Fear of Lowering Cardiovascular Risk by Achieving Blood Pressure Goals

Hypertension affects the vast majority of patients with CKD and increases the risk of cardiovascular disease, ESKD, and death. Over the past decade, a number of hypertension guidelines have been published with varying recommendations for BP goals in patients with CKD. Most recently, the American College of Cardiology/American Heart Association 2017 hypertension guidelines set a BP goal of <130/80 mm Hg for patients with CKD and others at elevated cardiovascular risk. These guidelines were heavily influenced by the landmark Systolic Blood Pressure Intervention Trial (SPRINT), which documented that an intensive BP goal to a systolic BP <120 mm Hg decreased the risk of cardiovascular disease and mortality in nondiabetic adults at high cardiovascular risk, many of whom had CKD; the intensive BP goal did not retard CKD progression. It is noteworthy that SPRINT measured BP with automated devices (5-minute wait period, average of three readings) often without observers, a technique that potentially results in BP values that are lower than what is typically measured in the office. Still, results from SPRINT along with long-term follow-up data from the Modification of Diet in Renal Disease and the African American Study of Kidney Disease and Hypertension suggest that a BP goal <130/80 mm Hg will reduce mortality in patients with CKD. Unfortunately, data are more limited in patients with diabetes or stage 4–5 CKD. Increased adverse events, including electrolyte abnormalities and decreased eGFR, necessitate careful laboratory monitoring. In conclusion, a BP goal of <130/80 is a reasonable, evidence-based BP goal in patients with CKD. Implementation of this intensive BP target will require increased attention to measuring BP accurately, assessing patient preferences and concurrent medical conditions, and monitoring for adverse effects of therapy.

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New blood pressure goals for patients with increased cardiovascular risk

Internal and Emergency Medicine ◽

10.1007/s11739-016-1477-8 ◽

2016 ◽

Vol 11 (5) ◽

pp. 753-754

Author(s):

Giulia Cernuschi ◽

◽

Elisa Maria Fiorelli

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

Blood Pressure Goals

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Abstract #414 Ambulatory Blood Pressure Monitoring and Correlation with Cardiovascular Risk Markers in Type 2 Diabetes In Association with The Prevalence of Non-Dippers

Endocrine Practice ◽

10.1016/s1530-891x(20)47175-7 ◽

2018 ◽

Vol 24 ◽

pp. 103

Author(s):

Rohit Kapoor ◽

Shivam Kapoor ◽

Rishabh Kapoor

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Cardiovascular Risk ◽

Ambulatory Blood Pressure Monitoring ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Risk Markers ◽

Pressure Monitoring

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Lowering salt intake reduces cardiovascular risk, as well as decreasing blood pressure

Nature Clinical Practice Endocrinology &#38 Metabolism ◽

10.1038/ncpendmet0549x ◽

2007 ◽

Vol 3 (8) ◽

pp. 562-563

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

Salt Intake

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Haematocrit: Relationships with Blood Lipids, Blood Pressure and other Cardiovascular Risk Factors

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648811 ◽

1994 ◽

Vol 72 (01) ◽

pp. 058-064 ◽

Cited By ~ 14

Author(s):

Goya Wannamethee ◽

A Gerald Shaper

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Blood Pressure ◽

Body Mass Index ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Alcohol Intake ◽

Blood Lipids ◽

The Other ◽

The Relationship

SummaryThe relationship between haematocrit and cardiovascular risk factors, particularly blood pressure and blood lipids, has been examined in detail in a large prospective study of 7735 middle-aged men drawn from general practices in 24 British towns. The analyses are restricted to the 5494 men free of any evidence of ischaemic heart disease at screening.Smoking, body mass index, physical activity, alcohol intake and lung function (FEV1) were factors strongly associated with haematocrit levels independent of each other. Age showed a significant but small independent association with haematocrit. Non-manual workers had slightly higher haematocrit levels than manual workers; this difference increased considerably and became significant after adjustment for the other risk factors. Diabetics showed significantly lower levels of haematocrit than non-diabetics. In the univariate analysis, haematocrit was significantly associated with total serum protein (r = 0*18), cholesterol (r = 0.16), triglyceride (r = 0.15), diastolic blood pressure (r = 0.17) and heart rate (r = 0.14); all at p <0.0001. A weaker but significant association was seen with systolic blood pressure (r = 0.09, p <0.001). These relationships remained significant even after adjustment for age, smoking, body mass index, physical activity, alcohol intake, lung function, presence of diabetes, social class and for each of the other biological variables; the relationship with systolic blood pressure was considerably weakened. No association was seen with blood glucose and HDL-cholesterol. This study has shown significant associations between several lifestyle characteristics and the haematocrit and supports the findings of a significant relationship between the haematocrit and blood lipids and blood pressure. It emphasises the role of the haematocrit in assessing the risk of ischaemic heart disease and stroke in individuals, and the need to take haematocrit levels into account in determining the importance of other cardiovascular risk factors.

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Effects of vitamin D supplementation on blood pressure, glucocorticoids and cardiovascular risk markers in healthy subjects

Endocrine Abstracts ◽

10.1530/endoabs.31.p184 ◽

2013 ◽

pp. 1-1

Author(s):

Emad Al-dujaili ◽

Veronica Giudice ◽

Lorna Fyfe ◽

Joanna Kita

Keyword(s):

Blood Pressure ◽

Vitamin D ◽

Cardiovascular Risk ◽

Healthy Subjects ◽

Vitamin D Supplementation ◽

Risk Markers

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Device therapy of resistant hypertension

Orvosi Hetilap ◽

10.1556/oh.2013.29543 ◽

2013 ◽

Vol 154 (6) ◽

pp. 203-208 ◽

Cited By ~ 1

Author(s):

Gábor Simonyi ◽

J. Róbert Bedros ◽

Mihály Medvegy

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

Resistant Hypertension ◽

Carotid Sinus ◽

Maximum Tolerated Dose ◽

Reduce Blood Pressure ◽

Nerve Fibers ◽

Uncontrolled Hypertension ◽

Sympathetic Nerve Fibers ◽

Treatment Of Hypertension

It is well known that hypertension is an independent cardiovascular risk factor. Treatment of hypertension frequently includes administration of three or more drugs. Resistant hypertension is defined when blood pressure remains above target value despite full doses (the patient’s maximum tolerated dose) of antihypertensive medication consisting of at least three different classes of drugs including a diuretic. Pharmacological treatment of hypertension is often unsuccessful despite the increasing number of drug combinations. Uncontrolled hypertension, however, increases the cardiovascular risk. Device treatment of resistant hypertension is currently testing two major fields. One of them the stimulation of baroreceptors in the carotid sinus and the other is radiofrequency ablation of sympathetic nerve fibers around renal arteries to reduce blood pressure in drug resistant hypertension. Orv. Hetil., 2013, 154, 203–208.

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