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Related Concept Videos

Hypertension I: Introduction01:28

Hypertension I: Introduction

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Hypertension is a widespread, long-term medical condition where blood pressure in the arteries remains elevated. It is characterized by systolic blood pressure readings of 130 mm Hg or above or diastolic blood pressure (DBP) readings of 80 mm Hg or higher. Unmanaged hypertension poses significant health risks, making the distinction between primary (or essential) hypertension and secondary hypertension crucial, as their management and implications vary.Primary HypertensionPrimary hypertension,...
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Hypertension and Regulation of Blood Pressure01:18

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Hypertension, the most common cardiovascular disease, is diagnosed through repeated measurements of elevated blood pressure. Its risks, including damage to the kidney, heart, and brain, are directly proportional to blood pressure levels. Starting from 115/75 mm Hg, the risk of cardiovascular disease doubles with each increment of 20/10 mm Hg. The diagnosis relies on blood pressure measurements, not on patient symptoms, as hypertension is often asymptomatic until end-organ damage is imminent or...
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Hypertension II: Pathophysiology01:29

Hypertension II: Pathophysiology

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Hypertension is a chronic condition in which the blood's force against artery walls is excessively high, posing risks such as heart disease. The condition's underlying mechanisms involve complex interactions among the cardiovascular, kidney, and autonomic nervous systems.Renin-Angiotensin-Aldosterone System (RAAS): This system significantly influences blood pressure regulation. When blood pressure decreases, the kidneys secrete renin. This enzyme transforms angiotensinogen, a plasma protein,...
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Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

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The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
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Antihypertensive Drugs: Angiotensin II Receptor Blockers01:30

Antihypertensive Drugs: Angiotensin II Receptor Blockers

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In the renin-angiotensin-aldosterone system, a hormone called angiotensin II plays a crucial role. It binds to the AT1 receptors in vascular smooth muscles coupled with Gq proteins. The activation of these receptors activates an enzyme called phospholipase C, which releases two molecules: inositol trisphosphate and diacylglycerol. These molecules cause a chain reaction that leads to the phosphorylation of myosin light chains and promotes interaction between actin and myosin, leading to smooth...
2.9K
Hypertension III: Clinical Manifestations and Diagnostic Studies01:30

Hypertension III: Clinical Manifestations and Diagnostic Studies

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Hypertension is asymptomatic and also referred to as the "silent killer" until it progresses to a severe stage or causes target organ disease. Patients may experience symptoms stemming from the strain on blood vessels and tissues in various organs or the heart's increased workload.Physical exams might show no abnormalities other than high blood pressure. Signs of vascular damage, when present, correspond to the organs supplied by the affected vessels, leading to target organ damage. For...
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Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
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Resistant or refractory hypertension: are they different?

Rodrigo Modolo1, Ana Paula de Faria, Aurélio Almeida

  • 1Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas, FCM 10 Building, 1st Floor, Campinas, SP, Brazil, 13083-970.

Current Hypertension Reports
|August 21, 2014
PubMed
Summary

Resistant hypertension (RHTN) is uncontrolled blood pressure despite medication. Refractory hypertension, a severe RHTN subset, shows higher cardiovascular risks and organ damage, requiring more intensive management.

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Area of Science:

  • Cardiology
  • Nephrology
  • Internal Medicine

Background:

  • Resistant hypertension (RHTN) is defined by uncontrolled blood pressure (BP) despite multiple medications.
  • Refractory hypertension is a severe subset of RHTN, characterized by persistent uncontrolled BP even with intensified treatment.
  • Recent research highlights distinct characteristics differentiating refractory hypertension from general RHTN.

Purpose of the Study:

  • To review and synthesize current data on the distinct phenotypes of resistant and refractory hypertension.
  • To delineate the specific clinical characteristics and risk factors associated with refractory hypertension.
  • To provide an updated overview of these high-risk patient groups.

Main Methods:

  • Comprehensive literature review of key studies on resistant and refractory hypertension.
  • Analysis of identified phenotypes and their associated clinical features.
  • Synthesis of data to characterize differences between RHTN and refractory hypertension.

Main Results:

  • Refractory hypertension patients exhibit increased cardiovascular risk and target organ damage.
  • Specific characteristics include higher prevalence in individuals of African descent, increased coronary heart disease, and myocardial ischemia.
  • Other identified factors include aldosterone excess, adipokine deregulation, and potential sympathetic hyperactivation.

Conclusions:

  • Refractory hypertension represents a distinct, high-risk phenotype within resistant hypertension.
  • Understanding these differences is crucial for targeted patient management and risk stratification.
  • Further research is warranted to elucidate the mechanisms and optimize treatment strategies for refractory hypertension.