Resistant Hypertension: Disease Burden and Emerging Treatment Options.

Purpose Of Review: To define resistant hypertension (RHT), review its pathophysiology and disease burden, identify barriers to effective hypertension management, and to highlight emerging treatment options.

Recent Findings: RHT is defined as uncontrolled blood pressure (BP) ≥ 130/80 mm Hg despite concurrent prescription of ≥ 3 or ≥ 4 antihypertensive drugs in different classes or controlled BP despite prescription of  ≥ to 4 drugs, at maximally tolerated doses, including a diuretic. BP is regulated by a complex interplay between the renin-angiotensin-aldosterone system, the sympathetic nervous system, the endothelin system, natriuretic peptides, the arterial vasculature, and the immune system; disruption of any of these can increase BP.

Adverse Health Outcomes Associated With Refractory and Treatment-Resistant Hypertension in the Chronic Renal Insufficiency Cohort.

Refractory hypertension (RfH) is a severe phenotype of antihypertension treatment failure. Treatment-resistant hypertension (TRH), a less severe form of difficult-to-treat hypertension, has been associated with significantly worse health outcomes. However, no studies currently show how health outcomes may worsen upon progression to RfH.

Estimating prevalence and test accuracy in disease ecology: How Bayesian latent class analysis can boost or bias imperfect test results.

Obtaining accurate estimates of disease prevalence is crucial for the monitoring and management of wildlife populations but can be difficult if different diagnostic tests yield conflicting results and if the accuracy of each diagnostic test is unknown. Bayesian latent class analysis (BLCA) modeling offers a potential solution, providing estimates of prevalence levels and diagnostic test accuracy under the realistic assumption that no diagnostic test is perfect.In typical applications of this approach, the specificity of one test is fixed at or close to 100%, allowing the model to simultaneously estimate the sensitivity and specificity of all other tests, in addition to infection prevalence.

Linking longitudinal and cross-sectional biomarker data to understand host-pathogen dynamics: Leptospira in California sea lions (Zalophus californianus) as a case study.

Confronted with the challenge of understanding population-level processes, disease ecologists and epidemiologists often simplify quantitative data into distinct physiological states (e.g. susceptible, exposed, infected, recovered).

Serious Adverse Events Cluster in Participants Experiencing the Primary Composite Cardiovascular Endpoint: A Post Hoc Analysis of the SPRINT Trial.

Background: Intensively treated participants in the SPRINT study experienced fewer primary cardiovascular composite study endpoints (CVD events) and lower mortality, although 38% of participants experienced a serious adverse event (SAE). The relationship of SAEs with CVD events is unknown.

Methods: CVD events were defined as either myocardial infarction, acute coronary syndrome, decompensated heart failure, stroke, or death from cardiovascular causes.

Prevalence of refractory hypertension in the United States from 1999 to 2014.

Objectives: Refractory hypertension has been defined as uncontrolled blood pressure (at or above 140/90 mmHg) when on five or more classes of antihypertensive medication, inclusive of a diuretic. Because unbiased estimates of the prevalence of refractory hypertension in the United States are lacking, we aim to provide such estimates using data from the National Health and Nutrition Examination Surveys (NHANES).

Methods: Refractory hypertension was assessed across multiple NHANES cycles using the aforementioned definition.

Fixed-rate insulin for adult diabetic ketoacidosis is associated with more frequent hypoglycaemia than rate-reduction method: a retrospective cohort study.

Objective: To assess whether hypoglycaemia incidence during management of adult diabetic ketoacidosis (DKA) differed following transition from a fixed-rate insulin protocol to a protocol using an empiric insulin rate reduction after normoglycaemia.

Methods: We retrospectively reviewed charts from adult patients managed with a DKA order set before and after order set revision. In cohort 1 (n = 77), insulin rate was 0.

Clay content and pH: soil characteristic associations with the persistent presence of chronic wasting disease in northern Illinois.

Environmental reservoirs are important to infectious disease transmission and persistence, but empirical analyses are relatively few. The natural environment is a reservoir for prions that cause chronic wasting disease (CWD) and influences the risk of transmission to susceptible cervids. Soil is one environmental component demonstrated to affect prion infectivity and persistence.

Detecting signals of chronic shedding to explain pathogen persistence: Leptospira interrogans in California sea lions.

Identifying mechanisms driving pathogen persistence is a vital component of wildlife disease ecology and control. Asymptomatic, chronically infected individuals are an oft-cited potential reservoir of infection, but demonstrations of the importance of chronic shedding to pathogen persistence at the population-level remain scarce. Studying chronic shedding using commonly collected disease data is hampered by numerous challenges, including short-term surveillance that focuses on single epidemics and acutely ill individuals, the subtle dynamical influence of chronic shedding relative to more obvious epidemic drivers, and poor ability to differentiate between the effects of population prevalence of chronic shedding vs.

Inferring infection hazard in wildlife populations by linking data across individual and population scales.

Our ability to infer unobservable disease-dynamic processes such as force of infection (infection hazard for susceptible hosts) has transformed our understanding of disease transmission mechanisms and capacity to predict disease dynamics. Conventional methods for inferring FOI estimate a time-averaged value and are based on population-level processes. Because many pathogens exhibit epidemic cycling and FOI is the result of processes acting across the scales of individuals and populations, a flexible framework that extends to epidemic dynamics and links within-host processes to FOI is needed.

Epidemiological models to control the spread of information in marine mammals.

Socially transmitted wildlife behaviours that create human-wildlife conflict are an emerging problem for conservation efforts, but also provide a unique opportunity to apply principles of infectious disease control to wildlife management. As an example, California sea lions (Zalophus californianus) have learned to exploit concentrations of migratory adult salmonids below the fish ladders at Bonneville Dam, impeding endangered salmonid recovery. Proliferation of this foraging behaviour in the sea lion population has resulted in a controversial culling programme of individual sea lions at the dam, but the impact of such culling remains unclear.

Mapping U.S. cattle shipment networks: Spatial and temporal patterns of trade communities from 2009 to 2011.

The application of network analysis to cattle shipments broadens our understanding of shipment patterns beyond pairwise interactions to the network as a whole. Such a quantitative description of cattle shipments in the U.S.

Identification of migratory bird flyways in North America using community detection on biological networks.

Migratory behavior of waterfowl populations in North America has traditionally been broadly characterized by four north-south flyways, and these flyways have been central to the management of waterfowl populations for more than 80 yr. However, previous flyway characterizations are not easily updated with current bird movement data and fail to provide assessments of the importance of specific geographical regions to the identification of flyways. Here, we developed a network model of migratory movement for four waterfowl species, Mallard (Anas platyrhnchos), Northern Pintail (A.

Mapping influenza transmission in the ferret model to transmission in humans.

The controversy surrounding 'gain-of-function' experiments on high-consequence avian influenza viruses has highlighted the role of ferret transmission experiments in studying the transmission potential of novel influenza strains. However, the mapping between influenza transmission in ferrets and in humans is unsubstantiated. We address this gap by compiling and analyzing 240 estimates of influenza transmission in ferrets and humans.

Utility of mosquito surveillance data for spatial prioritization of vector control against dengue viruses in three Brazilian cities.

Background: Vector control remains the primary defense against dengue fever. Its success relies on the assumption that vector density is related to disease transmission. Two operational issues include the amount by which mosquito density should be reduced to minimize transmission and the spatio-temporal allotment of resources needed to reduce mosquito density in a cost-effective manner.

Eight challenges in modelling disease ecology in multi-host, multi-agent systems.

Many disease systems exhibit complexities not captured by current theoretical and empirical work. In particular, systems with multiple host species and multiple infectious agents (i.e.

Antibiotic Efficacy in Eliminating Leptospiruria in California Sea Lions () Stranding with Leptospirosis.

Stranded California sea lions () along the California coast have been diagnosed with leptospirosis every year since at least the 1980s. Between September 2010 and November 2011, we followed 14 stranded California sea lions that survived to release and evaluated antibiotic efficacy in eliminating leptospiruria (urinary shedding of leptospires). Leptospiruria was assessed by real-time PCR of urine and urine culture, with persistence assessed using longitudinally collected samples.

The impact of movements and animal density on continental scale cattle disease outbreaks in the United States.

Globalization has increased the potential for the introduction and spread of novel pathogens over large spatial scales necessitating continental-scale disease models to guide emergency preparedness. Livestock disease spread models, such as those for the 2001 foot-and-mouth disease (FMD) epidemic in the United Kingdom, represent some of the best case studies of large-scale disease spread. However, generalization of these models to explore disease outcomes in other systems, such as the United States's cattle industry, has been hampered by differences in system size and complexity and the absence of suitable livestock movement data.

A national-scale picture of U.S. cattle movements obtained from Interstate Certificate of Veterinary Inspection data.

We present the first comprehensive description of how shipments of cattle connect the geographic extent and production diversity of the United States cattle industry. We built a network of cattle movement from a state-stratified 10% systematic sample of calendar year 2009 Interstate Certificates of Veterinary Inspection (ICVI) data. ICVIs are required to certify the apparent health of cattle moving across state borders and allow us to examine cattle movements at the county scale.

Assessment of paper interstate certificates of veterinary inspection used to support disease tracing in cattle.

Objective: To evaluate the differences among each state's Interstate Certificate of Veterinary Inspection (ICVI) form and the legibility of data on paper ICVIs used to support disease tracing in cattle.

Design: Descriptive retrospective cross-sectional study.

Sample: Examples of ICVIs from 50 states and 7,630 randomly sampled completed paper ICVIs for cattle from 48 states.

Transmission shifts underlie variability in population responses to Yersinia pestis infection.

Host populations for the plague bacterium, Yersinia pestis, are highly variable in their response to plague ranging from near deterministic extinction (i.e., epizootic dynamics) to a low probability of extinction despite persistent infection (i.