Effectiveness of furosemide in uncontrolled hypertension in the elderly: role of renin profiling

Vlase, H; Panagopoulos, Georgia; Michelis, Michael F.

doi:10.1016/s0895-7061(02)03260-0

Cited by 26 publications

(12 citation statements)

References 31 publications

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“…A pathogenic role of fluid retention is suggested by studies demonstrating that successful control of resistant hypertension often requires intensification of diuretic therapy. 12, 14, 28-30 Such a role is further supported by studies linking indices of increased volume expansion to resistant hypertension and reduction in fluid retention to overcoming treatment resistance. For example, Taler et al reported that resistant hypertension was characterized by increased thoracic fluid content as measured by thoracic impedance.…”

Section: Mechanisms: Role Of Excess Fluid Retention Vs Heightened Symentioning

confidence: 92%

Refractory Hypertension

et al. 2016

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Section: Mechanisms: Role Of Excess Fluid Retention Vs Heightened Symentioning

confidence: 92%

Refractory Hypertension

et al. 2016

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“…16 In a separate study it was reported that increased diuresis with the use of furosemide significantly improved blood pressure control in 12 elderly patients with hypertension whose blood pressure was uncontrolled on multidrug regimens. 121 The above studies indicate that patients with resistant hypertension frequently have inappropriate volume expansion contributing to their treatment resistance such that a diuretic is essential to maximize blood pressure control. In most patients, use of a long-acting thiazide diuretic will be most effective.…”

Section: Diuretic Therapymentioning

confidence: 99%

Resistant Hypertension: Diagnosis, Evaluation, and Treatment

Calhoun¹,

Jones²,

et al. 2008

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Abstract-Resistant hypertension is a common clinical problem faced by both primary care clinicians and specialists. While the exact prevalence of resistant hypertension is unknown, clinical trials suggest that it is not rare, involving perhaps 20% to 30% of study participants. As older age and obesity are 2 of the strongest risk factors for uncontrolled hypertension, the incidence of resistant hypertension will likely increase as the population becomes more elderly and heavier. The prognosis of resistant hypertension is unknown, but cardiovascular risk is undoubtedly increased as patients often have a history of long-standing, severe hypertension complicated by multiple other cardiovascular risk factors such as obesity, sleep apnea, diabetes, and chronic kidney disease. The diagnosis of resistant hypertension requires use of good blood pressure technique to confirm persistently elevated blood pressure levels. Pseudoresistance, including lack of blood pressure control secondary to poor medication adherence or white coat hypertension, must be excluded. Resistant hypertension is almost always multifactorial in etiology. Successful treatment requires identification and reversal of lifestyle factors contributing to treatment resistance; diagnosis and appropriate treatment of secondary causes of hypertension; and use of effective multidrug regimens. As a subgroup, patients with resistant hypertension have not been widely studied. Observational assessments have allowed for identification of demographic and lifestyle characteristics associated with resistant hypertension, and the role of secondary causes of hypertension in promoting treatment resistance is well documented; however, identification of broader mechanisms of treatment resistance is lacking. In particular, attempts to elucidate potential genetic causes of resistant hypertension have been limited. Recommendations for the pharmacological treatment of resistant hypertension remain largely empiric due to the lack of systematic assessments of 3 or 4 drug combinations. Studies of resistant hypertension are limited by the high cardiovascular risk of patients within this subgroup, which generally precludes safe withdrawal of medications; the presence of multiple disease processes (eg, sleep apnea, diabetes, chronic kidney disease, atherosclerotic disease) and their associated medical therapies, which confound interpretation of study results; and the difficulty in enrolling large numbers of study participants. Expanding our understanding of the causes of resistant hypertension and thereby potentially allowing for more effective prevention and/or treatment will be essential to improve the long-term clinical management of this disorder.

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“…[5][6][7][8][9][10] The National Ambulatory Medical Care Survey (NAMCS), an annual nationally representative sample of office visits in the US, collects blood pressure measurements, diagnoses and medications. We sought to assess the prevalence of resistant hypertension among office visits to physicians who typically manage hypertension, describe trends in physicians' use of recommended medications 2 years after publication of the AHA guidelines, and determine whether use of recommended medications varied by regional-level, physician-level, or patient-level characteristics.…”

Section: Introductionmentioning

confidence: 99%

Physician Underutilization of Effective Medications for Resistant Hypertension at Office Visits in the United States: NAMCS 2006–2010

et al. 2013

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BACKGROUND:The American Heart Association (AHA) published guidelines for treatment of resistant hypertension in 2008 recommending use of thiazide diuretics (particularly chlorthalidone), aldosterone antagonists, and fixed-dose combination medications, but it is unclear the extent to which these guidelines are being followed. OBJECTIVE: To describe trends in physician use of recommended medications for resistant hypertension and assess variations in medication use based on geography, physician specialty and patient characteristics. DESIGN: Cross-sectional analysis using the National Ambulatory Medical Care Survey from 2006 to 2010. STUDY SAMPLE: We analyzed visits of hypertension patients to family physicians, general internists, and cardiologists. Resistant hypertension was defined as concurrent use of ≥ 4 classes of blood pressure (BP) medications or elevated BP despite the use of ≥ 3 medications. Pregnant patients and visits with diagnosed heart failure or end-stage renal disease were excluded. MAIN OUTC OME: U se of A HA-r ec ommen d ed medications for management of resistant hypertension. RESULTS: Of 19,500 patient visits with hypertension, 1,567 or 7.1 % CI (6.6-7.7 %) met criteria for resistant hypertension. Thiazide diuretic use was reported in 58.9 % of visits pre-guidelines vs. 54.8 % postguidelines (p=0.37). Use of aldosterone antagonists was low and also did not change significantly after guideline publication (3.1 % vs. 4.5 %, p=0.27). Fixeddose combinations use was 42.0 % before and 37 % after guideline publication (p = 0.29). Each 10-year increase in patient age was associated with lower thiazide use (OR 0.87,, as was presence of comorbid ischemic heart disease (OR 0.62, CI 0.41-0.94). Medication use did not vary by geography or physician specialty. CONCLUSION: Use of AHA-recommended medications for resistant hypertension remains low after publication of guidelines. Healthcare systems should encourage more frequent prescribing of these medications to improve care in this high-risk population.

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Effectiveness of furosemide in uncontrolled hypertension in the elderly: role of renin profiling

Cited by 26 publications

References 31 publications

Refractory Hypertension

Refractory Hypertension

Resistant Hypertension: Diagnosis, Evaluation, and Treatment

Physician Underutilization of Effective Medications for Resistant Hypertension at Office Visits in the United States: NAMCS 2006–2010

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