Hypertension Journal

EDITORIAL

S. N. Narasingan

From the Desk of Editor

[Year:2018] [Month:October-December] [Volume:4 ] [Number:4] [Pages No:182]



It gives me great pleasure to be the Guest Editor for this issue of Hypertension Journal. This journal covers many interesting topics which were delivered as guest lectures during BPCON 2018 conducted by the Indian Society of Hypertension on September 7-9, 2018, at Chennai. The authors who contributed articles to this special and exclusive journal are leading experts in their own field with special interest in the field of hypertension. Sharing knowledge and disseminating the same are of at most importance when we are witnessing so much of advances in the field of hypertension.


GUEST EDITORIAL

V. V. Muthusamy

Hypertension and Heart Failure with Preserved Ejection Fraction

[Year:2018] [Month:October-December] [Volume:4 ] [Number:4] [Pages No:183-184]



In the past four decades, there is an increase in the incidence and prevalence of heart failure. It is the most common cause of hospital admission after the age of 65-year-old individuals. In heart failure, there is structural and functional impairment of ventricular filling or ejection of blood. More than 75% of heart failure patients have antecedent hypertension. Hypertension accounts for 39% of risk in men and 59% of risk in women. Elevation of blood pressure leads to structural changes in the myocardium which, in turn, results in heart failure.

How to cite this article: Muthusamy VV. Hypertension and Heart Failure with Preserved Ejection Fraction. Hypertens 2018;4(4): 183-184.

Source of support: Nil,

Conflict of interest: None


REVIEW ARTICLE

Prabhash Chand Manoria, Nidhi Mishra

Hypertension: New Facets

[Year:2018] [Month:October-December] [Volume:4 ] [Number:4] [Pages No:185-188]



The guidelines for hypertension provide all information regarding day-to-day management of hypertension. However, there are several issues such as mortality in a controlled hypertensive, fibrosis in cardiovascular system, vascular age, and target heterogeneity in response to decrease blood pressure which also require attention as they are clinically relevant.

Key words: J-Curve, BPV, fibrosis

How to cite this article: Manoria PC, Mishra N. Hypertension: New Facets. Hypertens 2018;4(4): 185-188.

Source of support: Nil,

Conflict of interest: None

Received: 07-07-2018;

Accepted: 11-08-2018


REVIEW ARTICLE

S. S. Iyengar

Assessment of Cardiovascular Risk Profile in Clinical Practice

[Year:2018] [Month:October-December] [Volume:4 ] [Number:4] [Pages No:189-191]



The burden of cardiovascular disease continues to be high and heavy. There is some encouraging declining trend emerging in the west, but it is on the increase in our country. Prevention, in general, and primordial and primary prevention, in particular, are important in dealing with cardiovascular disease in resource-constrained countries. Risk assessment of atherosclerotic cardiovascular disease is necessary to decide the intensity of preventive measures. There are a number of risk assessment tools available, and one that suits our practice and population should be utilized.

Key words: Cardiovascular risk, Atherosclerotic cardiovascular disease, Risk assesment tools.

How to cite this article: Iyengar SS. Assessment of Cardiovascular Risk Profile in Clinical Practice. Hypertens 2018;4(4): 189-191.

Source of support: Nil,

Conflict of interest: None

Received: 19-06-2018;

Accepted: 14-07-2018


REVIEW ARTICLE

S. N. Narasingan

Hypertension Outcome Trials: How Relevant are they in the Real World Practice of Medicine?

[Year:2018] [Month:October-December] [Volume:4 ] [Number:4] [Pages No:192-199]



Hypertension is a major risk factor for cardiovascular (CV) morbidity and mortality. The prevalence of hypertension is increasing in alarming proportion in both urban and rural population in India. Benefits of lowering blood pressure (BP) resulted in the reduction of CV risk, including mortality benefit. Randomized control trials conducted in people with hypertension had shown beneficial effects in the treatment group compared to that of the placebo or other comparator drugs. Trials in hypertensive participants have given us lot of information about efficacy and safety of pharmacological agents. Combination therapy has shown more advantages for reaching the BP goals early and for additional benefits of CV outcome. There are some controversial issues about usage of certain drugs and the goals of BP in people with diabetes and chronic kidney disease. However, meta-analysis of various trials gave answers for some issues. This chapter will focus on major hypertension outcome trials and their relevance in the real world practice of medicine.

Key words: Hypertension, CV risk, anti hypertensive drugs

How to cite this article: Narasingan SN. Hypertension Outcome Trials: How Relevant are they in the Real World Practice of Medicine? Hypertens 2018;4(4): 192-199.

Source of support: Nil,

Conflict of interest: None

Received: 8-10-2018;

Accepted: 10-11-2018


REVIEW ARTICLE

T. Govindan Unni

Isolated Systolic Hypertension

[Year:2018] [Month:October-December] [Volume:4 ] [Number:4] [Pages No:200-203]



Isolated systolic hypertension (ISH) is a problem of major public health concern as its incidence is increasing. It is difficult to control and is an important risk factor for cardiovascular disease. This article discusses the pathophysiology behind ISH and how to go about treating this condition. The article also discusses about ISH in the young, which is a totally different entity with respect to pathophysiology and treatment.

Key words: Hypertension, systolic, isolated

How to cite this article: Unni TG. Isolated Systolic Hypertension. Hypertens 2018;4(4): 200-203.

Source of support: Nil,

Conflict of interest: None

Received: 19-07-2018;

Accepted: 23-08-2018


REVIEW ARTICLE

N. Gopalakrishnan, R. Aravinth Kumar

How to Detect Early Kidney Disease in Hypertension?

[Year:2018] [Month:October-December] [Volume:4 ] [Number:4] [Pages No:204-206]



There is high prevalence of kidney disease among hypertensive patients. Identifying kidney disease in hypertensive patients at the earliest is of paramount importance in preventing progression to ESRD. Simple and cost-effective techniques are available for screening kidney disease and all medical care professionals need to be sensitized to do an early screening for kidney disease in all hypertensive patients at presentation. Treating chronic kidney disease (CKD) significantly improves cardio-vascular mortality in hypertensive patients which increases exponentially when there is co-existing hypertension and CKD.

Key words: Chronic kidney disease (CKD), early screening, hypertension

How to cite this article: Gopalakrishnan N, Kumar AR. How to Detect Early Kidney Disease in Hypertension? Hypertens 2018;4(4): 204-206.

Source of support: Nil,

Conflict of interest: None

Received: 19-06-2018;

Accepted: 02-08-2018


REVIEW ARTICLE

I. Sathyamurthy, K. N. Srinivasan

Renovascular Hypertension

[Year:2018] [Month:October-December] [Volume:4 ] [Number:4] [Pages No:207-211]



Renovascular Hypertension (RVH) is the most common cause of secondary hypertension. High index of suspicion is needed to diagnose this condition. Two major causes for RVH are renal artery stenosis (RAS) secondary to atherosclerosis (~90%) and fibromuscular dysplasia (~10%). Certain clinical clues for RVH are unprovoked hypokalemia, abdominal bruit, age of the onset of hypertension (<30 years or >55 years), the absence of the family history of hypertension, recent onset of hypertension (duration <1 year), difference of kidney size >1 cm, unexplained azotemia, recurrent flash pulmonary oedema, new onset azotemia with initiation of ACEI, and resistant or refractory hypertension. Revascularization by Percutaneous transluminal renal angioplasty (PTRA)/surgery as indicated should be instituted whenever there is medical failure or worsening of azotemia with maximal medical therapy for RVH.

Key words: Renovascular Hypertension, renal artery stenosis, percutaneous transluminal renal angioplasty

How to cite this article: Sathyamurthy I, Srinivasan KN. Renovascular Hypertension. Hypertens 2018;4(4): 207-211.

Source of support: Nil,

Conflict of interest: None

Received: 07-06-2018;

Accepted: 08-08-2018


REVIEW ARTICLE

Sudha Ekambaram, Vaishanvi Raman

Diagnosis and Management of Pediatric Hypertension

[Year:2018] [Month:October-December] [Volume:4 ] [Number:4] [Pages No:212-218]



Hypertension (HT), a modifiable risk factor in adults, is a major risk factor for cardiovascular disease. Blood pressure (BP) originates in childhood and tracks to adulthood and hence very important to diagnose and appropriately manage childhood HT for healthy adulthood. In this article, we have attempted to answer the following questions: (1) What is HT in children and adolescents? (2) When does it begin? (3) What initiates it? (4) Who is susceptible? (5) What can be done during childhood to prevent consequences of HT during adult life? The updates of the recent American Academy of Pediatrics 2017 guidelines on HT for children have been included with importance to the prevention of HT through healthy lifestyle and vigilant screening including 24 h ambulatory BP monitoring.

Key words: Adult hypertension, childhood blood pressure, obesity, pediatric hypertension, preterm, prevention, risk factors

How to cite this article: Ekambaram S, Raman V. Diagnosis and Management of Pediatric Hypertension. Hypertens 2018;4(4): 212-218.

Source of support: Nil,

Conflict of interest: None

Received: 18-07-2018;

Accepted: 28-08-2018


REVIEW ARTICLE

S. Ramasamy, J. M. Ravichandran, Pradeep G. Nayar

Central Aortic Blood Pressure: An Evidence-based Approach

[Year:2018] [Month:October-December] [Volume:4 ] [Number:4] [Pages No:219-224]



The conventional brachial blood pressure measurement remains as a principle tool to assess cardiovascular risks and monitor the effect of drug therapies. The convenience of measuring the blood pressure in the brachial artery and its cost-effectiveness made it a gold standard for measuring the blood pressure across the world. Even though the diastolic pressure and mean arterial pressure are close to constant throughout the arterial tree, the systolic pressure is not. The systolic pressure widely varies in different segments of the arterial system. This makes the measured brachial pressure inaccurate reflection of load in the central hemodynamics. All the major end organs such as the heart, brain, kidneys, and large arteries, which bear the brunt of hypertension, actually perceive the pressure on the central elastic arteries and certainly not on the brachial artery. Due to the complex mechanism of the presence of wave reflection, pulse pressure amplification, and arrival of the reflected wave to the aorta, the central aortic systolic pressure and brachial pressure were never identical. To add to this complexity, the drug has a differential effect on the brachial and central aortic pressure. In future, the management of hypertension will revolve around central blood pressure and central aortic pressure waveform analysis.

Key words: Central blood pressure, wave reflection, pressure amplification, arterial stiffness, cardiovascular events

How to cite this article: Ramasamy S, Ravichandran JM, Nayar PG. Central Aortic Blood Pressure: An Evidence-based Approach. Hypertens 2019;4(4): 219-224.

Source of support: Nil,

Conflict of interest: None

Received: 19-07-2018;

Accepted: 25-08-2018


REVIEW ARTICLE

Abraham Oomman, K. Abhinaya

Resistant Hypertension 2018

[Year:2018] [Month:October-December] [Volume:4 ] [Number:4] [Pages No:225-231]



Resistant hypertension (HT) (RH) is defined as blood pressure (BP) that remains elevated above the target despite simultaneous treatment with three antihypertensive agents of different classes, at maximum or maximally tolerated doses and at the appropriate dosing frequency. Patients requiring four or more antihypertensives to achieve BP targets are also included. About 12-15% of individuals treated for high BP would have RH. They are at higher risk of cardiovascular morbidity and mortality. White coat effect and pseudohypertension should be ruled out before diagnosing RH. Drug compliance and assessment for comorbidities such as sleep disturbances, obesity, diabetes, and secondary HT are important. The treatment is primarily lifestyle and risk factor modification as well as pharmacotherapy. Diuretics, especially spironolactone and eplerenone, should be used appropriately. Divided dosing, bedtime dosing, and use of fixed-dose combinations should be applied. Renal artery stenting for significant renal artery stenosis is useful in carefully selected subsets. Among interventional approaches, renal denervation (RDN) showed initial promise, but sham-controlled trial could not prove a significant benefit. Modifications of the RDN techniques hold promise. Other interventional techniques such as baroreceptor activation therapy still need further studies. In addition, clinical inertia by the physician should be avoided.

Key words: Resistant hypertension, hypertension, secondary hypertension, renal artery stenting, renal denervation, target blood pressure

How to cite this article: Oomman A, Abhinaya K. Resistant Hypertension 2018. Hypertens 2018;4(4): 225-231.

Source of support: Nil,

Conflict of interest: None

Received: 11-07-2018;

Accepted: 19-08-2018


REVIEW ARTICLE

Asha Mahilmaran

Rare and unusual causes of hypertension

[Year:2018] [Month:October-December] [Volume:4 ] [Number:4] [Pages No:232-236]



Background: Hypertension in most cases is primary, the exact etiology not known but there may be risk factors such as salt excess, obesity, lack of physical activity, genetic factors, metabolic syndrome, and diabetes. However, there exists a subgroup of patients with hypertension with underlying etiology, referred to as secondary hypertension, and constitutes about 5-10% of patients with hypertension. The importance of diagnosis of the secondary causes of hypertension is to detect a potentially reversible etiology. Some of these causes are rare and unless looked for, can be easily missed.

Methods: A review of age-specific causes, approach, rare diseases of the aorta, endocrine, renal, iatrogenic, and substance abuse have been discussed. The importance of suspecting unusual causes in patients with uncontrolled hypertension, hypertension in the young, in the presence of target organ damage is emphasized. Case reports of rare cases have been included.

Conclusion: A systematic approach and knowledge of various rare causes will help suspect and lead to the correct diagnosis in many cases of secondary rare causes of hypertension. It gives a unique opportunity to cure hypertension in some cases and if the underlying cause is undiagnosed may result in morbidity and even prove fatal in some cases.

Key words: Secondary hypertension, renal artery stenosis, coarctation of aorta, pheochromocytoma, pseudopheochromocytoma, hyperaldosteronism

How to cite this article: Mahilmaran A. Rare and unusual causes of hypertension. Hypertens 2018;4(4): 232-236.

Source of support: Nil,

Conflict of interest: None

Received: 26-6-2018;

Accepted: 7-08-2018