The in-hospital cardiac mortality rate is high for patients who undergo vascular surgery and experience clinically significant PMI. Stress of surgery (increased intraoperative bleeding and aortic, peripheral vascular, and emergency surgery), poor preoperative cardiac functional status (congestive heart failure, lower ejection fraction, diagnosis of coronary artery disease), and preoperative history of coronary artery bypass grafting are the factors that determine perioperative cardiac morbidity and mortality rates.

Abstract-Abnormal hemodynamics play a central role in the development and perpetuation of high blood pressure. We hypothesized that hypertension therapy guided by noninvasive hemodynamics with impedance cardiography could aid primary care physicians in reducing blood pressure more effectively. Uncontrolled hypertensive patients on 1 to 3 medications were randomized by 3:2 ratio to either a standard arm or hemodynamic arm that used impedance cardiography (BioZ, CardioDynamics). Each patient completed 5 study visits with a 2-week washout period followed by 3 months of treatment. A total of 164 patients from 11 centers completed the study, 95 in the standard arm and 69 in the hemodynamic arm. At baseline and after washout, there were no differences between arms in number of medications or demographic, blood pressure, or hemodynamic characteristics. Hypertension is a major public health concern, because it significantly increases risk of coronary artery disease, heart failure, renal disease, and stroke. 4 In spite of major public health and medical education efforts and availability of effective antihypertensive agents, blood pressure (BP) control rates in the United States remain low, with only 31% of hypertensives and 54% of those actively treated and taking medications achieving BP Ͻ140/90 mm Hg. 5 Why is BP control such an elusive goal? The reasons are numerous and complex. However, inadequate pharmacological treatment remains the most common cause of uncontrolled BP in actively treated patients. 6 Hypertension is a hemodynamic-related disorder. BP rises as the result of increased systemic vascular resistance (SVR), cardiac output (CO), fluid volume, or a combination of these factors. 7,8 Consequently, antihypertensive agents lower BP by reducing SVR, CO, fluid volume, or combinations thereof. 9 Previous authors hypothesized that hemodynamic information could help tailor therapy and subsequently improve BP control. 10 Invasive procedures for hemodynamic profiling are not warranted in outpatient clinics, and noninvasive procedures, such as echocardiography, are costly and operator dependent. 11 Impedance cardiography (ICG) has emerged as a reliable noninvasive method to measure hemodynamics in physician offices. In a randomized, controlled trial, ICG-guided treatment improved BP control rates in resistant hypertension treated by hypertension specialists. 12 We hypothesized that ICG-guided treatment could aid physicians in reducing BP more effectively than standard care in a population of uncontrolled hypertensive patients receiving 1 to 3 medications in a primary care setting. Methods EligibilityMale and female patients (age range, 18 to 75 years) were eligible if they had a diagnosis of essential hypertension and were currently on

The surgical correction of atherosclerotic renovascular disease resulted in blood pressure benefit and retrieval of renal function in selected patients with hypertension. The patients with cured hypertension or improved EGFR after operation showed increased dialysis-free survival as compared with other patients who underwent surgery.

Surgical correction of atherosclerotic renovascular disease can retrieve excretory renal function in selected hypertensive patients with ischemic nephropathy. Patients with improved renal function had a significant and independent increase in dialysis-free survival in comparison with patients whose function was unchanged and patients whose function was worsened after operation. These results add further evidence in support of a prospective, randomized trial designed to define the value of renal artery intervention in patients with ischemic nephropathy.

D espite the well known benefits of effective longterm antihypertensive drug therapy in reducing cardiovascular risk, almost three quarters of US adults with hypertension fail to achieve adequate blood pressure control. 1 This statistic is, in part, attributable to the rate of discontinuation of antihypertensive medications due to the occurrence of troublesome side effects. Appearance of treatment-related side effects may actually make patients feel worse than they did before beginning antihypertensive therapy, particularly since most patients with hypertension are asymptomatic. 2 As many as 70% of hypertensive patients who experience side effects are noncompliant with their antihypertensive medication, and patients experiencing a negative impact on their quality of life have a 40%−60% higher rate of therapy discontinuation than patients whose quality of life is unaffected. 3,4 On the other hand, blood pressure control may be associated with quality of life improvement (patients feeling better). The inability of patients to stay on therapy in the long term may be one of the factors contributing to the development of hypertension-related complications and higher overall health care expenditures. 5 Sexual dysfunction induced by antihypertensive medications is one of the poorly recognized side effects impacting the patient's ability to stay on therapy. Moreover, this side effect of antihypertensive medications is strongly associated with an impaired quality of life. 6−8 Many commonly prescribed antihypertensive medications may give rise to sexual dysfunction, which often presents in men