Hypertension is the leading cause, worldwide, of premature death or surviving with disabilities due to damage to the heart, the brain, or the kidneys. Making a correct diagnosis of hypertension is an essential step in reducing the impact of elevated blood pressure (BP) on an individual's health. In this article, we will use a typical case to illustrate the steps involved in confirming a diagnosis of hypertension, along with the rationale for the usage of the current out-of-office BP measurement tools, to correctly identify and confirm elevated BP. The reader will be guided through an explanation of how to use the office BPs with, or without, complementary information from BPs readings obtained using at home devices, or through the use of an ambulatory BP monitors. The utility of these different approaches to how, and settings within which, BP is measured are also examined.

Key words: Hypertension, home blood pressure monitoring, self-monitoring of blood pressure, ambulatory blood pressure monitoring, blood pressure measurement

How to cite this article: Townsend RR. Confirming a Diagnosis of “Hypertension.” Hypertens 2021;7(1): 1-6.

Received: 05-04-2021;

Accepted: 15-04-2021

Systemic vascular disease is a major public health issue all over the world. Vascular disease causes significant morbidity and excessive mortality. Risk factors for vascular disease like hypertension, diabetes, hyperlipidemia, and tobacco consumption inflict vascular disease by causing endothelial dysfunction. Endothelium, the innermost layer of the blood vessels governs vascular tone and vasomotion. Abnormal endothelial function promotes vasoconstriction and atherothrombosis. Thus, endothelial dysfunction predisposes to vascular disease affecting target organs--- brain, heart, and the kidneys, etc. Endothelial dysfunction, thus, is a precursor in the onset and progression of systemic vascular disease and atherosclerosis. Future interventions to prevent vascular disease should include modalities to preserve endothelial function and to reverse endothelial dysfunction. Endothelial function is critical to maintain holistic public health.

Key words: Cardiovascular Disease (CVD), Endothelium, homeostasis

How to cite this article: Townsend RR. Confirming a Diagnosis of “Hypertension.” Hypertens 2021;7(1): 1-6.

Received: 23-03-2021;

Accepted: 31-03-2021

Hypertension remains a leading etiology of end-stage kidney disease. The disease has a complex pathophysiology and contributes to a wide array of morbidities and mortality for patients across the globe. Due to the lack of published data on the subject, diagnosing and monitoring hypertension in the dialysis population poses a great challenge, as currently there are no published blood pressure target goals and in-center monitoring is often not reliable. Moreover, the management of this condition involves conservative approaches for both adjusting dialysis prescriptions and limiting dietary fluid and sodium intake. Therapy is often escalated with pharmacologic agents, of which emerging data suggest that it may be useful to use certain drug classes initially. However, professional guidelines do not provide specific drug therapy recommendations at this time.

Key words: Dialysis, End-stage kidney disease, Hypertension, Management, Pathophysiology

How to cite this article: Farmakis C, Collazo-Maldonado R. Hypertension in end-stage kidney disease. Hypertens 2021;7(1): 14-18.

Received: 29-04-2021;

Accepted: 08-05-2021

Hypertension is one of the leading causes of cardiovascular disease-related morbidity and mortality globally. Over the last several decades, there has been a broad shift in the management and pharmacologic treatment, specifically of hypertension, from a step-care approach to an individualized approach, and now to a population-based approach to increase the control rate of hypertension with the overall goal of decreasing major cardiovascular events related to poor control of hypertension. The Global HEARTS initiative of the World Health Organization and the HEARTS in the Americas Program of the Pan American Health Organization, in addition to the efforts of other organizations, serve as a blueprint for the implementation of a standardized, population-based approach to treating hypertension in the primary health-care setting. We have implemented components of such a program in our primary care clinic and resistant hypertension clinic here in Columbia, South Carolina, U.S. While the U.S. is a high-income country, the demographics of our clinic is one of low income and health literacy and our population is primarily black and Hispanic, female, and of an older age. Our clinic has successfully applied population-based treatment principles on an individualized basis to improve hypertension control rates and cardiovascular disease in our local community.

Key words: Hypertension, Hypertension clinic, Population-based care, Resistant hypertension

How to cite this article: Edwards EW, Rhinehart G, Ridley E, Chandler CW, Garrick C, DiPette DJ. Implementation of a Resistant Hypertension Control Program in a Low-income Primary Care Setting in a High-Income Country: Lessons Learned and Global Applicability. Hypertens 2021;7(1): 19-26.

Received: 17-04-2021;

Accepted: 24-04-2021

While Coronavirus disease-2019 (COVID-19) is primarily a respiratory tract infection in most cases of mild to moderate disease, severe disease can involve multi-organ failure including acute kidney injury (AKI). COVID-19-associated AKI may require renal replacement therapy (RRT) in the acute setting or chronically after hospital discharge. The COVID-19 pandemic presented considerable difficulties to the nephrology community, requiring epidemiologic, clinical, and pathologic studies of AKI associated with the acute phase of infection. In this review article, AKI studies, pathologic entities, and specific adaptations to RRT will be discussed.

Key words: Acute kidney injury, Collapsing glomerulopathy, Coronavirus disease-2019, Renal replacement therapy

How to cite this article: Regina S, Collazo-Maldonado R. Kidney disease in the coronavirus disease-2019 pandemic. Hypertens 2021;7(1): 27-31.

Received: 24-04-2021;

Accepted: 01-05-2021

Hypocaloric weight reduction, with or without increased physical activity, lowers blood pressure (BP). Heart rate, sympathetic nervous system, and renin-angiotensin-aldosterone system activity also decline. However, with time, substantial weight is typically regained in most individuals who lose weight, and the beneficial effects of weight loss on BP decline or are reversed. The initial decline in BP with weight loss is likely enhanced by negative caloric balance. Thus, even with isocaloric weight loss maintenance, the magnitude of the initial BP reduction appears to decline with time. Of further concern, the complex physiological (counterregulatory) adaptations to weight loss foster weight regain as more calories are desired than required and energy expenditure falls. Sustained weight loss generally requires a substantial long-term time commitment to physical activity and a high level of vigilance. High protein, low glycemic, high fiber, and reduced energy density diets may also be beneficial in reducing hunger and increasing satiety. Individuals who are counseled to lose weight should be aware of the challenges in maintaining weight loss, receive education on the lifestyle changes required to sustain weight loss, and commit to an evidence-based plan designed to foster long-term success. Future research directed at blocking or ameliorating the disproportionately large reductions of anorexigenic hormones and decreases in energy expenditure that accompany weight loss would help sustain the beneficial effects of weight loss on BP.

Key words: Lifestyle, weight loss, weight regain, hypertension, blood pressure

How to cite this article: Egan BM, Sutherland S, Hall ME. Limited Long-Term Efficacy of Lifestyle-Mediated Weight Loss on Blood Pressure Control the Biology of Weight Regain. Hypertens 2021;7(1):32-38.

Received: 18-12-2020;

Accepted: 02-01-2021

The remarkable reductions in cardiovascular events and the blunting of the decline in kidney function observed in clinical trials of patients with diabetes, cardiovascular disease, and/or chronic kidney disease treated with sodium-glucose co-transporter 2 (SGLT2) inhibitors are accompanied by a modest reduction in systolic (2–5 mm Hg) and diastolic (0.5–2.5 mm Hg) blood pressure. Blood pressure reduction occurs across a spectrum of blood pressure elevations, possibly including those with resistant hypertension, many of whom are already taking a variety of antihypertensive drugs. SGLT2 inhibitors appear to lower blood pressure to a greater extent in hypertensive Black and Asian individuals than White individuals. Mechanisms by which SGLT2 inhibitors likely contribute to blood pressure reduction and other cardiovascular and kidney benefits involve a variety of neuroendocrine, kidney, and hemodynamic systems. Some of these components include osmotic diuresis and natriuresis with a consequent decline in both interstitial and intravascular volume, weight reduction, a reduction in arterial stiffness, cardiac ventricular remodeling, loss of salt sensitivity, a decrease in uric acid concentrations, and a complicated interaction with the renin-angiotensin-aldosterone and sympathetic nervous systems. This review will provide an update on mechanisms purported to contribute to blood pressure reduction and the cardiovascular and kidney benefits observed with this the class of agents.

Key words: Blood pressure, cardiovascular disease, chronic kidney disease, diabetes, SGLT2 inhibitors

How to cite this article: Triozzi JL, Navaneethan SD, Gregg LP, Taylor AA. Sodium-glucose Co-transporter 2 Inhibitors and Blood Pressure Reduction among Patients with Diabetes, Cardiovascular Disease, Chronic Kidney Disease. Hypertens 2021;7(1): 39-45.

Received: 30-4-2021;

Accepted: 04-05-2021

The American Heart Association/American College of Cardiology (AHA/ACC) Guidelines for the management of high blood pressure (BP) recommend intensive BP goals in high-risk individuals. However, intensive BP therapy comes with a higher risk of side effects. It is, therefore, important to identify individuals with higher cardiovascular risk who will in turn derive the greatest absolute benefit from BP reduction. In line with this, both ACC/AHA and European guidelines on the management of hypertension recommend the use of risk assessment using traditional risk factors. The European guidelines also recommend complementing risk estimation using additional markers of hypertension-mediated organ damage. Cardiac biomarkers such as natriuretic peptide and high sensitivity cardiac troponins (hs-cTn) reflect structural and/or functional changes in end organs (i.e., myocardium, vasculature) and have been associated with increased cardiovascular risk. These cardiac biomarkers may supplement risk assessment of patients with elevated BP and help personalize treatment strategies. Both NT-pro B type Natriuretic Peptide (NT-proBNP) and hs-cTn have been shown to predict cardiovascular events across different systolic and diastolic BP categories. Furthermore, observational data suggest that individuals with elevated levels of NT-proBNP and/or high-sensitivity troponin have lower numbers needed to treat to prevent cardiovascular events with intensive BP therapy, with the lowest NNT seen in those with elevated levels of both. While the data related to biomarkers in hypertension are encouraging, future randomized clinical trials are needed to further characterize the clinical utility of biomarker-based evaluation and treatment strategies in patients with hypertension.

Key words: Hypertension, biomarkers, cardiovascular risk assessment, NT-pro B type natriuretic peptide, high sensitivity cardiac troponins

How to cite this article: Hussain A, Deshotels M, Nambi PV, Bansal K, Jneid H, Nambi V. Troponin and B-type Natriuretic Peptides Biomarkers in the Management of Hypertension. Hypertens 2021;7(1):46-53.

Received: 12-05-2021;

Accepted: 13-05-2021

Prediction models are extensively used in numerous areas including clinical settings where a prediction model helps to detect or screen high-risk subjects for early interventions to prevent an adverse outcome, assist in medical decision-making to help both doctors and patients to make an informed choice regarding the treatment, and assist in health-care services with planning and quality management. There are two main components of prediction modeling: model development and model validation. Once a model is developed using an appropriate modeling strategy, its utility is assessed through model validation. Model validation provides a true test of a model’s predictive ability when the model is applied on an independent dataset. A model may show outstanding predictive accuracy in a dataset that was used to develop the model, but its predictive accuracy may decline radically when applied to a different dataset. In the era of precision health where disease prevention through early detection is highly encouraged, accurate prediction of a validated model has become even more important for successful screening. Different clinical practice guidelines also recommend incorporating only those prediction models in clinical practice that has demonstrated good predictive accuracy in multiple validation studies. Our purpose is to introduce the readers with the basic concept of model validation and illustrates the fundamental steps and procedures that are necessary to implement model validation.

Key words: External validation, internal validation, model validation, Prediction model

How to cite this article: Chowdhury MZI, Turin TC. Validating prediction models for use in clinical practice: concept, steps, and procedures focusing on hypertension risk prediction. Hypertens 2021;7(1):54-62.

Received: 18-12-2020;

Accepted: 02-01-2021