Hypertension Journal

1.GUEST EDITORIAL

Hypertension in Asia

Boon Wee Teo
[Year:2018] [Month:April-June] [Volume:4 ] [Number:2] [Pages No:64-65] [No. of Hits: 554]
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  • [Abstract]
  • [DOI : [DOI : 10.15713/ins.johtn.0106]]

ABSTRACT

Hypertension affects a substantial number of Asians.[1] It is a disease multiplier and is associated with high rates of adverse cardiovascular events (myocardial infarction and strokes) and death. It increases the likelihood of chronic kidney disease and/or progression to end-stage kidney disease. It remains one of the easiest risk factors to control and yet is also a difficult one to target.

How to cite this article: Teo BW.Hypertension in Asia. Hypertens 2018;4(2): 64-65.

Source of support: Nil,

Conflict of interest: None

2.ORIGINAL ARTICLE

Contribution of Hypertension to Cerebrovascular Disease in the Asian Population

Umer Khan, Chan Gek Cher, Martin Lee
[Year:2018] [Month:April-June] [Volume:4 ] [Number:2] [Pages No:66-71] [No. of Hits: 531]
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  • [Abstract]
  • [DOI : [DOI : 10.15713/ins.johtn.0107]]

ABSTRACT

Aim: This study aims to explore the effect of hypertension on cerebrovascular disease in the Asian population.

Background: Hypertension (defined as systolic blood pressure [SBP] >140 mmHg or diastolic BP >90 mmHg) is a risk factor for cerebrovascular disease. Chronic hypertension contributes to endothelial damage and impaired autoregulation, in the long-term leading to plaque formation and increasing risk of both ischemic and hemorrhagic stroke.

Review Results: In Asian populations, the proportion of hemorrhagic strokes to ischemic strokes is higher in underdeveloped areas and demonstrates a decline in longitudinal studies as areas undergo development. Asians also have a higher burden of occult small vessel disease. Hypertension, diabetes, and smoking are the main risk factors for stroke in Asian countries, exacerbated by a high-salt diet and increasing prevalence of metabolic syndrome in developed nations. Asians also have a more sustained morning surge of blood pressure, highlighting the importance of monitoring home blood pressure to guide treatment. Treatment should employ both non-pharmacological and pharmacological interventions. Targeting SBP <140 mmHg has shown to reduce the risk of stroke and other cardiovascular events, as well as occult small vessel disease, regardless of agent used. Novel treatments such as renal denervation were ineffective in reducing SBP (SYMPLICITY trial), and work on genetic testing of polymorphisms involved in blood pressure regulation remains in its early stages.

Clinical Significance: Management of hypertension should be tailored to the Asian demographic with a focus on risk factor reduction, being vigilant for subclinical stroke, as well as tight blood pressure control <140 mmHg to reduce the risk of cerebrovascular disease.

Key Words: Asian, cerebrovascular disease, hypertension, literature review, stroke

How to cite this article: Khan U, Chan GC, Lee M. Contribution of Hypertension to Cerebrovascular Disease in the Asian Population. Hypertens 2018;4(2) 66-71.

Source of support: Nil,

Conflict of interest: None

Received 01-05-2018;

Accepted 09-07-2018

3.REVIEW ARTICLE

Blood Pressure Measurement Methodologies

Charmaine Si Min Sia, Wei Zhen Hong, Christopher Cheang Han Leo
[Year:2018] [Month:April-June] [Volume:4 ] [Number:2] [Pages No:72-77] [No. of Hits: 770]
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  • [Abstract]
  • [DOI : [DOI : 10.15713/ins.johtn.0108]]

ABSTRACT

Blood pressure (BP) is an important vital sign used to determine a patient’s clinical status and is applied in numerous settings such as clinics or hospitals, ambulatory, and self-monitoring. It not only serves to help medical professionals guide treatment but also assists patients in self-monitoring of their clinical condition. Accurate measurements and user-friendly interphases are, therefore, crucial to allow for ease of interpretation and for appropriate follow-up measures once BP values are obtained. There are various methods to obtain BP measurements (intermittent, continuous, invasive, and non-invasive), each come with their own advantages and disadvantages. With the advancement of medical science, the most commonly used method to date would be the oscillatory method through automated monitoring devices and further developments are underway to improve both accuracy and accessibility of BP measurement.

Key words: Blood pressure, methodologies, pseudoaneurysm

How to cite this article: Sia CSM, Hong WZ, Leo CCH. Blood Pressure Measurement Methodologies. Hypertens 2018;4(1): 72-77.

Source of support: Nil,

Conflict of interest: None

Received: 07-04-2018;

Accepted: 09-06-2018

4.REVIEW ARTICLE

Hypertension and Chronic Disease Burden

Haidong He, Horng Ruey Chua, Boon Wee Teo
[Year:2018] [Month:April-June] [Volume:4 ] [Number:2] [Pages No:78-83] [No. of Hits: 625]
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  • [DOI : [DOI : 10.15713/ins.johtn.0109]]

ABSTRACT

Lifestyle-related non-communicable chronic diseases are the major causes of morbidity and mortality in both developed and developing countries. The major inter-related chronic diseases that have an impact on the population include hypertension, obesity, dyslipidemia, diabetes, and metabolic syndrome. Hypertension is ranked third in terms of the global burden of disease. It is the predominant risk factor for mortality and makes cardiovascular disease the primary cause of death. While we can identify these conditions and complications, it is not so clear how we can assess the burden of these chronic diseases and their association with hypertension. Despite the development of detection methods and equipment, there are still no good markers to relate the diagnosis and control of hypertension before target organ damage occurs. Recent studies using retinal imaging suggest that it is possible to look at the microvasculature to assess disease burden as a result of hypertension. Hypertensive retinopathy is a complication of hypertension. The eye and kidney have similar structures, so there is a close relationship between retinal vessel changes and heart, cerebrovascular, and kidney diseases. Retinal vessel changes reflect the burden of hypertension on these chronic diseases. We can infer the damage of end organs and provide earlier information for the diagnosis and treatment of hypertension.

Key words: Cardiovascular disease, cerebrovascular disease, chronic kidney disease, hypertensive retinopathy

How to cite this article: He H, Chua HR, Teo BW. Hypertension and chronic disease burden. Hypertens 2018;4(2): 78-83.

Source of support: Nil,

Conflict of interest: None

Received: 11-05-2018;

Accepted: 27-6-2018

5.REVIEW ARTICLE

Hypertension Trends in Asia

Yan Ting Chua, Weng Kin Wong, Satya P. K. Goll amudi, Cheang Han Leo
[Year:2018] [Month:April-June] [Volume:4 ] [Number:2] [Pages No:84-88] [No. of Hits: 1511]
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  • [Abstract]
  • [DOI : [DOI : 10.15713/ins.johtn.0110]]

ABSTRACT

Hypertension is an often silent yet modifiable risk factor of cardiovascular morbidity and mortality. Despite increasing recognition of its adverse health impacts, global prevalence remains on the rise and hypertension control remains suboptimal. A similar trend has been observed in South-East Asia, particularly in less-affluent areas, where hypertension prevalence is rising but awareness and control rates are dismal. Contributory factors identified include accessibility of healthcare, different health-seeking behaviour, lifestyle factors such as dietary salt intake, and lack of individual recognition of potential downstream complications. Strategies employed in the fight against hypertension in South-East Asia will need to address these different needs, taking into consideration the interplay of differing socioeconomic status and education level amidst varying racial and cultural beliefs and traditions.

Key words: Hypertension, Blood pressure, Asia, Cardiovascular

How to cite this article: Chua YT, Wong WK, Gollamudi SPK, Leo CH. Hypertension Trends in Asia. Hypertens 2018;4(1): 84-88.

Source of support: Nil,

Conflict of interest: None

Received: 17-07-2018;

Accepted: 29-07-2018

6.REVIEW ARTICLE

Central Aortic Blood Pressure as an Indica tor of Prognosis: An Asian Perspective

Clara Lee Ying Ngoh, Weng Kin Wong, Lieng Hsi Ling
[Year:2018] [Month:April-June] [Volume:4 ] [Number:2] [Pages No:89-93] [No. of Hits: 665]
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  • [DOI : [DOI : 10.15713/ins.johtn.0111]]

ABSTRACT

Brachial cuff sphygmomanometer remains the major method by which blood pressure (BP) is assessed clinically. However, this is a poor surrogate for central aortic BP. There is increasing evidence that central aortic BP can act as a marker of cardiovascular (CV) and peripheral vascular disease burden and that central pressures may be able to predict CV events and mortality. This, in turn, could have implications for the development and application of future pharmacological therapies. This review article examines the evidence surrounding the above and its controversies. It concludes that while central BP is an exciting new frontier, more research is required for central BP to become commonplace in clinical medicine.

Key words: Asian, augmentation, central blood pressure, prognosis, pulse wave velocity

How to cite this article: Ngoh CLY, Wong WK, Ling LH. Central Aortic Blood Pressure as an Indicator of Prognosis: An Asian Perspective. Hypertens 2018;4(2): 89-93.

Source of support: Nil,

Conflict of interest: None

Received: 05-05-2018;

Accepted 09-06-2018

7.REVIEW ARTICLE

Salt and Hypertension Hypothesis - Still Relevant

Emmett T. Y. Wong, Hersharan K. Sran, Subramanian Srinivas
[Year:2018] [Month:April-June] [Volume:4 ] [Number:2] [Pages No:94-99] [No. of Hits: 1293]
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  • [DOI : [DOI : 10.15713/ins.johtn.0112]]

ABSTRACT

Dietary salt intake is a common and important risk factor for hypertension. There has been a shift in the understanding of the pathogenesis of hypertension and the role that salt plays in its development - from the centrality of kidney, to the concept of salt sensitivity and more lately, hypertension as a disorder of endothelial function. There remains much heated debate and controversy about the relation between salt and hypertension, with both proponents and opponents pointing to observational, experimental, and epidemiological evidence supporting their claims. Other dietary factors such as refined sugars and potassium have also been identified as important contributory factors to hypertension, raising the question of whether the role of salt was as central as it was purported to be. While few would challenge the evidence showing the benefit of a low-salt diet in hypertensive patients, the contention is whether the same strategy of salt restriction should apply to normotensive populations to prevent hypertension, given observational data that low-salt intake may be associated with increased cardiovascular risk. With increasing prevalence of hypertension and burden of metabolic diseases worldwide, more evidence in the form of randomized controlled trials is required to determine whether a lowsalt intake should be recommended as policy, which must strive to benefit majority of the population without causing harm to the minority. Until then, the salt and hypertension hypothesis is likely to remain relevant in the foreseeable future.

Key words: Controversy, endothelial function, hypertension, salt sensitivity

How to cite this article:Wong ETY, Sran HK, Srinivas S. Salt and Hypertension Hypothesis - Still Relevant. Hypertens 2018;4(1): 94-99.

Source of support: Nil,

Conflict of interest: None

Received 21-04-2018;

Accepted 29-05-2018

8.REVIEW ARTICLE

The Dual Disease Burden of Hypertension and Diabetes

Yi Da, Behram Khan, A. vathsala
[Year:2018] [Month:April-June] [Volume:4 ] [Number:2] [Pages No:100-106] [No. of Hits: 694]
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  • [DOI : [DOI : 10.15713/ins.johtn.0113]]

ABSTRACT

Hypertension and diabetes are among the most common non-communicable diseases worldwide with a global prevalence of 22% and 9%, respectively. In Singapore, the prevalence of both diseases is higher at 23.5% and 11.3%, respectively, and similar trends are evident in much of Asia. There is an even higher prevalence of hypertension among diabetics, likely contributed to by inappropriate activation of the renin-angiotensin-aldosterone system (RAAS), altered sodium transport, a complex interaction of hyperinsulinemia and insulin resistance with obesity, RAAS, arterial baroreceptor reflex impairment, leading to an activated sympathetic nervous system, and the coexistence of kidney damage accelerated by hypertension. While angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers remain the mainstay of treatment for the comorbidities of hypertension and diabetes, various guidelines are inconsistent with blood pressure thresholds and treatment goals. Shared lifestyle factors in the etiology of hypertension and diabetes do provide further opportunities for non-pharmacologic intervention. Taken together, strategies that incorporate early diagnosis of diabetes and hypertension and its complications, disease self-management and education, and optimal medical and lifestyle management will reduce the burden of complications from these dual conditions.

Key words: Cardiovascular disease, diabetic kidney disease, renin-angiotensin-aldosterone system, vascular complication

How to cite this article: Da Y, Khan B, Vathsala A. The Dual Disease Burden of Hypertension and Diabetes. Hypertens 2018;4(2): 100-106.

Source of support: Nil,

Conflict of interest: None

Received: 26-06-2018;

Accepted: 17-07-2018

9.REVIEW ARTICLE

The Dual Burden of Hypertension and Hyperlipidemia

Jia Neng Tan, Sabrina Wong Peixin Haroon
[Year:2018] [Month:April-June] [Volume:4 ] [Number:2] [Pages No:107-112] [No. of Hits: 502]
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  • [Abstract]
  • [DOI : [DOI : 10.15713/ins.johtn.0114]]

ABSTRACT

Hypertension and hyperlipidemia are chronic diseases with high socioeconomic burdens. They contribute significantly to mortality and morbidity amongst populations. Globally, hypertension is estimated to cause 7.1 million deaths and hypercholesterolemia contributes to 4.4 million deaths. They share common pathophysiological pathways and the combination of hypertension and hyperlidpidemia predisposes individuals to higher risk of cardiovascular events. Despite this knowledge, we are far from attaining the target treatment goals and these dismal results are sobering in the face of cardiovascular morbidity and mortality.

Key words: Hypertension, Hyperlipidemia, Cardiovascular, Mortality

How to cite this article: Tan JN, Haroon SWP, Lau T. The Dual Burden of Hypertension and Hyperlipidemia. Hypertens 2018;4(2): 107-112.

Source of support: Nil,

Conflict of interest: None

Received: 25-04-2018;

Accepted: 12-05-2018

10.REVIEW ARTICLE

Obstructive Sleep Apnea and Cardiovascular Disease - An Asian Perspective

Zi Yun Chang, San May Low, Serene Wong, See Meng Khoo, Pei Loo Tok
[Year:2018] [Month:April-June] [Volume:4 ] [Number:2] [Pages No:113-118] [No. of Hits: 1007]
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  • [Abstract]
  • [DOI : [DOI : 10.15713/ins.johtn.0115]]

ABSTRACT

Obstructive Sleep Apnea (OSA) is a chronic condition in which there is repetitive partial or complete collapse of pharynx during sleep. OSA is the most common sleep-related breathing disorder, and is increasingly being recognized as an important risk factor in cardiovascular diseases. OSA is prevalent in Asian populations despite lower prevalence of obesity as compared to Caucasian counterparts, suggesting possible differences in pathophysiology. There is increasing evidence that the effect of OSA on cardiovascular diseases is significant in the Asian population and is associated with poorer outcomes. In this review article, we look at OSA particularly in the Asian context, as well as examine the correlation between OSA and cardiovascular disease.

Keywords: Asians, cardiovascular disease, OSA, arrhythmias, heart failure, CPAP

How to cite this article: Chang ZY, Low SM, Wong S, Khoo SM, Tok PL. Obstructive Sleep Apnea and Cardiovascular Disease - An Asian Perspective. Hypertens 2018;4(2): 113-118.

Source of support: Nil,

Conflict of interest: None

Received: on 30-03-2018;

Accepted: on 15-05-2018

11.REVIEW ARTICLE

Contribution of Hypertension to Chronic Kidney Disease

Leanne Ca Yin Leong, Horng Ruey Chua, Priyanka Khatri
[Year:2018] [Month:April-June] [Volume:4 ] [Number:2] [Pages No:119-124] [No. of Hits: 580]
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  • [DOI : [DOI : 10.15713/ins.johtn.0116]]

ABSTRACT

Hypertension is one of the most prevalent chronic diseases worldwide and is a major risk factor for a decline in kidney function in patients with diabetic and non-diabetic kidney diseases. Conversely, patients with chronic kidney disease (CKD) inevitably develop hypertension during the course of the disease. Hypertension causes loss of autoregulation of afferent arterioles which leads to transmission of high systemic blood pressure to the glomeruli resulting in glomerular ischemia and subsequently glomerulosclerosis. Achieving optimal blood pressure control remains an integral component in the care of managing patients with CKD and is relevant at all stages of the disease irrespective of the underlying etiology. Blood pressure targets should be individualized based on age, comorbidities, and presence of proteinuria. Lifestyle changes notably sodium restriction should be implemented in all patients in addition to the antihypertensive therapy. Blockers of the renin-angiotensin-aldosterone system should be the agents of choice in the treatment of hypertension in CKD because of their antiproteinuric and renoprotective effect.

Key words: Hypertension, chronic kidney disease, proteinuria, blood pressure monitoring, nephrosclerosis, cardiovascular diseases

How to cite this article: Leong Leanne CY, Chua HR, Khatri P. Contribution of Hypertension to Chronic Kidney Disease. Hypertens 2018;4(2): 119-124.

Source of support: Nil,

Conflict of interest: None

Received: 01-06-2018;

Accepted: 09-07-2018