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COMPLICATIONS OF HYPERTENSION
Sudhir Kumar

Hypertension and Hemorrhagic Stroke

[Year:2017] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:53] [Pages No:89-93][No of Hits : 1596]


ABSTRACT

Hemorrhagic strokes are common and account for 20 to 30% of all strokes in India and the rest of Asia. Patients admitted with intracerebral hemorrhage (ICH) are usually sicker, and ICH is associated with worse outcomes (as compared with ischemic strokes). Hypertension is the commonest risk factor for spontaneous ICH, responsible for up to 80% of all cases of ICH, either alone or in combination with other etiological factors. Elevated blood pressure (BP) during the first few hours to days after ICH leads to worse outcomes (higher death and disability rates). This is because high BP is directly linked to hematoma expansion and increased mass effect. Therefore, rapid lowering of BP is recommended if systolic BP > 160 mm Hg. Intravenous labetalol and nicardipine are both equally safe and effective for this purpose. Survivors of ICH have a higher risk of developing recurrence of ICH both over the short term and over the long term. Aggressive BP lowering is recommended in ICH survivors postdischarge from the hospital. The target BP of <130/80 mm Hg should be maintained in them to reduce the risk of ICH recurrence.

Keywords: Antihypertensive agents, Hematoma, Hemorrhagic stroke, Hypertension, Intracerebral hemorrhage, Labetalol, Mortality, Nicardipine, Outcome, Perindopril, Recurrence.

How to cite this article: Kumar S. Hypertension and Hemorrhagic Stroke. Hypertens J 2017;3(2):89-93.

Source of support: Nil

Conflict of interest: None


 
ENDOTHELIAL PATHOPHYSIOLOGY
Jay Khambhati, Suegene K Lee, Bryan Kindya, Devinder Dhindsa, Pratik B Sandesara, Arshed A Quyyumi

Endothelial Dysfunction and Essential Hypertension

[Year:2017] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:53] [Pages No:81-88][No of Hits : 684]


ABSTRACT

Systemic hypertension is a chronic disorder of cardiovascular system characterized by an increase in systemic vascular resistance (SVR). Although the level of blood pressure is a product of SVR and cardiac output, it is the former which is responsible for chronic blood pressure elevation. A number of biochemical, biophysical, and neuro-humoral factors participate in the maintenance of SVR. Whatever the underlying molecular mechanism may be for elevated SVR, the end consequence is endothelial dysfunction. Normal endothelium promotes vasodilation and prevention of local thrombotic phenomena whereas abnormal endothelium promotes vasoconstriction and thrombotic processes. One of the basic pathophysiological aberrations in hypertension is abnormal endothelial function. A number of blood pressure lowering strategies (life-style modification and or anti-hypertensive drugs) result in reversing endothelial dysfunction in hypertension. Thus, endothelial function is considered both as a mechanism and a therapeutic target in hypertension. This review summarizes the physiology and pathophysiology of endothelium in hypertension.

Keywords: Aminothiols, Cardiovascular, Dimethylarginine, Hypertension.

How to cite this article: Khambhati J, Lee SK, Kindya B, Dhindsa D, Sandesara PB, Quyyumi AA. Endothelial Dysfunction and Essential Hypertension. Hypertens J 2017;3(2):81-88.

Source of support: AAQ is supported by the National Institutes of Health (NIH) grants 5P01HL101398-02, 1P20HL113451-01, 1R56HL126558-01, 1RF1AG051633-01, R01 NS064162- 01, R01 HL89650-01, HL095479-01, 1U10HL110302-01, 1DP3DK094346-01, 2P01HL086773-06A1.

Conflict of interest: None


 
HYPERTENSION AND NEUROGENIC IMPACT
Sudhir Kumar

Hypertension and Ischemic Stroke

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:53] [Pages No:39-43][No of Hits : 1409]


ABSTRACT

Stroke is among the leading causes of death and disability worldwide. Ischemic stroke is 3 to 4 times more common than hemorrhagic stroke. Hypertension is the commonest risk factor for ischemic stroke, in addition to diabetes mellitus, dyslipidemia and smoking. Blood pressure (BP) lowering with appropriate antihypertensive agents would lead to reduction of first ever stroke as well as recurrent strokes. This article discusses the epidemiology of strokes in India, role of hypertension in ischemic stroke causation and its recurrence; BP targets to be achieved, and the preferred antihypertensive agents. In addition, management of hypertension in the setting of acute ischemic stroke is also discussed. Blood pressure lowering is generally avoided within the first 24 hours after acute ischemic stroke. Proper BP management is one of the keys to ensure better outcomes in acute stroke setting.

Keywords: Antihyper tensive agents, Epidemiology, Hypertension, India, Ischemic, Prevention, Risk factor, Stroke, Stroke recurrence, Target BP.

How to cite this article: Kumar S. Hypertension and Ischemic Stroke. Hypertens J 2016;2(1):39-43.

Source of support: Nil

Conflict of interest: None


 
HYPERTENSION AND THE KIDNEY
P Vijay Varma, M Rajasekara Chakravarthi, G Jyothsna

Hypertension in Patients with Chronic Kidney Disease

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:53] [Pages No:28-34][No of Hits : 1230]


ABSTRACT

The prevalence of hypertension in chronic kidney disease (CKD) patients exceeds that of the general population. Uncontrolled hypertension plays a significant role in progression to end stage renal disease and results in increased cardiovascular morbidity and mortality. A complex interplay between various pathophysiologic mechanisms is responsible for the development of hypertension in this patient population. The major factors being extracellular volume overload, increased endothelin-1 release and excess renin-angiotensin-aldosterone system and sympathetic nervous system activity. Dietary and lifestyle modifications have synergistic effects to drug therapy in the control of hypertension. There is no single blood pressure target that is optimal for all CKD patients. It is important to individualize the treatment depending on age, the severity of albuminuria, and comorbidities. Drugs blocking the renin-angiotensin-aldosterone system are the recommended first-line antihypertensive agents for most CKD patients. Intradialytic hypertension may be prevented by individualizing the dialysis prescription and using nondialyzable antihypertensives. New onset of hypertension in the elderly or new onset of difficult to control hypertension in a previously well controlled hypertensive patient should prompt the work up for atherosclerotic renal vascular disease.

Keywords: Aldosterone, Angiotensin, Chronic, Hypertension, Kidney, Renin.

How to cite this article: Varma PV, Chakravarthi MR, Jyothsna G. Hypertension in Patients with Chronic Kidney Disease. Hypertens J 2016;2(1):28-34.

Source of support: Nil

Conflict of interest: None


 
PATHOPHYSIOLOGY OF HYPERTENSION
PP Mohanan

Metabolic Syndrome in the Indian Population: Public Health Implications

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:53] [Pages No:1-6][No of Hits : 1097]


ABSTRACT

Metabolic syndrome (MS) is now being increasing recognized as an emerging threat which will invade desktops of public health policy planners in the decades to come. The clusters which make this syndrome and its etiopathogenesis will keep getting varied in different ethnic populations, regions and countries. Factors like migration, socioeconomic status, lifestyle, nutrition habits play important role. Therefore, research in MS provides an interdisciplinary forum to explore the pathophysiology, recognition, and treatment of the cluster of conditions associated with the evolving entity of MS.

Keywords: Atherosclerotic, Dyslipidemia, Intramyocellular lipids.

How to cite this article: Mohanan PP. Metabolic Syndrome in the Indian Population: Public Health Implications. Hypertens J 2016;2(1):1-6.

Source of support: Nil

Conflict of interest: None


 
SECONDARY HYPERTENSION
Samuel J Mann

Severe Paroxysmal Hypertension: Pseudopheochromocytoma

[Year:2016] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:53] [Pages No:96-102][No of Hits : 1056]


ABSTRACT

Paroxysmal hypertension always engenders a search for a catecholamine-secreting pheochromocytoma (pheo). However, in 98% of cases, a pheo is not found, and the cause and management of the paroxysmal hypertension have remained a largely unstudied mystery. This review presents an approach to understanding and successfully treating this disorder, which is increasingly known as “pseudopheochromocytoma,” or “pseudopheo.” Patients with this disorder experience sudden, unprovoked, and symptomatic blood pressure elevations that are likely linked to stimulation of the sympathetic nervous system. Psychological characteristics associated with this disorder suggest a basis in repressed emotion related either to prior emotional trauma or to a repressive (nonemotional) coping style. Based on this understanding, successful intervention is possible in most of the cases. Hypertensive paroxysms can usually be managed acutely with an anxiolytic agent, such as alprazolam, an antihypertensive agent that targets the sympathetic nervous system, such as clonidine, or a combination of the two. Severe paroxysms may require an intravenous agent, such as labetalol or nitroprusside. In patients with severe and/or frequent paroxysms, recurrence of paroxysms can be prevented in most of the cases with an antidepressant drug. The importance of reassurance cannot be overstated. The possible role of psychotherapeutic intervention requires further study. Fortunately, with appropriately selected intervention, paroxysms can be effectively treated or eliminated in most patients.

Keywords: Catecholamines, Hypertension, Labile hypertension, Paroxysmal hypertension, Pheochromocytoma, Pseudopheochromocytoma.

How to cite this article: Mann SJ. Severe Paroxysmal Hypertension: Pseudopheochromocytoma. Hypertens J 2016;2(2):96-102.

Source of support: Nil

Conflict of interest: None


 
PATHOPHYSIOLOGY
Amier Ahmad, Navin C Nanda

Echocardiographic Evaluation of Left Ventricular Systolic and Diastolic Function in Hypertension

[Year:2016] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:80] [Pages No:113-117][No of Hits : 972]


ABSTRACT

Hypertension is a significant health problem, i.e., associated with considerable morbidity and mortality. The hallmark of hypertensive disease is a gradual increase in left ventricular (LV) mass, resulting in concentric hypertrophy and eventual diastolic dysfunction of the left ventricle secondary to LV stiffness and impaired relaxation. Late stages may be characterized by severe LV systolic dysfunction and dilatation. Echocardiography offers clinicians a quick, reliable, and inexpensive method of assessing changes in LV function resulting from hypertension. In this review, we summarize various echocardiographic parameters, including their advantages and disadvantages, and clinicians should be familiar with in order to ascertain an assessment of cardiovascular risk in hypertensive patients.

Keywords: Echocardiography, Hypertension, Left ventricular diastolic function, Lef t ventricular systolic function, Three-dimensional echocardiography, Two-dimensional echocardiography.

How to cite this article: Ahmad A, Nanda NC. Echocardiographic Evaluation of Left Ventricular Systolic and Diastolic Function in Hypertension. Hypertens J 2016;2(3):113-117.

Source of support: Nil

Conflict of interest: None


 
NEWER THERAPEUTIC INSIGHT
Prabhash C Manoria, Pankaj Manoria, Nidhi Mishra

Angiotensin Receptor Neprilysin Inhibitor for the Treatment of Cardiovascular Diseases: A New Approach

[Year:2016] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:80] [Pages No:145-152][No of Hits : 941]


ABSTRACT

A new revolution has begun in the management of chronic heart failure with reduced ejection fraction (CHFrEF). The new blockbuster angiotensin receptor neprilysin inhibitor (ARNI/LCZ696) has evoked a new concept of multisystem neurohormonal modulation, and indeed, this has shown an additional decrease in cardiovascular (CV) mortality on top of all standard evidence-based drugs for the treatment of CHFrEF, i.e., angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), beta blockers, and mineralocorticoid receptor antagonists (MRAs) coupled with diuretics. LCZ696 has two drugs, ARB valsartan and neprilysin inhibitor sacubitril, fused in a molecular complex. The combination provides a dual strategy of combating neurohormonal activation in heart failure (HF), i.e., by blocking harmful effect of renin-angiotensinaldosterone system by valsartan and simultaneously increasing the activation of vasoactive peptides by inhibiting neprilysin. It was evaluated in the PARADIGM-HF (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial, which produced a statistically significant dramatic reduction of 20% in the primary end point of a composite of death from CV cause and hospitalization for HF. The combination is well tolerated, and side effects are minimal. LCZ696 has been approved for clinical use and has been endorsed by the European Society of Cardiology and American College of Cardiology/American Heart Association/ Heart Failure Society of America 2016 guidelines. What is very exciting is that it has emerged as a replacement therapy for class I A drug (ACE/ARB) rather than as a mere add-on therapy, which is the usual story with any new drug. The drug is likely to be available in India in the near future.

Keywords: Angiotensin receptor neprilysin inhibitor review, Heart failure with reduced ejection fraction, PARADIGM-HF.

How to cite this article: Manoria PC, Manoria P, Mishra N. Angiotensin Receptor Neprilysin Inhibitor for the Treatment of Cardiovascular Diseases: A New Approach. Hypertens J 2016;2(3):145-152.

Source of support: Nil

Conflict of interest: None


 
THERAPEUTIC UPDATE
Soumitra Kumar

Therapeutic Role of Beta-blockers in Hypertension: A Pragmatic Reappraisal

[Year:2016] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:53] [Pages No:80-85][No of Hits : 716]


ABSTRACT

Beta-blockers have been used as first-time antihypertensives for decades and such use has also been recommended by guidelines. However, subsequently some meta-analyses questioned this status of beta-blockers by bringing to light their limitation in terms of stroke prevention and their metabolic sideeffects. Following this, several major international hypertension guidelines have removed beta-blockers from the first line of recommended drugs. Some other guidelines, however, have retained them as first-line antihypertensive. Age is an important determinant of choice of antihypertensives and beta-blockers have proven to be very useful in young hypertensives especially if overweight. Amidst these controversies, vasodilatory beta-blockers have emerged with a new promise. They are potent antihypertensives with better reduction of central aortic pressure and a neutral or favorable metabolic profile.

Keywords: Age, Metabolic effects, Stroke, Vasodilatory.

How to cite this article: Kumar S. Therapeutic Role of Betablockers in Hypertension: A Pragmatic Reappraisal. Hypertens J 2016;2(2):80-85.

Source of support: Nil

Conflict of interest: None


 
NEWER THERAPEUTIC INSIGHT
Gary E Sander, Camilo Fernandez, Philip J Kadowitz, Thomas D Giles

Sodium-Glucose Co-transporter 2 Inhibitor: A Perspective on Cardiovascular Risk Reduction in Type 2 Diabetes Mellitus

[Year:2016] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:80] [Pages No:139-144][No of Hits : 710]


ABSTRACT

Aim: To provide a perspective on the effect of Sodium-glucose co-transporter 2 (SGLT2) inhibitors on cardiovascular (CV) risk reduction in type 2 diabetes mellitus (DM) patients.

Background: Sodium-glucose co-transporter 2 inhibitors have been introduced as hypoglycemic agents for the treatment of type 2 diabetes by the unique mechanism of inhibiting the SGLT2 protein-mediated uptake of glucose by the kidney, producing an osmotic diuresis and some degree of natriuresis. The Food and Drug Administration (FDA) has thus far approved three drugs of this class for the treatment of type 2 diabetes - empagliflozin, canagliflozin, and dapagliflozin.

Review results: During the clinical trials performed to establish efficacy in diabetes control, these drugs were found to exert a range of beneficial effects beyond glucose lowering. The most interesting of these has been a reduction in systolic blood pressure (SBP) by an average of 3 to 5 mm Hg and diastolic blood pressure (DBP) of 2 to 3 mm Hg. A larger and even more unexpected discovery was that empagliflozin reduced the primary outcome of death from CV causes and nonfatal myocardial infarctions and strokes from 12.1% in the placebo group to 10.5% in an empagliflozin group in a clinical trial enrolling high CV risk patients. Overall, there was a 30 to 40% reduction in heart failure hospitalizations (HFHs) and all-cause deaths, with the event reduction appearing within the first 6 months and persisting to the trial conclusion.

Conclusion: The mechanisms for the aforementioned impressive beneficial events remain unclear, but may involve improvements in such parameters as blood pressure, vascular volume, myocardial glucose availability, reduced arterial vascular stiffness, and improvements in autonomic nervous system function. At this time, all approved SGLT2 inhibitors appear similar in pharmacological actions. Clinical trials are now in progress - or under development - that will further explore the CV actions and outcomes of these drugs.

Clinical significance: This review may aid to unify the existing knowledge on SGLT2 inhibitors and CV risk reduction, and set the path for further research endeavors to clarify mechanisms of action associated with additional CV benefits.

Keywords: Blood pressure, Cardiovascular outcomes, Cardiovascular risk, Hypertension, SGLT2 inhibitors, Type 2 diabetes mellitus.

How to cite this article: Sander GE, Fernandez C, Kadowitz PJ, Giles TD. Sodium-Glucose Co-transporter 2 Inhibitor: A Perspective on Cardiovascular Risk Reduction in Type 2 Diabetes Mellitus. Hypertens J 2016;2(3):139-144.

Source of support: Nil

Conflict of interest: None


 
MECHANISM
Meenakshi Chenniappan

Blood Pressure Variability: Assessment, Prognostic Significance, and Management

[Year:2016] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:80] [Pages No:124-130][No of Hits : 651]


ABSTRACT

Over the years, physicians and researches alike have tried to understand the parameter in blood pressure which would offer as an ideal risk marker to predict cardiovascular events. Our focus has shifted from diastolic pressure to systolic pressure to pulse pressure, etc. In spite of optimal control of all the above target pressures, hypertensive subjects still end up with stroke and high blood pressure has been noted as a defining factor in them. This has led to physicians identifying a phenomenon called blood pressure variability. Individuals exhibiting similar clinic or home blood pressure can differ considerably with respect to their average day and night time values, beat-bybeat blood pressure variation during wakefulness and sleep, responses to mental and physical stimuli, and intersession and seasonal variation. There is now evidence that several such representations of blood pressure variability, if augmented, increase cardiovascular risk independent of the average of conventionally acquired blood pressure readings.

Keywords: Antihypertensive drugs, β-blockers, Placebo.

How to cite this article: Chenniappan M. Blood Pressure Variability: Assessment, Prognostic Significance, and Management. Hypertens J 2016;2(3):124-130.

Source of support: Nil

Conflict of interest: None


 
HYPERTENSION AND DIABETES
Karthik Rao N, KM Prasanna Kumar

Sodium Glucose Cotransporter-2 Inhibitors in Clinical Practice: Impact beyond Glycemic Control

[Year:2016] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:53] [Pages No:74-79][No of Hits : 588]


ABSTRACT

Type 2 diabetes mellitus is a metabolic disorder that occurs due to an interplay of multiple perplexing pathophysiological mechanisms and leads to hyperglycemia. However, till date there has been no single unique molecule that can by itself effectively address all the metabolic abnormalities occurring in type 2 diabetes. Furthermore, type 2 diabetes must be managed with agents that can combat hyperglycemia without causing hypoglycemia and adverse cardiovascular outcomes. Thus, the need of the hour is for a unique molecule that can deliver beyond glycemic control and can in addition address the cardiovascular risk factors that arise in type 2 diabetes. Sodium glucose cotransporter-2 (SGLT-2) inhibitors are the latest of the oral hypoglycemic agents that act by insulin-independent mechanisms and tackle several cardiovascular risk factors that occur in type 2 diabetes. The scope of this article will be to focus primarily on the cardiovascular benefits of SGLT-2 inhibitors and its actions beyond glycemic control in providing a comprehensive care in the management of type 2 diabetes.

Keywords: Cardiovascular safety, Extra antihyperglycemic actions, Review, Sodium glucose cotransporter-2 inhibitors, Type 2 diabetes.

How to cite this article: Rao NK, Kumar KMP. Sodium Glucose Cotransporter-2 Inhibitors in Clinical Practice: Impact beyond Glycemic Control. Hypertens J 2016;2(2):74-79.

Source of support: Nil

Conflict of interest: None


 
THERAPEUTIC IMPLICATION
Anil Pareek, Mahesh Abhyankar, Suraj Ghag

Renaissance of Chlorthalidone

[Year:2016] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:45] [Pages No:200-208][No of Hits : 587]


ABSTRACT

Hypertension is the major cardiovascular (CV) risk factor and remains inadequately treated in most populations. Thiazides have been the mainstay of hypertension treatment, either as monotherapy or in combination with other antihypertensives.
The most overwhelming evidences of blood pressure (BP) reduction, CV risk reduction, stroke reduction and mortality reduction are demonstrated with chlorthalidone (CTD), established through many landmark studies including the latest SPRINT trial. Chlorthalidone has a longer elimination half life and is two-times more potent than hydrochlorothiazide (HCTZ). The 24 hours BP control, specially late-night to early-morning control is better with CTD compared to HCTZ.
The American Diabetes Association recommends various drugs including a thiazide diuretic to achieve BP targets. Despite a less favorable metabolic profile, initial therapy with thiazide-like diuretics offers similar, and in some instances possibly superior CV outcomes in older hypertensive adults with metabolic syndrome, as compared to treatment with calcium channel blockers (CCB) and angiotensin converting enzyme inhibitor (ACE-I).
Hypokalemia is the major concern associated with CTD use, probably because of use of high doses > 25 mg. Use of low-dose CTD, especially 6.25 mg, is not associated with any significant change in potassium and sodium levels. This further reduces the risk of new-onset diabetes. Published Indian evidence indicates that use of low-dose of CTD (6.25 mg) could reduce dose-related concerns about metabolic adverse effects.
Thiazide-type diuretics offer added beneficial effects in terms of reduced risk of hip and pelvic fractures in elderly. ALLHAT and SHEP study have demonstrated that development of incident diabetes with CTD did not have significant associations with CV mortality rate or total mortality rate.
In conclusion, the risk of diabetes associated with CTD should not discourage clinicians from using it long-term to reduce CV risks. CV risk reduction remains the ultimate goal of any antihypertensive therapy and the beneficial effects of CTD remain unsurpassed in this aspect.

Keywords: Hypertension, Chlorthalidone, Diuretics, Thiazides.

How to cite this article: Pareek A, Abhyankar M, Ghag S. Renaissance of Chlorthalidone. Hypertens J 2016;2(4):200-208.

Source of support: Nil

Conflict of interest: Authors are employed with IPCA laboratories Ltd. in research work of Chlorthalidone.


 
CASE REPORT
Mohsin Wali, Bhavya Tyagi

An uncommon Case of Resistant Hypertension: Stenosis of Renal Artery

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:53] [Pages No:51-53][No of Hits : 585]


ABSTRACT

Hypertension is one of the most important risk factors for mortality and morbidity globally. It is the most common chronic cardiovascular disease that results in increased hospital admissions worldwide. As hypertension has a long list of primary as well as secondary causes, hypertension induced by renal artery stenosis (RAS) is a form of secondary hypertension caused by renin overproduction and it affects approximately 2 to 5% of hypertensive patients. We report a case of RAS as a cause of resistant hypertension. It is important to make a note that resistant hypertension is the blood pressure above a goal despite adherence to at least three optimally dosed antihypertensive medications of different classes, one of which is a diuretic. Besides, there are other categories of resistant hypertension or difficult-to-treat hypertension such as primary hyperaldosteronism, thyrotoxicosis, chronic kidney disease, drug-drug interactions as well steroids, nonsteroidal anti-inflammatory drugs, erythropoietin, and herbal preparations such as liquorice. Morbid obesity is also associated with resistant hypertension.

Keywords: Chronic kidney disease, Obstructive renal arterial disease, Renal artery stenosis, Resistant hypertension.

How to cite this article: Wali M, Tyagi B. An uncommon Case of Resistant Hypertension: Stenosis of Renal Artery. Hypertens J 2016;2(1):51-53.

Source of support: Nil

Conflict of interest: None


 
PATHOPHYSIOLOGY OF HYPERTENSION
Tiny Nair

White Crystals Controversy: Sugar rather than Salt as the Etiology of Hypertension

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:53] [Pages No:7-9][No of Hits : 569]


ABSTRACT

Traditionally, salt intake is linked to hypertension, and salt restriction forms the foundation for “lifestyle” management of hypertension. Despite an increase in incidence of hypertension in the population, data did not show any increase in salt intake over longer time frame. Increased intake of processed food amounts to increase in sugars especially fructose. Rampant and excessive commercial use of high fructose corn syrup in ready-to-eat “fast” food results in hypertension by various mechanisms. This interesting shift of concept of white crystals from salt to sugar is reviewed in this commentary.

Keywords: High fructose corn syrup, Hypertension, Salt, Sugar.

How to cite this article: Nair T. White Crystals Controversy: Sugar rather than Salt as the Etiology of Hypertension. Hypertens J 2016;2(1):7-9.

Source of support: Nil

Conflict of interest: None


 
MECHANISM
Mie Saiki, Vesna D Garovic

Hypertension and Pregnancy: Mechanisms and Management

[Year:2016] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:80] [Pages No:131-138][No of Hits : 504]


ABSTRACT

Hypertensive pregnancy disorders encompass a spectrum of conditions, including preeclampsia, a multisystem hypertensive disease that is unique to pregnancy, eclampsia, and gestational and chronic hypertension. Severe forms of preeclampsia, including its convulsive form - eclampsia - represent obstetrical emergencies, the therapy of which is immediate delivery. The goal of antihypertensive therapy in these patients is to prevent maternal cardiac, cerebrovascular, and renal complications. Central to the medical management of hypertension in pregnancy is the careful balance between maternal benefits from improved blood pressure control and fetal risks from intrauterine drug exposure and changes in uteroplacental perfusion. Women with chronic hypertension and hypertension onset before pregnancy should undergo prepregnancy counseling regarding medication safety during pregnancy and evaluation for end-organ damage, which will help define their blood pressure goals during pregnancy. Women with gestational hypertension (hypertension onset in the second half of pregnancy) require close monitoring for signs of progression to preeclampsia. Adequate care of these patients relies on regular follow-ups, judicious use of antihypertensive medications, and close monitoring for early signs of preeclampsia. While these patients are typically cared for by high-risk obstetricians, input from internists and related subspecialties increasingly is being recognized as important for optimization of patient blood pressure treatment and overall pregnancy outcomes.

Keywords: Blood pressure management, Hypertensive pregnancy disorders, Preeclampsia.

How to cite this article: Saiki M, Garovic VD. Hypertension and Pregnancy: Mechanisms and Management. Hypertens J 2016;2(3):131-138. Source of support: Nil Conflict of interest: None


 
Hemodynamics of hypertension
Sandeep Bansal, Anwar H Ansari

Clinical Significance of Blood Pressure Levels during Treadmill Exercise Testing

[Year:2015] [Month:October-December] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:83-87][No of Hits : 1876]


ABSTRACT

Treadmill exercise testing is the most common noninvasive test to assess patients with suspected or known cardiovascular disease. Measurement of blood pressure (BP) during exercise stress is cumbersome due to patient motion and hemodynamic changes during exercise. Different population studies give differing levels for abnormal BP response to exercise and there is no unanimity about the level of BP at which exercise test is contraindicated or terminated. However, studies uniformly associate abnormal BP responses to exercise not only with risk of future hypertension but also with cardiovascular events, stroke and mortality. The present article provides a brief account of common precautions in BP measurement, the diagnostic and prognostic significance of different BP responses during exercise stress testing.

Keywords: Exercise stress test, Hypertensive response, Hypotensive response, Recovery phase.

How to cite this article: Bansal S, Ansari AH. Clinical Significance of Blood Pressure Levels during Treadmill Exercise Testing. Hypertens J 2015;1(2):83-87.

Source of support: Nil

Conflict of interest: None


 
Hemodynamics of hypertension
Ravi R Kasliwal, Kushagra Mahansaria, Manish Bansal

Central Aortic Blood Pressure and Pulse Wave Velocity as Additional Markers in Patients with Hypertension

[Year:2015] [Month:October-December] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:73-82][No of Hits : 1812]


ABSTRACT

Arterial stiffness is a pathological manifestation of cumulative vascular damage resulting from various known and unknown vascular risk factors. Central aortic pressure and pulse wave velocity are the two most commonly used and the most informative non-invasive measures of arterial stiffness. Numerous studies have documented incremental value of these measures in a variety of clinical conditions, most notably, hypertension. In hypertensive subjects, assessment of arterial stiffness not only provides incremental information about vascular risk, it also helps in guiding therapeutic decision making and serves as a tool for monitoring response to antihypertensive therapy.

Keywords: Arterial stiffness, Arteriosclerosis, Subclinical atherosclerosis, Vascular damage.

How to cite this article: Kasliwal RR, Mahansaria K, Bansal M. Central Aortic Blood Pressure and Pulse Wave Velocity as Additional Markers in Patients with Hypertension. Hypertens J 2015;1(2):73-82.

Source of support: Nil

Conflict of interest: None


 
Lifestyle changes
Subhash Chandra Manchanda, Kushal Madan

Yoga and Hypertension

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:28-33][No of Hits : 1614]


ABSTRACT

Hypertension is a major public health problem and is an important risk factor for stroke, coronary heart disease and renal failure. The blood pressure is not well controlled with drug therapy in large number of individuals, especially in the developing countries. There is a need for less expensive nonpharmacological alternative methods to control blood pressure. Yoga may be such cost-effective alternative. Several uncontrolled and randomized control trials have evaluated short- and long-term effects of yoga/meditation-based techniques in prehypertension and mild hypertension. Though, the results are mixed and there are several methodological limitations in reported studies, majority of studies demonstrate a modest decrease in both systolic and diastolic blood pressure. This modest decrease may significantly decrease the stroke mortality and coronary heart disease in general population. A recent scientific statement of American Heart Association also suggests that it is reasonable for all individuals with blood pressure levels more than 120/80 mm Hg to consider alternative approaches like transcendental medication as adjunct method to lower blood pressure.

Keywords: Meditation, Prehypertension, Psychosocial stress, Yoga.

How to cite this article: Manchanda SC, Madan K. Yoga and Hypertension. Hypertens J 2015;1(1):28-33.

Source of support: Nil

Conflict of interest: None


 
Therapeutics update
Sanjeev Sharma

Hypertension Therapeutics Update: A Brief Clinical Summary on Azilsartan, Cilnidipine and Nebivolol

[Year:2015] [Month:October-December] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:111-117][No of Hits : 1389]


ABSTRACT

Uncontrolled hypertension is the major risk factor for cardiovascular disease. The economic burden of disease is enormous in developed as well as in developing countries. The epidemiological studies have explained many etiological factors associated with chronic untreated hypertension, which varies according to geography and ethnicity.
In last five decades, many classes and types of antihypertensive drugs have been developed. This pharmacological review provides an update on new molecules belonging to three pharmacological classes of antihypertensives-angiotensin receptor blocker (azilsartan), calcium channel blocker (cilnidipine) and beta blocker (nebivolol) and their clinical implications.

Keywords: Azilsartan, Calcium channel L/N-type, Cilnidipine, Hypertension, Nebivolol, Newer drugs for hypertension, Vasodilation with Nebivolol.

How to cite this article: Sharma S. Hypertension Therapeutics Update: A Brief Clinical Summary on Azilsartan, Cilnidipine and Nebivolol. Hypertens J 2015;1(2):111-117.

Source of support: Nil

Conflict of interest: None


 
Status Report
Rajeev Gupta

Hypertension as a Public Health Problem in India

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:1-3][No of Hits : 1149]


ABSTRACT

Hypertension is the most important risk factor for global morbidity and mortality. It has assumed epidemic proportions in India with an estimated 100 million patients. In recent decades, the disease is increasing more rapidly in rural than in urban population. Status of hypertension treatment and control is dismal in India with about a third of patients on treatment and only 20% controlled. Innovative system-based strategies using a combination of public health approaches and physician led clinic-based management are required to prevent premature cardiovascular disease burden due to hypertension.

Keywords: Cardiovascular disease, Hypertension epidemiology, Public health approach, Risk factors.

How to cite this article: Gupta R. Hypertension as a Public Health Problem in India. Hypertens J 2015;1(1):1-3.

Source of support: Nil

Conflict of interest: None


 
Review Article
Niteen V Deshpande

Risk Assessment in Young Hypertensives

[Year:2015] [Month:October-December] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:94-99][No of Hits : 863]


ABSTRACT

Hypertension (HT) in young (< 40 years) is a significant problem in India. Preventing cardiovascular disease in these young hypertensives is a major challenge as management strategies for young hypertensives are not very clear. Risk assessment in young hypertensives is also limited as most of the risk assessment algorithms apply to population above 40 years. Unfortunately, we do not have a specific algorithm for Indian patients. The algorithm given by Joint British Societies (JBS-3) appears to be most suited for risk assessment in young Indian Hypertensive individuals. Additionally, multiple newer markers may be needed to understand the cardiovascular risk completely in the young hypertensive population.

Keywords: Cardiovascular risk assessment, Risk markers, Young hypertensives.

How to cite this article: Deshpande NV. Risk Assessment in Young Hypertensives. Hypertens J 2015;1(2):94-99.

Source of support: Nil

Conflict of interest: None


 
Novel Therapy
Nicholas Paivanas, John Bisognano, John Gassler

Carotid Baroreceptor Stimulation for Resistant Hypertension

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:40-44][No of Hits : 834]


ABSTRACT

Pharmacologic therapy for hypertension is effective for the majority of patients with hypertension, but there remains a subset of the population with treatment resistant hypertension who cannot achieve their blood pressure (BP) goal despite multiple medications. For these patients at increased risk of cardiovascular disease and end-organ damage, additional therapies need to be considered. This review will cover a non-pharmacologic approach to hypertension through stimulation of the Baroreflex (Baroreflex activation therapy). While Baroreflex therapy remains investigational at this time, for patients with treatment resistant hypertension, this therapy may offer a novel option to achieve BP goals and hopefully reduce the risk of heart attack and stroke.

Keywords: Baroreflex activation therapy, Carotid baroreceptor, Treatment resistant hypertension.

How to cite this article: Paivanas N, Bisognano J, Gassler J. Carotid Baroreceptor Stimulation for Resistant Hypertension. Hypertens J 2015;1(1):40-44.

Source of support: Nil

Conflict of interest: None


 
Hypertension Guidelines
Michael A Weber

Similarities and Differences among Recent Hypertension Guidelines

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:4-12][No of Hits : 633]


ABSTRACT

Hypertension treatment guidelines are intended to provide recommendations to practitioners on key issues such as diagnostic criteria and blood pressure treatment targets, the optimal use of lifestyle changes as well as drug therapy, and the management of co-existing cardiovascular risk factors. Unfortunately, despite several major clinical outcomes trials in hypertension, there is still insufficient evidence to allow firm recommendations in important areas. A major uncertainty with potentially large implications for stroke and cardiovascular event rates is the systolic blood pressure target in people aged 60 years or more: should it be 150 mm Hg or 140 mm Hg? This commentary addresses this and other controversial issues and differences of opinion across the several authoritative guidelines published in the last few years.

Keywords: Antihypertensive therapy, Diagnosis of hypertension, Hypertension treatment guidelines.

Abbreviations: ACC: American College of Cardiology; ACCOMPLISH: Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension; AHA: American Heart Association; ASH: American Society of Hypertension; CDC: Centers for Disease Control; ESC: European Society of Cardiology; ESH: European Society of Hypertension; HYVET: Hypertension in the Very Elderly Trial; INVEST: International Verapamil SR Trandolapril Study; ISH: International Society of Hypertension; JNC: Joint National Committee; NHLBI: National Heart, Lung and Blood Institute; NICE: National Institute for Clinical Excellence; NIH: National Institutes of Health; SHEP: Systolic Hypertension in the Elderly Program; Syst-Eur: Systolic Hypertension in Europe Trial; VALUE: Valsartan Antihypertensive Long-term Use Evaluation.

How to cite this article: Weber MA. Similarities and Differences among Recent Hypertension Guidelines. Hypertens J 2015;1(1):4-12.

Source of support: Nil

Conflict of interest: None


 
Review Article
Brent M Egan

Treatment Resistant Hypertension: A Pragmatic Management Approach

[Year:2015] [Month:October-December] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:106-110][No of Hits : 620]


ABSTRACT

Treatment resistant hypertension (TRH) is defined by office blood pressure (BP) uncontrolled on ≥ 3 or controlled on ≥ 4 antihypertensive medications, preferably at optimal doses and including a diuretic. Among treated hypertensives, ~30% of uncontrolled and 10% of controlled individuals have apparent treatment resistant hypertension (aTRH). Apparent treatment resistant hypertension is used when optimal therapy, patient adherence, and BP measurement artifacts are unknown. In . 50% of aTRH patients, BP measurement artifacts (‘office’ TRH), suboptimal regimens, or suboptimal adherence are present, i.e. pseudoresistance. Patients with ‘office’ TRH have fewer cardiovascular events (CVE) than those with persistent hypertension. Patients with suboptimal regimens or adherence and persistent hypertension appear to have excess CVE. ‘Office’ TRH is minimized by averaging several BP values obtained with an accurate, automated monitor, while the patient is alone in the examination room’. Home or ambulatory BP monitoring directly confirm ‘office’ TRH or persistent hypertension. Optimal therapy is reasonably defined by ≥3 different antihypertensive medication classes, e.g. thiazide-type diuretic, renin-angiotensin blocker and calcium antagonist at ≥50% of maximum recommended doses. Intensifying diuretic therapy is effective for controlling many TRH patients who are volume expanded. Personalized strategies, e.g. renin or hemodynamics, can inform successful therapy. Patient blood pressure self-monitoring and attention to adverse effects, medication costs, and pill burden can improve adherence. Suspected secondary hypertension should be evaluated and interfering substances or medications discontinued. These approaches will identify or correct the problem in ~80% of aTRH patients. Referral to a hypertension specialist is recommended for TRH patients not successfully managed with the pragmatic approach outlined.

Keywords: Cardiovascular disease, Nonadherence, Office resistance, Pseudoresistant hypertension, Spironolactone, Treatment resistant hypertension.

How to cite this article: Egan BM. Treatment Resistant Hypertension: A Pragmatic Management Approach. Hypertens J 2015;1(1):106-110.

Source of support: Nil

Conflict of interest: None


 
Continuing medical education (CME)
Tiny Nair

Medical Statistics Made Easy for the Medical Practitioner

[Year:2015] [Month:October-December] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:63-67][No of Hits : 590]


ABSTRACT

Understanding basic medical statistics is important in today’s medical practice, not merely as an academic exercise but to translate medical information into day-to-day patient care. This review article tries to address basics of medical statistics to the end user.

Keywords: Clinical trial, Probability, Standard deviation, Statistics.

How to cite this article: Nair T. Medical Statistics Made Easy for the Medical Practitioner. Hypertens J 2015;1(2):63-67.

Source of support: Nil

Conflict of interest: None


 
Hypertension —Special Situations
K Subba Reddy

Hypertensive Emergencies and Urgencies: A Clinical Guide

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:51-56][No of Hits : 583]


ABSTRACT

Hypertension being a common medical condition is resulting in increased hospital admissions worldwide and, moreover, hypertensive emergencies and urgencies have led to an increment in critical care patients. It is, therefore, evident that urgent diagnosis and immediate and appropriate treatment of these conditions is paramount in reducing mortality and morbidity.
Manifestations of the hypertensive emergencies and urgencies may vary depending on the target organ that is affected. Fortunately, more effective and relatively safe drugs are available, nowadays, to lower blood pressure (BP) quickly in these lifethreatening situations. Critical care physicians should be familiar with all pharmacological and clinical actions of the medications available in treating these hypertensive emergencies, along with the appropriateness of the choice of medication in any given situation.
The purpose of review is to understand the therapeutic interventions in treating a hypertensive crisis.

Keywords: Acute aortic dissection, Hypertensive encephalopathy, Left ventricular failure, Pharmacological therapy.

How to cite this article: Reddy KS. Hypertensive Emergencies and Urgencies: A Clinical Guide. Hypertens J 2015;1(1):51-56.

Source of support: Nil

Conflict of interest: None


 
Blood Pressure Measurement
Balaji Pakshirajan, Mullasari Sankaradas Ajit

Ambulatory Blood Pressure Measurements in the Management of Hypertension: Practical Importance

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:13-21][No of Hits : 518]


ABSTRACT

Ambulatory blood pressure measurement (ABPM) gives better prediction of cardiovascular morbidity and mortality, and endorgan damage associated with hypertension (HTN) than clinic or casual blood pressure measurements, since the diurnal blood pressure profile and nocturnal blood pressure levels are not ascertained by the later.1 Although the technology has been available for more than three decades, its role in the evaluation and management of hypertension has been well established only in the past decade. Ambulatory blood pressure measurement is indicated to identify ‘white coat’ effect/hypertension, masked hypertension, to evaluate drug-resistant hypertension, and to assess adequacy of control in patients at high-risk of cardiovascular disease. The various blood pressure categorizations afforded by ambulatory blood pressure monitoring are valuable for clinical management of high blood pressure and prevention of cardiovascular events. This review summarizes the utility of ambulatory blood pressure monitoring in the management of hypertension and its practical importance.

Keywords: Ambulatory, Blood pressure monitoring, Hypertension.

How to cite this article: Pakshirajan B, Ajit MS. Ambulatory Blood Pressure Measurements in the Management of Hypertension: Practical Importance. Hypertens J 2015;1(1): 13-21.

Source of support: Nil

Conflict of interest: None


 
Nutrition
PK Sasidharan

Vitamin D and Hypertension: An Overview of Current Scenario

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:34-39][No of Hits : 506]


ABSTRACT

India has become the capital of all communicable diseases and noncommunicable diseases like hypertension and diabetes. Vitamin D deficiency is also very high in the Indian subcontinent (as high as 80–90%). Therefore, it is possible that these issues are interrelated, or we should look for possible relations. The landmark study by us suggested the cause of vitamin D deficiency as poor dietary intake or in other words due to malnutrition. Vitamin D deficiency is multifactorial in etiology; the etiological factors vary from place to place and person to person. The three primary reasons for the deficiency are: lack of balanced diet, reduced sunlight exposure and increased melanin in the skin. Even if, by chance, someone gets adequate vitamin D from diet and sunlight, its activation in the liver and kidneys is defective due to increasing prevalence of liver and kidney diseases. Liver diseases are on the increase due to overeating with consequent obesity and nonalcoholic liver disease, or due to alcohol intake and exposure to hepatotoxic agents or infections. Subclinical liver disease is now widely prevalent in the people with consequent poor activation of vitamin D. Increasing renal diseases due to several reasons and the lack of vegetables and fruits consumption with consequent hypomagnesemia contribute to poor 1-hydroxylation in the kidneys. Lack of intake of balanced diet, lack of outdoor exercises and eating more food are all lifestyle issues, and the same are the causes for diseases, like hypertension, diabetes, ischemic heart disease (IHD), strokes and cancers and, therefore, the link between vitamin D deficiency and these diseases become very obvious. It is only natural that we see vitamin D deficiency in all the diseases, or supplementation of vitamin D benefits all the patients. To tackle the problem of vitamin D deficiency in India, we need to address all the healthcare issues simultaneously and empower the people for regular intake of balanced diet, doing regular exercise and exposure to sunlight through systematic and meticulous social, educational, agricultural and financial reforms. Therefore, all disease control programs in India should focus on empowering the people, by the necessary social reforms and its implementation. As an interim measure, fortification of foodstuffs like oil or wheat-flour also may be tried till such time that all sections of the society are empowered for taking balanced diet regularly.

Keywords: Balanced diet, Consumerism, Hypertension, Lifestyle, Vitamin D.

How to cite this article: Sasidharan PK. Vitamin D and Hypertension: An Overview of Current Scenario. Hypertens J 2015;1(1):34-39.

Source of support: Nil

Conflict of interest: None


 
Renal Denervation
Sebastian Ewen, Lucas Lauder, Michael Böhm, Felix Mahfoud

Catheter-based Renal Denervation for Therapy of Hypertension: Is There a Hope for Its Resurgence?

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:45-50][No of Hits : 504]


ABSTRACT

Hypertension (HTN) is the most common chronic cardiovascular disease with increasing prevalence all over the world. Despite the availability of many effective antihypertensive drugs, blood pressure control to target values remains low. Resistant hypertension is defined as ‘blood pressure above goal in adherent patients despite a triple antihypertensive therapy in maximum or maximum tolerated doses, including a diuretic, which is found in approximately 8 to 18% of all hypertensives’. Treatment requires a multimodal therapy concept, including-polypharmacy, lifestyle modification and a systematic identification of secondary causes of HTN or pseudoresistance. Increased activity of the sympathetic nervous system has been identified as main contributor to the development and maintenance of resistant HTN. Catheterbased renal denervation has been introduced as a minimal invasive option for patients with resistant HTN. However, the clinical evidence in support of renal denervation as an effective interventional technique is conflicting. A number of observational studies and four randomized, controlled trials (Symplicity HTN-2, Prague 15, RSD-LEIPZIG and DENERHTN) support both safety and efficacy of this new therapy, but some smaller studies and the large, single-blind, randomized, sham-controlled Symplicity HTN-3 trial failed to show superiority of renal denervation when compared to medical therapy alone. The present review aims at providing an overview about catheter-based renal denervation for treatment of HTN.

Keywords: Hypertension, Renal denervation, Symplicity, Therapy resistance.

How to cite this article: Ewen S, Lauder L, Böhm M, Mahfoud F. Catheter-based Renal Denervation for Therapy of Hypertension: Is There a Hope for Its Resurgence? Hypertens J 2015;1(1):45-50.

Source of support: Nil

Conflict of interest: None


 
BLOOD PRESSURE MECHANISM
Narsingh Verma

Sympathetic Nervous System and Hypertension

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:47] [Pages No:27-36][No of Hits : 415]


ABSTRACT

Aim: The review emphasizes on the sympathetic and parasympathetic abnormalities in essential hypertension, the possible mechanisms underlying these abnormalities, and their importance in the development and progression of the structural and functional cardiovascular (CV) damage that characterizes hypertension.

Background: Apart from being a hemodynamic phenomenon, primary hypertension is a vicious syndrome involving abnormal adiposity, overactivation of the adrenergic system, metabolic abnormalities, and activation of the immune system. Physiological studies have established the key role played by the autonomic nervous system in modulating CV functions and in controlling arterial pressure values. Many factors contribute to increased sympathetic nerve activity in metabolic abnormalities including obesity, impaired baroreflex sensitivity, hyperinsulinemia, and elevated adipokine levels.

Review results: Experimental and clinical investigations clearly indicate that the origin, progression, and outcome of hypertension are related to dysfunction of the autonomic CV system, especially to abnormal activation of the adrenergic division. The activation of the sympathetic nervous system is essential in energy homeostasis and can exert intense metabolic effects. Accumulating data from a number of studies suggest that central sympathetic overactivity plays a crucial role in the causative factors and complications of several metabolic conditions that can cluster to form the metabolic syndrome.

Conclusion: This review provides an evidence of attenuation of autonomic CV control in essential hypertension and that sympathetic overdrive is a major component of this autonomic dysregulation. Arterial pressure control requires complex integration of regulatory mechanisms across multiple physiological systems. A continuous increase in blood pressure therefore, reflects a failure of one or more of these controls.

Clinical significance: The findings discussed herein provide a rationale for pursuing sympathetic deactivation by nonpharmacological as well as pharmacological interventions aimed at lowering elevated blood pressure values and protecting patients from hypertension-related complications.

Keywords: Hypertension, Neural regulation, Sympathetic nervous system.

How to cite this article: Verma N. Sympathetic Nervous System and Hypertension. Hypertens J 2017;3(1):27-36.

Source of support: Nil

Conflict of interest: None


 
HYPERTENSION AND HORMONAL STATUS
Anuj Maheshwari, Bharti Maheshwari

Hypertension and Menopause

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:47] [Pages No:23-26][No of Hits : 411]


ABSTRACT

Hypertension is more common in postmenopausal females than males. As they move in postmenopausal state, a normal protection from cardiovascular (CV) disease is withdrawn and control of hypertension also becomes tougher despite being more sincere in blood pressure (BP) monitoring and treatment. They are more affected with nondipping in night, which reflects more target organ damage. Renin-angiotensin system activation may lead to postmenopausal hypertension though it is not the sole cause. Obesity is another causal factor as a component of metabolic syndrome, which also impacts outcome of antihypertensive therapy in postmenopausal females. Sympathetic activation increases BP, which is aggravated further by weight gain, increased leptin level, and age. Role of estrogen is not clear in normal protection of young females from CV risks or its low level in postmenopausal women with hypertension. Young girls with polycystic ovary syndrome have elevated serum androgens which are low after menopause but increases up to premenopausal level till 70 years of age and correlates with body mass index only in postmenopausal age. Increased serum testosterone correlates with risk of type 2 diabetes mellitus in postmenopausal females. Sympathetic activation with anxiety and depression may lead to hypertension which is established with metabolic syndrome also. Angiotensin-converting-enzyme inhibitors are used for BP for reducing anxiety and depression. Therefore, it needs different treatment approach for postmenopausal hypertension.

Keywords: Androgen, Anxiety, Depression, Diabetes, Estrogen, Hypertension, Menopause, Metabolic, Obesity, Renin-Angiotensin system.

How to cite this article: Maheshwari A, Maheshwari B. Hypertension and Menopause. Hypertens J 2017;3(1):23-26.

Source of support: Nil

Conflict of interest: None


 
BLOOD PRESSURE MECHANISM
R Chandni, Uday M Jadhav

Salt Intake and Blood Pressure Levels: Is the Concept Valid?

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:47] [Pages No:7-11][No of Hits : 374]


ABSTRACT

Globally, sodium intake has increased over the years, and it is seen in all ages, both genders, and in various ethnic groups including Indians. High dietary salt is a major contributor to the increasing incidence of hypertension, with an estimated 30% of hypertension attributed to high salt intake. Salt intake in the developed countries largely comes from prepackaged and processed foods, shelf-stable food, and bakery items. In the Asian communities, the contributing source is in the form of added table salt and in cooking. Sodium balance is maintained by increasing the arterial blood pressure, resulting in a pressure natriuresis and increased urinary sodium excretion in the presence of high sodium chloride intake. Low sodium intake to less than 3 gm/day leads to activation of renin-angiotensin-aldosterone system.
Recently, there have been reports about the deleterious effects of low blood sodium, and there is recognition of the concept of a J-shaped curve. Weak research methodologies with the use of methods like single spot urine samples and single 24-hour urine sodium excretion to estimate usual salt intake have been likely to influence the J curve in the studies so far. In this context, two trials were undertaken in Trials of Hypertension Prevention (TOHP), which implemented sodium reduction. There was no evidence of a J-shaped or nonlinear relationship, and direct relationship with total mortality was demonstrated even at the lowest levels of sodium intake and consistent with a benefit of reduced sodium and sodium/ potassium intake on total mortality over a 20-year period.
This review summarizes an overview of current understanding of the concept of salt in hypertension. Dietary sodium is the most accepted and time-tested intervention in prevention and treatment of hypertension, which needs to be implemented but with an unresolved issue of more aggressive salt intake reduction on cardiovascular events.

Keywords: Blood pressure, Hypertension, Salt, Sodium chloride.

How to cite this article: Chandni R, Jadhav UM. Salt Intake and Blood Pressure Levels: Is the Concept Valid? Hypertens J 2017;3(1):7-11.

Source of support: Nil

Conflict of interest: Nil


 
SECONDARY HYPERTENSION
Sreenivas K Arramraju

Secondary Causes of Hypertension: Illustrative Cases

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:47] [Pages No:20-22][No of Hits : 241]


ABSTRACT

Secondary hypertension is defined as increased systemic blood pressure due to an identifiable cause. The incidence of secondary hypertension varies from 5 to 10%. The most common etiology of secondary hypertension is due to renovascular causes. In this article, we briefly discuss as to when and how to suspect this pathology and give two illustrative real-world case examples with follow-up.

Keywords: Renal artery stenosis, Renovascular hypertension, Secondary hypertension.

How to cite this article: Arramraju SK. Secondary Causes of Hypertension: Illustrative Cases. Hypertens J 2017;3(1):20-22.

Source of support: Nil

Conflict of interest: None


 
THERAPEUTIC
Mohsin Wali, C Venkata S Ram

Device-based Therapies for Resistant Hypertension: Current Status

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:47] [Pages No:44-49][No of Hits : 215]


ABSTRACT

Resistant hypertension is a serious consequence of uncontrolled hypertension. This condition can lead to significant target organ damage. Individuals with resistant hypertension are highly vulnerable to excessive morbidity and premature mortality. Hence, it is important to recognise resistant hypertension as a distinct clinical entity. Whereas aggressive medical therapy is indicated to control resistant hypertension, there is a growing interest and considerable ongoing research on the role of mechanical device based approaches to control hypertension. Although the results of device based therapy of resistant hypertension are inconsistent, this alternative approach should be pursued further by newer research protocols and novel methodology.

Keywords: Baroreceptor activation therapy, Resistant hypertension, Renal denervation therapy, Uncontrolled hypertension.

How to cite this article: Wali M, Ram CVS. Device-based Therapies for Resistant Hypertension: Current Status. Hypertens J 2017;3(1):44-49.

Source of support: Nil

Conflict of interest: None


 
ENDOTHELIAL FACTORS IN METABOLIC SYNDROME
Suegene K Lee, Jay Khambhati, Ankit Bhargava, Marc C Engels, Pratik B Sandesara, Arshed A Quyyumi

Endothelial Dysfunction and Metabolic Syndrome

[Year:2017] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:53] [Pages No:72-80][No of Hits : 204]


ABSTRACT

Atherosclerotic cardiovascular disease (ASCVD) continues to be the leading cause of death worldwide. Metabolic syndrome is associated with an increased risk of ASCVD. With the prevalence of metabolic syndrome continuing to increase, it is important to understand the relationship between these risk factors and development of ASCVD. Endothelial dysfunction (ED), an early, essential step in atherosclerotic plaque formation, is the key link. Here we review diagnostic methods of ED and the mechanisms of each metabolic syndrome component contributing to ED. Finally, the effects of current treatments of metabolic syndrome on ED will also be discussed.

Keywords: Atherosclerotic cardiovascular disease, Endothelial dysfunction, Metabolic syndrome.

How to cite this article: Lee SK, Khambhati J, Bhargava A, Engels MC, Sandesara PB, Quyyumi AA. Endothelial Dysfunction and Metabolic Syndrome. Hypertens J 2017;3(2):72-80.

Source of support: Nil

Conflict of interest: None


 
CLINICAL MANAGEMENT
Clarence E Grim

Potassium and Blood Pressure: How to Test the Effects of DASH Diet in your Patient with Hypertension

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:47] [Pages No:37-41][No of Hits : 204]


ABSTRACT

This article reviews the 90+ year history of increasing potassium intake (K) and lowering sodium (Na) intake in the treatment of hypertension (HTN). It then reviews the DASH Diet eating plan as an intervention to lower blood pressure (BP) by both increasing K intake and lowering Na intake. The term DASH Diet Sensitive (DDS) HTN is used to describe those whose BP decreases significantly when consuming the DASH Diet. A method to determine your patient’s BP is outlined that has been found effective even in the most extreme form of salt-sensitive HTN-classic primary aldosteronism. This requires a series of home BP measurements before starting and during the 14 days of the DASH eating plan and checking a spot urine for Na/K/ creatinine to monitor adherence. The beauty of this method is that if the patient follows the recommendations exactly, the maximum systolic BP effect is apparent by 1 week and the diastolic effect in 2 weeks. Thus, only 3 weeks is required to see if this is an effective intervention in your patient’s HTN. If so, the next task is to determine if DASH is an eating plan that your patient (and family) can live with.

Keywords: Adherence, Blood pressure, Compliance, DASH diet, Home blood pressure, Nocturia, Nutrition, Potassium, Sodium, Urine Na/K ratio.

How to cite this article: Grim CE. Potassium and Blood Pressure: How to Test the Effects of DASH Diet in your Patient with Hypertension. Hypertens J 2017;3(1):37-41.

Source of support: Nil

Conflict of interest: None


 
TRENDS IN HYPERTENSION TREATMENT GOALS
Brent M Egan, Jiexiang Li, C Shaun Wagner

Controlling Systolic Blood Pressure below 140 mm Hg in Most Hypertensive Patients matches Systolic Blood Pressure Intervention Trial Intensive Treatment: Practical Implications for Patient Care?.

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:47] [Pages No:12-19][No of Hits : 197]


ABSTRACT

The Systolic Blood Pressure Intervention Trial (SPRINT) investigators concluded that most hypertensive patients would benefit from treating systolic blood pressure (SBP, mm Hg) to a target below 140 benchmark, as intensive treatment (SBP, 121.5) led to 25% fewer cardiovascular endpoints than standard treatment (SBP, 134.6) in high-risk patients. This conclusion reflects at least three assumptions addressed in this report. First, SBP with SPRINT standard was similar to or lower than SBP of treated adults in usual care. Second, SBP with SPRINT intensive treatment was lower than in adults with treated hypertension controlled to <140 with usual care. Third, SPRINTs rigorous blood pressure (BP) measurement methods translate to most care settings. Systolic blood pressure in a representative sample of US adults [National Health and Nutrition Examination Survey .18 years with treated hypertension fell from 137.1 in 1999.2002 to 130.1 in 2009.2012 as control to SBP <140 rose from 60 to 72%. Over the time, SBP in treated adults controlled to <140 fell from 123.0 to 120.9 as percentages with SBP <130 rose from 66.1 to 74.7%. The SPRINT BP measurement protocol led to SBP ~3 and ~7 below daytime ambulatory SBP for standard and intensive treatment respectively, whereas usual clinic SBP is ~5 above daytime ambulatory SBP. Thus, SBP 134.6 and 121.5 with SPRINT standard and intensive treatment are comparable to usual clinic SBP of 142.6 and 133.5 respectively. Systolic blood pressure intervention trial Intensive Treatment standard and intensive treatment fall short of SBP with usual care, especially when measurement methodologies are considered. Systolic blood pressure intervention trial supports the current SBP goal <140 based on usual clinic measurement methods.

Keywords: Blood pressure, Cardiovascular disease, Hypertension.

How to cite this article: Egan BM, Li J, Wagner CS. Controlling Systolic Blood Pressure below 140 mm Hg in Most Hypertensive Patients matches Systolic Blood Pressure Intervention Trial Intensive Treatment: Practical Implications for Patient Care. Hypertens J 2017;3(1):12-19.

Source of support: This work was supported in part by contracts from the CDC through the South Carolina Department of Health and Environmental Control.

Conflict of interest: None


 
REVIEW ARTICLE
Norm RC Campbell

Recommended Standards for assessing Blood Pressure in Human Research where Blood Pressure or Hypertension is a Major Focus

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:47] [Pages No:1-6][No of Hits : 183]


ABSTRACT

National and international recommendations for assessing blood pressure advocate for specific training and accuracy assessment of observers, use of a standardized technical procedure, as well as use of accurate and appropriate equipment. However, these recommendations are often not adhered to even in research studies that relate directly to blood pressure or antihypertensive therapies. Inaccurate, nonreproducible blood pressure values can result from nonstandardized assessments, and impair the ability to define the population being studied; fail to identify people who are susceptible to hypotensive adverse events; and reduce the ability to assess the impact of interventions on blood pressure. A consortium of national and international health and scientific organizations oversaw an expert review and consensus process to develop minimum standards for assessing blood pressure in human clinical and epidemiological research patients where (1) blood pressure or hypertension is a major endpoint, or (2) blood pressure or hypertension is thought to be a major mediator of the research outcome (e.g., a study on an antihypertensive therapy or lifestyle change with a cardiovascular outcome). Minimum standards are presented for training of observers, technical aspects of assessing blood pressure, and equipment used, based on existing national and international recommendations. A limitation is that some existing recommendation processes were not systematic or did not assess the strength of evidence supporting specific recommendations. Funding agencies, journal editors, and reviewers should require adherence to these minimum standards for all new research on the patient populations described above. Researchers should modify their study designs to meet the minimum standards. Readers need to use caution in interpreting studies if the standards are not met.

Keywords: Blood pressure, Blood pressure measurement, Epidemiology, Hypertension, Research, Research standards.

How to cite this article: Campbell NRC. Recommended Standards for assessing Blood Pressure in Human Research where Blood Pressure or Hypertension is a Major Focus. Hypertens J 2017;3(1):1-6.

Source of support: Funding was provided by the Heart and Stroke Foundation (Canada), Canadian Institute for Health Research Chair in Hypertension Prevention and Control with kind support from the World Hypertension League.

Conflict of interest: Specific conflicts of interest for each member of the TRUE Consortium can be found in Appendix A. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.


 
SPECIAL SITUATIONS
Mohan V Deshpande, Niteen V Deshpande

Assessment of End Organ Damage in Hypertension—Left Ventricular Hypertrophy

[Year:2017] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:60] [Pages No:139-146][No of Hits : 179]


ABSTRACT

Left ventricular Hypertrophy (LVH) is an important consequence of systemic hypertension and is considered as target organ damage. LVH has significant impact on the prognosis and regression of LVH correlates with better outcomes in hypertensive individuals. Electrocardiography (ECG) remains the basic tool to diagnose LVH in hypertension although it has significant limitations in terms of sensitivity and specificity. Echocardiography not only provides a better estimate of LVH but also allows better quantification of left ventricular mass and volumes, while providing clues for other causes of LVH. Cardiac magnetic resonance Imaging (CMR) is considered the gold standard for estimation and characterization of LVH, but is limited due to its availability and cost. Computed Tomography of heart also offers reliable estimate of LVH at the cost of high radiation exposure and is not recommended for this purpose. Assessment of LVH should be done using ECG in every patient with hypertension while echocardiography and CMR should be reserved for specific indications

Keywords: Electrocardiography, Hypertension, Left ventricular hypertrophy.

How to cite this article: Deshpande MV, Deshpande NV. Assessment of End Organ Damage in Hypertension—Left Ventricular Hypertrophy. Hypertens J 2017;3(3):139-146.

Source of support: Nil

Conflict of interest: None


 
PHYSIOLOGY OF BLOOD PRESSURE REGULATION
Nibedita Priyadarsini, Sajal C Singh, Manish Goyal, Sushil C Mahapatra

Central Blood Pressure: Current Evidence and Clinical Importance in Hypertensive Disorders during Pregnancy

[Year:2017] [Month:October-December] [Volumn:3 ] [Number:4] [Pages:28] [Pages No:173-177][No of Hits : 174]


ABSTRACT

Hypertensive disorders complicate 5 to 10% of all pregnancies and hypertension is a major pregnancy complication associated with both fetal and maternal morbidity and mortality. Measurement of brachial blood pressure (BP) is a routine clinical assessment tool for management of various hypertensive disorders. Systolic pressure varies throughout the vasculature; aortic systolic pressure [or central blood pressure (CBP)] is actually lower than that of systolic BP in brachial artery. Central to peripheral pressure difference is highly variable among individuals. In various studies, it has been reported that CBP is a better predictor of cardiovascular events as compared with peripheral BP. Hypertensive disorders in pregnancy are associated with increased arterial stiffness indices, both during and after pregnancy leading to differences in central and peripheral pressures. In this article, the issues related to importance of CBP measurement for management of hypertensive disorders in pregnancy have been discussed.

Keywords: Central blood pressure, Eclampsia, Hypertension, Preeclampsia, Pregnancy-induced hypertension.

How to cite this article: Priyadarsini N, Singh SC, Goyal M, Mahapatra SC. Central Blood Pressure: Current Evidence and Clinical Importance in Hypertensive Disorders during Pregnancy. Hypertens J 2017;3(4):173-177.

Source of support: Nil

Conflict of interest: None


 
SECONDARY HYPERTENSION
K Jitender Reddy, K Pradyumna Reddy

Fibromuscular Dysplasia in Clinical Practice: A Case-based Review

[Year:2017] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:53] [Pages No:101-104][No of Hits : 173]


ABSTRACT

Fibromuscular dysplasia (FMD) is an idiopathic, nonatherosclerotic, noninflammatory disease with segmental involvement of the blood vessels that cause abnormal growth within the wall of an artery in any region of body. Fibromuscular dysplasia has been found in nearly every arterial bed in the body. However, the most common arteries affected are the renal and carotid arteries. It is a heterogeneous group of vascular lesions characterized by an idiopathic, noninflammatory, and nonatherosclerotic angiopathy of small and medium-sized arteries. The prevalence of FMD is estimated between 4 and 6% in the renal arteries and between 0.3 and 3% in the cervicoencephalic arteries.
Imaging and radiologists play an important role in diagnosing the abnormality with knowledge of patient complaints with respect to fibromuscular disease. The most common imaging finding is dilatations, beaded appearance of vessels, and aneurysms. The less common findings are tortuous vessels, ectasia, kinking, loops, and dissection. The radiologist should be aware of these so that FMD can be diagnosed in young females with hypertension not responding well to treatment or familial hypertension.
Its signs and symptoms help the radiologist to diagnose early. The objective of this review is therefore to increase radiologists’ and clinicians’ awareness of FMD’s epidemiology, pathophysiology, clinical presentation, classical and minor/ rare radiological findings, and possible complications in other arteries in the abdomen.

Epidemiology: The prevalence is unknown. It is most common in young women with a female to male ratio of 3:1, and is typically diagnosed between the ages of 30 and 50 years. It is less than 2% of all hypertensions.

Keywords: Computed tomography angiography, Digital subtraction angiography, Fibromuscular dysplasia, Hypertension, Magnetic resonance angiography, Percutaneous transluminal angioplasty, Renal arteries, Renal artery stenosis.

How to cite this article: Reddy KJ, Reddy KP. Fibromuscular Dysplasia in Clinical Practice: A Case-based Review. Hypertens J 2017;3(2):101-104.

Source of support: Nil

Conflict of interest: None


 
PHYSIOLOGY OF BLOOD PRESSURE REGULATION
Anuj Maheshwari, Harish Basera

Salt Sensitivity and Hypertension

[Year:2017] [Month:October-December] [Volumn:3 ] [Number:4] [Pages:28] [Pages No:178-182][No of Hits : 168]


ABSTRACT

Enough evidence is there to link excess salt intake with cardiovascular and renal risks through hypertension though substantial evidence is also there to support that blood pressure is not always responding to salt. A lot of metabolic and neurohormonal factors determine this salt sensitivity in addition to genetic factors that determine substantial excretion of salt, so it may not increase blood pressure despite high intake. Salt-sensitive hypertensives have reduced levels of urinary endothelin, contributing to impaired natriuresis in response to a salt load. Salt load also increases free radicals and paradoxically decreases excretion of nitric oxide metabolites in salt-sensitive individuals. Type 2 diabetic patients with microalbuminuria are more salt sensitive as they have lower urinary excretion of nitric oxide. Nitric oxide deficiency facilitates endothelial dysfunction causing hypertension in salt-sensitive people, impeding vasodilation after salt load. Sympathetic nervous system plays a significant role in maintenance of blood pressure in response to salt through urinary and plasma levels of catecholamine and renal nerve activity. Apart from this, atrial natriuretic peptides (ANPs) and cytochrome P450-derived metabolites of arachidonic acid play significant roles. Insomnia and menopause increase salt sensitivity. Kidney provides sensitive and specific biomarkers for salt sensitivity in the form of proteomics, and renal proximal tubule cells, microribonucleic acid (miRNA), and exosomes are excreted into the urine apart from genetic biomarkers. A J-shaped curve relationship exists between salt intake and mortality. Salt intakes above and below the range of 2.5 to 6.0 gm/day are associated with high cardiovascular risk. Salt restriction can be a cause of hypertension in inverse salt-sensitive people. Available prevalence studies do not differentiate between salt-sensitive and salt-resistant populations, nor do they include normotensive salt-sensitive people who get their blood pressure raised in response to dietary salt. In these circumstances, salt sensitivity arises as an independent risk factor for cardiovascular mortality and morbidity.

Keywords: Dietary salt, Hypertension, Salt sensitivity.

How to cite this article: Maheshwari A, Basera H. Salt Sensitivity and Hypertension. Hypertens J 2017;3(4):178-182.

Source of support: Nil

Conflict of interest: None


 
HYPERTENSIVE CRISIS
Imran Rizvi, Ravindra K Garg, Hardeep S Malhotra, Neeraj Kumar, Manan M Mehta, Ravi Uniyal, Shweta Pandey

Management of Blood Pressure during Acute Stroke: A Narrative Review

[Year:2017] [Month:October-December] [Volumn:3 ] [Number:4] [Pages:28] [Pages No:183-188][No of Hits : 159]


ABSTRACT

Hypertension is among the most important risk factors for the occurrence of stroke. Acute stroke patients commonly have an elevated blood pressure (BP), and maintaining an appropriate level of BP is a crucial step in the successful management of acute stroke. In this article, we review various trial and published guidelines for the management of hypertension during intracerebral hemorrhage (ICH) and acute ischemic stroke. Patients with ICH were found to have systolic BP (SBP) in the range of 150 to 220 mm Hg and need acute lowering of SBP to less than 140 mm Hg. It is safe to do so if there are no contraindications. If a patient with ICH presents with an SBP of more than 220 mm Hg, then the BP should be lowered aggressively using intravenous infusion along with frequent monitoring. Patients of acute ischemic stroke, who have BP >185/110 mm Hg, should have their BP rapidly controlled, if they are being considered for thrombolytic therapy. Injectable labetalol, nicardipine, hydralinzine, and enalaprilat are considered appropriate for acute management of elevated BP in patients with acute ischemic stroke. Patients of acute ischemic stroke with SBP > 180 to 230 mm Hg or diastolic BP (DBP) > 105 to 120 mm Hg should receive intravenous labetalol 10 mg; this can be followed by a continuous infusion at the rate of 2 to 8 mg/min, if required. Nicardipine infusion is another alternative that can be uptitrated according to the desired BP levels. For secondary prevention of ischemic stroke, BP lowering can be done after first several days. The SBP > 140 mm Hg and DBP >90 mm Hg should be treated.

Keywords: Hypertension, Intracerebral hemorrhage, Ischemic stroke, Labetalol, Nicardipine.

How to cite this article: Rizvi I, Garg RK, Malhotra HS, Kumar N, Mehta MM, Uniyal R, Pandey S. Management of Blood Pressure during Acute Stroke: A Narrative Review. Hypertens J 2017;3(4):183-188.

Source of support: Nil

Conflict of interest: None


 
PHYSIOLOGY OF BLOOD PRESSURE REGULATION
Narsingh Verma, Arvind K Pal

Effect of Altitude on Blood Pressure

[Year:2017] [Month:October-December] [Volumn:3 ] [Number:4] [Pages:28] [Pages No:171-172][No of Hits : 159]


ABSTRACT

The effect of higher altitude over the blood pressure (BP) is not exactly known, and it appears to vary both between and within individuals. The effects of lower temperature, light, increased physical stress, and duration of living at higher altitude also play a significant role. Most of the studies showed that higher altitude correlated with rising BP. This change in BP is due to many factors, the important one being the effect of hypoxia causing activation of sympathetic nervous system. Activation of sympathetic nervous system causes an increase in cardiac output, heart rate, and peripheral vasoconstriction, which lead to increase in BP. The incidence of BP in high latitudes is controversial; some research shows greater rates while others show lesser rates of hypertension in these individuals. It may be due to the effects of multiple other confounding factors like genetic, ecological, and lifestyle variables. Hence, increasing popularity of high-altitude travel needs further research to evaluate this problem. Furthermore, the implications of altitude-induced hypertension for cardiovascular risk and end-organ damage require more clarification.

Keywords: Altitude, Hypertension, Hypoxia.

How to cite this article: Verma N, Pal AK. Effect of Altitude on Blood Pressure. Hypertens J 2017;3(4):171-172.

Source of support: Nil

Conflict of interest: None


 
MECHANISMS
Brent M Egan

Increased Sympathetic Drive, Elevated Heart Rate, and the Cardiovascular Continuum

[Year:2017] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:60] [Pages No:105-112][No of Hits : 154]


ABSTRACT

The cardiovascular continuum has been recognized for the past three decades in which antecedent risk factors, including hypertension and obesity, contribute to structural and functional cardiac and vascular changes. These risk factors and pathophysiological changes lead to left ventricular hypertrophy, myocardial infarction, cardiac dysfunction, heart failure, and death. Sudden death occurs more often among individuals with left ventricular hypertrophy, myocardial infarction, and heart failure. Several lines of evidence establish links between the sympathetic nervous system (SNS), heart rate, and cardiovascular risk factors, such as hypertension, inflammation, insulin resistance, and diabetes. These antecedent factors, with ongoing contributions from increased sympathetic drive and faster heart rates, often progress to asymptomatic functional and structural cardiovascular disease and subsequently to clinical cardiovascular disease and death, including sudden death. Increased sympathetic drive and faster heart rates can reflect familial and presumably genetic factors, various acute and chronic stressors, and obesity, especially abdominal-visceral obesity, which alter sympathovagal balance. Interventions, including lifestyle changes and pharmacotherapy that reduce heart rate and sympathetic drive, can interrupt the cardiovascular continuum at several points in this progressively deleterious pathway. Given the global obesity epidemic and the stresses of contemporary life, which can include crime, noise, and less stable families, it is important for clinicians to understand the role of increased sympathetic drive and faster heart rates in the continuum of cardiovascular risk, clinical cardiovascular disease, and death. Clinicians should be prepared to offer their patients lifestyle guidance and pharmacotherapy to interrupt this continuum and enhance cardiovascular health.

Keywords: Cardiovascular disease, Nonadherence, Office resistance, Pseudoresistant hypertension, Spironolactone, Treatment-resistant hypertension.

How to cite this article: Egan BM. Increased Sympathetic Drive, Elevated Heart Rate, and the Cardiovascular Continuum. Hypertens J 2017;3(3):105-112.

Source of support: Nil

Conflict of interest: None


 
HISTORICAL VIGNETTES
Rajeev Agarwala

A Chapter from History

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:47] [Pages No:42-43][No of Hits : 154]


ABSTRACT

Measuring blood pressure is standard clinical procedure performed on every adult patient. But, one hardly remembers the person who first conceptualized blood circulation theory or the one who measured blood pressure quantitatively

How to cite this article: Agarwala R. A Chapter from History. Hypertens J 2017;3(1):42-43.

Source of support: Nil

Conflict of interest: None


 
CARDIOVASCULAR PHYSIOLOGY
Nina Radford

Move Over Blood Pressure: Make Room for Cardiorespiratory Fitness as a Vital Sign

[Year:2017] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:53] [Pages No:51-57][No of Hits : 154]


ABSTRACT

Cardiorespiratory fitness (CRF) describes the ability of an individual to perform physical exercise, an activity that relies on the cardiovascular system’s capacity to facilitate oxygen delivery to working muscles and the pulmonary system’s ability to clear carbon dioxide from the blood. Ideally, CRF is measured using cardiopulmonary stress testing (exercise with analysis of gas exchange). To enhance the feasibility of assessing CRF in large populations, prediction equations using only exercise variables were developed to provide measures of estimated CRF. More recently, nonexercise methods of assessing CRF have been developed. Using exercise (objective) methods of measuring CRF, a robust evidence base has developed describing the inverse association of CRF with total mortality, nonfatal cardiovascular events, incident cancer, cancer survival, chronic conditions, and dementia; CRF has also been shown to be inversely related to development of cardiac risk factors including hypertension. Because CRF provides a strong, graded inverse association with cardiovascular and all-cause mortality, recent American Heart Association scientific statements have vigorously promoted the concept of CRF as a vital sign: All adults should have an estimation of CRF included in their annual health care visits along with resting blood pressure (BP), heart rate, and body mass index (BMI). The addition of CRF as a vital sign provides enhanced risk prediction that can improve patient care and encourage the incorporation of physical activity (PA) programs into treatments plans aimed at improved health outcomes.

Keywords: Cardiorespiratory fitness, Cardiovascular disease, Hypertension, Physical activity, Prevention.

How to cite this article: Radford N. Move over Blood Pressure: Make Room for Cardiorespiratory Fitness as a Vital Sign. Hypertens J 2017;3(2):51-57.

Source of support: Nil

Conflict of interest: None


 
PHYSICAL FITNESS
Uday M Jadhav

Physician Heal Thyself: Lead by Example—My Personal Tale of Physical Fitness

[Year:2017] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:53] [Pages No:64-66][No of Hits : 146]


ABSTRACT

Exercise is the most effective antiaging pill ever discovered. This is a small commentary on my way of lifestyle modification for a better quality and peaceful existence.
To exercise for a physician who preaches lifestyle modifications is sacrificing professional work and the capital gains. Swimming has some element of aerobic and anaerobic metabolism; as the swim distance increases, so does the contribution of aerobic metabolism. Anaerobic work is best done at the fastest possible speeds. Anaerobic threshold along with aerobic threshold and VO2max constitutes the exercise physiology that make up the aerobic profile.
Shavasana which is an integral part of yoga sets in calmness of the mind and release of thoughts turning inward away from the more mundane things in life. The physiological benefits of deep relaxation are numerous, including those on control of heart rate and blood pressure. The practice of yoga and meditation recently had an endorsement from the American Heart Association in the first ever released guideline on meditation.

Kewwords: Exercise, Shavasana, Swimming, Yoga.

How to cite this article: Jadhav UM. Physician Heal Thyself: Lead by Example—My Personal Tale of Physical Fitness. Hypertens J 2017;3(2):64-66.

Source of support: Nil

Conflict of interest: None


 
CARDIOVASCULAR THERAPEUTICS
Prabhash C Manoria, Nidhi Mishra

Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors: Ready to Target Atherosclerotic Cardiovascular Disease beyond Statins

[Year:2017] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:60] [Pages No:147-153][No of Hits : 145]


ABSTRACT

Dyslipidemia contributes to 50% of atherogenic cardiovascular events (CVEs). Statins decrease low-density lipoprotein cholesterol (LDL-C) on an average of 1 mmol and this is transformed into 20 to 25% reduction in CVE. Proprotein convertase subtilisin/kexin type 9 (PCSK9) fully humanized monoclonal antibodies (MoAbs) decrease LDL-C by another 1 to 1½ mmol on top of statins and this decreases CVE by another 20%. Therefore, the era has come when we are able to minimize the dyslipidemia-related atherogenic risk to a very great extent. The PCSK9 MoAbs require 12 to 26 injections per year. Inclisiran, which is a small interfering ribonucleic acid (siRNA), has shown to decrease LDL-C consistently for 6 months after a single injection. It is therefore emerging as a very important competitor to PCSK9 MoAbs. The future ongoing trials will tell us more about this molecule.

Keywords: Alirocumab, Proprotein convertase subtilisin/kexin type 9 inhibitors evolocumab, Small interfering ribonucleic acid.

How to cite this article: Manoria PC, Mishra N. Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors: Ready to Target Atherosclerotic Cardiovascular Disease beyond Statins. Hypertens J 2017;3(3):147-153.

Source of support: Nil

Conflict of interest: None


 
COMMENTARY ON HYPERTENSION GUIDELINES
Mahim Saran, Sudhanshu K Dwivedi

Impact of American College of Cardiology/American Heart Association Guidelines 2017

[Year:2017] [Month:October-December] [Volumn:3 ] [Number:4] [Pages:28] [Pages No:193-195][No of Hits : 144]


ABSTRACT

Reduction in the level of blood pressure (BP) from 140/90 to 130/80 mm Hg for defining hypertension is one of the major practice changing modifications of the 2017 American College of Cardiology/American Heart Association guidelines which are bound to have a huge societal impact. The number of hypertension patients will increase 1.5 times after this definition change. Although the BP levels for defining hypertension have changed, the levels at which pharmacological therapy should be started have remained the same, i.e., ≥140/90 mm Hg (Stage 2 hypertension according to newer guidelines) except in special situations (clinical atherosclerotic cardiovascular disease or estimated 10-year cardiovascular disease risk of ≥10%). All in all, definitely these guidelines are more comprehensive, give a much more clarity to the treating physician, and are aimed at better long-term prevention of target-organ damage. But at the same time, they leave us in the same dilemma which arises after every major guideline change: how to deal with patients who are being treated as per the old guidelines?

Keywords: Guidelines, Hypertension, Noncommunicable disease.

How to cite this article: Saran M, Dwivedi SK. Impact of American College of Cardiology/American Heart Association Guidelines 2017. Hypertens J 2017;3(4):193-195.

Source of support: Nil

Conflict of interest: None


 
NON-TRADITIONAL RISK FACTORS FOR HYPERTENSION
Ajai Singh, Narsingh Verma, Manish Yadav, Sabir Ali

Analysis of Hypertension as a Risk Factor for Osteoarthritis Knee

[Year:2017] [Month:October-December] [Volumn:3 ] [Number:4] [Pages:28] [Pages No:167-170][No of Hits : 138]


ABSTRACT

The basic objective of the recent analysis was to study hypertension as a risk factor for osteoarthritis (OA) knee. In this study, totally 155 patients of OA knee, of age more than 40 years, were enrolled for the study. The study was carried out in the Department of Orthopedic Surgery, King George’s Medical University (KGMU), Lucknow, Uttar Pradesh, India. According to the diagnostic criteria of the American College of Rheumatology, the cases were taken into consideration. A brief history about the disease was taken, and complete examinations were done. For the clinical severity, visual analog scale (VAS) and Lequesne index were done and for radiological severity assessment, Kellgren—Lawrence (KL) grading and X-ray bilateral knee were done to observe the radiological changes. Moreover, the blood pressure was measured consecutively in both arms for three times via auscultatory method following the American Heart Association guidelines, and the average was calculated and recorded. If the recorded average is greater than 140/90 mm Hg, then the subject is labeled as “hypertensive.” In this study, we found a significant association between the severity of the OA knee and hypertension. The study is not only for our knowledge enrichment about the association of OA and hypertension, but also to fill the gaps with related information; it will reshape our knowledge toward the management of heart disease, hypertension, and OA. Also, we can determine the new possible risk factors for these diseases.

Keywords: Hypertension, Metabolic syndrome, Obesity, Osteoarthritis, Osteoarthritis knee.

How to cite this article: Singh A, Verma N, Yadav M, Ali S. Analysis of Hypertension as a Risk Factor for Osteoarthritis Knee. Hypertens J 2017;3(4):167-170.

Source of support: Nil

Conflict of interest: None


 
NON-PHARMACOLOGICAL TREATMENT OF HYPERTENSION
Sunita Tiwari, Arvind K Pal

Yoga and Hypertension

[Year:2017] [Month:October-December] [Volumn:3 ] [Number:4] [Pages:28] [Pages No:189-192][No of Hits : 134]


ABSTRACT

High blood pressure (BP) is a major public health problem worldwide. It is an important risk factor for acute myocardial infarction, cerebrovascular disease, chronic renal failure, and congestive heart failure. Lifestyle modifications play an important role in prehypertensive individuals and also act as an adjunct to antihypertensive therapy. Yoga practices have been shown to be effective in reducing BP in hypertensive population. The probable mechanism by which yoga reduces BP is by reduction in sympathetic activity, facilitating autonomic balance, which reduces chemoreceptor responses, and enhancing baroreflex sensitivity. Yoga is also effective as an adjunct therapy in reducing antihypertensive medication use. There is a need for recognition of yoga by our health system as a complementary therapy for treating hypertension (HPT).

Keywords: High blood pressure, Lifestyle modification, Yoga.

How to cite this article: Tiwari S, Pal AK. Yoga and Hypertension. Hypertens J 2017;3(4):189-192.

Source of support: Nil

Conflict of interest: None


 
EARLIER STAGE OF HYPERTENSION
Arvind K Pancholia

Prehypertension: What to Do?

[Year:2017] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:53] [Pages No:67-71][No of Hits : 134]


ABSTRACT

Prehypertension (PHTN) is a global health problem that carries the risk of being prone to developing hypertension in the future along with double the risk of cardiovascular disease (CVD). Its prevalence is 25 to 50% based on data from different countries, and it varies with age, sex, birth weight, and body mass index (BMI). Regarding its pathophysiology, several mechanisms have been proposed, but the most validated are Ras activation, oxidative stress, inflammatory cytokines, sympathetic overdrive, and central nervous system activation. Therapeutic lifestyle changes are the foundation for all therapies in prehypertensive patients, which are recommended by almost all guidelines. Drug therapy has also been tried in a couple of trials and is recommended in high-risk patients.

Keywords: Dietary approaches to stop hypertension diet, Hypertension, Sodium

How to cite this article: Pancholia AK. Prehypertension: What to Do? Hypertens J 2017;3(2):67-71.

Source of support: Nil

Conflict of interest: None


 
NOVEL CONCEPT
Shipra Bhardwaj, Narsingh Verma, VS Narain, Vinod Kumar, Kshitij Bhardwaj, Saumya Mishra

Chronic Supplementation of Melatonin restores Impaired Circadian Rhythm in Patients with Coronary Artery Disease

[Year:2017] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:53] [Pages No:94-100][No of Hits : 127]


ABSTRACT

Blood pressure (BP) has a characteristic and reproducible circadian pattern with high values during the day and low values at night. Previous studies have shown that in patients with coronary artery disease (CAD), the nocturnal dip of BP is absent or blunted, which may be correlated to the reduced melatonin levels or altered melatonin–cortisol interplay. Our objective was to assess the effect of bedtime melatonin administration on circadian pattern of BP and heart rate (HR) in CAD patients. One hundred CAD patients were recruited for the study. General health records were individually maintained. Each study participant was given a 5 mg pure melatonin supplement each night at bedtime for a period of 1 year. A 24 hour/7 day ambulatory blood pressure monitoring (ABPM) using ambulatory blood pressure monitor and serum melatonin level estimations were done initially, after 6 months, and after 1 year of melatonin supplementation. The rhythmic parameters of systolic BP (SBP) and diastolic BP (DBP), HR, viz. midline-estimating statistic of rhythm (MESOR), double amplitude, acrophase, 3 hour fractionated hyperbaric index (HBI) were significantly reduced and serum melatonin concentration significantly increased after 6 and 12 months of exogenous melatonin supplementation. Circadian hyperamplitude tension (CHAT) incidence decreased as melatonin treatment progressed. The number of subject diagnosed with CHAT was as follows: 37/100 at the beginning, 17/100 after 6 months, and 6/100 after 12 months. These data suggest that 5 mg/day melatonin treatment improved and restored the circadian pattern of BP in CAD subjects.

Keywords: Ambulatory blood pressure monitoring, Circadian hyperamplitude tension, Coronary artery disease, Hyperbaric index, Melatonin.

How to cite this article: Bhardwaj S, Verma N, Narain VS, Kumar V, Bhardwaj K, Mishra S. Chronic Supplementation of Melatonin restores impaired Circadian Rhythm in Patients with Coronary Artery Disease. Hypertens J 2017;3(2):94-100.

Source of support: Nil

Conflict of interest: None


 
Editorial
Mark Niebylski

Editorial

[Year:2017] [Month:January-March] [Volumn:3 ] [Number:1] [Pages:47] [Pages No:iv][No of Hits : 122]


ABSTRACT

Congratulations on your team’s tremendous work in supporting the mission of the World Hypertension League in the detection and control of hypertension globally, through your blood pressure screening offered in conjunction with World Hypertension Day 2017.


 
SPECIAL SITUATIONS
Brent M Egan

Treatment-Resistant Hypertension: A Pragmatic Management Approach

[Year:2017] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:60] [Pages No:125-130][No of Hits : 115]


ABSTRACT

Treatment-resistant hypertension (TRH) is defined as office blood pressure (BP) uncontrolled on ≤3 or controlled on ≥4 antihypertensive medications at optimal doses. Apparent (a) TRH, a term used when medication dose, patient adherence, and out-of-office BP are unknown, impacts ~30% of treated, uncontrolled hypertensives. Approximately 50% of uncontrolled aTRH patients were not prescribed optimal therapy defined as ≥50% of maximum recommended doses of three different BP medication classes. Suboptimal adherence occurs in ~10 to 60% of aTRH cases. Out-of-office readings are nonhypertensive in roughly one-third of aTRH patients. Only ~30 to <50% of aTRH patients are truly treatment resistant. “Office” TRH has a favorable prognosis, underlining the importance of out-of-office BP. Suboptimal regimens and adherence with hypertension outside the office are likely associated with poor outcomes. Standardized treatment algorithms can improve appropriate prescribing. The BP self-monitoring, single-pill combinations, inexpensive medications, and shared decision making can improve adherence. Controlled TRH does not produce the expected reduction of cardiovascular events, suggesting that greater attention to other vascular risk factors and subclinical target organ change is important. The TRH patients have secondary hypertension more often than non-TRH patients, especially primary aldosteronism, yet most will not have an identifiable secondary cause. Many TRH patients are volume expanded and respond to intensified diuretic therapy, dietary sodium restriction, dual calcium channel blocker therapy, or addition of ƒ¿1-adrenoceptor antagonists. Plasma renin activity or hemodynamics can also inform successful and more personalized therapy. Referral to a hypertension specialist can be helpful if the approaches noted do not control BP in TRH.

Keywords: Cardiovascular disease, Nonadherence, Office resistance, Pseudoresistant hypertension, Spironolactone, Treatment-resistant hypertension.

How to cite this article: Egan BM. Treatment-Resistant Hypertension: A Pragmatic Management Approach. Hypertens J 2017;3(3):125-130.

Source of support: Nil

Conflict of interest: None


 
PROLOGUE
Madan Lal Brahma Bhatt

PROLOGUE

[Year:2017] [Month:October-December] [Volumn:3 ] [Number:4] [Pages:28] [Pages No:iv][No of Hits : 114]


ABSTRACT

It is matter of great pride that Hypertension Journal is bringing out an special issue. We live in a rapidly changing environment. Throughout the world, human health is being shaped by the same powerful forces: demographic ageing, rapid urbanization, globalization, and unhealthy lifestyles, etc.


 
CARDIOVASCULAR PHYSIOLOGY
Narsingh Verma, Shipra Bharadwaj

Circadian Rhythms: Attributes, Disruption and Implementation in cardiometabolic health

[Year:2017] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:53] [Pages No:58-63][No of Hits : 114]


ABSTRACT

It is a well-known fact, proved by evidence, that all the organisms consist of an internal biological clock, right from the singlecelled organisms to humans. In the hierarchy of classification of vertebrate, these rhythms have shown to play an important role concerning the physiological aspects of all organisms. Not only are these rhythms related to sleep, seasonal migration, reproduction, etc., in animals, but also, in humans, circadian rhythms control various vegetative functions including regulation of temperature, cardiac activity, endocrine secretion, blood pressure (BP), oxygen utilization, metabolic rate, menstrual and ovarian cycles, and other body functions. The change in the normal pattern of the circadian clock because of genetic, behavioral, and various environmental factors can produce cardiovascular, metabolic, and endocrinal disorders including hypertension and diabetes. The concentration of glucose in plasma displays circadian variation; in the morning hours, it is the highest. Since the level of insulin depends on the feeding behavior, the glucose concentration follows the daily rhythm of intake of food. On the contrary, BP and other cardiovascular reflexes have characteristic and diurnal circadian rhythms. Circadian trends are exhibited in many cardiovascular pathophysiological conditions like stroke, myocardial infarction, rhythm disorders, and bed death syndrome. There is enough evidence to show that disruption of circadian rhythms can act as a risk factor for the development of cardiovascular diseases. Recent research also suggests that the circadian clock and associated central as well as peripheral genes are responsible for glucose and lipid metabolic rhythms.

Keywords: Cardiometabolic functions, Chronomics, Circadian rhytms, Midline estimating statistic of rhythm.

How to cite this article: Verma N, Bharadwaj S. Circadian Rhythms: Attributes, Disruption, and Implementation Cardiometabolic Health. Hypertens J 2017;3(2):58-63.

Source of support: Nil

Conflict of interest: None


 
MECHANISMS
Amal K Banerjee

Biomarkers in Congestive Heart Failure: Clinical Importance

[Year:2017] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:60] [Pages No:118-124][No of Hits : 108]


ABSTRACT

Congestive heart failure is a serious condition with high prevalence of morbidity and premature mortality. If not properly treated, congestive heart failure (CHF) has the same adverse prognosis as a malignancy. It is important to identify CHF early so that its progression to end-stage heart disease can be avoided. In addition to clinical suspicion, certain biomarkers can be utilized in the diagnosis and management of CHF. Thus, appropriate management of CHF with require clinical diagnosis combined with rational utilization of biomarkers. Recent advances in biochemical technology have confirmed the usefulness of certain biomarkers in the detection diagnosis and treatment of CHF.

Keywords: Biomarkers, Clinical diagnosis, Heart failure, Morbidity, Prognosis.

How to cite this article: Banerjee AK. Biomarkers in Congestive Heart Failure: Clinical Importance. Hypertens J 2017; 3(3):118-124.

Source of support: Nil

Conflict of interest: None


 
MECHANISMS
Tiny Nair, Akash Nair

Hypertension in Pregnancy: Do We need a New Algorithm?

[Year:2017] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:60] [Pages No:113-117][No of Hits : 104]


ABSTRACT

Management of hypertension in pregnancy is a challenge, since the spectrum spreads from asymptomatic status to life-threatening complications like eclampsia. The time-tested American College of Obstetricians and Gynecologists (ACOG) classification fails to precisely prognosticate outcome of this complicated spectrum. Detection and risk stratification has undergone significant conceptual changes with the newer understanding of pathophysiology of this complex problem, mandating change in diagnostic algorithms. Introduction of biochemical high-risk markers like soluble fms-like tyrosine kinase 1 (sFlt-1):placental growth factor (PlGF) ratio has profoundly impacted risk stratification. A new four-question-based algorithm is suggested and its implications are discussed.

Keywords: Algorithm, Eclampsia, Hypertension, Preeclampsia, Pregnancy.

How to cite this article: Nair T, Nair A. Hypertension in Pregnancy: Do We need a New Algorithm? Hypertens J 2017;3(3):113-117.

Source of support: Nil

Conflict of interest: None


 
CARDIO-DIABETES
M Rajasekara Chakravarthi, Hari K Marri

Renal Effects of Sodium-glucose-linked Transporter 2 Inhibitors

[Year:2017] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:60] [Pages No:154-160][No of Hits : 101]


ABSTRACT

Diabetic nephropathy (DN) is the most common cause of end-stage renal disease worldwide. Sodium-glucose-linked transporter 2 (SGLT2) inhibitors are a new and promising class of antidiabetic agents that target renal tubular glucose reabsorption. Their action is based on the blockage of SGLT2 sodium- glucose cotransporters that are located at the luminal membrane of tubular cells of the proximal convoluted tubule (PCT), inducing glucosuria. It has been proven that they significantly reduce glycated hemoglobin (HbA1c), along with fasting and postprandial plasma glucose in patients with type II diabetes mellitus (T2DM). Glomerular hyperfiltration is a potential risk factor for DN. The SGLT2 inhibitors reduce sodium reabsorption in the proximal tubule, causing, through tubuloglomerular feedback (TGF), afferent arteriole vasoconstriction and reduction in hyperfiltration. The SGLT2 inhibitors reduced glomerular hyperfiltration in patients with T1DM, and in patients with T2DM, they caused transient acute reductions in glomerular filtration rate (GFR), followed by a progressive recovery and stabilization of renal function. Interestingly, recent studies consistently demonstrated a reduction in albuminuria. Recently, it was demonstrated that empagliflozin presents a significant cardioprotective effect. Although the SGLT2 inhibitors’ efficacy is affected by renal function, new data have been presented that some SGLT2 inhibitors, even in mild and moderate renal impairments, induce significant HbA1c reduction. Although these data are promising, only dedicated renal outcome trials will clarify whether SGLT2 inhibitors, in addition to their glycemic and blood pressure (BP) benefits, may provide nephroprotective effects.

Keywords: Diabetic kidney disease, Hyperfiltration, Renoprotection, Sodium-glucose-linked transporter 2 inhibitors.

How to cite this article: Chakravarthi MR, Marri HK. Renal Effects of Sodium-glucose-linked Transporter 2 Inhibitors. Hypertens J 2017;3(3):154-160.

Source of support: Nil

Conflict of interest: None


 
CARDIO-DIABETES
Shamanna S Iyengar

Cardiovascular Protective Actions of Sodium Glucose Cotransporter 2 Inhibitors

[Year:2017] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:60] [Pages No:161-165][No of Hits : 98]


ABSTRACT

Diabetes mellitus is a major health problem in our country, and the prevalence is on the increase. Cardiovascular complications are the commonest causes of mortality and morbidity in patients with type II diabetes mellitus. Diabetes may not be a coronary artery disease (CAD) equivalent, but it certainly carries a high risk for atherosclerotic cardiovascular disease (CVD). There are effective drugs to treat hyperglycemia, and these drugs may be having adverse effects or advantageous outcomes on CVD, or they may be neutral. While developing antidiabetic drugs, it has become necessary to study their effect on CVD and outcome.

Among the newer antidiabetic drugs, sodium glucose cotransporter 2 (SGLT2) inhibitors have exhibited impressive cardiovascular benefits. Various mechanisms have been proposed to explain their improved cardiovascular outcome. They are not without adverse effects. There are a number of SGLT2 inhibitor preparations, and it is debatable whether this cardiovascular benefit is a class effect or individual drug specific. These newer antidiabetic drugs are looking beyond blood sugar control.

Keywords: Cardioprotective antidiabetic drugs, Heart and diabetes, Sodium glucose cotransporter 2 inhibitors.

How to cite this article: Iyengar SS. Cardiovascular Protective Actions of Sodium Glucose Cotransporter 2 Inhibitors. Hypertens J 2017;3(3):161-165.

Source of support: Nil

Conflict of interest: None


 
SPECIAL SITUATIONS
Richard J Auchus

Clinical and Laboratory Assessment of Patients with Suspected Primary Aldosteronism

[Year:2017] [Month:July-September] [Volumn:3 ] [Number:3] [Pages:60] [Pages No:131-138][No of Hits : 97]


ABSTRACT

Primary aldosteronism (PA) was described over 60 years ago, but the relevance of PA to the burden of hypertension has never been greater. Best estimates from studies in a variety of settings indicate that PA is present in 5 to 8% of all patients with hypertension and up to 20% of patients with resistant hypertension. Progress in our understanding of the pathogenesis of PA helps to explain how PA can be so common and the genesis of bilateral hyperaldosteronism (BHA). Pitfalls in the evaluation of PA certainly exist, but these difficulties with the later stages of the evaluation should not impede liberal screening in groups of patients with a high prevalence of PA. In fact, the initial stages of the evaluation are utterly simple, and screening can make an enormous impact on the care of these patients. This article will provide a practical review of the approach to the patient suspected of having PA, which is by far the most common cause of secondary hypertension.

Keywords: Adrenal adenoma, Adrenal hyperplasia, Aldosterone, Hypertension, Hypokalemia, Ion channel, Primary aldosteronism, Renin.

How to cite this article: Auchus RJ. Clinical and Laboratory Assessment of Patients with Suspected Primary Aldosteronism. Hypertens J 2017;3(3):131-138.

Source of support: Nil

Conflict of interest: None


 
Editorial
C Venkata S Ram

Physician—Heel Thyself

[Year:2017] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:53] [Pages No:iv][No of Hits : 92]


ABSTRACT

Greetings to the readership of the Hypertension Journal. It gives me great pleasure to inform you that the Journal is doing very well in terms of academic recognition and acceptance by the medical community in South Asia. I want to thank the editorial board, contributors, and readers for making the Hypertension Journal, a flagship in South Asia.


 
PATHOPHYSIOLOGY
Vijay Viswanathan, A Anitha Rani

Proteinuria in Nondiabetic Patients: Clinical Significance

[Year:2016] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:80] [Pages No:118-123][No of Hits : 489]


ABSTRACT

Proteinuria is a major health care problem, which affects millions of peoples globally. It is a characteristic of Diabetic Nephropathy and a strong indicator of kidney disease and renal dysfunction. It occurs in different forms with varied degree of severity. Proteinuria can be classified based on the amount and type of the protein and the pathological damage. Process involved in proteinuria is complex and multifactorial which includes tubular absorption, hemodynamics of glomerular and diffusion gradients. A continuous function of kidney is necessary for regular urine formation. In normal physiological condition urine is free of protein and this action was efficiently performed by nephrons in the kidneys. Nephrons play a major role in filtration and reabsorption. Thus kidney disease is associated with the malfunction of reabsorption mechanism.

Keywords: Clinical, Diabetes, Glomerular filtration, Proteinuria, Renal function.

How to cite this article: Viswanathan V, Rani AA. Proteinuria in Nondiabetic Patients: Clinical Significance. Hypertens J 2016;2(3):118-123.

Source of support: Nil

Conflict of interest: None


 
HYPERTENSION AND CARDIOVASCULAR DISEASE
Jennifer B Cowart, Addison A Taylor, Jeffrey T Bates, Vijay Nambi

Blood Pressure, Troponin, and Cardiovascular Function

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:53] [Pages No:21-27][No of Hits : 477]


ABSTRACT

Hypertension (HTN) is a well-known risk factor for cardiovascular (CV) morbidity and mortality and has been associated with more CV events, including coronary heart disease (CHD), stroke, and heart failure (HF). Although lowering blood pressure (BP) has been associated with improved CV outcomes, there is an epidemiological-clinical trial discordance. Patients at highest risk for CV events benefit the most from BP reduction, but these patients are not easily identified on the basis of a single BP measurement. Earlier identification of high-risk phenotypes may assist in identifying subjects who may benefit from an increased intensity of therapy. Recently, high-sensitivity troponin (hsTn) assays have been developed (available for research in the United States and commercially in Europe), and evidence shows that elevated hsTn levels are predictive of incident HTN, left ventricular hypertrophy (LVH), CV events (including HF), and mortality. This article will review the evidence for and suggest possible future approaches in incorporating cardiac biomarkers in the management of HTN.

Keywords: Biomarkers, Blood pressure, Cardiovascular disease, Coronary artery disease, Heart failure, High-sensitivity troponin, Hypertension, Prevention, Risk factors.

How to cite this article: Cowart JB, Taylor AA, Bates JT, Nambi V. Blood Pressure, Troponin, and Cardiovascular Function. Hypertens J 2016;2(1):21-27.

Source of support: Nil

Conflict of interest: Dr Nambi has indicated that he has the following disclosures: Research grants-Veterans Affairs MERIT grant. Regional Advisory board: Sanofi. He is a coinvestigator on a provisional patent (patent no. 61721475) entitled biomarkers to improve prediction of heart failure risk filed by Baylor College of Medicine, Roche.


 
CASE REPORT
Amit A Bharadiya, GS Karthik, DVSNL Sharma, V Shanta Ram

Primary Hyperaldosteronism: Typical Clinical Manifestations

[Year:2016] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:53] [Pages No:105-107][No of Hits : 477]


ABSTRACT

A 34-year-old lady presented to the hospital with symptoms of headache and exertional dyspnea. On examination, she was found to have blood pressure of 180/120 mm Hg, which was confirmed and her blood pressure was unresponsive to standard antihypertensive therapy. She had easily inducible and unprovoked hypokalemia even on small doses of diuretic. The possibility of primary hyperaldosteronism was considered. Her plasma aldosterone was high with low plasma renin activity, confirming the biochemical diagnosis of hyperaldosteronism. She underwent workup with computed tomography of the abdomen that showed left adrenal mass, likely an adenoma. After proper medical preparation, she underwent laparoscopic adrenalectomy. Upon successful removal of the adrenal mass, her aldosterone, renin, potassium, and blood pressure levels were normalized. This case illustrates classical features of primary hyperaldosteronism with clinical diagnostic and therapeutic considerations.

Keywords: Hypokalemia, Primary hyperaldosteronism, Secondary hypertension.

How to cite this article: Bharadiya AA, Karthik GS, Sharma DVSNL, Ram VS. Primary Hyperaldosteronism: Typical Clinical Manifestations. Hypertens J 2016;2(2):105-107.

Source of support: Nil

Conflict of interest: None


 
HYPERTENSION AND CARDIOVASCULAR DISEASE
K Venugopal, Z Sajan Ahmad

Management of Hypertension in Patients with Cardiovascular Disease

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:53] [Pages No:10-15][No of Hits : 468]


ABSTRACT

Systemic hypertension (HTN) is the most common risk factor for cardiovascular disease (CVD) in the world. Management of HTN in established CVD requires an integrated approach that is built on the foundation of pathophysiology and tailored to the major patient subsets - stable ischemic heart disease (SIHD), acute coronary syndromes (ACS) and heart failure (HF). This review expands on these concepts by establishing the link between hypertension and the CVD subsets, discussing goals and targets in each situation, and finally looking at what the current guidelines recommend regarding the choice of pharmacotherapy.

Keywords: Acute coronary syndrome, Hear t failure, Hypertension, Stable ischemic heart disease.

How to cite this article: Venugopal K, Ahmad ZS. Management of Hypertension in Patients with Cardiovascular Disease. Hypertens J 2016;2(1):10-15

Source of support: Nil

Conflict of interest: None


 
TARGET ORGAN DAMAGE
Puneet Gupta, William B White

Small Vessel Disease of the Brain and Stroke: Association with Clinic and Ambulatory Blood Pressure

[Year:2016] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:53] [Pages No:65-73][No of Hits : 455]


ABSTRACT

Several potential vascular risk factors exist for the development and accumulation of small vessel disease of the brain and stroke in older people. In older people followed up for several years, we and others have reported that white matter hyperintensity lesions on magnetic resonance imaging nearly doubled in volume and were associated with alterations in neurologic function. In this article, we review blood pressure (BP) as a risk factor for the development and pathogenesis of small vessel disease and stroke in older persons. The research efforts have focused on ambulatory BP measurements, which have proven to be a stronger indicator than clinic pressures for the progression of small vessel disease in older people as well as the development of stroke. Based on relations among 24 hours systolic BP levels, the accrual of small vessel disease, and relations with cognitive function and mobility, we have designed the INFINITY trial, a novel interventional study that uses ambulatory BP to guide antihypertensive therapy addressed at improving functional decline.

Keywords: Ambulatory blood pressure, Cerebral small vessel disease, Stroke, Systolic hypertension.

How to cite this article: Gupta P, White WB. Small Vessel Disease of the Brain and Stroke: Association with Clinic and Ambulatory Blood Pressure. Hypertens J 2016;2(2):65-73.

Source of support: National Institutes of Health R01AG022092

Conflict of interest: None


 
ADJUVANT THERAPY FOR CARDIOVASCULAR HEALTH
Nagaraj Desai, Chilkunda Raviprakash Venkatesh

Statins for All Patients with Hypertension—It is still not Prime Time!

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:53] [Pages No:44-50][No of Hits : 443]


ABSTRACT

The hydroxymethylglutaryl (HMG) coenzyme A (CoA) reductase inhibitors (popularly known as statins) are very widely used drugs for the secondary and the primary prevention of cardiovascular (CV) events. Many medical societies have enthusiastically been updating their recommendations as the new evidences emerge. Considering statins routinely for all patients who are diagnosed to have systemic hypertension is possibly not prudent considering the currently available data. It is not uncommon that a person is diagnosed to have hypertension in thirties and forties. Although exposing him to statins on a very long term may have certain advantages such as prevention of CV events, it is well known that the residual risks in statin trials have been very significant. Moreover, militating against this suggestion is the lifetime risk of side effects and costs of therapies even when one chooses “more economical” statins. In the interim, clinical judgment on the merits of the case after a thorough discussion between care giver and seeker is reasonable.

Keywords: HMG-CoA reductase inhibitors, Hypertension, Primary prevention, Statins.

How to cite this article: Desai N, Venkatesh CR. Statins for All Patients with Hypertension-It is still not Prime Time! Hypertens J 2016;2(1):44-50.

Source of support: Nil

Conflict of interest: None


 
THERAPEUTIC IMPLICATION
Prakash Deedwania, Tushar Acharya

Clinical Implications of Recent Therapeutic Trials in Hypertension: Insights from SPRINT and HOPE-3 Trials

[Year:2016] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:45] [Pages No:194-199][No of Hits : 430]


ABSTRACT

Hypertension is a global pandemic of ever growing proportions. It is the most important population attributable risk-factor for ischemic heart disease, stroke and cardiovascular mortality. Appropriate blood pressure (BP) control with antihypertensive agents reduces these cardiovascular complications but very tight BP control can lead to adverse effects like hypotension and renal dysfunction, especially in the elderly. Moreover, the relationship between BP and ischemic heart disease and all-cause mortality follows a J-shaped curve with a signal of higher mortality at low BP ranges. Blood pressure targets across various age and cardiovascular risk groups are not well defined. In the paucity of clinical trial data, many of the BP targets suggested by panels like the Joint National Committee are based on expert consensus. Two recent randomized clinical trials, Systolic Blood Pressure Intervention Trial (SPRINT) and Heart Outcomes Prevention Evaluation (HOPE-3), have extended our knowledge of the BP control paradigm. The SPRINT trial evaluated the benefits of intensive BP reduction to a target systolic BP of 120 mm Hg by addition/up-titration of various antihypertensive medications in a high-risk patient population. The HOPE-3 trial was a primary prevention trial that evaluated the utility of BP lowering in intermediate-risk patients without known cardiovascular disease using a fixed dose drug combination. These trials are discussed in detail in this review.

Keywords: Blood pressure, Clinical trials, Hypertension control.

How to cite this article: Deedwania P, Acharya T. Clinical Implications of Recent Therapeutic Trials in Hypertension: Insights from SPRINT and HOPE-3 Trials. Hypertens J 2016;2(4):194-199.

Source of support: Nil

Conflict of interest: None


 
HYPERTENSION AND CARDIOVASCULAR DISEASE
T Govindan Unni

J-Curve Phenomenon—Current Understanding and Clinical Implications

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:53] [Pages No:16-20][No of Hits : 426]


ABSTRACT

J-curve can be defined as an increase in event rates when the blood pressure (BP) goes below a particular level. Now that we have safe and powerful drugs available for treatment of hypertension, it has become possible to bring down the BP to very low levels. However, the concept of “lower is better” is now being questioned. Trials looking at J-curve have given conflicting results. Probably, there is no J-curve for systolic BP. J-curve for stroke and renal end points is also debatable. It is in patients with significant obstructive coronary artery disease that there are data for a J curve for diastolic BP. In such patients, we should gradually titrate the dose of drugs, carefully watching for increasing angina. Isolated systolic hypertension (ISH) is another situation wherein care has to be taken when aggressively reducing systolic BP. Even here, there are questions to be answered. The low diastolic BP could be a marker of increased aortic stiffness. Or, the low diastolic BP may be due to other associated comorbid conditions. The fear of J-curve should not lead to undertreatment and thus deny patients the benefit of BP reduction.

Keywords: Curve, Hypertension, Hypoperfusion.

How to cite this article: Unni TG. J-Curve Phenomenon- Current Understanding and Clinical Implications. Hypertens J 2016;2(1):16-20.

Source of support: Nil

Conflict of interest: None


 
HYPERTENSION AND NEUROGENIC IMPACT
Ulhas M Pandurangi

Neurogenic Factors and Blood Pressure Regulation

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:53] [Pages No:35-38][No of Hits : 382]


ABSTRACT

Over the years, clinical and experimental studies have established the pivotal role of neurogenic factors in the genesis, progression, and prognosis of hypertension. It is accepted that sympathetic nervous system dominance over vagal influence is largely responsible for hypertension. Such an imbalance is seen strikingly in resistant hypertension. Lifestyle modifications leading to reduced sympathetic tone and increased vagal tone consistently provide control of hypertension and to some extent reversal or delaying of end-organ damage. However, studies with pharmacological and device-based therapies that aimed to modify autonomic tone to regulate neurogenic factors and to achieve desired blood pressure control have not produced encouraging results. The role of beta-blocker drugs has also been questioned. Catheter-based renal denervation strategy has fallen short of expectation. Understanding thoroughly the mechanisms underlying alterations in the neurogenic factors, the result of abnormal neurogenic milieu at the cellular and molecular levels and methods to identify susceptible individuals either by genetic study or by accurate measures of autonomic tone is expected to help tailor anti-hypertensive therapy and thereby improve outcomes.

Keywrods: Anti-natriuresis, Glutamatergic synapse, Vasomotor sympathetic nerve discharge.

How to cite this article: Pandurangi UM. Neurogenic Factors and Blood Pressure Regulation. Hypertens J 2016;2(1): 35-38.

Source of support: Nil

Conflict of interest: None


 
EDITORIAL COMMENTARY
Daniel T Lackland, C Venkata S Ram

World Hypertension League: Its Scope, Purpose, and Impact in South Asia

[Year:2016] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:53] [Pages No:55-56][No of Hits : 376]


ABSTRACT

How to cite this article: Lackland DT, Ram CVS. World Hypertension League: Its Scope, Purpose, and Impact in South Asia. Hypertens J 2016;2(2):55-56.

Source of support: Nil

Conflict of interest: None


 
SECONDARY HYPERTENSION
Ashish Nandwani, Vijay Kher

Renovascular Hypertension

[Year:2016] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:53] [Pages No:86-95][No of Hits : 367]


ABSTRACT

Renovascular disease caused by renal artery stenosis leading to reduced renal perfusion can produce a range of clinical conditions ranging from incidental finding on angiography without any hemodynamic significance to renovascular hypertension (RVH) with or without ischemic and hypertensive renal injury. A fall in renal perfusion pressure is sufficient to initiate RVH that only occurs when 70 to 80% of artery lumen is occluded. Atherosclerosis, fibromuscular dysplasia, and vasculitis involving the renal arteries are the leading causes of renovascular disease. With improvement in imaging studies, significant renal artery stenosis is detected more often than before. Management includes medical therapy aiming at blood pressure control and cardiovascular risk factor management. Renal revascularization is considered in patients with deteriorating renal functions and resistant hypertension.

Keywords: Atherosclerotic renovascular disease, Fibromuscular dysplasia, Percutaneous transluminal renal angioplasty, Renin–angiotensin–aldosterone system, Renovascular hypertension.

How to cite this article: Nandwani A, Kher V. Renovascular Hypertension. Hypertens J 2016;2(2):86-95.

Source of support: Nil

Conflict of interest: None


 
COMMENTARIE
Aram V Chobanian

Current Use of Diuretics in the Management of Hypertension

[Year:2016] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:45] [Pages No:181-182][No of Hits : 354]


ABSTRACT

No single class of antihypertensive drugs has had as much impact on the treatment of hypertension as diuretics. The introduction in the late 1950s of chlorothiazide and its analogues revolutionized the treatment of hypertensio.

How to cite this article: Chobanian AV. Current Use of Diuretics in the Management of Hypertension. Hypertens J 2016;2(4):181-182.

Source of support: Nil

Conflict of interest: None


 
HTN – DEVICE BASED THERAPY
Atul Pathak, Benjamin Honton, Olivier Fondard, Nicolas Dumonteil, Didier Tchetche, Jean Fajadet

Autonomic Neuromodulation through Devices for Hypertension

[Year:2016] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:45] [Pages No:211-218][No of Hits : 350]


ABSTRACT

Hypertension continues to be a major contributor for total and cardiovascular morbidity and mortality. This is directly related to lack in blood pressure control despite multiple pharmacological options available. This may occur not only as a rare consequence of true-resistant hypertension (RHTN) but also due to lack of adherence, or mostly the consequence, of adverse drug reactions. In recent years, there has been a rapid expansion of device-based therapies proposed as novel nonpharmacological approaches to treating hypertension. In this review, we discuss novel devices-renal nerve denervation, baroreflex activation therapy (BAT), carotid body (CB) ablation, central iliac arteriovenous anastomosis, deep brain stimulation (DBS), median nerve stimulation, and vagal nerve stimulation (VNS). We highlight the mechanism of action of devices, the level of evidence available to date, and ongoing or upcoming trials. This review also suggests appropriate device selection for different hypertension phenotypes.

Keywords: Arteriovenous anastomosis, Baroreflex activation, Carotid sinus stimulation, Coupler, Hypertension, Interventional devices, Renal denervation.

How to cite this article: Pathak A, Honton B, Fondard O, Dumonteil N, Tchetche D, Fajadet J. Autonomic Neuromodulation through Devices for Hypertension. Hypertens J 2016;2(4):211-218.

Source of support: Nil

Conflict of interest: None


 
BLOOD PRESSURE PHYSIOLOGY
Tiny Nair

Systolic and Diastolic Blood Pressure: Do We Add or Subtract to estimate the Blood Pressure Burden?

[Year:2016] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:45] [Pages No:221-224][No of Hits : 334]


ABSTRACT

The parameters that are taken into account during diagnosis or treatment of hypertension are the systolic blood pressure (SBP) and the diastolic blood pressure (DBP). Also, the importance of pulse pressure (PP), which is the difference between SBP and DBP, has been highlighted in determining the outcome of hypertension. A radically new concept of blood pressure burden (BPB), which is the sum of SBP and DBP (SBP+DBP) is proposed.

Keywords: Blood pressure burden, Diastolic blood pressure, Hypertension, J curve, Physiology, Systolic blood pressure.

How to cite this article: Nair T. Systolic and Diastolic Blood Pressure: Do We add or subtract to estimate the Blood Pressure Burden? Hypertens J 2016;2(4):221-224.

Source of support: Nil

Conflict of interest: None


 
SALT AND BLOOD PRESSURE
Norm RC Campbell, Francesco P Cappuccio

Dietary Salt and Blood Pressure: Verdict is Clear, so why Any Debate?.

[Year:2016] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:53] [Pages No:57-59][No of Hits : 313]


ABSTRACT

Repeated reviews of the evidence to produce recommendations for dietary salt intake have been conducted by independent committees of national and international scientific and governmental organizations. These recommendations support reducing dietary salt to less than 6 gm/day and many to less than 5 gm/day. Nevertheless, there is controversy about recommendations to reduce dietary salt. This commentary discusses low quality research studies and commercial interests as sources of the controversy. Especially, research that assesses usual salt intake in individuals based on a single spontaneously voided (spot) urine sample is discussed as a weak research method prone to erroneous findings. Further, some investigators have altered scientific formula to make their data using spot urine samples appear more robust and made misleading and false statements about evidence relating to dietary salt. Counterintuitive findings based on studies that have used spot urine samples is frequently disregarded in expert committee review given the low quality evidence is incompatible with higher quality evidence which shows direct linear relationships between dietary salt, hypertension and cardiovascular disease in the general population.

Keywords: Blood pressure, Cardiovascular disease, Conflict of interest, Diet, Hypertension, Nutrition, Public health, Salt, Sodium.

How to cite this article: Campbell NRC, Cappuccio FP. Dietary Salt and Blood Pressure: Verdict is Clear, so why Any Debate? Hypertens J 2016;2(2):57-59.

Source of support: Nil

Conflict of interest: None


 
COMMENTARIE
Michael A Weber

Will the Systolic Blood Pressure Intervention Trial (SPRINT) change Treatment Targets in Hypertension?

[Year:2016] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:45] [Pages No:183-188][No of Hits : 304]


ABSTRACT

Most of the current guidelines recommend a target systolic blood pressure (SBP) of < 140 mm Hg when treating hypertension. However, in the recent systolic blood pressure intervention trial (SPRINT) study which compared targets of 140 and 120 mm Hg in patients at high cardiovascular risk and concluded that there were greater cardiovascular (CV) and mortality benefits at the lower target, including those patients aged above 75 years. The blood pressure (BP) measurement method in SPRINT was unconventional and the achieved SBP in the intensively treated patients corresponds to pressure in an orifice valve of about 130 mm Hg. Importantly, SPRINT excluded patients with diabetes or at low CV risk. These patients should be treated to <140 mm Hg since CV events may increase at more aggressive targets. In communities with limited resources it is often not possible to evaluate CV risk and <140 mm Hg should be the usual target; indeed, in Stage 1 hypertension, drug therapy can be delayed while lifestyle changes are tried.

Keywords: Cardiovascular risk, Hypertension guidelines, Systolic blood pressure, Systolic blood pressure intervention trial.

How to cite this article: Weber MA. Will the Systolic Blood Pressure Intervention Trial (SPRINT) change Treatment Targets in Hypertension? Hypertens J 2016;2(4):183-188.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Gino Seravalle, Guido Grassi

Heart Rate as a Marker of Cardiovascular Prognosis

[Year:2016] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:45] [Pages No:189-193][No of Hits : 286]


ABSTRACT

Although several studies have shown that elevated heart rate (HR) is a powerful, independent, and consistent predictor of cardiovascular events and all-cause mortality, it is still considered an epiphenomenon of a general disorder rather than an independent risk factor. Several questions regarding the clinical significance of a resting HR as marker of cardiovascular risk are still unanswered, rendering the inclusion of this hemodynamic variable in the list of cardiovascular risk factors problematic, at least for time being. This paper will examine which HR value better reflects the cardiovascular risk, the predictive power, the complex pathophysiological mechanisms underlying the relationship between HR and cardiovascular risk. It will evaluate whether HR should be considered a true risk factor for cardiovascular diseases or simply a marker of autonomic imbalance, and finally, it will consider the effects of HR reduction on cardiovascular morbidity.

Keywords: Cardiovascular risk, Heart rate, Predictivity, Sympathetic nervous system.

How to cite this article: Seravalle G, Grassi G. Heart Rate as a Marker of Cardiovascular Prognosis. Hypertens J 2016;2(4):189-193.

Source of support: Nil

Conflict of interest: None


 
THERAPEUTIC LESSON IN HYPERTENSION
Franz H Messerli

The Chlorthalidone Saga: How the US Medical Community was mislead in Past?

[Year:2016] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:45] [Pages No:209-210][No of Hits : 243]


ABSTRACT

In this issue of the journal Pareek and colleagues provide a thorough, comprehensive review article on chlorthalidone (CTD). They report that in various global large trials like TOMHS, MRFIT, SHEP, ALLHAT, and SPRINT, CTD has reduced cardiovascular (CV) events, strokes, and, most importantly, mortality across various patient subgroups.

Keywords: Chlorthalidone, Hydrochlorothiazide, Thiazides.

How to cite this article: Messerli FH. The Chlorthalidone Saga: How the US Medical Community was mislead in Past? Hypertens J 2016;2(4):209-210.

Source of support: Nil

Conflict of interest: None


 
MECHANISMS OF HYPERTENSION
Poghni A Peri-Okonny, Wanpen Vongpatanasin

Evaluation of Sympathetic Activity in Hypertension

[Year:2016] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:53] [Pages No:60-64][No of Hits : 227]


ABSTRACT

The sympathetic nervous system (SNS) plays a major role in the pathogenesis of hypertension and contributes to hypertensive target organ complications. Advances in technology over the last three decades have improved the ability to measure sympathetic nerve activity (SNA), thus enabling investigators to probe the role of SNS in the development of cardiovascular diseases. The most direct method of measuring SNA employs the technique of microneurography, which involves recording of postganglionic sympathetic action potential using a subcutaneous electrode inserted into the candidate nerve. This method allows assessment of sympathetic vasoconstrictor discharge to the peripheral circulation in hypertension and provides prognostic information in patients with cardiovascular diseases. However, application of microneurography and other methods of assessment of SNS activity, including norepinephrine spillover and imaging of SNS innervation, in routine clinical practice is limited by availability of the technique and lack of normal reference range established from large population-based data. Nevertheless, these measurements provide further insight into mechanisms of hypertension and effectiveness of various interventions in modifying sympathetic regulation of blood pressure.

Keywords: Hypertension, Microneurography, Muscle sympathetic nerve activity, Norepinephrine spillover, Renal denervation, Sympathetic nerve activity.

How to cite this article: Peri-Okonny PA, Vongpatanasin W. Evaluation of Sympathetic Activity in Hypertension. Hypertens J 2016;2(2):60-64.

Source of support: Nil

Conflict of interest: None


 
Editorial
C Venkata S Ram

From the Editor-in-Chief

[Year:2016] [Month:January-March] [Volumn:2 ] [Number:1] [Pages:53] [Pages No:v][No of Hits : 219]


ABSTRACT

On behalf of the editorial board and publishers of the Hypertension Journal (HTNJ), I am bringing to you this third issue of the journal-dedicated to hypertension, comorbidities, and associated disorders. The feedback which we received about the quality of this journal is overwhelming. Let me assure the readers that it is only the beginning of this journal and together we will continue to progress to meet your expectations-for the benefit of the community.


 
PATHOPHYSIOLOGY
Shawna D Nesbitt

Prehypertension: Does It Still Matter?

[Year:2016] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:80] [Pages No:109-112][No of Hits : 217]


ABSTRACT

Prehypertension was introduced in the JNC staging of blood pressure in 2003. The rationale for this classification was the progressive nature of hypertensive disease. Recently clinical trials have demonstrated clear benefits of treatment to blood pressure levels of 120/80 mm Hg, which is the lower threshold of prehypertension. Furthermore other trials suggest that early treatment may be more important in long-term risk reduction rather than immediate risk reduction. These new findings raise questions regarding the current classification and use of medication in the range of prehypertensive blood pressure.

Keywords: Blood pressure, Hypertension, Prehypertension. How to cite this article: Nesbitt SD. Prehypertension: Does It Still Matter? Hypertens J 2016;2(3):109-112.

Source of support: Nil

Conflict of interest: None


 
IMAGES IN HYPERTENSION
Kakarla S Rao

Pheochromocytoma

[Year:2016] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:45] [Pages No:225-226][No of Hits : 217]


ABSTRACT

Pheochromocytomas are rare catecholamine-producing tumors derived from chromaffin cells; 10% of these are malignant, 10% are bilateral, and 10% are extra-adrenal. These are imaged with a variety of modalities including computed tomography, magnetic resonance imaging, scintigraphy, and rarely angiography.

Keywords: Hypertension, Imaging methods, Pheochromocytoma.

How to cite this article: Rao KS. Pheochromocytoma. Hypertens J 2016;2(4):225-226.

Source of support: Nil

Conflict of interest: None


 
CSI 2016 ROUND-UP
Tiny Nair

Hypertension Capsule—Cardiological Society of India 2016: Swallow It!

[Year:2016] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:45] [Pages No:219-220][No of Hits : 201]


ABSTRACT

The 68th annual conference of the Cardiological Society of India was held at Kochi, Kerala, from December 8 to 11, 2016. An overall coverage of the most important topics on hypertension is summarized.

Keywords: Cardiological society of India annual conference 2016, Hypertension, Rosuvastatin.

How to cite this article: Nair T. Hypertension Capsule— Cardiological Society of India 2016: Swallow It! Hypertens J 2016;2(4):219-220.

Source of support: Nil

Conflict of interest: None


 
RESISTANT HYPERTENSION
Venkatesh K Raman, Vasilios Papademetriou

Revival of Renal Denervation Therapy for Hypertension: Real Hope or just a Dream?

[Year:2016] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:80] [Pages No:160-168][No of Hits : 199]


ABSTRACT

The sympathetic nervous system (SNS) has long been recognized as important to the initiation and maintenance of hypertension. From groundbreaking experimental physiology in the 1850s to single nerve fiber studies more than one 100 years later, the growing body of preclinical evidence supports this framework and has informed attempts at therapeutic clinical intervention. Prior to the availability of long-term oral antihypertensive therapy in the mid-1950s, operative approaches to SNS interruption were of variable efficacy and sometimes limiting side effects. Surgery was then abandoned as a panoply of drugs were introduced and shown to be effective in reducing blood pressure and, more importantly, decreasing major cardiovascular events. Despite the availability of dozens of agents, a small but significant percentage of patients do not achieve target pressures on multiple medications and are characterized as resistant or refractory. Nonsurgical, catheter-delivered radiofrequency ablation (RFA) to achieve renal SNS denervation has emerged as an option in these patients. Early clinical studies suggested marked reductions in office-based blood pressures. Results of the pivotal, sham-controlled SYMPLICITY HTN-3 study, however, were disappointing and did not show a significant difference in blood pressure reduction between treated and control groups. Post hoc analyses suggest that incomplete denervation was an important contributor to the much smaller blood pressure effect compared with earlier trials. Additional clinical anatomic and preclinical studies have greatly elucidated the distribution of sympathetic nerves in the renal periarterial space and provided insight into broad principles that might successfully move the field forward. A number of newer treatment platforms that include multielectrode RFA, focused high-energy ultrasound, and local periarterial delivery of neurolytics seem to justify the cautious enthusiasm that renal denervation (RDN) will eventually fulfill its promise in the treatment of resistant hypertension and perhaps other syndromes characterized by sympathetic overactivity.

Keywords: Ambulatory blood pressure monitoring, Norepinephrine, Radiofrequency ablation, Renal denervation, Renal sympathetic nervous activity, Sympathetic nervous system.

How to cite this article: Raman VK, Papademetriou V. Revival of Renal Denervation Therapy for Hypertension: Real Hope or just a Dream? Hypertens J 2016;2(3):160-168.

Source of support: Nil

Conflict of interest: None


 
IMAGES IN HYPERTENSION
Kakarla S Rao

Fibromuscular Dysplasia of Renal Artery

[Year:2016] [Month:April-June] [Volumn:2 ] [Number:2] [Pages:53] [Pages No:103-104][No of Hits : 191]


ABSTRACT

Fibromuscular dysplasia (FMD) of the renel artery is one of the etiological factors of secondary hypertension. The etiology is unknown. Conventional radiography is ideal when interventional methods are planned. The beaded appearance is the typical appearance of FMD on angiogram.

Keywords: Fibromuscular dysplasia, Idiopathic, Nonatherosclerotic.

How to cite this article: Rao KS. Fibromuscular Dysplasia of Renal Artery. Hypertens J 2016;2(2):103-104.

Source of support: Nil

Conflict of interest: None


 
RESISTANT HYPERTENSION
David A Calhoun

Clinical Perspective

[Year:2016] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:80] [Pages No:153-159][No of Hits : 177]


ABSTRACT

Resistant or difficult-to-treat hypertension is a common clinical problem affecting 10 to 15% of treated hypertensive patients. Effective management of resistant hypertension firstly requires distinguishing pseudo-resistant from true resistant hypertension. Common causes of pseudo-resistance include inaccurate blood pressure (BP) measurement, white coat effect, poor medication adherence, and undertreatment. Pharmacologic treatment of resistant hypertension requires use of effective multidrug antihypertensive regimens, including especially diuretic therapy. An initial three-drug regimen of an angiotensinconverting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB), amlodipine, and a long-acting thiazide diuretic is recommended. Chlorthalidone is recommended as the preferred thiazide diuretic of choice given its long half-life and superior efficacy. A large body of literature now clearly establishes spironolactone as the most effective fourth medication for treatment of resistant hypertension. Renal nerve denervation (RND) is under intensive investigation to determine its true antihypertensive benefit, especially for treating uncontrolled resistant hypertension. Recent studies suggest that while the technique will likely provide some benefit in terms of additional BP reduction, it will not likely cure patients of their resistant hypertension as most subjects participating in studies of RND have generally continued medical therapy with use of the same or nearly the same number of medications. Accordingly, clinicians, even with the availability of renal nerve derivation, will have to remain facile in prescribing multiple drug combinations for treating resistant hypertension.

Keywords: Chlorthalidone, Renal nerve denervation, Resistant hypertension, Spironolactone.

How to cite this article: Calhoun DA. Clinical Perspective. Hypertens J 2016;2(3):153-159.

Source of support: This work was supported by NIH grant RO1 HL113004.

Conflict of interest: Dr Calhoun has received grant support from Medtronic and Valencia Technologies. He also serves as a consultant for Valencia Technologies.


 
From the Desk of Editor-in-Chief
C Venkata S Ram

From the Desk of Editor-in-Chief

[Year:2016] [Month:October-December] [Volumn:2 ] [Number:4] [Pages:45] [Pages No:iv][No of Hits : 167]


ABSTRACT

Greetings to the readers and supporters of the Hypertension Journal, and our best wishes for 2017. I am pleased to report to the editorial board and the readers that the journal had a remarkable 2016 in terms of visibility, appeal, respect, and national recognition. I want to thank the publishers, the editorial board, and reviewers for the success of the journal. And we will make additional progress, be assured.


 
RESISTANT HYPERTENSION
Debbie L Cohen

Device-based Therapies for Hypertension

[Year:2016] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:80] [Pages No:169-177][No of Hits : 154]


ABSTRACT

Hypertension is a major public health issue and due to poor blood pressure (BP) control rates, worldwide, alternative nonpharmacological therapies are being sought to help improve blood pressure control. There are multiple catheter-based renal denervation (RDN) devices that are available and being studied in various hypertensive populations. The procedure has been shown to be safe, but the efficacy has been variable and enthusiasm for the procedure has been tempered particularly after the negative results from the largest RDN sham-controlled study - SYMPLICITY HTN-3 study. New studies are underway in investigating this technology in patients with less severe hypertension using a dual approach of a group off medication and a group on one to three standard antihypertensive medications. The rationale behind this study design is that in untreated hypertension, this approach will isolate the blood pressure lowering effect of the RDN procedure itself, and in the group assigned to standard antihypertensives, this study design will evaluate the effect of RDN in the presence of a standardized medication regimen. Other innovative noninvasive methods of RDN including a noninvasive ultrasound technology are also being investigated. Baroreceptor inhibition is also continuing to be studied by investigating a newer more patient-friendly device using a unilateral carotid baroreceptor stimulator. Other newer innovative technologies and devices are also discussed including ethanol-based sympathicolysis of the renal nerves and use of an arteriovenous fistula (AVF) device to lower blood pressure. All these methodologies should be considered experimental and cannot be recommended currently for clinical care.

Keywords: Baroreceptor inhibition, Catheter-based renal denervation, Hypertension, Sympathetic nervous system.

How to cite this article: Cohen DL. Device-based Therapies for Hypertension. Hypertens J 2016;2(3):169-177.

Source of support: Nil

Conflict of interest: None


 
IMAGES IN HYPERTENSION
Kakarla Subbarao

Primary Aldosteronism

[Year:2016] [Month:July-September] [Volumn:2 ] [Number:3] [Pages:80] [Pages No:178-179][No of Hits : 125]


ABSTRACT

Primary aldosteronism (PA) is an important secondary cause of hypertension. Although rare, PA should be suspected in patients with resistant hypertension who demonstrate unexplained hypokalemia. Correct diagnosis of the condition leads to appropriate medical or surgical therapy which can improve and/or cure the condition.

Keywords: Adrenal gland, Chemical-shift, Primary aldosteronism. How to cite this article: Subbarao K. Primary Aldosteronism. Hypertens J 2016;2(3):178-179.

Source of support: Nil

Conflict of interest: None


 
Case Report
Amit A Bharadiya, Pratap C Rath, Byomakesh Dikshit, Sunder Chidambaram, M Somasekhar

Intimal Fibromuscular Dysplasia of Renal Artery: A Rare Case of Hypertension

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:57-61][No of Hits : 493]


ABSTRACT

Hypertension has a long list of primary as well as secondary causes. Fibromuscular dysplasia is amongst the rare secondary causes of hypertension. Intimal fibroplasia as a pathologic cause occurs in less than 10% of patients with fibromuscular dysplasia. We report a rare case of hypertension due to intimal fibromuscular dysplasia of renal artery, treated successfully with renal angioplasty and stenting. It is important to note that intimal fibromuscular dysplasia mimics atherosclerotic lesions morphologically and on renal angiography.

Keywords: Fibromuscular dysplasia, Hypertension, Renal angioplasty, Renal artery stenosis.

How to cite this article: Bharadiya AA, Rath PC, Dikshit B, Chidambaram S, Somasekhar M. Intimal Fibromuscular Dysplasia of Renal Artery: A Rare Case of Hypertension. Hypertens J 2015;1(1):57-61.

Source of support: Nil

Conflict of interest: None


 
Population Sciences
Daniel T Lackland

Stroke and Hypertension: Recent Trends of High Blood Pressure and the Decline in Stroke Mortality

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:22-27][No of Hits : 457]


ABSTRACT

High blood pressure has long been recognized as associated with increased risk of stroke. Basically, the higher the systolic blood pressure, the greater the risk of stroke. The high blood pressure risks are evident in both genders, all ages and all population. Since the 1970s, evidence has been generated determining that lowering the blood pressure reduces the risks of stroke. At the population level, the blood pressure distributions in the United States have shifted to the left, i.e. current population blood pressure levels are lower than previous decades. These lower blood pressures are associated with lower stroke risks. The lower blood pressures are attributed to structured programs implemented specifically to lower blood pressure in the population, clinical guidelines detailed to pharmacologically lower pressures, hypertension prevention efforts and programs, and additional resources devoted to lower blood pressure. These intervention and prevention have been effective in lowering blood pressures and stroke risk reduction. While additional improvements remain to be accomplished globally, the models of lower blood pressures and hypertension should be considered one of the major public health success stories in the past 50 years and a major objective for population risk reduction throughout the world.

Keywords: Blood pressure, Disease risks, Hypertension, Population, Stroke.

How to cite this article: Lackland DT. Stroke and Hypertension: Recent Trends of High Blood Pressure and the Decline in Stroke Mortality. Hypertens J 2015;1(1):22-27.

Source of support: Nil

Conflict of interest: None


 
Editorial
C Venkata S Ram

From the Editor-in-Chief

[Year:2015] [Month:October-December] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:iv][No of Hits : 404]


ABSTRACT

I am pleased to inform the readers that the inaugural issue of the Hypertension Journal was very well received. The feedback was extremely positive. The current issue covers several important dimensions of hypertension which are of practical importance to the clinicians.


 
Lifestyle changes
Aashish Contractor, Abraham Samuel Babu

A Sensible Reappraisal of Lifestyle Modifications to Treat Hypertension

[Year:2015] [Month:October-December] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:68-72][No of Hits : 360]


ABSTRACT

The prevalence of hypertension worldwide is rapidly increasing and is projected to cross 1.5 billion adults by 2025. Reduction in hypertension will provide the largest benefit for premature cardiovascular disease mortality. Lifestyle modification, which primarily includes an increase in physical activity and alterations in diet can contribute greatly to both, prevention and management of hypertension. However, in terms of specific recommendations for these lifestyle interventions, there is still a need for greater evidence from randomized controlled trials. This article reviews some of the new data in the area of lifestyle modification, for the control and management of hypertension. Regular aerobic exercise, along with dynamic resistance training has shown to have a beneficial effect in the management of hypertension. Besides structured exercise, an increase in daily physical activity has proven benefits. An increase in cardiorespiratory fitness, has shown to have a positive impact on both hypertension, and reducing cardiovascular disease morbidity and mortality. Current dietary guidelines for the management of hypertension, included a reduction in daily sodium intake and processed foods. In addition, smoking cessation, control of weight and limitation of alcohol intake contribute to a healthy lifestyle for hypertension management.

Keywords: Diet, Exercise, Hypertension, Lifestyle, Physical activity.

How to cite this article: Contractor A, Babu AS. A Sensible Reappraisal of Lifestyle Modifications to Treat Hypertension. Hypertens J 2015;1(2):68-72.

Source of support: Nil

Conflict of interest: None


 
Editorial
C Venkata S Ram

From the Editor-in-Chief

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:iv][No of Hits : 342]


ABSTRACT

A New Journal dedicated to Hypertension is Born

Dear Readers and Authors,
On behalf of the editorial board and the publishers, I welcome you to the inaugural issue of the ‘Hypertension Journal’. It is my immense pleasure to serve as the Editor-in-Chief of this new journal, first of its kind in India/South Asia. The aim of the journal is to provide scientific information in a scholarly manner. Since hypertension is multifactorial in terms of etiology and manifestations, the new journal will strive to provide a better understanding of various diversified perspectives of hypertension. The journal will publish research articles, reviews and case reports to enhance the knowledge base of healthcare providers dealing with hypertension. I would encourage you to submit your reviews, concepts, commentaries and original work for publication in the journal.


 
From the Desk of the Publisher
Jitendar P Vij

From the Desk of the Publisher

[Year:2015] [Month:July-September] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:v][No of Hits : 305]


ABSTRACT

A New Journal dedicated to Hypertension is Born

We, at Jaypee Brothers Medical Publishers (P) Ltd., proudly announce the birth of a new journal, aptly called the ‘Hypertension Journal’ (HTNJ). The journal is the first of its kind to be published in South Asia, solely dedicated to hypertension and associated disorders. As all of you know, hypertension is a major risk factor for premature morbidity and excessive mortality in the community. Untreated hypertension has a negative impact on the public health of our country.


 
Case Report
GS Karthik, B Dixit, PC Rath

Primary Hyperaldosteronism: An Unusual but not a Rare Entity

[Year:2015] [Month:October-December] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:118-120][No of Hits : 301]


ABSTRACT

A 36 years old gentleman presented to hospital with symptoms of viral illness. In addition to fever, he was found to have blood pressure of 240/160 mm Hg which was confirmed by repeated measurements. There was no evidence of target organ damage. His febrile illness turned out to be due to swine flu. Due to severe hypertension, he was admitted to the intensive care unit (ICU) for parenteral antihypertensive drug therapy. He had unexplained severe hypokalemia and metabolic alkalosis. The possibility of primary hyperaldosteronism was considered, plasma aldosterone level was high and plasma renin activity was low, confirming the (biochemical) diagnosis of hyperaldosteronism. He underwent additional work-up and was given specific antihypertensive drugs. The case illustrates classical features of primary hyperaldosteronism, diagnostic and therapeutic considerations.

Keywords: Adrenal glands, Aldosterone-renin ratio, Hypertension, Hypokalemia, Primary hyperaldosteronism.

How to cite this article: Karthik GS, Dixit B, Rath PC. Primary Hyperaldosteronism: An Unusual but not a Rare Entity. Hypertens J 2015;1(2):118-120.

Source of support: Nil

Conflict of interest: None


 
Review Article
IB Vijayalakshmi, Chitra Narasimhan

Hypertension in Children and Adolescents

[Year:2015] [Month:October-December] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:88-93][No of Hits : 274]


ABSTRACT

Introduction: Pediatric hypertension has been recognized as an important health issue over the past years. In children though the etiology of hypertension is predominantly secondary, the prevalence of primary hypertension has been increasing at an alarming rate, particularly in adolescents and older children.

Discussion: The prevalence of hypertension in children increases with increasing body mass index percentile, placing obese children at three times higher risk of becoming hypertensive. It has been shown that weight loss by itself can decrease blood pressure and other associated cardiovascular risk factors should also be expected to regress or improve with weight loss. Dietary changes can involve portion-size control, decrease in consumption of sugar-containing beverages, energy-dense snacks, increase in consumption of fresh fruits, vegetables, low-fat dairy, stopping smoking and abstinence from alcohol use. Secondary hypertension due to specific conditions can be controlled and treated successfully by appropriate timely interventions both surgical and nonsurgical.

Conclusion: Pediatric hypertension is a serious disease that should be neither overlooked nor ignored. The evaluation and treatment of hypertension in childhood has continued to evolve over the past four decades. There is a great need to diagnose and treat hypertension when it develops in childhood to decrease the risk of cardiovascular morbidity in adulthood.

Keywords: Aortic stenting, Aortoarteritis, Coarctoplasty, Coil occlusion of renal artery, Renal artery angioplasty.

How to cite this article: Vijayalakshmi IB, Narasimhan C. Hypertension in Children and Adolescents. Hypertens J 2015;1(2):88-93.

Source of support: Nil

Conflict of interest: None


 
Review Article
Saumitra Ray

Hypertension in the Old and Very Old: Current Concepts

[Year:2015] [Month:October-December] [Volumn:1 ] [Number:2] [Pages:57] [Pages No:100-105][No of Hits : 253]


ABSTRACT

Old age is defined variably in medical parlor. Blood pressure (BP) increases with age as a continuous variable. Hypertension is the single most attributable risk factor for death worldwide and accounts for considerable morbidity. Control of BP reverses this process. However, when to treat the elderly and how, is sometimes a confusing area. Due to high rates of comorbidities and drug adverse effects, often the elderly are undertreated. But, it should be made clear that the benefit of treatment of BP in the elderly is very high and if treatment is provided with reasonable standard of care, the benefit far outweighs the risk.

Keywords: Elderly, Guidelines, Hypertension.

How to cite this article: Ray S. Hypertension in the Old and Very Old: Current Concepts. Hypertens J 2015;1(2):100-105.

Source of support: Nil

Conflict of interest: None



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