Hypertension Journal

1.COMPLICATIONS OF HYPERTENSION

Hypertension and Hemorrhagic Stroke

Sudhir Kumar
[Year:2017] [Month:April-June] [Volume:3 ] [Number:2] [Pages No:89-93] [No. of Hits: 21971]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0077]]

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.ENDOTHELIAL FACTORS IN METABOLIC SYNDROME

Endothelial Dysfunction and Metabolic Syndrome

Suegene K Lee, Jay Khambhati, Ankit Bhargava, Marc C Engels, Pratik B Sandesara, Arshed A Quyyumi
[Year:2017] [Month:April-June] [Volume:3 ] [Number:2] [Pages No:72-80] [No. of Hits: 8170]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0075]]

ABSTRACT

Atherosclerotic cardiovascular disease (ASCVD) continues to be the leading cause of death worldwide. Metabolic syndrome is associated with an increased risk of ASCVD. With the prevalence of metabolic syndrome continuing to increase, it is important to understand the relationship between these risk factors and development of ASCVD. Endothelial dysfunction (ED), an early, essential step in atherosclerotic plaque formation, is the key link. Here we review diagnostic methods of ED and the mechanisms of each metabolic syndrome component contributing to ED. Finally, the effects of current treatments of metabolic syndrome on ED will also be discussed.

Keywords: Atherosclerotic cardiovascular disease, Endothelial dysfunction, Metabolic syndrome.

How to cite this article: Lee SK, Khambhati J, Bhargava A, Engels MC, Sandesara PB, Quyyumi AA. Endothelial Dysfunction and Metabolic Syndrome. Hypertens J 2017;3(2):72-80.

Source of support: Nil

Conflict of interest: None

3.ENDOTHELIAL PATHOPHYSIOLOGY

Endothelial Dysfunction and Essential Hypertension

Jay Khambhati, Suegene K Lee, Bryan Kindya, Devinder Dhindsa, Pratik B Sandesara, Arshed A Quyyumi
[Year:2017] [Month:April-June] [Volume:3 ] [Number:2] [Pages No:81-88] [No. of Hits: 7102]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0076]]

ABSTRACT

Systemic hypertension is a chronic disorder of cardiovascular system characterized by an increase in systemic vascular resistance (SVR). Although the level of blood pressure is a product of SVR and cardiac output, it is the former which is responsible for chronic blood pressure elevation. A number of biochemical, biophysical, and neuro-humoral factors participate in the maintenance of SVR. Whatever the underlying molecular mechanism may be for elevated SVR, the end consequence is endothelial dysfunction. Normal endothelium promotes vasodilation and prevention of local thrombotic phenomena whereas abnormal endothelium promotes vasoconstriction and thrombotic processes. One of the basic pathophysiological aberrations in hypertension is abnormal endothelial function. A number of blood pressure lowering strategies (life-style modification and or anti-hypertensive drugs) result in reversing endothelial dysfunction in hypertension. Thus, endothelial function is considered both as a mechanism and a therapeutic target in hypertension. This review summarizes the physiology and pathophysiology of endothelium in hypertension.

Keywords: Aminothiols, Cardiovascular, Dimethylarginine, Hypertension.

How to cite this article: Khambhati J, Lee SK, Kindya B, Dhindsa D, Sandesara PB, Quyyumi AA. Endothelial Dysfunction and Essential Hypertension. Hypertens J 2017;3(2):81-88.

Source of support: AAQ is supported by the National Institutes of Health (NIH) grants 5P01HL101398-02, 1P20HL113451-01, 1R56HL126558-01, 1RF1AG051633-01, R01 NS064162- 01, R01 HL89650-01, HL095479-01, 1U10HL110302-01, 1DP3DK094346-01, 2P01HL086773-06A1.

Conflict of interest: None

4.Editorial

Physician—Heel Thyself

C Venkata S Ram
[Year:2017] [Month:April-June] [Volume:3 ] [Number:2] [Pages No:iv] [No. of Hits: 6106]
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ABSTRACT

Greetings to the readership of the Hypertension Journal. It gives me great pleasure to inform you that the Journal is doing very well in terms of academic recognition and acceptance by the medical community in South Asia. I want to thank the editorial board, contributors, and readers for making the Hypertension Journal, a flagship in South Asia.

5.CARDIOVASCULAR PHYSIOLOGY

Move Over Blood Pressure: Make Room for Cardiorespiratory Fitness as a Vital Sign

Nina Radford
[Year:2017] [Month:April-June] [Volume:3 ] [Number:2] [Pages No:51-57] [No. of Hits: 354]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0071]]

ABSTRACT

Cardiorespiratory fitness (CRF) describes the ability of an individual to perform physical exercise, an activity that relies on the cardiovascular system’s capacity to facilitate oxygen delivery to working muscles and the pulmonary system’s ability to clear carbon dioxide from the blood. Ideally, CRF is measured using cardiopulmonary stress testing (exercise with analysis of gas exchange). To enhance the feasibility of assessing CRF in large populations, prediction equations using only exercise variables were developed to provide measures of estimated CRF. More recently, nonexercise methods of assessing CRF have been developed. Using exercise (objective) methods of measuring CRF, a robust evidence base has developed describing the inverse association of CRF with total mortality, nonfatal cardiovascular events, incident cancer, cancer survival, chronic conditions, and dementia; CRF has also been shown to be inversely related to development of cardiac risk factors including hypertension. Because CRF provides a strong, graded inverse association with cardiovascular and all-cause mortality, recent American Heart Association scientific statements have vigorously promoted the concept of CRF as a vital sign: All adults should have an estimation of CRF included in their annual health care visits along with resting blood pressure (BP), heart rate, and body mass index (BMI). The addition of CRF as a vital sign provides enhanced risk prediction that can improve patient care and encourage the incorporation of physical activity (PA) programs into treatments plans aimed at improved health outcomes.

Keywords: Cardiorespiratory fitness, Cardiovascular disease, Hypertension, Physical activity, Prevention.

How to cite this article: Radford N. Move over Blood Pressure: Make Room for Cardiorespiratory Fitness as a Vital Sign. Hypertens J 2017;3(2):51-57.

Source of support: Nil

Conflict of interest: None

6.CARDIOVASCULAR PHYSIOLOGY

Circadian Rhythms: Attributes, Disruption and Implementation in cardiometabolic health

Narsingh Verma, Shipra Bharadwaj
[Year:2017] [Month:April-June] [Volume:3 ] [Number:2] [Pages No:58-63] [No. of Hits: 337]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0072]]

ABSTRACT

It is a well-known fact, proved by evidence, that all the organisms consist of an internal biological clock, right from the singlecelled organisms to humans. In the hierarchy of classification of vertebrate, these rhythms have shown to play an important role concerning the physiological aspects of all organisms. Not only are these rhythms related to sleep, seasonal migration, reproduction, etc., in animals, but also, in humans, circadian rhythms control various vegetative functions including regulation of temperature, cardiac activity, endocrine secretion, blood pressure (BP), oxygen utilization, metabolic rate, menstrual and ovarian cycles, and other body functions. The change in the normal pattern of the circadian clock because of genetic, behavioral, and various environmental factors can produce cardiovascular, metabolic, and endocrinal disorders including hypertension and diabetes. The concentration of glucose in plasma displays circadian variation; in the morning hours, it is the highest. Since the level of insulin depends on the feeding behavior, the glucose concentration follows the daily rhythm of intake of food. On the contrary, BP and other cardiovascular reflexes have characteristic and diurnal circadian rhythms. Circadian trends are exhibited in many cardiovascular pathophysiological conditions like stroke, myocardial infarction, rhythm disorders, and bed death syndrome. There is enough evidence to show that disruption of circadian rhythms can act as a risk factor for the development of cardiovascular diseases. Recent research also suggests that the circadian clock and associated central as well as peripheral genes are responsible for glucose and lipid metabolic rhythms.

Keywords: Cardiometabolic functions, Chronomics, Circadian rhytms, Midline estimating statistic of rhythm.

How to cite this article: Verma N, Bharadwaj S. Circadian Rhythms: Attributes, Disruption, and Implementation Cardiometabolic Health. Hypertens J 2017;3(2):58-63.

Source of support: Nil

Conflict of interest: None

7.PHYSICAL FITNESS

Physician Heal Thyself: Lead by Example—My Personal Tale of Physical Fitness

Uday M Jadhav
[Year:2017] [Month:April-June] [Volume:3 ] [Number:2] [Pages No:64-66] [No. of Hits: 6904]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0073]]

ABSTRACT

Exercise is the most effective antiaging pill ever discovered. This is a small commentary on my way of lifestyle modification for a better quality and peaceful existence.
To exercise for a physician who preaches lifestyle modifications is sacrificing professional work and the capital gains. Swimming has some element of aerobic and anaerobic metabolism; as the swim distance increases, so does the contribution of aerobic metabolism. Anaerobic work is best done at the fastest possible speeds. Anaerobic threshold along with aerobic threshold and VO2max constitutes the exercise physiology that make up the aerobic profile.
Shavasana which is an integral part of yoga sets in calmness of the mind and release of thoughts turning inward away from the more mundane things in life. The physiological benefits of deep relaxation are numerous, including those on control of heart rate and blood pressure. The practice of yoga and meditation recently had an endorsement from the American Heart Association in the first ever released guideline on meditation.

Kewwords: Exercise, Shavasana, Swimming, Yoga.

How to cite this article: Jadhav UM. Physician Heal Thyself: Lead by Example—My Personal Tale of Physical Fitness. Hypertens J 2017;3(2):64-66.

Source of support: Nil

Conflict of interest: None

8.EARLIER STAGE OF HYPERTENSION

Prehypertension: What to Do?

Arvind K Pancholia
[Year:2017] [Month:April-June] [Volume:3 ] [Number:2] [Pages No:67-71] [No. of Hits: 13917]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0074]]

ABSTRACT

Prehypertension (PHTN) is a global health problem that carries the risk of being prone to developing hypertension in the future along with double the risk of cardiovascular disease (CVD). Its prevalence is 25 to 50% based on data from different countries, and it varies with age, sex, birth weight, and body mass index (BMI). Regarding its pathophysiology, several mechanisms have been proposed, but the most validated are Ras activation, oxidative stress, inflammatory cytokines, sympathetic overdrive, and central nervous system activation. Therapeutic lifestyle changes are the foundation for all therapies in prehypertensive patients, which are recommended by almost all guidelines. Drug therapy has also been tried in a couple of trials and is recommended in high-risk patients.

Keywords: Dietary approaches to stop hypertension diet, Hypertension, Sodium

How to cite this article: Pancholia AK. Prehypertension: What to Do? Hypertens J 2017;3(2):67-71.

Source of support: Nil

Conflict of interest: None

9.NOVEL CONCEPT

Chronic Supplementation of Melatonin restores Impaired Circadian Rhythm in Patients with Coronary Artery Disease

Shipra Bhardwaj, Narsingh Verma, VS Narain, Vinod Kumar, Kshitij Bhardwaj, Saumya Mishra
[Year:2017] [Month:April-June] [Volume:3 ] [Number:2] [Pages No:94-100] [No. of Hits: 318]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0078]]

ABSTRACT

Blood pressure (BP) has a characteristic and reproducible circadian pattern with high values during the day and low values at night. Previous studies have shown that in patients with coronary artery disease (CAD), the nocturnal dip of BP is absent or blunted, which may be correlated to the reduced melatonin levels or altered melatonin–cortisol interplay. Our objective was to assess the effect of bedtime melatonin administration on circadian pattern of BP and heart rate (HR) in CAD patients. One hundred CAD patients were recruited for the study. General health records were individually maintained. Each study participant was given a 5 mg pure melatonin supplement each night at bedtime for a period of 1 year. A 24 hour/7 day ambulatory blood pressure monitoring (ABPM) using ambulatory blood pressure monitor and serum melatonin level estimations were done initially, after 6 months, and after 1 year of melatonin supplementation. The rhythmic parameters of systolic BP (SBP) and diastolic BP (DBP), HR, viz. midline-estimating statistic of rhythm (MESOR), double amplitude, acrophase, 3 hour fractionated hyperbaric index (HBI) were significantly reduced and serum melatonin concentration significantly increased after 6 and 12 months of exogenous melatonin supplementation. Circadian hyperamplitude tension (CHAT) incidence decreased as melatonin treatment progressed. The number of subject diagnosed with CHAT was as follows: 37/100 at the beginning, 17/100 after 6 months, and 6/100 after 12 months. These data suggest that 5 mg/day melatonin treatment improved and restored the circadian pattern of BP in CAD subjects.

Keywords: Ambulatory blood pressure monitoring, Circadian hyperamplitude tension, Coronary artery disease, Hyperbaric index, Melatonin.

How to cite this article: Bhardwaj S, Verma N, Narain VS, Kumar V, Bhardwaj K, Mishra S. Chronic Supplementation of Melatonin restores impaired Circadian Rhythm in Patients with Coronary Artery Disease. Hypertens J 2017;3(2):94-100.

Source of support: Nil

Conflict of interest: None

10.SECONDARY HYPERTENSION

Fibromuscular Dysplasia in Clinical Practice: A Case-based Review

K Jitender Reddy, K Pradyumna Reddy
[Year:2017] [Month:April-June] [Volume:3 ] [Number:2] [Pages No:101-104] [No. of Hits: 7863]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0079]]

ABSTRACT

Fibromuscular dysplasia (FMD) is an idiopathic, nonatherosclerotic, noninflammatory disease with segmental involvement of the blood vessels that cause abnormal growth within the wall of an artery in any region of body. Fibromuscular dysplasia has been found in nearly every arterial bed in the body. However, the most common arteries affected are the renal and carotid arteries. It is a heterogeneous group of vascular lesions characterized by an idiopathic, noninflammatory, and nonatherosclerotic angiopathy of small and medium-sized arteries. The prevalence of FMD is estimated between 4 and 6% in the renal arteries and between 0.3 and 3% in the cervicoencephalic arteries.
Imaging and radiologists play an important role in diagnosing the abnormality with knowledge of patient complaints with respect to fibromuscular disease. The most common imaging finding is dilatations, beaded appearance of vessels, and aneurysms. The less common findings are tortuous vessels, ectasia, kinking, loops, and dissection. The radiologist should be aware of these so that FMD can be diagnosed in young females with hypertension not responding well to treatment or familial hypertension.
Its signs and symptoms help the radiologist to diagnose early. The objective of this review is therefore to increase radiologists’ and clinicians’ awareness of FMD’s epidemiology, pathophysiology, clinical presentation, classical and minor/ rare radiological findings, and possible complications in other arteries in the abdomen.

Epidemiology: The prevalence is unknown. It is most common in young women with a female to male ratio of 3:1, and is typically diagnosed between the ages of 30 and 50 years. It is less than 2% of all hypertensions.

Keywords: Computed tomography angiography, Digital subtraction angiography, Fibromuscular dysplasia, Hypertension, Magnetic resonance angiography, Percutaneous transluminal angioplasty, Renal arteries, Renal artery stenosis.

How to cite this article: Reddy KJ, Reddy KP. Fibromuscular Dysplasia in Clinical Practice: A Case-based Review. Hypertens J 2017;3(2):101-104.

Source of support: Nil

Conflict of interest: None