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Hypertension Causes

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181. Pharmacotherapy for hypertension in adults aged 18 to 59 years. (PubMed)

of therapy are in people 18 to 59 years of age.To quantify antihypertensive drug effects on all-cause mortality in adults aged 18 to 59 years with mild to moderate primary hypertension. To quantify effects on cardiovascular mortality plus morbidity (including cerebrovascular and coronary heart disease mortality plus morbidity), withdrawal due adverse events and estimate magnitude of systolic blood pressure (SBP) and diastolic blood pressure (DBP) lowering at one year.The Cochrane Hypertension Information (...) antihypertensive pharmacotherapy with a placebo or no treatment in adults aged 18 to 59 years with mild to moderate primary hypertension defined as SBP 140 mmHg or greater or DBP 90 mmHg or greater at baseline, or both.The outcomes assessed were all-cause mortality, total cardiovascular (CVS) mortality plus morbidity, withdrawals due to adverse events, and decrease in SBP and DBP. For dichotomous outcomes, we used risk ratio (RR) with 95% confidence interval (CI) and a fixed-effect model to combine outcomes

2017 Cochrane

182. Renal denervation for resistant hypertension. (PubMed)

sympathetic ablation (renal denervation) has been recently proposed as a possible therapeutic alternative to treat this condition.We sought to evaluate the short- and long-term effects of renal denervation in individuals with resistant hypertension on clinical end points, including fatal and non-fatal cardiovascular events, all-cause mortality, hospital admissions, quality of life, blood pressure control, left ventricular hypertrophy, cardiovascular and metabolic profile, and kidney function, as well (...) of the evidence was low for cardiovascular outcomes and adverse events and moderate for lack of effect on blood pressure and renal function.In patients with resistant hypertension, there is low quality evidence that renal denervation does not change major cardiovascular events, and renal function. There was moderate quality evidence that it does not change blood pressure and and low quality evidence that it caused an increaseof bradycardia episodes. Future trials measuring patient-centred instead of surrogate

2017 Cochrane

183. Eplerenone for hypertension. (PubMed)

monotherapy versus placebo for primary hypertension in adults. Outcomes of interest were all-cause mortality, cardiovascular events (fatal or non-fatal myocardial infarction), cerebrovascular events (fatal or non fatal strokes), adverse events or withdrawals due to adverse events, and systolic and diastolic blood pressure.We searched the Cochrane Hypertension Specialised Register, CENTRAL, MEDLINE, Embase, and two trials registers up to 3 March 2016. We handsearched references from retrieved studies (...) Eplerenone for hypertension. Eplerenone is an aldosterone receptor blocker that is chemically derived from spironolactone. In Canada, it is indicated for use as adjunctive therapy to reduce mortality for heart failure patients with New York Heart Association (NYHA) class II systolic chronic heart failure and left ventricular systolic dysfunction. It is also used as adjunctive therapy for patients with heart failure following myocardial infarction. Additionally, it is indicated for the treatment

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2017 Cochrane

184. Thiazide diuretic-caused hyponatremia in the elderly hypertensive: will a bottle of Nepro a day keep hyponatremia and the doctor away? Study protocol for a proof-of-concept feasibility trial (PubMed)

Thiazide diuretic-caused hyponatremia in the elderly hypertensive: will a bottle of Nepro a day keep hyponatremia and the doctor away? Study protocol for a proof-of-concept feasibility trial Hypertension is the most common modifiable risk factor for cardiovascular disease, with an increasing prevalence with age, but with easily available medications to control it. Adverse effects of these medications do limit their use, in particular hyponatremia due to thiazide and thiazide-like diuretics

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2018 Pilot and feasibility studies

185. Renin dependent hypertension caused by accessory renal arteries (PubMed)

Renin dependent hypertension caused by accessory renal arteries Hypokalemia in the presence of hypertension is often attributed to primary hyperaldosteronism as a cause of secondary hypertension, however secondary hyperaldosteronism may present similarly. Accessory renal arteries are variants in the vascular anatomy which are often thought to be innocuous but in some circumstances can cause renovascular hypertension leading to secondary hyperaldosteronism.We report 2 cases of hypertension (...) with secondary hyperaldosteronism associated with accessory renal arteries. Both patients presented with hypokalemia and further investigations revealed hyperaldosteronism with unsuppressed renin levels. Imaging studies showed the presence of accessory renal artery.Accessory renal arteries are a potential cause renovascular hypertension which can be detected via CT angiography or magnetic resonance angiography. Hormonal evaluation should be undertaken to determine whether its presence contributes

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2018 Clinical hypertension

186. Albumin-to-creatinine ratio as a predictor of all-cause mortality and hospitalization of congestive heart failure in Chinese elder hypertensive patients with high cardiovascular risks (PubMed)

Albumin-to-creatinine ratio as a predictor of all-cause mortality and hospitalization of congestive heart failure in Chinese elder hypertensive patients with high cardiovascular risks Data are limited with regard to the relationship of albuminuria and major adverse cardiovascular events (MACE) in Chinese elder patients with high cardiovascular risk.We did a retrospective cohort study using Chinese elder patients with high cardiovascular risks (n = 1474) to identify the association of albumin (...) -to-creatinine ratio (ACR) and the incidence of MACE and all-cause mortality. Individuals were followed up from January, 2002 to November, 2007. The all-cause mortality and MACE, composite outcome of cardiovascular death, myocardial infarction, stroke and hospitalization of congestive heart failure were defined as primary endpoint.During the median following up of 56 months, 213 patients developed primary endpoint and 117 patients died. Patients with higher baseline urinary ACR (> 30 mg/g) experienced

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2018 Clinical hypertension

187. Hypertension and diabetes: if chlortalidone is unavailable, an ACE inhibitor should be the drug of choice

Hypertension and diabetes: if chlortalidone is unavailable, an ACE inhibitor should be the drug of choice Prescrire IN ENGLISH - Spotlight ''Hypertension and diabetes: if chlortalidone is unavailable, an ACE inhibitor should be the drug of choice'', 1 June 2017 {1} {1} {1} | | > > > Hypertension and diabetes: if chlortalidone is unavailable, an ACE inhibitor should be the drug of choice Spotlight Every month, the subjects in Prescrire’s Spotlight. 100 most recent :  |   |    (...) |   |   |   |   |   |   |  Spotlight Hypertension and diabetes: if chlortalidone is unavailable, an ACE inhibitor should be the drug of choice Hypertension treatment in diabetes patients aims to reduce the risk of complications: cardiovascular events, end-stage renal failure, deterioration of eyesight. Patients with diabetes are exposed to arterial damage, including coronary artery disease and stroke, and damage to the blood capillaries

2017 Prescrire

188. Treatment of Hypertension in Association With Renovascular Disease

is present; however, this caution does not preclude use of these drugs. Most patients will have been treated with a RAAS inhibitor before diagnosis of renovascular hypertension is made or suspected. In randomized controlled trials, such as CORAL, a RAAS inhibitor was a proximal part of treatment protocol . Anticipated soon is inclusion of guidance specific to non-atherosclerotic causes, such as fibromuscular dysplasia, in which estimates of benefit on hypertension outcomes might be larger . Certainly (...) for patients with ostial atherosclerotic renal artery stenosis and renal insufficiency. J Am Soc Nephrol 2001;12:1475-8. Van de Yen PJG, Kaatee R, Beutler JJ, et al. Arterial stenting and balloon angioplasty in ostial atherosclerotic renovascular disease: a randomised trial. Lancet 1999;353:282-6. Trinquart L, Mounier-Vehier C, Sapoval M, Gagnon N, Plouin PF. Efficacy of revascularization for renal artery stenosis caused by fibromuscular dysplasia: a systematic review and meta-analysis. Hypertension

2018 Hypertension Canada

189. Treatment of Hypertension in Association With Diabetes Mellitus

even exceed those of aggressive glycemic control in people with diabetes mellitus for the prevention of cardiovascular complications . Because cardiovascular disease is the most common cause of death in patients with diabetes mellitus , BP control is paramount in these patients. In subjects with diabetes, there is randomized, clinical trial evidence supporting lower BP levels (two major trials are the United Kingdom Prospective Diabetes Study Group [UKPDS]-38 trial and the Hypertension Optimal (...) and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000;355:253-9. Bakris GL, Weir MR. Angiotensin-converting enzyme inhibitor- associated elevations in serum creatinine. Is this a cause for concern? Arch Intern Med 2000;160:685-93. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhager WH, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic

2018 Hypertension Canada

190. Treatment of Hypertension in Association With Left Ventricular Hypertrophy

drugs. In summary, while antihypertensive therapy improves left ventricular mass and reduces cardiovascular morbidity and mortality in patients with LVH, no one anti-hypertensive class is superior to all others. Most major classes of antihypertensive agents (except direct arterial vasodilators, such as hydralazine or minoxidil) have been shown to cause LVH regression, but not always to the same degree in relation to the amount of BP lowering achieved. Therefore, antihypertensive treatment should (...) Treatment of Hypertension in Association With Left Ventricular Hypertrophy IX. Treatment of Hypertension in Association With Left Ventricular Hypertrophy | Hypertension Canada Guidelines Subgroup Members: Simon W. Rabkin, MD; Gordon W. Moe, MD, MSc; Jonathan G. Howlett, MD Central Review Committee: Stella S. Daskalopoulou, MD MSc DIC PhD (Chair); Kaberi Dasgupta, MD MSc; Kelly B. Zarnke, MD MSc; Kara Nerenberg, MD, MSc; Alexander A. Leung, MD MPH; Kevin C. Harris, MD MHSc; Kerry McBrien, MD MPH

2018 Hypertension Canada

191. Treatment of Hypertension in Association With Nondiabetic Chronic Kidney Disease

Treatment of Hypertension in Association With Nondiabetic Chronic Kidney Disease X. Treatment of Hypertension in Association With Nondiabetic Chronic Kidney Disease | Hypertension Canada Guidelines Subgroup Members: Marcel Ruzicka, MD PhD; Sheldon W. Tobe, MD MScCH; Ramesh Prasad, MBBS MSc MA PhD; Michel Vallée, MD PhD; Cedric Edwards, MD Central Review Committee: Stella S. Daskalopoulou, MD MSc DIC PhD (Chair); Kaberi Dasgupta, MD MSc; Kelly B. Zarnke, MD MSc; Kara Nerenberg, MD, MSc (...) ; Alexander A. Leung, MD MPH; Kevin C. Harris, MD MHSc; Kerry McBrien, MD MPH; Sonia Butalia, BSc MD MSc; Meranda Nakhla, MD MSc Co-Chairs: Doreen M. Rabi, MD MSc, Stella S. Daskalopoulou, MD MSc DIC PhD This information is based on the Hypertension Canada guidelines published in Nerenberg, Kara A. et al. Hypertension Canada’s 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children. . Recommendations For patients with nondiabetic chronic kidney

2018 Hypertension Canada

192. Treatment of Hypertension in Association With Ischemic Heart Disease

Treatment of Hypertension in Association With Ischemic Heart Disease VI. Treatment of Hypertension in Association With Ischemic Heart Disease | Hypertension Canada Guidelines Subgroup Members: Simon W. Rabkin, MD, Gordon W. Moe, MD MSc, Jonathan G. Howlett, MD Central Review Committee: Stella S. Daskalopoulou, MD MSc DIC PhD (Chair); Kaberi Dasgupta, MD MSc; Kelly B. Zarnke, MD MSc; Kara Nerenberg, MD, MSc; Alexander A. Leung, MD MPH; Kevin C. Harris, MD MHSc; Kerry McBrien, MD MPH; Sonia (...) Butalia, BSc MD MSc; Meranda Nakhla, MD MSc Co-Chairs: Doreen M. Rabi, MD MSc, Stella S. Daskalopoulou, MD MSc DIC PhD This information is based on the Hypertension Canada guidelines published in Nerenberg, Kara A. et al. Hypertension Canada’s 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children. . Guidelines Guidelines for hypertensive patients with coronary artery disease (CAD) For most hypertensive patients with CAD, an ACE inhibitor

2018 Hypertension Canada

193. Global Vascular Protection Therapy for Adults with Hypertension Without Compelling Indications for Specific Agents

they should be on statin therapy. Mean LDL cholesterol was 3.4 mmol/L at baseline and was lowered by 1.0 mmol/L in the simvastatin arm versus the placebo arm. The primary outcome (all-cause mortality) was reduced significantly with simvastatin therapy (HR 0.87; 95%CI, 0.81 to 0.94, NNT=278 patient-years), as was the composite outcome of the first major vascular event (HR 0.76; 95%CI, 0.72 to 0.81). The benefits of simvastatin were similar in the 41% of trial participants with hypertension as in those (...) %) or recent myocardial infarction (within past 3 months) Indication for, but not currently receiving, a beta-blocker Institutionalized elderly Inconclusive evidence Diabetes mellitus Previous stroke eGFR <20 mL/min/1.73 m 2 Contraindications Patient unwilling or unable to adhere to multiple medications Standing SBP <110 mm Hg Inability to measure SBP accurately Known secondary cause(s) of hypertension References Genest J, Frohlich J, Fodor G, McPherson R. Recommendations for the management of dyslipidemia

2018 Hypertension Canada

194. Choice of therapy for Adults With Hypertension Without Compelling Indications for Specific Agents

antihypertensive classes. Thiazides There is strong evidence from meta-analyses of 16 placebo-controlled trials to indicate that thiazide diuretics, particularly at low doses (defined as < 50 mg/day hydrochlorothiazide), reduce stroke, myocardial infarction (MI), heart failure, and cardiovascular and all-cause mortality in patients with hypertension (Relative Risk Reduction [RRR], 25% to 30%) . ALLHAT confirmed the central role of thiazide diuretics in first-line therapy of hypertension without compelling (...) trials in patients with atherosclerotic risk factors showed clear reductions in stroke (RR, 0.70; 95%CI, 0.57 to 0.85), MI (RR, 0.80; 95%CI, 0.72 to 0.89), cardiovascular death (RR, 0.74; 95%CI, 0.64 to 0.85) and all-cause mortality (RR, 0.84; 95%CI, 0.76 to 0.94) with these agents (observed effect sizes were similar in patients with and without hypertension) . Although some subjects with blood pressure levels in the normal range were included, the observed benefits are widely felt to be due to blood

2018 Hypertension Canada

195. Prevention & Treatment of Hypertension - Health Behaviour Management

of developing hyperkalemia including: Patients receiving renin-angiotensin-aldosterone inhibitors Patients receiving other drugs that can cause hyperkalemia (eg, trimethoprim and sulfamethoxazole, amiloride, or triamterene) Patients with chronic kidney disease (glomerular filtration rate < 60 mL/min/1.73 m2) Patients with baseline serum potassium > 4.5 mmol/L H. Stress management 1. In hypertensive patients in whom stress might be a contributor to high BP, stress management should be considered (...) Prevention & Treatment of Hypertension - Health Behaviour Management I. Health Behaviour Management | Hypertension Canada Guidelines Subgroup Members: Simon L. Bacon, PhD; Janusz Kaczorowski, PhD; Luc Trudeau, MD; Swapnil Hiremath, MD MPH; Norman RC. Campbell, MD; Michael Roerecke, PhD; Joanne Arcand, PhD RD Central Review Committee: Stella S. Daskalopoulou, MD MSc DIC PhD (Chair); Kaberi Dasgupta, MD MSc; Kelly B. Zarnke, MD MSc; Kara Nerenberg, MD, MSc; Alexander A. Leung, MD MPH; Kevin C

2018 Hypertension Canada

196. Diagnosis & Assessment of Hypertension - Lab Tests

ventricular hypertrophy (LVH) or a prior myocardial infarction, both of which portend a higher risk of future cardiovascular events and death . Finally, both the routine and optional investigations aid in the screening for some of the modifiable causes of hypertension. For example recurrent and/or severe hypokalemia may indicate the presence of primary hyperaldosteronism. When compared with oral glucose tolerance testing, a systematic review suggests that A1C and fasting glucose levels demonstrate (...) Diagnosis & Assessment of Hypertension - Lab Tests V. Routine and Optional Laboratory Tests for the Investigation of Patients with Hypertension | Hypertension Canada Guidelines Subgroup Members: Brian Penner, MD; Ellen Burgess, MD; Praveena Sivapalan, MD Central Review Committee: Stella S. Daskalopoulou, MD MSc DIC PhD (Chair); Kaberi Dasgupta, MD MSc; Kelly B. Zarnke, MD MSc; Kara Nerenberg, MD, MSc; Alexander A. Leung, MD MPH; Kevin C. Harris, MD MHSc; Kerry McBrien, MD MPH; Sonia Butalia

2018 Hypertension Canada

197. Diagnosis & Assessment of Hypertension - Diagnosis

all visits) is ≥160 mmHg systolic or ≥100 mm Hg diastolic; At visit 4 or 5, mean non-AOBP measurement (averaged across all visits) is ≥140 mmHg systolic or ≥90 mmHg diastolic. Investigations for secondary causes of hypertension should be initiated in patients with suggestive clinical and/or laboratory features (outlined in , VII and II) (Grade D). If at the last diagnostic visit the patient is not diagnosed as hypertensive and has no evidence of macrovascular target organ damage, the patient’s BP (...) . A marked elevation in blood pressure in the presence of acute symptoms or progressive target organ damage in the brain, eye, heart, or kidney is a hypertensive emergency . An asymptomatic severe blood pressure elevation without evidence of target organ damage and not due to an acutely reversible cause (e.g. pain, urinary retention) constitutes a hypertensive urgency . Historically, a ≥180/110 mm Hg has been used to define severe blood pressure elevation ; however, this threshold is arbitrary should

2018 Hypertension Canada

198. Diagnosing hypertension in Indigenous Canadians (DREAM-GLOBAL): A randomized controlled trial to compare the effectiveness of short message service messaging for management of hypertension: Main results. (PubMed)

Diagnosing hypertension in Indigenous Canadians (DREAM-GLOBAL): A randomized controlled trial to compare the effectiveness of short message service messaging for management of hypertension: Main results. Hypertension, the leading cause of cardiovascular morbidity and mortality, affects more than 1 billion people globally. The rise in mobile health in particular the use of mobile phones and short message service (SMS) to support disease management provides an opportunity to improve hypertension (...) awareness, treatment, and control, in remote and vulnerable patient populations. The primary objective of this randomized controlled study was to assess the effect of active (with hypertension specific management SMS) or passive (health behaviors SMS alone) on the difference in blood pressure (BP) reduction between the active and passive SMS groups in hypertensive Canadian First Nations people from six rural and remote communities. Pragmatic features of the study included shifting of BP measures to non

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2019 Journal of clinical hypertension (Greenwich, Conn.)

199. Racial and Ethnic Differences in Pediatric Pulmonary Hypertension: An Analysis of the Pediatric Pulmonary Hypertension Network Registry. (PubMed)

pulmonary hypertension (HR, 2.84; 95% CI, 1.15-7.04; P = .0241).We found significant racial variability in the prevalence of pulmonary hypertension subtypes and survival outcomes among children with pulmonary hypertension. Given the substantial burden of this disease, further studies to validate phenotypic differences and to understand the underlying causes of survival disparities between racial and ethnic groups are warranted.Copyright © 2019 Elsevier Inc. All rights reserved. (...) Racial and Ethnic Differences in Pediatric Pulmonary Hypertension: An Analysis of the Pediatric Pulmonary Hypertension Network Registry. To investigate racial and ethnic differences in pulmonary hypertension subtypes and survival differences in a pediatric population.This was a retrospective analysis of a cohort of patients with pulmonary hypertension (aged ≤18 years) enrolled in the Pediatric Pulmonary Hypertension Network registry between 2014 and 2018, comprising patients at eight Pediatric

2019 Journal of Pediatrics

200. A comparative meta-analysis of prospective observational studies on masked hypertension and masked uncontrolled hypertension defined by ambulatory and home blood pressure. (PubMed)

was defined as a normal clinic BP (<140/90 mmHg) in the presence of an elevated 24 h, daytime or night-time ambulatory or home BP. Clinical outcomes included all-cause and cardiovascular mortality, and fatal and nonfatal cardiovascular, stroke, cardiac, coronary and renal disease events.In total, 21 studies (n = 130 318) were included. Overall, compared with normotensive participants, masked hypertensive patients had a 5.7/2.9 mmHg higher clinic BP and 18.7/9.8 mmHg higher out-of-office BP. The pooled (...) risk ratio for masked hypertension versus normotension was 1.67 (95% confidence interval, 1.32-2.13) and 2.19 (1.72-2.78) for all-cause (eight studies) and cardiovascular mortality (three studies), respectively, and 1.71 (1.53-1.91), 1.95 (1.36-2.80), 1.76 (1.33-2.33), 1.62 (0.27-9.60), 3.85 (2.03-7.31) for fatal and nonfatal cardiovascular (15 studies), stroke (two studies), cardiac (two studies), coronary (two studies) and renal disease events (two studies), respectively. Risk ratios for all

2019 Journal of Hypertension

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