Dr. Joseph L. Izzo, Jr., from the University at Buffalo/Erie County Medical Center, Buffalo, NY moderated the topic “The New Hypertension Guidelines: Hits and Misses” with Dr. Jan Basile from the Medical University of South Carolina/Ralph H. Johnson VA Medical Center, Charleston, SC, Dr. Marvin Moser from the Yale University School of Medicine, New Haven, CT, and Dr. Alan H. Gradman from the Temple University School of Medicine (Clinical Campus), Pittsburgh, PA participating. The discussion focused primarily on: What constitutes a good guideline; the usefulness of the new recommendations by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; the role of combination therapy in managing patients with resistant hypertension; the use of race as a decision point in selecting drugs for treating hypertension; specific recommendations for best practices when it comes to managing the hard-to-treat patient; and the existence and relevance of J-curves. (Med Roundtable Cardiovasc Ed. 2014;4(1):e54–e63) ©2014 FoxP2Media, LLC

Dr. Marvin Moser from Yale University and Dr. Norman Kaplan from the University of Texas Southwestern Medical Center at Dallas participated in this discussion focusing on the topic Hypertension: Truly Resistant or Just Difficult to Control? The discussion focused primarily on: (1) treatment of resistant hypertentsion, (2) differentiation between truly resistant patients and patients who are difficult to treat, (3) white coat hypertension as a factor, (4) blood pressure monitoring, (5) renal vascular disease and aldosteronism, (6) surgical and pharmaceutical therapy, (7) intensity of medication to illicit response and patient condition, (8) treatment of older patient populations, (9) the impact of lifestyle changes on blood pressure reduction, (10) treatment of middle-aged patient populations, and (11) impact of NSAIDs on therapy. (Med Roundtable Cardiovasc Ed. 2010;1(3):200-206) ©2010 FoxP2 Media, LLC

A large proportion of the world's population live in areas with dengue virus (DENV) transmission resulting in tens of millions of symptomatic dengue cases each year. Serious complications following DENV infection occur more frequently in those suffering from a second or subsequent infection implicating virus-specific immunity as having a role in pathogenesis. In recent years outbreaks of the related Zika virus (ZIKV) have been associated with birth defects and neurological complications. As DENV and ZIKV share a viral vector sequential infections can occur. Given the sequence homology between the two viruses, the generation of cross-reactive immune responses is highly likely. This review examines the role immunopathogenesis plays during DENV infection as well as highlighting recent studies that demonstrate DENV immunity may have an effect on the outcome of ZIKV infection.

The purpose of this research study was to examine whether level of acculturation is a predictor of body mass index, waist circumference, and waist–hip ratio in Filipino Americans with hypertension in the United States. The Filipino Americans (N = 108) were recruited from a primary care clinic in the United States. Two instruments were used to collect and operationalize the variables, specifically: (1) Socioeconomic/Demographic Questionnaire and (2) A Short Acculturation Scale for Filipino Americans. Descriptive statistics and partial least squares were used to calculate the results. The partial least square path model identified acculturation as a predictor of body mass index, wait circumference, and waist–hip ratio among Filipino Americans. The positive path coefficient (β = 0.384) was statistically significant (t = 5.92, P < .001). Health care providers need to stress the importance of the degree of acculturation when developing culturally appropriate lifestyle and health promotion interventions among immigrant patients with hypertension.

To assess frequency of adverse events, efficacy, and clinical outcomes of percutaneous portal vein embolization (PVE) in patients with bilobar colorectal liver metastases undergoing staged hepatectomy with preservation of segment IV ± I only.Retrospective analysis was performed of 40 consecutive patients who underwent right PVE after successful left lobectomy between 2005 and 2013. Rates of adverse events, future liver remnant (FLR) > 30% compared with baseline liver volume, clinical success (completion of staged hepatectomy with clearance of liver metastases), and overall survival were analyzed.PVE was performed using polyvinyl alcohol particles (n = 7; 17.5%), particles plus coils (n = 23; 57.5%), and N-butyl cyanoacrylate glue plus ethiodized oil (n = 10; 25%). Technical success was 100%. After PVE, 20% (n = 8) of patients exhibited portal venous thrombosis, ranging from isolated intrahepatic portal branch thrombosis to massive thrombosis of the main portal vein (n = 3) and responsible for periportal cavernoma and portal hypertension in 5 patients. Of patients, 23 (57.5%) had FLR ≥ 30%, and 21 (52.5%) had clinical success. Six patients had significant stenosis or occlusion of the left portal vein or biliary system after original left lobectomy, which was independently associated with FLR < 30% (R2 = 0.24). Clinical success was the only independent variable associated with survival (R2 = 0.25).PVE for staged hepatectomy with preservation of segment IV ± I only is technically feasible, leading to adequate hypertrophy and clinical success rates in these patients with poor oncologic prognosis. Portal venous thrombosis is greater after the procedure than in the setting of standard PVE.

There is a reported association between hypertension (HTN) and sleep disorders. The American Academy of Pediatrics recommends screening children with HTN for sleep disorders because sleep disorders increase the risk for cardiovascular disease. We quantified the frequency and severity of sleep disorders within our institution's hypertensive pediatric population and evaluated the effectiveness of performing nocturnal polysomnography (NPSG). In the hypertensive pediatric population referred for NPSG at our institution, 64% were diagnosed with obstructive sleep apnea (OSA) and/or periodic limb movement disorder. Thirty-three percent of those children with HTN had moderate to severe OSA, whereas only 20% of all children evaluated by NPSG had moderate to severe OSA. Those children with HTN were also two times more likely to be diagnosed with periodic limb movement disorder. Screening for sleep disorders and obtaining NPSG in children with HTN increase the identification of comorbid sleep disorders and reduce the risk for cardiovascular disease.

Team-based care has been recommended for patients with treatment-resistant hypertension (TRH), but its efficacy in this setting is unknown. We compared a physician-pharmacist collaborative model (PPCM) to usual care in patients with TRH participating in the Collaboration Among Pharmacists and Physicians To Improve Outcomes Now study. At baseline, 169 patients (27% of Collaboration Among Pharmacists and Physicians To Improve Outcomes Now patients) had TRH: 111 received the PPCM intervention and 58 received usual care. Baseline characteristics were similar between treatment arms. After 9 months, adjusted mean systolic blood pressure was reduced by 7 mm Hg more with PPCM intervention than usual care (P = .036). Blood pressure control was 34.2% with PPCM versus 25.9% with usual care (adjusted odds ratio, 1.92; 95% confidence interval, 0.33–11.2). These findings suggest that team-based care in the primary care setting may be effective for TRH. Additional research is needed regarding the long-term impact of these models and to identify patients most likely to benefit from team-based interventions.

Dr. Marvin Moser from the Yale School of Medicine moderated the topic JNC 8 - What Might Be Expected? with Drs. Jan Basile from the Medical University of South Carolina, Norman Kaplan from UT Southwestern Medical School at Dallas, and Ronald Victor from Cedars-Sinai Medical Center, Los Angeles participating. The discussion focused primarily on: (1) Joint National Committee (JNC) reports prior to the forthcoming JNC 8, (2) progress in controlling hypertension, including special populations (3) blood pressure goals, (4) diagnostic evaluation of the hypertensive patient, (5) lifestyle changes that impact blood pressure, (6) initial therapy, including the use of beta-blockers and direct renin inhibitors, including eldery and obese populations, (7) combination therapy, (8) safety of ARBs and cancer, and (9) predictions on the recommendations that might be included in the forthcoming JNC 8 report. (Med Roundtable Cardiovasc Ed. 2010;1(4):267-275) ©2010 FoxP2 Media, LLC

OBJECTIVE:Noninvasive blood pressure (BP) measurement often triggers a transient rise in BP, known as an alerting reaction. However, the prevalence and prognostic significance of the alerting reaction has never been assessed in the general population. METHODS:We evaluated the association between the alerting reaction and left ventricular mass by MRI and urinary albumin-to-creatinine ratio in the Dallas Heart Study, a large population sample of 3069 individuals. Participants were categorized into four groups based on levels of consecutive BP: first, normal first BP and average third to fifth (avg3-5) BP of less than 140/90 mmHg (control group); second, high first BP of at least 140/90 mmHg and normal (avg3-5) BP (alerting reaction group); third, normal first BP and high (avg3-5) BP; and fourth, high first to fifth BP. Then, associations between BP categories with incident cardiovascular outcomes (coronary heart disease, stroke, atrial fibrillation, heart failure, and cardiovascular death) over a median follow-up period of 9.4 years were assessed. RESULTS:The sample-weighted prevalence of isolated hypertension during the first BP measurement was 9.6%. Presence of an alerting reaction was independently associated with increased left ventricular mass, urinary albumin-to-creatinine ratio, cardiovascular events after adjustment for traditional cardiovascular risk factors, and baseline BP (adjusted hazard ratio 1.24, 95% confidence interval 1.07-1.43). CONCLUSION:Our study indicated that the alerting reaction is independently associated with increased cardiovascular and renal complications.

See related article, pp 1041–1046 Attention must be paid to the article by Roush et al1 in this edition of Hypertension . The authors use robust statistics to compare the antihypertensive potency and adverse effects of hydrochlorothiazide versus indapamide in the 10 publications that could be identified, wherein the 2 drugs were compared head-to-head in trials lasting ≥4 weeks. Indapamide, used as 2.5 mg tablets in all but 1 trial, provided a 54% greater reduction in systolic blood pressure, that is, −5.1 mm Hg (confidence interval, −8.7 to −1.6) than seen with hydrochlorothiazide in doses from 12.5 to 50 mg/d. The relative doses were greater for hydrochlorothiazide in 5 trials and equivalent in 3 trials. The blood pressures were measured by office sphygmomanometry in all these trials but reference is given to studies using 24-hour ambulatory measurements, which showed ≥24-hour duration of diuretic and antihypertensive efficacy with the immediate formulation of indapamide and ≥32-hour duration with the sustained formulation (which was used in only one of the trials).2 Roush et al1 refer to multiple additional vasodilatory actions described in the literature in support of the greater reduction of blood pressure …