Re: From AHA delay in DX Conn's

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I know Dr. Beevers very well. Need someone to do a PUBMED on renin/aldo and aging. Thanks CE Grim MDOn Feb 16, 2012, at 6:28 AM, Francis Bill SUSPECTED PA wrote: Skip to main page content Hypertension Home • Subscriptions • Archives • Feedback • Authors • Help • AHA Journals Home Search: GO Advanced Search User Name Password Sign In Expand+ Hypertensionhyper.ahajournals.org Hypertension. 2008; 52: e22 Published online before print July 28, 2008, doi: 10.1161/​HYPERTENSIONAHA.108.117697 Letters to the Editor Delay in the Diagnosis of Conn's Syndrome: A Single-Center Experience Over 30 Years Tarvinder S. Dhanjal, D. Gareth Beevers+ Author Affiliations University Department of Medicine, City Hospital, Birmingham, United Kingdom Next Section IntroductionTo the Editor:The study reported by Rossi et al1 addressed predictors of outcome in aldosterone-producing adenoma (APA) patients postadrenalectomy. The time-dependent process of adverse vascular remodeling, determined by an increased media/lumen ratio of resistance arteries, was hypothesized to predict a poorer response to adrenalectomy. Indeed, the media/lumen ratio and the known duration of hypertension were significant predictors of response to adrenalectomy in APA patients who were categorized into cured, markedly improved, or mildly improved subgroups. In particular, the mean duration of hypertension in the 3 groups was 2.6±0.9, 8.0±1.3, and 17.3±5.0 years, respectively. We encountered a patient who was referred to us for investigation of hypertension 15 years after first diagnosis.2 We confirmed an APA, diameter 3.8 cm, possibly the largest APA in the English literature. We therefore investigated whether the duration of hypertension was related to tumor size, but we found no relationship. We investigated a total of 19 patients with APA and 10 patients with idiopathic hyperaldosteronism (IHA) from our center over the past 30 years. The Table shows the delay in referral from primary care to the hypertension clinic (delay 1), the delay in diagnosis of APA/IHA within the hypertension clinic (delay 2), and the total duration of hypertension to diagnosis of APA/IHA (total delay). We found that the duration of pre-existing hypertension to diagnosis in our APA patients was ≈8 years, which was very similar to the subgroup of APA patients reported by Rossi et al whom underwent adrenalectomy resulting in a markedly improved BP outcome. The diagnosis of APA was made within 1 year (0.8±0.3 years) of attending our hypertension clinic so most of the delay in diagnosis occurs within the primary care setting (7.2±1.6 years). View this table: In this window In a new window Table. Delay in the Diagnosis of Conn's Syndrome APA patients with an extensive history of preexisting hypertension are likely to have associated target organ damage in the kidney and vasculature, thus contributing to persistent hypertension despite successful adrenalectomy. Indeed, those APA patients reported by Rossi et al,1 who were cured by adrenalectomy, had pre-existing hypertension for a mean duration of <3 years. Furthermore, Fukudome et al3 reported a mean duration of pre-existing hypertension of 6 years in their APA patients cured by adrenalectomy and 10 years in those who were not cured. Primary hyperaldosteronism is the most common endocrine cause of hypertension. Our observations, along with those reported by Rossi et al,1 emphasize that increased awareness is necessary by primary health care professionals to minimize the delay in diagnosis and achieve a prompt surgical cure. Previous SectionNext Section AcknowledgmentsDisclosures None. Previous Section References ↵ Rossi GP, Bolognesi M, Rizzoni D, Seccia TM, Piva A, Porteri E, Tiberio GA, Giulini SM, Agabiti-Rosei E, Pessina AC. Vascular remodeling and duration of hypertension predict outcome of adrenalectomy in primary aldosteronism patients. Hypertension. 2008; 51: 1366–1371. Abstract/FREE Full Text ↵ Felmeden DC, Gearty JG, Dawkins DM, Beevers G. Hypertension due to a giant aldosterone-secreting adenoma. J Renin Angiotensin Aldosterone Syst. 2001; 2: 43–44. FREE Full Text ↵ Fukudome Y, Fujii K, Arima H, Ohya Y, Tsuchihashi T, Abe I, Fujishima M. Discriminating factors for recurrent hypertension in patients with primary aldosteronism after adrenalectomy. Hypertens Res. 2002; 25: 11–18. CrossRefMedline CiteULike Complore Connotea Delicious Digg Facebook Google+ Mendeley Reddit Technorati TwitterWhat's this? Articles citing this article Response to Delay in the Diagnosis of Conn's Syndrome: A Single-Center Experience Over 30 Years Hypertension. 2008;52:e23, Full Text PDF « Prev Article | Next Article »Table of Contents This Article Hypertension. 2008; 52: e22 Published online before print July 28, 2008, doi: 10.1161/​HYPERTENSIONAHA.108.117697 ExtractFree » Full TextFree PDFFree All Versions of this Article: HYPERTENSIONAHA.108.117697v1 52/3/e22 most recent - Classifications Letters to the Editor - Services E-mail this article to a friend Alert me when this article is cited Alert me if a correction is posted Similar articles in this journal Similar articles in PubMed Download to citation manager Request Permissions + Citing Articles View citing article information Citing articles via Google Scholar + Google Scholar Articles by Dhanjal, T. S. Articles by Beevers, D. G. Search for related content + PubMed PubMed citation Articles by Dhanjal, T. S. Articles by Beevers, D. G. 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An interesting article that raised a question for me around this statement: " APA

patients with an extensive history of preexisting hypertension are likely to

have associated target organ damage in the kidney and vasculature, thus

contributing to persistent hypertension despite successful adrenalectomy.

Indeed, those APA patients reported by Rossi et al,1 who were cured by

adrenalectomy, had pre-existing hypertension for a mean duration of <3 years.

Furthermore, Fukudome et al3 reported a mean duration of pre-existing

hypertension of 6 years in their APA patients cured by adrenalectomy and 10

years in those who were not cured.. "

If one delays the adrenalectomy for say 22 months and then needs to proceed with

surgery did the clock stop when PA came under control ~2years prior or the day

the surgeon got the knife out?

I ask this because as I understand it we still produce extra aldosterone which

is then neutralized in the body. (antagonists - 3. pharmacology neutralizing

agent: a drug that neutralizes the effect of a substance on the body

Encarta ® World English Dictionary © & (P) 1998-2005 Microsoft Corporation. All

rights reserved.)

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> Hypertensionhyper.ahajournals.org

> 1. Hypertension. 2008; 52: e22 Published online before print July

> 28, 2008, doi: 10.1161/​HYPERTENSIONAHA.108.117697

>

> * Letters to the Editor

> Delay in the Diagnosis of Conn's Syndrome: A Single-Center

> Experience Over 30 Years

> 1. Tarvinder S. Dhanjal

> <http://hyper.ahajournals.org/search?author1=Tarvinder+S.+Dhanjal & sortsp\

> ec=date & submit=Submit> ,

> 2. D. Gareth Beevers

> <http://hyper.ahajournals.org/search?author1=D.+Gareth+Beevers & sortspec=\

> date & submit=Submit>

>

> +

> <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\

> 0a-973b-4fdc66f10ea6#> Author Affiliations

>

> 1. University Department of Medicine, City Hospital, Birmingham,

> United Kingdom

> Next Section

> <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\

> 0a-973b-4fdc66f10ea6#ack-1> Introduction

> To the Editor:

>

> The study reported by Rossi et al1

> <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\

> 0a-973b-4fdc66f10ea6#ref-1> addressed predictors of outcome in

> aldosterone-producing adenoma (APA) patients postadrenalectomy. The

> time-dependent process of adverse vascular remodeling, determined by an

> increased media/lumen ratio of resistance arteries, was hypothesized to

> predict a poorer response to adrenalectomy. Indeed, the media/lumen

> ratio and the known duration of hypertension were significant predictors

> of response to adrenalectomy in APA patients who were categorized into

> cured, markedly improved, or mildly improved subgroups. In particular,

> the mean duration of hypertension in the 3 groups was 2.6±0.9,

> 8.0±1.3, and 17.3±5.0 years, respectively.

>

> We encountered a patient who was referred to us for investigation of

> hypertension 15 years after first diagnosis.2

> <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\

> 0a-973b-4fdc66f10ea6#ref-2> We confirmed an APA, diameter 3.8 cm,

> possibly the largest APA in the English literature. We therefore

> investigated whether the duration of hypertension was related to tumor

> size, but we found no relationship. We investigated a total of 19

> patients with APA and 10 patients with idiopathic hyperaldosteronism

> (IHA) from our center over the past 30 years. The Table

> <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\

> 0a-973b-4fdc66f10ea6#T1> shows the delay in referral from primary care

> to the hypertension clinic (delay 1), the delay in diagnosis of APA/IHA

> within the hypertension clinic (delay 2), and the total duration of

> hypertension to diagnosis of APA/IHA (total delay). We found that the

> duration of pre-existing hypertension to diagnosis in our APA patients

> was ≈8 years, which was very similar to the subgroup of APA

> patients reported by Rossi et al whom underwent adrenalectomy resulting

> in a markedly improved BP outcome. The diagnosis of APA was made within

> 1 year (0.8±0.3 years) of attending our hypertension clinic so most

> of the delay in diagnosis occurs within the primary care setting

> (7.2±1.6 years).

> View this table:

> * In this window

> <http://hyper.ahajournals.org/content/52/3/e22/T1.expansion.html>

> * In a new window

> <http://hyper.ahajournals.org/content/52/3/e22/T1.expansion.html>

>

> Table. Delay in the Diagnosis of Conn's Syndrome

>

> APA patients with an extensive history of preexisting hypertension are

> likely to have associated target organ damage in the kidney and

> vasculature, thus contributing to persistent hypertension despite

> successful adrenalectomy. Indeed, those APA patients reported by Rossi

> et al,1

> <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\

> 0a-973b-4fdc66f10ea6#ref-1> who were cured by adrenalectomy, had

> pre-existing hypertension for a mean duration of <3 years. Furthermore,

> Fukudome et al3

> <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\

> 0a-973b-4fdc66f10ea6#ref-3> reported a mean duration of pre-existing

> hypertension of 6 years in their APA patients cured by adrenalectomy and

> 10 years in those who were not cured.

>

> Primary hyperaldosteronism is the most common endocrine cause of

> hypertension. Our observations, along with those reported by Rossi et

> al,1

> <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\

> 0a-973b-4fdc66f10ea6#ref-1> emphasize that increased awareness is

> necessary by primary health care professionals to minimize the delay in

> diagnosis and achieve a prompt surgical cure.

> Previous Section

> <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\

> 0a-973b-4fdc66f10ea6#intro-header> Next Section

> <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\

> 0a-973b-4fdc66f10ea6#ref-list-1> Acknowledgments

> Disclosures

>

> None.

> Previous Section

> <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\

> 0a-973b-4fdc66f10ea6#ack-1> References

> 1. ↵

> <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\

> 0a-973b-4fdc66f10ea6#xref-ref-1-1> Rossi GP, Bolognesi M, Rizzoni D,

> Seccia TM, Piva A, Porteri E, Tiberio GA, Giulini SM, Agabiti-Rosei E,

> Pessina AC. Vascular remodeling and duration of hypertension predict

> outcome of adrenalectomy in primary aldosteronism patients.

> Hypertension. 2008; 51: 1366–1371. Abstract/FREE Full Text

> <http://hyper.ahajournals.org/cgi/ijlink?linkType=ABST & journalCode=hyper\

> tensionaha & resid=51/5/1366>

> 2. ↵

> <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\

> 0a-973b-4fdc66f10ea6#xref-ref-2-1> Felmeden DC, Gearty JG, Dawkins

> DM, Beevers G. Hypertension due to a giant aldosterone-secreting

> adenoma. J Renin Angiotensin Aldosterone Syst. 2001; 2: 43–44. FREE

> Full Text

> <http://hyper.ahajournals.org/cgi/ijlink?linkType=PDF & journalCode=spjra & \

> resid=2/1/43>

> 3. ↵

> <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\

> 0a-973b-4fdc66f10ea6#xref-ref-3-1> Fukudome Y, Fujii K, Arima H, Ohya

> Y, Tsuchihashi T, Abe I, Fujishima M. Discriminating factors for

> recurrent hypertension in patients with primary aldosteronism after

> adrenalectomy. Hypertens Res. 2002; 25: 11–18. CrossRef

> <http://hyper.ahajournals.org/external-ref?access_num=10.1291/hypres.25.\

> 11 & link_type=DOI> Medline

> <http://hyper.ahajournals.org/external-ref?access_num=11924716 & link_type\

> =MED>

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Matra: no excess salt no excess aldosterone increase in BP, or fibrosis of heart, brain and kidney or blood vessels. Now repeat.And DASH.CE Grim MDOn Feb 16, 2012, at 9:33 AM, jclark24p wrote: An interesting article that raised a question for me around this statement: "APA patients with an extensive history of preexisting hypertension are likely to have associated target organ damage in the kidney and vasculature, thus contributing to persistent hypertension despite successful adrenalectomy. Indeed, those APA patients reported by Rossi et al,1 who were cured by adrenalectomy, had pre-existing hypertension for a mean duration of <3 years. Furthermore, Fukudome et al3 reported a mean duration of pre-existing hypertension of 6 years in their APA patients cured by adrenalectomy and 10 years in those who were not cured.." If one delays the adrenalectomy for say 22 months and then needs to proceed with surgery did the clock stop when PA came under control ~2years prior or the day the surgeon got the knife out? I ask this because as I understand it we still produce extra aldosterone which is then neutralized in the body. (antagonists - 3. pharmacology neutralizing agent: a drug that neutralizes the effect of a substance on the body Encarta ® World English Dictionary © & (P) 1998-2005 Microsoft Corporation. All rights reserved.) > > > * [donate] > <https://donate.americanheart.org/ecommerce/aha/aha_index.jsp> > * [help] <http://hyper.ahajournals.org/help> > * [aha] > <http://www.heart.org/HEARTORG/General/Contact-Us_UCM_308813_Article.jsp\ > > > * [home] <http://www.americanheart.org/> > <http://hyper.ahajournals.org/> <http://www.americanheart.org/> > Skip to main page content > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#content-block> > > * Hypertension Home <http://hyper.ahajournals.org/> > * • > * Subscriptions <http://hyper.ahajournals.org/subscriptions> > * • > * Archives <http://hyper.ahajournals.org/content/by/year> > * • > * Feedback <http://hyper.ahajournals.org/feedback> > * • > * Authors <http://hyper.ahajournals.org/site/misc/ifora.xhtml> > * • > * Help <http://hyper.ahajournals.org/help> > * • > * AHA Journals Home <http://www.ahajournals.org/> > Search: GO > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#> Advanced Search > <http://hyper.ahajournals.org/search> User Name Password Sign In > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#> > * > > * Expand+ > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#> > Hypertensionhyper.ahajournals.org > 1. Hypertension. 2008; 52: e22 Published online before print July > 28, 2008, doi: 10.1161/​HYPERTENSIONAHA.108.117697 > > * Letters to the Editor > Delay in the Diagnosis of Conn's Syndrome: A Single-Center > Experience Over 30 Years > 1. Tarvinder S. Dhanjal > <http://hyper.ahajournals.org/search?author1=Tarvinder+S.+Dhanjal & sortsp\ > ec=date & submit=Submit> , > 2. D. Gareth Beevers > <http://hyper.ahajournals.org/search?author1=D.+Gareth+Beevers & sortspec=\ > date & submit=Submit> > > + > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#> Author Affiliations > > 1. University Department of Medicine, City Hospital, Birmingham, > United Kingdom > Next Section > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#ack-1> Introduction > To the Editor: > > The study reported by Rossi et al1 > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#ref-1> addressed predictors of outcome in > aldosterone-producing adenoma (APA) patients postadrenalectomy. The > time-dependent process of adverse vascular remodeling, determined by an > increased media/lumen ratio of resistance arteries, was hypothesized to > predict a poorer response to adrenalectomy. Indeed, the media/lumen > ratio and the known duration of hypertension were significant predictors > of response to adrenalectomy in APA patients who were categorized into > cured, markedly improved, or mildly improved subgroups. In particular, > the mean duration of hypertension in the 3 groups was 2.6±0.9, > 8.0±1.3, and 17.3±5.0 years, respectively. > > We encountered a patient who was referred to us for investigation of > hypertension 15 years after first diagnosis.2 > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#ref-2> We confirmed an APA, diameter 3.8 cm, > possibly the largest APA in the English literature. We therefore > investigated whether the duration of hypertension was related to tumor > size, but we found no relationship. We investigated a total of 19 > patients with APA and 10 patients with idiopathic hyperaldosteronism > (IHA) from our center over the past 30 years. The Table > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#T1> shows the delay in referral from primary care > to the hypertension clinic (delay 1), the delay in diagnosis of APA/IHA > within the hypertension clinic (delay 2), and the total duration of > hypertension to diagnosis of APA/IHA (total delay). We found that the > duration of pre-existing hypertension to diagnosis in our APA patients > was ≈8 years, which was very similar to the subgroup of APA > patients reported by Rossi et al whom underwent adrenalectomy resulting > in a markedly improved BP outcome. The diagnosis of APA was made within > 1 year (0.8±0.3 years) of attending our hypertension clinic so most > of the delay in diagnosis occurs within the primary care setting > (7.2±1.6 years). > View this table: > * In this window > <http://hyper.ahajournals.org/content/52/3/e22/T1.expansion.html> > * In a new window > <http://hyper.ahajournals.org/content/52/3/e22/T1.expansion.html> > > Table. Delay in the Diagnosis of Conn's Syndrome > > APA patients with an extensive history of preexisting hypertension are > likely to have associated target organ damage in the kidney and > vasculature, thus contributing to persistent hypertension despite > successful adrenalectomy. Indeed, those APA patients reported by Rossi > et al,1 > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#ref-1> who were cured by adrenalectomy, had > pre-existing hypertension for a mean duration of <3 years. Furthermore, > Fukudome et al3 > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#ref-3> reported a mean duration of pre-existing > hypertension of 6 years in their APA patients cured by adrenalectomy and > 10 years in those who were not cured. > > Primary hyperaldosteronism is the most common endocrine cause of > hypertension. Our observations, along with those reported by Rossi et > al,1 > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#ref-1> emphasize that increased awareness is > necessary by primary health care professionals to minimize the delay in > diagnosis and achieve a prompt surgical cure. > Previous Section > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#intro-header> Next Section > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#ref-list-1> Acknowledgments > Disclosures > > None. > Previous Section > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#ack-1> References > 1. ↵ > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#xref-ref-1-1> Rossi GP, Bolognesi M, Rizzoni D, > Seccia TM, Piva A, Porteri E, Tiberio GA, Giulini SM, Agabiti-Rosei E, > Pessina AC. Vascular remodeling and duration of hypertension predict > outcome of adrenalectomy in primary aldosteronism patients. > Hypertension. 2008; 51: 1366–1371. Abstract/FREE Full Text > <http://hyper.ahajournals.org/cgi/ijlink?linkType=ABST & journalCode=hyper\ > tensionaha & resid=51/5/1366> > 2. ↵ > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#xref-ref-2-1> Felmeden DC, Gearty JG, Dawkins > DM, Beevers G. Hypertension due to a giant aldosterone-secreting > adenoma. J Renin Angiotensin Aldosterone Syst. 2001; 2: 43–44. FREE > Full Text > <http://hyper.ahajournals.org/cgi/ijlink?linkType=PDF & journalCode=spjra & \ > resid=2/1/43> > 3. ↵ > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#xref-ref-3-1> Fukudome Y, Fujii K, Arima H, Ohya > Y, Tsuchihashi T, Abe I, Fujishima M. Discriminating factors for > recurrent hypertension in patients with primary aldosteronism after > adrenalectomy. Hypertens Res. 2002; 25: 11–18. 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References > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#ref-list-1> > Current Issue > March 2012 <http://hyper.ahajournals.org/content/current> Alert me to > new issues of > Hypertension » <http://www.ahajournals.org/cgi/alerts/etoc> > * About Hypertension > <http://hyper.ahajournals.org/site/misc/about.xhtml> > * Instructions for Authors > <http://hyper.ahajournals.org/site/misc/ifora.xhtml> > * Online Submission/Peer Review > <http://submit-hyper.ahajournals.org/index.dtl/?ctst=y> > * Editorial Board > <http://hyper.ahajournals.org/site/misc/edboard.xhtml> > * RSS Feeds <http://www.ahajournals.org/rss/> > * Advertiser Information > <http://hyper.ahajournals.org/site/misc/HYP.pdf> > Spotlight [banner1homepage] > <http://hyper.ahajournals.org/site/misc/2012Changes.xhtml> Most > * Most Read > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#> > * Most Cited > <http://hyper.ahajournals.org/content/52/3/e22.full?sid=d11d66f5-c7fe-4a\ > 0a-973b-4fdc66f10ea6#> > > * Most Read > 1. Recommendations for Blood Pressure Measurement in Humans and > Experimental Animals: Part 1: Blood Pressure Measurement in Humans: A > Statement for Professionals From the Subcommittee of Professional and > Public Education of the American Heart Association Council on High Blood > Pressure Research > <http://hyper.ahajournals.org/cgi/content/short/45/1/142?rss=1 & amp;ssour\ > ce=mfr> > 2. Seventh Report of the Joint National Committee on Prevention, > Detection, Evaluation, and Treatment of High Blood Pressure > <http://hyper.ahajournals.org/cgi/content/short/42/6/1206?rss=1 & amp;ssou\ > rce=mfr> > 3. Update on the Use of Antihypertensive Drugs in Pregnancy > <http://hyper.ahajournals.org/cgi/content/short/51/4/960?rss=1 & amp;ssour\ > ce=mfr> > 4. Resistant Hypertension: Diagnosis, Evaluation, and Treatment: A > Scientific Statement From the American Heart Association Professional > Education Committee of the Council for High Blood Pressure Research > <http://hyper.ahajournals.org/cgi/content/short/51/6/1403?rss=1 & amp;ssou\ > rce=mfr> > 5. Relation Between Blood Pressure and Vascular Events and Mortality > in Patients With Manifest Vascular Disease: J-Curve Revisited > <http://hyper.ahajournals.org/cgi/content/short/59/1/14?rss=1 & amp;ssourc\ > e=mfr> > » View all Most Read articles > <http://hyper.ahajournals.org/reports/most-read> > 6. Most Cited > 1. Seventh Report of the Joint National Committee on Prevention, > Detection, Evaluation, and Treatment of High Blood Pressure > <http://hyper.ahajournals.org/cgi/content/short/42/6/1206?rss=1 & amp;ssou\ > rce=mfc> > 2. Prevalence of Hypertension in the US Adult Population : Results > From the Third National Health and Nutrition Examination Survey, > 1988-1991 > <http://hyper.ahajournals.org/cgi/content/short/25/3/305?rss=1 & amp;ssour\ > ce=mfc> > 3. Aortic Stiffness Is an Independent Predictor of All-Cause and > Cardiovascular Mortality in Hypertensive Patients > <http://hyper.ahajournals.org/cgi/content/short/37/5/1236?rss=1 & amp;ssou\ > rce=mfc> > 4. Trends in the Prevalence, Awareness, Treatment, and Control of > Hypertension in the Adult US Population : Data From the Health > Examination Surveys, 1960 to 1991 > <http://hyper.ahajournals.org/cgi/content/short/26/1/60?rss=1 & amp;ssourc\ > e=mfc> > 5. Ambulatory blood pressure. An independent predictor of prognosis > in essential hypertension [published erratum appears in Hypertension > 1995 Mar;25(3):462] > <http://hyper.ahajournals.org/cgi/content/short/24/6/793?rss=1 & amp;ssour\ > ce=mfc> > » View all Most Cited articles > <http://hyper.ahajournals.org/reports/most-cited> > Alternate International Access <http://intl-hyper.ahajournals.org/> > [more info] <http://hyper.ahajournals.org/help/using/alternate-route> > Copyright © 2012 by American Heart Association, Inc. All rights > reserved. Unauthorized use prohibited. > <http://www.americanheart.org/presenter.jhtml?identifier=11406> > > * Print ISSN: 0194-911X > * Online ISSN: 1524-4563 >