Strategies for managing perioperative hypertension.

Curr Hypertens Rep. 2009 Jun;11(3):173-7

Authors: Desai RG, Muntazar M, Goldberg ME

Acute perioperative hypertension is associated with a higher risk of perioperative myocardial ischemia, bleeding, stroke, and renal failure. The immediate concern of short-term antihypertensive therapy is to prevent excessive surgical bleeding from arterial anastomoses, myocardial ischemia, and neurologic complications while causing minimal adverse effects until oral therapy can be resumed. This article reviews perioperative hypertension emergencies/urgencies and various approaches for management.

PMID: 19442325 [PubMed - indexed for MEDLINE]

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Management of hypertension in patients with coronary artery disease.

Curr Hypertens Rep. 2008 Oct;10(5):349-54

Authors: Vongpatanasin W

Hypertension is present in three of four patients with coronary artery disease (CAD) but remains largely uncontrolled in most patients. Treating hypertension in these patients is complicated by the concern of precipitating coronary ischemia when diastolic blood pressure (DBP) is reduced excessively. However, an emerging body of evidence from recent clinical trials in high-risk hypertensive patients with or without CAD demonstrated the benefit of intensive drug therapy, even when DBP fell much lower than 80 mm Hg, in terms of reducing cardiovascular events and progression of coronary and carotid atherosclerosis. Accordingly, the American Heart Association has now set the target BP goal to less than 130/80 mm Hg in hypertensive patients with CAD. Given the enormous gap between current BP levels in patients with CAD and the new target BP goals, multiple drug therapy is essential to achieve BP control and improve cardiovascular outcomes.

PMID: 18775110 [PubMed - indexed for MEDLINE]

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Hypertension management in patients with chronic kidney disease.

Curr Hypertens Rep. 2008 Oct;10(5):367-73

Authors: Palmer BF

Hypertension is one of the major risk factors for the development and progression of chronic kidney disease. The loss of renal function leads to impaired renal autoregulation and renders the kidney vulnerable to the damaging effects of uncontrolled hypertension. Mounting evidence indicates that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers slow the progression of chronic kidney disease through effects beyond lowering blood pressure. Studies are needed to determine whether high doses of the single agent or combination therapy is most effective in providing renal protection. Urinary protein excretion is a useful tool for monitoring and titrating therapy to maximize renal protection. Changes in the serum creatinine concentration and hyperkalemia are complications of antihypertensive therapy in patients with chronic kidney disease that can be successfully managed to allow continued use of renin-angiotensin blockade.

PMID: 18775113 [PubMed - indexed for MEDLINE]

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Now that we have a direct renin inhibitor, what should we do with it?

Curr Hypertens Rep. 2008 Jun;10(3):194-200

Authors: Stanton A

Aliskiren is the first renin inhibitor to be licensed for use as an antihypertensive drug in both the United States and Europe. Opinions vary considerably concerning the future of aliskiren and renin inhibition. Some experts argue that renin inhibitors should only be prescribed when less expensive blockers of the renin-angiotensin system (RAS), with established effects on morbidity and mortality, are not tolerated or have failed to reduce blood pressure effectively. Others propose that because renin is a highly specific catalyst for the rate-limiting step of the RAS, renin inhibitors have the potential to supersede angiotensin-converting enzyme inhibitors and angiotensin receptor blockers as the preferred inhibitors of the cascade in patients with particular pathologies and/or genotypes. It has also been suggested that dual blockade of the RAS might be particularly advantageous. This review discusses the currently available evidence, and concludes with speculation concerning the future of direct renin inhibition.

PMID: 18765089 [PubMed - indexed for MEDLINE]

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