1,721,163 research outputs found
Diastolic heart failure
No full textHeart failure with preserved ejection fraction (i.e. diastolic heart failure) accounts for about half of heart failure cases. The aim of this review is to reflect current knowledge regarding the epidemiology, pathophysiology and treatment. Diastolic heart failure patients are principally elderly and predominantly female. Numerous pathophysiological alterations in this disease have been shown and recent therapeutic recommendations include control of cardiovascular risk factors and symptoms. New therapeutic options, such as inhibition of late sodium current, aldosterone receptor blockade, combined inhibition of AT1 receptor and the enzyme neprilysin, and phosphodiesterase 5 inhibition are discussed in this review and ongoing clinical trials are also briefly presented. Diastolic heart failure remains a cardiac disease which is difficult to treat; however, new study results allow a better definition of a population of patients who could benefit from specific therapies
Invasive treatment of hypertension. Update 2016
No full textInvasive treatment methods-more specifically renal denervation and baroreceptor activator therapy-have been used for the treatment of therapy-resistant hypertension for several years now. In particular, renal denervation has aroused great interest because it was easy to perform and the first studies provided very promising results. Meanwhile, however, three randomized, blinded studies have been published, and none showed a significant benefit of renal denervation compared to a sham procedure. In addition, in several studies it was demonstrated that intensification of drug therapy, particularly with spironolactone, is at least comparable. Carotid sinus node baroreceptor activator therapy tends to be superior to renal denervation, but the probe currently used is not optimal. The first results by inserting an arteriovenous shunt between the iliac artery and vein are promising, but lack long-term safety data. Currently, all invasive treatment procedures should be performed within the framework of studies or accurate register surveys
Interventional strategies in hypertension management
No full textA number of invasive treatment approaches have become established in the management of severe treatment-resistant hypertension in recent years, including renal denervation and baroreceptor activation therapy. Both methods achieve their antihypertensive effect by influencing the autonomic nervous system. Renal denervation in particular has stimulated considerable interest, since it is simple to perform and initial studies have yielded highly promising results. However, enthusiasm has waned significantly since the initial euphoria. This is due to the fact that the first randomized placebo-controlled double-blind study showed the method to have no significant effect on blood pressure. This experience illustrates the importance of conducting double-blind studies. On the other hand, these results should not lead to renal denervation being shelved. On the contrary, it is worth attempting to improve the treatment and develop criteria to identify which patients it is likely to benefit. Although experience with baroreceptor activation therapy is significantly more limited, similar conclusions can be drawn on it, despite the fact that-in contrast to renal denervation-it achieved a blood pressure reduction of around 10 mmHg in a double-blind study. A potential novel treatment approach lies in creating an arteriovenous shunt between the iliac artery and vein, which has a particularly marked effect on diastolic blood pressure by reducing peripheral resistance. Therapy using brain stimulation of areas in the brainstem region responsible for blood pressure regulation is still at an experimental stage
Letter by Wachter et al Regarding Article "Cost-Effectiveness of Outpatient Cardiac Monitoring to Detect Atrial Fibrillation After Ischemic Stroke"
No full textImpact of diabetes and hypertension on the heart
No full textPurpose of review Hypertension and diabetes both contribute to cardiovascular disease. The purpose of this review is to summarize novel epidemiological and clinical insights into the risk continuum of blood pressure and abnormalities in glucose metabolism for cardiovascular adverse remodelling, summarize the current mechanistic knowledge on hypertensive heart disease and diabetic cardiomyopathy, outline the effects of hypertension and diabetes on diastolic dysfunction and heart failure with normal ejection fraction, and discuss novel therapeutic aspects in these disease entities. Recent findings The prevalence of diabetes mellitus and hypertension increases in western populations and largely contributes to adverse cardiovascular remodelling and the growing number of patients with heart failure. Recently, diastolic heart failure (i.e., heart failure with normal ejection fraction) has been recognized as a major adverse manifestation of hypertension and diabetes, but convincing therapeutic strategies other than strict risk factor control are still lacking. However, due to clearer definitions and novel noninvasive diagnostic techniques for heart failure with normal ejection fraction, future studies may better define new specific therapeutic approaches. Summary New insights into the epidemiology and pathophysiology of diabetes-associated and hypertension-associated cardiac alterations may open the field for novel preventive therapeutic strategies tailored to reduce the risk of heart failure in this large population at risk
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