The Canadian journal of cardiology
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Review Comparative Study
The obesity epidemic and its impact on hypertension.
Global obesity rates have increased steadily in both developed and emerging countries over the past several decades with little signs of slowing down. Over 1.5 billion people worldwide are overweight or obese and over 40 million children under the age of 5 are overweight. Obesity is associated with increased morbidity, disability, and premature mortality from cardiovascular disease, diabetes, cancers, and musculoskeletal disorders. ⋯ Pharmacotherapy and bariatric surgery for obesity are adjunctive measures when health behaviour interventions fail to achieve the body weight and health targets. Successful management of overweight and obese persons requires a comprehensive, multifaceted framework that integrates population health, public health, and medical health models to dismantle the proximal and distal drivers of the obesogenic environment in which we live. Prevention of obesity is no longer a lofty but rather necessary goal that urgently calls for action from governments at all levels, in conjunction with all public and private sector stakeholders, in order to combat a serious and growing public health concern.
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Resistant hypertension (RHTN) is defined as a blood pressure remaining above goal despite the concurrent use of 3 antihypertensive medications of different classes, including, ideally a diuretic. RHTN is an important health problem with a prevalence rate expected to increase as populations become older, more obese, and at higher risk of having diabetes and chronic kidney disease, all of which are important risk factors for development of RHTN. The role of aldosterone has gained increasing recognition as a significant contributor to antihypertensive treatment resistance. ⋯ Furthermore, marked antihypertensive effects are seen when mineralocorticoid antagonists are added to the treatment regimen of patients with RHTN, further supporting aldosterone excess as an important cause of RHTN. A close association exists between hyperaldosteronism, RHTN, and obstructive sleep apnea (OSA) based upon recent studies which indicate that OSA is worsened by aldosterone-mediated fluid retention. This interaction is supported by preliminary data which demonstrates improvement in OSA severity after treatment with spironolactone.
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Comparative Study
Antihypertensive medication use, adherence, stops, and starts in Canadians with hypertension.
Some of the greatest barriers to achieving blood pressure control are perceived to be failure to prescribe antihypertensive medication and lack of adherence to medication prescriptions. ⋯ Compatible with high rates of hypertension control, most Canadians diagnosed with hypertension take antihypertensive medications and report adherence. Widespread implementation of self-management strategies for blood pressure control and standardized instructions on antihypertensive medication may further optimize drug treatment.