1.
Clinical challenges in diagnosing and managing adult hypertension.
Handler, J
Cleveland Clinic journal of medicine. 2015;(12 Suppl 2):S36-41
Abstract
Although there is still no consensus on how to diagnose hypertension, opinion is moving toward incorporating out-of-office blood pressure measurements into the process. The SPRINT trial poses potential opportunities and challenges. Simplified antihypertensive drug regimens incorporating single pill combinations are very effective.
2.
Outcomes of drug-based and surgical treatments for primary aldosteronism.
Steichen, O, Lorthioir, A, Zinzindohoue, F, Plouin, PF, Amar, L
Advances in chronic kidney disease. 2015;(3):196-203
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Abstract
Treatments for primary aldosteronism (PA) aim to correct or prevent the deleterious consequences of hyperaldosteronism: hypertension, hypokalemia, and direct target organ damage. Patients with unilateral PA considered fit for surgery can undergo laparoscopic adrenalectomy, which significantly decreases blood pressure (BP) and medications in most cases and cures hypertension in about 40%. Mineralocorticoid receptor antagonists (MRA) are used to treat patients with bilateral PA and those with unilateral PA if surgery is not possible or not desired. Spironolactone is more potent than eplerenone, but high doses are poorly tolerated in men. MRA can be replaced or complemented with epithelial sodium channel blockers, such as amiloride. Thiazide diuretics and calcium channel blockers are used when the first-line drugs are insufficient to control BP. Dietary sodium restriction should be implemented in all cases because the deleterious consequences of hyperaldosteronism are dependent on salt loading. Several studies comparing the results of surgery and MRA have reported no differences in terms of BP, serum potassium concentration, or cardiovascular and kidney outcomes, although the benefits of treatment tend to be observed sooner with surgery. Patients with PA display relative glomerular hyperfiltration, which is reversed by specific treatment, revealing CKD in 30% of patients. However, further kidney damage is lessened by the treatment of PA.
4.
Pharmacological management of hypertension.
Higgins, B, Williams, B, ,
Clinical medicine (London, England). 2007;(6):612-6
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Abstract
Hypertension is a major risk factor for cardiovascular disease, and is both common and amenable to treatment. Several major new studies have appeared recently and in response the National Institute for Health and Clinical Excellence and the British Hypertension Society have collaborated to update their respective guidelines on primary hypertension, and to agree joint recommendations. The update focuses only on pharmacological aspects of treatment. Wherever possible, the recommendations are based on the clinical outcomes of mortality, stroke, myocardial infarction, heart failure, and new onset diabetes mellitus, rather than on blood pressure lowering. A brief treatment algorithm is included. In summary, either calcium channel inhibitors or thiazide-type diuretics should be the preferred initial agent for use in primary hypertension in most patients, although angiotensin converting enzyme (ACE) inhibitors (including angiotensin-II receptor inhibitors if ACE-intolerant) are preferred in patients younger than 55.
5.
Combination therapy in the management of hypertension: focus on angiotensin receptor blockers combined with diuretics.
Palatini, P
Journal of clinical hypertension (Greenwich, Conn.). 2005;(2):96-101
Abstract
There is increasing evidence that combination therapy should be emphasized more than it is at present for the initial treatment of hypertensive patients. Recent guidelines acknowledge the value of combination therapy, although some treatment algorithms fail to echo this message. Observations from major clinical trials in the elderly, diabetics, stroke patients, and African Americans all indicate that combination therapy is necessary to control blood pressure in the majority of these patients. Several combination therapies such as an angiotensin II receptor blocker and a diuretic, an angiotensin-converting enzyme inhibitor with a diuretic, a beta blocker with a diuretic, or an angiotensin-converting enzyme inhibitor with a calcium antagonist have been shown to be effective in patients who do not respond to monotherapy. The current review focuses on the newest such combination; an angiotensin II receptor blocker and a diuretic may have an added advantage of being well tolerated. Recent studies have shown that angiotensin II receptor blockers, given alone or combined with a diuretic, may prevent some cardiovascular outcomes independent of their blood pressure-lowering efficacy.
6.
Diuretic-related side effects: development and treatment.
Sica, DA
Journal of clinical hypertension (Greenwich, Conn.). 2004;(9):532-40
Abstract
Diuretics are important therapeutic tools. First, they effectively reduce blood pressure and have been shown in numerous hypertension clinical trials to reduce both cardiovascular and cerebrovascular morbidity and mortality. In addition, their use has been equally effective in controlling cardiovascular events as angiotensin-converting enzyme inhibitors or calcium channel blockers. Diuretics are currently recommended by the Seventh Report of the Joint National Commission on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure report as first-line therapy for the treatment of hypertension. In addition, they remain an important aspect of congestive heart failure treatment in that they improve the congestive symptomatology, which typifies the more advanced stages of congestive heart failure. This article reviews the commonly encountered side effects with the various diuretic classes. Where indicated, the mechanistic basis and treatment of such side effects is further discussed.
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Treat high blood pressure sooner: tougher, simpler JNC 7 guidelines.
Vidt, DG, Borazanian, RA
Cleveland Clinic journal of medicine. 2003;(8):721-8