The American Journal of the Medical Sciences, Jun 1, 2005
An aggressive global approach to screening and to the management of the metabolic syndrome is rec... more An aggressive global approach to screening and to the management of the metabolic syndrome is recommended to slow the growth of the syndrome throughout the United States. Prevention should begin in childhood with healthy nutrition, daily physical activity, and annual measurement of weight, height, and blood pressure beginning at 3 years of age. Such screenings will identify cardiovascular risk factors early, allow the health care provider to define global cardiovascular risk with the COSEHC Cardiovascular Risk Assessment Tool, and allow treatment of each risk factor. Lifelong lifestyle modifications and pharmacologic therapy will be required in most patients. Antihypertensive therapy for these patients should begin with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker unless a compelling indication for another drug is present. Metformin should be considered the first drug for glucose control in the patient with type 2 diabetes. A statin should be used initially for hyperlipidemia unless contraindicated. Combinations of antihypertensive, antiglycemic, and lipid-lowering agents will often be required.
Hypertension is a forum for the presentation of scientific investigation of the highest quality i... more Hypertension is a forum for the presentation of scientific investigation of the highest quality in the broad field of cardiovascular regulation as it may affect high blood pressure research. The editors are interested in receiving original articles that deal with either basic or clinical research in the fields of biochemistry, cellular and molecular biology, immunology, physiology, pharmacology, and epidemiology. In
The American Journal of the Medical Sciences, Jun 1, 2005
An aggressive global approach to screening and to the management of the metabolic syndrome is rec... more An aggressive global approach to screening and to the management of the metabolic syndrome is recommended to slow the growth of the syndrome throughout the United States. Prevention should begin in childhood with healthy nutrition, daily physical activity, and annual measurement of weight, height, and blood pressure beginning at 3 years of age. Such screenings will identify cardiovascular risk factors early, allow the health care provider to define global cardiovascular risk with the COSEHC Cardiovascular Risk Assessment Tool, and allow treatment of each risk factor. Lifelong lifestyle modifications and pharmacologic therapy will be required in most patients. Antihypertensive therapy for these patients should begin with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker unless a compelling indication for another drug is present. Metformin should be considered the first drug for glucose control in the patient with type 2 diabetes. A statin should be used initially for hyperlipidemia unless contraindicated. Combinations of antihypertensive, antiglycemic, and lipid-lowering agents will often be required.
Introduction: Cardiac surgery causes direct trauma to cardiac tissue and disrupts the normal peri... more Introduction: Cardiac surgery causes direct trauma to cardiac tissue and disrupts the normal pericardial fluid (PCF), leaving the heart exposed to PCF and mediastinal contents comprised of inflammatory cells and their products. This can potentially have adverse effects on the myocardium, in particular the thin-walled atria, leading to initiation of postoperative atrial fibrillation (AF). After cardiac surgery, the pericardium remains open, and chest drains are routinely placed to prevent fluid accumulation around the heart. However, few studies have examined inflammation in post-operative PCF composition over an extended period of time. Purpose: The purpose of this study is to describe the trajectory and concentration of pro-inflammatory factors in PCF after cardiac surgery over time and compare levels of inflammatory molecules in post-surgical PCF to those in the blood. Methods: PCF was collected immediately after the pericardial sac was incised with the heart beating (time 0), and from the mediastinal d...
Angiotensin converting enzyme (ACE) inhibitors have been avoided as an initial therapeutic option... more Angiotensin converting enzyme (ACE) inhibitors have been avoided as an initial therapeutic option in the treatment of hypertension in African-Americans. A major reason for this has been the widespread perception of clinicians that these agents have poor blood pressure (BP) lowering efficacy in this population. Remarkably uniform and pervasive interpretations of clinical trial data have formed the basis of this clinical perception and can be summarised as follows: (1) there has been a lesser BP lowering effect of ACE inhibitors in African-Americans compared to whites, particularly at low doses; and (2) short-acting ACE inhibitors like captopril prescribed at the midpoint of its maximal total daily dose lower BP less effectively than higher doses of calcium antagonists in African-Americans. A reinterpretation of published data from these same clinical trials suggests that: (1) the majority of African-Americans have meaningful BP responses to ACE inhibitors, albeit at a higher average dose than in whites; and (2) high levels of dietary sodium intake appear to explain a significant portion of the racial differences in BP response at the lower doses of ACE inhibitors. Thus, ACE inhibitors can effectively lower BP in African-Americans. These data suggest that the clinician should not avoid these agents in African-Americans because of a presumed lack of BP lowering efficacy. Rather, we should recognise the importance of adequate drug dosing and modest reductions in dietary sodium intake in augmenting the BP lowering effect of ACE inhibitors in hypertensive African-Americans.
Sexual dysfunction associated with hypertension or antihypertensive therapies may impact the abil... more Sexual dysfunction associated with hypertension or antihypertensive therapies may impact the ability of patients to stay on therapy and lead to deterioration in patients' quality of life. Therefore, it is important for practitioners to become familiar with the wide variation in sexual side effects produced by antihypertensive agents and to discuss the potential occurrence of these side effects with their patients. In many cases, a change in the patient's drug regimen may help patients overcome specific sexual side effects experienced with certain treatments. Practitioners should consider selecting an antihypertensive therapy that is highly effective in lowering blood pressure but preserves patients' quality of life. The effect of medications on sexual function remains controversial. Some blinded trials report little difference between placebo and specific medications, whereas other studies indicate that antihypertensive medications increase sexual dysfunction, which has an impact on quality of life. Recent evidence suggests that losartan, an angiotensin II antagonist, is not typically associated with development of sexual dysfunction and may actually positively impact several indices of sexual function (erectile function, sexual satisfaction, and frequency of sexual activity) as well as perceived quality of life. Thus, angiotensin II antagonists may offer a therapeutic option to prevent or correct erectile dysfunction in patients with hypertension. The favorable effects of these agents on sexual function may be related, in part, to their ability to block angiotensin II, which has recently become recognized as an important mediator of detumescence and possibly erectile dysfunction.
Introduction The increased prevalence of heart failure with preserved ejection fraction (HFpEF) i... more Introduction The increased prevalence of heart failure with preserved ejection fraction (HFpEF) in women after menopause is linked to estrogen deficiency-induced increases in systolic hypertension and chamber stiffness, with corresponding reductions in myocardial relaxation. New evidence reveals that the anti-remodeling and lusitropic benefits of estrogen in preventing diastolic dysfunction, the precursor of HFpEF, may be due, in part, to a GPER-mediated suppression of cardiac ACE activity. The aim of this study was to investigate the effects of monotherapy with the GPER specific agonist G1 against ACE inhibition on preserving diastolic function after estrogen loss and compare it to combination therapy, G1 plus lisinopril, in a hypertensive rodent model. Methods Twenty SHR females underwent bilateral ovariectomy (OVX) while 5 SHRs received sham surgery at 11–12 weeks of age; 8 weeks post-surgery, rats were randomized (n=5/group) to receive either a subcutaneous blank (vehicle) or G-1 pellet (100 mg/kg) pl...
The American Journal of the Medical Sciences, Jun 1, 2005
An aggressive global approach to screening and to the management of the metabolic syndrome is rec... more An aggressive global approach to screening and to the management of the metabolic syndrome is recommended to slow the growth of the syndrome throughout the United States. Prevention should begin in childhood with healthy nutrition, daily physical activity, and annual measurement of weight, height, and blood pressure beginning at 3 years of age. Such screenings will identify cardiovascular risk factors early, allow the health care provider to define global cardiovascular risk with the COSEHC Cardiovascular Risk Assessment Tool, and allow treatment of each risk factor. Lifelong lifestyle modifications and pharmacologic therapy will be required in most patients. Antihypertensive therapy for these patients should begin with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker unless a compelling indication for another drug is present. Metformin should be considered the first drug for glucose control in the patient with type 2 diabetes. A statin should be used initially for hyperlipidemia unless contraindicated. Combinations of antihypertensive, antiglycemic, and lipid-lowering agents will often be required.
Hypertension is a forum for the presentation of scientific investigation of the highest quality i... more Hypertension is a forum for the presentation of scientific investigation of the highest quality in the broad field of cardiovascular regulation as it may affect high blood pressure research. The editors are interested in receiving original articles that deal with either basic or clinical research in the fields of biochemistry, cellular and molecular biology, immunology, physiology, pharmacology, and epidemiology. In
The American Journal of the Medical Sciences, Jun 1, 2005
An aggressive global approach to screening and to the management of the metabolic syndrome is rec... more An aggressive global approach to screening and to the management of the metabolic syndrome is recommended to slow the growth of the syndrome throughout the United States. Prevention should begin in childhood with healthy nutrition, daily physical activity, and annual measurement of weight, height, and blood pressure beginning at 3 years of age. Such screenings will identify cardiovascular risk factors early, allow the health care provider to define global cardiovascular risk with the COSEHC Cardiovascular Risk Assessment Tool, and allow treatment of each risk factor. Lifelong lifestyle modifications and pharmacologic therapy will be required in most patients. Antihypertensive therapy for these patients should begin with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker unless a compelling indication for another drug is present. Metformin should be considered the first drug for glucose control in the patient with type 2 diabetes. A statin should be used initially for hyperlipidemia unless contraindicated. Combinations of antihypertensive, antiglycemic, and lipid-lowering agents will often be required.
Introduction: Cardiac surgery causes direct trauma to cardiac tissue and disrupts the normal peri... more Introduction: Cardiac surgery causes direct trauma to cardiac tissue and disrupts the normal pericardial fluid (PCF), leaving the heart exposed to PCF and mediastinal contents comprised of inflammatory cells and their products. This can potentially have adverse effects on the myocardium, in particular the thin-walled atria, leading to initiation of postoperative atrial fibrillation (AF). After cardiac surgery, the pericardium remains open, and chest drains are routinely placed to prevent fluid accumulation around the heart. However, few studies have examined inflammation in post-operative PCF composition over an extended period of time. Purpose: The purpose of this study is to describe the trajectory and concentration of pro-inflammatory factors in PCF after cardiac surgery over time and compare levels of inflammatory molecules in post-surgical PCF to those in the blood. Methods: PCF was collected immediately after the pericardial sac was incised with the heart beating (time 0), and from the mediastinal d...
Angiotensin converting enzyme (ACE) inhibitors have been avoided as an initial therapeutic option... more Angiotensin converting enzyme (ACE) inhibitors have been avoided as an initial therapeutic option in the treatment of hypertension in African-Americans. A major reason for this has been the widespread perception of clinicians that these agents have poor blood pressure (BP) lowering efficacy in this population. Remarkably uniform and pervasive interpretations of clinical trial data have formed the basis of this clinical perception and can be summarised as follows: (1) there has been a lesser BP lowering effect of ACE inhibitors in African-Americans compared to whites, particularly at low doses; and (2) short-acting ACE inhibitors like captopril prescribed at the midpoint of its maximal total daily dose lower BP less effectively than higher doses of calcium antagonists in African-Americans. A reinterpretation of published data from these same clinical trials suggests that: (1) the majority of African-Americans have meaningful BP responses to ACE inhibitors, albeit at a higher average dose than in whites; and (2) high levels of dietary sodium intake appear to explain a significant portion of the racial differences in BP response at the lower doses of ACE inhibitors. Thus, ACE inhibitors can effectively lower BP in African-Americans. These data suggest that the clinician should not avoid these agents in African-Americans because of a presumed lack of BP lowering efficacy. Rather, we should recognise the importance of adequate drug dosing and modest reductions in dietary sodium intake in augmenting the BP lowering effect of ACE inhibitors in hypertensive African-Americans.
Sexual dysfunction associated with hypertension or antihypertensive therapies may impact the abil... more Sexual dysfunction associated with hypertension or antihypertensive therapies may impact the ability of patients to stay on therapy and lead to deterioration in patients' quality of life. Therefore, it is important for practitioners to become familiar with the wide variation in sexual side effects produced by antihypertensive agents and to discuss the potential occurrence of these side effects with their patients. In many cases, a change in the patient's drug regimen may help patients overcome specific sexual side effects experienced with certain treatments. Practitioners should consider selecting an antihypertensive therapy that is highly effective in lowering blood pressure but preserves patients' quality of life. The effect of medications on sexual function remains controversial. Some blinded trials report little difference between placebo and specific medications, whereas other studies indicate that antihypertensive medications increase sexual dysfunction, which has an impact on quality of life. Recent evidence suggests that losartan, an angiotensin II antagonist, is not typically associated with development of sexual dysfunction and may actually positively impact several indices of sexual function (erectile function, sexual satisfaction, and frequency of sexual activity) as well as perceived quality of life. Thus, angiotensin II antagonists may offer a therapeutic option to prevent or correct erectile dysfunction in patients with hypertension. The favorable effects of these agents on sexual function may be related, in part, to their ability to block angiotensin II, which has recently become recognized as an important mediator of detumescence and possibly erectile dysfunction.
Introduction The increased prevalence of heart failure with preserved ejection fraction (HFpEF) i... more Introduction The increased prevalence of heart failure with preserved ejection fraction (HFpEF) in women after menopause is linked to estrogen deficiency-induced increases in systolic hypertension and chamber stiffness, with corresponding reductions in myocardial relaxation. New evidence reveals that the anti-remodeling and lusitropic benefits of estrogen in preventing diastolic dysfunction, the precursor of HFpEF, may be due, in part, to a GPER-mediated suppression of cardiac ACE activity. The aim of this study was to investigate the effects of monotherapy with the GPER specific agonist G1 against ACE inhibition on preserving diastolic function after estrogen loss and compare it to combination therapy, G1 plus lisinopril, in a hypertensive rodent model. Methods Twenty SHR females underwent bilateral ovariectomy (OVX) while 5 SHRs received sham surgery at 11–12 weeks of age; 8 weeks post-surgery, rats were randomized (n=5/group) to receive either a subcutaneous blank (vehicle) or G-1 pellet (100 mg/kg) pl...
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