Resistant Hypertension: Where are We Now and Where Do We Go from Here?

Pathan, Mansur K; Cohen, Debbie L.

doi:10.2147/ibpc.s223334

Cited by 10 publications

(2 citation statements)

References 85 publications

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“…1 Among individuals with hypertension, those with resistant hypertension (RH) appear to have the greatest risk of cerebrovascular disease and associated cognitive impairment. 2 Although the deleterious effects of RH on cognitive function are likely multifactorial, emerging evidence suggests that elevated levels adults, with precision medicine frameworks emphasizing the use of elevated inflammatory cytokines to identify vulnerable middle-aged adults for lifestyle changes. 5 Lifestyle modification, including exercise and dietary modification, is an established approach to improve both hypertension and cognitive function.…”

Section: Introductionmentioning

confidence: 99%

“…Hypertension is one of the primary causes of cardiovascular disease, stroke, Alzheimer's Disease, and Alzheimer's Disease and related dementias (AD/ADRD) 1 . Among individuals with hypertension, those with resistant hypertension (RH) appear to have the greatest risk of cerebrovascular disease and associated cognitive impairment 2 . Although the deleterious effects of RH on cognitive function are likely multifactorial, emerging evidence suggests that elevated levels of pro‐inflammatory cytokines may be a critical, central mechanism by which RH worsens cognition 3,4 .…”

Section: Introductionmentioning

confidence: 99%

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Inflammation moderates the effects of lifestyle modification on neurocognition among individuals with resistant hypertension

Avorgbedor

Blumenthal

Hinderliter

et al. 2022

J of Clinical Hypertension

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Individuals with resistant hypertension (RH) have the greatest risk of cerebrovascular disease and cognitive impairment among individuals with hypertension. Elevated levels of pro-inflammatory cytokines may represent a critical yet unexamined factor influencing the impact of healthy lifestyle changes on cognitive function. We explored the influence of inflammation on changes in cognition following lifestyle modification among individuals with RH participating in the TRIUMPH clinical trial. One hundred forty participants with RH completed a battery of neurocognitive tests along with the inflammatory marker C-reactive protein (hsCRP) and were subsequently randomized to an intensive 4-month lifestyle modification intervention or to education and physician advice control. Results indicated that the effects of lifestyle modification on Executive Function and Learning were moderated by pre-intervention hsCRP levels (P = .049), with treatment efficacy increasing across levels of baseline inflammation levels (low: d = 0.12; mild: d = 0.43; moderate: d = 0.81). We conclude that inflammatory profiles may help identify individuals more likely to improve executive functioning resulting from lifestyle modification.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Inflammation moderates the effects of lifestyle modification on neurocognition among individuals with resistant hypertension

Avorgbedor

Blumenthal

Hinderliter

et al. 2022

J of Clinical Hypertension

View full text Add to dashboard Cite

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Resistant Hypertension: Disease Burden and Emerging Treatment Options

Flack,

Buhnerkempe,

Moore

2024

Curr Hypertens Rep

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Purpose of Review To define resistant hypertension (RHT), review its pathophysiology and disease burden, identify barriers to effective hypertension management, and to highlight emerging treatment options. Recent Findings RHT is defined as uncontrolled blood pressure (BP) ≥ 130/80 mm Hg despite concurrent prescription of ≥ 3 or ≥ 4 antihypertensive drugs in different classes or controlled BP despite prescription of ≥ to 4 drugs, at maximally tolerated doses, including a diuretic. BP is regulated by a complex interplay between the renin–angiotensin–aldosterone system, the sympathetic nervous system, the endothelin system, natriuretic peptides, the arterial vasculature, and the immune system; disruption of any of these can increase BP. RHT is disproportionately manifest in African Americans, older patients, and those with diabetes and/or chronic kidney disease (CKD). Amongst drug-treated hypertensives, only one-quarter have been treated intensively enough (prescribed > 2 drugs) to be considered for this diagnosis. New treatment strategies aimed at novel therapeutic targets include inhibition of sodium-glucose cotransporter 2, aminopeptidase A, aldosterone synthesis, phosphodiesterase 5, xanthine oxidase, and dopamine beta-hydroxylase, as well as soluble guanylate cyclase stimulation, nonsteroidal mineralocorticoid receptor antagonism, and dual endothelin receptor antagonism. Summary The burden of RHT remains high. Better use of currently approved therapies and integrating emerging therapies are welcome additions to the therapeutic armamentarium for addressing needs in high-risk aTRH patients.

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Association of endothelial nitric oxide synthase intron 4a/b gene polymorphisms and hypertension: a systematic review and meta-analysis

Chen

et al. 2021

J Int Med Res

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Objective We conducted meta-analysis of relevant case-control trials to determine the association between endothelial nitric oxide synthase (eNOS) intron 4a/b gene polymorphisms and hypertension susceptibility. Methods We searched the PubMed, Cochrane, and Embase databases using relevant keywords and reviewed pertinent literature sources. All articles published up to July 2019 were considered for inclusion. Based on the qualified studies, we performed a meta-analysis of the associations between eNOS intron 4a/b polymorphisms and the risk of hypertension. Results Fourteen studies were included in this meta-analysis, including 3344 cases and 3377 controls. The eNOS intron 4a/b locus was significantly associated with increased susceptibility to hypertension (including essential hypertension) in the overall population, according to dominant, allelic, homozygote, heterozygote, and regressive models, in the mixed population according to the regressive model, and in Caucasians according to the dominant, allelic, heterozygote, and regressive models. The eNOS intron 4a/b locus was also significantly associated with increased susceptibility to essential hypertension in the mixed population according to the heterozygote model. Conclusion eNOS intron 4a/b gene polymorphisms increase susceptibility to hypertension, including essential hypertension.

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Resistant Hypertension: Where are We Now and Where Do We Go from Here?

Cited by 10 publications

References 85 publications

Inflammation moderates the effects of lifestyle modification on neurocognition among individuals with resistant hypertension

Inflammation moderates the effects of lifestyle modification on neurocognition among individuals with resistant hypertension

Resistant Hypertension: Disease Burden and Emerging Treatment Options

Association of endothelial nitric oxide synthase intron 4a/b gene polymorphisms and hypertension: a systematic review and meta-analysis

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