Wang TJ, Vasan RS. Epidemiology of uncontrolled hypertension in the United States

Boston University, Boston, Massachusetts, United States
Circulation (Impact Factor: 14.43). 10/2005; 112(11):1651-62. DOI: 10.1161/CIRCULATIONAHA.104.490599
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    • "More recently, OSA has been identified as an independent risk factor for HT (Lavie et al., 2000; Peppard et al., 2000; Marin et al., 2012), as one of the major clinical conditions that favors poorly controlled HT (Oliveras and Schmieder, 2013), and as the most common condition associated with resistant HT (Pedrosa et al., 2011). OSA and HT are two prevailing risk factors for several cardiovascular events (Wang and Vasan, 2005; Baguet et al., 2009). Due to their high prevalence and cardiovascular morbidity (Wolf et al., 2007; Malhotra and Loscalzo, 2009), OSA and HT are now acknowledged as public health problems. "
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    ABSTRACT: Sleep apnea/hypopnea disorders include centrally originated diseases and obstructive sleep apnea (OSA). This last condition is renowned as a frequent secondary cause of hypertension (HT). The mechanisms involved in the pathogenesis of HT can be summarized in relation to two main pathways: sympathetic nervous system stimulation mediated mainly by activation of carotid body (CB) chemoreflexes and/or asphyxia, and, by no means the least important, the systemic effects of chronic intermittent hypoxia (CIH). The use of animal models has revealed that CIH is the critical stimulus underlying sympathetic activity and hypertension, and that this effect requires the presence of functional arterial chemoreceptors, which are hyperactive in CIH. These models of CIH mimic the HT observed in humans and allow the study of CIH independently without the mechanical obstruction component. The effect of continuous positive airway pressure (CPAP), the gold standard treatment for OSA patients, to reduce blood pressure seems to be modest and concomitant antihypertensive therapy is still required. We focus this review on the efficacy of pharmacological interventions to revert HT associated with CIH conditions in both animal models and humans. First, we explore the experimental animal models, developed to mimic HT related to CIH, which have been used to investigate the effect of antihypertensive drugs (AHDs). Second, we review what is known about drug efficacy to reverse HT induced by CIH in animals. Moreover, findings in humans with OSA are cited to demonstrate the lack of strong evidence for the establishment of a first-line antihypertensive regimen for these patients. Indeed, specific therapeutic guidelines for the pharmacological treatment of HT in these patients are still lacking. Finally, we discuss the future perspectives concerning the non-pharmacological and pharmacological management of this particular type of HT.
    Frontiers in Physiology 09/2014; 5:361. DOI:10.3389/fphys.2014.00361 · 3.53 Impact Factor
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    • "Several authors report that there might be no treatment intensification when the assessed values lie close to the desired threshold,8,10,11,21 especially if patients are already on therapy, and more time is needed to assess the effects of existing therapy.21 The presence of comorbidities raises uncertainty as to whether existing guidelines are systematically appropriate. "
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    ABSTRACT: Failure to initiate or intensify therapy according to evidence-based guidelines is increasingly being acknowledged as a phenomenon that contributes to inadequate management of chronic conditions, and is referred to as clinical inertia. However, the number and complexity of factors associated with the clinical reasoning that underlies the decision-making processes in medicine calls for a critical examination of the consistency of the concept. Indeed, in the absence of information on and justification of treatment decisions that were made, clinical inertia may be only apparent, and actually reflect good clinical practice. This integrative review seeks to address the factors generally associated with clinical inaction, in order to better delineate the concept of true clinical inertia.
    05/2014; 5:141-147. DOI:10.2147/AMEP.S59022
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    • "Controlled blood pressure was defined as systolic blood pressure (SBP) <140 mm Hg or diastolic blood pressure (DBP) <90 mm Hg [11]. Uncontrolled hypertension was defined as SBP >140 mm Hg and DBP >90 mm Hg in both diabetic and nondiabetic patients who were either aware of their problem or under pharmacological treatment [12]. The sample was drawn using computerized medical record system International Classification of Diseases-9-Coordination and Maintenance (ICD-9-CM) at health information management system in the hospital. "
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    ABSTRACT: Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) were the most commonly administered medication in the ER. The mean (SD) drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29) mm Hg and on per oral treatment was 43 (27) mm Hg. The maximum mean (SD) drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51) mm Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24). Conclusion. The prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup.
    01/2014; 2014:1-7. DOI:10.1155/2014/413071
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