Treatment of Resistant Hypertension: An Update in Device Therapy

Hypertension is the most prevalent cardiac risk factor. In the United some estimates show 60% of 60-year-olds, 70% of 70-year-olds, an 80% of 80-year-olds being hypertensive. Often, blood pressure becomes resistant or refractory. Device therapy represents a new approach to treating this disease. The best studied of these nonpharmacologic approaches to resistant/refractory hypertension include renal denervation, carotid sinus stimulators, and central arteriovenous fistula placement. This chapter will focus on novel device therapy and literature review of its use in clinical trials

An Update on the Controversies in Anemia Management in Chronic Kidney Disease: Lessons Learned and Lost

Background. Erythropoietin deficiency and anemia occur in Chronic Kidney Disease (CKD) and may be treated with Erythropoietin Stimulating Agents (ESAs). The optimal hemoglobin, in non-End Stage Renal Disease CKD, is controversial. Methods. We review three recent randomized trials in anemia in CKD: CHOIR, CREATE, and TREAT. Results. CHOIR (N=1432) was terminated early with more frequent death and cardiovascular outcomes in the higher Hb group (HR 1.34: 95% C.I. 1.03–1.74, P=.03). CREATE (N=603) showed no difference in primary cardiovascular endpoints. Stroke was more common in the higher Hb group (HR 1.92; 95% C.I. 1.38–2.68; P<.001) in TREAT (N=4038). Conclusions. There is no benefit to an Hb outside the 10–12 g/dL range in this population. To avoid transfusions and improve Quality of Life, ESAs should be used cautiously, especially in patients with Diabetes, CKD, risk factors for stroke, and ESA resistance

Secondary hypertension, issues in diagnosis and treatment.

Secondary hypertension (SH) often implies a correctable form of nonessential hypertension. Often certain clinical clues prompt a more extensive evaluation of the causes of the hypertension. Renovascular disease, intrinsic renal disease, primary hyperaldosteronism, and obstructive sleep apnea represent the most common causes of SH. This article defines the disorder and details its epidemiology, prevalence, pathophysiology, physical findings, and treatment strategies