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Renal denervation reduces office systolic BP by an average of 4-6 mm Hg more than control patients and is proposed as adjunctive treatment to pharmacotherapy for patients with uncontrolled hypertension.[5] How is treatment delivered? Renal denervation will be investigated in populations that have sympathetic overdrive, including patients with chronic kidney disease, heart failure or atrial fibrillation.[4] Renal denervation is an innovative catheter-based intervention for patients with uncontrolled hypertension. Renal denervation (RDN) is a minimally invasive catheter-based intervention that uses 1 of a range of techniques to disrupt renal afferent and efferent nerve signals between the kidney and brain. [Extracted from the article]

Background: Curcumin, a popular herbal supplement from the plant turmeric, has prevented ischemic reperfusion and toxin-induced injury in many animal studies and a single-centre randomized human trial. We sought to test whether perioperative oral curcumin (compared with placebo) affects the inflammatory response and risk of postrepair complications after elective abdominal aortic aneurysm repair in humans.Methods: We conducted a parallel-group, randomized, placebo-controlled trial of patients from 10 hospitals in Canada who were scheduled to undergo elective repair of an unruptured abdominal aortic aneurysm (November 2011 to November 2014). Patients in the treatment group received perioperative oral curcumin (2000-mg doses 8 times over 4 d). Patients, health care providers and local research staff were unaware of the treatment assignment. The primary outcomes were median concentrations of 4 bio markers indicating injury and inflammation (postoperative urine interleukin-18 and perioperative rise in serum creatinine, plasma N-terminal pro-B-type natriuretic peptide and plasma high-sensitivity C-reactive protein).Results: Baseline characteristics were similar in the 2 groups (606 patients overall; median age 76 yr). More than 85% of patients in each group took more than 80% of their scheduled capsules. Neither curcumin nor placebo significantly affected any of the 4 biomarkers (p > 0.05 for all comparisons). Regarding the secondary outcomes, there was a higher risk of acute kidney injury with curcumin than with placebo (17% v. 10%, p = 0.01), but no between-group difference in the median length of hospital stay (5 v. 5 days, p > 0.9) or the risk of clinical events (9% v. 9%, p = 0.9).Interpretation: Curcumin had no beneficial effects when used in elective abdominal aortic aneurysm repair. These findings emphasize the importance of testing turmeric and curcumin before espousing their health benefits, as is currently done in the popular media.Trial Registration: ClinicalTrials.gov, no. NCT01225094. [ABSTRACT FROM AUTHOR]

The article discusses the 2018 update to the Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE), a guideline which targets primary care health care practitioners. The 2018 update includes a total of 77 recommendations and 52 new recommendations, including multifaceted care for patients with cardiovascular risks. The guideline added a new category for hypertension for high-risk individuals and lists of risk factors of heart failure, hypertension and stroke.

The article highlights the new and important changes in the 2014 Canadian Cardiovascular Harmonized National Guidelines Endeavour guideline. It cites several topic areas of change such as lifestyle management, risk-factor screening and risk stratification, and treatment targets for dyslipidemia. Information is also presented on the composition of the guideline panel, guideline development, and guideline tools and resources for providers and patients.

The article discusses the harmonization of the clinical practice guidelines that prevent and treat cardiovascular disease in Canada. It states that the Canadian Cardiovascular Harmonization of National Guidelines Endeavour (C-CHANGE) initiative was developed to harmonize the 400 recommendations into 89 key recommendations through using a consensus model. It mentions that the initiative proposes an outcome evaluation plan for tracking of clinical and health system outcomes.

The article discusses guidelines for chronic kidney disease management that were developed by the Canadian Society of Nephrology. The guidelines explains key aspects of the management of the disease to promote shared care for these patients by general practitioners and specialists. In particular, these guidelines are for the care of patients who are not undergoing dialysis. The authors offer recommendations from the guidelines on aspects of management of chronic kidney disease. These include strategies for treatment, targets for different abnormalities and frequency of follow-up based on the evidence available.

Background: First Nations people with diabetes mellitus and hypertension are at greater risk of renal and cardiovascular complications than are non-native patients because of barriers to health care services. We conducted this randomized controlled trial to assess whether a community-based treatment strategy implemented by home care nurses would be effective in controlling hypertension in First Nations people with existing hypertension and type 2 diabetes. Methods: We compared 2 community-based strategies for controlling hypertension in First Nations people with existing hypertension and diabetes. In the intervention group, a home care nurse followed a predefined treatment algorithm of pharmacologic antihypertensive therapy. In the control group, treatment decisions were made by each subject's primary care physician. The primary outcome measure was the difference between the 2 groups in the change in systolic blood pressure after 12 months. Secondary outcome measures were the change in diastolic blood pressure over time, the change in urine albumin status and the incidence of adverse events. Results: Both groups experienced a significant reduction in systolic blood pressure by the final visit (by 24.0 [standard deviation (SD) 13.5] mm Hg in the intervention group and by 17.0 [SD 18.6] mm Hg in the control group); p< 0.001 in each case). However, the difference between the 2 groups in this change was not significant. Patients in the intervention group had a larger decrease in diastolic blood pressure over time than did those in the control group (by 11.6 [SD 10.6] mm Hg v. 6.8 [SD 11.1] mm Hg respectively; p= 0.05). The groups did not differ significantly in terms of changes in urine albumin excretion or incidence of adverse events. Interpretation: High rates of blood pressure control in the community were achieved in both groups in the DREAM 3 study. The addition of a home care nurse to implement a treatment strategy for blood pressure control was more effective in lowering diastolic than systolic blood pressure compared with home care visits for blood pressure monitoring alone and follow-up treatment by a family physician. [ABSTRACT FROM AUTHOR]

Answers several questions about the therapy for patients with hypertension and diabetes mellitus. Reason for the lower threshold for initiating antihypertensive treatment and the target blood pressures in people with diabetes compared with people with uncomplicated hypertension; Antihypertensive therapies recommended for people with diabetes; Possibility of combining an angiotensin-converting enzyme inhibitor and angiotensin-receptor blocker because of the nephropathy.

Reports on microalbuminuria in diabetes mellitus patients. Diagnosis and patients at risk; Incidence of microalbuminuria and effects, including increased risk for cardiovascular and renal disease; Use of antiangiotensin therapy and blood pressure control to reduce urine albumin levels and give renal protection; Need for patients with type 2 diabetes to be screened annually for microalbuminuria.

Provides letter to the editor and responses. Discussion of the relationship between microalbuminuria and children with diabetes, and points out the article they are responding to only dealt with the care of adults; Provision of a letter in response to an article about meningitis and cochlear implantation.