Stress, Genes, and Hypertension. Contribution of the ISIAH Rat Strain Study
AbstractPurpose of ReviewAcute psychoemotional stress is one of the causes of a sharp increase in blood pressure. However, the question if the stress may promote the hypertensive disease development is still open. This review aims, firstly, to show that the genetically determined enhanced responsiveness to stress is linked to sustained hypertension development and, secondly, to characterize the main physiological mechanisms and genetic factors implicated in the pathogenesis of stress-sensitive hypertension.Recent FindingsRecent findings helped to characterize the main neuroendocrine mechanisms and the specificity of the ge...
Source: Current Hypertension Reports - June 16, 2018 Category: Primary Care Source Type: research

Resistant Hypertension: Time to Consider the Best Fifth Anti-Hypertensive Treatment
AbstractPurpose of ReviewResistant hypertension (RH) is a growing clinical condition worldwide associated with target-organ damage and poor prognosis compared to non-resistant counterparts. The purpose of this review is to perform a critical evaluation of preferable drug choices for managing RH highlighting the evidence that significant proportion of patients remained uncontrolled despite using four anti-hypertensive drugs.Recent FindingsUntil recently, the fourth drug therapy was main derived from personal opinion or small interventional studies. The recent data derived from two multicentric randomized trials, namely PATH...
Source: Current Hypertension Reports - June 16, 2018 Category: Primary Care Source Type: research

Nurse ’s Contribution to Alleviate Non-adherence to Hypertension Treatment
AbstractPurpose of ReviewHypertension consists a major risk factor for cardiovascular events. Despite the proven effectiveness of antihypertensive treatment, approximately half of hypertensive patients have inadequate blood pressure control. Non-adherence to medication has been shown to be an important barrier to achieving adequate blood pressure control and nurse interventions can substantially improve therapeutic compliance. We sought to evaluate the role of nurse interventions in alleviating non-adherence to medication in patients with hypertension by performing a systematic review of the literature for all relevant art...
Source: Current Hypertension Reports - June 15, 2018 Category: Primary Care Source Type: research

Treatment of Hypertension in Chronic Kidney Disease
AbstractPurpose of ReviewChronic kidney disease (CKD) is recognized as a worldwide epidemic. Hypertension commonly coexists with CKD and its prevalence is progressively increasing as kidney function declines.Recent FindingsFor patients with established CKD and/or diabetes with albuminuria, the updated hypertension guidelines have recommended a blood pressure (BP) goal
Source: Current Hypertension Reports - June 11, 2018 Category: Primary Care Source Type: research

Resistant Hypertension in Pregnancy: How to Manage?
AbstractPurpose of ReviewThe concept of resistant hypertension may be changed during pregnancy by the physiological hemodynamic changes and the particularities of therapy choices in this period. This review discusses the management of pregnant patients with preexisting resistant hypertension and also of those who develop severe hypertension in gestation and puerperium.Recent FindingsThe main cause of severe hypertension in pregnancy is preeclampsia, and differential diagnosis must be done with secondary or primary hypertension. Women with preexisting resistant hypertension may need pharmacological therapy adjustment. Sever...
Source: Current Hypertension Reports - June 11, 2018 Category: Primary Care Source Type: research

Interplay between the renin-angiotensin system, the canonical WNT/ β-catenin pathway and PPARγ in hypertension
AbstractPurpose of ReviewHeterogeneous causes can determinate hypertension.Recent FindingsThe renin-angiotensin system (RAS) has a major role in the pathophysiology of blood pressure. Angiotensin II and aldosterone are overexpressed during hypertension and lead to hypertension development and its cardiovascular complications. In several tissues, the overactivation of the canonical WNT/ β-catenin pathway leads to inactivation of peroxisome proliferator-activated receptor gamma (PPARγ), while PPARγ stimulation induces a decrease of the canonical WNT/β-catenin pathway. In hypertension, the WNT/β-cat...
Source: Current Hypertension Reports - June 9, 2018 Category: Primary Care Source Type: research

Disparities in Hypertension Among African-Americans: Implications of Insufficient Sleep
We present contemporary evidence on the unequal burden of insufficient sleep in Blacks/African-Americans and the repercussions for disparate risk of hypertension.Recent FindingsThe prevalence of insufficient sleep is high and rising and has been recognized as an important cardiovascular risk factor. Presumably due to a constellation of environmental, psychosocial, and individual determinants, these risks appear exacerbated in Blacks/African-Americans, who are more likely to experience short sleep than other ethnic/racial groups. Population-based data suggest that the risk of hypertension associated with sleep deficiency is...
Source: Current Hypertension Reports - June 8, 2018 Category: Primary Care Source Type: research

Hypertension in Pediatric Dialysis Patients: Etiology, Evaluation, and Management
AbstractPurpose of ReviewReview epidemiology, pathophysiology, and management of hypertension in the pediatric dialysis population.Recent FindingsInterdialytic blood pressure measurement, especially with ambulatory blood pressure monitoring, is the gold standard to assess for hypertension. Tools to assess dry weight aid in achievement of euvolemia, the primary therapy for management of hypertension. Persistent hypertension should be treated with antihypertensive medications and potentially with native nephrectomies.SummaryCardiovascular disease continues to be the primary cause of morbidity and mortality in the dialysis po...
Source: Current Hypertension Reports - June 8, 2018 Category: Primary Care Source Type: research

Preeclampsia Risks in Kidney Donors and Recipients
AbstractPurpose of ReviewTo review the studies and practice guidelines on the preeclampsia risks in kidney donors and recipients.Recent FindingsThere is a small increased risk of gestational hypertension and preeclampsia in pregnancies that follow kidney donation. Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline (2017) and the 2015 American Society of Transplantation (AST) consensus conference statement recommends counseling kidney donors about this increased risk. There is no observed increase in fetal complications or eclampsia post-kidney donation. Preeclampsia is more commonly observed in ki...
Source: Current Hypertension Reports - June 8, 2018 Category: Primary Care Source Type: research

ACE Inhibitor-Induced Angioedema: a Review
ConclusionACE-I are frequently used therapeutic agents that are associated with angioedema. Their use should be avoided in high-risk individuals and early diagnosis, tracheal intubation in cases of airway compromise, and absolute avoidance of re-challenge are important. (Source: Current Hypertension Reports)
Source: Current Hypertension Reports - June 8, 2018 Category: Primary Care Source Type: research

Focused Update on Pharmacologic Management of Hypertensive Emergencies
AbstractPurpose of ReviewHypertensive emergency is defined as a systolic blood pressure>  180 mmHg or a diastolic blood pressure>  120 mmHg with evidence of new or progressive end-organ damage. The purpose of this paper is to review advances in the treatment of hypertensive emergencies within the last 5 years.Recent FindingsNew literature and recommendations for managing hypertensive emergencies in the setting of pregnancy, stroke, and heart failure have been published.SummaryOral nifedipine is now considered an alternative first-line therapy, along with intravenous hydralazine and labeta...
Source: Current Hypertension Reports - June 8, 2018 Category: Primary Care Source Type: research

Sex-Specific Contributions of Endothelin to Hypertension
AbstractPurpose of ReviewMen and women differ in the prevalence, pathophysiology and control rate of hypertension in an age-dependent manner. The renal endothelin system plays a central role in sex differences in blood pressure regulation by control of sodium excretion and vascular function. Improving our understanding of the sex differences in the endothelin system, especially in regard to blood pressure regulation and sodium homeostasis, will fill a significant gap in our knowledge and may identify sex-specific therapeutic targets for management of hypertension.Recent FindingsThe current review will highlight evidence fo...
Source: Current Hypertension Reports - June 8, 2018 Category: Primary Care Source Type: research

The Use of Precision Medicine to Manage Obstructive Sleep Apnea Treatment in Patients with Resistant Hypertension: Current Evidence and Future Directions
AbstractPurpose of ReviewThe significant prevalence of resistant hypertension (RH) and the high cardiovascular risk of the population of patients with RH have indicated the necessity to identify its main causes. Among these, obstructive sleep apnea (OSA) is considered the most well-established cause.Recent FindingsIn recent years, several studies have shown a beneficial effect of continuous positive airway pressure (CPAP) treatment on blood pressure (BP), but this effect exhibits great variability. The diagnosis and management of OSA in patients with RH suggest a clinical option for a phenotype of patients for whom therape...
Source: Current Hypertension Reports - June 8, 2018 Category: Primary Care Source Type: research

Recent Findings in the Genetics of Blood Pressure: How to Apply in Practice or Is a Moonshot Required?
AbstractPurpose of ReviewHypertension is recognised as the biggest contributor to the global burden of disease, but it is controlled in less than a fifth of patients worldwide, despite being relatively easy to detect and the availability of inexpensive safe generic drugs. Blood pressure is regulated by a complex network of physiologic pathways with currently available drugs targeting key receptors or enzymes in the top pathways. Major advances in the dissection of both monogenic and polygenic determinants of blood pressure regulation and variation have not resulted in rapid translation of these discoveries into clinical ap...
Source: Current Hypertension Reports - June 7, 2018 Category: Primary Care Source Type: research

Carotid Body Ablation: a New Target to Address Central Autonomic Dysfunction
AbstractPurpose of ReviewAn abnormal heightened carotid body (CB) chemoreflex, which produces autonomic dysfunction and sympathetic overactivation, is the common hallmark of obstructive sleep apnea (OSA), resistant hypertension, systolic heart failure (HF), and cardiometabolic diseases. Accordingly, it has been proposed that the elimination of the CB chemosensory input to the brainstem may reduce the autonomic and cardiorespiratory alterations in sympathetic-associated diseases in humans.Recent FindingsA growing body of evidence obtained in preclinical animal models support that an enhanced CB discharge produces sympatheti...
Source: Current Hypertension Reports - May 22, 2018 Category: Primary Care Source Type: research

Insomnia, Short Sleep Duration, and High Blood Pressure: Recent Evidence and Future Directions for the Prevention and Management of Hypertension
AbstractPurpose of ReviewTo summarize research from the past 2  years on the association between insomnia, short sleep duration, and hypertension and provide a critical analysis of the evidence and suggestions for future directions in this field.Recent FindingsEvidence indicates that the association between insomnia and elevated blood pressure (BP) or stage 1 and 2 hypertension is stronger in those with chronic insomnia, as compared to those with isolated insomnia symptoms, and primarily found in those with the insomnia with objective short sleep duration phenotype. There is a key gap in ambulatory BP monitoring acros...
Source: Current Hypertension Reports - May 19, 2018 Category: Primary Care Source Type: research

Update on Endothelin Receptor Antagonists in Hypertension
AbstractPurpose of ReviewTo review the most recent data on the development of endothelin receptor antagonists (ERAs) for the treatment of hypertension and the management of diabetic nephropathyRecent FindingsRecent reviews and meta-analyses of experimental and clinical data obtained with ERAs confirmed that endothelin receptor blockade is associated with significant decreases in blood pressure in essential hypertension but also in resistant hypertension. In addition, in patients with diabetic nephropathy, ERAs induce significant 30 –40% decreases in albuminuria when administered on top of blockers of the renin-angiot...
Source: Current Hypertension Reports - May 19, 2018 Category: Primary Care Source Type: research

Genetics of Resistant Hypertension: the Missing Heritability and Opportunities
AbstractPurpose of the ReviewBlood pressure regulation in humans has long been known to be a genetically determined trait. The identification of causal genetic modulators for this trait has been unfulfilling at the least. Despite the recent advances of genome-wide genetic studies, loci associated with hypertension or blood pressure still explain a very low percentage of the overall variation of blood pressure in the general population. This has precluded the translation of discoveries in the genetics of human hypertension to clinical use. Here, we propose the combined use of resistant hypertension as a trait for mapping ge...
Source: Current Hypertension Reports - May 19, 2018 Category: Primary Care Source Type: research

ConfidenHT ™ System for Diagnostic Mapping of Renal Nerves
AbstractPurpose of ReviewTo summarize the evidence regarding the distribution of renal nerves and their patterns of anatomic variations in animal and human settings. Moreover, the methodology and results of studies regarding renal nerve stimulation (RNS) in both preclinical and clinical models are presented.Recent FindingsThere are differences regarding the number and the size of renal fibers, as well as their distance from the lumen in the diverse parts of the main renal arteries and the branches. In both animals and humans, RNS is safe and results in an increase of blood pressure (BP) while the effect on heart rate varie...
Source: Current Hypertension Reports - May 19, 2018 Category: Primary Care Source Type: research

Dietary Modifications and Lipid Accumulation Product Are Associated with Systolic and Diastolic Blood Pressures in the Women ’s Health Trial: Feasibility Study in Minority Populations
AbstractPurpose of ReviewApproximately 65% of adults over 60  years in the USA are hypertensive. Poor dietary habits and sedentary lifestyles are fueling the hypertension epidemic. The effects of higher intakes of fruits and vegetables and whole-grain products on systolic and diastolic blood pressures were analyzed using data at baseline, 6 months, and 12  months on 349 and 573 subjects, respectively, in the control and intervention groups of the Women’s Health Trial: Feasibility Study in Minority Populations.Recent FindingsModels for systolic and diastolic blood pressures have been estimated using cro...
Source: Current Hypertension Reports - May 19, 2018 Category: Primary Care Source Type: research

Correction to: Dimerization of AT 2 and Mas Receptors in Control of Blood Pressure
In the original publication, the Fig.  1 caption contains an error. The original article has been corrected. (Source: Current Hypertension Reports)
Source: Current Hypertension Reports - May 12, 2018 Category: Primary Care Source Type: research

Endovascular Baroreflex Amplification for Resistant Hypertension
AbstractPurpose of reviewMost hypertension devices have been designed to interrupt or modify the sympathetic nervous system, which seems to be unbalanced in hypertension. Carotid baroreceptors play a pivotal role in maintaining adrenergic balance via a direct feedback interface and would be an exceptional target for intervention. The purpose of this review is to define the role of the baroreceptor in hypertension, to examine device-based therapies targeting the baroreflex and to explore future promises of endovascular baroreflex amplification (EBA).Recent findingsIn the last two decades, two therapeutic strategies targetin...
Source: Current Hypertension Reports - May 9, 2018 Category: Primary Care Source Type: research

Anti-Inflammatory Effects of Melatonin in Obesity and Hypertension
AbstractPurpose of ReviewHere, we review the known relations between hypertension and obesity to inflammation and postulate the endogenous protective effect of melatonin and its potential as a therapeutic agent. We will describe the multiple effects of melatonin on blood pressure, adiposity, body weight, and focus on mitochondrial-related anti-inflammatory and antioxidant protective effects.Recent FindingsHypertension and obesity are usually associated with systemic and tissular inflammation. The progressive affection of target-organs involves multiple mediators of inflammation, most of them redundant, which make anti-infl...
Source: Current Hypertension Reports - May 9, 2018 Category: Primary Care Source Type: research

Modulation of Vascular Reactivity by Perivascular Adipose Tissue (PVAT)
AbstractPurpose of ReviewIn this review, we discuss the role of perivascular adipose tissue (PVAT) in the modulation of vascular contractility and arterial pressure, focusing on the role of the renin-angiotensin-aldosterone system and oxidative stress/inflammation.Recent FindingsPVAT possesses a relevant endocrine-paracrine activity, which may be altered in several pathophysiological and clinical conditions. During the last two decades, it has been shown that PVAT may modulate vascular reactivity. It has also been previously demonstrated that inflammation in adipose tissue may be implicated in vascular dysfunction. In part...
Source: Current Hypertension Reports - May 7, 2018 Category: Primary Care Source Type: research

The Role of Circadian Rhythms in the Hypertension of Diabetes Mellitus and the Metabolic Syndrome
AbstractPurpose of the ReviewCellular circadian clocks regulate physiological functions during day and night. It has been convincingly demonstrated that hypertension in patients suffering from diabetes mellitus or metabolic syndrome is characterized in most cases by a disturbed 24-h profile resulting in a nondipper pattern. We consider possible correlation between biological clocks and symptoms of the metabolic syndrome.Recent FindingsChanges in circadian clock function have been linked to metabolic disorders in genome-wide association studies. Epidemiological studies have shown that a loss of nocturnal decline in blood pr...
Source: Current Hypertension Reports - May 5, 2018 Category: Primary Care Source Type: research

Dimerization of AT 2 and Mas Receptors in Control of Blood Pressure
AbstractPurpose of ReviewAngiotensin type 2 receptor (AT2R) and receptor Mas (MasR) are part of the “protective arm” of the renin angiotensin system. Gene and pharmacological manipulation studies reveal that AT2R and MasR are involved in natriuretic, vasodilatory, and anti-inflammatory responses and in lowering blood pressure in various animal models under normal and pathological conditions such as salt-sensitive hypertension, obesity, and diabetes. The scope of this review is to discuss co-localization and heterodimerization as potential molecular mechanisms of AT2R- and MasR-mediated functions including antih...
Source: Current Hypertension Reports - May 1, 2018 Category: Primary Care Source Type: research

Selective vs. Global Renal Denervation: a Case for Less Is More
AbstractPurpose of ReviewReview the renal nerve anatomy and physiology basics and explore the concept of global vs. selective renal denervation (RDN) to uncover some of the fundamental limitations of non-targeted renal nerve ablation and the potential superiority of selective RDN.Recent FindingsRecent trials testing the efficacy of RDN showed mixed results. Initial investigations targeted global RDN as a therapeutic goal. The repeat observation of heterogeneous response to RDN including non-responders with lack of a BP reduction, or even more unsettling, BP elevations after RDN has raised concern for the detrimental effect...
Source: Current Hypertension Reports - May 1, 2018 Category: Primary Care Source Type: research

A Systematic Review of Sleep, Hypertension, and Cardiovascular Risk in Children and Adolescents
AbstractPurpose of ReviewMany of the risk factors for heart disease have recently been shown to develop during childhood such as left ventricular hypertrophy and fibrous plaque lesions. As risk for cardiovascular disease in children and adolescents has risen, sleep duration has decreased, and inadequate sleep in children and adolescents has been found to be associated with cardiovascular disease risk. The aims of this manuscript are to provide an updated systematic review of the literature assessing sleep, hypertension, and cardiovascular risk and evaluate the strength of the evidence based on the available research.Recent...
Source: Current Hypertension Reports - May 1, 2018 Category: Primary Care Source Type: research

Hypertension in Developing Countries: A Major Challenge for the Future
AbstractPurpose of ReviewOutline recent epidemiologic data regarding hypertension in developing countries, distinguish differences from developed countries, and identify challenges in management and future perspectives.Recent FindingsIncreased sugar intake, air and noise pollution, and low birth weight are emerging hypertension risk factors. The major challenges in management are difficulties in accurate diagnosis of hypertension and adequate blood pressure control.SummaryIn contrast to developed countries, hypertension prevalence rates are on the rise in developing countries with no improvement in awareness or control rat...
Source: Current Hypertension Reports - May 1, 2018 Category: Primary Care Source Type: research

The Complement Alternative Pathway and Preeclampsia
AbstractPurpose of ReviewSignificant and intricate immune adaptations are essential for the establishment and maintenance of normal pregnancy. Preeclampsia is a morbid, potentially life-threatening disease for both mother and neonate that occurs uniquely in pregnancy, at least in part, due to maternal immune maladaptation. We aim to review the literature that focuses on case reports, diagnostic approaches, and treatment strategies for disorders of the complement alternative pathway (CAP) as related to preeclampsia.Recent FindingsThere is evidence of complement dysregulation in preeclampsia and HELLP syndrome, similar to th...
Source: Current Hypertension Reports - May 1, 2018 Category: Primary Care Source Type: research

Arterial Distensibility, Physical Activity, and the Metabolic Syndrome
AbstractPurpose of ReviewMetabolic syndrome (MetS), a cluster of risk factors including central obesity, metabolic abnormalities, and arterial hypertension, is a well-known determinant of arterial wall remodeling and stiffening. The mechanisms whereby MetS promotes arterial stiffening include increased sympathetic activity with the associated fast heart rate, enhanced activity of the renin-angiotensin-aldosterone system, increased production of inflammatory cytokines and reactive oxygen species, and reduction of nitric oxide availability. These adverse effects can explain why aerobic physical activity can retard the age-re...
Source: Current Hypertension Reports - May 1, 2018 Category: Primary Care Source Type: research

The Role of Interleukin-10 in the Pathophysiology of Preeclampsia
AbstractPurpose of ReviewThe pathophysiology of preeclampsia is complex and not entirely understood. A key feature in preeclampsia development is an immunological imbalance that shifts the maternal immune response from one of tolerance towards one promoting chronic inflammation and endothelial dysfunction. As a key regulator of immunity, IL-10 not only has immunomodulatory activity, but also directly benefits vasculature and promotes successful cellular interactions at the maternal-fetal interface. Here we focus on the mechanisms by which the dysregulation of IL-10 may contribute to the pathophysiology of preeclampsia.Rece...
Source: Current Hypertension Reports - April 30, 2018 Category: Primary Care Source Type: research

The Endothelin System: A Critical Player in the Pathophysiology of Preeclampsia
AbstractPurpose of ReviewPreeclampsia (PE) is a disorder of pregnancy typically characterized by new-onset hypertension and proteinuria after gestational week 20. Although preeclampsia is one of the leading causes of maternal and perinatal morbidity and death worldwide, the mechanisms of the pathogenesis of the disorder remain unclear and treatment options are limited. Placental ischemic events and the release of placental factors appear to play a critical role in the pathophysiology. These factors contribute to a generalized systemic vascular endothelial dysfunction and result in increased systemic vascular resistance and...
Source: Current Hypertension Reports - April 10, 2018 Category: Primary Care Source Type: research

Understanding the Haemodynamics of Hypertension
This article introduces the haemodynamic principles that underpin the pathophysiology of hypertension and introduces a rational physiological approach to appropriate pharmacologic treatment.Recent findingsOutdated understanding of haemodynamics based on previous measurement systems can no longer be applied to our understanding of the circulation. We question the current view of hypertension as defined by a predominantly systolic blood pressure and introduce the concept of vasogenic, cardiogenic and mixed-origin hypertension. We postulate that failure to identify the individual ’s haemodynamic pattern may lead to the ...
Source: Current Hypertension Reports - April 10, 2018 Category: Primary Care Source Type: research

Blood Pressure Goals in Acute Stroke —How Low Do You Go?
AbstractPurpose of ReviewElevations in systolic blood pressure (BP) greater than 140  mmHg are reported in the majority (75%) of patients with acute ischemic stroke and in 80% of patients with acute intracerebral hemorrhages (ICH). This paper summarizes and updates the current knowledge regarding the proper management strategy for elevated BP in patients with acute stroke.Recent Findings and SummaryRecent studies have generally showed a neutral effect of BP reduction on clinical outcomes among acute ischemic stroke patients. Thus, because of the lack of convincing evidence from clinical trials, aggressive BP reduction...
Source: Current Hypertension Reports - April 10, 2018 Category: Primary Care Source Type: research

Atherosclerotic Renal Artery Stenosis: Should we Intervene Earlier?
AbstractPurpose of ReviewRandomized trials have failed to show clinical benefit in patients with atherosclerotic renal artery stenosis who were treated with angioplasty with or without stenting. However, these studies were done in patients with a high-grade stenosis. This paper examines whether there are arguments to consider patients with low-grade stenosis for angioplasty.Recent FindingsPatients with low-grade (
Source: Current Hypertension Reports - April 10, 2018 Category: Primary Care Source Type: research

Clinical and Molecular Features of Thiazide-Induced Hyponatremia
AbstractPurpose of ReviewHypertension affects more than 30% of the world ’s adult population and thiazide (and thiazide-like) diuretics are amongst the most widely used, effective, and least costly treatments available, with all-cause mortality benefits equivalent to angiotensin-converting enzyme inhibitors or calcium channel antagonists. A minority of patients develop thiazide-induced hyponatremia (TIH) and this is largely unpredictable at the point of thiazide prescription. In some cases, TIH can cause debilitating symptoms and require hospital admission. Although TIH affects only a minority of patients exposed to ...
Source: Current Hypertension Reports - April 10, 2018 Category: Primary Care Source Type: research

Community Outreach to African-Americans: Implementations for Controlling Hypertension
AbstractPurpose of ReviewThe purpose of this review is to examine the impact and effectiveness of community interventions for controlling hypertension in African-Americans. The questions addressed are as follows: Which salient prior and current community efforts focus on African-Americans and are most effective in controlling hypertension and patient-related outcomes? How are these efforts implemented and possibly sustained?Recent FindingsThe integration of out-of-office blood pressure measurements, novel hypertension control centers (i.e., barbershops), and community health workers improve hypertension control and may red...
Source: Current Hypertension Reports - April 10, 2018 Category: Primary Care Source Type: research

Updates to Adherence to Hypertension Medications
AbstractPurpose of ReviewThe purpose of this review is to discuss recent studies that have described approaches or interventions to improve hypertension medication adherence and to suggest how providers can integrate evidenced-based approaches into routine clinical care to improve medication adherence and blood pressure control.Recent FindingsFactors that can impact medication include patient-related factors, social- and economic-related factors, health system/health care team-related factors, and therapy-related factors. Overall, a multifaceted approach is needed to improve medication adherence. Important components inclu...
Source: Current Hypertension Reports - April 10, 2018 Category: Primary Care Source Type: research

Institutional Pathways to Improve Care of Patients with Elevated Blood Pressure in the Emergency Department
We present here several examples of successful policies developed and implemented by the authors. While brief inpatient and ED encounters cannot replace long-term outpatient care, they have the potential to serve as a crucial inlet to health care and an opportunity to optimize care. (Source: Current Hypertension Reports)
Source: Current Hypertension Reports - April 10, 2018 Category: Primary Care Source Type: research

Correction to: Percutaneous Creation of a Central Iliac Arteriovenous Anastomosis for the Treatment of Arterial Hypertension
AbstractIn the March 2018 issue ofCurrent Hypertension Reports, the second author ’s nameNathan A. Sobotka was inadvertently left out of the byline. Also, the author names were changed from initials to spelled out. The corrected author list is given above. The original article has been corrected. (Source: Current Hypertension Reports)
Source: Current Hypertension Reports - April 9, 2018 Category: Primary Care Source Type: research

Controlled Versus Uncontrolled Resistant Hypertension: Are They in the Same Bag?
AbstractPurpose of ReviewResistant hypertension (RHTN) is a condition in which besides the antihypertensive therapy using at least three different drugs (including a diuretics), brachial blood pressure does not reach the target (e.g., 140/90  mmHg).Recent FindingsDespite the diversity of clinical presentations, we divide RHTN in two major groups according to blood pressure and number of drugs taken: controlled (C-RHTN) and uncontrolled (UC-RHTN) resistant hypertension, with refractory hypertension (RfHTN) included in the latter subgroup.Both C-RHTN and UC-RHTN are heterogenic and complex syndromes. To better approach ...
Source: Current Hypertension Reports - March 27, 2018 Category: Primary Care Source Type: research

Control of Energy Expenditure by AgRP Neurons of the Arcuate Nucleus: Neurocircuitry, Signaling Pathways, and Angiotensin
AbstractPurpose of ReviewHere, we review the current understanding of the functional neuroanatomy of neurons expressing Agouti-related peptide (AgRP) and the angiotensin 1A receptor (AT1A) within the arcuate nucleus (ARC) in the control of energy balance.Recent FindingsThe development and maintenance of obesity involves suppression of resting metabolic rate (RMR). RMR control is integrated via AgRP and proopiomelanocortin neurons within the ARC. Their projections to other hypothalamic and extrahypothalamic nuclei contribute to RMR control, though relatively little is known about the contributions of individual projections ...
Source: Current Hypertension Reports - March 19, 2018 Category: Primary Care Source Type: research

Cerebral Haemodynamics: Effects of Systemic Arterial Pulsatile Function and Hypertension
AbstractPurpose of ReviewConcepts of pulsatile arterial haemodynamics, including relationships between oscillatory blood pressure and flow in systemic arteries, arterial stiffness and wave propagation phenomena have provided basic understanding of underlying haemodynamic mechanisms associated with elevated arterial blood pressure as a major factor of cardiovascular risk, particularly the deleterious effects of isolated systolic hypertension in the elderly. This topical review assesses the effects of pulsatility of blood pressure and flow in the systemic arteries on the brain. The review builds on the emerging notion of the...
Source: Current Hypertension Reports - March 19, 2018 Category: Primary Care Source Type: research

Dysregulation of the Renin-Angiotensin System and the Vasopressinergic System Interactions in Cardiovascular Disorders
AbstractPurpose of ReviewIn many instances, the renin-angiotensin system (RAS) and the vasopressinergic system (VPS) are jointly activated by the same stimuli and engaged in the regulation of the same processes.Recent FindingsAngiotensin II (Ang II) and arginine vasopressin (AVP), which are the main active compounds of the RAS and the VPS, interact at several levels. Firstly, Ang II, acting on AT1 receptors (AT1R), plays a significant role in the release of AVP from vasopressinergic neurons and AVP, stimulating V1a receptors (V1aR), regulates the release of renin in the kidney. Secondly, Ang II and AVP, acting on AT1R and ...
Source: Current Hypertension Reports - March 19, 2018 Category: Primary Care Source Type: research

Percutaneous Creation of a Central Iliac Arteriovenous Anastomosis for the Treatment of Arterial Hypertension
AbstractPurpose of ReviewProvision of a summary on the physiologic effects of arteriovenous fistula creation and description of previously published human data on the efficacy of a percutaneously implanted device creating an arteriovenous fistula. Though antihypertensive therapy is effective, some patient ’s blood pressure remains poorly controlled despite adherence to optimal medical therapy. Moreover, some patients are not compliant with recommended medical therapy due to side effects or personal decision. This has prompted exploration of alternative, device-based antihypertensive therapies inclu ding, among others...
Source: Current Hypertension Reports - March 19, 2018 Category: Primary Care Source Type: research

Therapeutic Vaccines for Hypertension: a New Option for Clinical Practice
AbstractPurpose of ReviewVaccines are commonly used as preventive methods, primarily against infectious diseases. The goal of our study is to develop the therapeutic vaccine for hypertension.Recent FindingsWe and others recently reported that an angiotensin II (AngII) vaccine for hypertension successfully attenuated elevated blood pressures in an animal model without any immunogenic side effects. In this system, an immunogenic molecule (i.e., KLH) with adjuvants provides an antigen that supports the activation of helper T cells. In addition, pretreatment with the AngII vaccine exerts neuroprotective effects in a cerebral i...
Source: Current Hypertension Reports - March 19, 2018 Category: Primary Care Source Type: research

Role of Mineralocorticoid Receptors in Obstructive Sleep Apnea and Metabolic Syndrome
AbstractPurpose of ReviewThis review will summarize recent developments in the research on the mineralocorticoid receptor and its impact on obstructive sleep apnea and metabolic syndrome.Recent FindingsAldosterone excess plays an important role in the association between resistant hypertension and obstructive sleep apnea. The prevalence of obesity is increasing rapidly worldwide and is especially common among patients with obstructive sleep apnea, resistant hypertension, and metabolic syndrome, suggesting probable mechanistic links between these three conditions. Mineralocorticoid receptor expression is increased in obese ...
Source: Current Hypertension Reports - March 19, 2018 Category: Primary Care Source Type: research

Novel Biomarkers to Detect Target Organ Damage in Acute Hypertension
AbstractPurpose of ReviewEarly lowering of blood pressure is advised for patients with severe hypertension associated with signs of impending or progressive organ damage, whereas aggressive treatment is not recommended in patients with asymptomatic severe hypertension. As treatment goals for asymptomatic hypertension and true hypertensive emergency drastically differ, it is essential to identify patients with evidence of impending or progressive organ damage. Biomarkers may assist providers in identifying high-risk patients who would benefit from early blood pressure reduction.Recent FindingsIn this review, we discuss both...
Source: Current Hypertension Reports - March 19, 2018 Category: Primary Care Source Type: research

Renal Nerve Stimulation as Procedural End Point for Renal Sympathetic Denervation
AbstractPurpose of ReviewRenal sympathetic denervation (RDN) as treatment option for hypertension has a strong rationale; however, variable effects on blood pressure (BP) have been reported ranging from non-response to marked reductions in BP. The absence of a procedural end point for RDN is one of the potential factors associated with the variable response. Studies have suggested the use of renal nerve stimulation (RNS) to adequately address this issue. This review aims to provide an overview of the clinical and experimental data available regarding the effects of RNS in the setting of RDN.Recent FindingsAnimal studies ha...
Source: Current Hypertension Reports - March 19, 2018 Category: Primary Care Source Type: research