Hypertension Journal


From the Editor-in-Chief

C Venkata S Ram

[Year:2016] [Month:January-March] [Volume:2 ] [Number:1] [Pages No:v] [No. of Hits: 36059]


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.


Metabolic Syndrome in the Indian Population: Public Health Implications

PP Mohanan

[Year:2016] [Month:January-March] [Volume:2 ] [Number:1] [Pages No:1-6] [No. of Hits: 22120] [No. of Citation: 10]


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


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

Tiny Nair

[Year:2016] [Month:January-March] [Volume:2 ] [Number:1] [Pages No:7-9] [No. of Hits: 14599]


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


Management of Hypertension in Patients with Cardiovascular Disease

K Venugopal, Z Sajan Ahmad

[Year:2016] [Month:January-March] [Volume:2 ] [Number:1] [Pages No:10-15] [No. of Hits: 33794]


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


J-Curve Phenomenon—Current Understanding and Clinical Implications

T Govindan Unni

[Year:2016] [Month:January-March] [Volume:2 ] [Number:1] [Pages No:16-20] [No. of Hits: 15938] [No. of Citation: 1]


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


Blood Pressure, Troponin, and Cardiovascular Function

Jennifer B Cowart, Addison A Taylor, Jeffrey T Bates, Vijay Nambi

[Year:2016] [Month:January-March] [Volume:2 ] [Number:1] [Pages No:21-27] [No. of Hits: 15515]


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.


Hypertension in Patients with Chronic Kidney Disease

P Vijay Varma, M Rajasekara Chakravarthi, G Jyothsna

[Year:2016] [Month:January-March] [Volume:2 ] [Number:1] [Pages No:28-34] [No. of Hits: 17595] [No. of Citation: 3]


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


Neurogenic Factors and Blood Pressure Regulation

Ulhas M Pandurangi

[Year:2016] [Month:January-March] [Volume:2 ] [Number:1] [Pages No:35-38] [No. of Hits: 12369]


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


Hypertension and Ischemic Stroke

Sudhir Kumar

[Year:2016] [Month:January-March] [Volume:2 ] [Number:1] [Pages No:39-43] [No. of Hits: 16927] [No. of Citation: 6]


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


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

Nagaraj Desai, Chilkunda Raviprakash Venkatesh

[Year:2016] [Month:January-March] [Volume:2 ] [Number:1] [Pages No:44-50] [No. of Hits: 13188]


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


An uncommon Case of Resistant Hypertension: Stenosis of Renal Artery

Mohsin Wali, Bhavya Tyagi

[Year:2016] [Month:January-March] [Volume:2 ] [Number:1] [Pages No:51-53] [No. of Hits: 13348] [No. of Citation: 1]


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