Cystone® for 1 year did not change urine chemistry or decrease stone burden in cystine stone formers.

Cystine kidney stones frequently recur because inadequate prevention exists. We recruited documented recurrent cystine kidney stone formers (6 men, 4 women, 44 ± 17 years) into a 2-phased study to assess safety and effectiveness of Cystone®, a herbal treatment used to prevent and facilitate passage of cystine kidney stones. The first phase was a randomized double-blinded 12 weeks crossover study assessing the effect of Cystone® versus placebo (2 tablets BID) on urinary chemistries.

Predictors of blood pressure response to the angiotensin receptor blocker candesartan in essential hypertension.

Background: Response to antihypertensive drugs varies widely among individuals.

Methods: We studied characteristics that might be predictive of blood pressure (BP) response in 203 African-American and 236 non-Hispanic white subjects with essential hypertension treated with candesartan, 32 mg/day for 6 weeks, after a drug-free washout period of at least 4 weeks (baseline). Measurements at enrollment, baseline, and at the end of the treatment were incorporated into linear regression models to quantify their additive contributions to predicting response.

Association of ambulatory blood pressure with ischemic brain injury.

Cerebral white matter hyperintensities on brain MRI (leukoaraiosis) are associated with increased risk of stroke and dementia. To assess the relationships of blood pressure level and circadian pattern with leukoaraiosis, we obtained 24-hour ambulatory blood pressure recordings and brain magnetic resonance images in 343 white and 267 black adults who were members of sibships that had >or=2 siblings with essential hypertension. In multiple linear regression models, factors associated with greater leukoaraiosis in both racial groups included age (P View Article and Find Full Text PDF

Improved blood pressure control with a physician-nurse team and home blood pressure measurement.

Objective: To assess whether a physician-nurse team model could improve long-term hypertension control rates by active intervention and modification of antihypertensive drug regimens based on home blood pressure (BP) measurements.

Patients And Methods: This study consisted of patients referred to a hypertension specialty clinic between July 1999 and June 2002 for the evaluation and management of uncontrolled hypertension. Patients were evaluated initially by a physician.

Physician-nurse team approaches to improve blood pressure control.

Hypertension is an asymptomatic chronic disease that contributes to the development of serious health problems including coronary artery disease, chronic renal failure, and stroke. Despite published guidelines addressing goals for the treatment of hypertension, control rates (defined as a blood pressure <140/90 mm Hg) have not increased in recent years, and uncontrolled hypertension remains a serious public health issue. Both patient- and provider-related factors contribute to these poor control rates, and new approaches to the management of hypertension must be sought.

Rapid adjustment of antihypertensive drugs produces a durable improvement in blood pressure.

Antihypertensive drugs are often initiated and adjusted over a period of weeks to months. It is not clear whether the time and inconvenience of this approach is necessary. We studied whether or not drug adjustment over several days in the context of a physician-nurse team could produce a durable blood pressure benefit according to home blood pressure measurements.

Are aneroid sphygmomanometers accurate in hospital and clinic settings?

Background: The aneroid sphygmomanometer is commonly used for the indirect measurement of blood pressure despite significant concerns about its accuracy. Although the mercury sphygmomanometer is highly accurate, there are concerns about the environmental toxicity of mercury. In response to various external pressures to become essentially mercury free, the Mayo Clinic, Rochester, Minn, has replaced many mercury sphygmomanometers with aneroid devices.

Importance of blood pressure reduction for prevention of progression of renal disease.

Despite reduction of stroke and coronary mortality rates, progression of renal disease to end stage continues to occur with increasing frequency. Recent studies emphasize common pathways of elevated arterial pressures that produce increased glomerular capillary pressures and increase filtered proteins in the urinary space. Such proteinuria, along with activation of the intrarenal renin-angiotensin system, endothelin, and inflammatory cytokines, magnifies progressive renal injury and fibrosis.

Posttransplantation hypertension related to calcineurin inhibitors.

Calcineurin inhibitors are a mainstay of transplant immunosuppression and commonly induce hypertension. They are highly lipid soluble and penetrate vascular smooth muscle cell membranes readily. Changes in vascular tone are universally observed during administration of these agents, particularly within the kidney, leading to diminished glomerular filtration and enhanced sodium retention.

Hypertension after liver transplantation: a predictive role for pretreatment hemodynamics and effects of isradipine on the systemic and renal circulations.

Hypertension developing after liver transplantation during immunosuppression with cyclosporine A reflects an unusual hemodynamic transition from peripheral vasodilation to systemic and renal vasoconstriction. Although dihydropyridine calcium channel blockers are often administered for their efficacy in promoting vasodilation, some liver transplant recipients report marked symptomatic intolerance to these agents. In the present study we examined systemic and renal responses to isradipine using systemic (thoracic bioimpedance) and renal hemodynamic measurements in 15 liver transplant recipients studied at the time of initial diagnosis of posttransplant hypertension and after 3 months of treatment.

Left ventricular diastolic dysfunction in patients with hypertension and preserved systolic function.

Objective: To assess prospectively diastolic function in hypertensive patients with preserved left ventricular function, particularly focusing on the limitation of the transmitral flow velocity curve alone to detect diastolic dysfunction.

Patients And Methods: Comprehensive Doppler analysis was performed in 51 hypertensive patients with preserved left ventricular systolic function.

Results: The ratio of the peak early diastolic filling wave velocity to the peak velocity of filling wave at atrial contraction was less than the age-adjusted mean value minus 2 SD in 16 patients, and the other 35 patients had a "normal" transmitral Doppler signal.

The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: What's New? What's Different?

Hypertension remains a major cause of cardiovascular morbidity and mortality in the United States. Disturbing trends have been reported recently and include declining rates of successful blood pressure control and increasing rates of stroke, congestive heart failure, and hypertension-associated end-stage renal disease. Recent clinical trials have demonstrated the potential benefits of more aggressive blood pressure control using specific antihypertensive agents in patients with both diabetic and nondiabetic renal disease.

Cyclosporin-induced hypertension: incidence, pathogenesis and management.

Blood pressure increases soon after administration of immunosuppressive regimens using cyclosporin. Characteristic vascular changes lead to systemic and renal vasoconstriction. Changes in blood pressure are commonly associated with disturbed circadian regulation and may promote the rapid development of target organ injury, including intracranial haemorrhage, left ventricular hypertrophy and microangiopathic haemolysis.

Late hypertension after liver transplantation: a comparison of cyclosporine and tacrolimus (FK 506).

Hypertension frequently develops early after liver transplantation when cyclosporine-based immunosuppression is used. However, initial experience with tacrolimus has suggested that its use leads to a lower early incidence of hypertension. In this study, the blood pressure status of patients treated with cyclosporine (n = 131) and those treated with tacrolimus (n = 28) was compared 24 months after liver transplantation.

Evolution of cardiovascular risk after liver transplantation: a comparison of cyclosporine A and tacrolimus (FK506).

The development of atherosclerotic cardiovascular complications is a common and serious problem for the long-term survivors of organ transplantation. Cyclosporine A plus steroid-based immuno-suppression regimens in these patients are associated with the development of hypertension, hyperlipidemia, obesity, and diabetes mellitus. Whether the new immunosuppressive agent tacrolimus (FK506) confers any advantage in terms of these cardiovascular risk factors has been less well studied.

Role of steroid dose in hypertension early after liver transplantation with tacrolimus (FK506) and cyclosporine.

Transplant immunosuppression using either cyclosporine (CsA) or tacrolimus (FK506) leads to renal vasoconstriction and nephrotoxicity. Despite producing similar effects within the kidney and blood vessels, clinical hypertension occurs less frequently with tacrolimus during the first year after transplantation, compared with CsA. To examine the role of steroid dose in early posttransplant hypertension, we measured blood pressure and kidney function in liver transplant recipients treated with tacrolimus and either high-dose (TAC-HI-P, n = 19) or low-dose (TAC-LO-P,n = 20) prednisone, compared with CsA-treated recipients (n = 29) receiving prednisone doses similar to the TAC-HI-P group.

Radiographic evaluation of the renal vasculature.

Renal artery stenosis is an important cause of hypertension and progressive renal insufficiency. Additionally, there is increasing concern that renovascular disease is a significant, but previously-unrecognized, cause of end-stage renal disease in certain subsets of patients. Advances in revascularization techniques offer a greater opportunity for blood pressure control and for the restoration or preservation of renal function.

Nurse management of posttransplant hypertension in liver transplant patients.

Hypertension develops soon after organ transplantation using cyclosporine- or FK506-based immunosuppression. Sustained rises in blood pressure require intervention to reduce the risk of intracranial bleeding and other cardiovascular complications. Antihypertensive treatment is complicated by reduced renal function and potential interference with absorption and/or metabolism of cyclosporine or FK506.

Hypertension after liver transplantation.

Hypertension developing after liver transplantation is nearly universal and likely reflects several pathogenic mechanisms. Foremost among these are altered vascular reactivity and vasoconstriction related to CSA, and probably FK506, administration, impaired GFR and sodium excretion, and the effects of steroids. This disorder is of both theoretical and practical importance in understanding blood pressure regulation in humans.

Effect of chronic respiratory acidosis on calcium metabolism in the rat.

Chronic metabolic acidosis typically results in hypercalciuria and negative calcium balance. The impact of chronic respiratory acidosis on calcium metabolism has been less well studied. To address this issue, metabolic balance and static bone histomorphometric data were obtained during a 14-day exposure of rats to 10% CO2 (blood pH 7.

Loss of nocturnal blood pressure fall after liver transplantation during immunosuppressive therapy.

Hypertension, which develops after organ transplantation during immunosuppression with cyclosporine (CSA), is often associated with a loss of nocturnal decrease in blood pressure. Few data correlate circadian blood pressure patterns before transplant with those observed at fixed time points after transplant, or address the role of alternate immunosuppressive agents such as FK506. FK506 is unrelated structurally to CSA and less often leads to hypertension early after transplant.

Urinary endothelin and renal vasoconstriction with cyclosporine or FK506 after liver transplantation.

Transplant immunosuppression using either cyclosporine (CsA) or FK506 leads to renal vasoconstriction. To examine the role of endothelin (ET) in this process, we measured plasma and urinary ET before and at intervals for two years after liver transplantation. Urinary prostacyclin (as 6-keto-PG-F1 alpha), thromboxane, glomerular filtration rate and renal plasma flow were also measured.

Renal sodium handling with cyclosporin A and FK506 after orthotopic liver transplantation.

Hypertension is common after orthotopic liver transplantation and may be due, in part, to cyclosporin A-induced renal dysfunction and/or enhanced proximal tubular sodium reabsorption. To determine whether enhanced proximal tubular sodium reabsorption is central to the development of posttransplant hypertension, measurements of renal hemodynamics and fractional clearances of lithium and sodium were compared 1 month after orthotopic liver transplantation in previously normotensive patients receiving either cyclosporin A (N = 24) or FK506 (N = 18), an immunosuppressive agent that is structurally unlike cyclosporin A and that has a lower reported incidence of hypertension. Median prednisone doses were 20 and 13 mg/day in the cyclosporin A and FK506 groups, respectively (P < 0.

Cyclosporine-induced hypertension after transplantation.

Objective: To describe the features and mechanisms of posttransplantation hypertension and suggest appropriate management of the disorder.

Design: We review our own experience and reports from the literature on hypertension in cyclosporine A (CSA)-treated transplant recipients.

Results: Soon after immunosuppression with CSA and corticosteroids, hypertension develops in most patients who undergo transplantation.