Publications by authors named "Jan N Basile"

103 Publications

How We Got Where We Are in Blood Pressure Targets.

Curr Hypertens Rep 2021 Jun 10;23(6):33. Epub 2021 Jun 10.

Medicine Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA.

Purpose Of Review: While we started clinical trials evaluating the benefit of lowering systolic BP's >160 mm Hg and diastolic BPs of <130 mm Hg, the latest guideline suggests a target of <130/80 mm Hg in those with hypertension. This article summarizes exactly how we got to where we are looking over the last half-century.

Recent Findings: Our understanding of systolic and diastolic blood pressure targets to improve cardiovascular outcomes has changed substantially over the past 5 decades. Regarding diastolic blood pressure targets to improve cardiovascular outcomes, initially the VA1 in 1967 had set the goal to <115 mmHg. Over time, several studies including the VA2, Hypertension Optimal Treatment (HOT), and United Kingdom Prospective Diabetes Study Group 38 (UKPDS38) highlighted even greater cardiovascular benefit with lower diastolic targets <80 mmHg, especially in diabetic patients. Of equal importance, multiple studies have focused the attention to systolic blood pressure targets. Starting in 1948 with the Framingham study, passing through the Systolic Hypertension in the Elderly Program (SHEP), Syst-Eur and Syst-China trials, all have set the systolic blood pressure goal <150 mmHg. Most recently, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial showed an improved cardiovascular outcome with a systolic blood pressure target <140 mmHg in patients with type 2 diabetes, while the Systolic Blood Pressure Intervention Trial (SPRINT) in non-diabetic patients moved it closer to 120 mmHg. There is "no one size fits all" when it comes to blood pressure targets to improve cardiovascular outcomes. To progress our understanding of individual blood pressure goals, future studies might develop a more standardized approach to highlight characteristics such as design and end point definitions while allowing clinical practitioners greater latitude to adapt guideline recommendations to individual patient characteristics and clinical needs.
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http://dx.doi.org/10.1007/s11906-021-01143-8DOI Listing
June 2021

Uncontrolled Hypertension in an Elderly Man on Multiple Antihypertensive Drugs.

Hypertension 2020 12 26;76(6):1658-1663. Epub 2020 Oct 26.

From the Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (M.R.D., S.J.T., G.L.S.), Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom.

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http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.15310DOI Listing
December 2020

Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association.

Circulation 2020 Jul 22;142(4):e42-e63. Epub 2020 Jun 22.

The diagnosis and management of hypertension, a common cardiovascular risk factor among the general population, have been based primarily on the measurement of blood pressure (BP) in the office. BP may differ considerably when measured in the office and when measured outside of the office setting, and higher out-of-office BP is associated with increased cardiovascular risk independent of office BP. Self-measured BP monitoring, the measurement of BP by an individual outside of the office at home, is a validated approach for out-of-office BP measurement. Several national and international hypertension guidelines endorse self-measured BP monitoring. Indications include the diagnosis of white-coat hypertension and masked hypertension and the identification of white-coat effect and masked uncontrolled hypertension. Other indications include confirming the diagnosis of resistant hypertension and detecting morning hypertension. Validated self-measured BP monitoring devices that use the oscillometric method are preferred, and a standardized BP measurement and monitoring protocol should be followed. Evidence from meta-analyses of randomized trials indicates that self-measured BP monitoring is associated with a reduction in BP and improved BP control, and the benefits of self-measured BP monitoring are greatest when done along with cointerventions. The addition of self-measured BP monitoring to office BP monitoring is cost-effective compared with office BP monitoring alone or usual care among individuals with high office BP. The use of self-measured BP monitoring is commonly reported by both individuals and providers. Therefore, self-measured BP monitoring has high potential for improving the diagnosis and management of hypertension in the United States. Randomized controlled trials examining the impact of self-measured BP monitoring on cardiovascular outcomes are needed. To adequately address barriers to the implementation of self-measured BP monitoring, financial investment is needed in the following areas: improving education and training of individuals and providers, building health information technology capacity, incorporating self-measured BP readings into clinical performance measures, supporting cointerventions, and enhancing reimbursement.
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http://dx.doi.org/10.1161/CIR.0000000000000803DOI Listing
July 2020

From the President, American Society of Hypertension.

J Am Soc Hypertens 2017 11 12;11(11):697. Epub 2017 Oct 12.

Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H Johnson VA Medical Center, Charleston, SC, USA.

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http://dx.doi.org/10.1016/j.jash.2017.10.005DOI Listing
November 2017

Hypertension and Its Complications in a Young Man With Autoimmune Disease.

Hypertension 2017 04 27;69(4):536-544. Epub 2017 Feb 27.

From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh, United Kingdom (E.M.-H., N.D.); Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (A.F.D.); Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.L.R.J.); Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham (S.O.); Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, IL (D.C.B.); Division of Clinical Pharmacology, Department of Medicine (F.E.) and Department of Medicine (C.L.L.), Vanderbilt University School of Medicine, Nashville, TN; Medical University of South Carolina, Charleston (J.N.B.); and Hypertension Unit, Nephrology Department, Hospital Universitari del Mar, Barcelona, Spain (A.O.).

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http://dx.doi.org/10.1161/HYPERTENSIONAHA.117.09036DOI Listing
April 2017

Orthostatic Hypotension in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Blood Pressure Trial: Prevalence, Incidence, and Prognostic Significance.

Hypertension 2016 10 8;68(4):888-95. Epub 2016 Aug 8.

From the National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., J.A.C.); Wake Forest University School of Medicine, Winston-Salem, NC (G.W.E., C.P.); Health Partners Institute for Education and Research, Minneapolis, MN (K.L.M., J.S.-H.); Kaiser Permanente of Georgia, Atlanta (J.B.); Medical University of South Carolina, Charleston (J.N.B.); Columbia University School of Medicine, New York, NY (J.T.B.); Berman Center for Outcomes and Clinical Research, Minneapolis, MN (R.G.); University of Minnesota School of Medicine, Minneapolis (K.P.); University of Michigan School of Medicine, Ann Arbor (R.P.-B.); and Veterans Affairs Medical Center, Memphis, TN (W.C.C.).

Orthostatic hypotension (OH) is associated with hypertension and diabetes mellitus. However, in populations with both hypertension and diabetes mellitus, its prevalence, the effect of intensive versus standard systolic blood pressure (BP) targets on incident OH, and its prognostic significance are unclear. In 4266 participants in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) BP trial, seated BP was measured 3×, followed by readings every minute for 3 minutes after standing. Orthostatic BP change, calculated as the minimum standing minus the mean seated systolic BP and diastolic BP, was assessed at baseline, 12 months, and 48 months. The relationship between OH and clinical outcomes (total and cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, heart failure hospitalization or death and the primary composite outcome of nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) was assessed using proportional hazards analysis. Consensus OH, defined by orthostatic decline in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg, occurred at ≥1 time point in 20% of participants. Neither age nor systolic BP treatment target (intensive, <120 mm Hg versus standard, <140 mm Hg) was related to OH incidence. Over a median follow-up of 46.9 months, OH was associated with increased risk of total death (hazard ratio, 1.61; 95% confidence interval, 1.11-2.36) and heart failure death/hospitalization (hazard ratio, 1.85, 95% confidence interval, 1.17-2.93), but not with the primary outcome or other prespecified outcomes. In patients with type 2 diabetes mellitus and hypertension, OH was common, not associated with intensive versus standard BP treatment goals, and predicted increased mortality and heart failure events.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.116.07474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016241PMC
October 2016

Cardiovascular Outcomes According to Systolic Blood Pressure in Patients With and Without Diabetes: An ACCOMPLISH Substudy.

J Clin Hypertens (Greenwich) 2016 Apr 28;18(4):299-307. Epub 2016 Mar 28.

Novartis Pharmaceuticals, East Hanover, NJ.

To evaluate the effects of achieved systolic blood pressure (SBP) during treatment on cardiovascular (CV) outcomes, the authors measured event rates of a composite primary endpoint (CV death or nonfatal myocardial infarction or stroke) at on-treatment SBPs of ≥140 mm Hg and the 10 mm Hg intervals of <140 mm Hg, <130 mm Hg, and <120 mm Hg in 6459 patients with diabetes (mean age, 67) and 4246 patients without diabetes (mean age, 69) from the Avoiding Cardiovascular Events in Combination Therapy in Patients Living With Systolic Hypertension (ACCOMPLISH) trial. In the diabetic cohort, the primary endpoint was 49% lower (P<.001) at <140 mm Hg than at ≥140 mm Hg, and the separate components of this endpoint were also significantly reduced. Further SBP reductions did not improve outcomes, and at <120 mm Hg they were no longer different (except for stroke) from ≥140 mm Hg. In contrast, in the nondiabetic cohort, the primary endpoint event rate fell steadily (although not significantly) through the decreasing SBP categories until it was reduced by 45% (P=.0413) at <120 mm Hg. Total stroke rates for both the diabetic (-56%, P=.0120) and nondiabetic (-68%, P=.0067) cohorts were lowest at <120 mm Hg, and adverse renal events (serum creatinine increase ≥50%) were significantly lowest in the range of 130 mm Hg to 139 mm Hg for both cohorts. Diabetic patients (<140 mm Hg or <130 mm Hg) and nondiabetic patients (<120 mm Hg) may require different SBP targets for optimal CV protection, although stroke and renal considerations should also influence the selection of blood pressure targets.
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http://dx.doi.org/10.1111/jch.12816DOI Listing
April 2016

A Multifactorial Approach to Reduce Cardiovascular Disease in Type 2 Diabetes Mellitus: Now More Than Ever.

Authors:
Jan N Basile

Hosp Pract (1995) 2016 2;44(1):9-20. Epub 2016 Feb 2.

a Professor of Medicine, Seinsheimer Cardiovascular Health Program , Medical University of South Carolina, Ralph H. Johnson VA Medical Center , Charleston , SC , USA.

Managing cardiovascular (CV) risk is an important part of caring for patients with type 2 diabetes mellitus, as the disease itself confers CV risk. Many CV risk factors (such as hypertension, dyslipidemia, and obesity) have been found to be more common among individuals with diabetes than in the general population. A growing body of evidence provides guidance for clinicians on how to balance control of hyperglycemia with management of these risk factors. Newer classes of antihyperglycemic agents have been associated with beneficial effects on several CV risk factors; several studies evaluating the effect of these newer diabetic medications on CV outcomes have been published, and several more are in progress. While evidence continues to unfold about the benefits of risk factor control in patients with type 1 diabetes mellitus, this article reviews evidence related to risk-factor control in patients with type 2 diabetes mellitus as well as recent findings on the effect of newer drug classes on CV risk factors and outcomes. Favorably altering CV risk factors appears to improve outcomes, and is more important now than ever before.
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http://dx.doi.org/10.1080/21548331.2016.1141656DOI Listing
June 2016

Ambulatory blood pressure monitoring to diagnose hypertension--an idea whose time has come.

J Am Soc Hypertens 2016 Feb 9;10(2):89-91. Epub 2015 Nov 9.

Seinsheimer Cardiovascular Health Program, Ralph H. Johnson VA Medical Center, Division of General Internal Medicine/Geriatrics, Medical University of South Carolina, Charleston, SC, USA.

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http://dx.doi.org/10.1016/j.jash.2015.10.010DOI Listing
February 2016

ASH 2015 Annual Primary Care Program: What you missed by not attending.

Authors:
Jan N Basile

J Am Soc Hypertens 2015 Nov 11;9(11):831-6. Epub 2015 Sep 11.

Seinsheimer Cardiovascular Health Program, Medical University of S. Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC, USA. Electronic address:

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http://dx.doi.org/10.1016/j.jash.2015.08.017DOI Listing
November 2015

Recent clinical trials.

J Am Soc Hypertens 2014 Oct 15;8(10):770-4; quiz 775-6. Epub 2014 Aug 15.

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http://dx.doi.org/10.1016/j.jash.2014.08.006DOI Listing
October 2014

Characteristics and long-term follow-up of participants with peripheral arterial disease during ALLHAT.

J Gen Intern Med 2014 Nov;29(11):1475-83

The University of Texas School of Public Health, 1200 Herman Pressler St., W-906, Houston, TX, 77030, USA,

Background: Hypertension is a major risk factor for peripheral artery disease (PAD). Little is known about relative efficacy of antihypertensive treatments for preventing PAD.

Objectives: To compare, by randomized treatment groups, hospitalized or revascularized PAD rates and subsequent morbidity and mortality among participants in the Antihypertensive and Lipid-Lower Treatment to Prevent Heart Attack Trial (ALLHAT).

Design: Randomized, double-blind, active-control trial in high-risk hypertensive participants.

Participants: Eight hundred thirty participants with specified secondary outcome of lower extremity PAD events during the randomized phase of ALLHAT.

Interventions/events: In-trial PAD events were reported during ALLHAT (1994-2002). Post-trial mortality data through 2006 were obtained from administrative databases. Mean follow-up was 8.8 years.

Main Measures: Baseline characteristics and intermediate outcomes in three treatment groups, using the Kaplan-Meier method to calculate cumulative event rates and post-PAD mortality rates, Cox proportional hazards regression model for hazard ratios and 95 % confidence intervals, and multivariate Cox regression models to examine risk differences among treatment groups.

Key Results: Following adjustment for baseline characteristics, neither participants assigned to the calcium-channel antagonist amlodipine nor to the ACE-inhibitor lisinopril showed a difference in risk of clinically advanced PAD compared with those in the chlorthalidone arm (HR, 0.86; 95 % CI, 0.72-1.03 and HR, 0.98; 95 % CI, 0.83-1.17, respectively). Of the 830 participants with in-trial PAD events, 63 % died compared to 34 % of those without PAD; there were no significant treatment group differences for subsequent nonfatal myocardial infarction, coronary revascularizations, strokes, heart failure, or mortality.

Conclusions: Neither amlodipine nor lisinopril showed superiority over chlorthalidone in reducing clinically advanced PAD risk. These findings reinforce the compelling need for comparative outcome trials examining treatment of PAD in high-risk hypertensive patients. Once PAD develops, cardiovascular event and mortality risk is high, regardless of type of antihypertensive treatment.
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http://dx.doi.org/10.1007/s11606-014-2947-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4238201PMC
November 2014

Renal sympathetic denervation for blood pressure control: a review of the current evidence and ongoing studies.

J Clin Hypertens (Greenwich) 2014 May 21;16(5):331-41. Epub 2014 Mar 21.

Division of Cardiology, Medical University of South Carolina, Charleston, SC; Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC.

Hypertensive heart disease is the leading cause of mortality and morbidity in the United States. Despite widespread availability of medical therapy, it remains a challenge to treat. Autonomic nervous system imbalance resulting in overactivity of the sympathetic nervous system is integral to the development of hypertension and ultimately the development of hypertensive heart disease. Although the results with renal sympathetic denervation so far have been encouraging, optimism has recently been tempered with the broadcast alert from Medtronic, the sponsor of Symplicity HTN-3, that the trial did not meet its primary efficacy endpoint. The principal focus of this article is to review the developments in renal sympathetic denervation for the treatment of resistant hypertension.
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http://dx.doi.org/10.1111/jch.12285DOI Listing
May 2014

Analysis of recent papers in hypertension treatment of hypertension in the setting of acute intracerebral hemorrhage: still no clear answer on the best BP level to intervene or what BP goal to achieve.

J Clin Hypertens (Greenwich) 2014 Jan 11;16(1):1-3. Epub 2013 Dec 11.

Seinsheimer Cardiovascular Health Program, Division of General Internal Medicine/Geriatrics, Medical University of South Carolina, Charleston, SC; Ralph H. Johnson VA Medical Center, Charleston, SC.

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http://dx.doi.org/10.1111/jch.12233DOI Listing
January 2014

Review of recent literature in hypertension: updated clinical practice guidelines for chronic kidney disease now include albuminuria in the classification system.

J Clin Hypertens (Greenwich) 2013 Dec 30;15(12):865-7. Epub 2013 Sep 30.

Department of Internal Medicine, University of Nevada School of Medicine, Reno, NV.

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http://dx.doi.org/10.1111/jch.12209DOI Listing
December 2013

Analysis of recent papers in hypertension. Initial combination therapy provides more prompt blood pressure control and reduces cardiovascular events but remains underutilized.

J Clin Hypertens (Greenwich) 2013 Aug 10;15(8):523-5. Epub 2013 May 10.

Seinsheimer Cardiovascular Health Program, Division of General Internal Medicine/Geriatrics, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC, USA.

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http://dx.doi.org/10.1111/jch.12124DOI Listing
August 2013

Pravastatin and cardiovascular outcomes stratified by baseline eGFR in the lipid- lowering component of ALLHAT.

Clin Nephrol 2013 Oct;80(4):235-48

Background/aims: The role of statins in preventing cardiovascular outcomes in patients with chronic kidney disease (CKD) is unclear. This paper compares cardiovascular outcomes with pravastatin vs. usual care, stratified by baseline estimated glomerular filtration rate (eGFR).

Methods: Post-hoc analyses of a prospective randomized open-label clinical trial; 10,151 participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (lipid-lowering component) were randomized to pravastatin 40 mg/day or usual care. Mean follow-up was 4.8 years.

Results: Through Year 6, total cholesterol declined in pravastatin (-20.7%) and usualcare groups (-11.2%). Use of statin therapy in the pravastatin group was 89.8% (Year 2) and 87.0% (Year 6). Usual-care group statin use increased from 8.2% (Year 2) to 23.5% (Year 6). By primary intention-to-treat analyses, no significant differences were seen between groups for coronary heart disease (CHD), total mortality or combined cardiovascular disease; findings were consistent across eGFR strata. In exploratory "as-treated" analyses (patients actually using pravastatin vs. not using), pravastatin therapy was associated with lower mortality (HR = 0.76 (0.68 - 0.85), p<0.001) and lover CHD (HR=0.84 (0.73-0.97), p=0.01), but not combined cardiovascular disease (HR=0.95 (0.88-1.04), p=0.30). Total cholesterol reduction of 10 mg/dl from baseline to Year 2 was associated with 5% lower CHD risk.

Conclusions: In hypertensive patients with moderate dyslipidemia, pravastatin was not superior to usual care in preventing total mortality or CHD independent of baseline eGFR level. However, exploratory "as-treated" analyses suggest improved mortality and CHD risk in participants using pravastatin, and decreased CHD events associated with achieved reduction in total cholesterol. Potential benefit from statin therapy may depend on degree of reduction achieved in total and LDL-cholesterol and adherence to therapy.
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http://dx.doi.org/10.5414/CN107922DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504135PMC
October 2013

Determining the relative antihypertensive potency and relative cardiovascular risk reduction associated with different thiazide and thiazide-type diuretics.

J Clin Hypertens (Greenwich) 2013 Jun 27;15(6):359-61. Epub 2013 Feb 27.

Seinsheimer Cardiovascular Health Program, Division of General Internal Medicine/Geriatrics, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC, USA.

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http://dx.doi.org/10.1111/jch.12079DOI Listing
June 2013

The potential of sodium glucose cotransporter 2 (SGLT2) inhibitors to reduce cardiovascular risk in patients with type 2 diabetes (T2DM).

Authors:
Jan N Basile

J Diabetes Complications 2013 May-Jun;27(3):280-6. Epub 2013 Feb 1.

Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Charleston, SC 29425, USA.

Type 2 diabetes mellitus (T2DM) significantly increases morbidity and mortality from cardiovascular disease (CVD). Treatments for patients with T2DM have the potential to reduce cardiovascular (CV) risk. This review focuses on the potential of a new class of antidiabetic agents, the sodium glucose cotransporter 2 (SGLT2) inhibitors, to reduce CV risk in patients with T2DM through reductions in hyperglycemia, blood pressure (BP), and body weight. The results of clinical trials of SGLT2 inhibitors are summarized and discussed.
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http://dx.doi.org/10.1016/j.jdiacomp.2012.12.004DOI Listing
November 2013

Analysis of recent papers in hypertension: Treatment of obstructive sleep apnea with continuous positive airway pressure appears to decrease the incidence of incident hypertension.

J Clin Hypertens (Greenwich) 2013 Feb 14;15(2):85-7. Epub 2012 Dec 14.

Seinsheimer Cardiovascular Health Program, Division of General Internal Medicine/Geriatrics, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC, USA.

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http://dx.doi.org/10.1111/jch.12041DOI Listing
February 2013

Analysis of recent papers in hypertension: nighttime administration of at least one antihypertensive medication is associated with better blood pressure control and cardiovascular outcomes in patients with type 2 diabetes or chronic kidney disease.

J Clin Hypertens (Greenwich) 2013 Jan 26;15(1):2-4. Epub 2012 Oct 26.

Seinsheimer Cardiovascular Health Program, Division of General Internal Medicine/Geriatrics, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC;Department of Internal Medicine, University of Nevada School of Medicine, Reno, NV 89502, USA.

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http://dx.doi.org/10.1111/jch.12028DOI Listing
January 2013

Exposure to air pollution increases the incidence of hypertension and diabetes in black women living in Los Angeles.

J Clin Hypertens (Greenwich) 2012 Nov 28;14(11):819-20. Epub 2012 Aug 28.

Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charlston, SC, USA.

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http://dx.doi.org/10.1111/jch.12000DOI Listing
November 2012

NHANES data highlight the clinical characteristics of those with poorly controlled hypertension.

J Clin Hypertens (Greenwich) 2012 Apr 6;14(4):267-8. Epub 2012 Mar 6.

Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC, USA.

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http://dx.doi.org/10.1111/j.1751-7176.2012.00596.xDOI Listing
April 2012

The Rheos Pivotol trial evaluating baroreflex activation therapy fails to meet efficacy and safety end points in resistant hypertension: back to the drawing board.

J Clin Hypertens (Greenwich) 2012 Mar 19;14(3):184-6. Epub 2012 Jan 19.

Department of Internal Medicine, University of Nevada School of Medicine, Saint Mary's Regional Medical Center, 645 North Arlington Street, Reno, NV 89503, USA.

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http://dx.doi.org/10.1111/j.1751-7176.2011.00584.xDOI Listing
March 2012

Mortality and morbidity during and after the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.

J Clin Hypertens (Greenwich) 2012 Jan 9;14(1):20-31. Epub 2011 Dec 9.

Memphis Veterans Affairs Medical Center, Memphis, TN, USA.

A randomized, double-blind, active-controlled, multicenter trial assigned 32,804 participants aged 55 years and older with hypertension and ≥ 1 other coronary heart disease risk factors to receive chlorthalidone (n=15,002), amlodipine (n=8898), or lisinopril (n=8904) for 4 to 8 years, when double-blinded therapy was discontinued. Passive surveillance continued for a total follow-up of 8 to 13 years using national administrative databases to ascertain deaths and hospitalizations. During the post-trial period, fatal outcomes and nonfatal outcomes were available for 98% and 65% of participants, respectively, due to lack of access to administrative databases for the remainder. This paper assesses whether mortality and morbidity differences persisted or new differences developed during the extended follow-up. Primary outcome was cardiovascular mortality and secondary outcomes were mortality, stroke, coronary heart disease, heart failure, cardiovascular disease, and end-stage renal disease. For the post-trial period, data are not available on medications or blood pressure levels. No significant differences (P<.05) appeared in cardiovascular mortality for amlodipine (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.93-1.06) or lisinopril (HR, 0.97; CI, 0.90-1.03), each compared with chlorthalidone. The only significant differences in secondary outcomes were for heart failure, which was higher with amlodipine (HR, 1.12; CI, 1.02-1.22), and stroke mortality, which was higher with lisinopril (HR, 1.20; CI, 1.01-1.41), each compared with chlorthalidone. Similar to the previously reported in-trial result, there was a significant treatment-by-race interaction for cardiovascular disease for lisinopril vs chlorthalidone. Black participants had higher risk than non-black participants taking lisinopril compared with chlorthalidone. After accounting for multiple comparisons, none of these results were significant. These findings suggest that neither calcium channel blockers nor angiotensin-converting enzyme inhibitors are superior to diuretics for the long-term prevention of major cardiovascular complications of hypertension.
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http://dx.doi.org/10.1111/j.1751-7176.2011.00568.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3261592PMC
January 2012

Spironolactone is more effective than eplerenone at lowering blood pressure in patients with primary aldosteronism.

J Clin Hypertens (Greenwich) 2011 Aug 14;13(8):629-31. Epub 2011 Jul 14.

Department of Internal Medicine, University of Nevada School of Medicine, Risk Reduction Center, Saint Mary's Regional Medical Center, Reno, NV 89503, USA.

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http://dx.doi.org/10.1111/j.1751-7176.2011.00495.xDOI Listing
August 2011

Catheter-based renal sympathetic nerve ablation controls blood pressure in more difficult-to-control patients taking multi-agent pharmacologic therapy.

J Clin Hypertens (Greenwich) 2011 Jun 22;13(6):455-7. Epub 2011 Apr 22.

Department of Internal Medicine, University of Nevada School of Medicine, Risk Reduction Center, Saint Mary's Regional Medical Center, Reno, NV, USA.

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http://dx.doi.org/10.1111/j.1751-7176.2011.00470.xDOI Listing
June 2011

Combination therapy in hypertension.

J Clin Hypertens (Greenwich) 2011 Mar 10;13(3):146-54. Epub 2010 Dec 10.

Western Pennsylvania Hospital, Pittsburgh, PA, USA.

The goal of antihypertensive therapy is to abolish the risks associated with blood pressure (BP) elevation without adversely affecting quality of life. Drug selection is based on efficacy in lowering BP and in reducing cardiovascular (CV) end points, including stroke, myocardial infarction, and heart failure. Although the choice of initial drug therapy exerts some effect on long-term outcomes, it is evident that BP reduction per se is the primary determinant of CV risk reduction. Available data suggest that at least 75% of patients will require combination therapy to achieve contemporary BP targets, and increasing emphasis is being placed on the practical tasks involved in consistently achieving and maintaining goal BP in clinical practice. It is within this context that the American Society of Hypertension presents this Position Paper on Combination Therapy for Hypertension. It will address the scientific basis of combination therapy, present the pharmacologic rationale for choosing specific drug combinations, and review patient selection criteria for initial and secondary use. The advantages and disadvantages of single-pill (fixed) drug combinations and the implications of recent clinical trials involving specific combination strategies will also be discussed.
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http://dx.doi.org/10.1111/j.1751-7176.2010.00397.xDOI Listing
March 2011