Increasing prevalence of hypertension (HTN) in children and adolescents has become a significant public health issue driving a considerable amount of research. Aspects discussed in this document include advances in the definition of HTN in 16 year or older, clinical significance of isolated systolic HTN in youth, the importance of out of office and central blood pressure measurement, new risk factors for HTN, methods to assess vascular phenotypes, clustering of cardiovascular risk factors and treatment strategies among others. The recommendations of the present document synthesize a considerable amount of scientific data and clinical experience and represent the best clinical wisdom upon which physicians, nurses and families should base their decisions. In addition, as they call attention to the burden of HTN in children and adolescents, and its contribution to the current epidemic of cardiovascular disease, these guidelines should encourage public policy makers to develop a global effort to improve identification and treatment of high blood pressure among children and adolescents.
- MeSH
- antihypertenziva terapeutické užití MeSH
- dítě MeSH
- hypertenze diagnóza epidemiologie genetika terapie MeSH
- komorbidita MeSH
- krevní tlak * MeSH
- lidé MeSH
- měření krevního tlaku metody MeSH
- mladiství MeSH
- prevalence MeSH
- rizikové faktory MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
- směrnice pro lékařskou praxi MeSH
BACKGROUND AND OBJECTIVES: The SBP values to be achieved by antihypertensive therapy in order to maximize reduction of cardiovascular outcomes are unknown; neither is it clear whether in patients with a previous cardiovascular event, the optimal values are lower than in the low-to-moderate risk hypertensive patients, or a more cautious blood pressure (BP) reduction should be obtained. Because of the uncertainty whether 'the lower the better' or the 'J-curve' hypothesis is correct, the European Society of Hypertension and the Chinese Hypertension League have promoted a randomized trial comparing antihypertensive treatment strategies aiming at three different SBP targets in hypertensive patients with a recent stroke or transient ischaemic attack. As the optimal level of low-density lipoprotein cholesterol (LDL-C) level is also unknown in these patients, LDL-C-lowering has been included in the design. PROTOCOL DESIGN: The European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment trial is a prospective multinational, randomized trial with a 3 × 2 factorial design comparing: three different SBP targets (1, <145-135; 2, <135-125; 3, <125 mmHg); two different LDL-C targets (target A, 2.8-1.8; target B, <1.8 mmol/l). The trial is to be conducted on 7500 patients aged at least 65 years (2500 in Europe, 5000 in China) with hypertension and a stroke or transient ischaemic attack 1-6 months before randomization. Antihypertensive and statin treatments will be initiated or modified using suitable registered agents chosen by the investigators, in order to maintain patients within the randomized SBP and LDL-C windows. All patients will be followed up every 3 months for BP and every 6 months for LDL-C. Ambulatory BP will be measured yearly. OUTCOMES: Primary outcome is time to stroke (fatal and non-fatal). Important secondary outcomes are: time to first major cardiovascular event; cognitive decline (Montreal Cognitive Assessment) and dementia. All major outcomes will be adjudicated by committees blind to randomized allocation. A Data and Safety Monitoring Board has open access to data and can recommend trial interruption for safety. SAMPLE SIZE CALCULATION: It has been calculated that 925 patients would reach the primary outcome after a mean 4-year follow-up, and this should provide at least 80% power to detect a 25% stroke difference between SBP targets and a 20% difference between LDL-C targets.
- MeSH
- antihypertenziva terapeutické užití MeSH
- cévní mozková příhoda prevence a kontrola MeSH
- demence etiologie MeSH
- hypertenze komplikace farmakoterapie MeSH
- kognice MeSH
- kognitivní poruchy prevence a kontrola MeSH
- krevní tlak účinky léků MeSH
- LDL-cholesterol krev MeSH
- lidé MeSH
- měření krevního tlaku MeSH
- prospektivní studie MeSH
- recidiva MeSH
- sekundární prevence metody MeSH
- senioři MeSH
- statiny terapeutické užití MeSH
- tranzitorní ischemická ataka farmakoterapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- Geografické názvy
- Čína MeSH
- Evropa MeSH
BACKGROUND AND OBJECTIVES: It is well established by a large number of randomized controlled trials that lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) by drugs are powerful means to reduce stroke incidence, but the optimal BP and LDL-C levels to be achieved are largely uncertain. Concerning BP targets, two hypotheses are being confronted: first, the lower the BP, the better the treatment outcome, and second, the hypothesis that too low BP values are accompanied by a lower benefit and even higher risk. It is also unknown whether BP lowering and LDL-C lowering have additive beneficial effects for the primary and secondary prevention of stroke, and whether these treatments can prevent cognitive decline after stroke. RESULTS: A review of existing data from randomized controlled trials confirms that solid evidence on optimal BP and LDL-C targets is missing, possible interactions between BP and LDL-C lowering treatments have never been directly investigated, and evidence in favour of a beneficial effect of BP or LDL-C lowering on cognitive decline is, at best, very weak. CONCLUSION: A new, large randomized controlled trial is needed to determine the optimal level of BP and LDL-C for the prevention of recurrent stroke and cognitive decline.
- MeSH
- cévní mozková příhoda prevence a kontrola MeSH
- cholesterol MeSH
- hypercholesterolemie farmakoterapie MeSH
- kognice MeSH
- kognitivní poruchy prevence a kontrola MeSH
- krevní tlak účinky léků MeSH
- LDL-cholesterol krev MeSH
- lidé MeSH
- primární prevence MeSH
- randomizované kontrolované studie jako téma MeSH
- recidiva MeSH
- sekundární prevence MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Drugs, ISSN 0012-6667 vol. 65, suppl. 2, 2005
42 s. : il., tab. ; 25 cm
- MeSH
- antihypertenziva farmakologie terapeutické užití MeSH
- blokátory kalciových kanálů farmakologie terapeutické užití MeSH
- hypertenze krev farmakoterapie MeSH
- průchodnost cév účinky léků MeSH
- Publikační typ
- sborníky MeSH
- Konspekt
- Farmacie. Farmakologie
- NLK Obory
- farmacie a farmakologie
- farmacie a farmakologie
- angiologie
- kardiologie
Drugs, ISSN 0012-6667 vol. 59, suppl. 2, 2000
40 s. : tab., grafy ; 26 cm
Drugs. 1, ISSN 0012-6667 Supplement vol. 57
29 s. : il. ; 26 cm
- MeSH
- antihypertenziva MeSH
- blokátory kalciových kanálů MeSH
- hypertenze farmakoterapie MeSH
- Publikační typ
- kongresy MeSH
- Konspekt
- Lékařské vědy. Lékařství
- NLK Obory
- farmacie a farmakologie
- kardiologie
- angiologie
Handbook of hypertension ; Vol. 17
xix, 1102 s. : il.
- MeSH
- hypertenze patofyziologie MeSH
- kardiovaskulární fyziologické jevy MeSH
- kardiovaskulární systém patofyziologie MeSH
- Publikační typ
- příručky MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- kardiologie
- vnitřní lékařství
[1st ed.] xvii, 266 s. : il.
- MeSH
- hypertenze MeSH
- terapie MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- angiologie
- terapie
Drugs ; Supplement Vol. 46. 2
VIII, 213 s. : obr., tab., grafy ; 25 cm
- MeSH
- antihypertenziva farmakologie MeSH
- hypertenze farmakoterapie terapie MeSH
- rizikové faktory MeSH
- Publikační typ
- kongresy MeSH
- Konspekt
- Farmacie. Farmakologie
- NLK Obory
- farmacie a farmakologie
