The racial disparity in hypertension and hypertension-related outcomes has been recognized for decades with African Americans with greater risks than Caucasians. Blood pressure levels have ...consistently been higher for African Americans with an earlier onset of hypertension. Although awareness and treatment levels of high blood pressure have been similar, racial differences in control rates are evident. The higher blood pressure levels for African Americans are associated with higher rates of stroke, end-stage renal disease and congestive heart failure. The reasons for the racial disparities in elevated blood pressure and hypertension-related outcomes risk remain unclear. However, the implications of the disparities of hypertension for prevention and clinical management are substantial, identifying African American men and women with excel hypertension risk and warranting interventions focused on these differences. In addition, focused research to identify the factors attributed to these disparities in risk burden is an essential need to address the evidence gaps.
Resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium ...channel blocker, a blocker of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. The antihypertensive drugs should be administered at maximum or maximally tolerated daily doses. RH also includes patients whose BP achieves target values on ≥4 antihypertensive medications. The diagnosis of RH requires assurance of antihypertensive medication adherence and exclusion of the “white-coat effect” (office BP above goal but out-of-office BP at or below target). The importance of RH is underscored by the associated risk of adverse outcomes compared with non-RH. This article is an updated American Heart Association scientific statement on the detection, evaluation, and management of RH. Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect, evaluation includes identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. Management of RH includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and, if BP remains elevated, stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower BP. If BP remains uncontrolled, referral to a hypertension specialist is advised.
AbstractObjectiveTo examine the dose-response relation between reduction in dietary sodium and blood pressure change and to explore the impact of intervention duration.DesignSystematic review and ...meta-analysis following PRISMA guidelines.Data sourcesOvid MEDLINE(R), EMBASE, and Cochrane Central Register of Controlled Trials (Wiley) and reference lists of relevant articles up to 21 January 2019.Inclusion criteriaRandomised trials comparing different levels of sodium intake undertaken among adult populations with estimates of intake made using 24 hour urinary sodium excretion.Data extraction and analysisTwo of three reviewers screened the records independently for eligibility. One reviewer extracted all data and the other two reviewed the data for accuracy. Reviewers performed random effects meta-analyses, subgroup analyses, and meta-regression.Results133 studies with 12 197 participants were included. The mean reductions (reduced sodium v usual sodium) of 24 hour urinary sodium, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were 130 mmol (95% confidence interval 115 to 145, P<0.001), 4.26 mm Hg (3.62 to 4.89, P<0.001), and 2.07 mm Hg (1.67 to 2.48, P<0.001), respectively. Each 50 mmol reduction in 24 hour sodium excretion was associated with a 1.10 mm Hg (0.66 to 1.54; P<0.001) reduction in SBP and a 0.33 mm Hg (0.04 to 0.63; P=0.03) reduction in DBP. Reductions in blood pressure were observed in diverse population subsets examined, including hypertensive and non-hypertensive individuals. For the same reduction in 24 hour urinary sodium there was greater SBP reduction in older people, non-white populations, and those with higher baseline SBP levels. In trials of less than 15 days’ duration, each 50 mmol reduction in 24 hour urinary sodium excretion was associated with a 1.05 mm Hg (0.40 to 1.70; P=0.002) SBP fall, less than half the effect observed in studies of longer duration (2.13 mm Hg; 0.85 to 3.40; P=0.002). Otherwise, there was no association between trial duration and SBP reduction.ConclusionsThe magnitude of blood pressure lowering achieved with sodium reduction showed a dose-response relation and was greater for older populations, non-white populations, and those with higher blood pressure. Short term studies underestimate the effect of sodium reduction on blood pressure.Systematic review registrationPROSPERO CRD42019140812.
Early-career academic faculty from underrepresented minority groups are under-represented among medical school faculty, less likely to receive research grants, less likely to be promoted, and report ...lower career satisfaction. The Training in Research for Academic Neurologists to Sustain Careers and Enhance the Numbers of Diverse Scholars (TRANSCENDS) program was established as a research training and mentoring program to foster careers of diverse early-career individuals in neurology. Early career individuals from underrepresented groups in the biomedical-research workforce were selected from applicants during the initial cycle (2016–2020). An innovative component of TRANSCENDS is the incorporation of multiple training activities including: an online graduate research degree program; monthly webinar conferences; specific interaction sessions at the annual American Academy of Neurology meeting and year-round communications between matched mentors and mentees. The program complements these attributes with the Master of Science in Clinical Research (MSCR) degree that includes the competencies for the clinical and translational research workforce. The TRANSCENDS Scholars are assessed on a regular and ongoing basis to evaluate impact and identify components that need to be enhanced. The assessment of the first cycle indicated high enthusiasm from the scholars, mentors and faculty with identification of specific activities for enhancement. The results of the evaluation clearly identified a high satisfaction with the TRANSCENDS program indicating a significant impact on the clinical neuroscience research workforce of diverse underrepresented clinical neuroscientists equipped to be successful academic researchers.
•The Training in Research for Academic Neurologists to Sustain Careers and Enhance Numbers of Diverse Scholars (TRANSCENDS) program foster early careers in neurology.•Individuals from underrepresented groups in the biomedical-research workforce are selected from a national pool of applicants.•Innovative training activities include: an online graduate research degree program; monthly webinar conferences; specific interaction sessions at the annual American Academy of Neurology meeting and year-round communications between matched mentors and mentees.•Training activities include an online graduate research degree program, monthly webinars, mentoring interactions, and conference events.•Expected that TRANSCENDS will result in a large return on investment in grants, publication, prominence, and research career independence.
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