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Biomedical subjects

Nitin Khosla

Publications and source records attributed to Nitin Khosla.

5 recordsLinked to original sources
PubMed2007

Antihypertensive therapy in the presence of proteinuria.

The presence of proteinuria is a well-known risk factor for both the progression of renal disease and cardiovascular morbidity and mortality, and decreases in urine protein excretion level were associated with a slower decrease in renal function and decrease in risk of cardiovascular events. Increased blood pressure has a major role in the development of proteinuria in patients with either diabetic or nondiabetic kidney disease, and all recent guidelines recommend a blood pressure goal less than 130/80 mm Hg in patients with proteinuria to achieve maximal renal and cardiovascular protection. Drugs interfering with the renin-angiotensin system, ie, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, should be used as first-line antihypertensive therapy in patients with proteinuria because they seem to have a blood pressure-independent antiproteinuric effect, and if blood pressure levels are still out of goal, a diuretic should be added to this regimen. A combination of an angiotensin-converting enzyme inhibitor with an angiotensin receptor blocker or other classes of medications shown to decrease protein excretion, such as nondihydropyridine calcium antagonists or aldosterone receptor blockers, should be considered to decrease proteinuria further. This review provides an extended summary of current evidence regarding the associations of blood pressure with proteinuria, the rationale for currently recommended blood pressure goals, and the use of various classes of antihypertensive agents in proteinuric patients.

Angiotensin Receptor Antagonists↗
PubMed2006

Expanding the definition of hypertension to incorporate global cardiovascular risk.

Recent epidemiologic analyses have changed the way that hypertension is viewed. Cardiovascular risk has been found to be elevated at levels of blood pressure previously believed to be normal and not imparting additional risk. Furthermore, the approach to hypertension has been shifted from viewing and treating it in isolation to a more comprehensive approach that incorporates a focus on global cardiovascular risk and the risk factors commonly associated with having an elevated blood pressure. However, control rates not only for hypertension but also for associated risk factors, such as hyperlipidemia and diabetes, remain abysmal, providing an even greater challenge to providers of care. To change this alarming trend, physicians must become aggressive in using the available armamentarium of lifestyle modifications and drugs in treating hypertension and other risk factors that increase the burden of atherosclerosis.

Antihypertensive Agents↗
PubMed2006

Microalbuminuria.

Microalbuminuria, originally described more than 3 decades ago as a predictor of nephropathy in patients who had type 1 diabetes mellitus and associated with higher cardiovascular risk, is now linked with increased risk for cardiovascular events rather than progression to end-stage kidney disease. This article reviews the role of microalbuminuria in the context of atherosclerotic vascular disease. It presents the methods for microalbuminuria assessment in clinical practice, its relations with other cardiovascular risk factors, and the pathophysiologic associations between microalbuminuria and vascular damage. In addition, this article discusses the prognostic significance of microalbuminuria for cardiovascular disease as well as existing therapeutic interventions for reducing urine albumin excretion in patients who are at high cardiovascular risk.

Albuminuria↗
PubMed2004

Management of hypertension in the cardiometabolic syndrome and diabetes.

This article reviews the goals of antihypertensive therapy in patients with the cardiometabolic syndrome, as well as diabetes in the context of reducing progression of kidney disease and decreasing cardiovascular (CV) mortality. All published guidelines recommend a blood pressure (BP) goal of less than 130/80 mm Hg in people with diabetes. To achieve this BP, an average of three different antihypertensive agents, appropriately dosed, are needed. Initial therapy includes an inhibitor of the renin-angiotensin-aldosterone system usually coupled with a thiazide diuretic. Beta-Blockers are often employed to both lower BP and reduce overall CV risk; however, nondihydropyridine calcium antagonists are comparable in benefit without the adverse metabolic effects. Changing lifestyle patterns to include exercise and proper diet, achieving target BP and lipid goals, and treating with an aspirin daily reduces the absolute risk of a CV event by 20% over less intensive treatment. Thus, treating the cardiometabolic syndrome requires an aggressive approach with a focus on both lifestyle modification and pharmacologic intervention.

Antihypertensive Agents↗