Non-adherence in Hypertension Management Deficit in Information or Trust?

Hypertension, a leading cause of cardiovascular morbidity and mortality worldwide, continues to challenge health professionals. There are too many patients with uncontrolled hypertension who end up with life altering or life ending complications. Over the years so much hypertension research has been conducted; and numerous effective antihypertensive drugs have been discovered and yet the rate of blood pressure control remains unacceptably low.

Effects of Lifestyle Modification on Telomerase Gene Expression in Hypertensive Patients: A Pilot Trial of Stress Reduction and Health Education Programs in African Americans.

Background: African Americans suffer from disproportionately high rates of hypertension and cardiovascular disease. Psychosocial stress, lifestyle and telomere dysfunction contribute to the pathogenesis of hypertension and cardiovascular disease. This study evaluated effects of stress reduction and lifestyle modification on blood pressure, telomerase gene expression and lifestyle factors in African Americans.

Obesity and Cardiovascular Diseases in a High-Risk Population: Evidence-Based Approach to CHD Risk Reduction.

Background: Obesity is becoming a worldwide public health problem and it is expected to worsen as its prevalence is increasing in children and adolescents. This report examined the distribution of major cardiovascular disease (CVD) risk factors and the effect of life-style changes on coronary heart disease (CHD) risk prediction in a high risk obese African Americans.

Methods: We examined the baseline distribution of CVD risk factors in 515 obese African Americans, with mean BMI of 42.

Blood Pressure Dipping and Urban Stressors in Young Adult African Americans.

Background: Blunted nocturnal blood pressure (BP) dipping is an early marker of cardiovascular risk that is prevalent among African Americans.

Purpose: We evaluated relationships of BP dipping to neighborhood and posttraumatic stress and sleep in urban residing young adult African Americans.

Methods: One hundred thirty-six black, predominately African American, men and women with a mean age of 22.

Effect of intensive blood pressure control on cardiovascular remodeling in hypertensive patients with nephrosclerosis.

Pulse pressure (PP), a marker of arterial system properties, has been linked to cardiovascular (CV) complications. We examined (a) association between unit changes of PP and (i) composite CV outcomes and (ii) development of left-ventricular hypertrophy (LVH) and (b) effect of mean arterial pressure (MAP) control on rate of change in PP. We studied 1094 nondiabetics with nephrosclerosis in the African American Study of Kidney Disease and Hypertension.

Relationship of left ventricular hypertrophy and diastolic function with cardiovascular and renal outcomes in African Americans with hypertensive chronic kidney disease.

African Americans with hypertension are at high risk for adverse outcomes from cardiovascular and renal disease. Patients with stage 3 or greater chronic kidney disease have a high prevalence of left ventricular (LV) hypertrophy and diastolic dysfunction. Our goal was to study prospectively the relationships of LV mass and diastolic function with subsequent cardiovascular and renal outcomes in the African American Study of Kidney Disease and Hypertension cohort study.

The metabolically healthy but obese phenotype in African Americans.

Obesity has become one of the leading public health concerns in the United States and worldwide. While obesity is associated with the metabolic syndrome, some obese individuals do not possess the constellation of the metabolic abnormalities and are referred to as metabolically healthy but obese (MHO) persons. Limited data exist on the prevalence and characteristics of the MHO in African Americans.

Nocturnal blood pressure nondipping in obese African-Americans.

Objectives: Nondipping pattern of circadian blood pressure (BP) is associated with increased cardiovascular morbidity and mortality; however, limited data are available among obese African-Americans. We, therefore, aimed to evaluate the pattern of circadian BP variation and to identify clinical conditions associated with nondipping in this population.

Methods: A total of 211 obese African-Americans enrolled in a weight-reduction program underwent 24-h ambulatory BP monitoring.

Malnutrition-inflammation modifies the relationship of cholesterol with cardiovascular disease.

In moderate and severe CKD, the association of cholesterol with subsequent cardiovascular disease (CVD) is weak. We examined whether malnutrition or inflammation (M-I) modifies the risk relationship between cholesterol levels and CVD events in African Americans with hypertensive CKD and a GFR between 20 and 65 ml/min per 1.73 m².

Intensive blood-pressure control in hypertensive chronic kidney disease.

Background: In observational studies, the relationship between blood pressure and end-stage renal disease (ESRD) is direct and progressive. The burden of hypertension-related chronic kidney disease and ESRD is especially high among black patients. Yet few trials have tested whether intensive blood-pressure control retards the progression of chronic kidney disease among black patients.

The relationship between flow-mediated dilatation of the brachial artery and intima-media thickness of the carotid artery to Framingham risk scores in older African Americans.

The objective of this study was to investigate the relationship of flow-mediated dilatation and intima-media thickness (IMT) with coronary risk in African Americans (AAs). Endothelial dysfunction and IMT of carotid arteries are considered early steps in atherosclerotic disease process and have been used as surrogate markers of subclinical atherosclerosis. Data were collected on 106 AAs with a mean age of 64.

Heart failure in ALLHAT: did blood pressure medication at study entry influence outcome?

J Clin Hypertens (Greenwich). 2009;11:466-474. (c)2009 Wiley Periodicals, Inc.

Posttraumatic stress disorder and nocturnal blood pressure dipping in young adult African Americans.

Objective: To evaluate the relationship between posttraumatic stress disorder (PTSD) and nocturnal blood pressure (BP) dipping in young adult African Americans (AAs). PTSD is associated with physical illnesses including cardiovascular conditions. Sleep disturbances related to heightened arousal likely contribute to physical health risk; however, this possibility has not been studied.

Metabolic syndrome, proteinuria, and the risk of progressive CKD in hypertensive African Americans.

Background: Chronic kidney disease (CKD) is more likely to progress to kidney failure (end-stage renal disease) in African Americans, although the reasons for this are unclear. Metabolic syndrome is a risk factor for the development of diabetes and cardiovascular disease and recently was linked to incident CKD. The purpose of this study is to examine whether metabolic syndrome is associated with kidney disease progression in hypertensive African Americans.

Cardiovascular outcomes in the African American Study of Kidney Disease and Hypertension (AASK) Trial.

Background: Patients with chronic kidney disease are at increased risk for cardiovascular (CV) events.

Methods: We randomly assigned 1,094 African Americans with hypertensive nephrosclerosis (glomerular filtration rate [GFR], 20 to 65 mL/min/1.73 m(2) [0.

Differing effects of antihypertensive drugs on the incidence of diabetes mellitus among patients with hypertensive kidney disease.

Background: The African American Study of Kidney Disease and Hypertension was a multicenter trial of African Americans with hypertensive kidney disease randomized to an angiotensin-converting enzyme inhibitor (ramipril), a beta-blocker (metoprolol succinate), or a calcium channel blocker (amlodipine besylate). We compared the incidence of type 2 diabetes mellitus (DM) and the composite outcome of impaired fasting glucose or DM (IFG/DM) for the African American Study of Kidney Disease and Hypertension interventions.

Methods: Cox regression models were used to evaluate (post hoc) the association of the randomized interventions and the relative risk (RR) of DM and IFG/DM and to assess the RR of DM and IFG/DM by several prerandomization characteristics.

Effect of diet and exercise on pulse pressure and cardiac function in morbid obesity: analysis of 24-hour ambulatory blood pressure.

Blood pressure is a major risk factor for cardiovascular events, although the role of pulse pressure, an independent predictor of arterial stiffness, has recently been emphasized. This study examines the baseline relationship between body mass index (BMI) and blood pressure indexes in 215 obese African Americans enrolled in a diet-exercise program. The subject population was 77% female, with a mean +/- SD age of 46.

The impact of body mass index on pulse pressure in obesity.

Objective: Pulse pressure, a marker of arterial vascular properties, has been linked to cardiovascular diseases and complications. This study examined the impact of excess body mass and cardiovascular disease risk factors on pulse pressure (PP).

Design: Cross-sectional and prospective study.

Obese African Americans: the prevalence of dyslipidemia, hypertension, and diabetes mellitus.

Context: The prevalence of the cardiovascular disease risk factors, dyslipidemia, hypertension, and diabetes mellitus, is increased in the setting of obesity.

Objective: To determine whether the prevalence of these risk factors increases with increasing body mass index in an obese cohort, or whether there is a threshold for their appearance.

Design And Setting: Individuals with body mass index > or = 30 kg/m2 joined a weight reduction program in the Howard University General Clinical Research Center.

Alcohol consumption and prognosis in patients with left ventricular systolic dysfunction after a myocardial infarction.

Objectives: We assessed the influence of alcohol intake on the development of symptomatic heart failure (HF) in patients with left ventricular (LV) dysfunction after a myocardial infarction (MI).

Background: In contrast to protection from coronary heart disease, alcohol consumption has been linked to cardiodepressant effects and has been considered contraindicated in patients with HF.

Methods: The Survival And Ventricular Enlargement (SAVE) trial randomized 2231 patients with a LV ejection fraction (EF) <40% following MI to an angiotensin-converting enzyme inhibitor or placebo.

Hypertension and concomitant diseases: a guide for evidence-based therapy.

Hypertension remains one of the leading causes of morbidity and mortality in the United States. Numerous antihypertensive agents are available today, and most hypertensive patients suffer from concomitant diseases/conditions. Many of these diseases/conditions require appropriate selection of antihypertensive agents.

Cardiovascular risk reduction in hypertensive black patients with left ventricular hypertrophy: the LIFE study.

Objectives: We report on a subanalysis of the effects of losartan and atenolol on cardiovascular events in black patients in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study.

Background: The LIFE study compared losartan-based to atenolol-based therapy in 9,193 hypertensive patients with left ventricular hypertrophy (LVH). Overall, the risk of the primary composite end point (cardiovascular death, stroke, myocardial infarction) was reduced by 13% (p = 0.

Response of lipoprotein(a) levels to therapeutic life-style change in obese African-Americans.

Lipoprotein(a) (Lp(a)) is regarded as an independent risk factor for Atherosclerotic cardiovascular disease. The objectives of this study were: to determine the effects of diet and exercise on Lp(a) and to evaluate the relation of Lp(a) with the lipid profile (total serum cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol). Baseline Lp(a), body mass index (BMI) and the lipid profiles were measured in 343 Obese (BMI >30kg/m(2)) African-Americans.

Design and statistical aspects of the African American Study of Kidney Disease and Hypertension (AASK).

The African American Study of Kidney Disease and Hypertension (AASK) is a multicenter randomized clinical trial designed to test the effectiveness of three anti-hypertensive drug regimens and two levels of BP control on the progression of hypertensive kidney disease. Participants include African-American men and women aged 18 to 70 yr who have hypertensive kidney disease and GFR between 20 and 65 ml/min per 1.73 m(2).

Validation of Heart Failure Events in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Participants Assigned to Doxazosin and Chlorthalidone.

BACKGROUND: The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is a randomized, double-blind, active-controlled trial designed to compare the rate of coronary heart disease events in high-risk hypertensive participants initially randomized to a diuretic (chlorthalidone) versus each of three alternative antihypertensive drugs: alpha-adrenergic blocker (doxazosin), ACE-inhibitor (lisinopril), and calcium-channel blocker (amlodipine). Combined cardiovascular disease risk was significantly increased in the doxazosin arm compared to the chlorthalidone arm (RR 1.25; 95% CI, 1.