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JAYPEE JOURNALS
International Scientific Journals from Jaypee
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1.  HYPERTENSION AND NEUROGENIC IMPACT
Hypertension and Ischemic Stroke
Sudhir Kumar
[Year:2016] [Month:January-March] [Volume:2 ] [Number:1] [Pages:53] [Pages No:39-43] [No of Hits : 801]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10043-0028 | FREE

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

 
2.  Status Report
Hypertension as a Public Health Problem in India
Rajeev Gupta
[Year:2015] [Month:July-September] [Volume:1 ] [Number:1] [Pages:61] [Pages No:1-3] [No of Hits : 607]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10043-0001 | FREE

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

 
3.  Review Article
Risk Assessment in Young Hypertensives
Niteen V Deshpande
[Year:2015] [Month:October-December] [Volume:1 ] [Number:2] [Pages:57] [Pages No:94-99] [No of Hits : 540]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10043-0016 | FREE

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

 
4.  PATHOPHYSIOLOGY OF HYPERTENSION
Metabolic Syndrome in the Indian Population: Public Health Implications
PP Mohanan
[Year:2016] [Month:January-March] [Volume:2 ] [Number:1] [Pages:53] [Pages No:1-6] [No of Hits : 319]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10043-0021 | FREE

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

 
5.  HYPERTENSION AND THE KIDNEY
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:53] [Pages No:28-34] [No of Hits : 312]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10043-0026 | FREE

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

 
6.  PATHOPHYSIOLOGY OF HYPERTENSION
White Crystals Controversy: Sugar rather than Salt as the Etiology of Hypertension
Tiny Nair
[Year:2016] [Month:January-March] [Volume:2 ] [Number:1] [Pages:53] [Pages No:7-9] [No of Hits : 266]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10043-0022 | FREE

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

 
7.  SECONDARY HYPERTENSION
Severe Paroxysmal Hypertension: Pseudopheochromocytoma
Samuel J Mann
[Year:2016] [Month:April-June] [Volume:2 ] [Number:2] [Pages:53] [Pages No:96-102] [No of Hits : 256]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10043-0038 | FREE

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

 
8.  CASE REPORT
An uncommon Case of Resistant Hypertension: Stenosis of Renal Artery
Mohsin Wali, Bhavya Tyagi
[Year:2016] [Month:January-March] [Volume:2 ] [Number:1] [Pages:53] [Pages No:51-53] [No of Hits : 253]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10043-0030 | FREE

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

 
9.  NEWER THERAPEUTIC INSIGHT
Sodium-Glucose Co-transporter 2 Inhibitor: A Perspective on Cardiovascular Risk Reduction in Type 2 Diabetes Mellitus
Gary E Sander, Camilo Fernandez, Philip J Kadowitz, Thomas D Giles
[Year:2016] [Month:July-September] [Volume:2 ] [Number:3] [Pages:80] [Pages No:139-144] [No of Hits : 238]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10043-0046 | FREE

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

 
10.  HYPERTENSION AND CARDIOVASCULAR DISEASE
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:53] [Pages No:21-27] [No of Hits : 217]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10043-0025 | FREE

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.

 
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