Role of TRPC6 in Progression of Diabetic Kidney Disease
AbstractPurpose of ReviewThe underlining goal of this review is to offer a concise, detailed look into current knowledge surrounding transient receptor potential canonical channel 6 (TRPC6) in the progression of diabetic kidney disease (DKD).Recent FindingsMutations and over-activation in TRPC6 channel activity lead to the development of glomeruli injury. Angiotensin II, reactive oxygen species, and other factors in the setting of DKD stimulate drastic increases in calcium influx through the TRPC6 channel, causing podocyte hypertrophy and foot process effacement. Loss of the podocytes further promote deterioration of the g...
Source: Current Hypertension Reports - May 21, 2019 Category: Primary Care Source Type: research

Community Health Workers in the Emergency Department —Can they Help with Chronic Hypertension Care
AbstractPurpose of ReviewTo review community health worker (CHW) interventions tailored for hypertension management and to determine if the emergency department (ED) population would benefit from such interventions.Recent FindingsWhen working with patients who have one or more chronic diseases, CHW interventions have been very successful in improving health outcomes and are cost-effective. CHWs use a variety of techniques to address social determinants that patients may face that effect how they manage their chronic disease(s). Current CHW interventions in the ED have targeted the “super-user” population.Summar...
Source: Current Hypertension Reports - May 21, 2019 Category: Primary Care Source Type: research

Orally Active Aminopeptidase A Inhibitor Prodrugs: Current State and Future Directions
AbstractPurpose of ReviewTo review the data supporting the use of aminopeptidase A (APA) inhibitor prodrugs as centrally acting antihypertensive agents.Recent FindingsBrain renin –angiotensin system (RAS) hyperactivity has been implicated in the development and maintenance of hypertension. Angiotensin III, generated by APA, one of the main effector peptides of the brain RAS, exerts a tonic stimulatory control over blood pressure in hypertensive rats. This identified brain APA as a potential therapeutic target for the treatment of hypertension, leading to the development of RB150/firibastat, an orally active prodrug o...
Source: Current Hypertension Reports - May 21, 2019 Category: Primary Care Source Type: research

Is Left Ventricular Hypertrophy a Valid Therapeutic Target?
AbstractPurpose of ReviewThe purpose of this review is to answer the question whether left ventricular hypertrophy (LVH) could be considered a therapeutic target in patients with hypertension. To fulfill this purpose, we briefly outline different methods of measuring LVH, then discuss the current evidence and unresolved controversies regarding the relationships among LVH, blood pressure (BP), and cardiovascular disease (CVD) outcomes.Recent FindingsThe methods and criteria used for defining LVH in clinical studies lack consistency and are inherently different. Electrocardiogram (ECG) has been the most common method, but so...
Source: Current Hypertension Reports - May 20, 2019 Category: Primary Care Source Type: research

Melanocortin-4 Receptors and Sympathetic Nervous System Activation in Hypertension
AbstractPurpose of ReviewTo highlight the role of the brain melanocortin 4 receptor (MC4R) for sympathetic nervous system (SNS) activation in hypertension.Recent FindingsHypertension is the most significant risk factor for developing cardiovascular disease. Although excess weight gain is associated with at least two thirds of primary hypertension cases, the pathophysiological mechanisms involved remain the subject of intense investigation. Multiple studies demonstrate an important role for increased sympathetic nervous system (SNS) activity in development and maintenance of hypertension, and that the brain MC4R modulates S...
Source: Current Hypertension Reports - April 26, 2019 Category: Primary Care Source Type: research

The Influence of Dietary Salt Beyond Blood Pressure
AbstractPurpose of ReviewExcess sodium from dietary salt (NaCl) is linked to elevations in blood pressure (BP). However, salt sensitivity of BP varies widely between individuals and there are data suggesting that salt adversely affects target organs, irrespective of BP.Recent Findings High dietary salt has been shown to adversely affect the vasculature, heart, kidneys, skin, brain, and bone. Common mediators of the target organ dysfunction include heightened inflammation and oxidative stress. These physiological alterations may contribute to disease development over time. Despite the adverse effects of salt on BP and sever...
Source: Current Hypertension Reports - April 25, 2019 Category: Primary Care Source Type: research

The Use of Risk Assessment Tools and Prognostic Scores in Managing Patients with Pulmonary Arterial Hypertension
AbstractPurpose of ReviewPulmonary arterial hypertension (PAH) is a chronic, progressive, and incurable disease with significant morbidity and mortality. Despite increasingly available treatment options, PAH patients continue to experience disease progression and increased rates of hospitalizations due to right heart failure. Physician ’s ability to comprehensively assess PAH patients, determine prognosis, and monitor disease progression and response to treatment remains critical in optimizing outcomes.Recent FindingsRisk assessment in PAH should include a range of clinical, hemodynamic, and exercise parameters, perf...
Source: Current Hypertension Reports - April 25, 2019 Category: Primary Care Source Type: research

New Approaches in Hypertension Management: a Review of Current and Developing Technologies and Their Potential Impact on Hypertension Care
AbstractHypertension is a key risk factor for cardiovascular disease. Currently, around a third of people with hypertension are undiagnosed, and of those diagnosed, around half are not taking antihypertensive medications. The World Health Organisation (WHO) estimates that high blood pressure directly or indirectly causes deaths of at least nine million people globally every year.Purpose of ReviewIn this review, we examine how emerging technologies might support improved detection and management of hypertension not only in the wider population but also within special population groups such as the elderly, pregnant women, an...
Source: Current Hypertension Reports - April 25, 2019 Category: Primary Care Source Type: research

The Management of Hypertension in 2018: What Should the Targets Be?
AbstractPurpose of ReviewTo provide an overview of the different guidelines for hypertension management from around the world.Recent FindingsThe guidelines discussed include those from the United States (US), Europe, Canada, and Latin America. All guidelines except the US define hypertension as>  140/90 mmHg, and the US defines it as>  130/80 mmHg. In general, all guidelines except those from the US emphasize lifestyle modification as the cornerstone of initial therapy given blood pressure levels  140/90 mmHg in the rest of the world. (Source: Current Hypertension Reports)
Source: Current Hypertension Reports - April 25, 2019 Category: Primary Care Source Type: research

Hypertension in Hispanics/Latinos: Epidemiology and Considerations for Management
AbstracPurpose of ReviewHispanic/Latino Americans are among the fastest growing ethnic populations in the United States (US). Hypertension, in particular uncontrolled hypertension, is a significant source of cardiovascular morbidity and mortality in this population. In this review, we outline the epidemiology of hypertension and certain considerations in the management of hypertension in this heterogeneous population.Recent FindingsSubstantial variation in hypertension prevalence and control exists among different ethnic subgroups of Hispanics. More specifically, and in the community, outcomes for hypertension management a...
Source: Current Hypertension Reports - April 25, 2019 Category: Primary Care Source Type: research

How Digital Health Can Be Applied for Preventing and Managing Hypertension
AbstractPurpose of ReviewTo summarize available data on digital health strategies for the prevention and management of hypertension, discussing the state-of-the-art, current limitations, and future perspective of this approach.Recent FindingsTechnology is developing at a fast pace and is providing a number of novel solutions for cardiovascular patients, in particular in the field of digital health. Even if the benefit of these approaches is intuitive, the methodological heterogeneity of the available studies and their small sample size have made it difficult to provide robust evidence regarding the usefulness and cost-effe...
Source: Current Hypertension Reports - April 22, 2019 Category: Primary Care Source Type: research

Family Dynamics in Sleep Health and Hypertension
AbstractPurpose of ReviewPresent a conceptual model and review the recent literature on family dynamics, sleep, and hypertension.Recent FindingsFamily dynamics predict hypertension and hypertension risk, in part, due to shared health behaviors. Sleep health behaviors (sleep duration, quality, and efficiency) predict hypertension risk in children and youth and are emerging as a family-level health behavior. Importantly, both family dynamics and sleep are modifiable. Family members influence one another ’s sleep through their physical presence and through psychological and emotional mechanisms. Family members’ sl...
Source: Current Hypertension Reports - April 13, 2019 Category: Primary Care Source Type: research

The Na + K + -ATPase Inhibitor Marinobufagenin and Early Cardiovascular Risk in Humans: a Review of Recent Evidence
AbstractPurpose of ReviewThis review synthesizes recent findings in humans pertaining to the relationships between marinobufagenin (MBG), a steroidal Na+/K+-ATPase inhibitor and salt-sensitivity biomarker, and early cardiovascular risk markers.Recent FindingsTwenty-four-hour urinary MBG strongly associates with habitual salt intake in young healthy adults (aged 20 –30 years). Furthermore, in young healthy adults free of detected cardiovascular disease, MBG associates with increased large artery stiffness and left ventricular mass independent of blood pressure. These findings in human studies corroborate mechanis...
Source: Current Hypertension Reports - April 12, 2019 Category: Primary Care Source Type: research

Epicardial Adipose Tissue and Cardiovascular Disease
AbstractPurpose of ReviewEpicardial adipose tissue has been associated with the development/progression of cardiovascular disease. We appraise the strength of the association between epicardial adipose tissue and development/progression of cardiovascular diseases like coronary artery disease, atrial fibrillation, and heart failure with preserved ejection fraction.Recent FindingsCross-sectional clinical and translational correlative studies have established an association between epicardial adipose tissue and progression of coronary artery disease. Recent studies question this association and underline the need for longitud...
Source: Current Hypertension Reports - April 5, 2019 Category: Primary Care Source Type: research

Sleep Duration and Blood Pressure: Recent Advances and Future Directions
AbstractPurpose of ReviewThis review discusses the recent literature on subjectively and objectively assessed sleep duration in relation to hypertension risk and out-of-clinic blood pressure (BP) measures and highlights critical areas for future research.Recent FindingsSleep duration, particularly short sleep, may influence BP through disturbed autonomic balance, hormonal imbalances, increased adiposity and metabolic dysfunction, and disrupted circadian rhythms. Observational studies indicate that short and long sleep are associated with hypertension risk, reduced nocturnal dipping, and elevated morning BP, but evidence is...
Source: Current Hypertension Reports - April 5, 2019 Category: Primary Care Source Type: research

Implications of the 2017 AAP Clinical Practice Guidelines for Management of Hypertension in Children and Adolescents: a Review
AbstractPurpose of ReviewTo evaluate the impact of the 2017 American Academy of Pediatrics Clinical Practice Guideline (2017 AAP CPG) for Screening and Management of High Blood Pressure in Children and Adolescents.Recent FindingsThe 2017 AAP CPG had several significant changes compared to the 2004 Fourth Report. This review will focus on the emerging evidence from the first studies to apply the 2017 AAP CPG and the simplified table it contains on the overall prevalence of HTN and on recognition among children and adolescents at a higher cardiovascular risk.SummaryRecent evidence suggests that use of the 2017 AAP CPG will r...
Source: Current Hypertension Reports - April 5, 2019 Category: Primary Care Source Type: research

Comparison of Cardiovascular Benefits of Bariatric Surgery and Abdominal Lipectomy
AbstractPurpose of ReviewThe purpose of this review is to examine recent evidence supporting effectiveness of bariatric surgery and abdominal lipectomy as interventional strategies aimed at reduction in incidence of cardiovascular disease (CVD) and related morbidity and mortality in obese and metabolic syndrome patients.Recent FindingsWhile several studies show reduction in CVD risk factors in patients who have undergone both the Roux-en-Y gastric bypass and sleeve gastrectomy, very few demonstrate actual improvements in cardiovascular function, or a decrease in CVD events or CVD-related mortality. Consequently, the cardio...
Source: Current Hypertension Reports - April 5, 2019 Category: Primary Care Source Type: research

Sleep and Resistant Hypertension
AbstractPurpose of ReviewThe goal of the present review is to describe the current findings on the association of sleep with resistant hypertension (hypertension that remains uncontrolled despite the use of three or more antihypertensive medications from different classes, including a diuretic).Recent FindingsSleep disturbances, particularly obstructive sleep apnea (OSA), are highly prevalent among adults who have resistant hypertension. Randomized controlled trials indicate that treating OSA has modest effects on blood pressure lowering among those with the highest initial blood pressure. There is a paucity of research on...
Source: Current Hypertension Reports - April 5, 2019 Category: Primary Care Source Type: research

Automated Office-Based Blood Pressure Measurement: an Overview and Guidance for Implementation in Primary Care
AbstractPurpose of ReviewThe purposes of this study are to review evidence supporting the use of automated office blood pressure (AOBP) measurement and to provide practical guidance for implementing it in clinical settings.Recent FindingsMean AOBP readings correlate with awake ambulatory blood pressure monitor (ABPM) values and predict cardiovascular outcomes better than conventional techniques. However, heterogeneity among readings suggests that AOBP does not replace ABPM. Blood pressure (BP) measurement protocols differ among commonly described AOBP devices, but all produce valid BP estimates. Rest periods should not pre...
Source: Current Hypertension Reports - April 4, 2019 Category: Primary Care Source Type: research

Pathogenesis of Familial Hyperaldosteronism Type II: New Concepts Involving Anion Channels
AbstractPurpose of ReviewThe application of advanced genetic techniques has recently begun to unravel the genetic basis for familial primary aldosteronism type 2 (FH-II).Recent FindingsWhole-exome sequencing in a large family with FH-II revealed a shared rare damaging heterozygous variant inCLCN2 (chr.3: g.184075850C>T, p.Arg172Gln) in three severely affected members. The gene encodes a chloride channel, ClC-2. A cohort of 80 unrelated individuals diagnosed with early-onset primary aldosteronism was also examined forCLCN2 mutations finding three further occurrences of p.Arg172Gln mutations and four single cases of other...
Source: Current Hypertension Reports - April 4, 2019 Category: Primary Care Source Type: research

Hypertension and Pre-Hypertension Among Iranian Adults Population: a Meta-Analysis of Prevalence, Awareness, Treatment, and Control
In this study, six international and national databases were searched from inception until August 30, 2018. Forty-eight studies performed on 417,392 participants were included in the meta-analysis. Based on the results of random effect method (95% CI), the overall prevalence of pre-hypertension, hypertension, awareness, treatment, and control were 31.6% (95% CI 24.9, 38.3; I2  = 99.7%), 20.4% (95% CI 16.5, 24.4; I2 = 99.9%), 49.3% (95% CI 44.8, 53.8; I2 = 98.5%), 44.8% (95% CI 28.3, 61.2; I2 = 99.9%), 37.4% (95% CI 29.0, 45.8; I2 = 99.3%), respectively.S...
Source: Current Hypertension Reports - April 4, 2019 Category: Primary Care Source Type: research

Obstructive Sleep Apnea and Hypertension: Why Treatment Does Not Consistently Improve Blood Pressure
AbstractPurpose of ReviewObstructive sleep apnea (OSA) and hypertension are two phenomena deeply linked together and, although a causal relationship has been suggested, a recent meta-analysis showed only a very modest effect of OSA treatment on blood pressure (BP). However, a vast number of randomized controlled trials published so far share some limitations, mainly of methodological nature: neither OSA nor BP is always assessed in a standardized way. Moreover, compliance with OSA treatment is often sub-optimal making the results of these trials difficult to interpret.Recent FindingsRecent studies have shown that antihyper...
Source: Current Hypertension Reports - April 4, 2019 Category: Primary Care Source Type: research

Microvascular Endothelial Dysfunction in Patients with Obesity
AbstractPurpose of ReviewTo examine the state of the art on the pathogenesis of endothelial dysfunction in the microcirculation of patients with obesity, focusing on the complex relationship between the consolidated and the novel mechanisms involved in this alteration.Recent FindingsHuman obesity is associated with vascular endothelial dysfunction, caused by a reduced nitric oxide availability secondary to an enhanced oxidative stress production. Pro-inflammatory cytokine generation, secreted by perivascular adipose tissue, is a major mechanism whereby obesity is associated with a reduced vascular NO availability. Vasculat...
Source: Current Hypertension Reports - April 4, 2019 Category: Primary Care Source Type: research

Revisiting the Brain Renin-Angiotensin System —Focus on Novel Therapies
AbstractPurpose of ReviewAlthough an independent brain renin-angiotensin system is often assumed to exist, evidence for this concept is weak. Most importantly, renin is lacking in the brain, and both brain angiotensinogen and angiotensin (Ang) II levels are exceptionally low. In fact, brain Ang II levels may well represent uptake of circulating Ang II via Ang II type 1 (AT1) receptors.Recent FindingsNevertheless, novel drugs are now aimed at the brain RAS, i.e., aminopeptidase A inhibitors should block Ang III formation from Ang II, and hence diminish AT1 receptor stimulation by Ang III, while AT2 and Mas receptor agonists...
Source: Current Hypertension Reports - April 4, 2019 Category: Primary Care Source Type: research

Masked Hypertension: Whom and How to Screen?
AbstractPurpose of ReviewTo review issues regarding the practical implementation of screening strategies for masked hypertension.Recent FindingsMasked hypertension has been associated with an increased risk of cardiovascular disease events and all-cause mortality. Recent guidelines have encouraged practitioners to use out-of-clinic monitoring to detect masked hypertension in some situations. However, it is unclear from these guidelines who should be screened or how to best measure out-of-office blood pressure. In this review, challenges to screening strategies for masked hypertension, and factors that should be considered ...
Source: Current Hypertension Reports - April 4, 2019 Category: Primary Care Source Type: research

Sexual Dysfunction in Women with Hypertension: a Systematic Review and Meta-analysis
AbstractPurpose of ReviewWe aimed to evaluate the prevalence of sexual dysfunction in hypertensive women and compare sexual dysfunction between hypertensive and non-hypertensive women.Recent FindingsConducted a systematic review in the following databases: PubMed, EMBASE, Scopus, Web of Science, IBECS, and Lilacs.We included articles evaluating the prevalence of sexual dysfunction in a woman and/or comparing sexual dysfunction between hypertensive and non-hypertensive women. Studies were excluded if they evaluated patients with secondary hypertension, examined sexual dysfunction caused by drugs, did not distinguish by gend...
Source: Current Hypertension Reports - April 3, 2019 Category: Primary Care Source Type: research

Management of Hypertension in the Obese Pregnant Patient
AbstractPurpose of ReviewTo evaluate recent developments in the management of hypertension in obese pregnant women.Recent FindingsThe mainstay of management targets prevention of hypertension with preconception counselling, entering pregnancy with a lower BMI, limiting weight gain, and taking low-dose aspirin to prevent pre-eclampsia from before 16  weeks’ gestation. There are conflicting results regarding the use of metformin in reducing hypertensive disease, but there is a high probability that it has a role to play. Clinical trials are in progress examining the use of statins in preventing pre-eclampsia, with...
Source: Current Hypertension Reports - March 26, 2019 Category: Primary Care Source Type: research

Eplerenone Versus Spironolactone in Resistant Hypertension: an Efficacy and/or Cost or Just a Men ’s Issue?
AbstractPurpose of ReviewTo review comparative efficacy and tolerability data between the two main mineralocorticoid receptor antagonists (MRAs), spironolactone and eplerenone, in patients with resistant hypertension (HTN). The focus was whether spironolactone, being the classical non-selective agent that has been used for years, albeit with several anti-androgenic side effects, can be rivaled by eplerenone, an apparently weaker, but better tolerated, more selective MRA.Recent FindingsEvidence has accumulated that resistant HTN is generally volume-dependent, attributable to varying degrees of aldosterone excess with its at...
Source: Current Hypertension Reports - March 2, 2019 Category: Primary Care Source Type: research

Emerging Therapy in Hypertension
AbstractPurpose of the ReviewPharmacology remains the mainstay of treatment for hypertension across the globe. In what may seem like a well-trodden field, there are actually an exciting array of new pathways for the treatment of hypertension on the horizon. This review seeks to discuss the most recent research in ongoing areas of drug development in the field of hypertension.Recent FindingsNovel areas of research in the field of hypertension pharmacology include central nervous system regulators, peripheral noradrenergic inhibitors, gastrointestinal sodium modulators, and a counter-regulatory arm of the renin-angiotensin-a...
Source: Current Hypertension Reports - March 2, 2019 Category: Primary Care Source Type: research

The Role of Arterial Hypertension in Mitral Valve Regurgitation
AbstractPurpose of ReviewTo review medical literature for evidence of association between hypertension and mitral regurgitation (MR) and summarize potential favorable effects of antihypertensive drugs on MR natural history and treatment.Recent FindingsHypertension and MR are common diseases affecting a large proportion of the general population. Contemporary evidence suggests that hypertension may worsen the progression and prognosis of MR through augmented mechanical stress and increased regurgitation volume. Renin-angiotensin axis inhibitors, beta-blockers, and vasodilators have been tested in order to prevent or decreas...
Source: Current Hypertension Reports - February 28, 2019 Category: Primary Care Source Type: research

Increased Risk of Hypertension in Young Adults in Southwest China: Impact of the 2017 ACC/AHA High Blood Pressure Guideline
AbstractPurpose of ReviewTo examine the impact of the new 2017 ACC/AHA hypertension guideline on the prevalence of hypertension, its constituent ratio, and their associated factors in southwest China.Recent FindingsA total of 14,220 permanent residents ≥ 18 years were enrolled in this survey. According to the 2017 ACC/AHA hypertension guideline, the hypertension prevalence was substantially increased (46.9% vs. 24.5%); consistent across different age and gender groups, while the hypertension awareness (23.8% vs. 45.6%); treatment (18.6% vs. 3 5.5%); control (2.3% vs. 11.2%); and control among treatment (9.6%...
Source: Current Hypertension Reports - February 28, 2019 Category: Primary Care Source Type: research

Incorporation of Novel Vascular Measures into Clinical Management: Recent Insights from the Framingham Heart Study
AbstractPurpose of ReviewThe review discusses evidence from the Framingham Heart Study that supports the assessment and utility of novel vascular and blood pressure measures to inform clinical management of blood pressure –related cardiovascular disease.Recent FindingsRecent Framingham Heart Study investigations provide new insights into the associations of novel and traditional vascular and blood pressure measures, such as measures of aortic stiffness, components of blood pressure waves, and orthostatic change in blood pressure, with cardiovascular disease events and brain structure and function. Novel vascular meas...
Source: Current Hypertension Reports - February 21, 2019 Category: Primary Care Source Type: research

Implementing Home Blood Pressure Monitoring into Clinical Practice
AbstractPurpose of ReviewTo review data supporting the use of home blood pressure monitoring (HBPM) and provide practical guidance to clinicians wishing to incorporate HBPM into their practice.Recent FindingsHBPM more accurately reflects the risk of cardiovascular events than office blood pressure measurement. In addition, there is high-quality evidence that HBPM combined with clinical support improves blood pressure control. Therefore, HBPM is increasingly recommended by guidelines to confirm the diagnosis of hypertension and evaluate the efficacy of blood pressure-lowering medications. Nevertheless, HBPM use remains low ...
Source: Current Hypertension Reports - February 12, 2019 Category: Primary Care Source Type: research

Weight Loss Medications in the Treatment of Obesity and Hypertension
AbstractPurpose of ReviewWeight loss is strongly associated with improvement in blood pressure; however, the mechanism of weight loss can impact the magnitude and sustainability of blood pressure reduction.Recent FindingsFive drugs —orlistat, lorcaserin, liraglutide, phentermine/topiramate, and naltrexone/bupropion—are currently approved for weight loss therapy in the USA. Naltrexone/bupropion results in an increase in in-office and ambulatory blood pressure compared to placebo. Other therapies are associated with modest l owering of blood pressure, and are generally well-tolerated; nonetheless, evidence is lim...
Source: Current Hypertension Reports - February 12, 2019 Category: Primary Care Source Type: research

Personalized Medicine and the Treatment of Hypertension
AbstractPurpose of ReviewThe purpose of this review is to discuss the implications of personalized medicine for the treatment of hypertension, including resistant hypertension.Recent FindingsWe suggest a framework for the personalized treatment of hypertension based on the concept of a trade-off between simplicity and personalization. This framework is based on treatment strategies classified as low, medium, or high information burden personalization approaches. The extent to which a higher information burden is justified depends on the clinical scenario, particularly the ease with which the blood pressure can be controlle...
Source: Current Hypertension Reports - February 12, 2019 Category: Primary Care Source Type: research

Blood Pressure Lowering and Sodium-Glucose Co-transporter 2 Inhibitors (SGLT2is): More Than Osmotic Diuresis
AbstractPurpose of ReviewThis is an update of data regarding changes in blood pressure using sodium-glucose co-transporter 2 inhibitors (SGLT2i) for the treatment of diabetes. The mechanism of blood pressure lowering by SGLT2i was thought to be due to their osmotic diuretic effects. New data, however, has emerged from meta-analyses and studies of people with impaired kidney function demonstrating similar or greater magnitudes of blood pressure reduction in the absence of significant glycosuria. Potential additional mechanisms are proposed and reviewed.Recent FindingsTwo separate meta-analyses in over 10,000 participants co...
Source: Current Hypertension Reports - February 12, 2019 Category: Primary Care Source Type: research

Dietary Fat and Blood Pressure
AbstractPurpose of ReviewDo dietary fats lower blood pressure? This review covers total fats, individual fatty acids and foods that provide specific fats.Recent FindingsEvidence for blood pressure lowering is stronger for supplements providing individual marine fatty acids than for fish intake since data on fish consumption are scarce. Such effects are more readily apparent in hypertensive than normal subjects. Biological mechanisms to support linkage between dietary fish oils and blood pressure are plausible. Information on other dietary fatty acids (saturates, linoleic acid, alpha-linolenic acid) is mostly less robust an...
Source: Current Hypertension Reports - February 12, 2019 Category: Primary Care Source Type: research

Real-World Strategies to Treat Hypertension Associated with Pediatric Obesity
AbstractPurpose of ReviewTo review the most recent literature on current strategies for the treatment of hypertension associated with pediatric obesity.Recent FindingsOver the last three decades, childhood and adolescent overweight and obesity prevalence in the USA has continued to rise. Unsurprisingly but rather disturbingly, this rising prevalence has been paralleled by an increase in cardiovascular disease (CVD) risk factors in childhood such as hypertension, dyslipidemia, and diabetes that become manifest earlier than previously reported. These childhood CVD risk factors are not only associated with target organ damage...
Source: Current Hypertension Reports - February 12, 2019 Category: Primary Care Source Type: research

Four-Limb Blood Pressure Measurement with an Oscillometric Device: a Tool for Diagnosing Peripheral Vascular Disease
AbstractPurpose of ReviewTraditionally, the term peripheral vascular disease (PAD) is restricted to the occlusive arterial disease in the leg, but now, the connotation of PAD is more widespread as it encompasses all extracoronary and extracerebral vascular disease. The incidence of PAD is increasing worldwide; therefore, it is necessary to diagnose PAD at an early stage.Recent FindingsOscillometric BP device is widely used for four-limb measurement in clinical practice and provides several parameters for evaluating inter-limb BP difference, such as ankle-brachial index (OS-ABI), inter-arm BP differences (IAD), and inter-an...
Source: Current Hypertension Reports - February 12, 2019 Category: Primary Care Source Type: research

A Meta-analysis to Determine the Validity of Taking Blood Pressure Using the Indirect Cuff Method
AbstractPurpose of ReviewThe purpose of this meta-analysis was to compare the magnitude of systematic bias (mean difference) and random error (standard deviation of mean difference) between the cuff method of indirect blood pressure and directly measured intra-arterial pressure.Recent FindingsBlood pressure is almost exclusively assessed using the indirect cuff method; however, numerous individual studies have questioned the validity relative to directly measured intra-arterial blood pressure.SummaryPubMed, SportsDiscus, and Scopus were searched through February 2018. Data were analyzed using a random effects model. A tota...
Source: Current Hypertension Reports - February 7, 2019 Category: Primary Care Source Type: research

Autoimmune Disease-Associated Hypertension
AbstractPurpose of ReviewTo highlight important new findings on the topic of autoimmune disease-associated hypertension.Recent FindingsAutoimmune diseases including systemic lupus erythematosus and rheumatoid arthritis are associated with an increased risk for hypertension and cardiovascular disease. A complex interaction among genetic, environmental, hormonal, and metabolic factors contribute to autoimmune disease susceptibility while promoting chronic inflammation that can lead to alterations in blood pressure. Recent studies emphasize an important mechanistic role for autoantibodies in autoimmune disease-associated hype...
Source: Current Hypertension Reports - February 2, 2019 Category: Primary Care Source Type: research

Innate and Innate-Like Immune System in Hypertension and Vascular Injury
AbstractPurpose of ReviewTo describe the important role played by innate and innate-like immunity in the pathophysiology of hypertension and vascular injury.Recent FindingsInnate immune cells, such as neutrophils, dendritic cells, myeloid-derived suppressor cells, and monocytes/macrophages and innate lymphoid cells such as natural killer cells and unconventional T lymphocytes likeγδ T cells contribute to hypertensive mechanisms by priming adaptive immune cells, leading to the triggering of vascular inflammation and blood pressure elevation or alternatively protecting against vascular injury. Specifically, monoc...
Source: Current Hypertension Reports - January 18, 2019 Category: Primary Care Source Type: research

Antihypertensive Agents in the Dialysis Patient
AbstractPurpose of ReviewHypertension and antihypertensive drug utilization are remarkably prevalent in ESRD patients. Management of blood pressure elevation in this population is complicated by many factors, including a multidimensional etiology, challenges in obtaining accurate and appropriately timed blood pressure measurements, highly specific drug dosing requirements, and a paucity of outcomes-based evidence to guide management decisions. The purpose of this review is to summarize and apply knowledge from existing clinical trials to enhance safe and effective use of antihypertensive agents in dialysis patients.Recent ...
Source: Current Hypertension Reports - January 18, 2019 Category: Primary Care Source Type: research

Unanswered Questions Regarding Blood Pressure Management for HF Prevention
AbstractPurpose of ReviewEvaluate the relevant new findings regarding hypertension treatment and heart failure prevention published in the past 3  years.Recent FindingsIn a recent secondary analysis of Systolic Blood Pressure Intervention Trial (SPRINT), randomization of more than 9000 patients>  50 years old with high cardiovascular risk but without diabetes to intensive treatment targeting blood pressure
Source: Current Hypertension Reports - January 18, 2019 Category: Primary Care Source Type: research

A Novel Mechanism of Renal Microcirculation Regulation: Connecting Tubule-Glomerular Feedback
AbstractPurpose of ReviewIn this review, we summarized the current knowledge of connecting tubule-glomerular feedback (CTGF), a novel mechanism of renal microcirculation regulation that integrates sodium handling in the connecting tubule (CNT) with kidney hemodynamics.Recent FindingsConnecting tubule-glomerular feedback is a crosstalk communication between the CNT and the afferent arteriole (Af-Art), initiated by sodium chloride through the epithelial sodium channel (ENaC). High sodium in the CNT induces Af-Art vasodilation, increasing glomerular pressure and the glomerular filtration rate and favoring sodium excretion. CT...
Source: Current Hypertension Reports - January 18, 2019 Category: Primary Care Source Type: research

Preventing Heart Failure by Treating Systolic Hypertension: What Does the SPRINT Add?
AbstractPurpose of ReviewPrevious trials definitively established that lowering systolic blood pressure (BP) to 140  mmHg prevented heart failure (HF) exacerbations, but the potential benefits and risks of further BP reduction remain unclear due to a paucity of trial-based data.Recent FindingsA recent secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) found that in older, high-risk, non-diabetic participants with systolic hypertension, a BP treatment target
Source: Current Hypertension Reports - January 18, 2019 Category: Primary Care Source Type: research

Management of “Hypertension” Based on Blood Pressure Level Versus an Absolute Cardiovascular Risk Approach
AbstractPurpose of ReviewTo address the tension between guideline recommendations and the evidence from clinical trials supporting them and clinician concerns of overtreatment of elevated blood pressure.Recent FindingsSystolic Blood Pressure Intervention trial (SPRINT) demonstrated lower blood pressure targets provided robust clinical benefit (reduced all-cause mortality) but also expected adverse events due to hypotension. Treatment thresholds for systolic blood pressure in the latest US guidelines have been lowered to 130  mmHg, although this has not been adopted elsewhere. These guidelines specify that treatment in...
Source: Current Hypertension Reports - January 18, 2019 Category: Primary Care Source Type: research

Recent Advances in Imaging of Hypertensive Heart Disease
AbstractPurpose of ReviewTo review recent advances in the imaging of hypertensive heart disease (HHD) with an emphasis on developments in the imaging of diffuse myocardial fibrosis using cardiac magnetic resonance (CMR).Recent FindingsHHD results from long-standing hypertension and is characterized by the development of left ventricular hypertrophy and diffuse interstitial fibrosis. Diffuse fibrosis traditionally required endomyocardial biopsy to diagnose, but recent developments using T1 mapping in CMR allow for noninvasive assessment. Studies using T1 mapping have shown an increase in extracellular volume fraction (ECV) ...
Source: Current Hypertension Reports - January 14, 2019 Category: Primary Care Source Type: research

Impact of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines on the Next Blood Pressure Guidelines in Asia
AbstractPurpose of ReviewTo estimate the impact of the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for high blood pressure (BP) on the next hypertension guidelines in Asia.Recent FindingsThe 2017 ACC/AHA guidelines for high BP in adults changed the diagnostic threshold and the management goal of BP from 140/90 to 130/80  mmHg. Another characteristic of the new guideline is its focus on a practical approach for the effective management of hypertension by using home and ambulatory BP monitoring; this point is also recommended in the 2014 Japanese Society of Hypertension Guidelines...
Source: Current Hypertension Reports - January 10, 2019 Category: Primary Care Source Type: research

Correction to: Chronotherapy for Hypertension
The meta-analysis referenced in the"Obstructive Sleep Apnea" section should instead refer to a meta-analysis for chronic kidney disease. Additionally, there are two mis-numbered reference citations in the “chronic kidney disease” section (ref. 107 should ref. 104 [Wang C et al. 2014] and ref. 105. (Source: Current Hypertension Reports)
Source: Current Hypertension Reports - December 4, 2018 Category: Primary Care Source Type: research