1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension

Alderman, M.; Arakawa, K; Beilin, Lawrie J.; Chalmers, John; Erdine, Serap; Fujishima, Masatoshi; Hamet, Pavel; Hannson, Lennart; Landsberg, Lewis; Leenen, Frans H. H.; Lindholm, Lars; Liu, Lisheng; Mabadeje, A. F. B.; MacMahon, Stephen; Mancia, Giuseppe; Martin, Ingerith; Mimran, A; Rahn, K. H.; Ribeiro, Adriana Bouças; Sleight, Peter; Whitworth, Judith A.; Zanchetti, Alberto; Neal, Bruce; Rodgers, Anthony; Mhurchú, Cliona Ní; Clark, T. Justin

doi:10.1097/00004872-199917020-00001

Cited by 1,222 publications

(24 citation statements)

References 167 publications

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“…An inverse relationship was found between the severity of arterial hypertension and graft survival. The World Health Organization’s recommends strict control of blood pressure in this specific high risk population [24]. Although blood pressure control is essential in renal transplant patients, many issues remain unresolved.…”

Section: Discussionmentioning

confidence: 99%

Renoprotective Effects of Losartan in Renal Transplant Recipients

Íñigo¹,

Campistol²,

Saracho³

et al. 2004

Nephron Clin Pract

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Background/Aims: Chronic allograft nephropathy is the main cause of late graft loss and nonimmunological factors, including hypertension and proteinuria, the principal etiological factors. In this context, blockage of the renin-angiotensin system could be helpful. The aim of the present study was to review the renoprotective efficacy of losartan in a large group of renal transplant patients undergoing long-term follow-up. Methods: A retrospective analysis of 276 renal transplant patients treated with losartan was performed. The indication for losartan was arterial hypertension in 163 patients, proteinuria in 37 patients and hypertension plus proteinuria in the remaining 76 patients. Clinical and biochemical parameters before starting losartan treatment (–6 months, –3 months and at baseline) and 3, 6, 9, 12, 18 and 24 months after the introduction of losartan were analyzed. Results: Arterial hypertension significantly decreased after the introduction of losartan (p = 0.000). Serum creatinine was significantly decreased by losartan therapy, and changes in the serum creatinine slope (1/sCr) before and after losartan were statistically significant. Proteinuria markedly decreased after the introduction of losartan. Clinical and biochemical tolerance of losartan was excellent in most patients and only 9 out of the 276 patients (3%) treated with losartan discontinued the drug because of an adverse event. During follow-up, only 3 patients required substitutive treatment with dialysis due to progressive deterioration of renal function in the context of chronic allograft nephropathy. Conclusion: Losartan demonstrated high efficacy as a renoprotective agent in renal transplant patients and could be useful in the treatment and prevention of chronic allograft nephropathy.

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Section: Discussionmentioning

confidence: 99%

Renoprotective Effects of Losartan in Renal Transplant Recipients

Íñigo¹,

Campistol²,

Saracho³

et al. 2004

Nephron Clin Pract

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“…Concerning the overall population, 34 patients in CT and 46 patients in HT had systolic blood pressure values ≥140 mm Hg and diastolic blood pressure values ≥90 mm Hg, and were thus considered hypertensive in accordance with the criteria of the 1999 WHO-ISH Committee [11]. Blood pressure values were obtained from the outpatient case files.…”

Section: Methodsmentioning

confidence: 99%

Cerebral Imaging Changes in Patients with Chronic Renal Failure Treated Conservatively or in Hemodialysis

Savazzi¹,

Cusmano

Musini³

2001

Nephron

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Background: Nonuremic patients with apparently normal memory and behavior, studied by means of cerebral computed tomography and found to have cerebral atrophy (CA), evidenced functional intellectual deficits when they underwent psychometric testing. The finding of CA has been repeatedly reported in limited case groups of uremic patients who also demonstrated functional intellectual deficits on the basis of the same tests. This retrospective study considered all diagnostic cerebral computed tomography scans done in our department between 1981 and 1998. Fifty-five uremic patients in conservative treatment (CT) and 111 patients in hemodialysis treatment (HT) were selected on the basis of the following two criteria: primary nephropathy as the cause of uremia and an age ≤55 years to exclude involutive brain changes occurring with age. Aims: The aims of the study were to determine the percent of uremic patients with CA, the characteristics of their CA (cortical or subcortical), and eventual associated morphological lesions. Results: CA was detected in 50.9% (cortical atrophy in 47.3% and subcortical atrophy in 3.6%) of the uremic patients in CT and in 77.5% of those in HT (cortical atrophy in 65.7% and subcortical atrophy in 7.7%). The average degree of CA was 0.872 in the patients in CT and 1.765 in the patients in HT. Thirty-four of the patients in the CT group and 46 in the HT group were hypertensive: these patients had a more severe degree of CA than the nonhypertensive subjects. In the CT group, the degree of CA in the hypertensive patients was 1.205 versus 0.428 for the nonhypertensive subjects. In the HT group, the degree of CA was 2.087 for the hypertensive patients versus 1.538 for the nonhypertensive patients. Of the overall population, 7.8% had ischemic lesions, 9.6% had endocranial calcifications, and 5.4% evidenced periventricular white matter hyperintensities. Conclusions: The high percent of CA found in young uremic patients increased in subjects in HT and, even more so in hypertensive patients. Vascular calcifications, focal ischemia and leukoaraiosis, well-known expressions of a chronic state of cerebrovascular insufficiency, were also found in HT patients; hypertension alone is a recognized accelerator of vascular damage. Thus, early and severe atherosclerosis and related hypoperfusion can be considered as the paramount causes of parenchymal cerebral damage in uremia.

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“…As in some other countries, these national criteria differ from those most recently recommended in the hypertension guidelines of the World Health Organization-International Society of Hypertension [31]. Using these guidelines, it is possible that a few patients would have been classified as patients with combined systolic/diastolic hypertension instead of as patients with pure ISH.…”

Section: Discussionmentioning

confidence: 99%

Isolated Systolic Hypertension from a Vascular Point of View

Muntinga

Heesen²,

Smit

et al. 2000

J Vasc Res

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Due to the results of antihypertensive intervention studies, isolated systolic hypertension (ISH) has gained new interest lately. Yet, apart from increased aortic stiffness, the specific pathophysiological features of ISH have remained largely undetermined. Therefore, we investigated the elastic properties of the vascular bed of an upper arm segment in uncomplicated ISH patients and matched normotensive controls using an electrical bioimpedance technique. Compared with the controls, the compliance of the arterial bed as a whole at normotensive blood pressure level was on the average 108.0% higher (p < 0.005) in the hypertensive patients. The blood volume of the arterial bed as a whole at operating blood pressure level and that of the larger arteries were significantly higher (40.5%, p < 0.05, and 40.5%, p < 0.01, respectively). The same held true for the venous blood volume (64.4%, p < 0.05), and for the width of the arterial compliance-pressure relation (34.6%, p < 0.01). We concluded that ISH is a separate pathophysiological entity in which all parts of a peripheral vascular bed are changed and the decreased buffering function of the aorta and large arteries is partly compensated for by an increase in small artery compliance.

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1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension

Cited by 1,222 publications

References 167 publications

Renoprotective Effects of Losartan in Renal Transplant Recipients

Renoprotective Effects of Losartan in Renal Transplant Recipients

Cerebral Imaging Changes in Patients with Chronic Renal Failure Treated Conservatively or in Hemodialysis

Isolated Systolic Hypertension from a Vascular Point of View

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