Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.4.23.15 (renin)
 35,795 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In uncomplicated hypertension, <140/90 mmHg is the treatment goal for individuals aged 18-79 and between 140 mmHg and 150 mmHg in those 80 years of age. Inhibitors of the renin-angiotensin-aldosterone system, as well as calcium channel blockers, are universally accepted as first-line therapy in uncomplicated hypertension, but controversy exists over the role of thiazide diuretics and beta blockers. Because at similar blood pressure (BP) levels, African Americans have more target organ damage than whites, a lower goal of <135/85 mmHg is recommended. In patients with coronary artery disease, diabetes, and chronic kidney disease, <130/80 mmHg is recommended. Masked hypertension, defined as normal clinic BP with a high average self-monitored or ambulatory BP, is prevalent in those with chronic kidney disease, diabetes, and obstructive sleep apnea. Masked hypertension is associated with worse outcome. Ambulatory BP monitoring for those at risk for masked hypertension needs to be incorporated into guidelines.
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PMID:Controversies in blood pressure goal guidelines and masked hypertension. 2254 77

Based on the SPRINT trial, it is highly likely that new SPRINT-era guidelines will establish a blood pressure (BP) goal of < 130/80 mm Hg for those aged 50 or older who are at high risk for a cardiovascular event. In this group, SPRINT demonstrated that assignment to an intensive-treatment systolic BP (SBP) goal of < 120 mm Hg significantly reduced cardiovascular events and mortality compared to those assigned to a standard-treatment SPB goal of < 140 mm Hg. This review critically assesses current hypertension guidelines and presents predictions for SPRINT-era guidelines in the elderly, African Americans, and patients with uncomplicated essential hypertension, diabetes, chronic kidney disease, cardiovascular disease, and coronary artery disease. Specific attention is paid to BP goals and preferred pharmacological antihypertensive therapy in these populations, and an algorithm that incorporates the SPRINT trial results is presented. Inhibitors of the renin-angiotensin-aldosterone system as well as calcium channel blockers are universally accepted as first-line therapy in uncomplicated hypertension, but controversy exists over the role of thiazide diuretics and beta blockers. This review also discusses a physiologically and outcomes-based approach to combination therapy for treatment of hypertension.
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PMID:Current and Future Treatment of Hypertension in the SPRINT Era. 2705 88


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