American journal of hypertension
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Comparative Study
Altered Mayer wave and baroreflex profiles in high spinal cord injury.
Spinal sympathetic neurons are distributed in cord segments from Th1 to L3. High spinal cord injury demonstrates severe orthostatic hypotension, but not lower cord injury. It remains to be clarified as to where is the critical spinal level disturbing neural cardiovascular regulations in response to orthostatic stress. ⋯ The low-level injury group and the control group demonstrated essentially similar autonomic nervous responses to postural shift, ie, a significant increase in Mayer wave power and an insignificant decrease in baroreflex sensitivity. On the contrary, the high-level injury group showed opposite responses, ie, an insignificant decrease in Mayer wave power and a significant increase in baroreflex sensitivity in response to postural shift. We conclude that spinal cord injury at Th3 or above eliminates normal neural cardiovascular responses to mild orthostatic stress in humans.
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The aim of this study was to investigate the effect of the definition of daytime and nighttime on ambulatory blood pressure (ABP) in pregnancy. To determine the prevalence of a <10% decrease in mean arterial pressure with sleep (nondipper) in pregnancy and the consistency of nondipper status throughout pregnancy. In a prospective, longitudinal study, 102 pregnant woman underwent 24-h ABP monitoring and recorded sleep patterns at < or = 14, 19 to 22, 27 to 30, 35 to 37 weeks' gestation and 5 to 9 weeks' postpartum. ⋯ A third of women were nondippers at least once during pregnancy, but only two women were consistent nondippers. The different definitions of day and night did not change group ABP measurements, but resulted in significant variation in ABP measurements in individual pregnant women. Nondippers were common and nondipper status frequently changed during pregnancy.
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Review
Will better-tolerated antihypertensive agents improve blood pressure control? JNC VI revisited.
Although we have incontrovertible evidence for the benefits of treating hypertension, only a minority of Americans with this disorder have blood pressure readings at the levels currently recommended by the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Recent trials have shown that if physicians set a goal, they can regularly reduce blood pressure to suggested levels using standard therapy. The barriers to reaching that goal in practice can be overcome if well-tolerated agents are used, if the importance of adherence to the regimen is emphasized and effectively conveyed, and if practitioners utilize the services of hypertension specialists should a goal not be reached. The availability of newer agents that are virtually free of side effects and the clear understanding of the value of aggressively managing hypertension make it imperative that all clinicians understand how to most effectively use the many tools available.
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A panel of clinicians from anesthesiology, surgery, nephrology, hypertension, cardiology, and pharmacology was convened to discuss pharmacologic therapeutics in the management of hypertensive crisis and perioperative hypertension. The panel discussed the advantages and limitations of currently available parenteral drugs, and assessed the potential use of fenoldopam mesylate, a drug in clinical development since 1981, and recently approved by the U. ⋯ Fenoldopam is a dopamine receptor (DA1 selective) agonist that is a systemic and renal vasodilator. It was concluded that fenoldopam offers significant advantages as a parenterally administered agent for the management of blood pressure in both hypertensive emergencies and in the perioperative setting.
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Randomized Controlled Trial Clinical Trial
Sustained antihypertensive actions of a dual angiotensin-converting enzyme neutral endopeptidase inhibitor, sampatrilat, in black hypertensive subjects.
Our objective was to evaluate the safety and antihypertensive efficacy of sampatrilat, a novel dual inhibitor of both angiotensin-converting enzyme (ACE) and neutral endopeptidase (NEP), in subjects poorly responsive to ACE inhibitor monotherapy. The ability of sampatrilat (50 to 100 mg daily) (n = 28) to lower blood pressure was compared with that of the ACE inhibitor lisinopril (10 to 20 mg daily) (n = 30) using a double-blind, randomized, parallel group study design over a 56-day treatment period in black hypertensives. Changes in systolic (SBP) and diastolic (DBP) blood pressure were determined using repeated ambulatory blood pressure (ABP) monitoring. ⋯ Alternatively, sampatrilat produced a sustained decrease in mean ABP over the 56-day treatment period (day 28: SBP = -7.3 +/- 1.8, DBP = -5.2 +/- 1.2; P < .01: day 56: SBP = -7.8 +/- 1.5; DBP = -5.2 +/- 0.95; P < 0.01) with a greater treatment effect on DBP than that of lisinopril at day 56 (P = .05). Treatment-emergent adverse events were noted to be similar between both treatment groups. We conclude that the antihypertensive actions of ACE/NEP inhibitor monotherapy in black subjects offers a novel therapeutic approach to patients otherwise resistant to the sustained antihypertensive actions of ACE inhibitor monotherapy.