Hypertension Journal

1.From the Desk of Editor-in-Chief

From the Desk of Editor-in-Chief

C Venkata S Ram

[Year:2016] [Month:October-December] [Volume:2 ] [Number:4] [Pages No:iv] [No. of Hits: 16338]


ABSTRACT

Greetings to the readers and supporters of the Hypertension Journal, and our best wishes for 2017. I am pleased to report to the editorial board and the readers that the journal had a remarkable 2016 in terms of visibility, appeal, respect, and national recognition. I want to thank the publishers, the editorial board, and reviewers for the success of the journal. And we will make additional progress, be assured.


2.COMMENTARIE

Current Use of Diuretics in the Management of Hypertension

Aram V Chobanian

[Year:2016] [Month:October-December] [Volume:2 ] [Number:4] [Pages No:181-182] [No. of Hits: 9746]


ABSTRACT

No single class of antihypertensive drugs has had as much impact on the treatment of hypertension as diuretics. The introduction in the late 1950s of chlorothiazide and its analogues revolutionized the treatment of hypertensio.

How to cite this article: Chobanian AV. Current Use of Diuretics in the Management of Hypertension. Hypertens J 2016;2(4):181-182.

Source of support: Nil

Conflict of interest: None


How to cite this article: Chobanian AV. Current Use of Diuretics in the Management of Hypertension. Hypertens J 2016;2(4):181-182.

Source of support: Nil

Conflict of interest: None

3.COMMENTARIE

Will the Systolic Blood Pressure Intervention Trial (SPRINT) change Treatment Targets in Hypertension?

Michael A Weber

[Year:2016] [Month:October-December] [Volume:2 ] [Number:4] [Pages No:183-188] [No. of Hits: 9470]


ABSTRACT

Most of the current guidelines recommend a target systolic blood pressure (SBP) of < 140 mm Hg when treating hypertension. However, in the recent systolic blood pressure intervention trial (SPRINT) study which compared targets of 140 and 120 mm Hg in patients at high cardiovascular risk and concluded that there were greater cardiovascular (CV) and mortality benefits at the lower target, including those patients aged above 75 years. The blood pressure (BP) measurement method in SPRINT was unconventional and the achieved SBP in the intensively treated patients corresponds to pressure in an orifice valve of about 130 mm Hg. Importantly, SPRINT excluded patients with diabetes or at low CV risk. These patients should be treated to <140 mm Hg since CV events may increase at more aggressive targets. In communities with limited resources it is often not possible to evaluate CV risk and <140 mm Hg should be the usual target; indeed, in Stage 1 hypertension, drug therapy can be delayed while lifestyle changes are tried.

Keywords: Cardiovascular risk, Hypertension guidelines, Systolic blood pressure, Systolic blood pressure intervention trial.

How to cite this article: Weber MA. Will the Systolic Blood Pressure Intervention Trial (SPRINT) change Treatment Targets in Hypertension? Hypertens J 2016;2(4):183-188.

Source of support: Nil

Conflict of interest: None


How to cite this article: Weber MA. Will the Systolic Blood Pressure Intervention Trial (SPRINT) change Treatment Targets in Hypertension? Hypertens J 2016;2(4):183-188.

Source of support: Nil

Conflict of interest: None

4.REVIEW ARTICLE

Heart Rate as a Marker of Cardiovascular Prognosis

Gino Seravalle, Guido Grassi

[Year:2016] [Month:October-December] [Volume:2 ] [Number:4] [Pages No:189-193] [No. of Hits: 9447]


ABSTRACT

Although several studies have shown that elevated heart rate (HR) is a powerful, independent, and consistent predictor of cardiovascular events and all-cause mortality, it is still considered an epiphenomenon of a general disorder rather than an independent risk factor. Several questions regarding the clinical significance of a resting HR as marker of cardiovascular risk are still unanswered, rendering the inclusion of this hemodynamic variable in the list of cardiovascular risk factors problematic, at least for time being. This paper will examine which HR value better reflects the cardiovascular risk, the predictive power, the complex pathophysiological mechanisms underlying the relationship between HR and cardiovascular risk. It will evaluate whether HR should be considered a true risk factor for cardiovascular diseases or simply a marker of autonomic imbalance, and finally, it will consider the effects of HR reduction on cardiovascular morbidity.

Keywords: Cardiovascular risk, Heart rate, Predictivity, Sympathetic nervous system.

How to cite this article: Seravalle G, Grassi G. Heart Rate as a Marker of Cardiovascular Prognosis. Hypertens J 2016;2(4):189-193.

Source of support: Nil

Conflict of interest: None


How to cite this article: Seravalle G, Grassi G. Heart Rate as a Marker of Cardiovascular Prognosis. Hypertens J 2016;2(4):189-193.

Source of support: Nil

Conflict of interest: None

5.THERAPEUTIC IMPLICATION

Clinical Implications of Recent Therapeutic Trials in Hypertension: Insights from SPRINT and HOPE-3 Trials

Prakash Deedwania, Tushar Acharya

[Year:2016] [Month:October-December] [Volume:2 ] [Number:4] [Pages No:194-199] [No. of Hits: 9543]


ABSTRACT

Hypertension is a global pandemic of ever growing proportions. It is the most important population attributable risk-factor for ischemic heart disease, stroke and cardiovascular mortality. Appropriate blood pressure (BP) control with antihypertensive agents reduces these cardiovascular complications but very tight BP control can lead to adverse effects like hypotension and renal dysfunction, especially in the elderly. Moreover, the relationship between BP and ischemic heart disease and all-cause mortality follows a J-shaped curve with a signal of higher mortality at low BP ranges. Blood pressure targets across various age and cardiovascular risk groups are not well defined. In the paucity of clinical trial data, many of the BP targets suggested by panels like the Joint National Committee are based on expert consensus. Two recent randomized clinical trials, Systolic Blood Pressure Intervention Trial (SPRINT) and Heart Outcomes Prevention Evaluation (HOPE-3), have extended our knowledge of the BP control paradigm. The SPRINT trial evaluated the benefits of intensive BP reduction to a target systolic BP of 120 mm Hg by addition/up-titration of various antihypertensive medications in a high-risk patient population. The HOPE-3 trial was a primary prevention trial that evaluated the utility of BP lowering in intermediate-risk patients without known cardiovascular disease using a fixed dose drug combination. These trials are discussed in detail in this review.

Keywords: Blood pressure, Clinical trials, Hypertension control.

How to cite this article: Deedwania P, Acharya T. Clinical Implications of Recent Therapeutic Trials in Hypertension: Insights from SPRINT and HOPE-3 Trials. Hypertens J 2016;2(4):194-199.

Source of support: Nil

Conflict of interest: None


How to cite this article: Deedwania P, Acharya T. Clinical Implications of Recent Therapeutic Trials in Hypertension: Insights from SPRINT and HOPE-3 Trials. Hypertens J 2016;2(4):194-199.

Source of support: Nil

Conflict of interest: None

6.THERAPEUTIC IMPLICATION

Renaissance of Chlorthalidone

Anil Pareek, Mahesh Abhyankar, Suraj Ghag

[Year:2016] [Month:October-December] [Volume:2 ] [Number:4] [Pages No:200-208] [No. of Hits: 10058]


ABSTRACT

Hypertension is the major cardiovascular (CV) risk factor and remains inadequately treated in most populations. Thiazides have been the mainstay of hypertension treatment, either as monotherapy or in combination with other antihypertensives.
The most overwhelming evidences of blood pressure (BP) reduction, CV risk reduction, stroke reduction and mortality reduction are demonstrated with chlorthalidone (CTD), established through many landmark studies including the latest SPRINT trial. Chlorthalidone has a longer elimination half life and is two-times more potent than hydrochlorothiazide (HCTZ). The 24 hours BP control, specially late-night to early-morning control is better with CTD compared to HCTZ.
The American Diabetes Association recommends various drugs including a thiazide diuretic to achieve BP targets. Despite a less favorable metabolic profile, initial therapy with thiazide-like diuretics offers similar, and in some instances possibly superior CV outcomes in older hypertensive adults with metabolic syndrome, as compared to treatment with calcium channel blockers (CCB) and angiotensin converting enzyme inhibitor (ACE-I).
Hypokalemia is the major concern associated with CTD use, probably because of use of high doses > 25 mg. Use of low-dose CTD, especially 6.25 mg, is not associated with any significant change in potassium and sodium levels. This further reduces the risk of new-onset diabetes. Published Indian evidence indicates that use of low-dose of CTD (6.25 mg) could reduce dose-related concerns about metabolic adverse effects.
Thiazide-type diuretics offer added beneficial effects in terms of reduced risk of hip and pelvic fractures in elderly. ALLHAT and SHEP study have demonstrated that development of incident diabetes with CTD did not have significant associations with CV mortality rate or total mortality rate.
In conclusion, the risk of diabetes associated with CTD should not discourage clinicians from using it long-term to reduce CV risks. CV risk reduction remains the ultimate goal of any antihypertensive therapy and the beneficial effects of CTD remain unsurpassed in this aspect.

Keywords: Hypertension, Chlorthalidone, Diuretics, Thiazides.

How to cite this article: Pareek A, Abhyankar M, Ghag S. Renaissance of Chlorthalidone. Hypertens J 2016;2(4):200-208.

Source of support: Nil

Conflict of interest: Authors are employed with IPCA laboratories Ltd. in research work of Chlorthalidone.


How to cite this article: Pareek A, Abhyankar M, Ghag S. Renaissance of Chlorthalidone. Hypertens J 2016;2(4):200-208.

Source of support: Nil

Conflict of interest: Authors are employed with IPCA laboratories Ltd. in research work of Chlorthalidone.

7.THERAPEUTIC LESSON IN HYPERTENSION

The Chlorthalidone Saga: How the US Medical Community was mislead in Past?

Franz H Messerli

[Year:2016] [Month:October-December] [Volume:2 ] [Number:4] [Pages No:209-210] [No. of Hits: 9558]


ABSTRACT

In this issue of the journal Pareek and colleagues provide a thorough, comprehensive review article on chlorthalidone (CTD). They report that in various global large trials like TOMHS, MRFIT, SHEP, ALLHAT, and SPRINT, CTD has reduced cardiovascular (CV) events, strokes, and, most importantly, mortality across various patient subgroups.

Keywords: Chlorthalidone, Hydrochlorothiazide, Thiazides.

How to cite this article: Messerli FH. The Chlorthalidone Saga: How the US Medical Community was mislead in Past? Hypertens J 2016;2(4):209-210.

Source of support: Nil

Conflict of interest: None


How to cite this article: Messerli FH. The Chlorthalidone Saga: How the US Medical Community was mislead in Past? Hypertens J 2016;2(4):209-210.

Source of support: Nil

Conflict of interest: None

8.HTN – DEVICE BASED THERAPY

Autonomic Neuromodulation through Devices for Hypertension

Atul Pathak, Benjamin Honton, Olivier Fondard, Nicolas Dumonteil, Didier Tchetche, Jean Fajadet

[Year:2016] [Month:October-December] [Volume:2 ] [Number:4] [Pages No:211-218] [No. of Hits: 11335]


ABSTRACT

Hypertension continues to be a major contributor for total and cardiovascular morbidity and mortality. This is directly related to lack in blood pressure control despite multiple pharmacological options available. This may occur not only as a rare consequence of true-resistant hypertension (RHTN) but also due to lack of adherence, or mostly the consequence, of adverse drug reactions. In recent years, there has been a rapid expansion of device-based therapies proposed as novel nonpharmacological approaches to treating hypertension. In this review, we discuss novel devices-renal nerve denervation, baroreflex activation therapy (BAT), carotid body (CB) ablation, central iliac arteriovenous anastomosis, deep brain stimulation (DBS), median nerve stimulation, and vagal nerve stimulation (VNS). We highlight the mechanism of action of devices, the level of evidence available to date, and ongoing or upcoming trials. This review also suggests appropriate device selection for different hypertension phenotypes.

Keywords: Arteriovenous anastomosis, Baroreflex activation, Carotid sinus stimulation, Coupler, Hypertension, Interventional devices, Renal denervation.

How to cite this article: Pathak A, Honton B, Fondard O, Dumonteil N, Tchetche D, Fajadet J. Autonomic Neuromodulation through Devices for Hypertension. Hypertens J 2016;2(4):211-218.

Source of support: Nil

Conflict of interest: None


How to cite this article: Pathak A, Honton B, Fondard O, Dumonteil N, Tchetche D, Fajadet J. Autonomic Neuromodulation through Devices for Hypertension. Hypertens J 2016;2(4):211-218.

Source of support: Nil

Conflict of interest: None

9.CSI 2016 ROUND-UP

Hypertension Capsule—Cardiological Society of India 2016: Swallow It!

Tiny Nair

[Year:2016] [Month:October-December] [Volume:2 ] [Number:4] [Pages No:219-220] [No. of Hits: 9506]


ABSTRACT

The 68th annual conference of the Cardiological Society of India was held at Kochi, Kerala, from December 8 to 11, 2016. An overall coverage of the most important topics on hypertension is summarized.

Keywords: Cardiological society of India annual conference 2016, Hypertension, Rosuvastatin.

How to cite this article: Nair T. Hypertension Capsule— Cardiological Society of India 2016: Swallow It! Hypertens J 2016;2(4):219-220.

Source of support: Nil

Conflict of interest: None


How to cite this article: Nair T. Hypertension Capsule— Cardiological Society of India 2016: Swallow It! Hypertens J 2016;2(4):219-220.

Source of support: Nil

Conflict of interest: None

10.BLOOD PRESSURE PHYSIOLOGY

Systolic and Diastolic Blood Pressure: Do We Add or Subtract to estimate the Blood Pressure Burden?

Tiny Nair

[Year:2016] [Month:October-December] [Volume:2 ] [Number:4] [Pages No:221-224] [No. of Hits: 9322] [No. of Citation: 3]


ABSTRACT

The parameters that are taken into account during diagnosis or treatment of hypertension are the systolic blood pressure (SBP) and the diastolic blood pressure (DBP). Also, the importance of pulse pressure (PP), which is the difference between SBP and DBP, has been highlighted in determining the outcome of hypertension. A radically new concept of blood pressure burden (BPB), which is the sum of SBP and DBP (SBP+DBP) is proposed.

Keywords: Blood pressure burden, Diastolic blood pressure, Hypertension, J curve, Physiology, Systolic blood pressure.

How to cite this article: Nair T. Systolic and Diastolic Blood Pressure: Do We add or subtract to estimate the Blood Pressure Burden? Hypertens J 2016;2(4):221-224.

Source of support: Nil

Conflict of interest: None


How to cite this article: Nair T. Systolic and Diastolic Blood Pressure: Do We add or subtract to estimate the Blood Pressure Burden? Hypertens J 2016;2(4):221-224.

Source of support: Nil

Conflict of interest: None

11.IMAGES IN HYPERTENSION

Pheochromocytoma

Kakarla S Rao

[Year:2016] [Month:October-December] [Volume:2 ] [Number:4] [Pages No:225-226] [No. of Hits: 9351] [No. of Citation: 85]


ABSTRACT

Pheochromocytomas are rare catecholamine-producing tumors derived from chromaffin cells; 10% of these are malignant, 10% are bilateral, and 10% are extra-adrenal. These are imaged with a variety of modalities including computed tomography, magnetic resonance imaging, scintigraphy, and rarely angiography.

Keywords: Hypertension, Imaging methods, Pheochromocytoma.

How to cite this article: Rao KS. Pheochromocytoma. Hypertens J 2016;2(4):225-226.

Source of support: Nil

Conflict of interest: None


How to cite this article: Rao KS. Pheochromocytoma. Hypertens J 2016;2(4):225-226.

Source of support: Nil

Conflict of interest: None