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Blood Pressure Control versus Atrial Fibrillation Management in Stroke Prevention
Abstract Hypertension is one of the major risk factors for atrial fibrillation which in turn is the most prevalent concomitant condition in hypertensive patients. While both these pathological conditions are independent risk factors for stroke, the association of hypertension and atrial fibrillation increases the incidence of disabling strokes. Moreover, documented or silent atrial fibrillation doubles the rate of cardiovascular death. Lowering blood pressure is strongly recommended, particularly for primary stroke prevention. However, a relatively small percentage of hypertensive patients still achieve the recom...
Source: Current Hypertension Reports - April 19, 2015 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 in ...
Source: Current Hypertension Reports - April 10, 2018 Category: Primary Care Source Type: research

Neuroprotective Mechanisms of the ACE2–Angiotensin-(1-7)–Mas Axis in Stroke
Abstract The discovery of beneficial neuroprotective effects of the angiotensin converting enzyme 2–angiotensin-(1-7)–Mas axis [ACE2–Ang-(1-7)–Mas] in ischemic and hemorrhagic stroke has spurred interest in a more complete characterization of its mechanisms of action. Here, we summarize findings that describe the protective role of the ACE2–Ang-(1-7)–Mas axis in stroke, along with a focused discussion on the potential mechanisms of neuroprotective effects of Ang-(1-7) in stroke. The latter incorporates evidence describing the actions of Ang-(1-7) to counter the deleterious effects of angiotensin II (A...
Source: Current Hypertension Reports - January 26, 2015 Category: Primary Care Source Type: research

Coronary Heart Disease Risk Factors and Outcomes in the Twenty-First Century: Findings from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Abstract REasons for Geographic and Racial Differences in Stroke (REGARDS) is a longitudinal study supported by the National Institutes of Health to determine the disparities in stroke-related mortality across USA. REGARDS has published a body of work designed to understand the disparities in prevalence, awareness, treatment, and control of coronary heart disease (CHD) and its risk factors in a biracial national cohort. REGARDS has focused on racial and geographical disparities in the quality and access to health care, the influence of lack of medical insurance, and has attempted to contrast current guidelines in...
Source: Current Hypertension Reports - March 21, 2015 Category: Primary Care Source Type: research

Hypertension and Stroke in Patients with Left Ventricular Assist Devices (LVADs)
Abstract Stroke is one of the most dreaded complications of left ventricular assist device therapy in patients with end-stage congestive heart failure. There is strong evidence linking anticoagulation and infection with ischemic and hemorrhagic strokes, though recent data has emerged regarding the importance of elevated blood pressure. In the recently completed Heartware Ventricular Assist Device studies, a mean arterial pressure greater than 90 mmHg was associated with greater stroke risk, particularly the hemorrhagic subtype. In this review, we discuss recent evidence regarding deleterious effects of uncontrol...
Source: Current Hypertension Reports - January 19, 2016 Category: Primary Care Source Type: research

Blood Pressure Management in Acute Ischemic Stroke
AbstractPurpose of ReviewAbrupt blood pressure (BP) rise is the most common clinical symptom of acute ischemic stroke (AIS). However, BP alterations during AIS reflect many diverse mechanisms, both stroke-related and nonspecific epiphenomena, which change over time and across patients. While extremes of BP as well as high BP variability have been related with worse outcomes in observational studies, optimal BP management after AIS remains challenging.Recent FindingsThis review discusses the complexity of the factors linking BP changes to the clinical outcomes of patients with AIS, depending on the treatment strategy and lo...
Source: Current Hypertension Reports - December 10, 2020 Category: Primary Care Source Type: research

Preventing the Progression of Prehypertension to Hypertension: Role of Antihypertensives
Abstract Recent guidelines for the diagnosis and management of hypertension reversed the historical trend to recommend lower blood pressure (BP) thresholds to diagnose hypertension in high-risk individuals, such as patients with diabetes and elderly patients. The decision to raise the BP thresholds for diagnosis of hypertension in patients with diabetes was mostly based on the findings of the ACCORD trial. Nonetheless, the results of the ACCORD trial are within the predicted benefit to prevent coronary artery disease and stroke by meta-analysis of randomized controlled trials (RCT), particularly in regard to the ...
Source: Current Hypertension Reports - November 28, 2014 Category: Primary Care Source Type: research

Cerebrovascular Dysfunction in Preeclamptic Pregnancies
Abstract Preeclampsia is a hypertensive, multisystem disorder of pregnancy that affects several organ systems, including the maternal brain. Cerebrovascular dysfunction during preeclampsia can lead to cerebral edema, seizures, stroke, and potentially maternal mortality. This review will discuss the effects of preeclampsia on the cerebrovasculature that may adversely affect the maternal brain, including cerebral blood flow (CBF) autoregulation and blood-brain barrier disruption and the resultant clinical outcomes including posterior reversible encephalopathy syndrome (PRES) and maternal stroke. Potential long-term...
Source: Current Hypertension Reports - June 30, 2015 Category: Primary Care Source Type: research

Asking the Patient or Measuring Blood Pressure in the Emergency Department: Which One is Best?
Abstract Blood pressure (BP) is obtained at the emergency department (ED) in the vast majority of patients; irrespective of chief complaint, and elevated BP, above the threshold for hypertension, is a common observation. In this review, we address the predictive value of measured BP in the ED compared to that of a history of hypertension in patients with chief complaints related to cardiovascular disease. In chest pain patients, a high BP at the ED is associated to a good prognosis, whereas the history of hypertension is associated to a poor prognosis. In heart failure, a high admission BP is consistently linked ...
Source: Current Hypertension Reports - May 20, 2016 Category: Primary Care Source Type: research

Isolated Systolic Hypertension in Young and Middle-Aged Adults
AbstractYoung and middle-aged adults (ages ≤50 years) are increasingly prone to stroke, kidney disease, and worsening cardiovascular disease (CVD) mortality. An alarming increase in the prevalence of high blood pressure (BP) may underlie the adverse trend. However, there is often uncertainty in BP management for young and middle-aged adul ts. Isolated systolic hypertension (ISH) is one such example. Whether ISH in young and middle-aged adults represents “pseudo” or “spurious” hypertension is still being debated. ISH in young and middle-aged adults is a heterogeneous entity; some individuals appear to have increa...
Source: Current Hypertension Reports - October 12, 2016 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 labetalol for women presenti...
Source: Current Hypertension Reports - June 8, 2018 Category: Primary Care Source Type: research

Metabolic Syndrome and Hypertension: Regular Exercise as Part of Lifestyle Management
Abstract The incorporation of physical activity and exercise represents a clinically important aspect in the management of metabolic syndrome, hypertension, and diabetes. While the benefit of exercise and active lifestyles is well documented for prevention and risk reduction of cardiovascular and stroke outcomes, the detailed regiment and recommendations are less clear. The components of a prescribed physical activity include consideration of activity type, frequency of an activity, activity duration, and intensity of a specific physical movement. The exercise parameters prescribed as part of the management of me...
Source: Current Hypertension Reports - September 5, 2014 Category: Primary Care Source Type: research

Obstructive Sleep Apnea and Hypertension: a Critical Review
Abstract Obstructive sleep apnea (OSA) is a prevalent sleep disorder which is characterized by recurrent upper closure with oxygen desaturation and sleep disruption. OSA increases the risk of vascular disorders in the form of stroke, myocardial infarction, congestive heart failure, and hypertension. The mechanisms underlying the vascular disorders are several and include intermittent hypoxia with release of cytokines, angiogenic inhibitors, free radicals, and adhesion molecules. During apneas, arterial blood pressure gradually rises and surges abruptly after the termination of apnea. Two thirds of patients with O...
Source: Current Hypertension Reports - August 20, 2014 Category: Primary Care Source Type: research

Visit-to-Visit Variability of Systolic Blood Pressure and Cardiovascular Disease
Abstract Visit-to-visit variability of blood pressure (VVV of BP) is gaining interest as a prognostic marker for stroke, cardiovascular disease, and all-cause mortality. In this review, we discuss different metrics used to define VVV of BP, explore the potential sources of this phenomenon including patient characteristics and antihypertensive medication classes, and discuss recent evidence of its relation with cardiovascular outcomes. Current evidence relies on secondary analyses of clinical trials or on observational studies, none of which was designed to examine VVV of BP specifically. More research is required...
Source: Current Hypertension Reports - March 9, 2015 Category: Primary Care Source Type: research

The Baroreflex in Hypertension
Abstract Hypertension is a complex syndrome that increases the risk of developing other medical comorbidities and interacts with other medical conditions to increase the risk of target end-organ damage such as cardiovascular disease, stroke, and renal disease. Hypertension remains under-recognized and poorly controlled in the USA and worldwide. In some patients, hypertension is resistant to optimal medical therapy. Over the last few decades, there has been an increasing understanding of the role of the sympathetic nervous system in the development and maintenance of hypertension. This update reviews the physiolog...
Source: Current Hypertension Reports - March 9, 2015 Category: Primary Care Source Type: research

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