NEJM â Collection Updates for Hypertension

IMAGES IN CLINICAL MEDICINE: Kinked Carotids

Robert L. Rosenthal, M.D. and Bradley R. Grimsley, M.D. — Thu, 04Â FebÂ 2010 00:00:00 -05:00

An 80-year-old woman presented with congestive heart failure due to aortic insufficiency associated with a markedly dilated ascending aorta. On physical examination, she was noted to have a pulsatile mass...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 1-2010 â A 75-Year-Old Man with Hypertension, Hyperglycemia, and Edema

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Dr. Jennifer L. Lyons (Medicine): A 75-year-old man was admitted to this hospital because of the recent onset of hypertension, hyperglycemia, and edema.

The patient had been in his usual state...

CLINICAL PROBLEM-SOLVING: A Crisis in Late Pregnancy

Thu, 03Â DecÂ 2009 00:00:00 -05:00

A 31-year-old woman in the 37th week of an uncomplicated pregnancy presented to the emergency department with sudden onset of severe bitemporal headache and shortness of breath. Her medical history...

REVIEW ARTICLE: Use of Diuretics in Patients with Hypertension

Michael E. Ernst, Pharm.D., and Marvin Moser, M.D. — Thu, 26Â NovÂ 2009 00:00:00 -05:00

Thiazide diuretics became available in the late 1950s and were the first effective oral antihypertensive agents with an acceptable side-effect profile.12 A half-century later, thiazides remain important medications for the...

CLINICAL THERAPEUTICS: Phosphodiesterase Type 5 Inhibitors for Pulmonary Arterial Hypertension

Stephen L. Archer, M.D., and Evangelos D. Michelakis, M.D. — Thu, 05Â NovÂ 2009 00:00:00 -05:00

A 46-year-old woman presents with progressive exertional dyspnea and recurrent exertional syncope. Her jugular venous pressure is 16 cm of water, and moderate peripheral edema is noted. Auscultation reveals a...

EDITORIAL: Blood-Pressure Control and Delay in Progression of Kidney Disease in Children

Julie R. Ingelfinger, M.D. — Thu, 22Â OctÂ 2009 00:00:00 -05:00

Many children with chronic kidney disease, even those in whom the disease is discovered very early, ultimately lose renal function; some ultimately progress to stage 5 chronic kidney disease (end-stage...

ORIGINAL ARTICLE: Strict Blood-Pressure Control and Progression of Renal Failure in Children

The ESCAPE Trial Group — Thu, 22Â OctÂ 2009 00:00:00 -05:00

Background: Although inhibition of the reninâangiotensin system delays the progression of renal failure in adults with chronic kidney disease, the blood-pressure target for optimal renal protection is controversial. We assessed...

PERSPECTIVE: When Diseases Disappear â The Case of Familial Dysautonomia

Thu, 22Â OctÂ 2009 00:00:00 -05:00

The success of genetic-screening programs raises an intriguing possibility: some dread diseases of the 20th century may soon become history. A representative example is familial dysautonomia, a severe neurologic condition,...

CLINICAL PROBLEM-SOLVING: A Change of Heart

Thu, 03Â SepÂ 2009 00:00:00 -05:00

A 57-year-old teacher with a history of hypertension presented to an urgent care center with nonradiating chest pressure and light-headedness. The chest pressure had begun soon after she arrived at...

CORRESPONDENCE: Renal Sympathetic-Nerve Ablation for Uncontrolled Hypertension

Thu, 27Â AugÂ 2009 00:00:00 -05:00

To the Editor: The renal sympathetic nerves have been identified as a major contributor to the complex pathophysiology of hypertension in both experimental models and in humans.1 Patients with essential...

IMAGES IN CLINICAL MEDICINE: Retinal Detachment in Malignant Hypertension

Iqbal Tajunisah, F.R.C.S. and Dinesh Kumar Patel, M.S. (Ophthal.) — Thu, 27Â AugÂ 2009 00:00:00 -05:00

A 37-year-old woman with no previous medical conditions presented with a 3-day history of headache and blurry vision. Her blood pressure was elevated, at 220/150 mm Hg, and visual acuity...

SPECIAL ARTICLE: The Hypertension Paradox â More Uncontrolled Disease despite Improved Therapy

Aram V. Chobanian, M.D. — Thu, 27Â AugÂ 2009 00:00:00 -05:00

The treatment of hypertension has been one of medicine's major successes of the past half-century. The remarkable advances in therapy have provided the newfound capability for lowering blood pressure in...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2009 â A 13-Year-Old Boy with Headache, Nausea, Seizures, and Hypertension

Thu, 23Â JulÂ 2009 00:00:00 -05:00

A 13-year-old boy was admitted to the hospital because of headache, nausea, seizures, renal failure, and hypertension.

The patient had been well until approximately 3 weeks earlier, when intermittent left-sided headaches...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2009 â A 36-Year-Old Woman with Headache, Hypertension, and Seizure 2 Weeks Post Partum

Thu, 12Â MarÂ 2009 00:00:00 -05:00

Dr. W. Taylor Kimberly: A 36-year-old woman was admitted to the hospital because of headaches, hypertension, and seizures.

Nineteen days before the current admission, she delivered healthy twins at 35.6 weeks...

VIDEOS IN CLINICAL MEDICINE: Blood-Pressure Measurement

Thu, 29Â JanÂ 2009 00:00:00 -05:00

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ORIGINAL ARTICLE: Modulation of Blood Pressure by Central Melanocortinergic Pathways

Thu, 01Â JanÂ 2009 00:00:00 -05:00

Background: Weight gain and weight loss are associated with changes in blood pressure through unknown mechanisms. Central melanocortinergic signaling is implicated in the control of energy balance and blood pressure...

EDITORIAL: Does It Matter How Hypertension Is Controlled?

Aram V. Chobanian, M.D. — Thu, 04Â DecÂ 2008 00:00:00 -05:00

Hypertension is one of the most important risk factors for cardiovascular and renal diseases. Currently, approximately 73 million adults in the United States and approximately 1 billion adults worldwide have...

ORIGINAL ARTICLE: Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients

Thu, 04Â DecÂ 2008 00:00:00 -05:00

Background: The optimal combination drug therapy for hypertension is not established, although current U.S. guidelines recommend inclusion of a diuretic. We hypothesized that treatment with the combination of an angiotensin-convertingâenzyme...

REVIEW ARTICLE: Uric Acid and Cardiovascular Risk

Daniel I. Feig, M.D., Ph.D., Duk-Hee Kang, M.D., and Richard J. Johnson, M.D. — Thu, 23Â OctÂ 2008 00:00:00 -05:00

An association of gout with hypertension, diabetes, kidney disease, and cardiovascular disease has been observed since the late 19th century. Early investigators, such as Frederick Mahomed, Alexander Haig, and Nathan...

ORIGINAL ARTICLE: Long-Term Follow-up after Tight Control of Blood Pressure in Type 2 Diabetes

Thu, 09Â OctÂ 2008 00:00:00 -05:00

Background: Post-trial monitoring of patients in the United Kingdom Prospective Diabetes Study (UKPDS) examined whether risk reductions for microvascular and macrovascular disease, achieved with the use of improved blood-pressure control...

IMAGES IN CLINICAL MEDICINE: Central Hemiretinal Arterial Occlusion

Kenneth C. Mathys, M.D. and Seema Garg, M.D., Ph.D. — Thu, 19Â JunÂ 2008 00:00:00 -05:00

A 65-year-old woman with a history of hypertension and cigarette smoking presented with complete loss of vision in the inferior field of the left eye, which she had noticed an...

EDITORIAL: Aliskiren and Dual Therapy in Type 2 Diabetes Mellitus

Julie R. Ingelfinger, M.D. — Thu, 05Â JunÂ 2008 00:00:00 -05:00

The discovery 110 years ago that crude kidney extract elicited a pressor reaction provided the first evidence of the existence of the reninâangiotensinâaldosterone system, a major vasoactive system,1 and the...

ORIGINAL ARTICLE: Aliskiren Combined with Losartan in Type 2 Diabetes and Nephropathy

Thu, 05Â JunÂ 2008 00:00:00 -05:00

Background: Diabetic nephropathy is the leading cause of end-stage renal disease in developed countries. We evaluated the renoprotective effects of dual blockade of the reninâangiotensinâaldosterone system by adding treatment with...

CLINICAL DECISIONS: Management of Carotid Stenosis â Polling Results

Thu, 15Â MayÂ 2008 00:00:00 -05:00

In early April, we presented the case of a 67-year-old man with asymptomatic carotid disease in Clinical Decisions,1 an interactive feature designed to assess how readers would manage a clinical...

EDITORIAL: Treating Hypertension in the Very Old

John B. Kostis, M.D. — Thu, 01Â MayÂ 2008 00:00:00 -05:00

Hypertension is prevalent and accounts for a large proportion of cardiovascular morbidity and mortality worldwide.1 There is a continuous, approximately linear, increase in systolic blood pressure with increasing age in...

IMAGES IN CLINICAL MEDICINE: Changes in the Brain Stem and Fundus in Malignant Hypertension

Michael S. Lee, M.D. and Brian J. Tienor, B.S. — Thu, 01Â MayÂ 2008 00:00:00 -05:00

A 53-year-old man presented with a 4-week history of bilateral retrobulbar headache and blurred vision. His blood pressure was 220/135 mm Hg; his neurologic examination was unremarkable. He had no...

ORIGINAL ARTICLE: Treatment of Hypertension in Patients 80 Years of Age or Older

Thu, 01Â MayÂ 2008 00:00:00 -05:00

Background: Whether the treatment of patients with hypertension who are 80 years of age or older is beneficial is unclear. It has been suggested that antihypertensive therapy may reduce the...

CLINICAL DECISIONS: Management of Carotid Stenosis

Thu, 10Â AprÂ 2008 00:00:00 -05:00

A 67-year-old man with a history of hypertension and hyperlipidemia is seen for a routine examination. His medications include hydrochlorothiazide (25 mg daily), simvastatin (20 mg daily), and aspirin (81...

CLINICAL PROBLEM-SOLVING: A Key Miscommunication â An 81-year-old woman presented to the emergency department with increasing abdominal distention, nausea, and vomiting

Thu, 06Â MarÂ 2008 00:00:00 -05:00

An 81-year-old woman presented to the emergency department with increasing abdominal distention, nausea, and vomiting. She also reported increasing shortness of breath and fatigue, which had become worse over the...

IMAGES IN CLINICAL MEDICINE: Retinal Arteriolar Cholesterol Emboli

Michael Colucciello, M.D. — Thu, 21Â FebÂ 2008 00:00:00 -05:00

A 59-year-old man with a medical history of hypertension, hyperlipidemia, and coronary artery disease presented with transient, painless visual obscuration in the left eye, and he was referred for retinal...

CLINICAL DECISIONS: Management of Type 2 Diabetes

Thu, 17Â JanÂ 2008 00:00:00 -05:00

A 55-year-old woman with type 2 diabetes, obesity, and hypertension has been under your care for the past 2 years. She has no history of microalbuminuria, retinopathy, or neuropathy. She...

ORIGINAL ARTICLE: Evidence of MEN-2 in the Original Description of Classic Pheochromocytoma

Thu, 27Â SepÂ 2007 00:00:00 -05:00

The first description of pheochromocytoma in 1886 has been attributed to Felix FrÃ¤nkel, who described an 18-year-old woman with bilateral adrenal âsarcoma and angio-sarcoma.â We reviewed the publication and then...

CLINICAL PRACTICE: Isolated Systolic Hypertension in the Elderly

Aram V. Chobanian, M.D. — Thu, 23Â AugÂ 2007 00:00:00 -05:00

A 68-year-old accountant visits his physician. He was told a year earlier that his blood pressure was somewhat elevated and was advised to reduce salt intake and increase physical activity....

REVIEW ARTICLE: Sodium and Potassium in the Pathogenesis of Hypertension

Horacio J. AdroguÃ©, M.D., and Nicolaos E. Madias, M.D. — Thu, 10Â MayÂ 2007 00:00:00 -05:00

Hypertension affects approximately 25% of the adult population worldwide, and its prevalence is predicted to increase by 60% by 2025, when a total of 1.56 billion people may be affected.1...

IMAGES IN CLINICAL MEDICINE: Duplication of the Inferior Vena Cava

Junaid Masood, F.R.C.S., M.Sc. and Jayanta M. Barua, M.D., F.R.C.S. — Thu, 03Â MayÂ 2007 00:00:00 -05:00

A 68-year-old man with hypertension presented with vague abdominal pain. Ultrasonography of the abdomen showed a renal mass in the left kidney. A computed tomographic scan of the abdomen showed...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2007 â A 56-Year-Old Woman with Renal Failure after HeartâLung Transplantation

Nelson B. Goes, M.D., and Robert B. Colvin, M.D. — Thu, 19Â AprÂ 2007 00:00:00 -05:00

A 56-year-old woman with a history of primary pulmonary hypertension and heart and lung transplantation was admitted to the hospital because of renal failure.

When the patient was approximately 43 years...

SPECIAL ARTICLE: Improving the Management of Chronic Disease at Community Health Centers

Thu, 01Â MarÂ 2007 00:00:00 -05:00

Background: The Health Disparities Collaboratives of the Health Resources and Services Administration (HRSA) were designed to improve care in community health centers, where many patients from ethnic and racial minority...

IMAGES IN CLINICAL MEDICINE: Central Retinal Artery Occlusion

Kayvan Arashvand, M.D. — Thu, 22Â FebÂ 2007 00:00:00 -05:00

A 76-year-old man with hypertension presented with a sudden, painless, and profound loss of vision in the right eye. Visual acuity was light perception only in the affected eye, with...

IMAGES IN CLINICAL MEDICINE: Arterial Microaneurysms in Polyarteritis Nodosa

Chandan Jyoti Das, M.D. and Ghan Shyam Pangtey, M.D. — Thu, 14Â DecÂ 2006 00:00:00 -05:00

A 19-year-old man presented with a 10-month history of Raynaud's phenomenon, fever, abdominal pain, and hypertension. On examination, he had multiple subcutaneous nodules on his forehead, and his blood pressure...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2006 â A 35-Year-Old Pregnant Woman with New Hypertension

Thu, 23Â NovÂ 2006 00:00:00 -05:00

Dr. Andrea L. Utz (Endocrinology): A 35-year-old pregnant woman (gravida 2, para 1) was admitted to this hospital at 19 weeks and 6 days of gestation because of the recent...

IMAGES IN CLINICAL MEDICINE: Fibromuscular Dysplasia of the Renal Artery

Christoph Caliezi, M.D. and Peter Reber, M.D. — Thu, 16Â NovÂ 2006 00:00:00 -05:00

During a routine preoperative checkup before a planned hysterectomy, a healthy 31-year-old woman was noted to have an elevated blood pressure of 230/130 mm Hg, mild headache without chest pain,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2006 â A 15-Year-Old Girl with Severe Obesity

Thu, 12Â OctÂ 2006 00:00:00 -05:00

A 15 1/2-year-old girl was seen in the outpatient Weight Center of this hospital for the evaluation of severe obesity. She had had a normal gestation without complications and had...

ORIGINAL ARTICLE: Effect of Ramipril on the Incidence of Diabetes

The DREAM Trial Investigators — Thu, 12Â OctÂ 2006 00:00:00 -05:00

Background: Previous studies have suggested that blockade of the reninâangiotensin system may prevent diabetes in people with cardiovascular disease or hypertension.

Methods: In a double-blind, randomized clinical trial with a 2-by-2...

ORIGINAL ARTICLE: Soluble Endoglin and Other Circulating Antiangiogenic Factors in Preeclampsia

Thu, 07Â SepÂ 2006 00:00:00 -05:00

Background: Alterations in circulating soluble fms-like tyrosine kinase 1 (sFlt1), an antiangiogenic protein, and placental growth factor (PlGF), a proangiogenic protein, appear to be involved in the pathogenesis of preeclampsia....

EDITORIAL: Explaining and Predicting Preeclampsia

Marshall D. Lindheimer, M.D., and Jason G. Umans, M.D., Ph.D. — Thu, 07Â SepÂ 2006 00:00:00 -05:00

Preeclampsia, either alone or superimposed on another disorder, is a major cause of maternal and fetal death and the leading cause of premature delivery worldwide.1 Underappreciated is the strain that...

CLINICAL PROBLEM-SOLVING: More Than Meets the Eye

Thu, 07Â SepÂ 2006 00:00:00 -05:00

A 61-year-old woman was hospitalized with a two-day history of palpitations and dyspnea. She was found to be in atrial fibrillation with a rapid ventricular response, and intravenous diltiazem and...

IMAGES IN CLINICAL MEDICINE: Ocular Bleeding Due to Anticoagulation

Latha G. Stead, M.D. and Kurtis A. Judson, M.D. — Thu, 24Â AugÂ 2006 00:00:00 -05:00

An 83-year-old woman with a history of hypertension, glaucoma, and atrial fibrillation, who had a pacemaker and was receiving warfarin, woke up with a sensation of pain in the right...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2006 â A 36-Year-Old Man with Numbness in the Right Hand and Hypertension

Thu, 27Â JulÂ 2006 00:00:00 -05:00

Dr. Joanna J. Wykrzykowska (Medicine): A 36-year-old man was admitted to the hospital because of a mass in the right adrenal gland. The patient had been well until seven months...

CLINICAL PRACTICE: Resistant or Difficult-to-Control Hypertension

Marvin Moser, M.D., and John F. Setaro, M.D. — Thu, 27Â JulÂ 2006 00:00:00 -05:00

A 70-year-old woman with a long-standing history of hypertension comes for follow-up. Her medications include atenolol (100 mg daily), hydrochlorothiazide (12.5 mg daily), lisinopril (40 mg daily), and ibuprofen (400...

IMAGES IN CLINICAL MEDICINE: Angioedema of the Tongue

Sjoerd W. Westra, M.D. and Cornelis P.C. de Jager, M.D. — Thu, 20Â JulÂ 2006 00:00:00 -05:00

A 75-year-old man presented to the emergency department with diffuse swelling of his tongue that had begun a few hours earlier. He had no known history of allergies. He had...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Transforming Growth Factor Î² Signaling, Vascular Remodeling, and Hypertension

Phyllis August, M.D., M.P.H., and Manikkam Suthanthiran, M.D. — Thu, 22Â JunÂ 2006 00:00:00 -05:00

Hypertension affects more than 1 billion adults worldwide and is the leading cause of preventable death. Despite the plethora of drugs available, the disease is adequately controlled in only about...

EDITORIAL: ACE Inhibitors and Congenital Anomalies

J.M. Friedman, M.D., Ph.D. — Thu, 08Â JunÂ 2006 00:00:00 -05:00

Angiotensin-convertingâenzyme (ACE) inhibitors are among the most widely prescribed antihypertensive agents in the United States, but when used in the second half of pregnancy, they can cause oligohydramnios, fetal growth...

ORIGINAL ARTICLE: Major Congenital Malformations after First-Trimester Exposure to ACE Inhibitors

Thu, 08Â JunÂ 2006 00:00:00 -05:00

Background: Use of angiotensin-convertingâenzyme (ACE) inhibitors during the second and third trimesters of pregnancy is contraindicated because of their association with an increased risk of fetopathy. In contrast, first-trimester use...

REVIEW ARTICLE: Ambulatory Blood-Pressure Monitoring

Thu, 01Â JunÂ 2006 00:00:00 -05:00

In the past 30 years, the techniques for measuring blood pressure to determine whether a patient has hypertension have undergone a substantial change. The bulk of our knowledge about the...

EDITORIAL: Pharmacotherapy for Prehypertension â Mission Accomplished?

Heribert Schunkert, M.D. — Thu, 20Â AprÂ 2006 00:00:00 -05:00

Prehypertension, defined as the blood-pressure range of 120 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic, is present in about 70 million Americans.12 The condition heralds...

ORIGINAL ARTICLE: Feasibility of Treating Prehypertension with an Angiotensin-Receptor Blocker

Thu, 20Â AprÂ 2006 00:00:00 -05:00

Background: Prehypertension is considered a precursor of stage 1 hypertension and a predictor of excessive cardiovascular risk. We investigated whether pharmacologic treatment of prehypertension prevents or postpones stage 1 hypertension.

Methods:...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2005 â A 29-Year-Old Pregnant Woman with the Nephrotic Syndrome and Hypertension

Thu, 15Â DecÂ 2005 00:00:00 -05:00

A 29-year-old pregnant woman with systemic lupus erythematosus was admitted to the hospital because of renal failure at 20 weeks 6 days of gestation.

The patient, a native of Panama, had...

IMAGES IN CLINICAL MEDICINE: Atherosclerotic Aortic Occlusion

Thanila A. Macedo, M.D. — Thu, 15Â SepÂ 2005 00:00:00 -05:00

A 46-year-old woman presented with lifestyle-limiting claudication of the legs. Symptoms had progressed over the previous seven years. She had hypertension, hyperlipidemia, and a smoking history of one pack per...

REVIEW ARTICLE: Adherence to Medication

Lars Osterberg, M.D., and Terrence Blaschke, M.D. — Thu, 04Â AugÂ 2005 00:00:00 -05:00

Adherence to (or compliance with) a medication regimen is generally defined as the extent to which patients take medications as prescribed by their health care providers. The word âadherenceâ is...

IMAGES IN CLINICAL MEDICINE: Improvement in Hypertensive Retinopathy after Treatment of Hypertension

Mark W.J. Strachan, M.D. and John A. McKnight, M.D. — Thu, 05Â MayÂ 2005 00:00:00 -05:00

A 34-year-old woman presented with a short history of headache and blurred vision. Her corrected visual acuity was 20/30 and N24 in the left eye and 20/20 and N5 in...

REVIEW ARTICLE: Hypertensive Retinopathy

Tien Y. Wong, M.D., Ph.D., and Paul Mitchell, M.D., Ph.D. — Thu, 25Â NovÂ 2004 00:00:00 -05:00

Hypertensive retinopathy is a condition characterized by a spectrum of retinal vascular signs in people with elevated blood pressure.1 The detection of hypertensive retinopathy with the use of an ophthalmoscope...

REVIEW ARTICLE: Managing Hyperkalemia Caused by Inhibitors of the ReninâAngiotensinâAldosterone System

Biff F. Palmer, M.D. — Thu, 05Â AugÂ 2004 00:00:00 -05:00

Angiotensin-convertingâenzyme (ACE) inhibitors and angiotensin-receptor blockers are used commonly in clinical practice to treat hypertension and decrease cardiovascular events in high-risk patients. A side effect of such therapy is the...

ORIGINAL ARTICLE: Rates of Hyperkalemia after Publication of the Randomized Aldactone Evaluation Study

Thu, 05Â AugÂ 2004 00:00:00 -05:00

Background: The Randomized Aldactone Evaluation Study (RALES) demonstrated that spironolactone significantly improves outcomes in patients with severe heart failure. Use of angiotensin-convertingâenzyme (ACE) inhibitors is also indicated in these patients....

PERSPECTIVE: Aldosterone â Villain or Bystander?

Robert G. Dluhy, M.D., and Gordon H. Williams, M.D. — Thu, 01Â JulÂ 2004 00:00:00 -05:00

The two primary regulators of aldosterone secretion are potassium and the reninâangiotensin system. The latter is involved in volume homeostasis, with high salt intake suppressing the reninâangiotensin system and aldosterone...

ORIGINAL ARTICLE: Serum Aldosterone and the Incidence of Hypertension in Nonhypertensive Persons

Thu, 01Â JulÂ 2004 00:00:00 -05:00

Background: Primary hyperaldosteronism is a well-recognized cause of secondary hypertension. It is unknown whether serum aldosterone levels within the physiologic range influence the risk of hypertension.

Methods: We investigated the relation...

IMAGES IN CLINICAL MEDICINE: Hypokalemia

Adam Nosworthy, M.B., B.Ch. — Thu, 27Â NovÂ 2003 00:00:00 -05:00

A 42-year-old man was hospitalized because he had had confusion, weakness, and lethargy for approximately a week. Hypertension had recently been diagnosed, and the patient had begun therapy with a...

ORIGINAL ARTICLE: Prognostic Value of Ambulatory Blood-Pressure Recordings in Patients with Treated Hypertension

Thu, 12Â JunÂ 2003 00:00:00 -05:00

Background: It is uncertain whether ambulatory blood-pressure measurements recorded for 24 hours in patients with treated hypertension predict cardiovascular events independently of blood-pressure measurements obtained in the physician's office and...

PERSPECTIVE: Ambulatory Blood-Pressure Monitoring in Clinical Practice

William B. White, M.D. — Thu, 12Â JunÂ 2003 00:00:00 -05:00

Ambulatory blood-pressure monitoring provides automated measurements of brachial-artery pressure over a 24-hour period while patients are engaging in their usual activities. This method has been used for more than 30...

EDITORIAL: Treating Hypertension â What Are We to Believe?

Edward D. Frohlich, M.D. — Thu, 13Â FebÂ 2003 00:00:00 -05:00

Not infrequently, on release of the results of major multicenter trials, the lay press promulgates an immediate response before physicians have had time to assess the peer-reviewed paper. By the...

CLINICAL PRACTICE: Initial Treatment of Hypertension

Phyllis August, M.D., M.P.H. — Thu, 13Â FebÂ 2003 00:00:00 -05:00

A 50-year-old black American has a blood pressure of 160/110 mm Hg on repeated measurements. He is 9 kg (20 lb) overweight, has a family history of hypertension, and smokes...

ORIGINAL ARTICLE: A Comparison of Outcomes with Angiotensin-ConvertingâEnzyme Inhibitors and Diuretics for Hypertension in the Elderly

Thu, 13Â FebÂ 2003 00:00:00 -05:00

Background: Treatment of hypertension with diuretics, beta-blockers, or both leads to improved outcomes. It has been postulated that agents that inhibit the reninâangiotensin system confer benefit beyond the reduction of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 3-2003 â A 36-Year-Old Man with Renal Failure, Hypertension, and Neurologic Abnormalities

Jonathan S. Coblyn, M.D., and Robert T. McCluskey, M.D. — Thu, 23Â JanÂ 2003 00:00:00 -05:00

A 36-year-old, right-handed man was admitted to the hospital because of seizures and severe hypertension.

The patient had an 18-year history of intravenous drug abuse, including abuse of heroin and cocaine...

PERSPECTIVE: Magnesium Sulfate for Preeclampsia

Michael F. Greene, M.D. — Thu, 23Â JanÂ 2003 00:00:00 -05:00

For centuries, practitioners of midwifery have feared the occurrence of convulsions during pregnancy because they carried a particularly grave prognosis for both mother and fetus. In 17th-century Paris, eclampsia was...

PERSPECTIVE: Is Microanatomy Destiny?

Julie R. Ingelfinger, M.D. — Thu, 09Â JanÂ 2003 00:00:00 -05:00

Dissecting the pathogenesis of primary, or âessential,â hypertension has proved elusive. In recent years, the hypothesis that having relatively fewer nephrons renders an otherwise healthy person more susceptible to renal...

IMAGES IN CLINICAL MEDICINE: Page Kidney

Guilherme H.M. Oliveira, M.D. and Alexander Schirger, M.D. — Thu, 09Â JanÂ 2003 00:00:00 -05:00

A 23-year-old man presented with a two-month history of hypertension. At 18 years of age, he had sustained an injury to the left flank while playing college football. His blood...

ORIGINAL ARTICLE: Nephron Number in Patients with Primary Hypertension

Thu, 09Â JanÂ 2003 00:00:00 -05:00

Background: A diminished number of nephrons has been proposed as one of the factors contributing to the development of primary hypertension.

Methods: To test this hypothesis, we used a three-dimensional stereologic...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Angiotensin-Converting Enzyme 2 â A New Cardiac Regulator

Thu, 28Â NovÂ 2002 00:00:00 -05:00

The reninâangiotensin system is a master regulator of human physiology. It controls blood pressure and fluid and electrolyte balance through coordinated effects on the heart, blood vessels, and kidneys. In...

CLINICAL PRACTICE: Nondiabetic Kidney Disease

Andrew S. Levey, M.D. — Thu, 07Â NovÂ 2002 00:00:00 -05:00

A 66-year-old man without diabetes has worsening high blood pressure, to 160/100 mm Hg. He has a serum creatinine level of 1.8 mg per deciliter (159 Î¼mol per liter), an...

REVIEW ARTICLE: Ventricular Septal Rupture after Acute Myocardial Infarction

Thu, 31Â OctÂ 2002 00:00:00 -05:00

When ventricular septal rupture complicates acute myocardial infarction, the mortality is high. Reperfusion therapy has reduced the incidence of septal rupture. However, rapid diagnosis, aggressive medical management, and surgical intervention...

REVIEW ARTICLE: Renal Dysfunction Complicating the Treatment of Hypertension

Biff F. Palmer, M.D. — Thu, 17Â OctÂ 2002 00:00:00 -05:00

Treatment of hypertension in patients with normal renal function does not generally cause renal dysfunction. By contrast, in patients with hypertension and chronic renal insufficiency, it is not uncommon for...

ORIGINAL ARTICLE: Increase in Nocturnal Blood Pressure and Progression to Microalbuminuria in Type 1 Diabetes

Thu, 12Â SepÂ 2002 00:00:00 -05:00

Background: Patients with type 1 diabetes mellitus and microalbuminuria often have elevated blood pressure while they are asleep, but it is not known whether the elevation develops concomitantly with microalbuminuria...

PERSPECTIVE: Ambulatory Blood-Pressure Monitoring as a Predictive Tool

Thu, 12Â SepÂ 2002 00:00:00 -05:00

Although some patients with type 1 diabetes mellitus have complications, such as diabetic nephropathy, many do not. Thus, a simple, noninvasive method of identifying those at highest â and lowest...

ORIGINAL ARTICLE: Inhaled Iloprost for Severe Pulmonary Hypertension

Thu, 01Â AugÂ 2002 00:00:00 -05:00

Background: Uncontrolled studies suggested that aerosolized iloprost, a stable analogue of prostacyclin, causes selective pulmonary vasodilatation and improves hemodynamics and exercise capacity in patients with pulmonary hypertension.

Methods: We compared repeated...

PERSPECTIVE: B-Type Natriuretic Peptide â A Window to the Heart

Thu, 18Â JulÂ 2002 00:00:00 -05:00

Left ventricular dysfunction, regardless of its cause, results in characteristic hemodynamic derangements and a process of neurohormonal activation. Among the neuronal and hormonal pathways activated are the sympathetic nervous system,...

EDITORIAL: Hypertension, Angiotensin II, and Oxidative Stress

Thu, 20Â JunÂ 2002 00:00:00 -05:00

Renovascular hypertension is a potentially curable form of secondary hypertension generally due to either atherosclerosis or fibromuscular dysplasia of one or both renal arteries.12 The critical element promoting hypertension in...

ORIGINAL ARTICLE: Endothelial Function and Oxidative Stress in Renovascular Hypertension

Thu, 20Â JunÂ 2002 00:00:00 -05:00

Background: It has been reported that renovascular hypertension activates the reninâangiotensin system, leading to an increase in oxidative stress. We sought to determine whether renal-artery angioplasty improves endothelial dysfunction in...

EDITORIAL: Pheochromocytoma â Death of an Axiom

Thu, 09Â MayÂ 2002 00:00:00 -05:00

Medical students often learn axioms in order to remember the key features of a disorder. The ârule of 10â used to describe pheochromocytomas is a good example: 10 percent are...

ORIGINAL ARTICLE: Germ-Line Mutations in Nonsyndromic Pheochromocytoma

Thu, 09Â MayÂ 2002 00:00:00 -05:00

Background: The group of susceptibility genes for pheochromocytoma that included the proto-oncogene RET (associated with multiple endocrine neoplasia type 2 [MEN-2]) and the tumor-suppressor gene VHL (associated with von HippelâLindau...

EDITORIAL: Treatment of Primary Pulmonary Hypertension â The Next Generation

Thu, 21Â MarÂ 2002 00:00:00 -05:00

Primary pulmonary hypertension predominantly affects women, frequently in the prime of life, and usually leads to death from right ventricular failure within a few years after diagnosis. It is a...

REVIEW ARTICLE: Subtle Acquired Renal Injury as a Mechanism of Salt-Sensitive Hypertension

Thu, 21Â MarÂ 2002 00:00:00 -05:00

In 1856 Ludwig Traube1 proposed a role of the kidney in the pathogenesis of hypertension on the basis that hypertension and vascular disease were often associated with chronic Bright's disease....

ORIGINAL ARTICLE: Bosentan Therapy for Pulmonary Arterial Hypertension

Thu, 21Â MarÂ 2002 00:00:00 -05:00

Background: Endothelin-1 is a potent vasoconstrictor and smooth-muscle mitogen. In a preliminary study, the orally administered dual endothelin-receptor antagonist bosentan improved exercise capacity and cardiopulmonary hemodynamics in patients with pulmonary...

SPECIAL ARTICLE: Outcomes of Reference Pricing for Angiotensin-ConvertingâEnzyme Inhibitors

Thu, 14Â MarÂ 2002 00:00:00 -05:00

Background: In January 1997, reference pricing for angiotensin-convertingâenzyme (ACE) inhibitors for patients 65 years of age or older was introduced in British Columbia, Canada. For medications within a specific class,...

REVIEW ARTICLE: Fenoldopam â A Selective Peripheral Dopamine-Receptor Agonist for the Treatment of Severe Hypertension

Michael B. Murphy, M.D., Clare Murray, M.B., and George D. Shorten, M.D. — Thu, 22Â NovÂ 2001 00:00:00 -05:00

Fenoldopam mesylate, a benzazepine derivative, is the first selective dopamine-1âreceptor agonist that has been approved for clinical use. Administered parenterally, it acts predominantly as a vasodilator in peripheral arteries and...

ORIGINAL ARTICLE: The Effect of Common Polymorphisms of the Î²-Adrenergic Receptor on Agonist-Mediated Vascular Desensitization

Thu, 04Â OctÂ 2001 00:00:00 -05:00

Background: With continuous exposure to Î²2-adrenergic agonists, vascular tissue becomes desensitized to agonist-mediated vasodilatation. We studied the effects of two common polymorphisms of the Î²2-adrenergic receptor, one at codon 16...

EDITORIAL: Prevention of End-Stage Renal Disease Due to Type 2 Diabetes

Thu, 20Â SepÂ 2001 00:00:00 -05:00

The prevalence of end-stage renal disease is increasing at an alarming rate. In 2000, chronic kidney failure developed in over 90,000 people in the United States; the current population of...

ORIGINAL ARTICLE: The Effect of Irbesartan on the Development of Diabetic Nephropathy in Patients with Type 2 Diabetes

Thu, 20Â SepÂ 2001 00:00:00 -05:00

Background: Microalbuminuria and hypertension are risk factors for diabetic nephropathy. Blockade of the reninâangiotensin system slows the progression to diabetic nephropathy in patients with type 1 diabetes, but similar data...

ORIGINAL ARTICLE: Effects of Losartan on Renal and Cardiovascular Outcomes in Patients with Type 2 Diabetes and Nephropathy

Thu, 20Â SepÂ 2001 00:00:00 -05:00

Background: Diabetic nephropathy is the leading cause of end-stage renal disease. Interruption of the reninâangiotensin system slows the progression of renal disease in patients with type 1 diabetes, but similar...

ORIGINAL ARTICLE: Renoprotective Effect of the Angiotensin-Receptor Antagonist Irbesartan in Patients with Nephropathy Due to Type 2 Diabetes

Thu, 20Â SepÂ 2001 00:00:00 -05:00

Background: It is unknown whether either the angiotensin-IIâreceptor blocker irbesartan or the calcium-channel blocker amlodipine slows the progression of nephropathy in patients with type 2 diabetes independently of its capacity...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2001 â Hypertensive Encephalopathy with Impaired Renal Function in a 67-Year-Old Woman with Polymyositis

Joseph H. Korn, M.D., and Shamila Mauiyyedi, M.D. — Thu, 23Â AugÂ 2001 00:00:00 -05:00

A 67-year-old woman was initially admitted to this hospital because of hypertensive encephalopathy.

The patient had been well until one month before admission, when she became weak and began to have...

EDITORIAL: Control of Hypertension â An Important National Priority

Thu, 16Â AugÂ 2001 00:00:00 -05:00

Despite very effective antihypertensive therapies and data from clinical trials demonstrating that lowering blood pressure reduces cardiovascular and renal complications, more than one fourth of the estimated 42 million people...

ORIGINAL ARTICLE: Characteristics of Patients with Uncontrolled Hypertension in the United States

David J. Hyman, M.D., M.P.H., and Valory N. Pavlik, Ph.D. — Thu, 16Â AugÂ 2001 00:00:00 -05:00

Background: Treatment of hypertension is one of the most common clinical responsibilities of U.S. physicians, yet only one fourth of patients with hypertension have their blood pressure adequately controlled.

Methods: We...

ORIGINAL ARTICLE: Neonatal Pulmonary Hypertension â Urea-Cycle Intermediates, Nitric Oxide Production, and Carbamoyl-Phosphate Synthetase Function

Thu, 14Â JunÂ 2001 00:00:00 -05:00

Background: Endogenous production of nitric oxide is vital for the decrease in pulmonary vascular resistance that normally occurs after birth. The precursor of nitric oxide is arginine, a urea-cycle intermediate....

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 13-2001 â A 19-Year-Old Man with Bouts of Hypertension and Severe Headaches

Paul R. Conlin, William C. Faquin — Thu, 26Â AprÂ 2001 00:00:00 -05:00

A 19-year-old man was admitted to the hospital because of headaches and hypertension.

The patient had been well until two years earlier, when he began to have episodic mild headaches that...

ORIGINAL ARTICLE: Noninvasive Diagnosis of Renal-Allograft Rejection by Measurement of Messenger RNA for Perforin and Granzyme B in Urine

Thu, 29Â MarÂ 2001 00:00:00 -05:00

Background: Acute rejection is a serious and frequent complication of renal transplantation, and its diagnosis is contingent on the invasive procedure of allograft biopsy. A noninvasive diagnostic test for rejection...

EDITORIAL: Risk Factors for Preeclampsia

Thu, 22Â MarÂ 2001 00:00:00 -05:00

An estimated 50,000 women per year worldwide die from preeclampsia. Preeclampsia is more likely to develop in women whose mothers had preeclampsia than in women whose mothers did not.1 The...

ORIGINAL ARTICLE: Paternal and Maternal Components of the Predisposition to Preeclampsia

Thu, 22Â MarÂ 2001 00:00:00 -05:00

Background: There is an inherited maternal predisposition to preeclampsia. Whether there is a paternal component, however, is not known.

Methods: We used records of the Utah Population Database to identify 298...

REVIEW ARTICLE: Renal-Artery Stenosis

Robert D. Safian, M.D., and Stephen C. Textor, M.D. — Thu, 08Â FebÂ 2001 00:00:00 -05:00

Primary diseases of the renal arteries often involve the large renal arteries, whereas secondary diseases are frequently characterized by small-vessel and intrarenal vascular disease. In this article, we will concentrate...

EDITORIAL: Beating High Blood Pressure with Low-Sodium DASH

Thu, 04Â JanÂ 2001 00:00:00 -05:00

The 1997 Dietary Approaches to Stop Hypertension (DASH) trial1 marked an important advance in the study of lifestyle factors as they relate to health and disease. Its findings were immediately...

ORIGINAL ARTICLE: Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet

Thu, 04Â JanÂ 2001 00:00:00 -05:00

Background: The effect of dietary composition on blood pressure is a subject of public health importance. We studied the effect of different levels of dietary sodium, in conjunction with the...

ORIGINAL ARTICLE: Obesity, Hypertension, and the Risk of Kidney Cancer in Men

Thu, 02Â NovÂ 2000 00:00:00 -05:00

Background: Obesity and hypertension have been implicated as risk factors for the development of renal-cell cancer.

Methods: We examined the health records of 363,992 Swedish men who underwent at least one...

ORIGINAL ARTICLE: Prospective Study of the Association between Sleep-Disordered Breathing and Hypertension

Thu, 11Â MayÂ 2000 00:00:00 -05:00

Background: Sleep-disordered breathing is prevalent in the general population and has been linked to chronically elevated blood pressure in cross-sectional epidemiologic studies. We performed a prospective, population-based study of the...

EDITORIAL: Renal Angioplasty for Lowering Blood Pressure

Thu, 06Â AprÂ 2000 00:00:00 -05:00

The great economist Joseph Schumpeter regarded creative destruction as an indispensable element of economic progress. In a similar vein, the report by van Jaarsveld et al.1 in this issue of...

ORIGINAL ARTICLE: The Effect of Balloon Angioplasty on Hypertension in Atherosclerotic Renal-Artery Stenosis

Thu, 06Â AprÂ 2000 00:00:00 -05:00

Background: Patients with hypertension and renal-artery stenosis are often treated with percutaneous transluminal renal angioplasty. However, the long-term effects of this procedure on blood pressure are not well understood.

Methods: We...

EDITORIAL: Antihypertensive Therapy and the Risk of Type 2 Diabetes Mellitus

Thu, 30Â MarÂ 2000 00:00:00 -05:00

Although thiazide diuretics and beta-blockers are often used as first-line therapy in patients with hypertension, including those with diabetes mellitus,1 the possibility that these drugs may promote glucose intolerance remains...

ORIGINAL ARTICLE: Hypertension and Antihypertensive Therapy as Risk Factors for Type 2 Diabetes Mellitus

Thu, 30Â MarÂ 2000 00:00:00 -05:00

Background: Previous research has suggested that thiazide diuretics and beta-blockers may promote the development of type 2 diabetes mellitus. However, the results of these studies have been inconsistent, and many...

EDITORIAL: Blood Pressure and the Risk of Cardiovascular Disease

Thu, 06Â JanÂ 2000 00:00:00 -05:00

The level of blood pressure has long been recognized as a determinant of the risks for several common cardiovascular diseases, including coronary heart disease, cerebrovascular disease, and heart failure. Throughout...

ORIGINAL ARTICLE: The Relation between Blood Pressure and Mortality Due to Coronary Heart Disease among Men in Different Parts of the World

Thu, 06Â JanÂ 2000 00:00:00 -05:00

Background: Elevated blood pressure is known to be a risk factor for death from coronary heart disease (CHD). However, it is unclear whether the risk of death from CHD in...

EDITORIAL: Sympathetic Overactivity in Hypertensive Patients with Chronic Renal Disease

Thu, 29Â AprÂ 1999 00:00:00 -05:00

It is not clear why blood pressure increases in patients with chronic renal failure. The most widely advanced explanation is that such increases are due to extracellular volume expansion caused...

ORIGINAL ARTICLE: Reduction of Sympathetic Hyperactivity by Enalapril in Patients with Chronic Renal Failure

Thu, 29Â AprÂ 1999 00:00:00 -05:00

Background: Inhibition of angiotensin-converting enzyme (ACE) reduces the risk of cardiovascular problems in patients with chronic renal failure. This effect may be due in part to a decrease in sympathetic...

EDITORIAL: Left Ventricular Hypertrophy in Hypertension

Thu, 22Â AprÂ 1999 00:00:00 -05:00

The adverse effect of left ventricular hypertrophy, as measured by the weight of the heart on the pathologist's scale, was recognized in the early part of this century, even before...

ORIGINAL ARTICLE: Trends in the Prevalence of Hypertension, Antihypertensive Therapy, and Left Ventricular Hypertrophy from 1950 to 1989

Thu, 22Â AprÂ 1999 00:00:00 -05:00

Background: Men and women with hypertension are at increased risk for cardiovascular disease, especially when left ventricular hypertrophy is present. We examined temporal trends in the use of antihypertensive medications...

REVIEW ARTICLE: The Expanding Spectrum of G Protein Diseases

Zvi Farfel, M.D., Henry R. Bourne, M.D., and Taroh Iiri, M.D., Ph.D. — Thu, 01Â AprÂ 1999 00:00:00 -05:00

Disease-causing mutations often reveal key pathways of physiologic regulation and their underlying molecular mechanisms. Mutations in the trimeric guanine nucleotide-binding proteins (G proteins), which relay signals initiated by photons, odorants,...

ORIGINAL ARTICLE: Effects of Calcium-Channel Blockade in Older Patients with Diabetes and Systolic Hypertension

Thu, 04Â MarÂ 1999 00:00:00 -05:00

Background: Recent reports suggest that calcium-channel blockers may be harmful in patients with diabetes and hypertension. We previously reported that antihypertensive treatment with the calcium-channel blocker nitrendipine reduced the risk...

IMAGES IN CLINICAL MEDICINE: Malignant Hypertension

Mark A. Perazella, M.D. and Rex L. Mahnensmith, M.D. — Thu, 31Â DecÂ 1998 00:00:00 -05:00

Figure 1. A 41-year-old woman with blurred vision and dyspnea was found to have severe hypertension (blood pressure, 240/125 mm Hg in both arms) and grade IV hypertensive retinopathy. Laboratory...

ORIGINAL ARTICLE: Inadequate Management of Blood Pressure in a Hypertensive Population

Thu, 31Â DecÂ 1998 00:00:00 -05:00

Background: Many patients with hypertension have inadequate control of their blood pressure. Improving the treatment of hypertension requires an understanding of the ways in which physicians manage this condition and...

REVIEW ARTICLE: Primary Aldosteronism

Arunabha Ganguly, M.D. — Thu, 17Â DecÂ 1998 00:00:00 -05:00

Primary aldosteronism resulting from an adrenocortical adenoma (aldosteronoma), as described by Conn,1 is one of a few potentially curable forms of hypertension. Aldosteronoma is the most common cause of primary...

REVIEW ARTICLE: Carvedilol

William H. Frishman, M.D. — Thu, 10Â DecÂ 1998 00:00:00 -05:00

Carvedilol is a Î²-adrenoreceptorâantagonist drug with Î±1-adrenoreceptorâantagonist activity. It was approved in the United States in September 1995 for the treatment of patients with essential hypertension and in May 1997,...

REVIEW ARTICLE: Pathophysiology of Progressive Nephropathies

Giuseppe Remuzzi, M.D., and Tullio Bertani, M.D. — Thu, 12Â NovÂ 1998 00:00:00 -05:00

In patients with renal diseases characterized by proteinuria, the initial insult to the kidney is usually followed by a progressive decline in the glomerular filtration rate. This decline has been...

ORIGINAL ARTICLE: Seasonal Changes in Blood Pressure in Patients with End-Stage Renal Disease Treated with Hemodialysis

Background: Many factors contribute to the regulation of blood pressure. The role of climate has received relatively little attention.

Methods: During a four-year period, we determined the influence of climate on...

ORIGINAL ARTICLE: Effect of Bradykinin-Receptor Blockade on the Response to Angiotensin-ConvertingâEnzyme Inhibitor in Normotensive and Hypertensive Subjects

Thu, 29Â OctÂ 1998 00:00:00 -05:00

Background: Angiotensin-convertingâenzyme (ACE) inhibitors not only decrease the production of angiotensin II but also decrease the degradation of bradykinin. In this study, a specific bradykinin-receptor antagonist, icatibant acetate (HOE 140),...

ORIGINAL ARTICLE: Risk Factors for Preeclampsia, Abruptio Placentae, and Adverse Neonatal Outcomes among Women with Chronic Hypertension

Thu, 03Â SepÂ 1998 00:00:00 -05:00

Background: Women with chronic hypertension who become pregnant have an increased risk of preeclampsia and adverse neonatal outcomes. However, within this group, the risk factors for these adverse events are...

ORIGINAL ARTICLE: The Effect of an Endothelin-Receptor Antagonist, Bosentan, on Blood Pressure in Patients with Essential Hypertension

Thu, 19Â MarÂ 1998 00:00:00 -05:00

Background: Endothelin is a powerful vasoconstrictor peptide derived from the endothelium. We evaluated the contribution of endothelin to blood-pressure regulation in patients with essential hypertension by studying the effect of...

EDITORIAL: Low-Dose Aspirin for Preeclampsia â The Unresolved Question

Thu, 12Â MarÂ 1998 00:00:00 -05:00

Preeclampsia, defined as hypertension and proteinuria or nondependent edema after 20 weeks' gestation, is a common complication of pregnancy. Endothelial-cell dysfunction with vasospasm, pathologic coagulation, and hypersensitivity to pressor substances...

ORIGINAL ARTICLE: Low-Dose Aspirin to Prevent Preeclampsia in Women at High Risk

Thu, 12Â MarÂ 1998 00:00:00 -05:00

Background: Whether low-dose aspirin prevents preeclampsia is unclear. It is not recommended as prophylaxis in women at low risk for preeclampsia but may reduce the incidence of the disease in...

EDITORIAL: Calcium-Channel Blockers for Hypertension â Uncertainty Continues

Thu, 05Â MarÂ 1998 00:00:00 -05:00

After the introduction of calcium-channel blockers into clinical practice nearly two decades ago, prescriptions for these drugs for the treatment of hypertension increased to the point where they became the...

ORIGINAL ARTICLE: The Effect of Nisoldipine as Compared with Enalapril on Cardiovascular Outcomes in Patients with Non-Insulin-Dependent Diabetes and Hypertension

Thu, 05Â MarÂ 1998 00:00:00 -05:00

Background: It has recently been reported that the use of calcium-channel blockers for hypertension may be associated with an increased risk of cardiovascular complications. Because this issue remains controversial, we...

ORIGINAL ARTICLE: Cumulative Effects of High Cholesterol Levels, High Blood Pressure, and Cigarette Smoking on Carotid Stenosis

Thu, 21Â AugÂ 1997 00:00:00 -05:00

Background: Single measurements of cardiovascular risk factors may not accurately reflect a person's past exposure to those risk factors. We therefore studied the long-term associations of cardiovascular risk factors such...

ORIGINAL ARTICLE: Trial of Calcium to Prevent Preeclampsia

Thu, 10Â JulÂ 1997 00:00:00 -05:00

Background: Previous trials have suggested that calcium supplementation during pregnancy may reduce the risk of preeclampsia. However, differences in study design and a low dietary calcium intake in the populations...

EDITORIAL: Prevention or Early Treatment of Preeclampsia

Thu, 10Â JulÂ 1997 00:00:00 -05:00

Preeclampsia continues to be a major health problem. It is a leading cause of maternal mortality in developed countries and is associated with a fivefold increase in perinatal mortality. It...

ORIGINAL ARTICLE: A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure

Thu, 17Â AprÂ 1997 00:00:00 -05:00

Background: It is known that obesity, sodium intake, and alcohol consumption influence blood pressure. In this clinical trial, Dietary Approaches to Stop Hypertension, we assessed the effects of dietary patterns...

REVIEW ARTICLE: Hypertension in Children

Alan R. Sinaiko, M.D. — Thu, 26Â DecÂ 1996 00:00:00 -05:00

The measurement of blood pressure is now firmly established as an important component of the routine pediatric physical examination. Nevertheless, blood pressure in children has been given serious attention only...

ORIGINAL ARTICLE: Preeclampsia â A State of Sympathetic Overactivity

Thu, 14Â NovÂ 1996 00:00:00 -05:00

Background: Preeclampsia is characterized by a marked increase in peripheral vascular resistance leading to an increase in blood pressure, but the triggering mechanisms are unclear.

Methods: To determine whether augmented sympathetic...

REVIEW ARTICLE: Treatment of Hypertension in Pregnant Women

Baha M. Sibai, M.D. — Thu, 25Â JulÂ 1996 00:00:00 -05:00

Hypertensive disorders are the most common medical complications of pregnancy and are an important cause of maternal and perinatal morbidity and mortality worldwide.1 During normal pregnancy, systolic pressure changes little;...

REVIEW ARTICLE: Hypertension and Associated Metabolic Abnormalities â The Role of Insulin Resistance and the Sympathoadrenal System

Gerald M. Reaven, M.D., Hans Lithell, M.D., and Lewis Landsberg, M.D. — Thu, 08Â FebÂ 1996 00:00:00 -05:00

Abnormalities of glucose, insulin, and lipoprotein metabolism are common in patients with hypertension. These changes can also be discerned in normotensive first-degree relatives of hypertensive patients. They are not present...

ORIGINAL ARTICLE: Blood Pressure and End-Stage Renal Disease in Men

Thu, 04Â JanÂ 1996 00:00:00 -05:00

Background: End-stage renal disease in the United States creates a large burden for both individuals and society as a whole. Efforts to prevent the condition require an understanding of modifiable...

NEJM â Collection Updates for Hypertension

IMAGES IN CLINICAL MEDICINE: Kinked Carotids

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 1-2010 â A 75-Year-Old Man with Hypertension, Hyperglycemia, and Edema

CLINICAL PROBLEM-SOLVING: A Crisis in Late Pregnancy

REVIEW ARTICLE: Use of Diuretics in Patients with Hypertension

CLINICAL THERAPEUTICS: Phosphodiesterase Type 5 Inhibitors for Pulmonary Arterial Hypertension

EDITORIAL: Blood-Pressure Control and Delay in Progression of Kidney Disease in Children

ORIGINAL ARTICLE: Strict Blood-Pressure Control and Progression of Renal Failure in Children

PERSPECTIVE: When Diseases Disappear â The Case of Familial Dysautonomia

CLINICAL PROBLEM-SOLVING: A Change of Heart

CORRESPONDENCE: Renal Sympathetic-Nerve Ablation for Uncontrolled Hypertension

IMAGES IN CLINICAL MEDICINE: Retinal Detachment in Malignant Hypertension

SPECIAL ARTICLE: The Hypertension Paradox â More Uncontrolled Disease despite Improved Therapy

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2009 â A 13-Year-Old Boy with Headache, Nausea, Seizures, and Hypertension

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2009 â A 36-Year-Old Woman with Headache, Hypertension, and Seizure 2 Weeks Post Partum

VIDEOS IN CLINICAL MEDICINE: Blood-Pressure Measurement

ORIGINAL ARTICLE: Modulation of Blood Pressure by Central Melanocortinergic Pathways

EDITORIAL: Does It Matter How Hypertension Is Controlled?

ORIGINAL ARTICLE: Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients

REVIEW ARTICLE: Uric Acid and Cardiovascular Risk

ORIGINAL ARTICLE: Long-Term Follow-up after Tight Control of Blood Pressure in Type 2 Diabetes

IMAGES IN CLINICAL MEDICINE: Central Hemiretinal Arterial Occlusion

EDITORIAL: Aliskiren and Dual Therapy in Type 2 Diabetes Mellitus

ORIGINAL ARTICLE: Aliskiren Combined with Losartan in Type 2 Diabetes and Nephropathy

CLINICAL DECISIONS: Management of Carotid Stenosis â Polling Results

EDITORIAL: Treating Hypertension in the Very Old

IMAGES IN CLINICAL MEDICINE: Changes in the Brain Stem and Fundus in Malignant Hypertension

ORIGINAL ARTICLE: Treatment of Hypertension in Patients 80 Years of Age or Older

CLINICAL DECISIONS: Management of Carotid Stenosis

CLINICAL PROBLEM-SOLVING: A Key Miscommunication â An 81-year-old woman presented to the emergency department with increasing abdominal distention, nausea, and vomiting

IMAGES IN CLINICAL MEDICINE: Retinal Arteriolar Cholesterol Emboli

CLINICAL DECISIONS: Management of Type 2 Diabetes

ORIGINAL ARTICLE: Evidence of MEN-2 in the Original Description of Classic Pheochromocytoma

CLINICAL PRACTICE: Isolated Systolic Hypertension in the Elderly

REVIEW ARTICLE: Sodium and Potassium in the Pathogenesis of Hypertension

IMAGES IN CLINICAL MEDICINE: Duplication of the Inferior Vena Cava

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2007 â A 56-Year-Old Woman with Renal Failure after HeartâLung Transplantation

SPECIAL ARTICLE: Improving the Management of Chronic Disease at Community Health Centers

IMAGES IN CLINICAL MEDICINE: Central Retinal Artery Occlusion

IMAGES IN CLINICAL MEDICINE: Arterial Microaneurysms in Polyarteritis Nodosa

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2006 â A 35-Year-Old Pregnant Woman with New Hypertension

IMAGES IN CLINICAL MEDICINE: Fibromuscular Dysplasia of the Renal Artery

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2006 â A 15-Year-Old Girl with Severe Obesity

ORIGINAL ARTICLE: Effect of Ramipril on the Incidence of Diabetes

ORIGINAL ARTICLE: Soluble Endoglin and Other Circulating Antiangiogenic Factors in Preeclampsia

EDITORIAL: Explaining and Predicting Preeclampsia

CLINICAL PROBLEM-SOLVING: More Than Meets the Eye

IMAGES IN CLINICAL MEDICINE: Ocular Bleeding Due to Anticoagulation

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2006 â A 36-Year-Old Man with Numbness in the Right Hand and Hypertension

CLINICAL PRACTICE: Resistant or Difficult-to-Control Hypertension

IMAGES IN CLINICAL MEDICINE: Angioedema of the Tongue

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Transforming Growth Factor Î² Signaling, Vascular Remodeling, and Hypertension

EDITORIAL: ACE Inhibitors and Congenital Anomalies

ORIGINAL ARTICLE: Major Congenital Malformations after First-Trimester Exposure to ACE Inhibitors

REVIEW ARTICLE: Ambulatory Blood-Pressure Monitoring

EDITORIAL: Pharmacotherapy for Prehypertension â Mission Accomplished?

ORIGINAL ARTICLE: Feasibility of Treating Prehypertension with an Angiotensin-Receptor Blocker

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2005 â A 29-Year-Old Pregnant Woman with the Nephrotic Syndrome and Hypertension

IMAGES IN CLINICAL MEDICINE: Atherosclerotic Aortic Occlusion

REVIEW ARTICLE: Adherence to Medication

IMAGES IN CLINICAL MEDICINE: Improvement in Hypertensive Retinopathy after Treatment of Hypertension

REVIEW ARTICLE: Hypertensive Retinopathy

REVIEW ARTICLE: Managing Hyperkalemia Caused by Inhibitors of the ReninâAngiotensinâAldosterone System

ORIGINAL ARTICLE: Rates of Hyperkalemia after Publication of the Randomized Aldactone Evaluation Study

PERSPECTIVE: Aldosterone â Villain or Bystander?

ORIGINAL ARTICLE: Serum Aldosterone and the Incidence of Hypertension in Nonhypertensive Persons

IMAGES IN CLINICAL MEDICINE: Hypokalemia

ORIGINAL ARTICLE: Prognostic Value of Ambulatory Blood-Pressure Recordings in Patients with Treated Hypertension

PERSPECTIVE: Ambulatory Blood-Pressure Monitoring in Clinical Practice

EDITORIAL: Treating Hypertension â What Are We to Believe?

CLINICAL PRACTICE: Initial Treatment of Hypertension

ORIGINAL ARTICLE: A Comparison of Outcomes with Angiotensin-ConvertingâEnzyme Inhibitors and Diuretics for Hypertension in the Elderly

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 3-2003 â A 36-Year-Old Man with Renal Failure, Hypertension, and Neurologic Abnormalities

PERSPECTIVE: Magnesium Sulfate for Preeclampsia

PERSPECTIVE: Is Microanatomy Destiny?

IMAGES IN CLINICAL MEDICINE: Page Kidney

ORIGINAL ARTICLE: Nephron Number in Patients with Primary Hypertension

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Angiotensin-Converting Enzyme 2 â A New Cardiac Regulator

CLINICAL PRACTICE: Nondiabetic Kidney Disease

REVIEW ARTICLE: Ventricular Septal Rupture after Acute Myocardial Infarction

NEJM â Collection Updates for Hypertension

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 1-2010 â A 75-Year-Old Man with Hypertension, Hyperglycemia, and Edema

PERSPECTIVE: When Diseases Disappear â The Case of Familial Dysautonomia

SPECIAL ARTICLE: The Hypertension Paradox â More Uncontrolled Disease despite Improved Therapy

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2009 â A 13-Year-Old Boy with Headache, Nausea, Seizures, and Hypertension

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2009 â A 36-Year-Old Woman with Headache, Hypertension, and Seizure 2 Weeks Post Partum

CLINICAL DECISIONS: Management of Carotid Stenosis â Polling Results

CLINICAL PROBLEM-SOLVING: A Key Miscommunication â An 81-year-old woman presented to the emergency department with increasing abdominal distention, nausea, and vomiting

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2007 â A 56-Year-Old Woman with Renal Failure after HeartâLung Transplantation

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2006 â A 35-Year-Old Pregnant Woman with New Hypertension

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2006 â A 15-Year-Old Girl with Severe Obesity

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2006 â A 36-Year-Old Man with Numbness in the Right Hand and Hypertension

EDITORIAL: Pharmacotherapy for Prehypertension â Mission Accomplished?

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2005 â A 29-Year-Old Pregnant Woman with the Nephrotic Syndrome and Hypertension

REVIEW ARTICLE: Managing Hyperkalemia Caused by Inhibitors of the ReninâAngiotensinâAldosterone System

PERSPECTIVE: Aldosterone â Villain or Bystander?

EDITORIAL: Treating Hypertension â What Are We to Believe?

ORIGINAL ARTICLE: A Comparison of Outcomes with Angiotensin-ConvertingâEnzyme Inhibitors and Diuretics for Hypertension in the Elderly

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 3-2003 â A 36-Year-Old Man with Renal Failure, Hypertension, and Neurologic Abnormalities

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Angiotensin-Converting Enzyme 2 â A New Cardiac Regulator

PERSPECTIVE: B-Type Natriuretic Peptide â A Window to the Heart

EDITORIAL: Pheochromocytoma â Death of an Axiom

EDITORIAL: Treatment of Primary Pulmonary Hypertension â The Next Generation

SPECIAL ARTICLE: Outcomes of Reference Pricing for Angiotensin-ConvertingâEnzyme Inhibitors

REVIEW ARTICLE: Fenoldopam â A Selective Peripheral Dopamine-Receptor Agonist for the Treatment of Severe Hypertension

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2001 â Hypertensive Encephalopathy with Impaired Renal Function in a 67-Year-Old Woman with Polymyositis

EDITORIAL: Control of Hypertension â An Important National Priority

ORIGINAL ARTICLE: Neonatal Pulmonary Hypertension â Urea-Cycle Intermediates, Nitric Oxide Production, and Carbamoyl-Phosphate Synthetase Function

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 13-2001 â A 19-Year-Old Man with Bouts of Hypertension and Severe Headaches

ORIGINAL ARTICLE: Effect of Bradykinin-Receptor Blockade on the Response to Angiotensin-ConvertingâEnzyme Inhibitor in Normotensive and Hypertensive Subjects

EDITORIAL: Low-Dose Aspirin for Preeclampsia â The Unresolved Question

EDITORIAL: Calcium-Channel Blockers for Hypertension â Uncertainty Continues

ORIGINAL ARTICLE: Preeclampsia â A State of Sympathetic Overactivity

REVIEW ARTICLE: Hypertension and Associated Metabolic Abnormalities â The Role of Insulin Resistance and the Sympathoadrenal System