sciences - Category: Neurology Source Type: research
This study aims to determine if SCZ patients are at increased risk of incident OSA.MethodsA total of 5092 newly diagnosed SCZ patients and 5092 non-SCZ controls matched by gender, age, and index year were included between 2000 and 2012 and followed to 2013. Participants newly diagnosed with OSA were defined as incidents. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence intervals (CI) of the OSA incidence rate between the two groups studied.ResultsSCZ patients were at increased risk of OSA compared to non-SCZ controls after adjusting for gender, age, comorbidities, and duration of anti...
Source: Social Psychiatry and Psychiatric Epidemiology - Category: Psychiatry Source Type: research
Atrial fibrillation (AF) is known to be one of the most common rhythm disorders encountered in clinical practice. Yet, AF only rarely occurs as a solitary diagnosis. On the contrary, AF typically is predisposed to be numerous factors. The most important predisposing factor for AF is age, with both AF incidence rates and prevalence rising with every life year [1]. Beyond age, arterial hypertension, cardiomyopathies, obstructive sleep apnea, or valvular dysfunction confer increased risk [2,3].
Source: International Journal of Cardiology - Category: Cardiology Authors: Tags: Editorial Source Type: research
Conclusion: The relationship between snoring and obesity has not been well explored. This study among slum-dwelling Indian women found a significant relationship between snoring and obesity. Future research should explore the underlying mechanisms connecting snoring to BMI.
Source: Lung India - Category: Respiratory Medicine Authors: Source Type: research
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