The American journal of the medical sciences
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Increased kidney absorption of salt and solute-free water resulting in volume overload is frequently observed in cirrhosis, especially with progression of the disease. Although diuretic therapy is able to control volume overload in the early stages of cirrhosis, it fails in a significant proportion of patients in late stages, giving rise to a situation termed "diuretic resistant ascites." This situation represents a state of functional renal failure called hepatorenal syndrome, which is further classified into 2 subgroups based on the severity of renal failure. ⋯ At the same time, an accumulating body of evidence has been pointing toward a direct interaction between the liver and the kidneys that may have an etiologic role for volume overload. Therefore, looking for a new hypothesis for volume overload in cirrhotics is of paramount importance to explain the pathophysiology behind this neat observation and to understand the available options to deal with this morbid complication of cirrhosis.
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The prevalence of reduced estimated glomerular filtration rate (eGFR) among U.S. adults aged 80 years and older increased between 1988 to 1994 and 2005 to 2010. Trends in the prevalence of albuminuria over this time period have not been reported in this population. ⋯ The proportion of U.S. adults aged 80 years and older with an elevated ACR remained relatively stable between 1988 to 1994 and 2005 to 2010. However, due to the growth of the oldest-old, the absolute number with albuminuria increased substantially over the past 2 decades.
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Although the efficacy and effectiveness of lifestyle modifications and antihypertensive pharmaceutical treatment for the prevention and control of hypertension and concomitant cardiovascular disease have been demonstrated in randomized controlled trials, this scientific knowledge has not been fully applied in the general population, especially in low-income communities. This article summarizes interventions to improve hypertension management and describes the rationale and study design for a cluster randomized trial testing whether a comprehensive intervention program within a national public primary care system will improve hypertension control among uninsured hypertensive men and women and their families. We will recruit 1,890 adults from 18 clinics within a public primary care network in Argentina. ⋯ The primary outcome is net change in systolic BP from baseline to month 18 between intervention and control groups among hypertensive study participants. The secondary outcomes are net change in diastolic BP, BP control and cost-effectiveness of the intervention. This study will generate urgently needed data on effective, practical and sustainable intervention programs aimed at controlling hypertension and concomitant cardiovascular disease in underserved populations in low- and middle-income countries.
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Cardiovascular risk factors in childhood are predictive of adulthood arterial stiffness. However, it is unknown whether this relationship varies by race or sex. ⋯ The associations of childhood cardiovascular risk factors with adult arterial stiffness varied by race and sex.
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The 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) was recently published. This guideline recommended that older adults (≥60 years) without diabetes or chronic kidney disease with systolic blood pressure (SBP) ≥150 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg be initiated on antihypertensive medication with a treatment goal SBP/DBP <150/90 mm Hg. ⋯ S. adults. In closing, we highlight future research needs related to hypertension and outcomes among older adults.