Archive for the ‘Hypertension’ Category

February 9, 2017

DASH (Dietary Approaches to Stop Hypertension) Diet and Risk of Subsequent Kidney Disease

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This trial looked Atherosclerosis Risk in Communities (ARIC) Study participants with baseline estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 (N = 14,882).  3,720 participants developed kidney disease during a median follow-up of 23 years. Participants with a DASH diet score in the lowest tertile were 16% more likely to develop kidney disease than those with the highest score tertile […]

1 Comment Posted in Clinical Nephrology, Clinical Trial Results, General Nephrology, Hypertension
August 14, 2016

Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75Years: A Randomized Clinical Trial

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This is a  multicenter, randomized clinical trial of patients aged 75 years or older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT) to determine the effects of intensive (<120 mm Hg) compared with standard (<140 mm Hg) SBP targets. The primary cardiovascular disease outcome was a composite of nonfatal myocardial infarction, acute coronary syndrome not resulting in a myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death from cardiovascular causes. All-cause mortality […]

No Comments Posted in Clinical Trial Results, Hypertension
March 23, 2016

Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis.

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This systematic review and meta-analysis of 19 trials included 44,989 participants,  with 2496 major cardiovascular events were recorded during a mean 3·8 years of follow-up.  Patients in the more intensive blood pressure-lowering treatment group had mean blood pressure levels of 133/76 mm Hg, compared with 140/81 mm Hg in the less intensive treatment group. Intensive blood pressure-lowering treatment achieved RR reductions for major cardiovascular events (14% [95% CI 4-22]), myocardial infarction […]

No Comments Posted in General Nephrology, Hypertension, Internal Medicine for Nephrologists
November 30, 2015

Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial

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This is a double-blind, placebo-controlled, crossover trial in patients with resistant hypertension that were taking maximally tolerated doses of 3 or more drugs. The authors found that the average reduction in home systolic blood pressure by spironolactone was superior to placebo (-8•70 mm Hg [95% CI -9•72 to -7•69]; p<0•0001), superior to the mean of […]

No Comments Posted in Clinical Nephrology, Clinical Trial Results, Hypertension
November 10, 2015

A Randomized Trial of Intensive versus Standard Blood-Pressure Control

In this RCT, a intensive BP target of less than 120 mm Hg was compared to a standard target of less than 140 mm Hg. The primary outcome (a composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes) was reduced (1.65% per year vs. 2.19% per year; HR […]

No Comments Posted in Hypertension
July 13, 2015

Treatment With Multiple Blood Pressure Medications, Achieved Blood Pressure, and Mortality in Older Nursing Home Residents The PARTAGE Study

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This longitudinal study of nursing home residents > 80 years of age showed a significant in interaction with <130 mmHg SBP and use of 2 more blood pressure lowering agents.  There was a comparatively higher risk of mortality (unadjusted hazard ratio [HR], 1.81; 95% CI, 1.36-2.41); adjusted HR, 1.78; 95% CI, 1.34-2.37; both P < .001) in these […]

No Comments Posted in Clinical Nephrology, Hypertension
March 18, 2015

Less-Tight versus Tight Control of Hypertension in Pregnancy

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This open, multicentre trial assigned women with nonproteinuric or gestatational hypertension to less tight control (target diastolic BP 100 mmHg) vs tight control (target diastolic BP 85 mmHg) with no difference observed in the primary outcome of pregnancy loss, high level neonatal care or overall maternal complications (secondary outcome).  However, the less tight control group […]

No Comments Posted in Clinical Nephrology, Clinical Trial Results, General Nephrology, Hypertension, Pregnancy and Hypertension/Renal Disease
January 24, 2015

Gestational Hypertension and Preeclampsia in Living Kidney Donors

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This retrospective cohort study of living donors matched to healthy nondonors in Ontario, Canada showed that young women who donated a kidney were more likely to suffer from gestational hypertension or preeclampsia (OR for donors 2.4).  There were no significant differences with respect to preterm birth or low birth weight.

Comments Off on Gestational Hypertension and Preeclampsia in Living Kidney Donors Posted in Hypertension, Pregnancy and Hypertension/Renal Disease
January 24, 2015

Effects of Blood Pressure Reduction in Mild Hypertension: A Systematic Review and Meta-analysis.

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This meta-analysis reveals the medical therapy in managing grade 1 hypertension (140-159/90-99 mmHg)  is likely to prevent stroke and death.

Comments Off on Effects of Blood Pressure Reduction in Mild Hypertension: A Systematic Review and Meta-analysis. Posted in Clinical Nephrology, Hypertension
January 24, 2015

Diagnostic and Predictive Accuracy of Blood Pressure Screening Methods With Consideration of Rescreening Intervals: An Updated Systematic Review for the U.S. Preventive Services Task Force.

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This task force shows the evidence that supports using ambulatory blood pressure monitoring as the reference standard for confirming elevated office blood pressure.  This will serve to confirm elevated blood pressure and avoid misdiagnosis and/or overtreatment.

Comments Off on Diagnostic and Predictive Accuracy of Blood Pressure Screening Methods With Consideration of Rescreening Intervals: An Updated Systematic Review for the U.S. Preventive Services Task Force. Posted in Clinical Nephrology, Hypertension
December 17, 2014

Hypertension

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This is a comprehensive clinical overview of hypertension.  Drawn from the ACP resources, it focusses on hypertension prevention, diagnosis, treatment, practice improvement, and patient information.    

Comments Off on Hypertension Posted in Clinical Nephrology, Hypertension
April 19, 2014

A Controlled Trial of Renal Denervation for Resistant Hypertension

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The SYMPLICITY HTN-3 trial did not show a significant reduction of systolic blood pressure in patients with resistant hypertension 6 months after renal-artery denervation as compared with a sham control.

2 Comments Posted in Clinical Trial Results, Hypertension
April 19, 2014

2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)

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2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)

1 Comment Posted in Clinical Practice Guidelines, Hypertension