Hypertension Journal

1.SECONDARY HYPERTENSION

Severe Paroxysmal Hypertension: Pseudopheochromocytoma

Samuel J Mann
[Year:2016] [Month:April-June] [Volume:2 ] [Number:2] [Pages No:96-102] [No. of Hits: 19361]
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  • [Abstract]
  • [DOI : [DOI : 10.5005/jp-journals-10043-0038]]

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

2.EDITORIAL COMMENTARY

World Hypertension League: Its Scope, Purpose, and Impact in South Asia

Daniel T Lackland, C Venkata S Ram
[Year:2016] [Month:April-June] [Volume:2 ] [Number:2] [Pages No:55-56] [No. of Hits: 12440]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0031]]

ABSTRACT

How to cite this article: Lackland DT, Ram CVS. World Hypertension League: Its Scope, Purpose, and Impact in South Asia. Hypertens J 2016;2(2):55-56.

Source of support: Nil

Conflict of interest: None

3.HYPERTENSION AND DIABETES

Sodium Glucose Cotransporter-2 Inhibitors in Clinical Practice: Impact beyond Glycemic Control

Karthik Rao N, KM Prasanna Kumar
[Year:2016] [Month:April-June] [Volume:2 ] [Number:2] [Pages No:74-79] [No. of Hits: 14056]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0035]]

ABSTRACT

Type 2 diabetes mellitus is a metabolic disorder that occurs due to an interplay of multiple perplexing pathophysiological mechanisms and leads to hyperglycemia. However, till date there has been no single unique molecule that can by itself effectively address all the metabolic abnormalities occurring in type 2 diabetes. Furthermore, type 2 diabetes must be managed with agents that can combat hyperglycemia without causing hypoglycemia and adverse cardiovascular outcomes. Thus, the need of the hour is for a unique molecule that can deliver beyond glycemic control and can in addition address the cardiovascular risk factors that arise in type 2 diabetes. Sodium glucose cotransporter-2 (SGLT-2) inhibitors are the latest of the oral hypoglycemic agents that act by insulin-independent mechanisms and tackle several cardiovascular risk factors that occur in type 2 diabetes. The scope of this article will be to focus primarily on the cardiovascular benefits of SGLT-2 inhibitors and its actions beyond glycemic control in providing a comprehensive care in the management of type 2 diabetes.

Keywords: Cardiovascular safety, Extra antihyperglycemic actions, Review, Sodium glucose cotransporter-2 inhibitors, Type 2 diabetes.

How to cite this article: Rao NK, Kumar KMP. Sodium Glucose Cotransporter-2 Inhibitors in Clinical Practice: Impact beyond Glycemic Control. Hypertens J 2016;2(2):74-79.

Source of support: Nil

Conflict of interest: None

4.SALT AND BLOOD PRESSURE

Dietary Salt and Blood Pressure: Verdict is Clear, so why Any Debate?.

Norm RC Campbell, Francesco P Cappuccio
[Year:2016] [Month:April-June] [Volume:2 ] [Number:2] [Pages No:57-59] [No. of Hits: 20597]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0032]]

ABSTRACT

Repeated reviews of the evidence to produce recommendations for dietary salt intake have been conducted by independent committees of national and international scientific and governmental organizations. These recommendations support reducing dietary salt to less than 6 gm/day and many to less than 5 gm/day. Nevertheless, there is controversy about recommendations to reduce dietary salt. This commentary discusses low quality research studies and commercial interests as sources of the controversy. Especially, research that assesses usual salt intake in individuals based on a single spontaneously voided (spot) urine sample is discussed as a weak research method prone to erroneous findings. Further, some investigators have altered scientific formula to make their data using spot urine samples appear more robust and made misleading and false statements about evidence relating to dietary salt. Counterintuitive findings based on studies that have used spot urine samples is frequently disregarded in expert committee review given the low quality evidence is incompatible with higher quality evidence which shows direct linear relationships between dietary salt, hypertension and cardiovascular disease in the general population.

Keywords: Blood pressure, Cardiovascular disease, Conflict of interest, Diet, Hypertension, Nutrition, Public health, Salt, Sodium.

How to cite this article: Campbell NRC, Cappuccio FP. Dietary Salt and Blood Pressure: Verdict is Clear, so why Any Debate? Hypertens J 2016;2(2):57-59.

Source of support: Nil

Conflict of interest: None

5.MECHANISMS OF HYPERTENSION

Evaluation of Sympathetic Activity in Hypertension

Poghni A Peri-Okonny, Wanpen Vongpatanasin
[Year:2016] [Month:April-June] [Volume:2 ] [Number:2] [Pages No:60-64] [No. of Hits: 12566]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0033]]

ABSTRACT

The sympathetic nervous system (SNS) plays a major role in the pathogenesis of hypertension and contributes to hypertensive target organ complications. Advances in technology over the last three decades have improved the ability to measure sympathetic nerve activity (SNA), thus enabling investigators to probe the role of SNS in the development of cardiovascular diseases. The most direct method of measuring SNA employs the technique of microneurography, which involves recording of postganglionic sympathetic action potential using a subcutaneous electrode inserted into the candidate nerve. This method allows assessment of sympathetic vasoconstrictor discharge to the peripheral circulation in hypertension and provides prognostic information in patients with cardiovascular diseases. However, application of microneurography and other methods of assessment of SNS activity, including norepinephrine spillover and imaging of SNS innervation, in routine clinical practice is limited by availability of the technique and lack of normal reference range established from large population-based data. Nevertheless, these measurements provide further insight into mechanisms of hypertension and effectiveness of various interventions in modifying sympathetic regulation of blood pressure.

Keywords: Hypertension, Microneurography, Muscle sympathetic nerve activity, Norepinephrine spillover, Renal denervation, Sympathetic nerve activity.

How to cite this article: Peri-Okonny PA, Vongpatanasin W. Evaluation of Sympathetic Activity in Hypertension. Hypertens J 2016;2(2):60-64.

Source of support: Nil

Conflict of interest: None

6.TARGET ORGAN DAMAGE

Small Vessel Disease of the Brain and Stroke: Association with Clinic and Ambulatory Blood Pressure

Puneet Gupta, William B White
[Year:2016] [Month:April-June] [Volume:2 ] [Number:2] [Pages No:65-73] [No. of Hits: 12637]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0034]]

ABSTRACT

Several potential vascular risk factors exist for the development and accumulation of small vessel disease of the brain and stroke in older people. In older people followed up for several years, we and others have reported that white matter hyperintensity lesions on magnetic resonance imaging nearly doubled in volume and were associated with alterations in neurologic function. In this article, we review blood pressure (BP) as a risk factor for the development and pathogenesis of small vessel disease and stroke in older persons. The research efforts have focused on ambulatory BP measurements, which have proven to be a stronger indicator than clinic pressures for the progression of small vessel disease in older people as well as the development of stroke. Based on relations among 24 hours systolic BP levels, the accrual of small vessel disease, and relations with cognitive function and mobility, we have designed the INFINITY trial, a novel interventional study that uses ambulatory BP to guide antihypertensive therapy addressed at improving functional decline.

Keywords: Ambulatory blood pressure, Cerebral small vessel disease, Stroke, Systolic hypertension.

How to cite this article: Gupta P, White WB. Small Vessel Disease of the Brain and Stroke: Association with Clinic and Ambulatory Blood Pressure. Hypertens J 2016;2(2):65-73.

Source of support: National Institutes of Health R01AG022092

Conflict of interest: None

7.THERAPEUTIC UPDATE

Therapeutic Role of Beta-blockers in Hypertension: A Pragmatic Reappraisal

Soumitra Kumar
[Year:2016] [Month:April-June] [Volume:2 ] [Number:2] [Pages No:80-85] [No. of Hits: 12948]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0036]]

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

8.SECONDARY HYPERTENSION

Renovascular Hypertension

Ashish Nandwani, Vijay Kher
[Year:2016] [Month:April-June] [Volume:2 ] [Number:2] [Pages No:86-95] [No. of Hits: 18165]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0037]]

ABSTRACT

Renovascular disease caused by renal artery stenosis leading to reduced renal perfusion can produce a range of clinical conditions ranging from incidental finding on angiography without any hemodynamic significance to renovascular hypertension (RVH) with or without ischemic and hypertensive renal injury. A fall in renal perfusion pressure is sufficient to initiate RVH that only occurs when 70 to 80% of artery lumen is occluded. Atherosclerosis, fibromuscular dysplasia, and vasculitis involving the renal arteries are the leading causes of renovascular disease. With improvement in imaging studies, significant renal artery stenosis is detected more often than before. Management includes medical therapy aiming at blood pressure control and cardiovascular risk factor management. Renal revascularization is considered in patients with deteriorating renal functions and resistant hypertension.

Keywords: Atherosclerotic renovascular disease, Fibromuscular dysplasia, Percutaneous transluminal renal angioplasty, Renin–angiotensin–aldosterone system, Renovascular hypertension.

How to cite this article: Nandwani A, Kher V. Renovascular Hypertension. Hypertens J 2016;2(2):86-95.

Source of support: Nil

Conflict of interest: None

9.IMAGES IN HYPERTENSION

Fibromuscular Dysplasia of Renal Artery

Kakarla S Rao
[Year:2016] [Month:April-June] [Volume:2 ] [Number:2] [Pages No:103-104] [No. of Hits: 10332]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0039]]

ABSTRACT

Fibromuscular dysplasia (FMD) of the renel artery is one of the etiological factors of secondary hypertension. The etiology is unknown. Conventional radiography is ideal when interventional methods are planned. The beaded appearance is the typical appearance of FMD on angiogram.

Keywords: Fibromuscular dysplasia, Idiopathic, Nonatherosclerotic.

How to cite this article: Rao KS. Fibromuscular Dysplasia of Renal Artery. Hypertens J 2016;2(2):103-104.

Source of support: Nil

Conflict of interest: None

10.CASE REPORT

Primary Hyperaldosteronism: Typical Clinical Manifestations

Amit A Bharadiya, GS Karthik, DVSNL Sharma, V Shanta Ram
[Year:2016] [Month:April-June] [Volume:2 ] [Number:2] [Pages No:105-107] [No. of Hits: 12452]
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  • [DOI : [DOI : 10.5005/jp-journals-10043-0040]]

ABSTRACT

A 34-year-old lady presented to the hospital with symptoms of headache and exertional dyspnea. On examination, she was found to have blood pressure of 180/120 mm Hg, which was confirmed and her blood pressure was unresponsive to standard antihypertensive therapy. She had easily inducible and unprovoked hypokalemia even on small doses of diuretic. The possibility of primary hyperaldosteronism was considered. Her plasma aldosterone was high with low plasma renin activity, confirming the biochemical diagnosis of hyperaldosteronism. She underwent workup with computed tomography of the abdomen that showed left adrenal mass, likely an adenoma. After proper medical preparation, she underwent laparoscopic adrenalectomy. Upon successful removal of the adrenal mass, her aldosterone, renin, potassium, and blood pressure levels were normalized. This case illustrates classical features of primary hyperaldosteronism with clinical diagnostic and therapeutic considerations.

Keywords: Hypokalemia, Primary hyperaldosteronism, Secondary hypertension.

How to cite this article: Bharadiya AA, Karthik GS, Sharma DVSNL, Ram VS. Primary Hyperaldosteronism: Typical Clinical Manifestations. Hypertens J 2016;2(2):105-107.

Source of support: Nil

Conflict of interest: None