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Hypertension: HELP
Articles by George N. Thomas
Based on 17 articles published since 2010
(Why 17 articles?)
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Between 2010 and 2020, George Thomas wrote the following 17 articles about Hypertension.
 
+ Citations + Abstracts
1 Editorial 2017 ACC/AHA hypertension guidelines: Toward tighter control. 2018

Blonsky, Rebecca / Pohl, Marc / Nally, Joseph V / Thomas, George. ·Nephrologist, Marshfield Clinic, Marshfield, WI, USA. · Consultant Staff, Department of Nephrology and Hypertension, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA. · Consultant Staff, Department of Nephrology and Hypertension, Glickman Urological Institute and Education Institute, Cleveland Clinic, Cleveland, OH, USA. · Clinical Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA. · Director, Center for Blood Pressure Disorders, Department of Nephrology and Hypertension, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA. thomasg3@ccf.org. · Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA. · Site Principal Investigator, Systolic Blood Pressure Intervention Trial (SPRINT). ·Cleve Clin J Med · Pubmed #30289752.

ABSTRACT: -- No abstract --

2 Review Hypertension Management in Chronic Kidney Disease and Diabetes: Lessons from the Systolic Blood Pressure Intervention Trial. 2019

Thomas, George. ·Center for Blood Pressure Disorders, Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, Q7 Glickman Tower, Cleveland, OH 44195, USA. Electronic address: thomasg3@ccf.org. ·Cardiol Clin · Pubmed #31279424.

ABSTRACT: Based on observational and clinical trials, formulation of hypertension guidelines began in 1977. Successive guideline reports recommended lower blood pressure goals, with emphasis shifting to treatment of systolic hypertension. In 2013, responsibility for hypertension guidelines was assigned to the American College of Cardiology and the American Heart Association. The new hypertension guideline was published in 2017, and the Systolic Blood Pressure Intervention Trial (SPRINT) informed many of the recommendations in the new guidelines. This article describes the SPRINT study results and the new guideline recommendations regarding hypertension management and blood pressure goals, with emphasis on chronic kidney disease and diabetes.

3 Review BP Measurement Techniques: What They Mean for Patients with Kidney Disease. 2018

Thomas, George / Drawz, Paul E. ·Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio; and. · Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, Minnesota draw0003@umn.edu. ·Clin J Am Soc Nephrol · Pubmed #29483139.

ABSTRACT: Patients with CKD typically have hypertension. Manual BP measurement in the office setting was used to define hypertension, establish eligibility, and assess BP targets in the epidemiologic studies and early randomized, controlled trials that inform current management of hypertension. Use of automated oscillometric devices has largely replaced manual BP measurement in the office and clinical trials. These newer devices may reduce the white coat effect and facilitate guideline-adherent measurement protocols. Obtaining BP measurements outside of the office with home and ambulatory BP monitoring is now more common. Out of office BPs are especially important in patients with CKD, because reduced GFR and proteinuria are associated with masked hypertension (normal office BP and elevated BP outside of the office), elevated nighttime BP, and abnormal diurnal variation in BP, all of which are associated with higher risk for target organ damage and adverse outcomes. Also, it is now feasible to routinely measure central BP and central hemodynamics. These measures are of greater importance to patients with CKD given the higher prevalence of increased sympathetic tone, arteriosclerosis, and inflammation as well as impaired sodium excretion and endothelial dysfunction, which lead to alterations in central BPs in this population. In this review, we describe various BP measurement techniques and how they apply to the care of patients with CKD.

4 Review Renal denervation: What happened, and why? 2017

Shishehbor, Mehdi H / Hammad, Tarek A / Thomas, George. ·Professor of Medicine, Case Western Reserve University, Cleveland, OH, USA. · Co-Chair, Harring Heart and Vascular Institute, University Hospitals of Cleveland, Cleveland, OH, USA. · Director, Cardiovascular Interventional Center, University Hospitals of Cleveland, Cleveland, OH, USA. · Co-Director, Vascular Center, University Hospitals of Cleveland, OH, USA. shishem@gmail.com. · Site Principal Investigator, SYMPLICITY HTN-3 trial. · Department of Medicine, Division of Cardiology, The University of Texas Health Center at San Antonio, TX, USA. · Director, Center for Blood Pressure Disorders, Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. · Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA. · Investigator, SYMPLICITY HTN-3 trial. ·Cleve Clin J Med · Pubmed #28885911.

ABSTRACT: Despite promising results in initial trials, renal denervation failed to achieve its efficacy end points as a treatment for resistant hypertension in the SYMPLICITY HTN-3 trial, the largest trial of this treatment to date (N Engl J Med 2014; 370:1393-1401). Is renal denervation dead, or will future trials and newer technology revive it?

5 Review Research Needs to Improve Hypertension Treatment and Control in African Americans. 2016

Whelton, Paul K / Einhorn, Paula T / Muntner, Paul / Appel, Lawrence J / Cushman, William C / Diez Roux, Ana V / Ferdinand, Keith C / Rahman, Mahboob / Taylor, Herman A / Ard, Jamy / Arnett, Donna K / Carter, Barry L / Davis, Barry R / Freedman, Barry I / Cooper, Lisa A / Cooper, Richard / Desvigne-Nickens, Patrice / Gavini, Nara / Go, Alan S / Hyman, David J / Kimmel, Paul L / Margolis, Karen L / Miller, Edgar R / Mills, Katherine T / Mensah, George A / Navar, Ann M / Ogedegbe, Gbenga / Rakotz, Michael K / Thomas, George / Tobin, Jonathan N / Wright, Jackson T / Yoon, Sung Sug Sarah / Cutler, Jeffrey A / Anonymous7660880. ·From the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (P.K.W., K.C.F.), and Department of Medicine, Tulane University School of Medicine (P.K.W., K.C.F.), New Orleans, LA · Division of Cardiovascular Sciences (P.T.E., P.D.-N., G.A.M., J.A.C.), and Center for Translation Research and Implementation Science (N.G., G.A.M.), National Heart, Lung, and Blood Institute, Bethesda, MD · Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (P.M.) · Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A., L.A.C., E.R.M.) · Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.) · Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA (A.V.D.R.) · Department of Medicine, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland VA Medical Center, OH (M.R., J.T.W.) · Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA (H.A.T.) · Department of Epidemiology and Prevention (J.A.) and Department of Medicine (B.I.F., J.A.), Wake Forest School of Medicine, Wake Forest University, Winston Salem, NC · Dean's Office, University of Kentucky College of Public Health, Lexington (D.K.A.) · Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C.) · Department of Biostatistics, University of Texas School of Public Health, Houston (B.R.D.) · Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL (R.C.) · Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.) · Department of Internal Medicine, Baylor College of Medicine, Houston, TX (D.J.H.) · National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (P.L.K.) · HealthPartners Institute, Minneapolis, MN (K.L.M.) · Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.M.N.) · Department of Population Health, NYU School of Medicine, New York (G.O.) · American Medical Association, Chicago, IL (M.K.R.) · Department of Nephrology and Hypertension, Cleveland Clinic, OH (G.T.) · Clinical Directors Network (CND) and The Rockefeller University Center for Clinical and Translational Science, New York (J.N.T.) · and National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD (S.S.(S.)Y.). ·Hypertension · Pubmed #27620388.

ABSTRACT: -- No abstract --

6 Review Interpreting SPRINT: How low should you go? 2016

Thomas, George / Nally, Joseph V / Pohl, Marc A. ·Director, Center for Blood Pressure Disorders, Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic; Cleveland, OH, USA. E-mail: thomasg3@ccf.org. · Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA. · Cleveland Clinic Site Principal Investigator, Systolic Blood Pressure Intervention Trial (SPRINT). · Director, Center for Chronic Kidney Disease, Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. · Clinical Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA. · Ray W. Gifford Chair in Hypertension, Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. · Chair, Clinical Management Committee, Irbesartan Diabetic Nephropathy Trial. ·Cleve Clin J Med · Pubmed #26974989.

ABSTRACT: The Systolic Blood Pressure Intervention Trial (SPRINT) found evidence of cardiovascular benefit with intensive lowering of systolic blood pressure (goal < 120 mm Hg) compared with the currently recommended goal (< 140 mm Hg) in older patients with cardiovascular risk but without diabetes or stroke. This article reviews the trial design and protocol, summarizes the results, and briefly discusses the implications of these results.

7 Review Prediction of stroke risk in atrial fibrillation, prevention of stroke in atrial fibrillation, and the impact of long-term monitoring for detecting atrial fibrillation. 2011

Thomas, George / Lerman, Bruce B. ·Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, USA. ·Curr Atheroscler Rep · Pubmed #21647574.

ABSTRACT: Atrial fibrillation (AF) is a large public health problem that affects about 1% of the population in the United States. It confers an increased risk for stroke and thromboembolism, but the stroke risk is not equal in all patients. Further refinement in stratifying stroke risk in patients with AF will help in properly directing therapy for AF patients while minimizing adverse events. Warfarin is the first-line treatment for stroke reduction in patients with AF, but many new drugs are on the horizon that will significantly change practice. New and improved cardiac monitoring techniques and devices will help with detection of AF in those at risk for stroke and will assist in assessing which patients will most benefit from anticoagulation.

8 Article Diagnostic Performance of Blood Pressure Measurement Modalities in Living Kidney Donor Candidates. 2019

Armanyous, Sherif / Ohashi, Yasushi / Lioudis, Michael / Schold, Jesse D / Thomas, George / Poggio, Emilio D / Augustine, Joshua J. ·Department of Nephrology and Glickman Urological and Kidney Institute, and. · Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. · Department of Nephrology and Glickman Urological and Kidney Institute, and augustj4@ccf.org. ·Clin J Am Soc Nephrol · Pubmed #30948455.

ABSTRACT: BACKGROUND AND OBJECTIVES: Precise BP measurement to exclude hypertension is critical in evaluating potential living kidney donors. Ambulatory BP monitoring is considered the gold standard method for diagnosing hypertension, but it is cumbersome to perform. We sought to determine whether lower BP cutoffs using office and automated BP would reduce the rate of missed hypertension in potential living donors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We measured BP in 578 prospective donors using three modalities: ( RESULTS: Hypertension was diagnosed in 90 (16%) prospective donors by JNC-7 criteria and 198 (34%) prospective donors by ACC/AHA criteria. Masked hypertension was found in 3% of the total cohort by JNC-7 using the combination of office or automated BP, and it was seen in 24% by ACC/AHA guidelines. Using Youden index, cutoffs were derived for both office and automated BP using JNC-7 (<123/82 and <120/78 mm Hg) and ACC/AHA (<119/79 and <116/76 mm Hg) definitions. Using these lower cutoffs, the sensitivity for detecting hypertension improved from 79% to 87% for JNC-7 and from 32% to 87% by ACC/AHA definition, with negative predictive values of 95% and 87%, respectively. Missed (masked) hypertension was reduced to 2% and 4% of the entire cohort by JNC-7and ACC/AHA, respectively. CONCLUSIONS: The prevalence of hypertension was higher in living donor candidates using ACC/AHA compared JNC-7 definitions. Lower BP cutoffs in the clinic improved sensitivity and led to a low overall prevalence of missed hypertension in prospective living kidney donors.

9 Article Inflammation and Apparent Treatment-Resistant Hypertension in Patients With Chronic Kidney Disease. 2019

Chen, Jing / Bundy, Joshua D / Hamm, L Lee / Hsu, Chi-Yuan / Lash, James / Miller, Edgar R / Thomas, George / Cohen, Debbie L / Weir, Matthew R / Raj, Dominic S / Chen, Hsiang-Yu / Xie, Dawei / Rao, Panduranga / Wright, Jackson T / Rahman, Mahboob / He, Jiang. ·From the Department of Medicine (J.C., L.L.H., J.H.), Tulane University School of Medicine, New Orleans, LA. · Department of Epidemiology (J.C., J.D.B., L.L.H., J.H.), Tulane University School of Medicine, New Orleans, LA. · Tulane University Translational Science Institute, New Orleans, LA (J.C., L.L.H., J.H.). · Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.D.B.). · Department of Medicine, University of California San Francisco School of Medicine, CA (C.-y.H.). · Department of Medicine, University of Illinois College of Medicine, Chicago (J.L.). · Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (E.R.M.). · Department of Nephrology and Hypertension, Cleveland Clinic, OH (G.T.). · Department of Medicine (D.L.C.), University of Pennsylvania Perelman School of Medicine, Philadelphia. · Department of Medicine, University of Maryland School of Medicine, Baltimore (M.R.W.). · Department of Medicine, Georgetown University School of Medicine, Washington, DC (D.S.R.). · Department of Biostatistics, Epidemiology, and Informatics (H.-y.C., D.X.), University of Pennsylvania Perelman School of Medicine, Philadelphia. · Department of Medicine, University of Michigan School of Medicine, Ann Arbor (P.R.). · Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (J.T.W., M.R.). ·Hypertension · Pubmed #30776971.

ABSTRACT: Apparent treatment-resistant hypertension (ATRH) is highly prevalent and associated with cardiovascular disease risk in patients with chronic kidney disease. We analyzed the association of inflammatory biomarkers with ATRH and its complications in patients with chronic kidney disease. ATRH was defined as blood pressure ≥140/90 mm Hg while taking ≥3 antihypertensive medications or blood pressure <140/90 mm Hg while taking ≥4 medications. Analyses included 1359 CRIC study (Chronic Renal Insufficiency Cohort) participants with ATRH and 2008 hypertensive participants without. Logistic regression was used to examine cross-sectional associations of inflammatory biomarkers and ATRH adjusting for demographic, lifestyle, and clinical risk factors and treatments. Cox proportional hazards models were used to assess the impact of inflammatory biomarkers on associations of ATRH with composite cardiovascular disease and mortality beyond conventional risk factors. Multivariable-adjusted odds ratio (95% CI) of ATRH for the highest tertile versus the lowest tertile of inflammatory biomarker levels was 1.29 (95% CI, 1.05-1.59) for IL (interleukin)-6, 1.49 (95% CI, 1.20-1.85) for TNF-α (tumor necrosis factor-α), and 0.77 (95% CI, 0.63-0.95) for TGF-β (transforming growth factor-β). High-sensitivity CRP (C-reactive protein), fibrinogen, IL-1β, and IL-1 receptor antagonist were not significantly associated with ATRH. Adding inflammatory biomarkers to Cox models did not attenuate the significant association of ATRH with cardiovascular disease and mortality. Our findings show higher levels of IL-6 and TNF-α and lower levels of TGF-β were independently associated with odds of ATRH. Targeting specific inflammatory pathways may improve blood pressure control in patients with chronic kidney disease.

10 Article Outcomes, Costs, and 30-Day Readmissions After Catheter Ablation of Myocardial Infarct-Associated Ventricular Tachycardia in the Real World. 2018

Cheung, Jim W / Yeo, Ilhwan / Ip, James E / Thomas, George / Liu, Christopher F / Markowitz, Steven M / Lerman, Bruce B / Kim, Luke K. ·Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medicine-New York Presbyterian Hospital (J.W.C., J.E.I., G.T., C.F.L., S.M.M., B.B.L., L.K.K.). · Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (I.Y.). ·Circ Arrhythm Electrophysiol · Pubmed #30376735.

ABSTRACT: BACKGROUND: Patients undergoing catheter ablation of myocardial infarction-associated ventricular tachycardia (VT) have significant comorbidities that can increase the risks of adverse outcomes. The rates of readmissions after VT ablation are unknown. We sought to examine in-hospital outcomes, costs, and 30-day readmissions after catheter ablation of myocardial infarction-associated VT. METHODS: Using the Nationwide Readmissions Database, we evaluated 4109 admissions for catheter ablation of myocardial infarction-associated VT occurring between 2010 and 2015. On the basis of International Classification of Diseases, Ninth Revision, Clinical Modification and Clinical Classification Software codes, we identified comorbidities, procedural complications, 30-day readmissions, and costs associated with VT ablation. RESULTS: The index admission in-hospital mortality rate and procedural complication rate after VT ablation were 2.7% and 11.5%, respectively. Independent predictors of mortality included pulmonary hypertension, lung disease, obesity, and coagulopathy. Following discharge after VT ablation, the 30-day readmission rate was 19.2% with a median time to readmission of 10.0 days (IQR, 3.8-17.6 days) and an in-hospital mortality rate of 2.9%. Cardiac causes accounted for 74% of readmissions, with VT and congestive heart failure constituting 41% and 14% of all readmissions, respectively. Pulmonary hypertension, congestive heart failure, smoking, chronic pulmonary disease, and prolonged index hospitalization were significant independent predictors of 30-day readmission. After adjustment, 30-day readmissions were associated with a 38.9% increase in cumulative hospitalization costs. CONCLUSIONS: Thirty-day readmissions after catheter ablation of VT occur in nearly 1 out of 5 cases, with the majority of readmissions being caused by recurrent VT or congestive heart failure. Baseline comorbidities are significant predictors of procedural mortality, complications, and readmissions. Strategies to reduce recurrent VT postablation by improving procedural success, optimizing postablation heart failure treatment, and ensuring close postdischarge follow-up may help reduce readmissions and healthcare costs.

11 Article Characteristics and Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting. 2016

Patel, Krishna K / Young, Laura / Howell, Erik H / Hu, Bo / Rutecki, Gregory / Thomas, George / Rothberg, Michael B. ·Department of Internal Medicine, Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio. · Department of Internal Medicine, Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio2Department of Cardiology, University of Rochester, Rochester, New York. · Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio. · Department of Nephrology, Cleveland Clinic Foundation, Cleveland, Ohio. ·JAMA Intern Med · Pubmed #27294333.

ABSTRACT: IMPORTANCE: The prevalence and short-term outcomes of hypertensive urgency (systolic blood pressure ≥180 mm Hg and/or diastolic blood pressure ≥110 mm Hg) are unknown. Guidelines recommend achieving blood pressure control within 24 to 48 hours. However, some patients are referred to the emergency department (ED) or directly admitted to the hospital, and whether hospital management is associated with better outcomes is unknown. OBJECTIVES: To describe the prevalence of hypertensive urgency and the characteristics and short-term outcomes of these patients, and to determine whether referral to the hospital is associated with better outcomes than outpatient management. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study with propensity matching included all patients presenting with hypertensive urgency to an office in the Cleveland Clinic Healthcare system from January 1, 2008, to December 31, 2013. Pregnant women and patients referred to the hospital for symptoms or treatment of other conditions were excluded. Final follow-up was completed on June 30, 2014, and data were assessed from October 31, 2014, to May 31, 2015. EXPOSURES: Hospital vs ambulatory blood pressure management. MAIN OUTCOMES AND MEASURES: Major adverse cardiovascular events (MACE) consisting of acute coronary syndrome and stroke or transient ischemic attack, uncontrolled hypertension (≥140/90 mm Hg), and hospital admissions. RESULTS: Of 2 199 019 unique patient office visits, 59 836 (4.6%) met the definition of hypertensive urgency. After excluding 851 patients, 58 535 were included. Mean (SD) age was 63.1 (15.4) years; 57.7% were women; and 76.0% were white. Mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 31.1 (7.6); mean (SD) systolic blood pressure, 182.5 (16.6) mm Hg; and mean (SD) diastolic blood pressure, 96.4 (15.8) mm Hg. In the propensity-matched analysis, the 852 patients sent home were compared with the 426 patients referred to the hospital, with no significant difference in MACE at 7 days (0 vs 2 [0.5%]; P = .11), 8 to 30 days (0 vs 2 [0.5%]; P = .11), or 6 months (8 [0.9%] vs 4 [0.9%]; P > .99). Patients sent home were more likely to have uncontrolled hypertension at 1 month (735 of 852 [86.3%] vs 349 of 426 [81.9%]; P = .04) but not at 6 months (393 of 608 [64.6%] vs 213 of 320 [66.6%]; P = .56). Patients sent home had lower hospital admission rates at 7 days (40 [4.7%] vs 35 [8.2%]; P = .01) and at 8 to 30 days (59 [6.9%] vs 48 [11.3%]; P = .009). CONCLUSIONS AND RELEVANCE: Hypertensive urgency is common, but the rate of MACE in asymptomatic patients is very low. Visits to the ED were associated with more hospitalizations, but not improved outcomes. Most patients still had uncontrolled hypertension 6 months later.

12 Article Prevalence and Prognostic Significance of Apparent Treatment Resistant Hypertension in Chronic Kidney Disease: Report From the Chronic Renal Insufficiency Cohort Study. 2016

Thomas, George / Xie, Dawei / Chen, Hsiang-Yu / Anderson, Amanda H / Appel, Lawrence J / Bodana, Shirisha / Brecklin, Carolyn S / Drawz, Paul / Flack, John M / Miller, Edgar R / Steigerwalt, Susan P / Townsend, Raymond R / Weir, Matthew R / Wright, Jackson T / Rahman, Mahboob / Anonymous2110853. ·From the Department of Nephrology and Hypertension, Cleveland Clinic, OH (G.T.) · Departments of Medicine (R.R.T.) and Biostatistics and Epidemiology (A.H.A., D.X., H.-Y.C.), University of Pennsylvania Perelman School of Medicine, Philadelphia · Departments of Medicine (L.J.A., E.R.M.) and Epidemiology (L.J.A.), Johns Hopkins University, Baltimore, MD · Department of Nephrology, Ochsner Medical Center, New Orleans, LA (S.B.) · Department of Medicine, University of Illinois at Chicago (C.B.) · Department of Medicine, University of Minnesota, Minneapolis (P.D.) · Hypertension Section, Division of General Medicine, Department of Medicine, Southern Illinois University, Springfield (J.M.F.) · Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI (S.P.S.) · Department of Medicine, University of Maryland School of Medicine, Baltimore (M.R.W.) · Department of Medicine, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland VA Medical Center Cleveland, OH (J.T.W., M.R.). ·Hypertension · Pubmed #26711738.

ABSTRACT: The association between apparent treatment resistant hypertension (ATRH) and clinical outcomes is not well studied in chronic kidney disease. We analyzed data on 3367 hypertensive participants in the Chronic Renal Insufficiency Cohort (CRIC) to determine prevalence, associations, and clinical outcomes of ATRH in nondialysis chronic kidney disease patients. ATRH was defined as blood pressure ≥140/90 mm Hg on ≥3 antihypertensives, or use of ≥4 antihypertensives with blood pressure at goal at baseline visit. Prevalence of ATRH was 40.4%. Older age, male sex, black race, diabetes mellitus, and higher body mass index were independently associated with higher odds of having ATRH. Participants with ATRH had a higher risk of clinical events than participants without ATRH-composite of myocardial infarction, stroke, peripheral arterial disease, congestive heart failure (CHF), and all-cause mortality (hazard ratio [95% confidence interval], 1.38 [1.22-1.56]); renal events (1.28 [1.11-1.46]); CHF (1.66 [1.38-2.00]); and all-cause mortality (1.24 [1.06-1.45]). The subset of participants with ATRH and blood pressure at goal on ≥4 medications also had higher risk for composite of myocardial infarction, stroke, peripheral arterial disease, CHF, and all-cause mortality (hazard ratio [95% confidence interval], (1.30 [1.12-1.51]) and CHF (1.59 [1.28-1.99]) than those without ATRH. ATRH was associated with significantly higher risk for CHF and renal events only among those with estimated glomerular filtration rate ≥30 mL/min per 1.73 m(2). Our findings show that ATRH is common and associated with high risk of adverse outcomes in a cohort of patients with chronic kidney disease. This underscores the need for early identification and management of patients with ATRH and chronic kidney disease.

13 Article Longitudinal Effect of CPAP on BP in Resistant and Nonresistant Hypertension in a Large Clinic-Based Cohort. 2016

Walia, Harneet K / Griffith, Sandra D / Foldvary-Schaefer, Nancy / Thomas, George / Bravo, Emmanuel L / Moul, Douglas E / Mehra, Reena. ·Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH. Electronic address: waliah@ccf.org. · Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH. · Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH. · Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH. ·Chest · Pubmed #26225487.

ABSTRACT: BACKGROUND: Clinic-based effectiveness studies of sleep-disordered breathing (SDB) treatment in reducing BP in resistant hypertension (RHTN) vs non-RHTN are sparse. We hypothesize that CPAP use in SDB reduces BP significantly in RHTN and non-RHTN in a large clinic-based cohort. METHODS: Electronic medical records were reviewed in patients with SDB and comorbid RHTN and non-RHTN for CPAP therapy initiation (baseline) and subsequent visits. We estimated generalizable BP changes from multivariable mixed-effects linear models for systolic BP (SBP), diastolic BP, and mean arterial pressure, adjusting for RHTN status, age, sex, race, BMI, cardiac history, and diabetes and repeated measure correlation. RESULTS: Of 894 patients, 130 (15%) had RHTN at baseline (age, 58 ± 12 years; 52% men; BMI, 36 ± 9 kg/m(2)). Patients with RHTN had significantly higher BP overall (P < .001), most notably for SBP (6.9 mm Hg; 95% CI, 3.84, 9.94). In the year following CPAP initiation, improvements in BP indexes did not generally differ based on RHTN status in which RHTN status was a fixed effect. However, there was a significant decrease in SBP (3.08 mm Hg; 95% CI, 1.79, 4.37), diastolic BP (2.28; 95% CI, 1.56, 3.00), and mean arterial pressure (2.54 mm Hg; 95% CI, 1.73, 3.36) in both groups. CONCLUSIONS: In this clinic-based effectiveness study involving patients closely followed for BP control, a significant reduction of BP measures (strongest for SBP) was observed in response to CPAP which was similar in RHTN and non-RHTN groups thus informing expected clinical CPAP treatment response.

14 Article New hypertension guidelines: one size fits most? 2014

Thomas, George / Shishehbor, Mehdi / Brill, David / Nally, Joseph V. ·Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH. ·Cleve Clin J Med · Pubmed #24591473.

ABSTRACT: The report of the panel appointed to the eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8) is more evidence-based and focused than its predecessors, outlining a management strategy that is simpler and, in some instances, less aggressive. It has both strengths and weaknesses.

15 Article Human cardiosphere-derived cells from patients with chronic ischaemic heart disease can be routinely expanded from atrial but not epicardial ventricular biopsies. 2012

Chan, Helen H L / Meher Homji, Zaal / Gomes, Renata S M / Sweeney, Dominic / Thomas, George N / Tan, Jun Jie / Zhang, Huajun / Perbellini, Filippo / Stuckey, Daniel J / Watt, Suzanne M / Taggart, David / Clarke, Kieran / Martin-Rendon, Enca / Carr, Carolyn A. ·Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, UK. ·J Cardiovasc Transl Res · Pubmed #22752803.

ABSTRACT: To investigate the effects of age and disease on endogenous cardiac progenitor cells, we obtained right atrial and left ventricular epicardial biopsies from patients (n = 22) with chronic ischaemic heart disease and measured doubling time and surface marker expression in explant- and cardiosphere-derived cells (EDCs, CDCs). EDCs could be expanded from all atrial biopsy samples, but sufficient cells for cardiosphere culture were obtained from only 8 of 22 ventricular biopsies. EDCs from both atrium and ventricle contained a higher proportion of c-kit+ cells than CDCs, which contained few such cells. There was wide variation in expression of CD90 (atrial CDCs 5-92 % CD90+; ventricular CDCs 11-89 % CD90+), with atrial CDCs cultured from diabetic patients (n = 4) containing 1.6-fold more CD90+ cells than those from non-diabetic patients (n = 18). No effect of age or other co-morbidities was detected. Thus, CDCs from atrial biopsies may vary in their therapeutic potential.

16 Article Renal denervation to treat resistant hypertension: Guarded optimism. 2012

Thomas, George / Shishehbor, Mehdi H / Bravo, Emmanuel L / Nally, Joseph V. ·Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic. thomasg3@ccf.org ·Cleve Clin J Med · Pubmed #22751635.

ABSTRACT: Renal sympathetic denervation has shown promise in treating hypertension resistant to drug therapy. This procedure lowers blood pressure via targeted attenuation of renal sympathetic tone, and it has a favorable safety profile. But although there is reason for cautious optimism, we should keep in mind that the mechanisms of hypertension are complex and multifactorial, and further study of this novel therapy and its long-term effects is needed.

17 Minor In Reply: Blood pressure targets. 2016

Thomas, George / Nally, Joseph V / Pohl, Marc A. ·Cleveland Clinic, Cleveland, OH, USA. ·Cleve Clin J Med · Pubmed #27399858.

ABSTRACT: -- No abstract --