Thomas Giles

..Although the addition of aliskiren to valsartan did not significantly alter dipper status, our data suggest an increased contribution of the renin-angiotensin-aldosterone system to the nondipper status of hypertensive patients...

..Possible pharmacological interventions to restore normal function are suggested...

..A significant proportion of patients with type 2 diabetes mellitus and BP mildly above target range might be successfully treated for both processes with a single drug...

..This paper discusses the logic underlying the refinements in the definition of hypertension...

..2% vs 12.8%), and weight gain (2.56+/-4.62 kg vs 0.86+/-3.85 kg) were observed than with glyburide...

..g., elderly patients, African American patients), a vasodilating beta-blocker may be a particularly appropriate choice for these patient groups...

..Effective interventions targeting Mexican Americans and blacks as well as whites are essential to improving hypertension management...

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..Other cardiovascular therapies that may improve NO bioactivity include statins, l-arginine, and nonpharmacologic approaches such as exercise and dietary changes...

..This definition of hypertension will permit physicians to treat patients with the goal of reducing global risk for myocardial infarction, stroke, and chronic kidney disease...

..001). Olmesartan did not reduce mean SeDBP significantly compared with valsartan, although more patients attained blood pressure goal with olmesartan (P=.031). At week 12, all agents lowered blood pressure equivalently...

..Home BP was measured on the morning of clinic visits to minimize differences that timing might have on home versus office BP measures...

..This revision of the definition of hypertension and the need to assess BP levels in the context of global cardiovascular risk should lead to earlier detection of at-risk patients...

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..Taken together, understanding racial (black-white) contrasts to stress contribute to both prevention and treatment of hypertension, especially for black males...

..A large ongoing study is investigating whether therapy with an oral antidiabetic drug or an angiotensin II receptor blocker reduces the incidence of new-onset diabetes and cardiovascular events in high-risk patients...

..In this analysis, we evaluated the efficacy of the angiotensin II receptor blocker olmesartan medoxomil in reducing systolic blood pressure (SBP) and pulse pressure (PP) in hypertensive patients...

..Thus the risk-benefit ratio of using TZDs in patients who have diabetes and heart failure must be carefully considered in this patient population with comorbid disorders...

..Ultimately, the treatment decisions should be tailored to each patient, integrating as much information as possible concerning the patient's history, risk, pathophysiology, and lifestyle...

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..We believe it would be preferable to classify all individuals as either normal or hypertensive, based on their cardiovascular evaluation, using the four categories of normal and stages 1, 2, and 3 hypertension...

..The technique has demonstrated, for example, a significantly greater reduction in blood pressure for the last 6 h of the 24-h dosing interval with telmisartan compared with valsartan...

..We compared the effects of pioglitazone and glyburide on cardiac function in patients with type 2 diabetes, systolic dysfunction, and New York Heart Association (NYHA) functional Class II/III HF...

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..Last, an updated algorithm is provided that incorporates many of the new findings and is suggested as a starting point to achieve blood pressure goals...

..In this article, Drs Giles and Sander review the current definitions of hypertension in clinical practice and its evaluation in light of total cardiovascular risk...

..Recognition and identification of multiple risk factors and appropriate treatment in a manner that minimizes excessive oxidative stress is critical to the maintenance of normal endothelial cell function and cardiovascular risk reduction...

..This article examines the results of clinical trials of ACE inhibitors and ARBs and assesses the potential for improving outcomes through a more global inhibition of the RAS with renin inhibitors...

..Other agents such as angiotensin II-receptor blockers and mineralocorticoid (aldosterone) receptor antagonists may also be important...

..Glucose-lowering agents may be indicated, and drugs such as metformin and thiazolidinediones, which reduce insulin resistance, should form the basis of therapy. Carefully chosen therapy will effectively improve cardiovascular outcomes...

..These observations strongly support a role for the use of beta-blockers in patients with both heart failure and diabetes...

..The current challenge is designing and implementing effective clinical and public health interventions that lead to sustained dietary changes among individuals and more broadly in the general population...

..Such action will result in great benefit for patients by reducing morbidity and mortality and improving quality of life and will reduce the financial burden that is associated with this epidemic disease...

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..Clinical evidence reveals the association between beta-blockade and improved survival, and trials explore the role for beta-blockers in the prevention of sudden cardiac death...

..We studied the effect of low-dose ethanol consumption on cardiac function, geometry, and PKC isoforms in the rat with STZ-induced diabetes...

..In this clinical review, hypertension experts utilize a case study to provide a paradigm for treating older patients with stage 2 hypertension...

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..Townsend, MD, of the Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA; and Marvin Moser, MD, of the Department of Medicine/Cardiology, Yale University School of Medicine, New Haven, CT...

..001 for each) with the increases in the GWBI scores. Controlling blood pressure appears to be an important element in improving subjective health perceptions of hypertensive patients...

..We conclude that an angiotensin receptor blocker as part of a BP-lowering strategy is effective in previously untreated African-American patients, although a higher proportion will require the use of a diuretic compared with Caucasians...

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..A treatment algorithm based on the angiotensin receptor blocker, telmisartan, was confirmed by the blinded end point of ABPM as an efficacious alternative to other antihypertensive regimens in clinical practice...

..The authors maintained full control of the discussion and the resulting content of this article...

..Discussants included Suzanne Oparil, MD, University of Alabama at Birmingham, Birmingham, AL, and Thomas G. Pickering, MD, DPhil, Columbia Presbyterian Medical Center, New York, NY...

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..As a whole, overweight/obesity predispose or is associated with numerous cardiac complications such as coronary heart disease, heart failure, and sudden death through its impact on the cardiovascular system...

..Intervention response is variable, but the ongoing Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial, comparing medical therapy with and without stenting, should provide management guidance...

..Dr. Henry R. Black of Rush University Medical Center, Chicago, IL; and Dr. Vito M. Campese of the University of Southern California, Los Angeles, CA...

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..The exacerbation or prevention of EIH will be related to drug effects on the cell-signaling pathway. This research can define the cell-signaling pathway in EIH and provide new and novel approaches to treating EIH. ..