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PubMed1979

Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. Hypertension Detection and Follow-up Program Cooperative Group.

The Hypertension Detection and Follow-up Program (HDFP), in a community-based, randomized controlled trial involving 10,940 persons with high blood pressure (BP), compared the effects on five-year mortality of a systematic antihypertensive treatment program (Stepped Care [SC]) and referral to community medical therapy (Referred Care [RC]). Participants, recruited by population-based screening of 158,906 people aged 30 to 69 years in 14 communities througout the United States, were randomly assigned to SC or RC groups within each center and by entry diastolic blood pressure (DBP) (90 to 104, 105 to 114, and 115 + mm Hg). Over the five years of the study, more than two thirds of the SC participants continued to receive medication, and more than 50% achieved BP levels within the normotensive range, at or below the HDFP goal for DBP. Controls of BP was consistently better for the SC than for the RC group. Five-year mortality from all causes was 17% lower for the SC group compared to the RC group (6.4 vs 7.7 per 100, P less than .01) and 20% lower for the SC subgroup with entry DBP of 90 to 104 mm Hg compared to the corresponding RC subgroup (5.9 vs 7.4 per 100, P less than .01). These findings of the HDFP indicate that the systematic effective management of hypertension has a great potential for reducing mortality for the large numbers of people with high BP in the population, including those with "mild" hypertension.

Adult↗
PubMed1997

Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The Trials of Hypertension Prevention, phase II. The Trials of Hypertension Prevention Collaborative Research Group.

OBJECTIVE: To provide a firmer basis for preventing high blood pressure (BP), we tested interventions to promote weight loss, dietary sodium reduction, and their combination for lowering diastolic BP, systolic BP, and the incidence of hypertension during a 3- to 4-year period. METHODS: We conducted a randomized, 2 x 2 factorial, clinical trial, with BP levels measured by blinded observers. Nine academic medical centers recruited 2382 men and women (age range, 30-54 years) not taking antihypertensive drugs, with a diastolic BP of 83 to 89 mm Hg, a systolic BP lower than 140 mm Hg, and a body mass index (the weight in kilograms divided by the square of the height in meters) representing 110% to 165% of desirable body weight. Counseling aimed at helping participants achieve their desirable weight or a 4.5-kg or more weight reduction (in the weight loss and combined groups) and/or sodium intake of 80 mmol/d (in the sodium reduction and combined groups) was provided. RESULTS: From baseline, participants' weight decreased by 4.3 to 4.5 kg at 6 months and by approximately 2 kg at 36 months in the weight loss and combined groups compared with weight changes in the usual care group (all groups, P < .001). Sodium excretion decreased 50 and 40 mmol/d at 6 and 36 months, respectively, in the sodium reduction group and about 15 mmol/d less at each time point in the combined group compared with the usual care group (all groups, P < .01). Compared with the usual care group, BP decreased 3.7/2.7 mm Hg in the weight loss group, 2.9/1.6 mm Hg in the sodium reduction group, and 4.0/2.8 mm Hg in the combined group at 6 months (all groups, P < .001). At 36 months, BP decreases remained greater in the active intervention groups than in the usual care group (weight loss group, 1.3/0.9 mm Hg; sodium reduction group, 1.2/0.7 mm Hg; combined group, 1.1/0.6 mm Hg). Differences were statistically significant for systolic and diastolic BP in the weight loss group and for systolic BP in the sodium reduction group. Through 48 months, the incidence of hypertension (BP > or = 140 mm Hg systolic or > or = 90 mm Hg diastolic or the use of antihypertensive drugs) was significantly less in each active intervention group than the usual care group (average relative risks, 0.78-0.82). CONCLUSIONS: In overweight adults with high-normal BP, weight loss and reduction in sodium intake, individually and in combination, were effective in lowering systolic and diastolic BP, especially in the short-term (6 months). Although the effects on average BP declined over time, reductions in hypertension incidence were achieved.

Adult↗
PubMed1977

[Therapy of hypertension with dimapres. Studies on the effect of the anti-hypertensive drug dimapres in newly adjusted and pretreated hypertensive patients].

41 hypertensive patients were treated with the new anti-hypertensive agent dimapres (1 tablet contains 0.150 mg clonidine and 2.5 mg cyclothiazide). 20 patients had not been treated before, 17 had reserpine-saluretic-combinations and 4 alpha-methyldopa. The dose of the medicament was adapted to the particular requirements of the individual patient and lay between 2 X 1/2 and 3 X 1 tablet daily. After conspicuously high blood pressure readings at the first examination, the previously treated patients showed almost normal blood pressures after discontinuation of the therapy and 2-3 days acclimatisation, while the untreated patients showed pressures slightly above normal. The preparation was well tolerated and normal blood pressures could be obtained with dimapres in all patients. Changing over from other preparations presented no problems. Exercise tolerance tests showed that there was less tendency for the blood pressure to rise to any great height during treatment with dimapres. The patients could tolerate effort better. dimapres reduces the raised reactivity to external stimuli in the hypertensive patient to a normal level.

Adult↗
PubMed1992

Cost-effectiveness of present programs for detection of asymptomatic hypertension in relation to the severity of hypertension and proteinuric hypertension.

Proteinuric hypertension is an important cause of maternal and perinatal mortality. Eclampsia cannot always be prevented. The likelihood of identifying a new case of proteinuric hypertension at any particular visit is very low using traditional antenatal care schedules, and care could be focused on women at higher risk.

Cost-Benefit Analysis↗
PubMed1976

Enhancement of the anti-hypertensive effect of methyldopa and other anti-hypertensive drugs by carbidopa in spontaneously hypertensive rats.

1. A peripheral inhibitor of L-aromatic amino acid decarboxylase, carbidopa [(-)-L-alpha-hydrazino-3,4-dihydroxy-alpha-methylbenzenepropanoic acid monohydrate], at doses up to 25 mg/kg intraperitoneally or 30 mg/kg orally had no effect on directly recorded arterial pressure of spontaneously hypertensive rats derived from the Wistar/Okamoto strain. It enhanced, however, the anti-hypertensive effects of methydopa, hydrallazine, guanethidine and clonidine, and, to a lesser extent, reserpine and hydrochlorothiazide. The mechanism of this enhancement is presently unkonwn, but biochemical studies support the assumption that carbidopa is likely to reduce sympathetic nervous system activity. 2. The conversion of [3H]tyrosine (given intraperitoneally) to dopa (3,4-dihydroxypheylalanine) and catecholamines was measured in the hearts and adrenals of control rats and animals pretreated with carbidopa (100 mg/kg, intraperitoneally). Carbidopa significantly decreased the accumulation of 3H-labelled catecholamines in both organs and increased their total tyrosine content and the specific radioactivity of tyrosine.

Animals↗
PubMed1988

Beta 1- and beta 2-adrenoceptor-mediated relaxation responses in peripheral arteries from spontaneously hypertensive rats at pre-hypertensive and early hypertensive stages.

Beta-adrenoceptor-mediated relaxation of isolated arteries from spontaneously hypertensive rats (SHR) was studied. The relaxation responses of the femoral arteries of pre-hypertensive SHR (PHSHR) to isoprenaline (ISO) and dibutyryl cyclic AMP were less than those of the age-matched tissues of rats of the Wistar-Kyoto strain (WKY). The responses of the mesenteric arteries of PHSHR to ISO and noradrenaline (NA) but not fenoterol (FEN) and forskolin were diminished when compared to those from the WKY tissues. The diminished relaxation response to ISO was observed in the SHR arteries with and without endothelial cells as compared to similar arteries from WKY. Relative potency ratios of ISO:FEN:NA and the Schild plot data for atenolol and butoxamine suggested that there were only beta 1-adrenoceptors and predominantly beta 2-adrenoceptors mediating relaxation in the femoral and mesenteric arteries, respectively. There was no difference in beta-adrenoceptor subtypes between the SHR and WKY arteries. The evidence in this study suggests that beta 1-adrenoceptor-mediated relaxation was diminished in the femoral and mesenteric arteries of PHSHR.

Adrenergic beta-Agonists↗
PubMed2000

Therapeutic studies and arterial stiffness in hypertension: recommendations of the European Society of Hypertension. The Clinical Committee of Arterial Structure and Function. Working Group on Vascular Structure and Function of the European Society of Hypertension.

BACKGROUND: Increased pulse pressure and arterial stiffness are identified as predictors of cardiovascular risk in older hypertensive populations, particularly that of myocardial infarction. Because increased pulse pressure involves an increase in systolic (SBP) and a decrease in diastolic blood pressure (DBP), and because the former promotes cardiac hypertrophy and the latter alters coronary perfusion, a drug regimen reducing pulse pressure and decreasing arterial stiffness might further reduce cardiovascular risk. Under conventional treatment, normalization of DBP (< or = 90 mmHg) is not consistently associated with normalization of SBP (< or = 140 mmHg). THERAPEUTIC DESIGNS: In individuals older than 50 years, the goal of antihypertensive treatment should be, not only to decrease mean blood pressure (to less than 100 mmHg), but also to decrease pulse pressure (to less than 50 mmHg). Using appropriate pharmacological tools, trials should test whether an active decrease in arterial stiffness might produce an attenuation of the age-related increase in SBP and decrease in DBP, thus delaying the age-related increase in pulse pressure and decreasing further cardiovascular risk. This procedure requires concomitant non-invasive evaluations of aortic stiffness. CONCLUSION: The studies that are required in hypertension should use two different approaches: novel titrations of conventional drugs to achieve a decrease in either SBP or pulse pressure, and development of new drugs acting selectively on the large artery wall, to facilitate the conduct of subsequent controlled trials.

Antihypertensive Agents↗
PubMed1991

Family history and pathophysiological mechanisms of primary hypertension. Studies in non-hypertensive young men with positive and negative family histories of hypertension.

In an attempt to explore pathophysiological mechanisms relevant for the development for future primary hypertension, we investigated young normotensive men with positive family histories of hypertension (PFH) regarding blood pressure, body weight, systemic and renal haemodynamics as well as cardiovascular hormones and sodium homeostasis. Sixteen subjects with PFH and thirteen controls with negative family histories (NFH), matched for age and body weight were investigated at age 31 and after five years. Blood pressure and heart rate did not differ between the two groups at the first or follow-up examination. At follow-up body weight had increased and a positive correlation between blood pressure and body mass index was found in subjects with PFH, while subjects with NFH had unchanged blood pressure and body weight. Initially, intraerythrocyte sodium content was increased in subjects with PFH, however, at follow-up intraerythrocyte sodium content did not differ between the two groups. At follow-up systemic and renal haemodynamics and sodium homeostasis were investigated in fifteen subjects with PFH and in twenty-nine controls matched for age (36 +/- 5 year) and with NFH. The control group was divided into one group matched for body mass index (n = 15) and one group with normal body mass index (n = 14). Blood pressure and central venous pressure were measured during bolus injections of phenylephrine and during an acute saline/fluid load (1000ml 0.9% NaCl within 10 min). Renal haemodynamics and blood pressure were measured during low doses (0.1 and 0.5 ng/min/kg) continuous infusions of angiotensin II (AII). At baseline blood pressure, body weight and sodium excretion were higher in subjects with PFH and matched controls as compared with lean controls. Calf and forearm haemodynamics (pletysmography), plasma catecholamines, plasma renin activity, angiotensin II, aldosterone, blood volume and erythrocyte sodium efflux rate constant did not differ between the three groups. Circulating atrial natriuretic peptide was higher in subjects with PFH than in the two control groups. In subjects with PFH there was a negative correlation between renal sodium excretion at baseline and the ouabain-sensitive sodium efflux rate constant. During the acute saline/fluid load central venous pressure and systolic blood pressure increased more and venous vascular compliance (ml/mmHg/kg) was reduced in PFH. Atrial natriuretic peptide release and renal sodium excretion were blunted during saline/fluid load in subjects with PFH as compared with the two control groups. Renal blood flow and renal vascular resistance did not differ at baseline. Glomerular filtration rate was somewhat higher in PFH.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1995

Guidelines for the management of hypertension: the World Health Organization/International Society of Hypertension view. World Health Organization. International Society of Hypertension.

ORGANIZATIONS PRODUCING GUIDELINES: Guidelines or recommendations for the management of hypertension have periodically been produced by various organizations or specialized scientific societies, in particular the United States Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure and the World Health Organization/International Society of Hypertension Guidelines Sub-Committee. SIMILARITIES, DIFFERENCES AND EVALUATION OF GUIDELINES: There are many similarities between the different guidelines and any dissimilarities are mainly related to the choice of first-line drugs for treatment and the goal of treatment. In formulating guidelines it is important to avoid placing rigid constraints on practising doctors' decisions while helping them to exert the most careful and informed judgement in individual cases.

Antihypertensive Agents↗
PubMed2002

[The use of enalaprilat for the treatment of uncomplicated hypertensive crises in patients with hypertensive disease (essential hypertension)].

When used for the treatment of hypertensive crises enalaprilat produced pronounced lowering of both systolic and diastolic blood pressures. Lowering of blood pressure was accompanied by regression of clinical symptoms. There were no episodes of excessive blood pressure drop. The use of enalaprilat was associated with normalization of parameters of central and cerebral hemodynamics, lessening of degree of strain of regulatory systems of the body. Diminishment of left atrial dilatation and augmentation of left ventricular ejection fraction occurred in patients with initially dilated left atrium.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1997

[Usefulness of converting enzyme inhibitors in diagnosis of renovascular hypertension. I. Comparison of the effect of angiotensin converting enzyme inhibition on blood pressure and plasma renin activity in patients with primary hypertension and renovascular hypertension].

The aim of the study was to evaluate the effect of angiotensin converting enzyme inhibition on blood pressure and plasma renin activity (PRA) in patients with essential (EH) and renovascular (RVH) hypertension. Forty patients with RVH and sixty four with EH were studied. All patients underwent renal digital subtraction angiography in order to find out renal artery stenosis. Blood pressure was measured before and 15, 30, 45, 60 and 90 minutes after captopril administration in the captopril test. PRA was determined before and 60 minutes after captopril. It was shown that fall of systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressure after captopril was significant in each time period both in EH and RVH. Hypotensive effect was significantly higher (p < 0.001) in RVH. Basic PRA did not differ in the studied groups. 60 minutes after captopril administration PRA was significantly higher (p < 0.001) in patients with RVH. Absolute and percentage rise of PRA also differentiated studied groups (p < 0.001). Significant correlations were found between the change of PRA after captopril and fall of SAP, DAP and MAP in both groups. These relationships were stronger in RVH.

Adult↗
PubMed2006

Masked hypertension and target organ damage in treated hypertensive patients.

BACKGROUND: Recent studies have shown that an elevated ambulatory or home blood pressure (BP) in the absence of office BP-a phenomenon called masked hypertension-is associated with poor cardiovascular prognosis. However, it remains to be elucidated how masked hypertension modifies target organ damage in treated hypertensive patients. METHODS: A total of 332 outpatients with chronically treated essential hypertension were enrolled in the present study. Patients were classified into four groups according to office (<140/90 or >or=140/90 mm Hg) and daytime ambulatory (<135/85 or >or=135/85 mm Hg) BP levels; ie, controlled hypertension (low office and ambulatory BP), white-coat hypertension (high office but low ambulatory BP), masked hypertension (low office but high ambulatory BP), and sustained hypertension (high office and ambulatory BP). Left ventricular mass index, carotid maximal intima-media thickness, and urinary albumin levels were determined in all subjects. RESULTS: Of the patients, 51 (15%), 65 (20%), 74 (22%), and 142 (43%) were identified as having controlled hypertension, white-coat hypertension, masked hypertension, and sustained hypertension, respectively. Left ventricular mass index, maximal intima-media thickness, and urinary albumin level in masked hypertension were significantly higher than in controlled hypertension and white-coat hypertension, and were similar to those in sustained hypertension. Multivariate regression analyses revealed that the presence of masked hypertension was one of the independent determinants of left ventricular hypertrophy, carotid atherosclerosis, and albuminuria. CONCLUSIONS: Our findings indicate that masked hypertension is associated with advanced target organ damage in treated hypertensive patients, comparable to that in cases of sustained hypertension.

Aged↗
PubMed1989

[Relations between family history of essential hypertension and fetal prognosis in hypertension in pregnancy].

In a population of 134 hypertensive pregnant women, 66 per cent of whom had chronic (permanent) arterial hypertension, the frequency of essential hypertension in the pregnant women's fathers or mothers was 60 per cent. The rate of unfavourable foetal outcome, i.e. late abortion, still-birth, neonatal death, birth weight below 1,500 g, severe prematurity or severely stunted growth, was 21 per cent. This rate was the same in the presence or absence of a family history of essential hypertension. It was higher in women with hypertension in pregnancy than in women with chronic hypertension (30 vs 16 per cent; p less than 0.05), but a family history of hypertension (mostly in the mother) was more frequent among pregnant women with chronic hypertension (69 vs 43 per cent; p less than 0.01). A multivariate analysis of the entire population studied showed that a family history of hypertension was not an independent variable predictive of foetal outcome; however, hypertension in the father was such a variable. The influence of family history of hypertension on the foetal outcome was studied separately in women with chronic hypertension and in those with hypertension in pregnancy. The results showed statistically significant differences the other way round: a better foetal outcome was observed in cases of hypertension in pregnancy with a family history of hypertension (more rarely associated with pre-eclampsia), and a poorer foetal outcome was observed in cases of chronic hypertension with a similar family history (mostly in the father, and associated with a more severe hypertension). This study suggests that a family history of essential hypertension and the type of hypertension observed in the patient must be taken into account when evaluating the severity of hypertension in pregnant women.

Adult↗
PubMed2005

Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension.

BACKGROUND: The aim of this study was to evaluate the cardiovascular outcome in apparently responder hypertensive patients with responder and masked hypertension, and in apparently resistant hypertensive patients with false and true resistant hypertension. METHODS: The occurrence of fatal and nonfatal cardiovascular events was evaluated in 340 patients with responder hypertension (clinic blood pressure [BP] <140/90 mm Hg and daytime BP <135/85 mm Hg), 126 with masked hypertension (clinic BP <140/90 mm Hg and daytime BP >135 or 85 mm Hg), 146 with false resistant hypertension (clinic BP >or=140 or 90 mm Hg and daytime BP <135/85 mm Hg), and 130 with true resistant hypertension (clinic BP >or=140 or 90 mm Hg and daytime BP >135 or 85 mm Hg). RESULTS: During follow-up period (4.98 +/- 2.9 years), the event-rate per 100 patient-years was 0.87, 2.42, 1.2, and 4.1 in patients with responder, masked, false resistant, and true resistant hypertension, respectively. After adjustment for several covariates, including clinic BP (forced into the model), Cox regression analysis showed that cardiovascular risk was significantly higher in masked hypertension (masked versus responder hypertension, relative risk [RR] 2.28, 95% confidence interval [CI] 1.1-4.7, P < .05) and in true resistant hypertension (true resistant versus responder hypertension, RR 2.94, 95% CI 1.02-8.41, P < .05), whereas there was no significant difference between false resistant and responder hypertension. CONCLUSIONS: This study shows that patients with masked hypertension are at higher risk than those with responder hypertension, and that those with false resistant hypertension are at lower risk than those with true resistant hypertension. Ambulatory BP monitoring should be performed in treated hypertensive patients to obtain a better prognostic stratification.

Aged↗
PubMed2003

Treatment and blood pressure control in isolated systolic hypertension vs diastolic hypertension in primary care.

Cross-sectional surveys on prevalence, treatment and control of hypertension could not satisfactorily distinguish between diastolic hypertension and isolated systolic hypertension because the definition of hypertension included patients under pharmacological treatment. We assessed the situation in the two types of hypertension in general practice in Belgium, based on current blood pressure (BP) measurements and on BP prior to the initiation of drug therapy. Participating physicians enrolled the first 15 at least 55-year-old men visiting the surgery, measured their BP and recorded data on medical history including pretreatment BP, drug utilization, cardiovascular risk factors and target organ damage. Diastolic hypertension was defined as diastolic BP> or =90 mmHg, irrespective of systolic BP, and isolated systolic hypertension as systolic BP > or =140 mmHg and diastolic BP < 90 mmHg. Among 3761 evaluable patients, 74% were hypertensive. Among the 1533 hypertensive patients in whom blood pressure was known prior to treatment (n=965) or who were untreated at the study visit (n=568), 1164 had diastolic hypertension and 369 isolated systolic hypertension. The prevalence of antihypertensive treatment was, respectively, 75 and 25% (P<0.001) in these two types of hypertension. The odds of being treated were independently determined by type of hypertension, severity of hypertension and level of risk (P<0.001). BP was controlled in 25% of all patients with diastolic hypertension and in 13% of all patients with isolated systolic hypertension (P<0.001). About half of the treated patients with systolic hypertension were on a diuretic and/or a calcium-channel blocker. In conclusion, isolated systolic hypertension is less frequently treated than diastolic hypertension, overall BP control is poor and actual drug therapy diverges from recommendations based on placebo-controlled intervention trials.

Aged↗
PubMed1998

Ambulatory blood pressure in the hypertensive population: patterns and prevalence of hypertensive subforms.

BACKGROUND: A number of clinically identifiable patterns of blood pressure elevation are apparent using ambulatory measurement Their prevalence and age and sex distribution have not been described. The purpose of this study was to describe the epidemiology of patterns of high blood pressure in a large population. DESIGN: Retrospective database analysis of referral hypertensive population. PATIENTS: Clinic and ambulatory blood pressure measurements were performed in 2092 patients with essential hypertension while they were not taking antihypertensive medication. METHODS: The patients were classified into six groups on the basis of their ambulatory blood pressure monitoring profiles: white-coat hypertensives, borderline hypertensives, isolated systolic hypertensives, isolated diastolic hypertensives, combined systolic and diastolic hypertensives and nocturnal hypertensives. The categories were examined for age and sex differences. RESULTS: All patients were categorized into one of the six groups. The majority (56.2%) were systolodiastolic hypertensives, 12.9% were borderline and 10.8% were white-coat hypertensives. Isolated systolic hypertensives comprised 6.2% of the population, isolated diastolic hypertensives 6.9% and nocturnal hypertensives 7.1%. The isolated systolic hypertensives showed the greatest change with age, with a prevalence of < 5% in patients below 40 years of age, rising to almost 20% in the 70 plus age group. White-coat, isolated diastolic and borderline hypertensives showed the opposite change in prevalence, falling from younger to older age groups. Apart from a greater prevalence of white-coat hypertension in females, the patterns were largely similar between sexes. CONCLUSIONS: Ambulatory blood pressure monitoring allows the blood pressure pattern to be defined in hypertensive patients. The patterns identified here in a referral hypertensive cohort show changes in prevalence with age, and further study is required to determine the prognostic significance of hypertensive sub-forms.

Adolescent↗
PubMedDate not supplied

Management of resistant hypertension in patients with carotid stenosis: high prevalence of renovascular hypertension.

INTRODUCTION: Patients with carotid stenosis are at high risk of vascular events and therefore require an optimal control of risk factors such as hypertension. As the treatment of hypertension differs according to the cause, we examined the prevalence of resistant hypertension, and the cause of hypertension, among patients with carotid stenosis followed closely in two randomized trials of carotid endarterectomy. OBJECTIVE: The purpose of this study was to determine the prevalence of resistant hypertension and of secondary hypertension among patients with carotid stenosis. METHODS: A chart review was performed of all patients from our center who participated in the North American Symptomatic Carotid Endarterectomy Trial or the Asymptomatic Carotid Artery Study to determine the prevalence of renovascular hypertension. RESULTS: Among 170 patients with carotid stenosis followed in these two trials, 145 (83.5%) were hypertensive (systolic >160 or diastolic >90 mm Hg); at least 24 (14.1% overall, 16.6% of hypertensives) had renovascular hypertension based on either nuclear medicine renography, renal angiography or both; among the 79 patients with resistant hypertension (mean arterial pressure >130 mm Hg despite treatment), 20 (25.3%) had renovascular hypertension. Adrenocortical hyperplasia was the underlying cause of hypertension in 12 (7.1% of cases, 8.3% of hypertensives, 8.8% of resistant hypertensives). Blood pressures were significantly higher for patients with renovascular and adrenocortical hypertension (p < 0.0001 for systolic, p = 0.024 for diastolic pressures). CONCLUSION: Among patients with carotid stenosis, renovascular hypertension is unusually common. Resistant hypertension among such patients should lead to investigation and management directed at the cause of hypertension. Appropriate investigations might include plasma renin/aldosterone ratio, captopril renography and MRA of the renal arteries or renal angiography.

Aged↗