Device therapy of resistant hypertension

2013 ◽  
Vol 154 (6) ◽  
pp. 203-208 ◽  
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.

scholarly journals The Road to Better Management in Resistant Hypertension–Diagnostic and Therapeutic Insights

Pharmaceutics ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 714
Author(s):  
Elisabeta Bădilă ◽  
Cristina Japie ◽  
Emma Weiss ◽  
Ana-Maria Balahura ◽  
Daniela Bartoș ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Renin Angiotensin System ◽  
Drug Regimen ◽  
Secondary Hypertension ◽  
Adverse Outcomes ◽  
Uncontrolled Hypertension ◽  
White Coat Hypertension ◽  
Mineralocorticoid Receptor Antagonist ◽  
Mortality And Morbidity

Resistant hypertension (R-HTN) implies a higher mortality and morbidity compared to non-R-HTN due to increased cardiovascular risk and associated adverse outcomes—greater risk of developing chronic kidney disease, heart failure, stroke and myocardial infarction. R-HTN is considered when failing to lower blood pressure below 140/90 mmHg despite adequate lifestyle measures and optimal treatment with at least three medications, including a diuretic, and usually a blocker of the renin-angiotensin system and a calcium channel blocker, at maximally tolerated doses. Hereby, we discuss the diagnostic and therapeutic approach to a better management of R-HTN. Excluding pseudoresistance, secondary hypertension, white-coat hypertension and medication non-adherence is an important step when diagnosing R-HTN. Most recently different phenotypes associated to R-HTN have been described, specifically refractory and controlled R-HTN and masked uncontrolled hypertension. Optimizing the three-drug regimen, including the diuretic treatment, adding a mineralocorticoid receptor antagonist as the fourth drug, a β-blocker as the fifth drug and an α1-blocker or a peripheral vasodilator as a final option when failing to achieve target blood pressure values are current recommendations regarding the correct management of R-HTN.

scholarly journals Causes of Resistant Hypertension Detected by a Standardized Algorithm

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Livia Beatriz Santos Limonta ◽  
Letícia dos Santos Valandro ◽  
Flávio Gobis Shiraishi ◽  
Pasqual Barretti ◽  
Roberto Jorge da Silva Franco ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Secondary Hypertension ◽  
Control Blood Pressure ◽  
Primary Level ◽  
Standardized Protocol ◽  
Frequent Use ◽  
Drug Classes ◽  
Treatment Of Hypertension ◽  
Secondary Causes

Resistant hypertension (RH) is characterized by blood pressure above 140 × 90 mm Hg, despite the use, in appropriate doses, of three antihypertensive drug classes, including a diuretic, or the need of four classes to control blood pressure. Resistant hypertension patients are under a greater risk of presenting secondary causes of hypertension and may be benefited by therapeutical approach for this diagnosis. However, the RH is currently little studied, and more knowledge of this clinical condition is necessary. In addition, few studies had evaluated this issue in emergent countries. Therefore, we proposed the analysis of specific causes of RH by using a standardized protocol in Brazilian patients diagnosed in a center for the evaluation and treatment of hypertension. The management of these patients was conducted with the application of a preformulated protocol which aimed at the identification of the causes of resistant hypertension in each patient through management standardization. The data obtained suggest that among patients with resistant hypertension there is a higher prevalence of secondary hypertension, than that observed in general hypertensive ones and a higher prevalence of sleep apnea as well. But there are a predominance of obesity, noncompliance with diet, and frequent use of hypertensive drugs. These latter factors are likely approachable at primary level health care, since that detailed anamneses directed to the causes of resistant hypertension are applied.

scholarly journals May Measurement Month 2018: an analysis of blood pressure screening campaign results from Poland

2020 ◽  
Vol 22 (Supplement_H) ◽  
pp. H108-H111
Author(s):  
Piotr Jankowski ◽  
Maciej Banach ◽  
Jolanta Małyszko ◽  
Mirosław Mastej ◽  
Andrzej Tykarski ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Multiple Imputation ◽  
Alcohol Intake ◽  
Antihypertensive Drugs ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Raising Awareness ◽  
Treatment Of Hypertension ◽  
Global Initiative

Abstract Hypertension remains the most important cardiovascular risk factor in Poland. May Measurement Month is a global initiative organized by the International Society of Hypertension aimed at raising awareness of hypertension and the need for blood pressure (BP) screening and demonstrating the potential of the opportunistic BP measurements. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in 146 sites in May 2018. Blood pressure was measured in 6450 subjects (mean age: 41 ± 15 years; 59% females). After multiple imputation, the age and sex standardized systolic and diastolic BP was 126.7/78.4 mmHg in the whole analysed group, 132.8/81.3 mmHg in subjects taking antihypertensive drugs, and 125.7/78.0 mmHg in those not taking any antihypertensive drugs. After multiple imputation, the proportions of subjects with high BP (systolic ≥140 mmHg or diastolic ≥90 mmHg or on treatment for raised BP) were 22.2% in the whole analysed group, 39.2% in subjects taking antihypertensive drugs, and 18.6% those not taking any antihypertensive drugs. Overall, hypertension was present in 32.8% of participants, among them 38.7% were not aware of the disease, 53.1% were taking antihypertensive drugs, and 32.3% had BP controlled to target (<140/90 mmHg). Blood pressure was increasing with increasing body mass index and alcohol intake. Smokers and project participants with diabetes had increased average BP. In conclusion, this project provides additional evidence for a considerable potential for further reduction of cardiovascular risk through improvement in detection and treatment of hypertension in Poland.

scholarly journals Unilateral Renal Artery Sympathetic Denervation May Reduce Blood Pressure in Patients With Resistant Hypertension

2013 ◽  
Vol 15 (8) ◽  
pp. 606-606 ◽  
Author(s):  
Luciana Armaganijan ◽  
Rodolfo Staico ◽  
Alexandre Abizaid ◽  
Aline Moraes ◽  
Dalmo Moreira ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Artery ◽  
Resistant Hypertension ◽  
Reduce Blood Pressure ◽  
Sympathetic Denervation

scholarly journals Diuretics in treatment of patients with arterial hypertension

2009 ◽  
Vol 6 (4) ◽  
pp. 9-12
Author(s):  
Irina Evgen'evna Chazova ◽  
Lyudmila Gennadievna Ratova
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Arterial Hypertension ◽  
Disease Process ◽  
Low Doses ◽  
Treatment Of Hypertension ◽  
Artery Disease ◽  
High Doses

Since all cardiovascular risk factors contribute to coronary artery disease in patients with arterial hypertension, they should all be considered in the management of this disease process. Thiazides diuretics when used at high doses, negatively impact lipid and glucose metabolism. These findings have resulted in decreased use of diuretics in favor of newer agents such as ACE inhibitors and calcium antagonists. However, recent data have demonstrated that when used at low doses (6.25 or 25 mg of hydrochlorothiazide), diuretics lack significant metabolic side effects while bringing about significant reductions in blood pressure. Thus, at these doses, hydrochlorothiazide is a useful drug in the treatment of hypertension, both as monotherapy and in combination therapy.

scholarly journals Guest Editorial: Challenges in Resistant Hypertension

2016 ◽  
Vol 11 (1) ◽  
pp. 18
Author(s):  
Thomas Kahan ◽  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Resistant Hypertension ◽  
Blood Pressure Monitoring ◽  
Premature Death ◽  
Pressure Control ◽  
Secondary Hypertension ◽  
Uncontrolled Hypertension ◽  
Caregiver Support ◽  
The Individual

Hypertension is the major risk factor for disease and premature death. Although the efficacy of antihypertensive therapy is undisputed, few patients reach target blood pressure. Steps to improve treatment and control include assessment of global cardiovascular risk for the individual patient, improving caregiver support, education and organisation, increasing treatment persistence, using out of office blood pressure monitoring more often, detecting secondary hypertension forms, and referring patients with remaining uncontrolled hypertension to a specialist hypertension centre. In conclusion, there is room for improvement of blood pressure control in hypertensive patients. The clinical benefit of improved blood pressure control may be considerable. This may be particularly true for patients with resistant hypertension.

scholarly journals SERUM MAGNESIUM AND HYPERTENSION

2011 ◽  
Vol 18 (01) ◽  
pp. 139-141
Author(s):  
WALI MUHAMMAD MAHERI ◽  
MUHAMMAD ISHAQ ◽  
ISRAR AHMED AKHUND ◽  
Muhammad Sabir
Keyword(s):  
Blood Pressure ◽  
Serum Magnesium ◽  
Reduce Blood Pressure ◽  
Uncomplicated Hypertension ◽  
Test Parameters ◽  
Treatment Of Hypertension ◽  
Scale Population ◽  
Wide Scale ◽  
Public Health Challenge ◽  
Mild Hypertensive

Background: Despite advances in the prevention and treatment of hypertension over the past decade, hypertension remains an important public health challenge. Recent efforts to reduce the prevalence of hypertension have been focused on non-pharmacologic means, specifically diet. An increased intake of magnesium has been shown in some but not all studies to reduce blood pressure in patients with hypertension. Decreased Serum magnesium levels are associated with development of hypertension. Aims: This study was planned to investigate relation of serum magnesium with blood pressure in patients with mild uncomplicated hypertension. Subjects & Methods: Study was conducted at LUMHS hospital Jamshoro and DHQ hospital charsadda for the period of six months. Fifty known cases of uncomplicated mild hypertensive patients were selected, same number of healthy controls were also examined. Results: When results were summed up and test parameters were compared, it was seen that no significant differences were found in serum magnesium levels among both groups, when compared statistically. Conclusion: Finally we conclude that no relation of magnesium with hypertension was observed. Suggestions: Much more work on wide scale population may be needed to clarify the idea. 

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