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JAYPEE JOURNALS
International Scientific Journals from Jaypee
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1.  COMPLICATIONS OF HYPERTENSION
Hypertension and Hemorrhagic Stroke
Sudhir Kumar
[Year:2017] [Month:April-June] [Volume:3 ] [Number:2] [Pages:53] [Pages No:89-93] [No of Hits : 904]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10043-0077 | FREE

ABSTRACT

Hemorrhagic strokes are common and account for 20 to 30% of all strokes in India and the rest of Asia. Patients admitted with intracerebral hemorrhage (ICH) are usually sicker, and ICH is associated with worse outcomes (as compared with ischemic strokes). Hypertension is the commonest risk factor for spontaneous ICH, responsible for up to 80% of all cases of ICH, either alone or in combination with other etiological factors. Elevated blood pressure (BP) during the first few hours to days after ICH leads to worse outcomes (higher death and disability rates). This is because high BP is directly linked to hematoma expansion and increased mass effect. Therefore, rapid lowering of BP is recommended if systolic BP > 160 mm Hg. Intravenous labetalol and nicardipine are both equally safe and effective for this purpose. Survivors of ICH have a higher risk of developing recurrence of ICH both over the short term and over the long term. Aggressive BP lowering is recommended in ICH survivors postdischarge from the hospital. The target BP of <130/80 mm Hg should be maintained in them to reduce the risk of ICH recurrence.

Keywords: Antihypertensive agents, Hematoma, Hemorrhagic stroke, Hypertension, Intracerebral hemorrhage, Labetalol, Mortality, Nicardipine, Outcome, Perindopril, Recurrence.

How to cite this article: Kumar S. Hypertension and Hemorrhagic Stroke. Hypertens J 2017;3(2):89-93.

Source of support: Nil

Conflict of interest: None

 
2.  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 : 1203]
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

 
3.  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 : 1010]
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

 
4.  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 : 986]
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

 
5.  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 : 869]
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

 
6.  NEWER THERAPEUTIC INSIGHT
Angiotensin Receptor Neprilysin Inhibitor for the Treatment of Cardiovascular Diseases: A New Approach
Prabhash C Manoria, Pankaj Manoria, Nidhi Mishra
[Year:2016] [Month:July-September] [Volume:2 ] [Number:3] [Pages:80] [Pages No:145-152] [No of Hits : 843]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10043-0047 | FREE

ABSTRACT

A new revolution has begun in the management of chronic heart failure with reduced ejection fraction (CHFrEF). The new blockbuster angiotensin receptor neprilysin inhibitor (ARNI/LCZ696) has evoked a new concept of multisystem neurohormonal modulation, and indeed, this has shown an additional decrease in cardiovascular (CV) mortality on top of all standard evidence-based drugs for the treatment of CHFrEF, i.e., angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), beta blockers, and mineralocorticoid receptor antagonists (MRAs) coupled with diuretics. LCZ696 has two drugs, ARB valsartan and neprilysin inhibitor sacubitril, fused in a molecular complex. The combination provides a dual strategy of combating neurohormonal activation in heart failure (HF), i.e., by blocking harmful effect of renin-angiotensinaldosterone system by valsartan and simultaneously increasing the activation of vasoactive peptides by inhibiting neprilysin. It was evaluated in the PARADIGM-HF (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial, which produced a statistically significant dramatic reduction of 20% in the primary end point of a composite of death from CV cause and hospitalization for HF. The combination is well tolerated, and side effects are minimal. LCZ696 has been approved for clinical use and has been endorsed by the European Society of Cardiology and American College of Cardiology/American Heart Association/ Heart Failure Society of America 2016 guidelines. What is very exciting is that it has emerged as a replacement therapy for class I A drug (ACE/ARB) rather than as a mere add-on therapy, which is the usual story with any new drug. The drug is likely to be available in India in the near future.

Keywords: Angiotensin receptor neprilysin inhibitor review, Heart failure with reduced ejection fraction, PARADIGM-HF.

How to cite this article: Manoria PC, Manoria P, Mishra N. Angiotensin Receptor Neprilysin Inhibitor for the Treatment of Cardiovascular Diseases: A New Approach. Hypertens J 2016;2(3):145-152.

Source of support: Nil

Conflict of interest: None

 
7.  PATHOPHYSIOLOGY
Echocardiographic Evaluation of Left Ventricular Systolic and Diastolic Function in Hypertension
Amier Ahmad, Navin C Nanda
[Year:2016] [Month:July-September] [Volume:2 ] [Number:3] [Pages:80] [Pages No:113-117] [No of Hits : 841]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10043-0042 | FREE

ABSTRACT

Hypertension is a significant health problem, i.e., associated with considerable morbidity and mortality. The hallmark of hypertensive disease is a gradual increase in left ventricular (LV) mass, resulting in concentric hypertrophy and eventual diastolic dysfunction of the left ventricle secondary to LV stiffness and impaired relaxation. Late stages may be characterized by severe LV systolic dysfunction and dilatation. Echocardiography offers clinicians a quick, reliable, and inexpensive method of assessing changes in LV function resulting from hypertension. In this review, we summarize various echocardiographic parameters, including their advantages and disadvantages, and clinicians should be familiar with in order to ascertain an assessment of cardiovascular risk in hypertensive patients.

Keywords: Echocardiography, Hypertension, Left ventricular diastolic function, Lef t ventricular systolic function, Three-dimensional echocardiography, Two-dimensional echocardiography.

How to cite this article: Ahmad A, Nanda NC. Echocardiographic Evaluation of Left Ventricular Systolic and Diastolic Function in Hypertension. Hypertens J 2016;2(3):113-117.

Source of support: Nil

Conflict of interest: None

 
8.  THERAPEUTIC UPDATE
Therapeutic Role of Beta-blockers in Hypertension: A Pragmatic Reappraisal
Soumitra Kumar
[Year:2016] [Month:April-June] [Volume:2 ] [Number:2] [Pages:53] [Pages No:80-85] [No of Hits : 669]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10043-0036 | FREE

ABSTRACT

Beta-blockers have been used as first-time antihypertensives for decades and such use has also been recommended by guidelines. However, subsequently some meta-analyses questioned this status of beta-blockers by bringing to light their limitation in terms of stroke prevention and their metabolic sideeffects. Following this, several major international hypertension guidelines have removed beta-blockers from the first line of recommended drugs. Some other guidelines, however, have retained them as first-line antihypertensive. Age is an important determinant of choice of antihypertensives and beta-blockers have proven to be very useful in young hypertensives especially if overweight. Amidst these controversies, vasodilatory beta-blockers have emerged with a new promise. They are potent antihypertensives with better reduction of central aortic pressure and a neutral or favorable metabolic profile.

Keywords: Age, Metabolic effects, Stroke, Vasodilatory.

How to cite this article: Kumar S. Therapeutic Role of Betablockers in Hypertension: A Pragmatic Reappraisal. Hypertens J 2016;2(2):80-85.

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 : 649]
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.  MECHANISM
Blood Pressure Variability: Assessment, Prognostic Significance, and Management
Meenakshi Chenniappan
[Year:2016] [Month:July-September] [Volume:2 ] [Number:3] [Pages:80] [Pages No:124-130] [No of Hits : 586]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10043-0044 | FREE

ABSTRACT

Over the years, physicians and researches alike have tried to understand the parameter in blood pressure which would offer as an ideal risk marker to predict cardiovascular events. Our focus has shifted from diastolic pressure to systolic pressure to pulse pressure, etc. In spite of optimal control of all the above target pressures, hypertensive subjects still end up with stroke and high blood pressure has been noted as a defining factor in them. This has led to physicians identifying a phenomenon called blood pressure variability. Individuals exhibiting similar clinic or home blood pressure can differ considerably with respect to their average day and night time values, beat-bybeat blood pressure variation during wakefulness and sleep, responses to mental and physical stimuli, and intersession and seasonal variation. There is now evidence that several such representations of blood pressure variability, if augmented, increase cardiovascular risk independent of the average of conventionally acquired blood pressure readings.

Keywords: Antihypertensive drugs, β-blockers, Placebo.

How to cite this article: Chenniappan M. Blood Pressure Variability: Assessment, Prognostic Significance, and Management. Hypertens J 2016;2(3):124-130.

Source of support: Nil

Conflict of interest: None

 
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