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The DENERHTN Randomized Controlled Trial: Renal Denervation for Resistant Hypertension Revisited

17 Feb, 15 | by Alistair Lindsay

Despite large reductions in blood pressure seen in early studies of renal denervation, the SYMPLICITY HTN-3 randomized trial failed to show a reduction in systolic blood pressure with renal denervation when compared to medical therapy alone. As a result, interest in renal denervation as a treatment for resistant hypertension has waned.  In the DENERHTN trial, Azizi and colleagues assessed the incremental benefit of adding renal denervation to standardized stepped-care antihypertensive treatment (SSAHT) for patients with resistant hypertension in an open-label, randomized-controlled trial with blinded endpoint evaluation. After four weeks of a standardized anti-hypertensive regimen to confirm resistant hypertension, patients were randomized to renal denervation in addition to SSAHT versus SSAHT alone. more…

Long-term benefit with blood pressure control, but not tight glucose control, in established type 2 diabetics  

20 Dec, 14 | by Alistair Lindsay

Prior studies of type 1 diabetics and newly diagnosed type 2 diabetics have suggested long-term reduction in mortality and macrovascular event risk resulting from earlier periods of tight glucose control. In the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial, blood pressure control in patients with type 2 diabetes resulted in lower risk of death, macrovascular, and microvascular events. However, this study did not find similar benefit from tight glycemic control. The present study extends the observation of patients in this trial to 6-years after completion of the trial to assess for a long-term benefit associated with a period of tight glycemic control. Of the 10261 patients eligible for continuation, 8494 consented to continued observation. more…

Vegetarian diet associated with lower blood pressure  

29 Jun, 14 | by Alistair Lindsay

Conflicting evidence exists on the association between a vegetarian diet (involving no or rare meat consumption) and hypertension. In this meta-analysis, the authors included 7 controlled trials and 32 observational studies examining the association between vegetarian diets and hypertension. The 7 trials included 311 individuals with a mean age of 44.5 years.  After pooling of trial results, a vegetarian diet was associated with a mean reduction in systolic blood pressure (SBP) by 4.8mmHg (95% CI 3.1 to 6.6 mmHg reduction; P<.001) and diastolic blood pressure (DBP) by 2.2 mmHg (95% CI 1.0 to 3.5 mmHg reduction; P<.001). The 32 observational studies included 21,604 individuals with a mean age of 46.6 years.  After pooling results of these observational studies, a vegetarian diet was associated with lower SBP by 6.9 mmHg (95% CI 4.7 to 9.1 mmHg lower; P<.001) and lower DBP by 4.7 mmHg (95% CI 3.1 to 6.3 mmHg lower; P<.001). Meta-regression suggested that the association between vegetarian diet and BP was stronger amongst men and those with higher baseline BP. more…

Blood pressure control, not the specific medication regimen, is what matters

22 Nov, 13 | by Alistair Lindsay

The Blood Pressure Lowering Treatment Trialists’ Collaboration examined primary data from 23 trials as well as summary data from an additional 3 trials to define the cardiovascular effects of lowering blood pressure in people with and without chronic kidney disease.  This study included randomized trials of drugs to lower blood pressure that were compared to placebo or other drugs with at least 1000 patient years of follow up in each treatment arm.  The primary outcome was major cardiovascular events (the composite of stroke, myocardial infarction, heart failure or cardiovascular death), with secondary outcomes of each element of the composite outcome as well as all-cause mortality.  These 26 trials included 152,290 patients, of which 30,295 had impaired renal function (estimated glomerular filtration rate [eGFR] of < 60 mL/min/1.73m2).   Meta-analysis according to baseline kidney function was performed and pooled hazard ratios were estimated per 5 mm Hg lower systolic blood pressure.   Blood pressure lowering was found to reduce the risk of the primary outcome by approximately 17% per 5 mm Hg reduction in systolic blood pressure, regardless of eGFR .  Furthermore, there was no evidence of any difference in effect by choice of blood pressure control regimen. more…

Blood pressure telemonitoring leads to improved control

15 Jul, 13 | by Alistair Lindsay

Only half of US adults have blood pressure levels that are controlled to recommended levels.  Home blood pressure monitoring has previously been shown to be a useful adjunct to team-based care for hypertension, and home BP readings can predict cardiovascular risk more accurately than office BP measurements.  Recent studies have suggested that a combined approach using telemedicine with nurse- or pharmacist-led care may be effective at improving blood pressure control, but these studies did not include follow-up. more…

The importance of ambulatory blood pressure monitoring

15 Feb, 09 | by Alistair Lindsay

Among patients with resistant hypertension (RH) – defined as the failure to control blood pressure (BP) despite optimal treatment with at least 3 antihypertensive drugs in full dosages – controversy exists regarding the additive prognostic value of ambulatory blood pressure monitoring (ABPM) over clinic blood pressure readings (CBPR).  The prevalence of RH ranges from 10% to 30% of hypertensive subjects however these patients remain generally understudied. more…

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