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At least 19 recordsLinked to original sources
PubMed2026

Home blood pressure telemonitoring reveals race-specific patterns of target organ damage.

BACKGROUND: Racial differences in cardiac and renal target organ damage (TOD) may persist at comparable blood pressure levels. This study compared TOD in high-risk, non-African-American Black and White patients in relation to the home blood pressure (HBP). METHODS: UPRIGHT-HTM (NCT04299529) is an ongoing international trial comparing risk stratification strategies in asymptomatic patients, aged 55-75 &#x200a;years, with &#x2265;5 risk factors. Patients engage in HBP telemonitoring (OMRON HEM 9210-T). After 34.7&#x200a;months (median), 287 Black and 154 White patients underwent echocardiography. At baseline, their chronic kidney disease (CKD) grade was assessed by cross-classification of the race-free estimated glomerular filtration rate and albuminuria (2024 KDIGO guideline). HBP was stratified by the 2024 ESC thresholds. Linear and logistic regression models, including a race-by-HBP interaction term, were applied to assess associations with the home systolic HBP. RESULTS: The number of HBP readings was 252 215. Median systolic/diastolic HBP was 127/77&#x200a;mmHg with 142 patients (32.2%) having home hypertension. Fewer Black patients received statins or combination therapy for hypertension or diabetes. Among nonhypertensive White compared to Black patients, left atrial dimensions, mitral annular s', and stroke volume had a steeper slope in relation to systolic HBP. All patients had concentric left ventricular remodeling, but only 4 Black and 13 White patients had an ejection fraction&#x200a;<&#x200a;50%. CKD grade was worse in Black than White patients without association with HBP. CONCLUSIONS: TOD primarily affects the kidney in Black and the heart in White patients. Intensifying pharmacological treatment in sub-Saharan Africa, including antihypertensives, lipid-lowering agents, antidiabetic medications, and aspirin, should create an opportunity for improved overall cardiovascular and metabolic prevention.

Aged↗
PubMed1976

Hypertension, hypokalemia, hyporeninemia and severe target organ damage.

A 51-year-old woman with a 20-year history of severe hypertension and target organ damage had nondiuretic hypokalemia, kaluresis, suppressed plasma renin activity and elevated urinary excretion of aldosterone. Renal arteriography demonstrated unilateral renal artery stenosis secondary to fibromuscular hyperplasia. Blood pressure responded only minimally to almost all antihypertensive agents. Spironolactone, 300 to 400 mg/d, produced distinct improvement in blood pressure, which was maintained for 13 months.

Aldosterone↗
PubMed1977

Target organ damage in black hypertensives.

A representative sample of black hypertensives has been appraised to determine candidacy for hypertension treatment. A total of 1759 black residents were successfully screened at home. Forty-one percent of the males and 33% of the females had diastolic blood pressures of 95 mm Hg or greater. They were invited for secondary screening along with those hypertensives controlled on therapy. Clinical and laboratory evidence of cardiovascular disease was common among examined patients who were studied to determine their eligibility for therapy based on criteria of elevated blood pressure (greater than 104 mm Hg) at two visits, or evidence of end organ damage at lowere blood pressure levels. Of patients previously aware of their hypertension but not on therapy, 88% of the males and 67% of the females were considered candidates for therapy. Of patients not previously aware of their elevated blood pressure, 72% of the males and 67% of the females were considered candidates.

Adult↗
PubMed1975

Continuous recording of direct arterial pressure in unrestricted patients. Its role in the diagnosis and management of high blood pressure.

We have compared casual indirect measurements of arterial pressure obtained 1) by the general practitioner (GP) and 2) in the outpatient clinic (OPC) with 24 hour continuous recording of direct arterial pressure in two selected group of unrestricted patients. 1) Eight asymptomatic, untreated patients with suspected hypertension. 2) Eight asymptomatic, treated patients whose indirect pressure readings seemed inappropriately high when considered against a general absence of target organ damage. Both groups showed that usually there was good agreement between arterial pressure recorded indirectly by GP and OPC while continuous recording showed wide variability of systolic and diastolic pressures over 24 hours and a significant fall during sleep. The first groups with suspected hypertension showed that the indirect measurements were not significantly different from the 24 hour direct recording. The second group of patients on treatment for hypertension showed a discrepancy, the direct readings being significantly lower than the indirect. This difference (approixmately 30 mm Hg mean arterial pressure) would explain the lack of target organ damage and may have been due to the effect of exercise augmenting the hypotensive action of drugs or due to a well developed defense reflex which biased the indirect readings.

Adult↗
PubMed1979

A follow-up study of hypertensive patients after operative treatment of unilateral renovascular or renal disease.

A study of 44 hypertensive patients with unilateral renovascular or renal parenchymal disease is presented. All patients underwent corrective surgery. Out of the 44 operated patients, five did not participate in the follow-up examination. The remaining 39 patients constitute the study population. The effects of surgery on the hypertensive state could be evaluated in 35 patients, whereas four died less than two months after the operation. Follow-up studies were carried out at 8-60 months after the operation. The average period of observation was 32 months; 24 patients were observed for more than two years. As a group, the patients had severe hypertension with extensive target organ damage and widespread atherosclerosis. A fairly rigorous selection process was applied, and an unsatisfactory response to medical management was considered a point of major importance. In the majority of cases, renovascular lesions were atherosclerotic, with only two cases of fibromuscular dysplasia. Unilateral nephrectomy was performed in 32 patients, whereas seven underwent reconstructive vascular surgery. Out of 35 patients, 22 (63%) were cured, 8 (23%) improved and 5 (14%) unaltered. A gratifying regression of hypertensive lesions in target organs was observed in patients who were cured or improved by surgery. The frequency and severity of postoperative complications were related to the presence of extrarenal vascular disease.

Adult↗
PubMed1977

Management of the patient with renovascular hypertension.

Renal artery stenosis, either fibromuscular or atheromatous, is probably the most common cause of secondary hypertension in man. Both of these diseases are active, ongoing processes that may be ameliorated but not cured by medical or surgical treatment. The clinical history and examination of the patient with hypertension may help differentiate renovascular hypertension from essential hypertension. The presence of a systolic-diastolic or continuous bruit is often an indicator of severe renal artery stenosis. Systemic hypertension is the physiologic consequence of significant renal artery stenosis. Knowledge of the basic concepts of the renin-angiotensin-aldosterone system, as has evolved from experimental models of renovascular hypertension, forms the basis for understanding the process of evaluation and treatment of such patients. The treatment of choice for the patient with severe hypertension and a functionally significant renovascular lesion is surgical--both in terms of successful treatment of hypertension and improved long-term prognosis. Diligent periodic reevaluation of these patients as well as those with less severe hypertension who are receiving medical treatment enables the physician to select the proper management that offers optimal control of patient blood pressure and avoids target-organ damage to the kidneys, central nervous system, or cardiovascular system.

Humans↗
PubMed1977

Managing hypertension: the postgraduate medicine lecture.

Managing hypertension effectively requires careful evaluation of the patient, in particular for the presence of target-organ damage and of other risk factors for atherosclerosis. Dietary management has proved to be unsatisfactory in most hypertensive patients, as patients resist dietary restrictions or any other changes in life-style. Drug treatment has been shown to significantly reduce morbidity and mortality in patients with diastolic blood pressures above 104 mm Hg. Evidence suggests that drug treatment is also effective in those with diastolic pressures between 90 and 104 mm Hg. Selection of drugs is still an empirical decision--treatment with an oral diuretic usually is effective for mild hypertension (diastolic pressures 90 to 115 mm Hg). A sympathetic depressant, often propranolol, may be added to the regimen next, and if this is ineffective, a vasodilator (usually hydralazine) is included. Common side effects of antihypertensive drugs are seldom serious but can be annoying. Patients should be forewarned about them, and about the effects of untreated hypertension in an effort to improve compliance.

Antihypertensive Agents↗
PubMed1979

Practical approach to hypertension. 1. Diagnostic evaluation.

The comprehensive diagnostic evaluation once recommended for hypertension is no longer practical or necessary. In the majority of cases, a thorough history, physical examination, and basic laboratory workup are sufficient to determine the severity of the hypertension and to detect target organ damage. Secondary hypertension is truly rare in clinical practice and should not be pursued with complex, costly, and possibly risky tests unless specific indications are present.

Adult↗
PubMed1979

Identification and management of juvenile hypertension.

Juvenile hypertension is a new field of study, and a definitive approach to diagnosis and treatment has not yet been developed. This article outlines the approach at the hypertension clinic of Children's Hospital Medical Center, Cincinnati, where experience has confirmed the value of routine blood pressure measurement from an early age. Early identification and treatment may reverse target organ damage in youngsters with moderately severe or severe hypertension and may prevent sustained hypertension in those with borderline pressure elevations.

Adolescent↗
PubMed2025

Approach to the Patient With Primary Hyperparathyroidism in Multiple Endocrine Neoplasia Type 1.

Multiple endocrine neoplasia type 1 (MEN1) is a rare autosomal dominant hereditary disorder in which patients develop multiple endocrine tumors simultaneously. Among these, primary hyperparathyroidism is the most common and often the earliest manifestation. All patients with MEN1 and hypercalcemia should have surgery, with most patients requiring surgical treatment before the age of 50 years. The timing of parathyroid surgery mainly depends on hypercalcemia and the presence of renal or skeletal complications. The goals of treatment are to correct hypercalcemia, prevent target organ damage, and minimize the risk of postoperative hypoparathyroidism as much as possible. Currently, the most widely recommended surgical approach is subtotal parathyroidectomy via the cervical approach (removal of 3 or 3.5 glands). With advances in imaging technology, patients with clearly localized lesions-particularly younger patients-may be candidates for individualized unilateral resection (ie, removal of both glands on the affected side). In addition, recurrent hypercalcemia after surgery is relatively common in patients with MEN1. The management of the remaining glands remains challenging, such patients usually need reoperation, calcimimetic therapy, or clinical observation. For patients requiring repeated parathyroid surgeries, in addition to searching for multifocal lesions, the possibility of ectopic parathyroid glands should also be taken into account. Ectopic parathyroid adenoma, caused by abnormal embryonic migration, complicates surgery in both sporadic and MEN1-related primary hyperparathyroidism. However, in MEN1, their higher frequency and multiglandular distribution make localization even more challenging, often leading to incomplete resection and recurrence.

Humans↗
PubMed1976

The treatment of resistant hypertension.

Resistant hypertension can be defined in terms of lack of blood pressure response to hypotensive agents, but there may be a big difference between standing and lying blood pressure levels. In general target organ damage and papilloedema improve if the standing blood pressure is controlled; however, progression can occasionally be documented when only the supine blood pressure remains uncontrolled. Resistant hypertension was a frequent phenomenon when ganglion blocking agents and hydrallazine were the only effective hypotensive agents. With the advent of the thiazides, effective control of the blood pressure became the exception rather than the rule; however, it was not until the advent of adrenergic blocking agents that reduction of supine blood pressures was regularly achieved. The addition of hydrallazine or prazosin to a combination of a thiazide and beta-adrenoreceptor blocking agent produces a further significant fall in the blood pressure lying and standing. This combination will control the blood pressure in most patients, but a few remain refractory to maximum doses and will require treatment with oral diazoxide or minoxidil. Both these powerful vasodilators are very effective in resistant hypertension. Oral diazoxide permits excellent control and allows a 10-fold reduction in the doses of other agents. Minoxidil usually needs to be combined with moderate doses of beta-blocking agents to reduce the marked reflex tachycardia. Only a 50% reduction in other hypotensive agents was achieved in patients treated with minoxidil and two patients proved resistant to minoxidil, but subsequently responded to oral diazoxide.

Adrenergic beta-Antagonists↗
PubMed1978

Renal vasculature in essential hypertension: racial differences.

In an attempt to explain the greater morbidity from essential hypertension in the black as compared with the white race, we evaluated the intrarenal vasculature of 27 patients with hypertension (19 white and 8 black). All patients had mild-to-moderate hypertension (mean arterial pressure, 110 to 125 mm Hg), normal renal function, and minimal target-organ damage. All patients had selective renal angiograms, which were evaluated for arterial nephrosclerosis. Additionally, renal blood flow was estimated by the clearance of para-aminohippurate. Patient age, blood pressure, and plasma renin activity did not differ between the two races. Black hypertensives had significantly (P less 0.01) more severe nephrosclerosis than the white patients. Renal blood flow was lower (P less than 0.05) in black patients (390 +/- 35 ml/min - m2 body surface area) than white patients (473 +/- 19 ml/min - m2 body surface area). These findings may help to explain racial differences in morbidity and mortality from essential hypertension.

Adult↗
PubMed1975

Chronic experimental hyperuricemic nephropathy.

Sustained, moderately severe hyperuricemia and severe uricosuria were produced in male Wistar rats by feeding dietary supplements of oxonic acid (0.4 gm. per day) and uric acid (0.6 gm per day). After 1 month, the kidneys showed the previously described histologic features of urate-blockade nephropathy characterized by intratubular deposits, tubular injury, and an exudative response consisting of neutrophilic granulocytes with early tophus formation. After 36 and 52 weeks of hyperuricemia, and with no gross evidence of renal failure, the kidneys showed a predominantly interstitial mononuclear cell infiltrate around regenerated tubules, an increase in interstitial fibrous tissue, infrequent renal tophi, and renal stones. The glomeruli and blood vessels appeared completely normal. There was no evidence of arthritis and no other target organ damage was detected. The chronic renal changes present in this animal model of induced hyperuricemia resemble those seen in human gouty nephropathy. The evolution of the experimental urate nephropathy observed during 1 year suggests that a primary acute inflammatory tubular injury is followed by a diffuse chronic interstitial nephritis and that the glomeruli and blood vessels are not primarily involved in the renal disease. This animal model may provide the opportunity to study factors influencing the renal sequelae of sustained hyperuricemia.

Animals↗
PubMed1976

Labetalol in resistant hypertension.

1 The efficacy of labetalol in lowering blood pressure has been assessed in a group of 16 patients with severe hypertension whose blood pressure was inadequately controlled (supine diastolic blood pressure greater than 110 mmHg on two consecutive occasions) on existing therapy or in whom severe side-effects necessitated a change in therapy. 2 All patients had an original pretreatment supine diastolic blood pressure of greater than 120 mmHg and most had evidence of target organ damage. Patients were hospitalized for the purposes of changeover of therapy, labetalol being added to the existing regime which was reduced stepwise and eventually withdrawn. 3 Treatment with labetalol resulted in satisfactory blood pressure control in 10 of 16 patients in this study but high doses were required, the mean daily dose being 3,091 mg (range 1,200-8,000). 4 Treatment with discontinued in 6 patients on account of postural hypotension (3), failure to control supine diastolic blood pressure (2) and retention of urine (1). Long-term treatment was relatively free from side-effects. 5 From preliminary studies in animals it is suggested that an action within the central nervous system may contribute to the hypotensive effect of labetalol.

Adult↗
PubMed1978

Initial evaluation of patients with hypertension: an office procedure.

Traditionally the initial evaluation of a patient with high blood pressure has focused on exluding secondary correctable causes of hypertension. Such all-inclusive evaluations are expensive, time-consuming, and expose the patient to some risk. A complete history, physical examination, and relatively simple laboratory procedures such as CBC, urinalysis, SMA-6 and 12, and ECG yield sufficient information to detect damage to target organs caused by elevated blood pressure and to exclude the presence of secondary causes fairly adequately. In that small number of patients in whom clues for correctable causes of hypertension are uncovered, or if patients fail to respond to appropriate treatment for essential hypertension, a more extensive evaluation can be undertaken.

Auscultation↗
PubMed2026

Longitudinal comparison of treat-to-target states and clinical outcomes in patients with late-onset versus early-onset systemic lupus erythematosus.

OBJECTIVE: We compared demographic and clinical characteristics between patients with late-onset (LO) and early-onset (EO) systemic lupus erythematosus (SLE) and examined their longitudinal associations with treatment targets and long-term outcomes, irreversible organ damage accrual and health-related quality of life (HRQoL). METHODS: We analyzed prospectively collected data from patients enrolled in the Asia Pacific Lupus Collaboration cohort. Patients diagnosed with SLE at age >50 years were classified as LO-SLE and compared with those diagnosed at age &#x2264;50 years (EO-SLE). Longitudinal associations with treatment targets (LLDAS and DORIS remission), organ damage accrual (SLICC/ACR Damage Index), and HRQoL (SF36v2 physical and mental component summary (PCS and MCS) scores) were examined using multivariable multilevel logistic, recurrent-event survival, and linear mixed-effects models, respectively. Disease activity, flares, medication exposure, and other clinical characteristics were also compared between groups. RESULTS: Among 3,917 patients studied, 346 (8.8%) had LO-SLE. Compared with EO-SLE, patients with LO-SLE had lower disease activity, lower glucocorticoid and immunosuppressant exposure, and higher attainment of treatment targets; LO-SLE was associated with higher odds of attaining LLDAS (OR: 2.33 (1.66, 3.28)) and DORIS remission (OR: 2.22 (1.45, 3.38)). However, they were at a greater risk of damage accrual (HR:1.82 (1.50, 2.21)) and lower PCS scores, meaning poorer physical health (regression coefficient (RC) = -3.63 (-4.58, -2.68)) but not MCS (RC= 0.68 (-.50, 1.86)). CONCLUSION: Despite higher attainment of treatment targets, patients with LO-SLE experienced greater damage accrual and poorer physical health, suggesting that disease activity targets alone may not fully capture outcome risk in LO-SLE.

Journal Article↗
PubMed1977

Focal infection in perspective.

In this article some of the theoretical possibilities arising as a result of focal infection are discussed. Rheumatic fever is discussed as an example of a disease in which a number of possible mechanisms may act to produce tissue damage at a target area. The mechanisms examined are direct dissemination of organisms from the focus to the target area, the induction of L-phase bacteria, and toxic damage to target tissue. Host-mediated tissue damage by hypersensitivity or auto-immune mechanisms is considered as well.

Bacteria↗