Hypertension

In a separate analysis of patients enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, thin patients and those with moderate-to-severe obesity were at increased risk for cardiovascular events. These results indicate that patients at the low anda high ends of the body size spectrum should be treated aggressively to lower the risk of cardiovascular events.

The observed relationship linking obesity, severity of hypertension, and increase in cardiovascular risk was traditionally thought to emanate from the increase in circulatory volume, persistently increased systemic resistance from obesity, and clustering of major cardiovascular risk factors (eg, hypercholesterolemia and diabetes mellitus) among obese patients.

More important than the choice of pharmaceutical agent in the treatment of elderly hypertensive patients is the achievement of goal blood pressure. Low-dose diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers are equally effective in reducing cardiovascular end points. Most patients will require 2 or more drugs to achieve target blood pressure, and physicians should feel comfortable prescribing 3 to 4 agents to a significant proportion of patients.

In their review, Gradman and Morsy emphasize the need to treat isolated systolic hypertension (ISH) and systolic/diastolic hypertension in elderly patients.

We assessed whether there is a paradoxical increase in cardiovascular events with lower blood pressure values among patients with hypertension and coronary artery disease (CAD) who were enrolled in the International Verapamil-Trandolapril Study (INVEST). The relationship between systolic and diastolic pressure and the risk of primary outcome followed a J-curve pattern, with the relationship being relatively weak for systolic pressure but more significant for diastolic pressure. Our data indicate that excessive lowering of diastolic pressure in hypertensive patients with CAD should be avoided.

The manuscript by Messerli and colleagues, entitled "Dangers of aggressively lowering blood pressure in coronary artery disease," raises a controversial issue with important clinical implications—the J-shaped curve.

We assessed whether C-reactive protein (CRP) concentrations predicted future risk of hypertension in a cohort of young adults. Results showed that CRP levels do not independently predict risk of incident hypertension after accounting for body mass index. Further research is needed in the area of inflammation and hypertension, with a special focus on the effect of obesity and age-related changes on this process.

Is hypertension an inflammatory disease?

This study evaluated whether exogenous insulin use to control blood glucose in patients with type 2 diabetes was associated with the development of hypertension by analyzing data obtained from a large national sample in Taiwan. Exogenous insulin use was shown to be a significant risk factor for hypertension development.

Insulin resistance has been linked to an increased risk of hypertension, type 2 diabetes mellitus, and cardiovascular disease.

Diabetic cardiomyopathy is a clinical condition characterized by altered myocardial function in the absence of coronary artery disease, hypertension, and valvular or congenital heart disease. Patients with this condition exhibit changes in cardiac structure that may be attributed to the direct effect of diabetes mellitus. The author discusses the mechanisms, risk factors, screening, diagnosis, prevention, and treatment of cardiomyopathy in patients with diabetes.

Over a period of 14 years, we followed 282 patients aged 70 years or older who were hospitalized with heart failure. Median survival was 2.5 years, but 25% of patients died within 1 year, and 25% survived for at least 5 years following hospital discharge. A simple 7-item risk score based on data readily available at the time of hospitalization effectively stratified patients into low-, intermediate-, and high-risk categories for subsequent mortality.

We assessed the association between the incidence of coronary heart disease and alcohol consumption among hypertensive men enrolled in the Health "Professionals" Follow-Up Study. Moderate alcohol consumption (1 to 2 drinks per day) was associated with a lower risk of myocardial infarction, as in the general population, but was not associated with the risks of stroke, total mortality, or mortality from cardiovascular causes. These results show that men with hypertension who drink moderately may not need to change their drinking habits.

Stroke is an especially important disease to study in terms of secular trends because it is so common, deadly, and disabling.

We evaluated the prevalence of primary aldosteronism in subjects newly diagnosed with hypertension who were referred to specialized hypertension centers. An aldosterone-producing adenoma was diagnosed in the subjects with lateralized aldosterone secretion, adenoma at surgery and on pathologic evaluation, and a blood pressure fall after adrenalectomy. Evidence of excess autonomous aldosterone secretion without such criteria led to a diagnosis of idiopathic hyperaldosteronism. Aldosterone-producing adenoma and idiopathic hyperaldosteronism were conclusively diagnosed in 4.8% and 6.4% of the subjects, respectively. Thus, with a prevalence of 11.2%, primary aldosteronism is quite common in patients with newly diagnosed hypertension.

To determine whether alcohol-associated hypertension carries risks similar to those of hypertension in abstainers or light drinkers, we prospectively studied cardiovascular sequelae separately in heavy drinkers, light drinkers, and abstainers. The risk of all outcomes was progressively higher for increasing blood pressure categories, with similar associations in each alcohol category. These data indicate that the risks of hypertension are independent of the amount of alcohol intake.

Klatsky reports a link between elevated blood pressures and increased risk of hospitalizations for coronary heart disease and stroke that is independent of alcohol intake.

Atrial fibrillation (AF) is the most common arrhythmia, accounting for approximately one third of all patient discharges with arrhythmia as the principal diagnosis and the greatest number of hospitalization days for arrhythmia each year.

We evaluated the association between medication nonadherence and outcomes among subjects with diabetes mellitus. Nonadherent subjects had higher blood pressure, glycosylated hemoglobin, and low-density lipoprotein cholesterol levels. In addition, there was an association between medication nonadherence and an increased risk of all-cause hospitalization and all-cause mortality. These findings suggest that interventions are needed to increase medication adherence so that patients can realize the full benefit of prescribed therapies.

To evaluate the interactions between the weight loss drug, sibutramine, and different antihypertensive treatments, we randomly assigned 171 subjects taking 3 antihypertensive treatment regimens to receive sibutramine or placebo. Our study showed for the first time that combination therapy with an angiotensin-converting enzyme inhibitor and a calcium channel blocker is more advantageous than a ß blocker/diuretic-based-regimen with regard to supporting the weight-reducing actions and metabolic changes induced by sibutramine.

Obesity is a growing epidemic in the United States and around the world.

We conducted a substudy of the Rate Control Versus Electrical Cardioversion (RACE) study to evaluate cardiovascular morbidity, mortality, and the outcome of rate and rhythm control treatment in subjects with and without hypertension with persistent atrial fibrillation.