Hypertension

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Hypertension

NIH - Medical Encyclopedia: Essential hypertension

"Essential hypertension refers to high blood pressure with no identifiable cause. ...Usually, high blood pressure has no symptoms at all. That is why it is often called the 'silent killer.' "

Highlighted Article

Natural antioxidants from tomato extract reduce blood pressure in patients with grade-1 hypertension: a double-blind, placebo-controlled pilot study. (Am Heart J. 2006)

"A short-term treatment with antioxidant-rich tomato extract can reduce blood pressure in patients with grade-1 HT, naive to drug therapy."

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Hypertension

Diagnosis, Imaging, and Screening

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Ambulatory blood pressure monitoring as an investigative tool for characterizing resistant hypertension and its rational treatment. (J Clin Hypertens (Greenwich). 2007) "For example, ambulatory BP monitoring may be useful in verifying 24-hour control in high-risk patients whose office BP appears to be normal at rest or during the peak effect time of their antihypertensive agents. Evidence is mounting from studies that support the use of ambulatory BP monitoring in patients with resistant hypertension at the time of diagnosis and following clinically guided therapy."

Both daytime and nighttime blood pressure predict future risk "Both daytime and nighttime blood pressure are vital prognostic indicators, and therefore blood pressure should be recorded during the whole day, according to the results of a new study [1]. … They note that, in keeping with the views from previous published work that higher nighttime than daytime blood pressure has the worse prognosis, the current results do suggest that such people were at a higher risk of death from all causes than were those with a normal night-to-day ratio. However, the fully adjusted night-to-day ratio of systolic blood pressure was a weak predictor of fatal combined with nonfatal end points. Both antihypertensive treatment and reverse causality might explain this discrepancy, they say."

Circadian variation of blood pressure: The basis for the chronotherapy of hypertension. (Adv Drug Deliv Rev. 2007) "In most individuals, BP presents a morning increase, a small post-prandial valley, and a deeper descent during nocturnal rest. However, under certain pathophysiological conditions, the nocturnal BP decline may be reduced or even reversed. This cannot be determined by traditional clinical or home BP assessments. Subjects with a diminished nocturnal BP decline (non-dipper pattern) have a significantly worse prognosis than the ones with a normal dipper pattern. In particular, the non-dipper circadian BP pattern represents a risk factor for left ventricular hyperthropy, microalbuminuria, cerebrovascular disease, congestive heart failure, vascular dementia and myocardial infarction."

Estimating the proportion of young adults on antihypertensive treatment that have been correctly diagnosed. (J Hum Hypertens. 2007) "Because of biological variation in blood pressure, most young adults on treatment for hypertension have been misclassified as hypertensive. Most who have been correctly diagnosed are either clinically obese or have kidney disease."

Home Blood Pressure Is as Reliable as Ambulatory Blood Pressure in Predicting Target-Organ Damage in Hypertension (American Journal of Hypertension 2007) "These data suggest that home BP is as reliable as ambulatory monitoring in predicting hypertension-induced target-organ damage, and is superior to carefully taken office measurements."

How reliable is isolated clinical hypertension defined by a single 24-h ambulatory blood pressure monitoring? (Journal of Hypertension 2007) "Conclusions: These findings clearly indicate that: (i) the classification of ICH on the basis of a single ABPM, using the cut-offs suggested by major hypertension guidelines, has a limited short-term reproducibility and (ii) repeated ABPM recordings should be recommended to correctly diagnose patients with ICH and improve cardiovascular risk stratification."

Prognostic significance of variability in ambulatory and home blood pressure from the Ohasama study. (J Epidemiol. 2007) "A disturbed nocturnal decline in BP is associated with cerebral infarction and heart diseases, whereas a large morning pressor surge and a large nocturnal decline in BP, which are analogous to a large diurnal increase in BP, are both associated with cerebral hemorrhage. A high BP at various times of the day is associated with different subtypes of cerebrovascular and cardiovascular disease risk. Home BP in the morning and in the evening provide equally useful information for stroke risk, whereas morning hypertension, which is that specifically observed only in the morning, might be a good predictor of stroke, particularly among individuals using anti-hypertensive medication. The BP and heart rate variabilities estimated as standard deviation measured every 30 minutes by ambulatory monitoring are independent predictors."

Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7030 individuals. (J Hypertens. 2007) "OBJECTIVE: To investigate the multivariate-adjusted predictive value of systolic and diastolic blood pressures on conventional (CBP) and daytime (10-20 h) ambulatory (ABP) measurement. … CONCLUSIONS: ABP is superior to CBP in predicting cardiovascular events, but not total and noncardiovascular mortality. Cardiovascular risk gradually increases from normotension over white-coat and masked hypertension to sustained hypertension."

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