01:04CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2009 â A 36-Year-Old Woman with Headache, Hypertension, and Seizure 2 Weeks Post Partum -
Aneesh B. Singhal, M.D., W. Taylor Kimberly, M.D., Ph.D., Pamela W. Schaefer, M.D., and E. Tessa Hedley-Whyte, M.D.
New England Journal of Medicine - Hypertension
Dr. W. Taylor Kimberly: A 36-year-old woman was admitted to the hospital because of headaches, hypertension, and seizures.Nineteen days before the current admission, she delivered healthy twins at 35.6 weeks...
ORIGINAL ARTICLE: Modulation of Blood Pressure by Central Melanocortinergic Pathways -
Jerry R. Greenfield, M.D., Ph.D., Jeffrey W. Miller, M.D., Julia M. Keogh, B.Sc., Elana Henning, B.Soc.Sc., Julie H. Satterwhite, Ph.D., Gregory S. Cameron, Ph.D., Beatrice Astruc, M.D., John P. Mayer, Ph.D., Soren Brage, Ph.D., Teik Choon See, M.D., David J. Lomas, M.D., Stephen O'Rahilly, M.D., and I. Sadaf Farooqi, M.D., Ph.D.
New England Journal of Medicine - Hypertension
Background: Weight gain and weight loss are associated with changes in blood pressure through unknown mechanisms. Central melanocortinergic signaling is implicated in the control of energy balance and blood pressure...
Hypertension is one of the most important risk factors for cardiovascular and renal diseases. Currently, approximately 73 million adults in the United States and approximately 1 billion adults worldwide have...
An association of gout with hypertension, diabetes, kidney disease, and cardiovascular disease has been observed since the late 19th century. Early investigators, such as Frederick Mahomed, Alexander Haig, and Nathan...
Background: Post-trial monitoring of patients in the United Kingdom Prospective Diabetes Study (UKPDS) examined whether risk reductions for microvascular and macrovascular disease, achieved with the use of improved blood-pressure (...)
A 65-year-old woman with a history of hypertension and cigarette smoking presented with complete loss of vision in the inferior field of the left eye, which she had noticed an...
ORIGINAL ARTICLE: Aliskiren Combined with Losartan in Type 2 Diabetes and Nephropathy -
Hans-Henrik Parving, M.D., D.M.Sc., Frederik Persson, M.D., Julia B. Lewis, M.D., Edmund J. Lewis, M.D., and Norman K. Hollenberg, M.D., Ph.D., for the AVOID Study Investigators
New England Journal of Medicine - Hypertension
Background: Diabetic nephropathy is the leading cause of end-stage renal disease in developed countries. We evaluated the renoprotective effects of dual blockade of the reninâangiotensinâaldosterone system by adding treatment (...)
In early April, we presented the case of a 67-year-old man with asymptomatic carotid disease in Clinical Decisions,1 an interactive feature designed to assess how readers would manage a clinical...
Hypertension is prevalent and accounts for a large proportion of cardiovascular morbidity and mortality worldwide.1 There is a continuous, approximately linear, increase in systolic blood pressure with increasing age in...
A 53-year-old man presented with a 4-week history of bilateral retrobulbar headache and blurred vision. His blood pressure was 220/135 mm Hg; his neurologic examination was unremarkable. He had no...
ORIGINAL ARTICLE: Treatment of Hypertension in Patients 80 Years of Age or Older -
Nigel S. Beckett, M.B., Ch.B., Ruth Peters, Ph.D., Astrid E. Fletcher, Ph.D., Jan A. Staessen, M.D., Ph.D., Lisheng Liu, M.D., Dan Dumitrascu, M.D., Vassil Stoyanovsky, M.D., Riitta L. Antikainen, M.D., Ph.D., Yuri Nikitin, M.D., Craig Anderson, M.D., Ph.D., Alli Belhani, M.D., Françoise Forette, M.D., Chakravarthi Rajkumar, M.D., Ph.D., Lutgarde Thijs, M.Sc., Winston Banya, M.Sc., and Christopher J. Bulpitt, M.D., for the HYVET Study Group
New England Journal of Medicine - Hypertension
Background: Whether the treatment of patients with hypertension who are 80 years of age or older is beneficial is unclear. It has been suggested that antihypertensive therapy may reduce the...
A 67-year-old man with a history of hypertension and hyperlipidemia is seen for a routine examination. His medications include hydrochlorothiazide (25 mg daily), simvastatin (20 mg daily), and aspirin (81...
An 81-year-old woman presented to the emergency department with increasing abdominal distention, nausea, and vomiting. She also reported increasing shortness of breath and fatigue, which had become worse over the...
A 59-year-old man with a medical history of hypertension, hyperlipidemia, and coronary artery disease presented with transient, painless visual obscuration in the left eye, and he was referred for retinal...
A 55-year-old woman with type 2 diabetes, obesity, and hypertension has been under your care for the past 2 years. She has no history of microalbuminuria, retinopathy, or neuropathy. She...
ORIGINAL ARTICLE: Evidence of MEN-2 in the Original Description of Classic Pheochromocytoma -
Hartmut P.H. Neumann, M.D., Alexander Vortmeyer, M.D., Dieter Schmidt, M.D., Martin Werner, M.D., Zoran Erlic, M.D., Alberto Cascon, Ph.D., Birke Bausch, M.D., Andrzej Januszewicz, M.D., and Charis Eng, M.D., Ph.D.
New England Journal of Medicine - Hypertension
The first description of pheochromocytoma in 1886 has been attributed to Felix Fränkel, who described an 18-year-old woman with bilateral adrenal âsarcoma and angio-sarcoma.â We reviewed the publication and then...
A 68-year-old accountant visits his physician. He was told a year earlier that his blood pressure was somewhat elevated and was advised to reduce salt intake and increase physical activity....
Hypertension affects approximately 25% of the adult population worldwide, and its prevalence is predicted to increase by 60% by 2025, when a total of 1.56 billion people may be affected.1...
A 68-year-old man with hypertension presented with vague abdominal pain. Ultrasonography of the abdomen showed a renal mass in the left kidney. A computed tomographic scan of the abdomen showed...
A 56-year-old woman with a history of primary pulmonary hypertension and heart and lung transplantation was admitted to the hospital because of renal failure.When the patient was approximately 43 years...
SPECIAL ARTICLE: Improving the Management of Chronic Disease at Community Health Centers -
Bruce E. Landon, M.D., M.B.A., LeRoi S. Hicks, M.D., M.P.H., A. James O'Malley, Ph.D., Tracy A. Lieu, M.D., M.P.H., Thomas Keegan, Ph.D., Barbara J. McNeil, M.D., Ph.D., and Edward Guadagnoli, Ph.D.
New England Journal of Medicine - Hypertension
Background: The Health Disparities Collaboratives of the Health Resources and Services Administration (HRSA) were designed to improve care in community health centers, where many patients from ethnic and racial minority...
A 76-year-old man with hypertension presented with a sudden, painless, and profound loss of vision in the right eye. Visual acuity was light perception only in the affected eye, with...
A 19-year-old man presented with a 10-month history of Raynaud's phenomenon, fever, abdominal pain, and hypertension. On examination, he had multiple subcutaneous nodules on his forehead, and his blood pressure...
CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2006 â A 35-Year-Old Pregnant Woman with New Hypertension -
Anne Klibanski, M.D., Antonia E. Stephen, M.D., Michael F. Greene, M.D., Michael A. Blake, M.D., and Chin-Lee Wu, M.D., Ph.D.
New England Journal of Medicine - Hypertension
Dr. Andrea L. Utz (Endocrinology): A 35-year-old pregnant woman (gravida 2, para 1) was admitted to this hospital at 19 weeks and 6 days of gestation because of the recent...
During a routine preoperative checkup before a planned hysterectomy, a healthy 31-year-old woman was noted to have an elevated blood pressure of 230/130 mm Hg, mild headache without chest pain,...
A 15 1/2-year-old girl was seen in the outpatient Weight Center of this hospital for the evaluation of severe obesity. She had had a normal gestation without complications and had...
Background: Previous studies have suggested that blockade of the reninâangiotensin system may prevent diabetes in people with cardiovascular disease or hypertension.Methods: In a double-blind, randomized clinical trial with a (...)
ORIGINAL ARTICLE: Soluble Endoglin and Other Circulating Antiangiogenic Factors in Preeclampsia -
Richard J. Levine, M.D., M.P.H., Chun Lam, M.D., Cong Qian, M.S., Kai F. Yu, Ph.D., Sharon E. Maynard, M.D., Benjamin P. Sachs, M.B., B.S., D.P.H., Baha M. Sibai, M.D., Franklin H. Epstein, M.D., Roberto Romero, M.D., Ravi Thadhani, M.D., M.P.H., and S. Ananth Karumanchi, M.D., for the CPEP Study Group
New England Journal of Medicine - Hypertension
Background: Alterations in circulating soluble fms-like tyrosine kinase 1 (sFlt1), an antiangiogenic protein, and placental growth factor (PlGF), a proangiogenic protein, appear to be involved in the pathogenesis of preeclampsia....
Preeclampsia, either alone or superimposed on another disorder, is a major cause of maternal and fetal death and the leading cause of premature delivery worldwide.1 Underappreciated is the strain that...
A 61-year-old woman was hospitalized with a two-day history of palpitations and dyspnea. She was found to be in atrial fibrillation with a rapid ventricular response, and intravenous diltiazem and...
An 83-year-old woman with a history of hypertension, glaucoma, and atrial fibrillation, who had a pacemaker and was receiving warfarin, woke up with a sensation of pain in the right...
CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2006 â A 36-Year-Old Man with Numbness in the Right Hand and Hypertension -
Othon Iliopoulos, M.D., Gayun Chan-Smutko, M.S., C.G.C., R. Gilberto Gonzalez, M.D., Ph.D., David N. Louis, M.D., and James R. Stone, M.D., Ph.D.
New England Journal of Medicine - Hypertension
Dr. Joanna J. Wykrzykowska (Medicine): A 36-year-old man was admitted to the hospital because of a mass in the right adrenal gland. The patient had been well until seven months...
A 70-year-old woman with a long-standing history of hypertension comes for follow-up. Her medications include atenolol (100 mg daily), hydrochlorothiazide (12.5 mg daily), lisinopril (40 mg daily), and ibuprofen (400...
A 75-year-old man presented to the emergency department with diffuse swelling of his tongue that had begun a few hours earlier. He had no known history of allergies. He had...
Hypertension affects more than 1 billion adults worldwide and is the leading cause of preventable death. Despite the plethora of drugs available, the disease is adequately controlled in only about...
Angiotensin-convertingâenzyme (ACE) inhibitors are among the most widely prescribed antihypertensive agents in the United States, but when used in the second half of pregnancy, they can cause oligohydramnios, fetal growth...
ORIGINAL ARTICLE: Major Congenital Malformations after First-Trimester Exposure to ACE Inhibitors -
William O. Cooper, M.D., M.P.H., Sonia Hernandez-Diaz, M.D., Dr.P.H., Patrick G. Arbogast, Ph.D., Judith A. Dudley, B.S., Shannon Dyer, B.S., Patricia S. Gideon, R.N., Kathi Hall, B.S., and Wayne A. Ray, Ph.D.
New England Journal of Medicine - Hypertension
Background: Use of angiotensin-convertingâenzyme (ACE) inhibitors during the second and third trimesters of pregnancy is contraindicated because of their association with an increased risk of fetopathy. In contrast, first-trimester (...)
In the past 30 years, the techniques for measuring blood pressure to determine whether a patient has hypertension have undergone a substantial change. The bulk of our knowledge about the...
Prehypertension, defined as the blood-pressure range of 120 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic, is present in about 70 million Americans.12 The condition heralds...
ORIGINAL ARTICLE: Feasibility of Treating Prehypertension with an Angiotensin-Receptor Blocker -
Stevo Julius, M.D., Sc.D., Shawna D. Nesbitt, M.D., Brent M. Egan, M.D., Michael A. Weber, M.D., Eric L. Michelson, M.D., Niko Kaciroti, Ph.D., Henry R. Black, M.D., Richard H. Grimm, Jr., M.D., Ph.D., Franz H. Messerli, M.D., Suzanne Oparil, M.D., and M. Anthony Schork, Ph.D., for the Trial of Preventing Hypertension (TROPHY) Study Investigators
New England Journal of Medicine - Hypertension
Background: Prehypertension is considered a precursor of stage 1 hypertension and a predictor of excessive cardiovascular risk. We investigated whether pharmacologic treatment of prehypertension prevents or postpones stage 1 (...)
A 29-year-old pregnant woman with systemic lupus erythematosus was admitted to the hospital because of renal failure at 20 weeks 6 days of gestation.The patient, a native of Panama, had...
Adherence to (or compliance with) a medication regimen is generally defined as the extent to which patients take medications as prescribed by their health care providers. The word âadherenceâ is...
Angiotensin-convertingâenzyme (ACE) inhibitors and angiotensin-receptor blockers are used commonly in clinical practice to treat hypertension and decrease cardiovascular events in high-risk patients. A side effect of such therapy is (...)
ORIGINAL ARTICLE: Rates of Hyperkalemia after Publication of the Randomized Aldactone Evaluation Study -
David N. Juurlink, M.D., Ph.D., Muhammad M. Mamdani, Pharm.D., M.P.H., Douglas S. Lee, M.D., Alexander Kopp, B.A., Peter C. Austin, Ph.D., Andreas Laupacis, M.D., and Donald A. Redelmeier, M.D.
New England Journal of Medicine - Hypertension
Background: The Randomized Aldactone Evaluation Study (RALES) demonstrated that spironolactone significantly improves outcomes in patients with severe heart failure. Use of angiotensin-convertingâenzyme (ACE) inhibitors is also indicated in these (...)
The two primary regulators of aldosterone secretion are potassium and the reninâangiotensin system. The latter is involved in volume homeostasis, with high salt intake suppressing the reninâangiotensin system and aldosterone...
ORIGINAL ARTICLE: Serum Aldosterone and the Incidence of Hypertension in Nonhypertensive Persons -
Ramachandran S. Vasan, M.D., Jane C. Evans, D.Sc., Martin G. Larson, Sc.D., Peter W.F. Wilson, M.D., James B. Meigs, M.D., M.P.H., Nader Rifai, Ph.D., Emelia J. Benjamin, M.D., and Daniel Levy, M.D.
New England Journal of Medicine - Hypertension
Background: Primary hyperaldosteronism is a well-recognized cause of secondary hypertension. It is unknown whether serum aldosterone levels within the physiologic range influence the risk of hypertension.Methods: We investigated the (...)
A 42-year-old man was hospitalized because he had had confusion, weakness, and lethargy for approximately a week. Hypertension had recently been diagnosed, and the patient had begun therapy with a...
ORIGINAL ARTICLE: Prognostic Value of Ambulatory Blood-Pressure Recordings in Patients with Treated Hypertension -
Denis L. Clement, M.D., Ph.D., Marc L. De Buyzere, B.Sc., Dirk A. De Bacquer, Ph.D., Peter W. de Leeuw, M.D., Ph.D., Daniel A. Duprez, M.D., Ph.D., Robert H. Fagard, M.D., Ph.D., Peter J. Gheeraert, M.D., Luc H. Missault, M.D., Jacob J. Braun, M.D., Roland O. Six, M.D., Patricia Van Der Niepen, M.D., and Eoin O'Brien, M.D., Ph.D., for the Office versus Ambulatory Pressure Study Investigators
New England Journal of Medicine - Hypertension
Background: It is uncertain whether ambulatory blood-pressure measurements recorded for 24 hours in patients with treated hypertension predict cardiovascular events independently of blood-pressure measurements obtained in the physician's office (...)
Ambulatory blood-pressure monitoring provides automated measurements of brachial-artery pressure over a 24-hour period while patients are engaging in their usual activities. This method has been used for more than 30...
Not infrequently, on release of the results of major multicenter trials, the lay press promulgates an immediate response before physicians have had time to assess the peer-reviewed paper. By the...
A 50-year-old black American has a blood pressure of 160/110 mm Hg on repeated measurements. He is 9 kg (20 lb) overweight, has a family history of hypertension, and smokes...
ORIGINAL ARTICLE: A Comparison of Outcomes with Angiotensin-ConvertingâEnzyme Inhibitors and Diuretics for Hypertension in the Elderly -
Lindon M.H. Wing, M.B., B.S., Christopher M. Reid, Ph.D., Philip Ryan, M.B., B.S., Lawrence J. Beilin, M.D., Mark A. Brown, M.B., B.S., M.D., Garry L.R. Jennings, M.D., Colin I. Johnston, M.B., B.S., John J. McNeil, M.B., B.S., Graham J. Macdonald, M.D., John E. Marley, M.D., M.B., Ch.B., Trefor O. Morgan, M.B., B.S., and Malcolm J. West, M.B., B.S., for the Second Australian National Blood Pressure Study Group
New England Journal of Medicine - Hypertension
Background: Treatment of hypertension with diuretics, beta-blockers, or both leads to improved outcomes. It has been postulated that agents that inhibit the reninâangiotensin system confer benefit beyond the reduction of...
A 36-year-old, right-handed man was admitted to the hospital because of seizures and severe hypertension.The patient had an 18-year history of intravenous drug abuse, including abuse of heroin and cocaine...
For centuries, practitioners of midwifery have feared the occurrence of convulsions during pregnancy because they carried a particularly grave prognosis for both mother and fetus. In 17th-century Paris, eclampsia was...
Dissecting the pathogenesis of primary, or âessential,â hypertension has proved elusive. In recent years, the hypothesis that having relatively fewer nephrons renders an otherwise healthy person more susceptible to renal...
A 23-year-old man presented with a two-month history of hypertension. At 18 years of age, he had sustained an injury to the left flank while playing college football. His blood...
The reninâangiotensin system is a master regulator of human physiology. It controls blood pressure and fluid and electrolyte balance through coordinated effects on the heart, blood vessels, and kidneys. In...
A 66-year-old man without diabetes has worsening high blood pressure, to 160/100 mm Hg. He has a serum creatinine level of 1.8 mg per deciliter (159 μmol per liter), an...
When ventricular septal rupture complicates acute myocardial infarction, the mortality is high. Reperfusion therapy has reduced the incidence of septal rupture. However, rapid diagnosis, aggressive medical management, and surgical (...)
ORIGINAL ARTICLE: Increase in Nocturnal Blood Pressure and Progression to Microalbuminuria in Type 1 Diabetes -
Empar Lurbe, M.D., Josep Redon, M.D., Ajit Kesani, M.D., Jose Maria Pascual, M.D., Jose Tacons, M.D., Vicente Alvarez, M.D., and Daniel Batlle, M.D.
New England Journal of Medicine - Hypertension
Background: Patients with type 1 diabetes mellitus and microalbuminuria often have elevated blood pressure while they are asleep, but it is not known whether the elevation develops concomitantly with microalbuminuria...
ORIGINAL ARTICLE: Inhaled Iloprost for Severe Pulmonary Hypertension -
Horst Olschewski, M.D., Gerald Simonneau, M.D., Nazzareno Galiè, M.D., Timothy Higenbottam, M.D., Robert Naeije, M.D., Lewis J. Rubin, M.D., Sylvia Nikkho, M.D., Rudolf Speich, M.D., Marius M. Hoeper, M.D., Jürgen Behr, M.D., Jörg Winkler, M.D., Olivier Sitbon, M.D., Wladimir Popov, M.D., H. Ardeschir Ghofrani, M.D., Alessandra Manes, M.D., David G. Kiely, M.D., Ralph Ewert, M.D., Andreas Meyer, M.D., Paul A. Corris, F.R.C.P., Marion Delcroix, M.D., Miguel Gomez-Sanchez, M.D., Harald Siedentop, Dipl.Stat., and Werner Seeger, M.D., for the Aerosolized Iloprost Randomized Study (...)
New England Journal of Medicine - Hypertension
Background: Uncontrolled studies suggested that aerosolized iloprost, a stable analogue of prostacyclin, causes selective pulmonary vasodilatation and improves hemodynamics and exercise capacity in patients with pulmonary hypertension.Methods: We compared (...)
Left ventricular dysfunction, regardless of its cause, results in characteristic hemodynamic derangements and a process of neurohormonal activation. Among the neuronal and hormonal pathways activated are the sympathetic nervous (...)
Renovascular hypertension is a potentially curable form of secondary hypertension generally due to either atherosclerosis or fibromuscular dysplasia of one or both renal arteries.12 The critical element promoting hypertension (...)
ORIGINAL ARTICLE: Endothelial Function and Oxidative Stress in Renovascular Hypertension -
Yukihito Higashi, M.D., Shota Sasaki, M.D., Keigo Nakagawa, M.D., Hideo Matsuura, M.D., Tetsuya Oshima, M.D., and Kazuaki Chayama, M.D.
New England Journal of Medicine - Hypertension
Background: It has been reported that renovascular hypertension activates the reninâangiotensin system, leading to an increase in oxidative stress. We sought to determine whether renal-artery angioplasty improves endothelial dysfunction (...)
ORIGINAL ARTICLE: Germ-Line Mutations in Nonsyndromic Pheochromocytoma -
Hartmut P.H. Neumann, M.D., Birke Bausch, Sarah R. McWhinney, B.A., Bernhard U. Bender, M.D., Oliver Gimm, M.D., Gerlind Franke, Ph.D., Joerg Schipper, M.D., Joachim Klisch, M.D., Carsten Altehoefer, M.D., Klaus Zerres, M.D., Andrzej Januszewicz, M.D., Wendy M. Smith, B.A., Robin Munk, M.D., Tanja Manz, M.D., Sven Glaesker, M.D., Thomas W. Apel, Ph.D., Markus Treier, M.D., Martin Reineke, M.D., Martin K. Walz, M.D., Cuong Hoang-Vu, M.D., Michael Brauckhoff, M.D., Andreas Klein-Franke, M.D., Peter Klose, M.D., Heinrich Schmidt, M.D., Margarete Maier-Woelfle, M.D., Mariola Peçzkowska, M.D., (...)
New England Journal of Medicine - Hypertension
Background: The group of susceptibility genes for pheochromocytoma that included the proto-oncogene RET (associated with multiple endocrine neoplasia type 2 [MEN-2]) and the tumor-suppressor gene VHL (associated with von HippelâLindau...
In 1856 Ludwig Traube1 proposed a role of the kidney in the pathogenesis of hypertension on the basis that hypertension and vascular disease were often associated with chronic Bright's disease....
ORIGINAL ARTICLE: Bosentan Therapy for Pulmonary Arterial Hypertension -
Lewis J. Rubin, M.D., David B. Badesch, M.D., Robyn J. Barst, M.D., Nazzareno Galiè, M.D., Carol M. Black, M.D., Anne Keogh, M.D., Tomas Pulido, M.D., Adaani Frost, M.D., Sébastien Roux, M.D., Isabelle Leconte, Ph.D., Michael Landzberg, M.D., and Gérald Simonneau, M.D., for the Bosentan Randomized Trial of Endothelin Antagonist Therapy Study Group
New England Journal of Medicine - Hypertension
Background: Endothelin-1 is a potent vasoconstrictor and smooth-muscle mitogen. In a preliminary study, the orally administered dual endothelin-receptor antagonist bosentan improved exercise capacity and cardiopulmonary hemodynamics in patients with (...)
SPECIAL ARTICLE: Outcomes of Reference Pricing for Angiotensin-ConvertingâEnzyme Inhibitors -
Sebastian Schneeweiss, M.D., Alexander M. Walker, M.D., Robert J. Glynn, Ph.D., Malcolm Maclure, Sc.D., Colin Dormuth, M.A., and Stephen B. Soumerai, Sc.D.
New England Journal of Medicine - Hypertension
Background: In January 1997, reference pricing for angiotensin-convertingâenzyme (ACE) inhibitors for patients 65 years of age or older was introduced in British Columbia, Canada. For medications within a specific class,...
Fenoldopam mesylate, a benzazepine derivative, is the first selective dopamine-1âreceptor agonist that has been approved for clinical use. Administered parenterally, it acts predominantly as a vasodilator in peripheral arteries (...)
ORIGINAL ARTICLE: The Effect of Common Polymorphisms of the β-Adrenergic Receptor on Agonist-Mediated Vascular Desensitization -
Victor Dishy, M.D., Gbenga G. Sofowora, M.D., Hong-Guang Xie, M.D., Richard B. Kim, M.D., Daniel W. Byrne, M.S., C. Michael Stein, M.D., and Alastair J.J. Wood, M.D.
New England Journal of Medicine - Hypertension
Background: With continuous exposure to β2-adrenergic agonists, vascular tissue becomes desensitized to agonist-mediated vasodilatation. We studied the effects of two common polymorphisms of the β2-adrenergic receptor, one at codon (...)
The prevalence of end-stage renal disease is increasing at an alarming rate. In 2000, chronic kidney failure developed in over 90,000 people in the United States; the current population of...
ORIGINAL ARTICLE: The Effect of Irbesartan on the Development of Diabetic Nephropathy in Patients with Type 2 Diabetes -
Hans-Henrik Parving, M.D., D.M.Sc., Hendrik Lehnert, M.D., Jens Bröchner-Mortensen, M.D., D.M.Sc., Ramon Gomis, M.D., Steen Andersen, M.D., and Peter Arner, M.D., D.M.Sc., for the Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group
New England Journal of Medicine - Hypertension
Background: Microalbuminuria and hypertension are risk factors for diabetic nephropathy. Blockade of the reninâangiotensin system slows the progression to diabetic nephropathy in patients with type 1 diabetes, but similar data...
ORIGINAL ARTICLE: Effects of Losartan on Renal and Cardiovascular Outcomes in Patients with Type 2 Diabetes and Nephropathy -
Barry M. Brenner, M.D., Mark E. Cooper, M.D., Ph.D., Dick de Zeeuw, M.D., Ph.D., William F. Keane, M.D., William E. Mitch, M.D., Hans-Henrik Parving, M.D., Giuseppe Remuzzi, M.D., Steven M. Snapinn, Ph.D., Zhonxin Zhang, Ph.D., and Shahnaz Shahinfar, M.D., for the RENAAL Study Investigators
New England Journal of Medicine - Hypertension
Background: Diabetic nephropathy is the leading cause of end-stage renal disease. Interruption of the reninâangiotensin system slows the progression of renal disease in patients with type 1 diabetes, but similar...
ORIGINAL ARTICLE: Renoprotective Effect of the Angiotensin-Receptor Antagonist Irbesartan in Patients with Nephropathy Due to Type 2 Diabetes -
Edmund J. Lewis, M.D., Lawrence G. Hunsicker, M.D., William R. Clarke, Ph.D., Tomas Berl, M.D., Marc A. Pohl, M.D., Julia B. Lewis, M.D., Eberhard Ritz, M.D., Robert C. Atkins, M.D., Richard Rohde, B.S., and Itamar Raz, M.D., for the Collaborative Study Group
New England Journal of Medicine - Hypertension
Background: It is unknown whether either the angiotensin-IIâreceptor blocker irbesartan or the calcium-channel blocker amlodipine slows the progression of nephropathy in patients with type 2 diabetes independently of its capacity...
A 67-year-old woman was initially admitted to this hospital because of hypertensive encephalopathy.The patient had been well until one month before admission, when she became weak and began to have...
Despite very effective antihypertensive therapies and data from clinical trials demonstrating that lowering blood pressure reduces cardiovascular and renal complications, more than one fourth of the estimated 42 million people...
Background: Treatment of hypertension is one of the most common clinical responsibilities of U.S. physicians, yet only one fourth of patients with hypertension have their blood pressure adequately controlled.Methods: We...
ORIGINAL ARTICLE: Neonatal Pulmonary Hypertension â Urea-Cycle Intermediates, Nitric Oxide Production, and Carbamoyl-Phosphate Synthetase Function -
DeLinda L. Pearson, M.D., Sheila Dawling, Ph.D., William F. Walsh, M.D., Jonathan L. Haines, Ph.D., Brian W. Christman, M.D., Amy Bazyk, M.S., Nathan Scott, B.A., and Marshall L. Summar, M.D.
New England Journal of Medicine - Hypertension
Background: Endogenous production of nitric oxide is vital for the decrease in pulmonary vascular resistance that normally occurs after birth. The precursor of nitric oxide is arginine, a urea-cycle intermediate....
A 19-year-old man was admitted to the hospital because of headaches and hypertension.The patient had been well until two years earlier, when he began to have episodic mild headaches that...
ORIGINAL ARTICLE: Noninvasive Diagnosis of Renal-Allograft Rejection by Measurement of Messenger RNA for Perforin and Granzyme B in Urine -
Baogui Li, Ph.D., Choli Hartono, M.D., Ruchuang Ding, M.D., Vijay K. Sharma, Ph.D., Ravi Ramaswamy, M.D., Biao Qian, Ph.D., David Serur, M.D., Janet Mouradian, M.D., Joseph E. Schwartz, Ph.D., and Manikkam Suthanthiran, M.D.
New England Journal of Medicine - Hypertension
Background: Acute rejection is a serious and frequent complication of renal transplantation, and its diagnosis is contingent on the invasive procedure of allograft biopsy. A noninvasive diagnostic test for rejection...
An estimated 50,000 women per year worldwide die from preeclampsia. Preeclampsia is more likely to develop in women whose mothers had preeclampsia than in women whose mothers did not.1 The...
ORIGINAL ARTICLE: Paternal and Maternal Components of the Predisposition to Preeclampsia -
M. Sean Esplin, M.D., M. Bardett Fausett, M.D., Alison Fraser, M.S.P.H., Rich Kerber, Ph.D., Geri Mineau, Ph.D., Jorge Carrillo, M.D., and Michael W. Varner, M.D.
New England Journal of Medicine - Hypertension
Background: There is an inherited maternal predisposition to preeclampsia. Whether there is a paternal component, however, is not known.Methods: We used records of the Utah Population Database to identify 298...
Primary diseases of the renal arteries often involve the large renal arteries, whereas secondary diseases are frequently characterized by small-vessel and intrarenal vascular disease. In this article, we will concentrate...
ORIGINAL ARTICLE: Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet -
Frank M. Sacks, M.D., Laura P. Svetkey, M.D., William M. Vollmer, Ph.D., Lawrence J. Appel, M.D., George A. Bray, M.D., David Harsha, Ph.D., Eva Obarzanek, Ph.D., Paul R. Conlin, M.D., Edgar R. Miller III, M.D., Ph.D., Denise G. Simons-Morton, M.D., Ph.D., Njeri Karanja, Ph.D., Pao-Hwa Lin, Ph.D., Mikel Aickin, Ph.D., Marlene M. Most-Windhauser, Ph.D., Thomas J. Moore, M.D., Michael A. Proschan, Ph.D., and Jeffrey A. Cutler, M.D., for the DASHâSodium Collaborative Research (...)
New England Journal of Medicine - Hypertension
Background: The effect of dietary composition on blood pressure is a subject of public health importance. We studied the effect of different levels of dietary sodium, in conjunction with the...
ORIGINAL ARTICLE: Obesity, Hypertension, and the Risk of Kidney Cancer in Men -
Wong-Ho Chow, Ph.D., Gloria Gridley, M.S., Joseph F. Fraumeni, Jr., M.D., and Bengt Järvholm, M.D., Ph.D.
New England Journal of Medicine - Hypertension
Background: Obesity and hypertension have been implicated as risk factors for the development of renal-cell cancer.Methods: We examined the health records of 363,992 Swedish men who underwent at least one...
Background: Sleep-disordered breathing is prevalent in the general population and has been linked to chronically elevated blood pressure in cross-sectional epidemiologic studies. We performed a prospective, population-based study of (...)
The great economist Joseph Schumpeter regarded creative destruction as an indispensable element of economic progress. In a similar vein, the report by van Jaarsveld et al.1 in this issue of...
ORIGINAL ARTICLE: The Effect of Balloon Angioplasty on Hypertension in Atherosclerotic Renal-Artery Stenosis -
Brigit C. van Jaarsveld, M.D., Pieta Krijnen, M.Sc., Herman Pieterman, M.D., Frans H.M. Derkx, M.D., Jaap Deinum, M.D., Cornelis T. Postma, M.D., Ad Dees, M.D., Arend J.J. Woittiez, M.D., Anton K.M. Bartelink, M.D., Arie J. Man in `t Veld, M.D., and Maarten A.D.H. Schalekamp, M.D., for the Dutch Renal Artery Stenosis Intervention Cooperative Study Group
New England Journal of Medicine - Hypertension
Background: Patients with hypertension and renal-artery stenosis are often treated with percutaneous transluminal renal angioplasty. However, the long-term effects of this procedure on blood pressure are not well understood.Methods: (...)
Although thiazide diuretics and beta-blockers are often used as first-line therapy in patients with hypertension, including those with diabetes mellitus,1 the possibility that these drugs may promote glucose intolerance remains...
The level of blood pressure has long been recognized as a determinant of the risks for several common cardiovascular diseases, including coronary heart disease, cerebrovascular disease, and heart failure. Throughout...
ORIGINAL ARTICLE: The Relation between Blood Pressure and Mortality Due to Coronary Heart Disease among Men in Different Parts of the World -
Peggy C.W. van den Hoogen, M.Sc., Edith J.M. Feskens, Ph.D., Nico J.D. Nagelkerke, Ph.D., Alessandro Menotti, Ph.D., M.D., Aulikki Nissinen, Ph.D., M.D., and Daan Kromhout, Ph.D., M.P.H., for the Seven Countries Study Research Group
New England Journal of Medicine - Hypertension
Background: Elevated blood pressure is known to be a risk factor for death from coronary heart disease (CHD). However, it is unclear whether the risk of death from CHD in...
ORIGINAL ARTICLE: Reduction of Sympathetic Hyperactivity by Enalapril in Patients with Chronic Renal Failure -
Gerry Ligtenberg, M.D., Ph.D., Peter J. Blankestijn, M.D., Ph.D., P. Liam Oey, M.D., Ph.D., Inge H.H. Klein, M.D., Lioe-Ting Dijkhorst-Oei, M.D., Frans Boomsma, Ph.D., George H. Wieneke, Ph.D., Alexander C. van Huffelen, M.D., Ph.D., and Hein A. Koomans, M.D., Ph.D.
New England Journal of Medicine - Hypertension
Background: Inhibition of angiotensin-converting enzyme (ACE) reduces the risk of cardiovascular problems in patients with chronic renal failure. This effect may be due in part to a decrease in sympathetic...
The adverse effect of left ventricular hypertrophy, as measured by the weight of the heart on the pathologist's scale, was recognized in the early part of this century, even before...
ORIGINAL ARTICLE: Trends in the Prevalence of Hypertension, Antihypertensive Therapy, and Left Ventricular Hypertrophy from 1950 to 1989 -
Arend Mosterd, M.D., Ph.D., Ralph B. D'Agostino, Ph.D., Halit Silbershatz, Ph.D., Pamela A. Sytkowski, Ph.D., William B. Kannel, M.D., M.P.H., Diederick E. Grobbee, M.D., Ph.D., and Daniel Levy, M.D.
New England Journal of Medicine - Hypertension
Background: Men and women with hypertension are at increased risk for cardiovascular disease, especially when left ventricular hypertrophy is present. We examined temporal trends in the use of antihypertensive medications...
Disease-causing mutations often reveal key pathways of physiologic regulation and their underlying molecular mechanisms. Mutations in the trimeric guanine nucleotide-binding proteins (G proteins), which relay signals initiated by photons, (...)
In patients with renal diseases characterized by proteinuria, the initial insult to the kidney is usually followed by a progressive decline in the glomerular filtration rate. This decline has been...
Background: Many factors contribute to the regulation of blood pressure. The role of climate has received relatively little attention.Methods: During a four-year period, we determined the influence of climate on...
Background: Angiotensin-convertingâenzyme (ACE) inhibitors not only decrease the production of angiotensin II but also decrease the degradation of bradykinin. In this study, a specific bradykinin-receptor antagonist, icatibant acetate (HOE (...)
ORIGINAL ARTICLE: Risk Factors for Preeclampsia, Abruptio Placentae, and Adverse Neonatal Outcomes among Women with Chronic Hypertension -
Baha M. Sibai, M.D., Marshall Lindheimer, M.D., John Hauth, M.D., Steve Caritis, M.D., Peter VanDorsten, M.D., Mark Klebanoff, M.D., Cora MacPherson, M.S., Mark Landon, M.D., Menachem Miodovnik, M.D., Richard Paul, M.D., Paul Meis, M.D., and Mitchell Dombrowski, M.D., Gary Thurnau, M.D. , James Roberts, M.D., Donald McNellis, M.D., for the National Institute of Child Health and Human Development Network of MaternalâFetal Medicine Units
New England Journal of Medicine - Hypertension
Background: Women with chronic hypertension who become pregnant have an increased risk of preeclampsia and adverse neonatal outcomes. However, within this group, the risk factors for these adverse events are...
ORIGINAL ARTICLE: The Effect of an Endothelin-Receptor Antagonist, Bosentan, on Blood Pressure in Patients with Essential Hypertension -
Henry Krum, M.B., B.S., Ph.D., Reuven J. Viskoper, M.D., Yves Lacourciere, M.D., Michael Budde, Ph.D., and Vincent Charlon, Ph.D., for the Bosentan Hypertension Investigators
New England Journal of Medicine - Hypertension
Background: Endothelin is a powerful vasoconstrictor peptide derived from the endothelium. We evaluated the contribution of endothelin to blood-pressure regulation in patients with essential hypertension by studying the effect (...)
Preeclampsia, defined as hypertension and proteinuria or nondependent edema after 20 weeks' gestation, is a common complication of pregnancy. Endothelial-cell dysfunction with vasospasm, pathologic coagulation, and hypersensitivity to pressor (...)
After the introduction of calcium-channel blockers into clinical practice nearly two decades ago, prescriptions for these drugs for the treatment of hypertension increased to the point where they became the...
ORIGINAL ARTICLE: The Effect of Nisoldipine as Compared with Enalapril on Cardiovascular Outcomes in Patients with Non-Insulin-Dependent Diabetes and Hypertension -
Raymond O. Estacio, M.D., Barrett W. Jeffers, M.S., William R. Hiatt, M.D., Stacy L. Biggerstaff, M.S., Nancy Gifford, R.N., and Robert W. Schrier, M.D.
New England Journal of Medicine - Hypertension
Background: It has recently been reported that the use of calcium-channel blockers for hypertension may be associated with an increased risk of cardiovascular complications. Because this issue remains controversial, we...
ORIGINAL ARTICLE: Trial of Calcium to Prevent Preeclampsia -
Richard J. Levine, M.D., John C. Hauth, M.D., Luis B. Curet, M.D., Baha M. Sibai, M.D., Patrick M. Catalano, M.D., Cynthia D. Morris, Ph.D., Rebecca DerSimonian, Sc.D., Joy R. Esterlitz, M.S., Elizabeth G. Raymond, M.D., Diane E. Bild, M.D., John D. Clemens, M.D., and Jeffrey A. Cutler, M.D., Marian G. Ewell, Steven A. Friedman, Robert L. Goldenberg, Sig-Linda Jacobson, Gary M. Joffe, M.D, Mark A. Klebanoff, Alice S. Petrulis, M.D.
New England Journal of Medicine - Hypertension
Background: Previous trials have suggested that calcium supplementation during pregnancy may reduce the risk of preeclampsia. However, differences in study design and a low dietary calcium intake in the populations...
Preeclampsia continues to be a major health problem. It is a leading cause of maternal mortality in developed countries and is associated with a fivefold increase in perinatal mortality. It...
ORIGINAL ARTICLE: A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure -
Lawrence J. Appel, M.D., M.P.H., Thomas J. Moore, M.D., Eva Obarzanek, Ph.D., William M. Vollmer, Ph.D., Laura P. Svetkey, M.D., M.H.S., Frank M. Sacks, M.D., George A. Bray, M.D., Thomas M. Vogt, M.D., M.P.H., Jeffrey A. Cutler, M.D., Marlene M. Windhauser, Ph.D., R.D., Pao-Hwa Lin, Ph.D., and Njeri Karanja, Ph.D., Denise Simons-Morton, M.D., Ph.D., Marjorie McCullough, M.S., R.D., Janis Swain, M.S., R.D., Priscilla Steele, M.S., R.D., Marguerite A. Evans, M.S., R.D., Edgar R. Miller III, M.D., Ph.D., David W. Harsha, Ph.D., for the DASH Collaborative Research (...)
New England Journal of Medicine - Hypertension
Background: It is known that obesity, sodium intake, and alcohol consumption influence blood pressure. In this clinical trial, Dietary Approaches to Stop Hypertension, we assessed the effects of dietary patterns...
The measurement of blood pressure is now firmly established as an important component of the routine pediatric physical examination. Nevertheless, blood pressure in children has been given serious attention only...
Hypertensive disorders are the most common medical complications of pregnancy and are an important cause of maternal and perinatal morbidity and mortality worldwide.1 During normal pregnancy, systolic pressure changes little;...
Abnormalities of glucose, insulin, and lipoprotein metabolism are common in patients with hypertension. These changes can also be discerned in normotensive first-degree relatives of hypertensive patients. They are not present...
ORIGINAL ARTICLE: Blood Pressure and End-Stage Renal Disease in Men -
Michael J. Klag, M.D., M.P.H., Paul K. Whelton, M.D., Bryan L. Randall, M.S., James D. Neaton, Ph.D., Frederick L. Brancati, M.D., M.H.S., Charles E. Ford, Ph.D., Neil B. Shulman, M.D., and Jeremiah Stamler, M.D.
New England Journal of Medicine - Hypertension
Background: End-stage renal disease in the United States creates a large burden for both individuals and society as a whole. Efforts to prevent the condition require an understanding of modifiable...