Journal of hypertension
-
Journal of hypertension · Apr 2012
ReviewInhibition of the renin-angiotensin-aldosterone system: is there room for dual blockade in the cardiorenal continuum?
Antagonism of renin-angiotensin-aldosterone system is exerted through angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, renin inhibitors and mineralocorticoid receptor antagonists. These drugs have been successfully tested in numerous trials and in different clinical settings. The original indications of renin-angiotensin-aldosterone system blockers have progressively expanded from the advanced stages to the earlier stages of cardiorenal continuum. ⋯ The data from the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) study do not support this specific dual blockade approach. However, the dual blockade of angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists with direct renin inhibitors is currently under investigation while that based on an aldosterone blocker with any of the previous three drugs requires more evidence beyond heart failure. In this review, we revisited potential advantages of dual blockade of renin-angiotensin-aldosterone system in arterial hypertension and diabetes.
-
Journal of hypertension · Apr 2012
Clinical TrialImpact of lower achieved blood pressure on outcomes in hypertensive patients.
Hypertensive patients with ECG left-ventricular hypertrophy (LVH) are at increased risk of cardiovascular morbidity and mortality, and regression of ECG LVH is associated with improved cardiovascular outcomes. Although tighter control of systolic blood pressure (SBP) has been associated with a lower rate of ECG LVH, whether tighter vs. standard control of SBP is associated with greater reduction of cardiovascular risk is unclear. ⋯ Achieved SBP 130 mmHg or less is not associated with lower cardiovascular risk than SBP of 131 to 141 mmHg and is associated with a significantly increased risk of death and trend towards increased cardiovascular mortality. These findings support the need for randomized evaluation of treatment to more aggressive vs. conventional SBP targets.
-
Journal of hypertension · Apr 2012
EditorialLonging for clinical excellence: a critical outlook into the NICE recommendations on hypertension management--is nice always good?
The European Society of Hypertension and the European Society of Cardiology have started the preparation of the third edition of their joint guidelines on the management of arterial hypertension. The authors have focused on the new edition of the UK NICE guidelines to learn about the difficulties of disentangling evidence from wisdom when preparing recommendations. ⋯ NICE recommendations on these topics appear more based on opinion than evidence. Strenuous longing for evidence and clinical excellence is certainly meritorious, but such a nice approach is not always good.
-
Journal of hypertension · Apr 2012
Prognostic significance of masked and white-coat hypertension in the general population: the Finn-Home Study.
The clinical significance of masked and white-coat hypertension is still somewhat controversial. The aim of the present study was to investigate the prognosis of masked and white-coat hypertension using home blood pressure (BP) measurement. ⋯ Neither masked nor white-coat hypertension was an independent predictor of cardiovascular risk or all-cause mortality when concomitant other risk factors or baseline home BP levels were taken into account. The present study suggests that home BP level, along with other traditional risk factors, may be enough to stratify cardiovascular risk.