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Hypertension - recientes

Hypertension [Editorial Board]
7/6/2017
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Correction [Corrections]
7/6/2017
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Clinical Implications [Clinical Implications]
7/6/2017
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Oliver Smithies [In Memoriam]
7/6/2017
Thomas M. Coffman
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Resistant Hypertension [Recent Advances in Hypertension]
7/6/2017
Anping Cai, David A. Calhoun
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How Is the Brain Renin-Angiotensin System Regulated? [Brief Reviews]
7/6/2017
Pablo Nakagawa, Curt D. Sigmund
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Hypertension in Women [Excellence Award for Hypertension Research]
7/6/2017
Amier Ahmad, Suzanne Oparil
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Ambulatory Pulse Wave Velocity Monitoring [Editorial Commentary]
7/6/2017
Theodore G. Papaioannou, Dimitrios A. Vrachatis, Dimitris Tousoulis
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Delayed Response to Antihypertension Medication [Editorial Commentary]
7/6/2017
Merrill F. Elias, Rachael V. Torres
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Quarter Dose Combination Therapy [Editorial Commentary]
7/6/2017
Guido Grassi, Giuseppe Mancia
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Of Mice and Renin [Editorial Commentary]
7/6/2017
Michael Bader
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Aldosterone-Producing Adenomas [Editorial Commentary]
7/6/2017
Fumitoshi Satoh, Hironobu Sasano, Yuto Yamazaki, Sadayoshi Ito
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Long-Standing Problem of {beta}-Blocker-Elicited Hypoglycemia in Diabetes Mellitus [Editorial Commentary]
7/6/2017
Edoardo Casiglia, Valerie Tikhonoff
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Orthostatic Hypotension and Risk of Incident DementiaNovelty and Significance [Epidemiology/Population]
7/6/2017
Antoine Cremer, Aicha Soumare, Claudine Berr, Jean–Francois Dartigues, Audrey Gabelle, Philippe Gosse, Christophe Tzourio
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Several studies indicate a potential link between orthostatic hypotension (OH) and incident dementia but without substantial evidence to date. Our objective is to study the association between OH and dementia in a cohort of elderly individuals. To do so, baseline lying and standing blood pressure measurements were taken from 7425 subjects in the Three-City study. These subjects were then followed-up for 12 years. Cox proportional hazard models, adjusted for potential confounders, were used to estimate the risk of incident dementia according to OH status. Sensitivity analysis was performed using the so-called illness-death model, a specific statistical method which takes into account competitive risk with death. OH frequency was found to be around 13%, and 760 cases of dementia were diagnosed during follow-up. We observed significant associations between the presence of OH at baseline and the occurrence of dementia during the follow-up, with an increased risk of at least 25% observed regardless of the OH threshold and the statistical method used. In conclusion, there is an association between OH and dementia. Considering that OH is a common condition and is easy to measure, OH measurements could help to identify subjects with higher risk of dementia. Moreover, reducing OH could be a step to prevent conversion to dementia.

Prevalence, Treatment, and Control Rates of Conventional and Ambulatory Hypertension Across 10 Populations in 3 ContinentsNovelty and Significance [Epidemiology/Population]
7/6/2017
Jesus D. Melgareȷo, Gladys E. Maestre, Lutgarde Thiȷs, Kei Asayama, Jose Boggia, Edoardo Casiglia, Tine W. Hansen, Yutaka Imai, Lotte Jacobs, Jorgen Jeppesen, Kalina Kawecka–Jaszcz, Tatiana Kuznetsova, Yan Li, Sofia Malyutina, Yuri Nikitin, Takayoshi Ohkubo, Katarzyna Stolarz–Skrzypek, Ji–Guang Wang, Jan A. Staessen
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Hypertension is a major global health problem, but prevalence rates vary widely among regions. To determine prevalence, treatment, and control rates of hypertension, we measured conventional blood pressure (BP) and 24-hour ambulatory BP in 6546 subjects, aged 40 to 79 years, recruited from 10 community-dwelling cohorts on 3 continents. We determined how between-cohort differences in risk factors and socioeconomic factors influence hypertension rates. The overall prevalence was 49.3% (range between cohorts, 40.0%–86.8%) for conventional hypertension (conventional BP ≥140/90 mm Hg) and 48.7% (35.2%–66.5%) for ambulatory hypertension (ambulatory BP ≥130/80 mm Hg). Treatment and control rates for conventional hypertension were 48.0% (33.5%–74.1%) and 38.6% (10.1%–55.3%) respectively. The corresponding rates for ambulatory hypertension were 48.6% (30.5%–71.9%) and 45.6% (18.6%–64.2%). Among 1677 untreated subjects with conventional hypertension, 35.7% had white coat hypertension (23.5%–56.2%). Masked hypertension (conventional BP <140/90 mm Hg and ambulatory BP ≥130/80 mm Hg) occurred in 16.9% (8.8%–30.5%) of 3320 untreated subjects who were normotensive on conventional measurement. Exclusion of participants with diabetes mellitus, obesity, hypercholesterolemia, or history of cardiovascular complications resulted in a <9% reduction in the conventional and 24-hour ambulatory hypertension rates. Higher social and economic development, measured by the Human Development Index, was associated with lower rates of conventional and ambulatory hypertension. In conclusion, high rates of hypertension in all cohorts examined demonstrate the need for improvements in prevention, treatment, and control. Strategies for the management of hypertension should continue to not only focus on preventable and modifiable risk factors but also consider societal issues.

Association Between Endometriosis and Hypercholesterolemia or HypertensionNovelty and Significance [Epidemiology/Population]
7/6/2017
Fan Mu, Janet Rich-Edwards, Eric B. Rimm, Donna Spiegelman, John P. Forman, Stacey A. Missmer
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An altered hormonal or chronic systemic inflammatory milieu characterizing endometriosis may result in a higher risk of hypercholesterolemia and hypertension. Conversely, elevated low-density lipoprotein in hypercholesterolemia and chronic systemic inflammation resulting from hypertension may increase the risk of endometriosis. We assessed the association of laparoscopically confirmed endometriosis with hypercholesterolemia and hypertension in a large prospective cohort study. In 1989, 116 430 registered female nurses aged 25 to 42 completed the baseline questionnaire and were followed for 20 years. Multivariable Cox proportional hazards models were applied. In 1989, there were 4244 women with laparoscopically confirmed endometriosis and 91 554 women without. After adjusting for demographic, anthropometric, family history, reproductive, dietary, and lifestyle risk factors prospectively, comparing women with laparoscopically confirmed endometriosis to women without, the relative risks were 1.25 (95% confidence interval, 1.21–1.30) for development of hypercholesterolemia and 1.14 (95% confidence interval, 1.09–1.18) for hypertension. Conversely, the relative risks of developing laparoscopically confirmed endometriosis were 1.22 (95% confidence interval, 1.15–1.31) comparing women with hypercholesterolemia to women without and 1.29 (95% confidence interval, 1.18–1.41) comparing women with hypertension to women without. The strength of associations of laparoscopically confirmed endometriosis with hypercholesterolemia or hypertension was strongest among women aged ≤40 and weakened as age increased (P values for interaction <0.001). We observed that ≈45% of the associations between endometriosis and hypercholesterolemia and hypertension could be accounted for by treatment factors after endometriosis diagnosis, including greater frequency of hysterectomy/oophorectomy and earlier age for this surgery. In this large cohort study, laparoscopically confirmed endometriosis was prospectively associated with increased risk of hypercholesterolemia and hypertension. Conversely, hypercholesterolemia and hypertension were prospectively associated with higher risk of laparoscopically confirmed endometriosis.

Race and Sex Differences of Long-Term Blood Pressure Profiles From Childhood and Adult HypertensionNovelty and Significance [Epidemiology/Population]
7/6/2017
Wei Shen, Tao Zhang, Shengxu Li, Huijie Zhang, Bo Xi, Hongbing Shen, Camilo Fernandez, Lydia Bazzano, Jiang He, Wei Chen
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This study aims to characterize longitudinal blood pressure (BP) trajectories from childhood in black–white and sex groups and examine the association between childhood level–independent trajectories of BP and adult hypertension. The longitudinal cohort consisted of 2732 adults who had body mass index and BP measured 4 to 15 times from childhood (4–19 years) to adulthood (20–51 years). Model-estimated levels and linear slopes of BP and body mass index at childhood age points were calculated at 1-year intervals using the growth curve parameters and their first derivatives, respectively. Linear and nonlinear curve parameters differed significantly between race–sex groups; BP levels showed race and sex differences 15 years of age onward. Hypertensives had higher long-term BP levels than normotensives in race–sex groups. Although linear and nonlinear slope parameters of BP were race and sex specific, they differed consistently, significantly between hypertension and normotension groups. BP trajectories during young adulthood (20–35 years) were significantly greater in hypertensives than in normotensives; however, the trajectories during middle-aged adulthood (36–51 years) were significantly smaller in hypertensives than in normotensives. Level-independent linear slopes of systolic BP showed significantly negative associations (odds ratio=0.50≈0.76; P<0.001) during prepuberty period (4–11 years) but significantly positive associations (odd ratio=1.44≈2.80, P<0.001) during the puberty period (13–19 years) with adult hypertension, adjusting for covariates. These associations were consistent across race–sex groups. These observations indicate that adult hypertension originates in childhood, with different longitudinal BP trajectory profiles during young and middle-aged adulthood in black–white and sex groups. Puberty is a crucial period for the development of hypertension in later life.

Renin-Angiotensin-Aldosterone System Is Not Involved in the Arterial Stiffening Induced by Acute and Prolonged Exposure to High AltitudeNovelty and Significance [Clinical Trials]
7/6/2017
Miriam Revera, Paolo Salvi, Andrea Faini, Andrea Giuliano, Francesca Gregorini, Grzegorz Bilo, Carolina Lombardi, Giuseppe Mancia, Piergiuseppe Agostoni, Gianfranco Parati
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This randomized, double-blind, placebo-controlled study was designed to explore the effects of exposure to very high altitude hypoxia on vascular wall properties and to clarify the role of renin–angiotensin–aldosterone system inhibition on these vascular changes. Forty-seven healthy subjects were included in this study: 22 randomized to telmisartan (age, 40.3±10.8 years; 7 women) and 25 to placebo (age, 39.3±9.8 years; 7 women). Tests were performed at sea level, pre- and post-treatment, during acute exposure to 3400 and 5400-m altitude (Mt. Everest Base Camp), and after 2 weeks, at 5400 m. The effects of hypobaric hypoxia on mechanical properties of large arteries were assessed by applanation tonometry, measuring carotid–femoral pulse wave velocity, analyzing arterial pulse waveforms, and evaluating subendocardial oxygen supply/demand index. No differences in hemodynamic changes during acute and prolonged exposure to 5400-m altitude were found between telmisartan and placebo groups. Aortic pulse wave velocity significantly increased with altitude (P<0.001) from 7.41±1.25 m/s at sea level to 7.70±1.13 m/s at 3400 m and to 8.52±1.59 m/s at arrival at 5400 m (P<0.0001), remaining elevated during prolonged exposure to this altitude (8.41±1.12 m/s; P<0.0001). Subendocardial oxygen supply/demand index significantly decreased with acute exposure to 3400 m: from 1.72±0.30 m/s at sea level to 1.41±0.27 m/s at 3400 m (P<0.001), remaining significantly although slightly less reduced after reaching 5400 m (1.52±0.33) and after prolonged exposure to this altitude (1.53±0.25; P<0.001). In conclusion, the acute exposure to hypobaric hypoxia induces aortic stiffening and reduction in subendocardial oxygen supply/demand index. Renin–angiotensin–aldosterone system does not seem to play any significant role in these hemodynamic changes.Clinical Trial Registration—URL: https://www.clinicaltrialsregister.eu/. Unique identifier: 2008-000540-14.

Efficacy and Safety of Quarter-Dose Blood Pressure-Lowering AgentsNovelty and Significance [Clinical Trials]
7/6/2017
Alexander Bennett, Clara K. Chow, Michael Chou, Hakim-Moulay Dehbi, Ruth Webster, Abdul Salam, Anushka Patel, Bruce Neal, David Peiris, Jay Thakkar, John Chalmers, Mark Nelson, Christopher Reid, Graham S. Hillis, Mark Woodward, Sarah Hilmer, Tim Usherwood, Simon Thom, Anthony Rodgers
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There is a critical need for blood pressure–lowering strategies that have greater efficacy and minimal side effects. Low-dose combinations hold promise in this regard, but there are few data on very-low-dose therapy. We, therefore, conducted a systematic review and meta-analysis of randomized controlled trials with at least one quarter-dose and one placebo and standard-dose monotherapy arm. A search was conducted of Medline, Embase, Cochrane Registry, Food and Drug Administration, and European Medicinal Agency websites. Data on blood pressure and adverse events were pooled using a fixed-effect model, and bias was assessed using Cochrane risk of bias. The review included 42 trials involving 20 284 participants. Thirty-six comparisons evaluated quarter-dose with placebo and indicated a blood pressure reduction of −4.7/−2.4 mm Hg (P<0.001). Six comparisons were of dual quarter-dose therapy versus placebo, observing a −6.7/ −4.4 mm Hg (P<0.001) blood pressure reduction. There were no trials of triple quarter-dose combination versus placebo, but one quadruple quarter-dose study observed a blood pressure reduction of −22.4/−13.1 mm Hg versus placebo (P<0.001). Compared with standard-dose monotherapy, the blood pressure differences achieved by single (37 comparisons), dual (7 comparisons), and quadruple (1 trial) quarter-dose combinations were +3.7/+2.6 (P<0.001), +1.3/−0.3 (NS), and −13.1/−7.9 (P<0.001) mm Hg, respectively. In terms of adverse events, single and dual quarter-dose therapy was not significantly different from placebo and had significantly fewer adverse events compared with standard-dose monotherapy. Quarter-dose combinations could provide improvements in efficacy and tolerability of blood pressure–lowering therapy.

Heterogeneity in Early Responses in ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial)Novelty and Significance [Clinical Trials]
7/6/2017
Sanket S. Dhruva, Chenxi Huang, Erica S. Spatz, Andreas C. Coppi, Frederick Warner, Shu-Xia Li, Haiqun Lin, Xiao Xu, Curt D. Furberg, Barry R. Davis, Sara L. Pressel, Ronald R. Coifman, Harlan M. Krumholz
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Randomized trials of hypertension have seldom examined heterogeneity in response to treatments over time and the implications for cardiovascular outcomes. Understanding this heterogeneity, however, is a necessary step toward personalizing antihypertensive therapy. We applied trajectory-based modeling to data on 39 763 study participants of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) to identify distinct patterns of systolic blood pressure (SBP) response to randomized medications during the first 6 months of the trial. Two trajectory patterns were identified: immediate responders (85.5%), on average, had a decreasing SBP, whereas nonimmediate responders (14.5%), on average, had an initially increasing SBP followed by a decrease. Compared with those randomized to chlorthalidone, participants randomized to amlodipine (odds ratio, 1.20; 95% confidence interval [CI], 1.10–1.31), lisinopril (odds ratio, 1.88; 95% CI, 1.73–2.03), and doxazosin (odds ratio, 1.65; 95% CI, 1.52–1.78) had higher adjusted odds ratios associated with being a nonimmediate responder (versus immediate responder). After multivariable adjustment, nonimmediate responders had a higher hazard ratio of stroke (hazard ratio, 1.49; 95% CI, 1.21–1.84), combined cardiovascular disease (hazard ratio, 1.21; 95% CI, 1.11–1.31), and heart failure (hazard ratio, 1.48; 95% CI, 1.24–1.78) during follow-up between 6 months and 2 years. The SBP response trajectories provided superior discrimination for predicting downstream adverse cardiovascular events than classification based on difference in SBP between the first 2 measurements, SBP at 6 months, and average SBP during the first 6 months. Our findings demonstrate heterogeneity in response to antihypertensive therapies and show that chlorthalidone is associated with more favorable initial response than the other medications.







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