Hypertension Journal



Mark Niebylski

[Year:2017] [Month:January-March] [Volume:3 ] [Number:1] [Pages No:iv] [No. of Hits: 4201315] [No. of Citation: 1]


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.


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

Norm RC Campbell

[Year:2017] [Month:January-March] [Volume:3 ] [Number:1] [Pages No:1-6] [No. of Hits: 349] [No. of Citation: 20]


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.


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

R Chandni, Uday M Jadhav

[Year:2017] [Month:January-March] [Volume:3 ] [Number:1] [Pages No:7-11] [No. of Hits: 10660]


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


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?.

Brent M Egan, Jiexiang Li, C Shaun Wagner

[Year:2017] [Month:January-March] [Volume:3 ] [Number:1] [Pages No:12-19] [No. of Hits: 335]


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


Secondary Causes of Hypertension: Illustrative Cases

Sreenivas K Arramraju

[Year:2017] [Month:January-March] [Volume:3 ] [Number:1] [Pages No:20-22] [No. of Hits: 11662]


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


Hypertension and Menopause

Anuj Maheshwari, Bharti Maheshwari

[Year:2017] [Month:January-March] [Volume:3 ] [Number:1] [Pages No:23-26] [No. of Hits: 9958]


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


Sympathetic Nervous System and Hypertension

Narsingh Verma

[Year:2017] [Month:January-March] [Volume:3 ] [Number:1] [Pages No:27-36] [No. of Hits: 9666] [No. of Citation: 3]


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


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

Clarence E Grim

[Year:2017] [Month:January-March] [Volume:3 ] [Number:1] [Pages No:37-41] [No. of Hits: 323]


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


A Chapter from History

Rajeev Agarwala

[Year:2017] [Month:January-March] [Volume:3 ] [Number:1] [Pages No:42-43] [No. of Hits: 7483]


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


Device-based Therapies for Resistant Hypertension: Current Status

Mohsin Wali, C Venkata S Ram

[Year:2017] [Month:January-March] [Volume:3 ] [Number:1] [Pages No:44-49] [No. of Hits: 9420]


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