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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hypertension control has remained at 24% to 27% for the past decade, despite revision of national treatment guidelines, expansion of therapeutic options, and evidence from clinical trials that higher control rates are attainable. Uncontrolled hypertension contributes to the enormous health and economic burden from cardiovascular and renal disease. The risk for hypertension-related complications is increasing in the United States as comorbidities such as diabetes mellitus and congestive heart failure rise in a population that is becoming progressively older, more obese, and more ethnically diverse. Given regional variations in demographic characteristics and disease burdens, implementing evidence-based guidelines will be more effective if tailored appropriately to the local community. The Clinical Hypertension Specialist program is a positive response to an impending health care crisis. The impact of the Hypertension Specialist on blood pressure control can be leveraged by extending the academic mission of education, patient care, and health services research to the local community. The American Society of Hypertension regional chapter can serve as a forum for Clinical Hypertension Specialists from academic medicine and the community to define mutual goals, develop an action plan which is responsive to community needs, and monitor progress. With support from the chapter, Clinical Hypertension Specialists in the community can have an impact on the practice of medicine locally by contributing to the education of primary care providers, receiving referrals of patients with complicated hypertension, monitoring progress in meeting evidence-based goals, providing feedback to peers, and participating in multicenter trials.
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PMID:American Society of Hypertension regional chapters: leveraging the impact of the clinical hypertension specialist in the local community. 1199 Dec 26

The heart, kidney, brain, and arterial blood vessels are prime targets of hypertensive damage. Uncontrolled hypertension accelerates the damage to these organs and results in eventual organ failure and cardiovascular death and disability. Current guidelines for the appropriate treatment and control of hypertension requires an assessment of the presence of target organ damage. When present, evidence of target organ damage determines the urgency and intensity of drug treatment and may also dictate the choice of initial antihypertensive drug class. Thus, evaluation of persons with suspected or established hypertension must include a meticulous search for evidence of target organ damage. Fortunately, treatment with all antihypertensive medications that results in significant BP reductions also reduces fatal and nonfatal hypertensive complications and significantly slows down the progression to organ failure. Because of the important role that adverse activation of the renin-angiotensin-aldosterone system plays in target organ damage, drugs that antagonize this system have provided consistent and compelling proof of organ protection in both primary and secondary prevention of adverse outcomes. The challenge now is to use these and all other antihypertensive agents effectively to control BP to target levels in patients with hypertension. Continued emphasis on the adoption of lifestyle changes for prevention of hypertension in the first place or as adjunctive therapy in hypertensive patients is essential.
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PMID:The heart, kidney, and brain as target organs in hypertension. 1211 98

Cardiovascular disease is a leading cause of death in patients with end-stage renal disease. Uncontrolled hypertension and volume expansion contribute to alternations in left ventricular geometry and are independent predictors of poor survival in dialysis patients. Excessive salt intake is a major handicap with loss of residual renal function. Sodium removal becomes inadequate in the face of declining residual renal function. Continued salt intake and inadequate sodium removal lead to volume expansion, which aggravates arterial hypertension. In part I of this two-part review, we consider information on dietary salt intake and its relationship to blood pressure and volume control in peritoneal dialysis (PD) patients. In addition, we review recently published studies on the use of various PD modalities to remove sodium, emphasizing the significance of volume expansion and uncontrolled hypertension in PD patients. Part II reviews the various measures available to enhance sodium and fluid removal in PD patients.
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PMID:Volume expansion and sodium balance in peritoneal dialysis patients. Part I: Recent concepts in pathogenesis. 1476 32

Uncontrolled hypertension and its complications continue to be major health problems that disproportionately affect poor minority communities. Although dietary modification is an effective treatment for hypertension, it is not clear how hypertensive minority patients view diet as part of their treatment, and what barriers affect their abilities to eat healthy diets. We conducted nine focus groups with 88 African American and Latino patients treated for hypertension to assess their knowledge, attitudes, behaviors, and beliefs concerning hypertension. Participants generally agreed that certain foods and food additives play an important role in the cause and treatment of hypertension. However, they found clinician-recommended diets difficult to follow in the context of their family lives, social situations, and cultures. These diets were often considered expensive, an unwelcome departure from traditional and preferred diets, socially isolating, and not effective enough to obviate the need for medications. These findings suggest the importance of culturally sensitive approaches to dietary improvements.
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PMID:How do urban African Americans and Latinos view the influence of diet on hypertension? 1553 20

Surveys have shown that in as many as half of patients treated for hypertension, blood pressure (BP) is not controlled to target levels; many more persons have undertreated hypertension. Uncontrolled hypertension is a serious risk factor for cardiovascular events such as stroke, heart failure, myocardial infarction and target-organ diseases. Studies have shown that strict BP control significantly reduces the occurrence of these cardiovascular outcomes, in the majority of patients, effective BP control requires two or more antihypertensive agents. The combination of an angiotensin-receptor blocker (ARB) and a thiazide diuretic is appealing, since these agents have complimentary effects on BP reduction, left ventricular hypertrophy and progression of renal diseases. In addition, this combination provide excellent tolerability. The combination of an ARB and a thiazide diuretic may be of particular value in patient populations who tend to have poor BP control on monotherapy, or have additional cardiovascular or renal risk factors.
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PMID:Angiotensin-receptor blockers and diuretics--advantages of combination. 1582 41

Arterial hypertension develops in up to 80% of renal transplant recipients. Uncontrolled hypertension induces left ventricular hypertrophy, heart failure and death, but also promotes deterioration of allograft function. Cadaveric transplantation, delayed graft function, renal artery stenosis, presence of native kidneys, increased body weight and therapy with calcineurin inhibitors and steroids have been associated with an increased incidence of hypertension after kidney transplantation. Cyclosporine increases both systemic and renal vascular resistance, enhances sympathetic activation, endothelin production and, possibly, decreases vascular relaxation by decreasing the generation of nitric oxide. Tacrolimus has less pronounced prohypertensive role after renal transplantation. Corticosteroids contribute to the development of hypertension, since their withdrawal results in a significant decrease of blood pressure in the majority of patients. Renal artery stenosis occurs in almost 12% of hypertensive renal transplant recipients. It is a correctable cause of hypertension, and for this reason should be investigated in all suspected patients. Doppler ultrasonography is used as the screening method that is highly sensitive and specific in the hands of a well-experienced investigator. However, dependence of the method on the experience of the investigator is its major drawback. Magnetic resonance angiography and spinal computed tomography angiography are useful noninvasive methods, but arteriography remains a method for establishing the definitive diagnosis. Percutaneous balloon angioplasty, with or without placement of the stent, is successful in the majority of patients, but with a high incidence of restenoses (20%). Surgery is indicated for stenoses that cannot be treated with angioplasty or that recur. Auto-transplantation of the kidney with complex stenoses of graft arteries is useful in selected cases. Posttransplant hypertension should be aggressively treated to prevent the development of end-organ damage. Every effort should be invested in reducing immunosuppression when appropriate, together with salt restriction and weight reduction. Calcium channel blockers have good antihypertensive properties accompanied with minimization of cyclosporine-induced renal vasoconstriction. Angiotensin-converting enzyme inhibitors (ACEi) should be used in patients with proteinuria. Renal function should be carefully monitored after their introduction since they may cause transitory deterioration of glomerular filtration and/or hyperkaliemia. ACEi can induce anemia in renal transplant recipients, side effect that is often used in the treatment of posttransplant erythrocytosis. All other antihypertensive drugs could be used, with minoxidil being the most potent one. Patients with resistant hypertension should be investigated for the presence of renal artery stenosis. After exclusion of rejection, renal artery stenosis and recurrent disease, in cases of severe hypertension, native kidneys laparoscopic nephrectomy should be considered.
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PMID:[Arterial hypertension in renal transplant recipients]. 1836 9

Atrial fibrillation (AF) is an emerging public health problem. The most important risk factor for developing chronic AF is uncontrolled hypertension. Uncontrolled hypertension promotes the initiation and perpetuation of AF through atrial remodeling. Experimental evidence has demonstrated the important role of the renin-angiotensin system in atrial remodeling. Retrospective analysis of several large clinical trials and small prospective trials suggests the beneficial role of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in preventing the onset and recurrence of AF in different populations. Several large prospective trials with longer follow-up periods are in progress. These trials may provide definitive evidence for the use of these agents in the prevention of AF.
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PMID:Hypertension and atrial fibrillation. 1986 67

Hypertension is a common chronic medical condition affecting over 65 million Americans. Uncontrolled hypertension can progress to a hypertensive crisis defined as a systolic blood pressure >180 mm Hg or a diastolic blood pressure >120 mm Hg. Hypertensive crisis can be further classified as a hypertensive urgency or hypertensive emergency depending on end-organ involvement including cardiac, renal, and neurologic injury. The prompt recognition of a hypertensive emergency with the appropriate diagnostic tests and triage will lead to the adequate reduction of blood pressure, ameliorating the incidence of fatal outcomes. Severely hypertensive patients with acute end-organ damage (hypertensive emergencies) warrant admission to an intensive care unit for immediate reduction of blood pressure with a short-acting titratable intravenous antihypertensive medication. Hypertensive urgencies (severe hypertension with no or minimal end-organ damage) may in general be treated with oral antihypertensives as an outpatient. Rapid and short-lived intravenous medications commonly used are labetalol, esmolol, fenoldopam, nicardipine, sodium nitroprusside, and clevidipine. Medications such as hydralazine, immediate release nifedipine, and nitroglycerin should be avoided. Sodium nitroprusside should be used with caution because of its toxicity. The risk factors and prognosticators of a hypertensive crisis are still under recognized. Physicians should perform complete evaluations in patients who present with a hypertensive crisis to effectively reverse, intervene, and correct the underlying trigger, as well as improve long-term outcomes after the episode.
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PMID:Hypertensive crisis. 2016 May 37

Hypertension control rates are low in inner-city African-Americans. This article describes the demographic and clinical characteristics of uncontrolled hypertension in this population. During a single outpatient visit, normotensive and hypertensive African-American volunteers (age 18 to 55) completed a questionnaire, and the following measurements were obtained: blood pressure (BP), anthropometric measures, and blood chemistries. Volunteers received a gift for participating. Of the 3,943 volunteers, 52% were hypertensive. Among the hypertensives, 75% were aware of hypertension, and of those aware, 76% were on antihypertensive drug therapy. BP was uncontrolled in 78% of all hypertensives and in 60% of those on drug therapy. Males were two times more likely than females to have uncontrolled hypertension. Compared to participants with controlled hypertension, those with uncontrolled hypertension were younger, had lower body mass index, and were more likely to report smoking cigarettes, drinking alcohol, and less likely to report restricting dietary salt. Lack of hypertension control was primarily related to the lack of antihypertensive drug therapy rather than to inadequate drug therapy. Uncontrolled hypertension was associated with several self-reported aversive health behaviors, including not taking antihypertensive medications. Strategies to improve hypertension control should be directed to patients and to health care providers.
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PMID:Characteristics of inner-city African-Americans with uncontrolled hypertension. 2040 17

Uncontrolled hypertension is highly prevalent, presents without symptoms, and constitutes a major risk factor for atherosclerosis, heart disease, stroke, and diabetes. Several factors impede individuals from adhering to treatment, while others work against physician monitoring and medication adjustment as the condition changes. As family counselors and leaders of self-help and mutual aid groups, social workers are among the best positioned professionals to help individuals, couples, and families improve psychosocial dynamics associated with hypertension, secure support, and overcome barriers to lifestyle changes or medication adherence. An important case is made for training social workers from community social service agencies to engage and guide their clients in accurate self-screenings for hypertension and to refer those with elevated blood pressure for follow-up care.
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PMID:Agency social workers could monitor hypertension in the community. 2052 Dec 6


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