ABSTRACT

Since the beginning of the 21^st century, non-communicable diseases including cardiovascular diseases have become the leading cause of death in India accounting for more than 50% of deaths. Hypertension has been the principal driver of cardiovascular disease in India. Epidemiological studies have reported prevalence rates of 25-30% urban and 10-20% rural subjects in India which translates to 100 million cases. Hypertension lead to 1.6 million deaths and 33.9 million disability-adjusted life years in 2015 in India. Worldwide too, an estimated 1.4 billion people have hypertension (1/3^rd of world wide population) accounting to half of CV deaths (9.4 million deaths yearly). Thus, hypertension remains an important treatable disorder with a global impact. Despite the availability of effective therapy, treatment and control of ht is poor. In fact, less than half of the patients with hypertension are even aware of the disease.

ABSTRACT

In this issue of the Hypertension Journal, the academic faculty from the Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore India (SJICSR) have authored a series of articles on hypertension, its complications, management and recent advances. The authors have vast experience in treating cardiac disorders as well as providing preventive care. SJICSR is a 1000 bedded public, academic, tertiary care cardiac center in south India. It runs the largest cardiology fellowship program in the country (23 fellows each year). Last year, 6 lakh patients visited the outpatient department. 56531 patients were treated in hospital with over half being managed at highly subsidised financial rates given their low socio-economic status. The hospital had the distinction of performing the highest number of cath lab procedures in India (45000 cathlab procedures with 13000 angioplasties last year). In addition, it has the rare honor of performing the largest numbers of mitral valvuloplasties in the worldwide (annually more than 1300). This issue aims to bring a third world perspective to managing hypertension. Innovative solutions are needed to have a demonstrable impact on the health in developing countries. The lack of awareness, access to health care, out of pocket costs and prolonged treatment for a silent disorder create unique challenges. In line with the WHO-UN goal, we hope to achieve a 25% reduction in hypertension by 2025 and thereby reduce the associated premature mortality. Professor C. Venkat S Ram in his article has thrown more light on cardiovascular diseases in Women which is neglected in many countries.

ABSTRACT

Hypertension is implicated as an independent and strong risk factor, for the occurrence of coronary artery disease (CAD), stroke and renal failure that leads to significant morbidity and mortality throughout the world. Several epidemiological studies show a consistent relationship between high blood pressure (BP) and the risk of CAD. In this review, the BP goals in hypertensives with CAD are discussed. BP targets in accordance to recent guidelines are reviewed and the therapeutic strategies for the management of various presentations of CAD are highlighted. There is a controversy about the lower target range of BP in CAD patients. Some studies support the “J curve” hypothesis, whereas the recent SPRINT trial refutes it. Furthermore, lower BP targets are associated with prescription of multiple drugs, posing a problem of both cost and compliance for patients. Management includes treatment of hypertension along with targeting other comorbidities such as dyslipidemia, obesity, diabetes mellitus, and smoking.

Keywords: Hypertension, coronary artery disease, J curve, blood pressure targets

How to cite this article: Shetty LH, Ravindranath KS, Manjunath CN. Blood Pressure Goals in Patients with Coronary Artery Disease. Hypertens 2019;5(4):128-134.

Received: 29-12-2019;

Accepted: 14-02-2020

ABSTRACT

Hypertensive emergency is a rise in blood pressure (BP) >180/120 mmHg with an associated with end-organ injury, and symptoms and signs are usually dramatic. Complete medical history and quick clinical examination key to treatment. Intravenous antihypertensive medications chosen based on comorbid conditions, type and extent of end-organ injury, pharmacodynamics, and pharmacokinetic property of drugs. Target BP reduction is to reduce 25% of mean arterial pressure in 1^st h and further reduce systolic blood pressure to < 160 and diastolic blood pressure < 100 in next 2-6 h, and maintain the same BP for next 24 h, exceptions are aortic dissection, Eclampsia/Preeclampsia, acute stroke, and pheochromocytoma crisis. Labetalol, nitroglycerine, nicardipine, and esmolol cover most of the spectrum of hypertensive emergencies. Over enthusiastic blood pressure correction to be avoided to prevent ischemic effects may arise from rapid reduction in blood pressure.

Keywords: Hypertensive emergency, End-organ damage, Compelling conditions, Clevidipine, Nicardipine, Nitroglycerine, Esmolol, Labetalol

How to cite this article: Balaraju D, Ravindranath KS, Manjunath CN. Clinical Diagnosis and Treatment of Hypertensive Emergencies. Hypertens 2019;5(4):135-140.

Received: 02-01-2020;

Accepted: 12-02-2020

ABSTRACT

The left ventricular hypertrophy (LVH) in systemic hypertension (HTN) indicates target organ damage and is an independent risk factor for cardiovascular (CV) events. Among various modalities available for LVH assessment, cardiac magnetic resonance imaging has the highest sensitivity and specificity. M-mode echocardiography is the most widely method for LVH assessment currently due to its ease, availability, and reasonably good sensitivity and specificity. LVH is a risk factor for heart failure, stroke, coronary artery disease, and arrhythmias. Variable degree of LVH regression occurs with different antihypertensive medications. LVH regression with treatment has shown a reduction in the risk of CV events.

Keywords: Cardiovascular, hypertension, left ventricular hypertrophy

How to cite this article: Nishanth KR, Ravindranath KS, Manjunath CN. Hypertension and Left Ventricular Hypertrophy. Hypertens 2019;5(4): 141-145.

Received: 04-01-2020;

Accepted: 14-02-2020

ABSTRACT

Hypertension (HTN) is a risk factor for cardiovascular (CV) morbidity and mortality. Evidence from studies result in changing strategies for treating HTN. The impact of these trials is evidenced by change in guidelines as well as recommendations for managing HTN with respect to choice of drugs or interventions, as well as goals of treatment.

Keywords: Blood pressure, randomized, goal, treatment, cardiovascular risk, intensive

How to cite this article: Karur S, Shankarappa RK. Recent Clinical Trials in Hypertension – An Encapsulated Summary. Hypertens 2019;5(4): 146-149.

Received: 27-12-2019;

Accepted: 12-02-2020

ABSTRACT

Renovascular hypertension (RVH) constitutes a major cause of secondary hypertension. The most common causes for RVH are atherosclerosis and fibromuscular dysplasia. RVH is an important prognosticator of cardiovascular risk and requires aggressive therapy to reduce the cardiovascular risk. Development of newer antihypertensive drugs and also lifestyle and intense risk factor modification have eased the management and improved outcomes in patients with RVH. Role of revascularization and its benefits in patients with renovascular disease has shown a conflicting result in the various randomized trials. Individual patient-based approach by the treating physician is advised for the enhanced management of the patient with RVH.

Keywords: Renovascular hypertension, secondary hypertension, cardiovascular risk

How to cite this article: Vijaykumar JR, Srinivas BC, Ravindranath KS, Manjunath CN. Renovascular Hypertension. Hypertens 2019;5(4):150-156.

Received: 07-01-2020;

Accepted: 16-02-2020

ABSTRACT

Hypertension is an important risk factor of heart failure (HF). HF is a common cardiovascular disease, which carries a poor prognosis. Antecedent hypertension is present in 3/4^th of chronic HF patients. The risk of HF increases by 50% with 20 mmHg elevation of systolic blood pressure (BP). Among patients with HF, those with higher levels of systolic and diastolic BP are at greater risk of adverse events. Thus, optimal treatment of hypertension is vital in reducing the risk of incident HF and HF hospitalization.

Keywords: Hypertension, heart failure with preserved ejection fraction (HFpEF), heart failure with reduced ejection fraction (HFrEF)

How to cite this article: Manjunath SC. Medical Management of Hypertensive Heart. Hypertens 2019;5(4):157-164.

Received: 25-01-2020;

Accepted: 11-02-2020

ABSTRACT

Whereas heart disease is often thought of as a “man’s” problem, it is the most common cause of premature mortality in women. A diagnostic hurdle is that women may not present with typical manifestations of coronary artery disease (CAD). However, like men, women should take precautions to reduce the risk of cardiovascular diseases (CVDs). Some women with CAD may not complain of chest pain but present with neck, jaw, or shoulder pain, nausea, dizziness, or unusual fatigue. Women may describe chest pain as merely pressure or tightness. The symptoms of CVD in women may occur even at rest, not on exertion. Moreover, may women tend to downplay their symptoms. The risk factors for CAD in women include – hypertension, hyperlipidemia, diabetes, mental stress, depression, tobacco use, menopause, obesity, and pregnancy-related complications. The risk factors should be identified and controlled aggressively with close follow-up to minimize CV complications. In general, CVD treatment in women is similar to men, but those with a typical feature may derive less benefit from therapeutic and life-saving options. This chapter discusses the pathophysiology, diagnostic work-up, clinical management, and rehabilitation measures in women with CVDs.

Keywords: Hypertension, heart disease, women’s health, risk factors

How to cite this article: Ram CVS. Cardiovascular Disease in Women. Hypertens 2019;5(4):165-173.

Received: 17-01-2020;

Accepted: 11-02-2020