Archive for the ‘Hypertension’ Category

April 19, 2014

Cardiovascular protection by β-blockade in hypertensive haemodialysis patients: the Hypertension in Haemodialysis Patients Treated With Atenolol or Lisinopril (HDPAL) trial.

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This was an open-label trial of atenolol vs lisinopril administered three times per week post-dialysis in patient with hypertension and left ventricular hypertrophy. The atenolol treated group had lower cardiovascular morbidity and all-cause hospitalizations.

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December 21, 2013

Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease: A Clinical Practice Guideline From the Clinical Guidelines Committee of the American College of Physicians.

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This ACP guideline recommends a) against screening for chronic kidney disease in asymptomatic adults without risk factors for CKD, b) against testing for proteinuria in adults currently taking an ACEi or ARB, c) using an ACEi or ARB in patients with hypertension and CKD, and d) using a statin to manage elevated LDL in patients […]

1 Comment Posted in Chronic Kidney Disease, Hypertension, RAS Blockade
September 8, 2013

Risks and benefits of intensive blood pressure lowering in patients with type 2 diabetes

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This review discusses the basis for the blood pressure target of < 130/80 mm Hg for patients with hypertension and diabetes.

1 Comment Posted in Diabetes, Hypertension
September 8, 2013

Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis

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In patient with chronic kidney disease, this meta-analysis identified a 27% reduction (HR 0.73, 95% CI 0.62–0.86) in ESRD with intensive blood pressure lowering <130/80, whereas no effect was seen in patients without proteinuria. The accompanying editorial “Blood pressure targets in chronic kidney disease: Does proteinuria dictate how low we go?” discusses the interpretation of […]

4 Comments Posted in Chronic Kidney Disease, Hypertension
September 7, 2013

Use of Antihypertensive Medications and Breast Cancer Risk Among Women Aged 55 to 74 Years

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This case-control study identified an association between >10 years of calcium-channel blockers use and a higher risk of ductal breast cancer. The associated editorial Calcium-Channel Blockers and Breast Cancer: A Hypothesis Revived discusses how this finding may be interpreted.

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July 15, 2013

Effect of lower sodium intake on health: systematic review and meta-analyses

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This is another article that supports the literature for reduction in salt intake for overall population health. This systematic further shows that not only does salt lower blood pressure, but there are no adverse effects on lipids, catecholamine levels of renal function. Furthermore, it is associated with lower risk of stroke and fatal coronary heart […]

1 Comment Posted in General Nephrology, Hypertension
July 15, 2013

Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses

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Salt seems to get the most press, but potassium is an important player in the prevention of vascular disease. This systematic review of 22 RCTs and 11 cohort studies shows that systolic blood pressure was reduced by 7.16 (1.91 to 12.41) mm Hg when the potassium intake was 90-120 mmol/day, without any dose response. Furthermore, […]

2 Comments Posted in General Nephrology, Hypertension
July 14, 2013

Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials

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This Cochrane study supports the notion that our society needs to reduce total salt intake.. Thirty-four trials and over 3000 participants were included in this meta-analysis. The results are impressive: the mean change in urinary sodium was −75 mmol/24 h with an associated mean change in systolic blood pressure of −4.18 mm Hg (95% confidence interval […]

5 Comments Posted in General Nephrology, Hypertension
July 14, 2013

Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage

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This randomized controlled trial compared two strategies of blood pressure management after spontaneous intracerebral hemorrhage. Patients were randomized intensive blood treatment to target a systolic BP of No difference was seen in the composite of death or major disability. However, a significantly lower modified Rankin scores was seen with intensive treatment (odds ratio for greater […]

1 Comment Posted in Hypertension, Internal Medicine for Nephrologists
January 28, 2013

An angiotensin II receptor blocker-calcium channel blocker combination prevents cardiovascular events in elderly high-risk hypertensive patients with chronic kidney disease better than high-dose angiotensin II receptor blockade alone.

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The OSCAR study was a multicenter, open-label RCT carried out in Japanese elderly hypertensive patients. Patients were randomized to angiotensin II receptor blocker (ARB) dose up-titration versus an ARB plus calcium channel blocker combination. In the pre-specified subgroup of patients with CKD, more primary events (a composite of cardiovascular events and noncardiovascular death) occurred in […]

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November 25, 2012

KDIGO Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease

This KDIGO clinical practice guideline provides guidance on blood pressure management for all non-dialysis-dependent CKD patients and kidney transplant recipients.

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December 22, 2011

Novartis announces termination of ALTITUDE study

Novartis announced the termination of the ALTITUDE study in high-risk patients with diabetes and renal impairment. The study was designed to determine if aliskiren could reduce cardiovascular and renal morbidity and mortality, compared with placebo, when added to conventional treatment (including ACEi or ARB). Based on the recommendation from the Data Monitoring committee, it was felt […]

6 Comments Posted in Chronic Kidney Disease, Hypertension, RAS Blockade
December 22, 2011

Urinary Sodium and Potassium Excretion and Risk of Cardiovascular Events

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An observational analysis of cohorts from the ONTARGET and TRANSCEND trials looked at the association of urinary sodium and potassium with CV events and mortality. Sodium excretion and CV events showed a J-shaped relationship: sodium excretion of  < 3 g and >7 g per day was associated with an increased risk of CV events.  Risk […]

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