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Mann SJ. Neurogenic hypertension: pathophysiology, diagnosis and management. Clin Auton Res 2018; 28:363-374. [DOI: 10.1007/s10286-018-0541-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/19/2018] [Indexed: 02/07/2023]
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2
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Boonyasai RT, Rakotz MK, Lubomski LH, Daniel DM, Marsteller JA, Taylor KS, Cooper LA, Hasan O, Wynia MK. Measure accurately, Act rapidly, and Partner with patients: An intuitive and practical three-part framework to guide efforts to improve hypertension control. J Clin Hypertens (Greenwich) 2017; 19:684-694. [PMID: 28332303 PMCID: PMC8030781 DOI: 10.1111/jch.12995] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/18/2017] [Accepted: 01/23/2017] [Indexed: 02/26/2024]
Abstract
Hypertension is the leading cause of cardiovascular disease in the United States and worldwide. It also provides a useful model for team-based chronic disease management. This article describes the M.A.P. checklists: a framework to help practice teams summarize best practices for providing coordinated, evidence-based care to patients with hypertension. Consisting of three domains-Measure Accurately; Act Rapidly; and Partner With Patients, Families, and Communities-the checklists were developed by a team of clinicians, hypertension experts, and quality improvement experts through a multistep process that combined literature review, iterative feedback from a panel of internationally recognized experts, and pilot testing among a convenience sample of primary care practices in two states. In contrast to many guidelines, the M.A.P. checklists specifically target practice teams, instead of individual clinicians, and are designed to be brief, cognitively easy to consume and recall, and accessible to healthcare workers from a range of professional backgrounds.
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Affiliation(s)
- Romsai T. Boonyasai
- Johns Hopkins University School of MedicineBaltimoreMDUSA
- Armstrong Institute for Quality and Patient SafetyBaltimoreMDUSA
- Johns Hopkins Center to Eliminate Cardiovascular Health DisparitiesBaltimoreMDUSA
| | | | - Lisa H. Lubomski
- Johns Hopkins University School of MedicineBaltimoreMDUSA
- Armstrong Institute for Quality and Patient SafetyBaltimoreMDUSA
| | | | - Jill A. Marsteller
- Armstrong Institute for Quality and Patient SafetyBaltimoreMDUSA
- Johns Hopkins Center to Eliminate Cardiovascular Health DisparitiesBaltimoreMDUSA
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Lisa A. Cooper
- Johns Hopkins University School of MedicineBaltimoreMDUSA
- Armstrong Institute for Quality and Patient SafetyBaltimoreMDUSA
- Johns Hopkins Center to Eliminate Cardiovascular Health DisparitiesBaltimoreMDUSA
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Mann SJ. Redefining beta-blocker use in hypertension: selecting the right beta-blocker and the right patient. ACTA ACUST UNITED AC 2017; 11:54-65. [DOI: 10.1016/j.jash.2016.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 01/13/2023]
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Sinnott SJ, Tomlinson LA, Root AA, Mathur R, Mansfield KE, Smeeth L, Douglas IJ. Comparative effectiveness of fourth-line anti-hypertensive agents in resistant hypertension: A systematic review and meta-analysis. Eur J Prev Cardiol 2016; 24:228-238. [DOI: 10.1177/2047487316675194] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sarah-Jo Sinnott
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - Laurie A Tomlinson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - Adrian A Root
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - Kathryn E Mansfield
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - Ian J Douglas
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
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Weltermann B, Viehmann A, Kersting C. Improving management of resistant hypertension: Rationale and protocol for a cluster randomized trial addressing physician managers in primary care. Contemp Clin Trials 2016; 47:109-14. [PMID: 26718095 DOI: 10.1016/j.cct.2015.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/14/2015] [Accepted: 12/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Resistant hypertension (RH) is defined as uncontrolled blood pressure (BP) despite ≥3 antihypertensive agents. It is estimated to account for 12-28% of all hypertensive patients. Despite a higher risk of cardiovascular events, hypertension therapy in these patients is often insufficient. In a previous study we successfully tested an evidence-based, physician manager-centered hypertension management. METHODS For this cluster randomized trial (CRT), a random sample of 102 German primary care practices will be randomized into two study arms (1:1). Physician managers and practice assistants of the intervention arm will participate in three-session medical education on hypertension management to implement 1) standardized diagnostic and therapeutic procedures for RH patients, 2) structured recall of patients with uncontrolled BP, and 3) teaching and supervision of RH patients on BP self-measurements. Practice tools are provided to facilitate implementation, e.g., how to distinguish true from pseudo RH and guideline-based medication selection. Physicians will specify guideline-algorithms for their practice to manage RH. A secured web-based peer-group exchange with hypertension specialists is offered to both professional groups. Physicians of both study arms will consecutively recruit patients with RH. BP will be measured by ambulatory BP monitoring at baseline and after 12 months. The primary endpoint is defined as treatment success with either normalized BP (24h<130/80 mmHg) and/or a reduction by ≥20 mmHg systolic and/or ≥10 mmHg diastolic. Secondary analyses will focus on changes in physicians' knowledge and practice routines. DISCUSSION This CRT will determine the effectiveness of a physician manager-centered intervention on treatment success in high-risk patients.
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Affiliation(s)
- Birgitta Weltermann
- Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany.
| | - Anja Viehmann
- Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany.
| | - Christine Kersting
- Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany.
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Turner JR, Lee J. American Society of Hypertension Scientific Statements Addressing Resistant Hypertension. J Clin Hypertens (Greenwich) 2015; 18:175-8. [PMID: 26176561 DOI: 10.1111/jch.12617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J Rick Turner
- Cardiovascular Center of Excellence, Quintiles, Durham, NC
| | - John Lee
- Cardiovascular Center of Excellence, Quintiles, Durham, NC
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Weber F, Anlauf M. Treatment resistant hypertension--investigation and conservative management. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:425-31. [PMID: 25008301 DOI: 10.3238/arztebl.2014.0425] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 04/07/2014] [Accepted: 04/07/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND The introduction of invasive treatments, some of which are irreversible, for the entity called treatment-resistant hypertension (TRH) creates the need for a comprehensive discussion of the diagnostic evaluation that TRH requires and the available options for its conservative treatment. METHOD The pertinent literature is selectively reviewed in the light of the authors' longstanding clinical experience. RESULTS Our review of the literature suggests that the high prevalence of TRH in Germany (ca. 20%) can be nearly halved with the aid of more thorough diagnostic evaluation. Such an evaluation should include a review of the patient's antihypertensive drugs (adherence, daily dosing, concomitant medication), investigation for other vascular changes that might affect blood pressure measurement, and exclusion of white-coat hypertension, sleep apnea syndrome, and secondary rather than essential hypertension. As there have been no randomized trials of treatment for TRH, the physician confronted with such cases must devise treatments on the basis of observational data and pathophysiological reasoning (volume status considering renin levels, sympathetic blockade, vasodilatation). Such measures can presumably lower the number of truly treatment-resistant cases still further. CONCLUSION To save patients from preventable harm, patients should undergo a thorough diagnostic evaluation and-under close monitoring for side effects-conservative pharmacological and nonpharmacological treatments should be deployed before any invasive treatment is performed.
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Affiliation(s)
- Franz Weber
- St Walburga Hospital, Meschede, Private Practice at the Medical Care Center, Dialysis Center, Cuxhaven
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White WB, Turner JR, Sica DA, Bisognano JD, Calhoun DA, Townsend RR, Aronow HD, Bhatt DL, Bakris GL. Detection, evaluation, and treatment of severe and resistant hypertension: proceedings from an American Society of Hypertension Interactive forum held in Bethesda, MD, U.S.A., October 10th 2013. ACTA ACUST UNITED AC 2014; 8:743-57. [PMID: 25418497 DOI: 10.1016/j.jash.2014.06.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 06/26/2014] [Indexed: 01/13/2023]
Abstract
The epidemiology, evaluation, and management of severe and resistant hypertension in the United States (US) are evolving. The American Society of Hypertension held a multi-disciplinary forum in October 2013 to review the available evidence related to the management of resistant hypertension with both drug and device therapies. There is strong evidence that resistant hypertension is an important clinical problem in the US and many other regions of the world. Complex drug therapy is effective in most of the patients with severe and resistant hypertension, but there are certain individuals who may be refractory to multiple-drug regimens or have adverse effects that make adherence to the regimen difficult. When secondary forms of hypertension and pseudo-resistance, such as medication nonadherence, or white-coat hypertension based on marked differences between clinic and 24-hour ambulatory blood pressure monitoring, have been excluded, the impact of device therapy is under evaluation through clinical trials in the US and from clinical practice registries in Europe and Australia. Clinical trial data have been obtained primarily in patients whose resistant hypertension is defined as systolic clinic blood pressures of ≥160 mm Hg (or ≥ 150 mm Hg in type 2 diabetes) despite pharmacologic treatment with at least three antihypertensive drugs (one of which is a thiazide or loop diuretic). Baroreceptor stimulation therapy has shown modest benefit in a moderately sized sham-controlled study in drug-resistant hypertension. Patients selected for renal denervation have typically been restricted to those with preserved kidney function (estimated glomerular filtration rate ≥ 45 mL/min/1.73 m2). The first sham-controlled safety and efficacy trial for renal denervation (SYMPLICITY HTN-3) did not show benefit in this population when used in addition to an average of five antihypertensive medications. Analyses of controlled clinical trial data from future trials with novel designs will be of critical importance to determine the effectiveness of device therapy for patients with severe and resistant hypertension and will allow for proper determination of patient selection and whether it will be acceptable for clinical practice. At present, the focus on the management of severe and resistant hypertension will be through careful evaluation for pseudo-resistance and secondary forms of hypertension, appropriate use of combination pharmacologic therapy, and greater utility of specialists in hypertension.
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Affiliation(s)
- William B White
- Division of Hypertension and Clinical Pharmacology, Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, USA.
| | | | - Domenic A Sica
- Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | | | - David A Calhoun
- University of Alabama School of Medicine, Birmingham, AL, USA
| | - Raymond R Townsend
- Clinical & Translational Research Center at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Deepak L Bhatt
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Weber MA. Exploring Issues in Difficult-to-Treat Hypertension. J Clin Hypertens (Greenwich) 2013; 15:859-64. [DOI: 10.1111/jch.12219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Michael A. Weber
- Division of Cardiovascular Medicine; Downstate College of Medicine; State University of New York; Brooklyn NY
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Drexler YR, Bomback AS. Definition, identification and treatment of resistant hypertension in chronic kidney disease patients. Nephrol Dial Transplant 2013; 29:1327-35. [PMID: 24046194 DOI: 10.1093/ndt/gft346] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Resistant hypertension, the inability to achieve goal blood pressure despite the use of three or more appropriately dosed antihypertensive drugs (including a diuretic), remains a common clinical problem, especially in patients with chronic kidney disease (CKD). While the exact prevalence and prognosis of resistant hypertension in CKD patients remain unknown, resistant hypertension likely contributes significantly to increased cardiovascular risk and progression of kidney disease in this population. We review the identification and evaluation of patients with resistant hypertension, including the importance of 24-h ambulatory blood pressure monitoring in the identification of 'white-coat', 'masked' and 'non-dipper' hypertension, the latter of which has particular clinical and therapeutic importance in patients with resistant hypertension and CKD. We then discuss treatment strategies for resistant hypertension that target the pathophysiologic mechanisms underlying resistance to treatment, including persistent volume excess, incomplete renin-angiotensin-aldosterone system blockade and inadequate nocturnal blood pressure control. Finally, we propose a treatment algorithm for evaluation and treatment of resistant hypertension in patients with CKD.
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Affiliation(s)
- Yelena R Drexler
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Andrew S Bomback
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Kuritzky L. Improved Blood Pressure Control in the Hands of the Hypertension Specialist: Method, Magic, or Something in Between? J Clin Hypertens (Greenwich) 2013; 15:615-6. [DOI: 10.1111/jch.12151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 05/20/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Louis Kuritzky
- Family Medicine Residency Program; University of Florida; Gainesville FL
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Ruilope LM, Arribas F. [Resistant hypertension: from prevention to renal denervation]. Med Clin (Barc) 2013; 141:27-8. [PMID: 23337447 DOI: 10.1016/j.medcli.2012.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 11/15/2012] [Indexed: 11/29/2022]
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Comment on ESH position paper: renal denervation--an interventional therapy of resistant hypertension. J Hypertens 2013; 30:2441-2; author reply 2443. [PMID: 23151886 DOI: 10.1097/hjh.0b013e3283599bdb] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Feldman RD, Brass EP. From bad behaviour to bad biology: pitfalls and promises in the management of resistant hypertension. Can J Cardiol 2013; 29:549-56. [PMID: 23618504 DOI: 10.1016/j.cjca.2013.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 10/26/2022] Open
Abstract
Control rates for hypertension have dramatically improved during the past 2 decades-especially in Canada. However, hypertension remains one of the top risk factors for premature death globally. Furthermore, one-third of Canadians with hypertension have not obtained adequate blood pressure control. Most of these patients have resistant hypertension with uncontrolled blood pressure despite therapy. The etiology of resistant hypertension is multifactorial but includes both behavioural and biological factors. Among behavioural factors, nonadherence on the part of patients and especially clinical inertia on the part of health care professionals are contributing causes. An understanding of the root causes underlying the failure to control an individual's blood pressure is central to optimal subsequent management. Further advances in blood pressure control rates in this group of patients will depend on improvements in health care delivery systems and the further development of innovative therapies. Drugs combining multiple antihypertensive agents in a single pill and the development of new technologies to lower blood pressure, primarily by disruption of the sympathetic nervous system, have the potential to be useful strategies in this effort.
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Affiliation(s)
- Ross D Feldman
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario, Canada.
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Ruilope LM, Schmieder R. Current status of renal denervation in resistant hypertension. ACTA ACUST UNITED AC 2012; 6:414-6. [PMID: 23117009 DOI: 10.1016/j.jash.2012.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 10/01/2012] [Indexed: 11/24/2022]
Abstract
Resistant hypertension is a frequent form of arterial hypertension that, with the exception of malignant hypertension, constitutes the most dangerous stage of arterial hypertension. Recently we have improved the detection, diagnosis, and therapy of resistant hypertensives. The technique of renal denervation with a catheter has improved the control of blood pressure in such patients. The technique is simple, safe, and available data indicates that it is effective. More data and longer follow-up of patients are required to promote wide acceptance of this new technique.
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Affiliation(s)
- Luis M Ruilope
- Hypertension Unit, Hospital 12 de Octubre, and Department of Preventive Medicine and Public Health, Universidad Autónoma, Madrid, Spain.
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Mann SJ. Psychosomatic research in hypertension: the lack of impact of decades of research and new directions to consider. J Clin Hypertens (Greenwich) 2012; 14:657-64. [PMID: 23031141 DOI: 10.1111/j.1751-7176.2012.00686.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Samuel J Mann
- Division of Nephrology and Hypertension, Department of Medicine, Weill/Cornell Medical Center, New York Presbyterian Hospital, New York, NY 10021,USA.
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