The journal of clinical hypertension
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There has long been a recognized link between obstructive sleep apnea (OSA) and the cardiovascular system, no aspect of which has been more studied than blood pressure. Research in OSA has not only demonstrated dysregulation of homeostatic cardiovascular mechanisms but also has furthered our understanding of blood pressure regulatory control. ⋯ Accumulating data from randomized controlled treatment trials in OSA, particularly with continuous positive airway pressure, though sometimes inconsistent, suggest a potential role in blood pressure reduction. Further research is needed to better clarify indications for OSA treatment as well as its role as an adjunct to other antihypertensive treatments.
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Chronic kidney disease is both a cause and a consequence of hypertension. Extracellular volume expansion is an important, if not the most important, contributing factor to hypertension seen in chronic kidney disease. Beyond volume expansion, chronic kidney disease-related hypertension is without truly defining characteristics. ⋯ Prescription practice in such patients should be mindful of the need for multiple drug classes with at least one of them being a diuretic. Blood pressure goals in the patient with chronic kidney disease and hypertension are set at lower levels than those for patients with essential hypertension alone. It remains to be determined to what level blood pressure should be lowered in the patient with chronic kidney disease, however.
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J Clin Hypertens (Greenwich) · Mar 2008
Can ischemic stroke be caused by acute reduction of blood pressure in the acute phase of cardiovascular disease?
Acute-phase cardiovascular disease (CVD) frequently presents with markedly elevated blood pressure (BP) levels and often requires fairly rapid lowering of BP. On the other hand, aggressive lowering of systemic BP to the point that the cerebral BP decreases below a certain threshold may result in ischemic stroke. The authors retrospectively studied 192 consecutive patients with CVD who had markedly elevated BP and end-organ damage. ⋯ The incidence of ischemic stroke did not differ significantly between a standard BP-lowering group, in which the target BP reduction was within the parameters of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines, and a rapid BP-lowering group, in which the target BP was below these guidelines (7.1% vs 2.6%, respectively; P=.27, not significant). In stepwise multiple regression analysis, diabetes mellitus (beta=0.203, P=.008) and acute pulmonary edema (beta=0.228, P=.003) remained significant factors associated with the incidence of stroke. Thus, acute pulmonary edema and diabetes were the most important factors related to ischemic stroke during BP reduction in patients with marked elevations of BP regardless of the rapidity of BP lowering.