Latest news with #Hypertension
Medscape
3 days ago
- Health
- Medscape
Management of Hypertension in Primary Care
Hypertension is the most common chronic condition that primary care physicians treat. Knowledge about the causes and effective treatment strategies have evolved over the decades since I attended medical school, and I want to highlight some of the most useful approaches I have found over the years. What are the most common causes of secondary hypertension? Most hypertension (90%-95%) is essential hypertension. In medical school, I learned a list of rare diseases to consider as causes of secondary hypertension like pheochromocytoma, coarctation of the aorta, and Cushing syndrome. In the real world, the diagnoses with highest prevalence of secondary hypertension are obstructive sleep apnea (25%-50%), hyperaldosteronism (8%), atherosclerotic renal artery stenosis (5%), and drug or alcohol abuse (4%). The rare diseases listed above account for 0.1% or less of secondary hypertension. What is the best initial treatment for patients just diagnosed with hypertension? The biggest change from what I was taught in medical school is that for most patients, we should start with two-drug therapy to achieve the blood pressure (BP) goal if the initial BP is more than 20/10 mm Hg above the target BP goal. Patients with stage 1 hypertension are usually started on one medication if the goal is more modest BP lowering. What if your initial treatment with a single drug does not achieve its goal? Douglas S. Paauw, MD The standard approach for many years was to increase the dose of the single BP medication with the hope that there would be a more pronounced BP response. J.R. Benz and colleagues looked at the BP effect of doubling the dose of valsartan from 80 mg to 160 mg. The difference was an additional BP lowering of only 3 mm Hg/0.8 mm Hg. Patients who received a second drug (hydrochlorothiazide) in addition to 80 mg of valsartan rather than doubling the valsartan dose had an average reduction in BP of 12 mm Hg/6 mm Hg. In a meta-analysis comparing monotherapy with combination therapy for lowering BP, adding another drug lowered BP five times more than doubling the dose of the initial antihypertensive drug. What is the best approach to treating resistant hypertension? According to my training, patients with resistant hypertension needed a workup for secondary hypertension and rarely used drugs like clonidine and minoxidil were in play. De Jager and colleagues evaluated renal denervation in hypertension treatment. As part of the study, stored blood samples collected at study entry were evaluated for adherence to prescribed antihypertensive medications. In 80% of patients, fewer drugs were detected than prescribed. This high rate of nonadherence emphasizes that the first place to start in treatment of resistant hypertension is to carefully assess adherence. For patients with true resistant hypertension, de Souza et al studied 175 patients taking at least three antihypertensive medications and documented adherence. All patients were then given spironolactone, with a mean decrease in systolic BP of 16 mm Hg and diastolic BP of 9 mm Hg. Adding a mineralocorticoid receptor antagonist is recommended in the American College of Cardiology/American Heart Association guidelines. Recent data collected by Lee and colleagues show that amiloride is equivalent to spironolactone in patients with resistant hypertension, with systolic BP reductions of 13.6 mm Hg. Pearls:
Medscape
04-08-2025
- Health
- Medscape
Why Your Arm Shape Skews Blood Pressure Readings
Blood pressure (BP) measurement is a core component of patient assessment in clinical care. It helps guide medication dosing, supports treatment decisions, and is essential for the diagnosis of hypertension. As high BP is often asymptomatic, its accuracy is critical. Measurement errors can lead to misdiagnosis and inappropriate treatment. The Riva-Rocci-Korotkoff method, which uses a cuff sphygmomanometer to measure brachial BP, has been used in clinical practice for more than 100 years. Although BP thresholds and treatments have evolved, this method, which is now built into automated oscillometric cuff devices, remains the standard. It forms the basis of the World Health Organization recommendations and clinical hypertension guidelines. Although this technique may seem simple, it requires multiple steps to ensure accurate and consistent reading. A difference of 5 mm Hg in systolic BP could lead to the misclassification of hypertension in 84 million people worldwide. Measurement Accuracy Sex Differences Recent studies have shown sex-based differences in the accuracy of automated BP measurements compared with intra-arterial BP measurements. At the same intra-arterial BP level, systolic BP measured using an automated cuff was consistently lower in women than in men, suggesting an underestimation of cardiovascular risk in women. This discrepancy may lead to unrecognized undertreatment and could help explain why women face a higher risk for cardiovascular disease at brachial cuff BP levels similar to those of men. Anatomical Factors Anatomical differences may partially explain this variation. Individuals with a large difference between proximal and distal arm circumferences are more likely to receive inaccurate BP readings than those with a more uniform mid-arm shape. Consequently, women are more likely to experience poor fit with cylindrical cuffs that often extend beyond the elbow. Cuff Size Limited data exist on how cuff size affects the agreement between automated and manual BP readings and whether this varies by sex. A study of 3735 participants from the National Health and Nutrition Examination Survey (49% women; average age, 45 years) found that automated systolic BP readings were lower than manual readings. In women, the gap widened with larger cuffs, up to -6.4 mm Hg with extra-large cuffs. In men, underestimation occurred only with extra-large cuffs (-2.4 mm Hg). Differences in arm shape, body size, and adiposity were associated with discrepancies between automated and manual systolic BP readings in both sexes, particularly in extra-large cuffs. The agreement between the automated and manual systolic BP classifications decreased as cuff size decreased from moderate for adults and large cuffs to poor for extra-large cuffs. This pattern was similar in both women and men. Clinical Implications In women, automated systolic BP progressively underestimates manual systolic BP as cuff size increases. In men, this underestimation occurred only with extra-large cuffs. Differences between automated and manual systolic BP measurements were linked to arm size, body size, and adiposity in both sexes, particularly in extra-large cuffs. The agreement in hypertension classification between automated and manual systolic BP declined as cuff size increased, with similar patterns for women and men. The reduced accuracy of automated systolic BP measurements with larger cuffs may lead to inappropriate clinical decisions and requires further study. This story was translated from Univadis Italy.
Time of India
12-07-2025
- Health
- Time of India
How weather affects your blood pressure (and what you can do about it)
We often think of blood pressure as something affected by what we eat, how stressed we are, or whether we remembered to take our medication. But there's another factor quietly influencing those numbers: the weather. Temperature changes, both hot and cold, can alter how your heart and blood vessels behave. And for anyone living with hypertension, those shifts might have a greater effect than expected. As the weather becomes more and more erratic, it is necessary that we understand how fluctuations in weather are affecting our health. When it's hot, blood pressure may drop, but not without risks During summer, to cool itself, the body widens the blood vessels close to the surface of your skin, a process known as vasodilation. This allows heat to escape more easily. But behind the scenes, your heart has to work harder, beating faster and pushing more blood to the surface. This drop in vascular resistance can cause your blood pressure to fall. T Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like Upto 15% Discount for Salaried Individuals ICICI Pru Life Insurance Plan Get Quote Undo by Taboola by Taboola hat might sound like a good thing if you're hypertensive, and to some extent, it is. But the situation isn't quite that simple. High temperatures are accompanied by excessive sweating and fluid loss. If fluid loss is not compensated adequately, blood volume drops again. The body then responds by releasing vasopressin, a hormone that helps conserve water but also causes blood vessels to tighten again. The result is a rapid rise in blood pressure that can reverse the earlier drop and put strain on the heart. This kind of fluctuation can be especially dangerous if you're on medication that already promotes vasodilation. Even mild dehydration can hurt oxygen delivery to your organs and trigger complications. Cold temperatures raise pressure through vasoconstriction In colder weather, it is the opposite. The vessels constrict to keep heat from escaping. This narrowing is known as vasoconstriction. It increases resistance within the arteries, forcing the heart to work harder and ultimately causing your blood pressure to rise. A study published in the journal Hypertension followed more than 16,000 patients and found that over a third showed heightened sensitivity to cold temperatures. These individuals not only had higher systolic blood pressure during winter but were also more likely to experience cardiovascular complications. What's more, winter often leads to less physical activity, weight gain, and increased intake of salt-heavy foods. Reduced sunlight can also lower vitamin D levels, which has been linked to poorer blood pressure control. Altogether, it becomes a season where everything seems to work against stable heart health. How to keep your blood pressure steady despite weather shifts If you're living with high blood pressure, the best thing to do is stay ahead of the curve. Start by tracking your blood pressure regularly, especially as the seasons change. This might help you get in sync with the changes in your body better. In the heat, stay hydrated. Usually, it is advised to drink six to eight glasses of water a day. However, if it is a strenuous day physically more might be needed. Diuretic drinks like alcohol and excess caffeine should be kept in check, as they can worsen fluid loss. During winter, prioritize warmth and consistency. Dress in layers, stay physically active even if it means indoor stretches or light exercise, and maintain a comfortably heated environment. A diet rich in fruits, vegetables, and healthy fats, and low in sodium, will support cardiovascular health throughout the year.
Yahoo
10-07-2025
- Health
- Yahoo
Recor Medical Supports Proposed CMS National Coverage Determination of Renal Denervation for the Treatment of Hypertension
About the Paradise Ultrasound Renal Denervation System Recor Medical Supports Proposed CMS National Coverage Determination of Renal Denervation for the Treatment of Hypertension Palo Alto, CA, July 10, 2025 (GLOBE NEWSWIRE) -- Recor Medical, Inc. ('Recor') and its parent company, Otsuka Medical Devices Co., Ltd. ('Otsuka Medical Devices'), today announced their support for the Centers for Medicare and Medicaid Services' (CMS) proposed National Coverage Determination (NCD) for Renal Denervation (RDN), a device-based therapy for patients with uncontrolled hypertension—individuals whose blood pressure cannot be properly managed with lifestyle changes and medication. The proposed NCD, released on July 10, 2025, recommends coverage for ultrasound renal denervation (uRDN) and radiofrequency renal denervation (rfRDN) for uncontrolled hypertension. A 30-day public comment period is now open for healthcare professionals, professional societies, and industry to provide input before CMS issues its final determination in October. 'We are encouraged by CMS's proposed decision to provide Medicare coverage for uRDN in patients with uncontrolled hypertension—a population that continues to face significant unmet need,' said Lara Barghout, CEO of Recor Medical. 'This preliminary determination is a meaningful step forward in recognizing the clinical value of RDN and will aid in expanding access to the patients who need it.' Recor has been focused on developing and testing the Paradise uRDN system for the treatment of hypertension since 2009. The RADIANCE global program studied the Paradise system in three independently powered, sham-controlled, randomized clinical trials in over 500 patients with uncontrolled hypertension: RADIANCE II and RADIANCE-HTN SOLO, which studied patients with mild-moderate hypertension in an 'off-meds' setting, and RADIANCE-HTN TRIO, which studied patients with resistant hypertension on standardized triple antihypertensive therapy. Each trial met its prescribed primary efficacy endpoint with a favorable safety profile consistently observed following ultrasound RDN treatment. Recor has also initiated the US Global Paradise System (GPS) Post-Approval Study, which intends to collect real-world clinical evidence with long-term follow-up in 1,000 patients with uncontrolled hypertension. The Paradise uRDN system is currently commercially available for patients in the US having received FDA approval in November 2023. It is indicated to reduce blood pressure as an adjunctive treatment in hypertension patients in whom lifestyle modifications and antihypertensive medications do not adequately control blood pressure. About the Paradise uRDN SystemThe Paradise uRDN system is a first-of-its-kind ultrasound-based RDN technology designed to lower blood pressure by denervating the sympathetic nerves surrounding the renal arteries, reducing the overactivity that can lead to hypertension. The Paradise uRDN system delivers two to three doses of 360-degree ultrasound energy — lasting seven seconds each — through the main renal arteries to the surrounding nerves. The Paradise catheter features the exclusive HydroCooling™ system, which circulates sterile water through the balloon catheter during the procedure to help protect the renal artery wall. About Recor Medical, Medical, headquartered in Palo Alto, Calif., a wholly owned subsidiary of Otsuka Medical Devices Co., Ltd., is a medical technology company focused on transforming the management of hypertension. Recor has pioneered the use of the Paradise Ultrasound Renal Denervation system for the treatment of hypertension. The Paradise uRDN system is an investigational device in Japan, is FDA approved for sale in the United States, and is CE marked and approved for sale in markets where the CE mark is accepted, per approved indications for use. Recor has reported positive outcomes in three independent, randomized, sham-controlled studies of the Paradise uRDN system in patients with mild-to-moderate and resistant hypertension. In addition, Recor is conducting the Global Paradise System ('GPS') Registry in the European Union and the UK, and has initiated the US GPS post-approval study in the United Otsuka Medical Devices Co., Medical Devices Co., Ltd. engages in the global development and commercialization of medical devices that provide new therapeutic options in areas where patient needs cannot be met through pharmaceutical or other conventional treatment. Otsuka Medical Devices is a subsidiary of Otsuka Holdings Co., Ltd. ( a global healthcare company listed on the Tokyo Stock Exchange (JP 4578). ContactLisa OwensThe Mullings Grouplowens@ Attachments About the Paradise Ultrasound Renal Denervation System Recor Medical Supports Proposed CMS National Coverage Determination of Renal Denervation for the Treatment of Hypertension CONTACT: Lara Barghout Recor Medical +1 650 542 7700 in to access your portfolio
Daily Mirror
18-06-2025
- Health
- Daily Mirror
Cardiologist issues food advice to lower blood pressure in hours
A heart doctor says eating the right food is key and you can notice a difference in a matter of hours Munching on leafy greens might not seem as appealing as a biscuit, but such a tiny tweak to your eating habits could make a world of difference. And according to those in the know, tucking into a bit of spinach could be a game-changer. The often overlooked veg has the potential to lower your systolic blood pressure, and a doctor noted that improvements can be spotted within "hours" - and with "daily intake" it could work wonders. Speaking to Parade, Doctor Deepak Talreja, cardiologist and clinical chief of cardiology at Sentara Health, said: "Spinach may help lower systolic blood pressure, largely due to its rich content of dietary nitrates. "When we eat nitrate-rich foods like spinach, the body converts nitrates to nitric oxide, a molecule that relaxes and dilates blood vessels." With your blood vessels in a more relaxed and widened state, blood can flow more effortlessly, decreasing the vascular resistance, which is essentially the resistance to blood flow in the veins and arteries. "This can lead to a modest reduction in systolic blood pressure," he said. He proceeded to cite several studies backing the effects of spinach on systolic blood pressure and highlighted one study in particular. He said: "A randomised crossover trial published in Hypertension found that a diet high in nitrate-rich vegetables such as spinach significantly reduced both systolic and diastolic blood pressure in hypertensive patients, particularly when consumed regularly. "The effect may be seen within hours of consumption and can persist with daily intake. Regularly incorporating fresh spinach into meals - whether in salads, smoothies or sautés - can be a simple, natural way to support healthier blood pressure and overall cardiovascular wellbeing." Dr Talreja added: "While spinach alone won't replace medications or other proven treatments, it can be part of a broader dietary strategy aligned with the DASH (Dietary Approaches to Stop Hypertension) and Mediterranean diets - both of which are associated with lower cardiovascular risk." Rich in potassium, spinach also helps regulate sodium and blood pressure levels. Additionally, it is an excellent source of magnesium. As an antioxidant-rich food, spinach is high in vitamin C, vitamin E, and beta-carotene, which can help mitigate the risk of damage and clogged blood vessels, as well as high cholesterol. The Hypertension study adds that beetroot juice is also a great example of a "single dose of dietary inorganic nitrate" that can reduce your blood pressure. They said that in a double-blind, placebo-controlled trial, 68 people with hypertension were randomly assigned to drink either 250 mL of nitrate-rich beetroot juice or nitrate-free (placebo) juice every day for 4 weeks. Participants were either not on medication or already being treated for high blood pressure, and ranged in age from 18 to 85. Results showed that those who drank the nitrate-rich juice had significant reductions in blood pressure measured at the clinic, at home, and over 24 hours. These effects lasted throughout the 4 weeks with no signs of the body adapting (which they call "tachyphylaxis"). Additionally, blood vessel function improved by about 20%, and artery stiffness decreased. There were no changes in the placebo group. The researchers concluded: "This is the first evidence of durable BP reduction with dietary nitrate supplementation in a relevant patient group. These findings suggest a role for dietary nitrate as an affordable, readily-available, adjunctive treatment in the management of patients with hypertension (funded by The British Heart Foundation)."
