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Resistant Hypertension

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2. Renal denervation for resistant hypertension. (PubMed)

Renal denervation for resistant hypertension. Resistant hypertension is highly prevalent among the general hypertensive population and the clinical management of this condition remains problematic. Different approaches, including a more intensified antihypertensive therapy, lifestyle modifications, or both, have largely failed to improve patients' outcomes and to reduce cardiovascular and renal risk. As renal sympathetic hyperactivity is a major driver of resistant hypertension, renal (...) 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

2017 Cochrane

3. Baroreflex activation therapy for drug-resistant hypertension. A single technology assessment

Baroreflex activation therapy for drug-resistant hypertension. A single technology assessment Baroreflex activation therapy for drug-resistant hypertension. A single technology assessment - NIPH Selected items added to basket Close Search for: Søk Meny Infectious diseases & Vaccines Close Mental & Physical health Close Environment & Lifestyle Close Health in Norway Close Quality & Knowledge Close Research & Access to data Close About NIPH Close Baroreflex activation therapy for drug-resistant (...) hypertension. A single technology assessment Have you found an error? Order Download: Summary Background The Barostim therapy device is an active implantable device which delivers electrical stimulation to the baroreceptors located on the carotid artery with the aim of lowering blood pressure in patients with resistant hypertension. This device for baroreflex activation therapy has been produced as a first generation system (Rheos system), and the currently available second generation system (Barostim Neo

2017 Norwegian Institute of Public Health

4. Optimal Systolic Blood Pressure Target in Apparent Resistant and Non-Resistant Hypertension: A Pooled Analysis of Patient-Level Data from Sprint and ACCORD

Optimal Systolic Blood Pressure Target in Apparent Resistant and Non-Resistant Hypertension: A Pooled Analysis of Patient-Level Data from Sprint and ACCORD Prior studies suggest benefits of blood pressure lowering on cardiovascular risk may be attenuated in patients with resistant hypertension compared with the general hypertensive population, but prospective data are lacking.We assessed intensive (<120 mm Hg) versus standard (<140 mm Hg) systolic blood pressure targets on adverse outcome risk (...) according to baseline resistant hypertension status, using Action to Control Cardiovascular Risk in Diabetes (ACCORD) and Systolic Blood Pressure Intervention Trial (SPRINT) patient-level data. Patients were categorized as having baseline apparent resistant hypertension (blood pressure ≥130/80 mm Hg while using 3 antihypertensive drugs or use of ≥4 drugs regardless of blood pressure) or non-resistant hypertension (all others). Cox regression was used to assess effects of treatment assignment, resistant

2018 EvidenceUpdates

5. Resistant hypertension? Time to consider this fourth-line drug

Resistant hypertension? Time to consider this fourth-line drug Resistant hypertension? Time to consider this fourth-line drug Toggle navigation Shared more. Cited more. Safe forever. Toggle navigation View Item JavaScript is disabled for your browser. Some features of this site may not work without it. Search MOspace This Collection Browse Statistics Resistant hypertension? Time to consider this fourth-line drug View/ Open Date 2016-04 Format Metadata Abstract Resistant hypertension? Time (...) to consider this fourth-line drug For most adults with resistant hypertension, spironolactone is superior to doxazosin and bisoprolol as an adjunct to triple therapy. Practice changer: When a triple regimen of an ACE inhibitor or ARB, calcium channel blocker, and a thiazide diuretic fails to achieve the target blood pressure, try adding spironolactone. URI Part of Citation Journal of Family Practice, 65(04) 2016: 266-268. Rights OpenAccess. This work is licensed under a Creative Commons Attribution

2016 PURLS

6. Antihypertensive drug use in resistant and nonresistant hypertension and in controlled and uncontrolled resistant hypertension. (PubMed)

Antihypertensive drug use in resistant and nonresistant hypertension and in controlled and uncontrolled resistant hypertension. Treatment-resistant hypertension (TRH) is associated with particular clinical features, nonadherence, and suboptimal treatment. We assessed possible associations of antihypertensive drug classes, specific agents inside each class, and types of combinations, with the presence of non-TRH vs. TRH, and with controlled vs. uncontrolled TRH.Comparisons were done in 14 264

2018 Journal of Hypertension

7. Spironolactone Versus Clonidine as a Fourth-Drug Therapy for Resistant Hypertension: The ReHOT Randomized Study (Resistant Hypertension Optimal Treatment). (PubMed)

Spironolactone Versus Clonidine as a Fourth-Drug Therapy for Resistant Hypertension: The ReHOT Randomized Study (Resistant Hypertension Optimal Treatment). The aim of this study is to compare spironolactone versus clonidine as the fourth drug in patients with resistant hypertension in a multicenter, randomized trial. Medical therapy adherence was checked by pill counting. Patients with resistant hypertension (no office and ambulatory blood pressure [BP] monitoring control, despite treatment (...) with 3 drugs, including a diuretic, for 12 weeks) were randomized to an additional 12-week treatment with spironolactone (12.5-50 mg QD) or clonidine (0.1-0.3 mg BID). The primary end point was BP control during office (<140/90 mm Hg) and 24-h ambulatory (<130/80 mm Hg) BP monitoring. Secondary end points included BP control from each method and absolute BP reduction. From 1597 patients recruited, 11.7% (187 patients) fulfilled the resistant hypertension criteria. Compared with the spironolactone

2018 Hypertension Controlled trial quality: uncertain

8. Resistant Hypertension On Treatment (ResHypOT): sequential nephron blockade compared to dual blockade of the renin-angiotensin-aldosterone system plus bisoprolol in the treatment of resistant arterial hypertension – study protocol for a randomized contr (PubMed)

Resistant Hypertension On Treatment (ResHypOT): sequential nephron blockade compared to dual blockade of the renin-angiotensin-aldosterone system plus bisoprolol in the treatment of resistant arterial hypertension – study protocol for a randomized contr Resistant hypertension is characterized when the blood pressure (BP) remains above the recommended goal after taking three antihypertensive drugs with synergistic actions at their maximum recommended tolerated doses, preferably including (...) of hypotension (ambulatory BP monitoring (ABPM)). The sample size was calculated assuming an alpha error of 5% to reject the null hypothesis with a statistical power of 80% giving a total of 40 individuals per group.In recent years, the cost of resistant hypertension (RH) treatment has increased. Thus, identifying the contribution of intravascular volume and serum renin in maintaining BP levels could help tailor more effective hypertension treatment, whether by acting on the control of intravascular volume

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2018 Trials

9. Patiromer versus placebo to enable spironolactone use in patients with resistant hypertension and chronic kidney disease (AMBER): a phase 2, randomised, double-blind, placebo-controlled trial. (PubMed)

Patiromer versus placebo to enable spironolactone use in patients with resistant hypertension and chronic kidney disease (AMBER): a phase 2, randomised, double-blind, placebo-controlled trial. Spironolactone is effective at reducing blood pressure in patients with uncontrolled resistant hypertension. However, the use of spironolactone in patients with chronic kidney disease can be restricted by hyperkalaemia. We evaluated use of the potassium binder patiromer to allow more persistent use (...) of spironolactone in patients with chronic kidney disease and resistant hypertension.In this phase 2 multicentre, randomised, double-blind, placebo-controlled study, we enrolled participants aged 18 years and older with chronic kidney disease (estimated glomerular filtration rate 25 to ≤45 mL/min per 1·73 m2) and uncontrolled resistant hypertension from 62 outpatient centres in ten countries (Bulgaria, Croatia, Georgia, Hungary, Ukraine, France, Germany, South Africa, the UK, and the USA). Patients meeting all

2019 Lancet

10. A Three-Arm Randomized Trial of Different Renal Denervation Devices and Techniques in Patients With Resistant Hypertension (RADIOSOUND-HTN)

A Three-Arm Randomized Trial of Different Renal Denervation Devices and Techniques in Patients With Resistant Hypertension (RADIOSOUND-HTN) Both radiofrequency and ultrasound endovascular renal sympathetic denervation (RDN) have proven clinical efficacy for the treatment of hypertension. We performed a head-to-head comparison of these technologies.Patients with resistant hypertension were randomly assigned in a 1:1:1 manner to receive either treatment with (1) radiofrequency RDN of the main (...) ).In patients with resistant hypertension, endovascular ultrasound-based RDN was found to be superior to radiofrequency ablation of the main renal arteries only, whereas a combined approach of radiofrequency ablation of the main arteries, accessories, and side branches was not.URL: https://www.clinicaltrials.gov . Unique identifier: NCT02920034.

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2019 EvidenceUpdates

11. Gamechanger? Is Spironolactone the Magic Bullet for Resistant Hypertension?

Gamechanger? Is Spironolactone the Magic Bullet for Resistant Hypertension? Gamechanger? Is Spironolactone the Magic Bullet for Resistant Hypertension? – Clinical Correlations Search Gamechanger? Is Spironolactone the Magic Bullet for Resistant Hypertension? November 9, 2016 8 min read By Amar Parikh, MD Peer Reviewed Welcome to Gamechangers, a series that takes a critical look at the latest in medical literature to answer one important question: would the results of this article change my (...) . The patient is already on maximum doses of a calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEi), and a thiazide-like diuretic, and he refuses any beta blocker as he fears it will worsen his erectile dysfunction. What are your options for additional anti-hypertensives, and would you consider spironolactone? Why Does This Matter? Resistant hypertension (rHTN), defined as suboptimal blood pressure control despite treatment with at least three anti-hypertensives including a thiazide

2016 Clinical Correlations

12. Spironolactone is effective for treating resistant hypertension

Spironolactone is effective for treating resistant hypertension Spironolactone is effective for treating resistant hypertension Discover Portal Discover Portal Spironolactone is effective for treating resistant hypertension Published on 1 December 2015 doi: This trial investigated which drug is best added to high blood pressure (hypertension) treatment if blood pressure has not come down to normal levels after taking three blood pressure lowering drugs. Such “resistant hypertension” accounts (...) a healthy weight. NICE guidelines suggest that drug treatments are used in a “stepped” manner, with other drugs added to the regimen if initial treatment is not adequate. The NIHR funded this study, called PATHWAY-2, to investigate which of the add-on drugs currently recommended for resistant hypertension was most effective. What did this study do? The PATHWAY-2 trial recruited 335 participants and began with a month-long “run in” where each received a placebo treatment. This was in addition

2018 NIHR Dissemination Centre

13. Spironolactone is effective for treating resistant hypertension

Spironolactone is effective for treating resistant hypertension Spironolactone is effective for treating resistant hypertension Discover Portal Discover Portal Spironolactone is effective for treating resistant hypertension Published on 1 December 2015 doi: This trial investigated which drug is best added to high blood pressure (hypertension) treatment if blood pressure has not come down to normal levels after taking three blood pressure lowering drugs. Such “resistant hypertension” accounts (...) a healthy weight. NICE guidelines suggest that drug treatments are used in a “stepped” manner, with other drugs added to the regimen if initial treatment is not adequate. The NIHR funded this study, called PATHWAY-2, to investigate which of the add-on drugs currently recommended for resistant hypertension was most effective. What did this study do? The PATHWAY-2 trial recruited 335 participants and began with a month-long “run in” where each received a placebo treatment. This was in addition

2018 NIHR Dissemination Centre

14. Resistant Hypertension: Insights on Evaluation and Management in the Post-SPRINT (Systolic Blood Pressure Intervention Trial) Era.

Resistant Hypertension: Insights on Evaluation and Management in the Post-SPRINT (Systolic Blood Pressure Intervention Trial) Era. 27600177 2018 01 26 2018 01 26 1524-4563 68 5 2016 11 Hypertension (Dallas, Tex. : 1979) Hypertension Resistant Hypertension: Insights on Evaluation and Management in the Post-SPRINT (Systolic Blood Pressure Intervention Trial) Era. 1073-1080 Townsend Raymond R RR From the Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Division (...) therapeutic use Blood Pressure drug effects Blood Pressure Determination Comorbidity Drug Resistance Female Humans Hypertension diagnosis drug therapy Life Style Male Medication Therapy Management standards Middle Aged Practice Guidelines as Topic Prognosis Randomized Controlled Trials as Topic Risk Assessment Treatment Outcome United States 2016 9 8 6 0 2018 1 27 6 0 2016 9 8 6 0 ppublish 27600177 HYPERTENSIONAHA.116.07316 10.1161/HYPERTENSIONAHA.116.07316

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2018 Hypertension (Dallas, Tex. : 1979)

15. Blood Pressure and Renal Responses to Orthostatic Stress Before and After Radiofrequency Renal Denervation in Patients with Resistant Hypertension (PubMed)

Blood Pressure and Renal Responses to Orthostatic Stress Before and After Radiofrequency Renal Denervation in Patients with Resistant Hypertension In patients with resistant hypertension, renal denervation (RDN) studies have mainly focused their outcomes on blood pressure (BP). The aim of this study was to evaluate the long-term effect of RDN on neurohormonal profiles, renal hemodynamics and sodium excretion in a resting state and during stress induced by lower body negative pressure (LBNP (...) ).This was a single center prospective observational study. Norepinephrine, plasma renin activity (PRA), glomerular filtration rate (GFR), renal plasma flow (RPF) and sodium excretion were measured in unstimulated conditions (rest) and after one hour of LBNP at three different time points: before (M0), one (M1) and twelve months (M12) after RDN.Thirteen patients with resistant hypertension were included. In the resting state, no differences were observed in norepinephrine, PRA, sodium excretion and mean BP levels

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2018 Frontiers in cardiovascular medicine

16. Controlling resistant hypertension (PubMed)

Controlling resistant hypertension Resistant hypertension (failure to achieve target blood pressures with three or more antihypertensive drugs including a diuretic) is an important and preventable cause of stroke. Hypertension is highly prevalent in China (>60% of persons above age 65), and only ~6% of hypertensives in China are controlled to target levels. Most strokes occur among persons with resistant hypertension; approximately half of strokes could be prevented by blood pressure control (...) . Reasons for uncontrolled hypertension include (1) non-compliance; (2) consumption of substances that aggravated hypertension, such as excess salt, alcohol, licorice, decongestants and oral contraceptives; (3) therapeutic inertia (failure to intensify therapy when target blood pressures are not achieved); and (4) diagnostic inertia (failure to investigate the cause of resistant hypertension). In China, an additional factor is lack of availability of appropriate antihypertensive therapy in many

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2018 Stroke and vascular neurology

17. Effects of azilsartan compared with telmisartan on insulin resistance in patients with essential hypertension and type 2 diabetes mellitus: An open-label, randomized clinical trial. (PubMed)

Effects of azilsartan compared with telmisartan on insulin resistance in patients with essential hypertension and type 2 diabetes mellitus: An open-label, randomized clinical trial. Based on non-clinical data, it is expected that azilsartan, an angiotensin II receptor blocker, will help improve insulin resistance in addition to its hypotensive action. The present study is aimed to explore the effect of azilsartan compared to telmisartan on insulin sensitivity in hypertensive patients (...) in the clinical setting.This multicenter, randomized, open-label, parallel-group exploratory study was conducted in Japan. We randomized adult patients (≥20 years old) with grade I or II essential hypertension and coexisting type 2 diabetes (1:1) to receive either oral azilsartan (20 mg/day;17 patients) or telmisartan (40 mg/day;16 patients) for 12 weeks. The primary endpoint was the change in the homeostasis model assessment ratio of insulin resistance (HOMA-R) from the baseline at the end of the treatment

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2019 PLoS ONE Controlled trial quality: uncertain

18. Exercise as a tool for hypertension and resistant hypertension management: current insights (PubMed)

Exercise as a tool for hypertension and resistant hypertension management: current insights Although there has been an observed progress in the treatment of hypertension, its prevalence remains elevated and constitutes a leading cause of cardiovascular disease development. Resistant hypertension is a challenge for clinicians, as the available treatment options have reduced success. Physical activity and exercise training play an important role in the management of blood pressure. The importance (...) of physical activity and exercise training as part of a comprehensive lifestyle intervention is acknowledged by several professional organizations in their recommendations/guidelines for the management of arterial hypertension. Aerobic exercise, dynamic resistance exercise, and concurrent training - the combination of dynamic resistance and aerobic exercise training in the same exercise session or on separate days - has been demonstrated to reduce blood pressure and help in the management of hypertension

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2018 Integrated blood pressure control

19. Prevalence of treatment-resistant hypertension after considering pseudo-resistance and morbidity: a cross-sectional study in Irish primary care. (PubMed)

Prevalence of treatment-resistant hypertension after considering pseudo-resistance and morbidity: a cross-sectional study in Irish primary care. To confirm treatment-resistant hypertension (TRH), ambulatory blood pressure measurement (ABPM) must exclude white-coat hypertension (WCH), three or more medications should be prescribed at the optimal doses tolerated, and non-adherence and lifestyle should be examined. Most previous studies have not adequately considered pseudo-resistance and merely (...) provide an apparent TRH (aTRH) prevalence figure.To conduct a cross-sectional study of the prevalence of aTRH in general practice, and then consider pseudo-resistance and morbidity.With support, 16 practices ran an anatomical therapeutic chemical (ATC) drug search, identifying patients on any possible hypertensive medications, and then a search of individual patients' electronic records took place.ABPM was used to rule out WCH. The World Health Organization-defined daily dosing guidelines determined

2018 British Journal of General Practice

20. Optimal Systolic Blood Pressure Target in Apparent Resistant and Non-Resistant Hypertension: A Pooled Analysis of Patient-Level Data from Sprint and ACCORD. (PubMed)

Optimal Systolic Blood Pressure Target in Apparent Resistant and Non-Resistant Hypertension: A Pooled Analysis of Patient-Level Data from Sprint and ACCORD. Prior studies suggest benefits of blood pressure lowering on cardiovascular risk may be attenuated in patients with resistant hypertension compared with the general hypertensive population, but prospective data are lacking.We assessed intensive (<120 mm Hg) versus standard (<140 mm Hg) systolic blood pressure targets on adverse outcome risk (...) according to baseline resistant hypertension status, using Action to Control Cardiovascular Risk in Diabetes (ACCORD) and Systolic Blood Pressure Intervention Trial (SPRINT) patient-level data. Patients were categorized as having baseline apparent resistant hypertension (blood pressure ≥130/80 mm Hg while using 3 antihypertensive drugs or use of ≥4 drugs regardless of blood pressure) or non-resistant hypertension (all others). Cox regression was used to assess effects of treatment assignment, resistant

2018 American Journal of Medicine

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