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To compare the urine Congo‐red dot paper test (CRD) with dipstick urinalysis to screen preeclampsia (PE). A total of 409 paired spot urine samples were obtained prospectively from women with suspected pre‐eclampsia attending for routine hospital visits. Congo‐red dot paper test and dipstick urinalysis were examined and compared to screen pre‐eclampsia. The agreement between the two urinary test is modest (kappa coefficient = 0.28, 95% CI 0.14–0.42). The specificity of CRD was higher than urinalysis (97.4% vs. 90.4%, p <.001). Urinalysis performed better in sensitivity (77.3% vs. 40.9%, p =.04) and the area under the receiver operating characteristic curves (AUC) (0.84 [95% CI 0.74–0.94] vs. 0.69 [95% CI 0.55–0.83], p =.04) than CRD, respectively. The sensitivity, specificity, AUC of the parallel test of them is 86.4% (64.0%–96.4%), 89.1% (85.5%–92.0%), and 0.88 (95% CI 0.79–0.96). And the serial test is 31.8% (14.7%–54.9%), 98.7% (96.8%–99.5%), 0.65 (95% CI 0.51–0.79), accordingly. The urinalysis is a better diagnosing test for preeclampsia. CRD could aid in the diagnosis of patients with preeclampsia. Combined the two tests in suspected patients may further improve the performance in the diagnosis of preeclampsia. Further study need to be made for its potential clinical practice. [ABSTRACT FROM AUTHOR]

Accurate office blood pressure measurement remains crucial in the diagnosis and management of hypertension worldwide, including Latin America (LA). Office blood pressure (OBP) measurement is still the leading technique in LA for screening and diagnosis of hypertension, monitoring of treatment, and long-term follow-up. Despite this, due to the increasing awareness of the limitations affecting OBP and to the accumulating evidence on the importance of ambulatory BP monitoring (ABPM), as a complement of OBP in the clinical approach to the hypertensive patient, a progressively greater attention has been paid worldwide to the information on daytime and nighttime BP patterns offered by 24-h ABPM in the diagnostic, prognostic, and therapeutic management of hypertension. In LA countries, most of the Scientific Societies of Hypertension and/or Cardiology have issued guidelines for hypertension care, and most of them include a special section on ABPM. Also, full guidelines on ABPM are available. However, despite the available evidence on the advantages of ABPM for the diagnosis and management of hypertension in LA, availability of ABPM is often restricted to cities with large population, and access to this technology by lower-income patients is sometimes limited by its excessive cost. The authors hope that this document might stimulate health authorities in each LA Country, as well as in other countries in the world, to regulate ABPM access and to widen the range of patients able to access the benefits of this technique. [ABSTRACT FROM AUTHOR]

Out-of-office blood pressure (BP) monitoring appears to be a very useful approach to hypertension management insofar it allows to obtain multiple measurements in the usual environment of each individual, allows the detection of hypertension phenotypes, such as white-coat and masked hypertension, and appears to have superior prognostic value than the conventional office BP measurements. Out-of-office BP can be obtained through either home or ambulatory monitoring, which provide complementary and not identical information. Home BP monitoring yields BP values self-measured in subjects' usual living environment; it is an essential method for the evaluation of almost all untreated and treated subjects with suspected or diagnosed hypertension, best if combined with telemonitoring facilities, also allowing long-term monitoring. There is also increasing evidence that home BP monitoring improves long-term hypertension control rates by improving patients' adherence to prescribed treatment. In Latin American Countries, it is widely available, being relatively inexpensive, and well accepted by patients. Current US, Canadian, Japanese, and European guidelines recommend out-of-office BP monitoring to confirm and refine the diagnosis of hypertension. [ABSTRACT FROM AUTHOR]

The American Society of Hypertension is publishing a series of Position Papers in their official journals throughout the 2008 - 2009 years. The following Position Paper originally appeared: JASH. 2008;2(6):484–494. Hypertension complicates 5% to 7% of all pregnancies. A subset of preeclampsia, characterized by new-onset hypertension, proteinuria, and multisystem involvement, is responsible for substantial maternal and fetal morbidity and is a marker for future cardiac and metabolic disease. This American Society of Hypertension, Inc (ASH) position paper summarizes the clinical spectrum of hypertension in pregnancy, focusing on preeclampsia. Recent research breakthroughs relating to etiology are briefly reviewed. Topics include classification of the different forms of hypertension during pregnancy, status of the tests available to predict preeclampsia, and strategies to prevent preeclampsia and to manage this serious disease. The use of antihypertensive drugs in pregnancy, and the prevention and treatment of the convulsive phase of preeclampsia, eclampsia, with intravenous magnesium sulfate is also highlighted. Of special note, this guideline article, specifically requested, reviewed, and accepted by ASH, includes solicited review advice from the American College of Obstetricians and Gynecologists. [ABSTRACT FROM AUTHOR]

This paper provides recommendations on the treatment of orthostatic hypotension ( OH) as reviewed by the American Society of Hypertension. It focuses on recent reports on the evaluation and management of OH and provides practical advice for clinicians on how to screen, diagnose, and treat patients using behavioral, nonpharmacologic, and pharmacologic strategies. The authors also provide a stepwise approach on how to apply new findings to successfully control OH and reduce the risk of syncope and falls in these patients. Treatment of OH is also discussed in special situations such as in hypertensive and hospitalized patients. It should be noted, however, that research in this area is mostly limited to studies in small numbers of patients. Unfortunately, the trials of the type needed to develop evidence-based guidelines are not available for this condition. [ABSTRACT FROM AUTHOR]

Presents an analysis of recent papers in hypertension. "Appropriate Follow-Up of Patients With Hypertension"; "Light to Moderate Alcohol Consumption Is Associated With Reduced Cardiovascular Mortality in Hypertensive Men"; "Home Blood Pressure Measurement Predicts Cardiovascular Risk Better Than Office Blood Pressure Measurement."

Presents information on several papers about hypertension from the U.S. "Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs. Diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial," from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial officers and coordinators; "Primary Prevention of Hypertension: Clinical and Public Health Advisory From the National High Blood Pressure Education Program," from the National High Blood Pressure Education Coordinating Committee; "Prophylactic Treatment of Migraine With an Angiotensin II Receptor Blocker," by E. Tronvik, L. Stovner and G. Helde.

J Clin Hypertens (Greenwich). 2010;12:757-764. © 2010 Wiley Periodicals, Inc. Nonadherence and poor or no persistence in taking antihypertensive medications results in uncontrolled high blood pressure, poor clinical outcomes, and preventable health care costs. Factors associated with nonadherence are multilevel and relate not only to the patient, but also to the provider, health care system, health care organization, and community. National guideline committees have called for more aggressive approaches to implement strategies known to improve adherence and technologies known to enable changes at the systems level, including improved communication among providers and patients. Improvements in adherence and persistence are likely to be achieved by supporting patient self-management, a team approach to patient care, technology-supported office practice systems, better methods to measure adherence, and less clinical inertia. Integrating high blood pressure control into health care policies that emphasize and improve prevention and management of chronic illness remains a challenge. Four strategies are proposed: focusing on clinical outcomes; empowering informed, activated patients; developing prepared proactive practice teams; and advocating for health care policy reform. With hypertension remaining the most common reason for office visits, the time is now. [ABSTRACT FROM AUTHOR]

A substantial body of evidence has implicated several aspects of diet in the pathogenesis of elevated blood pressure (BP). Well-established risk factors for elevated BP include excess salt intake, low potassium intake, excess weight, high alcohol consumption, and suboptimal dietary pattern. African Americans are especially sensitive to the BP-raising effects of excess salt intake, insufficient potassium intake, and suboptimal diet. In this setting, dietary changes have the potential to substantially reduce racial disparities in BP and its consequences. In view of the age-related rise in BP in both children and adults, the direct, progressive relationship of BP with cardiovascular-renal diseases throughout the usual range of BP, and the worldwide epidemic of BP-related disease, efforts to reduce BP in nonhypertensive as well as hypertensive individuals are warranted. In nonhypertensives, dietary changes can lower BP and delay, if not prevent, hypertension. In uncomplicated stage I hypertension, dietary changes serve as initial treatment before drug therapy. In hypertensive individuals already on drug therapy, lifestyle modifications can further lower BP. The current challenge is designing and implementing effective clinical and public health interventions that lead to sustained dietary changes among individuals and more broadly in the general population. [ABSTRACT FROM AUTHOR]

This report updates concepts on hypertension management in patients with diabetes. It focuses on clinical outcomes literature published within the last 3 years and incorporates these observations into modifications of established guidelines. While the fundamentals of treatment and goal blood pressures remain unchanged, approaches to specific patient-related issues has changed. This update focuses on questions such as what to do when a patient has an elevated potassium level when therapy is initiated and whether combinations of agents that block the renin-angiotensin system still be used. In addition, there are updates from trials, just published and in press, that focus on related management issues influencing cardiovascular outcomes in persons with diabetes. Last, an updated algorithm is provided that incorporates many of the new findings and is suggested as a starting point to achieve blood pressure goals. [ABSTRACT FROM AUTHOR]

The article analyzes several studies related to hypertension. The use of angiotensin-converting enzyme inhibitors during pregnancy produces major congenital malformations in infants. The utilization of continuous positive airway pressure is ineffective in treating obstructive sleep apnea (OSA) in patients with hypertension. OSA is linked with increased sympathetic nervous system activity which may be related to the development of hypertension.

Comments on two research on pharmacologic therapy for prehypertension and therapeutic inertia as a barrier to blood pressure control. Blood pressure values of prehypertension; Results of the Trial of Preventing Hypertension that began in 1999; Definition of therapeutic inertia.

Presents an analysis of recent studies about hypertension. "Efficacy and Safety of Benazepril for Advanced Chronic Renal Insufficiency," by F. F. Hou and colleagues in a 2006 issue of the "New England Journal of Medicine"; "Urinary Albumin Excretion as a Predicator of the Development of Hypertension in the General Population," by A. H. Brantsma and colleagues in a 2006 issue of the "Journal of American Society of Nephrology."

The article comments on the study "Prevention of Cardiovascular Events With an Antihypertensive Regimen of Amlodipine Adding Perindopril as Required Versus Atenolol Adding Bendroflumethiazide as Required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm: A Multicentre Randomised Controlled Trial," by B. Dahlof, P. S. Sever, N. R. Poulter and colleagues. It explains that the trial suggests that atenolol is not an acceptable therapy for the treatment hypertension. Further, it suggests that a strategy using a calcium channel blockers is more effective than the β-blocker atenolol. It argues that the trial was not a trial of combination agent therapy and should not be interpreted as such. It also states the blood pressure in the trial was poorly controlled.

Discusses two studies on hypertension. "Effect of Soybean Protein on Blood Pressure: A Randomized, Controlled Trial," by J. He et al published in the 2005 issue of "Annals of Internal Medicine"; "North American Ginseng Exerts a Neutral Effect on Blood Pressure in Individuals With Hypertension," by P. M. Stavro et al published in the 2005 issue of "Hypertension."

Presents analyses of studies in hypertension. Effects of cyclooxygenase-2 inhibitors on blood pressure in patient with osteoarthritis; Safety and antihypertensive efficacy of the investigational oral renin inhibitor aliskiren.

Analyzes the findings of two studies which focused on hypertension. "Effect of Antihypertensive Agents on Cardiovascular Events in Patients With Coronary Disease and Normal Blood Pressure: the CAMELOT Study: A Randomized Controlled Trial," by S. E. Nissen, E.M. Tuczu, P. Libby et al; "Accuracy of Computed Tomographic Angiography and Magnetic Resonance Angiography for Diagnosing Renal Artery Stenosis," by G.B.C. Vasbinder, P.J. Nelemans, A.G.H. Kessels et al.

Discusses several research on hypertension. Comments regarding the use of atenolol as a drug for hypertension; Cardiovascular benefits that can be derived from angiotensin-converting enzyme inhibit therapy by low-risk patients with coronary artery disease and preserved left ventricular function; Information on protection against fracture offered by beta blockers.

Presents an overview of the "National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents," the fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Prevalence of overweight children; Therapeutic lifestyle changes; Role of aldosterone in the pathogenesis of essential hypertension.

Presents an analysis of articles tackling issues surrounding hypertension. Standard of care in patients who have coronary artery disease; Factor that reduced the risk of myocardial infarction stroke in high-risk patients.

Discusses the use of angiotensin-converting enzyme (ACE) inhibitor in reducing cardiovascular events and myocardial infarction based on the European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease clinical trial. Benefits of the ACE-inhibitor therapy; Statistics on patients who are involved in the trial; Association of the reduction in vascular events with small changes in systolic blood pressure and diastolic blood pressure.

Analyzes guidelines and studies related to the prevention and management of hypertension in Americans. Recommendations presented by the U.S. National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure to physicians in managing hypertensive patients; Findings of a study on the effects of a statin-based therapy on patients with hypertension and hypercholesterolemia; Guidelines released by the International Society of Hypertension in Blacks for the management of hypertension in African Americans.

Presents commentaries on several studies related to hypertension. Advantage of angiotensin-converting-enzyme over diuretics; Significance of combination therapy with an angiotensin-converting-enzyme inhibitor and angiotensin II receptor blocker; Accuracy of blood pressure measurement.

Presents an analysis of recent papers in hypertension as of January 2003. "Comparative Effect of a Losartan-Based Regimen and an Atenolol-Based Regimen in Patients With Left Ventricular Hypertrophy: A Life Substudy in Those With Isolated Systolic Hypertension," by S. E. Kjeldsen, B. Dahlof and R. B. Deveraux; "Lifestyle Modification Reduces Left Ventricular Hypertrophy," by A. Hinderliter, A. Sherwood and E. Gullette.

The article discusses the study "Valsatran, But Not Valsatran + Hydrochlorothiazide, Moderately Decreases C-Reactive Protein in Patients With Stage 2 Hypertension: The Val-Marc Trial." The study included men and women 8 to 75 years of age with stage 2 hypertension. The findings of the study are discussed. The trial raises the hypothesis that monotherapy with the angiotensin II receptor blocker valsatran may lower inflammation independent of the degree of blood pressure reduction achieved.

Comments on published studies regarding hypertension. "Angiotensin-Converting Enzyme Inhibitors and Calcium Channel Blockers for Coronary Heart Disease and Stroke Prevention," by P. Verdecchia and others; "Effects of Time of Day of Treatment on Ambulatory Blood Pressure Pattern of Patients With Resistant Hypertension," by R. C. Hermida and others.