Current hypertension reports
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Curr. Hypertens. Rep. · Oct 2010
ReviewThe impact of obstructive sleep apnea on chronic kidney disease.
Obstructive sleep apnea (OSA) is an important clinical problem in the chronic kidney disease (CKD) population. OSA is associated with hypoxemia and sleep fragmentation, which activates the sympathetic nervous system, the renin-angiotensin-aldosterone system, alters cardiovascular hemodynamics, and results in free radical generation. ⋯ OSA is also associated with hypertension, another important risk factor for CKD progression, particularly proteinuric CKD. OSA may mediate renal damage via several mechanisms, and there is a need to better elucidate the impact of OSA on incident renal disease and CKD progression.
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Curr. Hypertens. Rep. · Aug 2010
ReviewSystolic pressure, diastolic pressure, or pulse pressure as a cardiovascular risk factor in renal disease.
Chronic kidney disease is a leading global health problem with an increasing prevalence. Hypertension is present in most patients with chronic kidney disease, and hypertension-related nephrosclerosis is a top cause of progressive renal damage and end-stage renal disease. Systolic blood pressure (BP) and pulse pressure, together with nocturnal BP, are the most important factors favoring the progression of renal failure. Consequently, strict control of BP and other cardiovascular risk factors is required, including an adequate degree of suppression of the renin-angiotensin system in every patient.
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Cardiovascular disease is still the leading cause of death in North America. To improve outcomes, it will likely be necessary to identify new potentially treatable conditions. Sleep apnea affects approximately 50% of patients with cardiovascular disease and is associated with increased cardiovascular risk. ⋯ Further, it may not be the ideal treatment for central sleep apnea, and the benefits of alternatives such adaptive servo-ventilation are currently being tested. Randomized controlled trials are now needed to determine whether treating sleep apnea will improve survival and reduce cardiovascular disease risk. Until better evidence becomes available, testing for sleep apnea cannot be recommended as part of the routine cardiovascular disease risk assessment, nor can its treatment be recommended for the prevention or management of cardiovascular disease in asymptomatic patients.
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Curr. Hypertens. Rep. · Apr 2010
Review Historical ArticleThe evolution of renin-angiotensin blockade: angiotensin-converting enzyme inhibitors as the starting point.
The renin-angiotensin system has been a target in the treatment of hypertension for close to three decades. Several medication classes that block specific aspects of this system have emerged as useful therapies, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and, most recently, direct renin inhibitors. There has been a natural history to the development of each of these three drug classes, starting with their use as antihypertensive agents; thereafter, in each case they have been employed as end-organ protective agents. To date, there has been scant evidence to favor angiotensin receptor blockers or direct renin inhibitors over angiotensin-converting enzyme inhibitors in treating hypertension or in affording end-organ protection; thus, angiotensin-converting enzyme inhibitors remain the standard of care when renin-angiotensin system blockade is warranted.
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The hypertensive disorders of pregnancy are a leading cause of maternal mortality and morbidity. Complications are not limited to preeclampsia but also complicate both preexisting hypertension and isolated gestational hypertension. Blood pressure (BP) management is important but is only one aspect of management of the hypertensive disorders of pregnancy, which may be caused or exacerbated by underlying uteroplacental mismatch between maternal supply and fetal demand. ⋯ There is no consensus regarding management of nonsevere hypertension, and randomized controlled trials involving just over 3000 women have not clarified the relative maternal and perinatal risks and benefits. Although antihypertensive therapy may decrease transient severe maternal hypertension, therapy may also impair fetal growth and perinatal health and outcomes. The CHIPS Trial (Control of Hypertension In Pregnancy Study) is recruiting to answer this question.