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

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

Positive effect of cpap treatment on the control of difficult-to-treat hypertension. (Eur Respir J. 2007)

Drug Side-Effects and Interactions

A Meta-Analysis of 94,492 Patients With Hypertension Treated With ß-Blockers to Determine the Risk of New Onset Diabetes Mellitus (The American Journal of Cardiology 2007) "In conclusion, ß blockers are associated with an increased risk for new-onset DM, with no benefit for the end point of death or myocardial infarction and with a 15% increased risk for stroke compared with other agents. This risk was greater in patients with higher baseline body mass indexes and higher baseline fasting glucose levels and in studies in which ß blockers were less efficacious antihypertensive agents compared with other treatments."

Doctors Urged to Curb Reliance on Beta Blockers "Doctors should stop routinely using beta-blockers to control high blood pressure, said researchers who reviewed dozens of previously published studies and found that other hypertension pills work better and cause fewer side effects. For decades, beta-blockers and diuretics, also known as water pills, constituted the cornerstone of treatment for the 50 million Americans with high blood pressure. But a growing body of medical evidence shows that diuretics and newer blood-pressure medications are superior to beta-blockers at reducing high blood pressure, which can lead to heart attacks and strokes, said researchers whose report appeared Monday in the Journal of the American College of Cardiology. "

Use of beta-blockers for uncomplicated hypertension in the elderly: a cause for concern. (J Hum Hypertens. 2007)

Drugs

Choice of first antihypertensive – are existing guidelines ignored? (British Journal of Clinical Pharmacology 2007)

Systematic Review: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers for Treating Essential Hypertension. (Ann Intern Med. 2007) "CONCLUSION: Available evidence shows that ACE inhibitors and ARBs have similar effects on blood pressure control, and that ACE inhibitors have higher rates of cough than ARBs. Data regarding other outcomes are limited."

[Diuretic-based therapy.] (Nephrol Ther. 2007)

Angiotensin receptor blockers versus angiotensin-converting enzyme inhibitors: where do we stand now? (Am J Cardiol. 2007)

The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Heart Failure Validation Study: Diagnosis and Prognosis (Am Heart J. 2007) "Conclusions: An independent review of source documentation showed a high degree of agreement with the HF diagnoses assigned by site physicians and confirmed the higher risk of HF associated with first-step therapy using amlodipine, lisinopril, or doxazosin compared with chlorthalidone. Thiazide-type diuretics should be the preferred first-step therapy for prevention of HF in high-risk patients with hypertension."

Beta-blockers for hypertension. (Cochrane Database Syst Rev. 2007) "AUTHORS' CONCLUSIONS: The available evidence does not support the use of beta-blockers as first-line drugs in the treatment of hypertension. This conclusion is based on the relatively weak effect of beta-blockers to reduce stroke and the absence of an effect on coronary heart disease when compared to placebo or no treatment. More importantly, it is based on the trend towards worse outcomes in comparison with calcium-channel blockers, renin-angiotensin system inhibitors, and thiazide diuretics."

Exercise

Impact of exercise (walking) on blood pressure levels in African American adults with newly diagnosed hypertension. (Ethn Dis. 2007) "CONCLUSIONS: The findings of this study indicate that walking an extra 30 minutes a day is associated with lower mean blood pressure among adult African Americans with newly diagnosed hypertension."

The potential anti-inflammatory benefits of improving physical fitness in hypertension. (J Hypertens. 2007) "Hypertension is associated with an increased risk of stroke and atherosclerosis. In addition to elevated blood pressure, hypertension is characterized by neuroendocrine and immune activation, including elevated levels of C-reactive protein, inflammatory cytokines, and soluble adhesion molecules, which are predictive of morbidity and mortality outcomes. Pharmacological treatment for hypertension reduces blood pressure, but has limited effectiveness in reducing the accompanying inflammation and its associated morbidity and mortality. … Here, exercise is promoted as a potentially effective treatment for both the elevated blood pressure and chronic inflammation found in hypertension."

Cardiorespiratory fitness and risk of nonfatal cardiovascular disease in women and men with hypertension. (Am J Hypertens. 2007) "CONCLUSIONS: In adults with HTN, higher CRF is associated with lower risk of nonfatal CVD events, independent of other clinical risk predictors."

Too Old to Benefit from Sports? The Cardiovascular Effects of Exercise Training in Elderly Subjects Treated for Isolated Systolic Hypertension. (Kidney Blood Press Res. 2007) "Conclusion: The exercise-induced reduction of BP, which is mediated by improved endothelial function, is independent of pulse pressure. Thus, physical exercise is a helpful adjunct to control BP even in old hypertensives with markedly increased arterial stiffness."

Exercise training helps control blood pressure "The results showed that exercise training seemed to improve the nerve reflexes that help control blood pressure and heart rate. This was associated with a drop in blood pressure for the hypertensive patients."

Effect of exercise on blood pressure control in hypertensive patients. (Eur J Cardiovasc Prev Rehabil. 2007) "Endurance training decreases blood pressure through a reduction in systemic vascular resistance, in which the sympathetic nervous system and the renin-angiotensin system appear to be involved, and favourably affects concomitant cardiovascular risk factors. The few available data suggest that resistance training can reduce blood pressure. Exercise is a cornerstone therapy for the prevention, treatment and control of hypertension."

Aerobic exercise improves cardiorespiratory fitness but does not reduce blood pressure in prehypertensive African American women. (Ethn Dis. 2007) "CONCLUSIONS: Ten weeks of 30 minutes of aerobic exercise, three times a week at 70% VO2 peak, is a sufficient stimulus to improve cardiorespiratory fitness and workload achieved. However, this exercise regimen was not adequate in eliciting a simultaneous reduction in systolic, diastolic, or mean arterial blood pressure in this cohort of prehypertensive African American women. Additional studies are needed to determine specific exercise protocols that would be effective in lowering blood pressure in various populations. These exercise protocols may vary across ethnicity, sex, and disease status."

General Information

When Treating High Blood Pressure, Simplicity is Best, Study Suggests

Importance of aggressive blood pressure lowering when it may matter most. (Am J Cardiol. 2007) "Variation in blood pressure levels follows a reproducible circadian pattern, characterized by low levels during sleep and a rapid increase during the early-morning period. The incidence of cardiovascular events displays a similar circadian variation, with peak occurrence coinciding with the early-morning blood pressure surge. Numerous prospective studies have shown that blood pressure measured over a 24-hour period is superior to clinic blood pressure in predicting future cardiovascular events. Thus, the use of ambulatory blood pressure monitoring (ABPM) to identify patients at risk of cardiovascular events could improve the management of the patient with hypertension. ABPM has also become widely adopted to evaluate antihypertensive therapeutic options that might provide blood pressure reduction throughout the 24-hour dosing interval."

Choice of First Antihypertensive: Simple as ABCD? (American Journal of Hypertension 2007)

Why physicians who treat hypertension should know more about air pollution. (J Clin Hypertens (Greenwich). 2007)

[Medical treatment of pulmonary arterial hypertension.] (Ann Cardiol Angeiol (Paris). 2007)

Changes in cognitive measures associated with a lifestyle program for treated hypertensives: a randomized controlled trial (ADAPT). (Health Educ Res. 2007)

Discontinuation of beta-Blockers and the Risk of Myocardial Infarction in the Elderly. (Drug Saf. 2007) "CONCLUSION: Overall, discontinuation of beta-blockers was not associated with an increased risk of myocardial infarction. However, when analysed by beta-blocker subgroup, cessation of selective beta-blockers was associated with an increased risk of myocardial infarction during the first 180 days after discontinuation."

Severe hypokalemia, rhabdomyolysis, muscle paralysis, and respiratory impairment in a hypertensive patient taking herbal medicines containing licorice. (Intern Med. 2007)

Prevalence of comorbidities and their influence on blood pressure goal attainment in geriatric patients. (Am J Geriatr Cardiol. 2007) "At least 1 comorbidity was present in 88% of patients, and 61% had multiple comorbidities. The most common comorbidity was isolated systolic hypertension. The presence of diabetes or isolated systolic hypertension at initial visit and treatment with a thiazide diuretic at the final clinic visit were associated with significantly higher odds of patients not achieving blood pressure goal. A diagnosis of heart failure was associated with lower odds of not achieving blood pressure goal. These issues should be given special consideration during the evaluation, treatment selection, and long-term monitoring of this population."

A lifestyle program for treated hypertensives improved health-related behaviors and cardiovascular risk factors, a randomized controlled trial. (J Clin Epidemiol. 2007) "CONCLUSION: Improvements in behaviors and risk factors, several maintained long term, suggest the potential for long-term benefits in hypertensives."

Guidelines

The 2007 revised ESC/ESH Guidelines in the management of hypertension: clarifying individual patient care

Guidelines Updated for Treatment of Pulmonary Arterial Hypertension

New European guidelines on hypertension "The overall goal for blood-pressure reduction has remained the same—to lower BP to 140/90 mm Hg in the large majority of people. However, there has been a change in the recommendation for those with comorbidities, de Backer said. For example, there is a new goal of 130/80 mm Hg for people with established cardiovascular disease or diabetes. In terms of treatment recommendations, he said the new guidelines shy away from recommending one particular class of antihypertensive over another as first-line therapy; rather they emphasize the importance of selecting therapy for each individual, according to any comorbidities they may have. "We have noted the five important drug classes—diuretics, calcium-channel blockers, ACE inhibitors, beta blockers, and angiotensin-receptor blockers," he said. But from then on, "if we have to make a choice it should depend on comorbidities." "

The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2 -- therapy. (Can J Cardiol. 2007) "RECOMMENDATIONS: Dietary lifestyle modifications for prevention of hypertension, in addition to a well-balanced diet, include a dietary sodium intake of less than 100 mmol/day. In hypertensive patients, the dietary sodium intake should be limited to 65 mmol/day to 100 mmol/day. Other lifestyle modifications for both normotensive and hypertensive patients include: performing 30 min to 60 min of aerobic exercise four to seven days per week; maintaining a healthy body weight (body mass index of 18.5 kg/m2 to 24.9 kg/m2) and waist circumference (less than 102 cm in men and less than 88 cm in women); limiting alcohol consumption to no more than 14 units per week in men or nine units per week in women; following a diet reduced in saturated fat and cholesterol, and one that emphasizes fruits, vegetables and low-fat dairy products, dietary and soluble fibre, whole grains and protein from plant sources; and considering stress management in selected individuals with hypertension. . "

NGC - Hypertension guidelines. (2005)

Immunotherapy

Internet Sites

Treatment Information

DrugBank (drug structure)

FDA - MedWatch (Drug Alerts)

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

DrugDigest (drug interactions)

FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

NIH - Drug, Supplements, and Herbal Information

NIH - Herbal Supplements: Consider Safety, Too

NIH - Medicines

NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

Effect of 'No added salt diet' on blood pressure control and 24 hour urinary sodium excretion in mild to moderate hypertension. (BMC Cardiovascular Disorders 2007) "After 6 week of 'no added salt diet' systolic and diastolic BP significantly decreased during the day (mean decrease: 12.1 /6.8 mmhg) and at night (mean decrease: 11.1/5.9 mmhg ) which is statistically significant in comparison to control group (P 0.001 and 0.01)."

n-3 Fatty acids, hypertension and risk of cognitive decline among older adults in the Atherosclerosis Risk in Communities (ARIC) study. (Public Health Nutr. 2007) "ConclusionOne implication from our study is that diets rich in fatty acids of marine origin should be considered for middle-aged hypertensive subjects. To this end, randomised clinical trials are needed."

Effect of Soy Nuts on Blood Pressure and Lipid Levels in Hypertensive, Prehypertensive, and Normotensive Postmenopausal Women (Arch Intern Med. 2007)

Other

Other Treatments

Radiotherapy

Supplements-Vitamins-CAM

Quercetin reduces blood pressure in hypertensive subjects. (J Nutr. 2007) "These data are the first to our knowledge to show that quercetin supplementation reduces blood pressure in hypertensive subjects. Contrary to animal-based studies, there was no quercetin-evoked reduction in systemic markers of oxidative stress."

Fish oil supplementation improves large arterial elasticity in overweight hypertensive patients. (Eur J Clin Nutr. 2007)

Coenzyme Q10 in hypertension

Randomized Trial of Acupuncture to Lower Blood Pressure (Circulation. 2007)

Lowering homocysteine with B vitamins has no effect on blood pressure in older adults. (J Nutr. 2007)

Supplementation with vitamins C and e improves arterial stiffness and endothelial function in essential hypertensive patients. (Am J Hypertens. 2007) "CONCLUSIONS: Combined treatment with vitamins C and E has beneficial effects on endothelium-dependent vasodilation and arterial stiffness in untreated, essential hypertensive patients. This effect is associated with changes in plasma markers of oxidative stress."

Coenzyme Q10 in the treatment of hypertension: a meta-analysis of the clinical trials (Journal of Human Hypertension (2007)) "We conclude that coenzyme Q10 has the potential in hypertensive patients to lower systolic blood pressure by up to 17 mm Hg and diastolic blood pressure by up to 10 mm Hg without significant side effects."

Juice Powder Concentrate and Systemic Blood Pressure, Progression of Coronary Artery Calcium and Antioxidant Status in Hypertensive Subjects: A Pilot Study (Evidence-based Complementary and Alternative Medicine 2007) "The phytonutrient concentrate we utilized induced several favorable modifications of markers of vascular health in the subjects. This study supports the notion that plant nutrients are important components of a heart healthy diet."

Coenzyme Q(10) in the treatment of hypertension: a meta-analysis of the clinical trials. (J Hum Hypertens. 2007) "We conclude that coenzyme Q(10) has the potential in hypertensive patients to lower systolic blood pressure by up to 17 mm Hg and diastolic blood pressure by up to 10 mm Hg without significant side effects."

Surgery

Transplantation

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