The Experts below are selected from a list of 237 Experts worldwide ranked by ideXlab platform
Karl Heinz Rahn - One of the best experts on this subject based on the ideXlab platform.
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The role of calcium antagonists in patients with chronic renal failure
Pediatric Nephrology, 2005Co-Authors: Karl Heinz RahnAbstract:The objective of antihypertensive treatment in patients with chronic renal failure, many of whom have elevated blood pressure levels, is to reduce cardiovascular events and to slow down the progression of kidney function impairment. Calcium antagonists have been shown to be effective and safe antihypertensive drugs in patients from different age groups, including children. On the basis of numerous studies, one may conclude that the main benefit of antihypertensive therapy is because of the blood pressure lowering effect per se and that calcium antagonists do not differ from other antihypertensive drugs in the ability to prevent cardiovascular Complications of Hypertension. In particular, calcium antagonists are not inferior to other groups of antihypertensive agents in the prevention of coronary artery disease. There is, however, now evidence from controlled clinical trials that drugs interfering with the renin–angiotensin system are more beneficial than other antihypertensive agents in patients with chronic renal failure. Thus, several studies have demonstrated that ACE-inhibitors and, in patients with type-2 diabetic nephropathy, AT 1-antagonists are superior to other classes of antihypertensive drugs, including calcium antagonists, in delaying the progression of renal insufficiency. Therefore, in hypertensive patients with chronic renal failure antihypertensive treatment should be initiated with a drug that inhibits the renin–angiotensin system.
Mehmet Kanbay - One of the best experts on this subject based on the ideXlab platform.
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Clinical value of ambulatory blood pressure: Is it time to recommend for all patients with Hypertension?
Clinical and Experimental Nephrology, 2016Co-Authors: Yalcin Solak, Kazuomi Kario, Adrian Covic, Nathan Bertelsen, Baris Afsar, Abdullah Ozkok, Andrzej Wiecek, Mehmet KanbayAbstract:Hypertension is a very common disease, and office measurements of blood pressure are frequently inaccurate. Ambulatory Blood Pressure Monitoring (ABPM) offers a more accurate diagnosis, more detailed readings of average blood pressures, better blood pressure measurement during sleep, fewer false positives by detecting more white-coat Hypertension, and fewer false negatives by detecting more masked Hypertension. ABPM offers better management of clinical outcomes. For example, based on more accurate measurements of blood pressure variability, ABPM demonstrates that taking antihypertensive medication at night leads to better controlled nocturnal blood pressure, which translates into less end organ damage and fewer clinical Complications of Hypertension. For these reasons, albeit some shortcomings which were discussed, ABPM should be considered as a first-line tool for diagnosing and managing Hypertension.
F Forette - One of the best experts on this subject based on the ideXlab platform.
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Cerebral Complications of Hypertension
Journal of Human Hypertension, 2000Co-Authors: As Rigaud, Ml Seux, Ja Staessen, Wh Birkenhäger, F ForetteAbstract:Ischaemic and degenerative brain diseases are a major health problem leading to a devastating loss of autonomy. Hypertension has been shown to carry an increased risk not only for cerebrovascular morbidity and mortality but also for cognitive impairment and dementia. Although diastolic blood pressure is considered an important risk factor, it is now clear that isolated systolic Hypertension and elevated pulse pressure also play an important role in the development of brain Complications. Therefore the treatment of these conditions must urgently become a widespread tool of prevention. All the randomised placebo-controlled trials completed for the last 30 years have shown a reduction in fatal and/or non-fatal strokes. In the most recent trials in isolated systolic Hypertension in older patients, the benefit was even greater because of the higher risk in these populations. The new classes of drugs, in particular, calcium-channels blockers and angiotensin- converting enzyme inhibitors, have been shown to be as effective as the originally used diuretics and beta-blockers. Active treatment in the Syst-Eur trial based on nitrendipine as first step, possibly associated with enalapril and/or hydrochlorthiazide reduced not only stroke and cardiovascular Complications but also the incidence of dementia including Alzheimer’s disease. This important finding must be confirmed by further trials specifically focusing on the prevention of dementia. In addition, the importance of pulse pressure as a risk factor, underlines the need for new drugs which could increase aortic distensibility and decrease systolic blood pressure without greatly reducing diastolic pressure. Improving the management of Hypertension offers new opportunities to reduce age-related disease in older people and to promote healthy aging.
P Kallestrup - One of the best experts on this subject based on the ideXlab platform.
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Non-adherence to anti-hypertensive medication in low- and middle-income countries: a systematic review and meta-analysis of 92443 subjects
Journal of Human Hypertension, 2017Co-Authors: J Ø Nielsen, A D Shrestha, D Neupane, P KallestrupAbstract:Hypertension is a rising global burden, and low- and middle-income countries account for 80% of deaths due to Complications of Hypertension. Hypertension can be controlled by adhering to anti-hypertensive medication. However, non-adherence is an increasing challenge. This review aims to systematically evaluate non-adherence to anti-hypertensive medication among adults in low- and middle-income countries and explore factors affecting non-adherence to anti-hypertensive medication. We performed a systematic search for studies published between 1 January 2000 and 31 August 2015. A selection process was performed for data extraction with a combination of Medical Subject Headings terms: ‘Hypertension’ and ‘adherence’. Further search criteria were: language (‘english’), species (‘humans’), and low- and middle-income countries. A total of 22 studies met the inclusion criteria. The pooled percentage of non-adherence when using the eight-item Morisky Medication Adherence Scale (MMAS) was 63.35% (confidence of interval (CI): 38.78–87.91) and 25.45% (CI:17.23–33.76) when using the 80 and 90% cut-off scales. The factors were classified into the five dimensions of adherence defined by the World Health Organization, and the majority of the studies reported factors from the dimension ‘social and economic factors’. This systematic review demonstrated considerable variation of non-adherence to anti-hypertensive medication in low- and middle-income countries depending on the methods used to estimate non-adherence. The results showed a high non-adherence when the MMAS eight-item scale was used and low when the 80 and 90% cut-off scales were used. The majority of factors affecting non-adherence to anti-hypertensive medication fell within the World Health Organization defined dimension ‘social and economic factors’.
Sverre E Kjeldsen - One of the best experts on this subject based on the ideXlab platform.
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Complications of Hypertension and the role of angiotensin receptor blockers in Hypertension trials
Expert Review of Cardiovascular Therapy, 2007Co-Authors: Arnljot Flaa, Tonje A Aksnes, Arne Strand, Sverre E KjeldsenAbstract:Hypertension is a high-prevalence disease that may affect several organs. In recent years, data have accumulated indicating that angiotensin II receptor blockers (ARBs) may have a supplementary effect beyond lowering blood pressure. The aim of this review is to evaluate the impact of ARBs on the most important Complications of Hypertension – heart, cerebrovascular and renal diseases, and metabolic Complications – based on the findings from large clinical Hypertension trials. The results may indicate that ARBs have a superior effect compared with placebo or other antihypertensive drugs in order to prevent left ventricular hypertrophy, atrial fibrillation, stroke, renal disease and diabetes mellitus, while there appears to be no blood pressure-independent superior effect of ARBs regarding prevention of myocardial infarction or heart failure.