ABSTRACT

In ancient Indian Ayurvedic medicine, the quality of a patient’s pulse was correlated with cardiovascular health. A “hard pulse” was probably synonymous with the modern term “hypertension.” The history of hypertension of course would not be complete without describing Dr. Fredrick Akbar Mahomed’s contributions in the late 19th century. This Irish-Indian physician working in London at the Guy’s hospital first described conditions that later came to be known as “essential hypertension.” Some of his other important contributions were the demonstration that high blood pressure could exist in apparently healthy individuals, that high blood pressure was more prevalent in the elderly, and that the heart, kidneys, and brain could be affected negatively by high arterial pressure.^[1,2]

How to cite this article: Thomas S. Bisognano JD. Hypertens 2020. Hypertens 2020;6(1):1

Received: 12-03-2020;

Accepted: 30-03-2020

ABSTRACT

Blood pressure measurements in the office are strongly associated with cardiovascular disease morbidity and mortality, but do not correlate well with 24 h blood pressure values. Ambulatory blood pressure monitoring (ABPM) is a powerful tool for investigating the true blood pressure burden in individual patients and currently accepted as the gold standard for diagnosing hypertension. ABPM can improve cardiovascular risk stratification for individual patients and evaluate for other abnormal blood pressure phenotypes. Here, we review the use of APBM, summarize data suggesting the superior predictive value of ABPM for cardiovascular disease, and practical applications for its clinical use.

Keywords: Ambulatory blood pressure monitoring, hypertension, cardiovascular disease, masked hypertension

How to cite this article: Sabescumar J, Drury ER. Ambulatory Blood Pressure Monitoring. Hypertens 2020;6(1): 2-6.

Received: 12-03-2020;

Accepted: 30-03-2020

ABSTRACT

Most patients who develop primary hypertension are treated with medications despite lifestyle changes. For providers, determining when to start medications can be confusing as guidelines frequently change and determining which medication to start can also be challenging. In general, medication is initiated after assessing a patient’s risk for developing atherosclerotic cardiovascular disease using risk calculators as well as their medical comorbidities. Target blood pressure, time for follow-up, and initial medication(s) vary among patients. Firstline agents include thiazide diuretics, calcium channel blockers, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. Second-line agents include beta-blockers, diuretics, alpha-1 antagonists, alpha-2 agonists, and direct-acting vasodilators. It is important to note that not all classes of blood pressure-lowering medications are considered equal and each patient’s unique medical comorbidities should always be taken into account before initiating treatment. These medications have their own respective side effects and contraindications that providers should be aware of so that they can monitor for adverse reactions as well as council their patients.

Keywords: Angiotensin receptor blocker, angiotensin-converting enzyme inhibitor, atherosclerotic cardiovascular risk score, calcium channel blockers, hypertension, thiazide diuretics

How to cite this article: Gupta N, Schallek R. A Broad Review of Hypertension Pharmacology. Hypertens 2020;6(1): 7-11.

Received: 12-03-2020;

Accepted: 30-03-2020

ABSTRACT

More than a quarter of the population of both the United States and India have a diagnosis of hypertension (HTN). HTN can lead to multiorgan dysfunction, including hypertensive heart disease. Despite the well understood morbidity and mortality associated with HTN, only 48.3% of the United States’ and 10.7–20.2% of India’s hypertensive population are adequately treated. Hypertensive heart disease is the result of a complex interplay of several factors, which expose the patient to an increased risk of dysrhythmias and sudden cardiac death. Management of dysrhythmias in the setting of hypertensive heart disease is similar to normotensive patients, but with a focus on optimal blood pressure, which can often reverse the pathologic cardiac remodeling and reduce the burden of dysrhythmias.

Keywords: Hypertension, Blood Pressure, Dysrhythmias, Arrhythmias, India, United States, US

How to cite this article: Byrnes T, Huang D. Dysrhythmias and Hypertension. Hypertens 2020;6(1): 12-17.

Received: 12-03-2020;

Accepted: 30-03-2020

ABSTRACT

Hypertension is one of the leading causes of End Stage Renal Disease (ESRD) worldwide. The diagnosis and true prevalence estimates remain variable and challenging due the lack of a standardized definition. Most of the recommendations are based on expert opinions rather than high quality data. Ambulatory blood pressure measurement (ABPM) is the preferred method of diagnosing hypertension in this population but may not be readily available. Multiple factors are involved in the pathogenesis of hypertension ESRD including volume overload and impaired sodium balance, activation of the sympathetic nervous system and activation of the renin angiotensin aldosterone system. Management of hypertension in dialysis patients involves adjustment to dialysis prescription with meticulous attention to salt and water balance and dry weight. Pharmacological therapy is subsequently added if the blood pressure remains uncontrolled. There is no evidence supporting the use of one agent over another and the decision is generally individualized and made on the basis of any accompanying comorbidities. This review focuses on the current state of diagnosis and treatment of hypertension in ESRD patients.

Keywords: Blood pressure, dialysis, end stage renal disease, hypertension

How to cite this article: Gupta S, Liebman SE. Hypertension in End-Stage Renal Disease. Hypertens 2020;6(1): 18-23.

Received: 12-03-2020;

Accepted: 30-03-2020

ABSTRACT

The ability to consistently obtain accurate blood pressure measurements in the office setting has significant implications for the categorization, risk stratification, and treatment of hypertension at both a societal and individual level. However, obtaining consistently accurate assessments of blood pressure in the outpatient setting is a difficult task. Currently, there is a significant controversy in regard to the optimal method for measuring outpatient blood pressure given the multitude of devices, techniques, and practice guidelines available. In this review, we discuss the pros and cons for different measurement techniques, the most common sources of clinical error, and current guideline recommendations for the optimal timing and method for reliable outpatient blood pressure assessment.

Keywords: Diagnostic techniques and procedures, blood pressure determination, blood pressure monitoring, ambulatory

How to cite this article: Ayers B, Goodman A, Thomas S. Obtaining Accurate In-Office Blood Pressure Readings. Hypertens 2020;6(1): 24-27.

Received: 12-03-2020;

Accepted: 30-03-2020

ABSTRACT

Hypertension in pregnancy is an important cause of maternal morbidity and mortality, and also has a substantial effect on fetal outcomes. In addition, it portends a higher risk of cardiovascular disease for women later in their lives. Thus, it is critical that physicians identify hypertension during the gestational period, and treat it appropriately. First-line agents for treatment typically include beta-blockers and calcium-channel blockers.

Keywords: Hypertension, pregnancy, women’s health

How to cite this article: Armenia E, Vornovitsky M. Hypertension in Pregnancy. Hypertens 2020;6(1):28-29.

Received: 12-03-2020;

Accepted: 30-03-2020

ABSTRACT

Objectives: This article will discuss three questions. 1. Is there a link between hypertension and cognitive impairment? 2. Can treatment of hypertension prevent or slow down cognitive decline? 3. Which group of hypertensive patients are at higher risk for developing dementia? The relation between hypertension and cognitive function has been the subject of discussion and research for many years; recently, there has been a trend toward lower blood pressure goals and earlier intervention, this was implemented in the Eighth Joint National Committee (JNC 8) guidelines and adopted by the American Heart Association in 2017 as well as the European Society of Cardiology in 2018, these changes reflect the results of major clinical trials. Although the available data are promising in regard to better cardiovascular and mortality outcomes with lower blood pressure targets, their effect on cognitive decline is still uncertain. In this article, we review recent published literature studying the link between hypertension and cognitive impairment. We review the current understanding of the pathophysiology and identify the challenges facing the scientific community in ongoing and future studies. Identifying high-risk individuals as potential targets for aggressive monitoring and treatment is explored. We also review some of the suggested pharmacological and non-pharmacological intervention strategies to tackle this global epidemic.

Keywords: Cognitive impairment, dementia, hypertension

How to cite this article: Jebaje ZA, Williams G. A Review Article of Hypertension and Cognitive Decline. Hypertens 2020;6(1): 30-32.

Received: 12-03-2020;

Accepted: 30-03-2020

ABSTRACT

Left ventricular hypertrophy (LVH) is a manifestation of arterial hypertension and is an independent risk factor for cardiovascular disease morbidity and mortality. Both concentric and eccentric LVH independently increase risk of sudden cardiac death, coronary artery disease, arrhythmias, as well as congestive heart failure (CHF). Hypertension precedes the diagnosis of heart failure in the majority of patients with newly diagnosed CHF and remains the most important cause of diastolic heart failure. Treatment aimed at reducing left ventricular (LV) mass improves outcomes in such patients. Treatment with angiotensin converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor neprilysin inhibior, and aldosterone receptor blockers have been shown to significantly decrease LV mass. SGLT2 Inhibitors are emerging as a new class of medications that have been shown to improve cardiac outcomes likely through their effects on LV remodeling and diastolic function. In this review article we will focus on LVH and cardiovascular outcomes.

Keywords: Hypertension, Left Ventricular Hypertrophy, Heart Failure Preserved ejection fraction, Sodium Glucose Co-Transporter 2 Inhibitors

How to cite this article: Corbett JA, Naqvi SY, Bajwa FA. Hypertension, Left Ventricular Hypertrophy, and Heart Failure. Hypertens 2020;6(1): 33-37.

Received: 12-03-2020;

Accepted: 30-03-2020