Hypertension Journal

1.PATHOPHYSIOLOGY

Prehypertension: Does It Still Matter?

Shawna D Nesbitt

[Year:2016] [Month:July-September] [Volume:2 ] [Number:3] [Pages No:109-112] [No. of Hits: 12133]


ABSTRACT

Prehypertension was introduced in the JNC staging of blood pressure in 2003. The rationale for this classification was the progressive nature of hypertensive disease. Recently clinical trials have demonstrated clear benefits of treatment to blood pressure levels of 120/80 mm Hg, which is the lower threshold of prehypertension. Furthermore other trials suggest that early treatment may be more important in long-term risk reduction rather than immediate risk reduction. These new findings raise questions regarding the current classification and use of medication in the range of prehypertensive blood pressure.

Keywords: Blood pressure, Hypertension, Prehypertension. How to cite this article: Nesbitt SD. Prehypertension: Does It Still Matter? Hypertens J 2016;2(3):109-112.

Source of support: Nil

Conflict of interest: None


2.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 No:113-117] [No. of Hits: 13236]


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


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

3.PATHOPHYSIOLOGY

Proteinuria in Nondiabetic Patients: Clinical Significance

Vijay Viswanathan, A Anitha Rani

[Year:2016] [Month:July-September] [Volume:2 ] [Number:3] [Pages No:118-123] [No. of Hits: 15900] [No. of Citation: 1]


ABSTRACT

Proteinuria is a major health care problem, which affects millions of peoples globally. It is a characteristic of Diabetic Nephropathy and a strong indicator of kidney disease and renal dysfunction. It occurs in different forms with varied degree of severity. Proteinuria can be classified based on the amount and type of the protein and the pathological damage. Process involved in proteinuria is complex and multifactorial which includes tubular absorption, hemodynamics of glomerular and diffusion gradients. A continuous function of kidney is necessary for regular urine formation. In normal physiological condition urine is free of protein and this action was efficiently performed by nephrons in the kidneys. Nephrons play a major role in filtration and reabsorption. Thus kidney disease is associated with the malfunction of reabsorption mechanism.

Keywords: Clinical, Diabetes, Glomerular filtration, Proteinuria, Renal function.

How to cite this article: Viswanathan V, Rani AA. Proteinuria in Nondiabetic Patients: Clinical Significance. Hypertens J 2016;2(3):118-123.

Source of support: Nil

Conflict of interest: None


How to cite this article: Viswanathan V, Rani AA. Proteinuria in Nondiabetic Patients: Clinical Significance. Hypertens J 2016;2(3):118-123.

Source of support: Nil

Conflict of interest: None

4.MECHANISM

Blood Pressure Variability: Assessment, Prognostic Significance, and Management

Meenakshi Chenniappan

[Year:2016] [Month:July-September] [Volume:2 ] [Number:3] [Pages No:124-130] [No. of Hits: 23130] [No. of Citation: 32]


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


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

5.MECHANISM

Hypertension and Pregnancy: Mechanisms and Management

Mie Saiki, Vesna D Garovic

[Year:2016] [Month:July-September] [Volume:2 ] [Number:3] [Pages No:131-138] [No. of Hits: 12554]


ABSTRACT

Hypertensive pregnancy disorders encompass a spectrum of conditions, including preeclampsia, a multisystem hypertensive disease that is unique to pregnancy, eclampsia, and gestational and chronic hypertension. Severe forms of preeclampsia, including its convulsive form - eclampsia - represent obstetrical emergencies, the therapy of which is immediate delivery. The goal of antihypertensive therapy in these patients is to prevent maternal cardiac, cerebrovascular, and renal complications. Central to the medical management of hypertension in pregnancy is the careful balance between maternal benefits from improved blood pressure control and fetal risks from intrauterine drug exposure and changes in uteroplacental perfusion. Women with chronic hypertension and hypertension onset before pregnancy should undergo prepregnancy counseling regarding medication safety during pregnancy and evaluation for end-organ damage, which will help define their blood pressure goals during pregnancy. Women with gestational hypertension (hypertension onset in the second half of pregnancy) require close monitoring for signs of progression to preeclampsia. Adequate care of these patients relies on regular follow-ups, judicious use of antihypertensive medications, and close monitoring for early signs of preeclampsia. While these patients are typically cared for by high-risk obstetricians, input from internists and related subspecialties increasingly is being recognized as important for optimization of patient blood pressure treatment and overall pregnancy outcomes.

Keywords: Blood pressure management, Hypertensive pregnancy disorders, Preeclampsia.

How to cite this article: Saiki M, Garovic VD. Hypertension and Pregnancy: Mechanisms and Management. Hypertens J 2016;2(3):131-138. Source of support: Nil Conflict of interest: None


How to cite this article: Saiki M, Garovic VD. Hypertension and Pregnancy: Mechanisms and Management. Hypertens J 2016;2(3):131-138. Source of support: Nil Conflict of interest: None

6.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 No:139-144] [No. of Hits: 15159]


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


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

7.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 No:145-152] [No. of Hits: 13299] [No. of Citation: 1]


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


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

8.RESISTANT HYPERTENSION

Clinical Perspective

David A Calhoun

[Year:2016] [Month:July-September] [Volume:2 ] [Number:3] [Pages No:153-159] [No. of Hits: 13103]


ABSTRACT

Resistant or difficult-to-treat hypertension is a common clinical problem affecting 10 to 15% of treated hypertensive patients. Effective management of resistant hypertension firstly requires distinguishing pseudo-resistant from true resistant hypertension. Common causes of pseudo-resistance include inaccurate blood pressure (BP) measurement, white coat effect, poor medication adherence, and undertreatment. Pharmacologic treatment of resistant hypertension requires use of effective multidrug antihypertensive regimens, including especially diuretic therapy. An initial three-drug regimen of an angiotensinconverting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB), amlodipine, and a long-acting thiazide diuretic is recommended. Chlorthalidone is recommended as the preferred thiazide diuretic of choice given its long half-life and superior efficacy. A large body of literature now clearly establishes spironolactone as the most effective fourth medication for treatment of resistant hypertension. Renal nerve denervation (RND) is under intensive investigation to determine its true antihypertensive benefit, especially for treating uncontrolled resistant hypertension. Recent studies suggest that while the technique will likely provide some benefit in terms of additional BP reduction, it will not likely cure patients of their resistant hypertension as most subjects participating in studies of RND have generally continued medical therapy with use of the same or nearly the same number of medications. Accordingly, clinicians, even with the availability of renal nerve derivation, will have to remain facile in prescribing multiple drug combinations for treating resistant hypertension.

Keywords: Chlorthalidone, Renal nerve denervation, Resistant hypertension, Spironolactone.

How to cite this article: Calhoun DA. Clinical Perspective. Hypertens J 2016;2(3):153-159.

Source of support: This work was supported by NIH grant RO1 HL113004.

Conflict of interest: Dr Calhoun has received grant support from Medtronic and Valencia Technologies. He also serves as a consultant for Valencia Technologies.


How to cite this article: Calhoun DA. Clinical Perspective. Hypertens J 2016;2(3):153-159.

Source of support: This work was supported by NIH grant RO1 HL113004.

Conflict of interest: Dr Calhoun has received grant support from Medtronic and Valencia Technologies. He also serves as a consultant for Valencia Technologies.

9.RESISTANT HYPERTENSION

Revival of Renal Denervation Therapy for Hypertension: Real Hope or just a Dream?

Venkatesh K Raman, Vasilios Papademetriou

[Year:2016] [Month:July-September] [Volume:2 ] [Number:3] [Pages No:160-168] [No. of Hits: 10769]


ABSTRACT

The sympathetic nervous system (SNS) has long been recognized as important to the initiation and maintenance of hypertension. From groundbreaking experimental physiology in the 1850s to single nerve fiber studies more than one 100 years later, the growing body of preclinical evidence supports this framework and has informed attempts at therapeutic clinical intervention. Prior to the availability of long-term oral antihypertensive therapy in the mid-1950s, operative approaches to SNS interruption were of variable efficacy and sometimes limiting side effects. Surgery was then abandoned as a panoply of drugs were introduced and shown to be effective in reducing blood pressure and, more importantly, decreasing major cardiovascular events. Despite the availability of dozens of agents, a small but significant percentage of patients do not achieve target pressures on multiple medications and are characterized as resistant or refractory. Nonsurgical, catheter-delivered radiofrequency ablation (RFA) to achieve renal SNS denervation has emerged as an option in these patients. Early clinical studies suggested marked reductions in office-based blood pressures. Results of the pivotal, sham-controlled SYMPLICITY HTN-3 study, however, were disappointing and did not show a significant difference in blood pressure reduction between treated and control groups. Post hoc analyses suggest that incomplete denervation was an important contributor to the much smaller blood pressure effect compared with earlier trials. Additional clinical anatomic and preclinical studies have greatly elucidated the distribution of sympathetic nerves in the renal periarterial space and provided insight into broad principles that might successfully move the field forward. A number of newer treatment platforms that include multielectrode RFA, focused high-energy ultrasound, and local periarterial delivery of neurolytics seem to justify the cautious enthusiasm that renal denervation (RDN) will eventually fulfill its promise in the treatment of resistant hypertension and perhaps other syndromes characterized by sympathetic overactivity.

Keywords: Ambulatory blood pressure monitoring, Norepinephrine, Radiofrequency ablation, Renal denervation, Renal sympathetic nervous activity, Sympathetic nervous system.

How to cite this article: Raman VK, Papademetriou V. Revival of Renal Denervation Therapy for Hypertension: Real Hope or just a Dream? Hypertens J 2016;2(3):160-168.

Source of support: Nil

Conflict of interest: None


How to cite this article: Raman VK, Papademetriou V. Revival of Renal Denervation Therapy for Hypertension: Real Hope or just a Dream? Hypertens J 2016;2(3):160-168.

Source of support: Nil

Conflict of interest: None

10.RESISTANT HYPERTENSION

Device-based Therapies for Hypertension

Debbie L Cohen

[Year:2016] [Month:July-September] [Volume:2 ] [Number:3] [Pages No:169-177] [No. of Hits: 11097]


ABSTRACT

Hypertension is a major public health issue and due to poor blood pressure (BP) control rates, worldwide, alternative nonpharmacological therapies are being sought to help improve blood pressure control. There are multiple catheter-based renal denervation (RDN) devices that are available and being studied in various hypertensive populations. The procedure has been shown to be safe, but the efficacy has been variable and enthusiasm for the procedure has been tempered particularly after the negative results from the largest RDN sham-controlled study - SYMPLICITY HTN-3 study. New studies are underway in investigating this technology in patients with less severe hypertension using a dual approach of a group off medication and a group on one to three standard antihypertensive medications. The rationale behind this study design is that in untreated hypertension, this approach will isolate the blood pressure lowering effect of the RDN procedure itself, and in the group assigned to standard antihypertensives, this study design will evaluate the effect of RDN in the presence of a standardized medication regimen. Other innovative noninvasive methods of RDN including a noninvasive ultrasound technology are also being investigated. Baroreceptor inhibition is also continuing to be studied by investigating a newer more patient-friendly device using a unilateral carotid baroreceptor stimulator. Other newer innovative technologies and devices are also discussed including ethanol-based sympathicolysis of the renal nerves and use of an arteriovenous fistula (AVF) device to lower blood pressure. All these methodologies should be considered experimental and cannot be recommended currently for clinical care.

Keywords: Baroreceptor inhibition, Catheter-based renal denervation, Hypertension, Sympathetic nervous system.

How to cite this article: Cohen DL. Device-based Therapies for Hypertension. Hypertens J 2016;2(3):169-177.

Source of support: Nil

Conflict of interest: None


How to cite this article: Cohen DL. Device-based Therapies for Hypertension. Hypertens J 2016;2(3):169-177.

Source of support: Nil

Conflict of interest: None

11.IMAGES IN HYPERTENSION

Primary Aldosteronism

Kakarla Subbarao

[Year:2016] [Month:July-September] [Volume:2 ] [Number:3] [Pages No:178-179] [No. of Hits: 9752]


ABSTRACT

Primary aldosteronism (PA) is an important secondary cause of hypertension. Although rare, PA should be suspected in patients with resistant hypertension who demonstrate unexplained hypokalemia. Correct diagnosis of the condition leads to appropriate medical or surgical therapy which can improve and/or cure the condition.

Keywords: Adrenal gland, Chemical-shift, Primary aldosteronism. How to cite this article: Subbarao K. Primary Aldosteronism. Hypertens J 2016;2(3):178-179.

Source of support: Nil

Conflict of interest: None