- N Engl J Med 2021; 385:1994-1994
A 55-year-old man presented with a 1-week history of headache and blurred vision. His blood pressure was 250/170 mm Hg. Funduscopic examination revealed disk edema in both eyes, flame-shaped hemorrhages, hard exudates, and cotton-wool spots, findings that were consistent with malignant hypertensive retinopathy.
- N Engl J Med 2021; 385:1268-1279
In 8511 Chinese patients 60 to 80 years of age with hypertension, intensive treatment (systolic blood-pressure target, 110 to <130 mm Hg) resulted in a lower incidence of cardiovascular events than standard treatment (target, 130 to <150 mm Hg). The two groups had similar incidences of adverse events, except for...
- N Engl J Med 2021; 385:1328-1329
We often lament the lack of confirmatory studies that can either reassure us all that the previous evidence for a trialed intervention is robust or indicate that the evidence is questionable. Zhang and colleagues have conducted such a study — the STEP trial1 — which in essence investigates...
- N Engl J Med 2021; 384:1921-1930
In confirmation of a previous preliminary report, among patients who were at increased cardiovascular risk, targeting a systolic blood pressure less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of major adverse cardiovascular events, both during receipt of the randomly assigned therapy...
- N Engl J Med 2021; 384:1145-1155
A 16-year-old boy presented with headache, nausea, vomiting, and abdominal pain. He had been injured 17 months earlier in an ATV accident and again 2 months later while playing soccer. Since then, episodic headache had occurred. On evaluation, the pulse was 160 beats per minute, and the blood pressure 239/162...
- N Engl J Med 2020; 383:397-400
Certain influenza strains and SARS-CoV-2 gain access to cells by means of the ACE2 receptor. In this database study in the United Kingdom, investigators observed a null-to-protective effect on influenza susceptibility among those taking ACE inhibitors or angiotensin-receptor blockers, possibly owing to mechanisms relevant to infection with coronaviruses, including SARS-CoV-2.
- N Engl J Med 2020; 382:2431-2440
This population-based case–control study from northern Italy shows that the use of ACE inhibitors and ARBs was more frequent among patients with Covid-19 because of a higher prevalence of cardiovascular disease. However, there was no evidence that ACE inhibitors and ARBs affected the risk of Covid-19.
- N Engl J Med 2020; 382:2462-2464
The editors comment on three Journal articles that provide observational data about whether ACE inhibitors and ARBs are harmful in the context of the Covid-19 epidemic. None of the three studies showed evidence of harm with continued use of these agents.
- N Engl J Med 2020; 382:2441-2448
There is concern that patients taking renin–angiotensin–aldosterone system inhibitors have an increased risk of Covid-19, because angiotensin-converting enzyme 2 is a receptor for the virus. This study showed no increase in likelihood of a positive Covid-19 test or severe Covid-19 in patients taking any of five common classes of antihypertensive...
- N Engl J Med 2020; 382:758-760
The report by Jafar et al.1 in this issue of the Journal suggests that a low-cost intervention, if scaled up, “might translate into substantial reductions in premature deaths and disability.” This potential benefit arises from the reduction in systolic blood pressure shown in a cluster-randomized trial...
- N Engl J Med 2020; 382:717-726
A cluster-randomized, controlled trial in rural areas of Bangladesh, Pakistan, and Sri Lanka assessed a community-based intervention for treating hypertension. The intervention, which included home visits by community health workers and training of physicians, was more effective than usual care in controlling hypertension.
- N Engl J Med 2019; 381:1843-1852
Acute severe hypertension accompanied by acute target-organ injury (hypertensive emergency) requires immediate treatment with IV antihypertensive agents (based on the type of target-organ damage) in an ICU. In the absence of target-organ injury, treatment involves oral medication in the ambulatory setting.
- N Engl J Med 2019; 381:243-251
This study determined the effect of systolic and diastolic hypertension on a composite of myocardial infarction, ischemic stroke, or hemorrhagic stroke in 1.3 million adult outpatients. Systolic blood-pressure elevation affected outcomes more, but systolic and diastolic hypertension independently influenced cardiovascular risk.
- N Engl J Med 2019; 381:36-46
In a randomized, controlled trial involving patients with membranous nephropathy, rituximab was noninferior to cyclosporine in inducing complete or partial remission of proteinuria at 12 months and was superior in maintaining proteinuria remission for up to 24 months.
- N Engl J Med 2019; 381:86-88
Membranous nephropathy, the leading cause of nephrotic syndrome in adults (approximate incidence among white adults without diabetes, 8 to 10 cases per million population per year), is the result of IgG deposition in the subepithelial space of glomerular capillaries.1,2 Strategies for treating patients with membranous nephropathy have engendered...
- N Engl J Med 2019; 380:2429-2439
The relative effectiveness of two-drug combinations for blood-pressure control in black African patients is unknown. In this three-group randomized trial, amlodipine plus either hydrochlorothiazide or perindopril was more effective than perindopril plus hydrochlorothiazide in lowering blood pressure.
- N Engl J Med 2018; 378:1509-1520
In a registry study of 63,910 adults, 24-hour ambulatory BP was a stronger predictor of mortality than BP measured in the clinic. Masked hypertension (normal BP in the clinic but elevated ambulatory BP) was associated with a greater risk of death than sustained hypertension.
- N Engl J Med 2018; 378:1555-1556
Ambulatory blood-pressure monitoring provides the best confirmation of the presence of hypertension detected in the office setting. A systematic review sponsored by the Agency for Healthcare Research and Quality concluded that “evidence supports ambulatory blood-pressure monitoring as the reference standard for confirming elevated office blood pressure … to avoid misdiagnosis and...
- N Engl J Med 2018; 378:1345-1347
There are more than 200,000 deaths in the United States each year from heart disease, stroke, and hypertensive disease that could be avoided by timely and effective preventive medical care.1 The risk of avoidable cardiovascular deaths among black men is 80% higher than that among white men or...