Hypertension

• Diagnosis, Imaging, Screening
• General Information
• Guidelines
• Internet Sites
• Risk Factors
• Risk Reduction
• Treatment

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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.' "

NIH - High blood pressure (Hypertension) (Medical Encyclopedia) “Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as 2 numbers. For example, 140 over 90 (written as 140/90). • The top number is your systolic pressure, the pressure created when your heart beats. It is considered high if it is consistently over 140. • The bottom number is your diastolic pressure, the pressure inside blood vessels when the heart is at rest. It is considered high if it is consistently over 90. Either or both of these numbers may be too high. Pre-hypertension is when your systolic blood pressure is between 120 and 139 or your diastolic blood pressure is between 80 and 89 on multiple readings. If you have pre-hypertension, you are more likely to develop high blood pressure at some point. … Most of the time, no cause is identified. This is called essential hypertension. High blood pressure that results from a specific condition, habit, or medication is called secondary hypertension. Too much salt in your diet can lead to high blood pressure. Secondary hypertension may also be due to: • Adrenal gland tumor • Alcohol poisoning • Anxiety and stress • Appetite suppressants • Arteriosclerosis • Birth control pills • Certain cold medicines • Coarctation of the aorta • Cocaine use • Cushing syndrome • Diabetes • Kidney disease, including: o Glomerulonephritis (inflammation of kidneys) o Kidney failure o Renal artery stenosis o Renal vascular obstruction or narrowing • Migraine medicines • Hemolytic-uremic syndrome • Henoch-Schonlein purpura • Obesity • Pain • Periarteritis nodosa • Pregnancy (called gestational hypertension) • Radiation enteritis • Renal artery stenosis • Retroperitoneal fibrosis • Wilms' tumor “

NHS - Blood pressure (high) “Causes of high blood pressure There are two types of high blood pressure: • essential (or primary) high blood pressure - where there is no identifiable cause, and • secondary high blood pressure - where high blood pressure is the result of an underlying cause, such as kidney disease, or a particular type of medication that you are taking. Essential high blood pressure While the cause of essential high blood pressure remains unknown, there is compelling evidence to show that there are number of risk factors which increase your chances of developing the condition. These risk factors include: • age - the risk of developing high blood pressure increases as you get older, • a family history of high blood pressure - the condition seems to run in families, • being of Afro-Caribbean or South Asian origin, • obesity, • lack of exercise, • smoking, • excessive alcohol consumption, • high amount of salt in your diet, • high fat diet, and • stress. A number of other medical conditions have also been linked to an increase chance in developing essential high blood pressure, such as diabetes and kidney disease. Secondary high blood pressure A small amount of cases of high blood pressure (approximately 5%) are the result of an underlying condition or cause. These include: • kidney conditions, such as a kidney infection, or kidney disease, • narrowing of the arteries, • hormonal conditions, such as Cushing's syndrome (a condition where your body produces an excess of steroid hormones), • conditions affecting the tissue of the body, such as lupus (a condition where your immune system attacks healthy tissue), • medicines, such as the oral contraceptive pill, or the type of painkillers known as nonsteriodal anti-inflammatory drugs (NSAIDs), such as ibuprofen, • excessive alcohol consumption, and • illegal stimulants, such as cocaine, amphetamine and crystal meth”

Highlighted Articles

Prognostic Significance of Between-Arm Blood Pressure Differences (Hypertension. 2008) “Every 10-mm Hg difference in systolic BP between the arms conferred a mortality hazard of 1.24 (95% CI: 1.01 to 1.52) after adjusting for average systolic BP and chronic kidney disease. BP differences between arms are reproducible and carry prognostic information. Patients should have evaluation of BP in both arms at the screening visit.”

Salt intake, blood pressure and clinical outcomes. (Current Opinion in Nephrology & Hypertension. 2008) “Summary: Average sodium consumption in the US population is excessively high, and well above recommended limits. Because most sodium derives from processed and restaurant foods, a reduction of sodium in these sources, as recently called for by the American Medical Association, is necessary to reduce exposure.”

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

Drug Side-Effects and Interactions

Drugs

Fifty years of thiazide diuretic therapy for hypertension. (Arch Intern Med. 2009)

Four Basics And Some Good Information About Beta-Blocker Treatment For High Blood Pressure “Beta-blockers are a family of medicines also known as beta-adrenergic blocking agents. When you take beta blockers, the heart beats more slowly and with less force, reducing blood pressure. For these medicines to be effective, it is very important that they are taken regularly and without interruption, as prescribed by the doctor.”

Blood pressure lowering efficacy of diuretics as second-line therapy for primary hypertension. (Cochrane Database Syst Rev. 2009)

Blood pressure lowering efficacy of alpha blockers for primary hypertension. (Cochrane Database Syst Rev. 2009)

Blood pressure lowering efficacy of loop diuretics for primary hypertension. (Cochrane Database Syst Rev. 2009)

First-line drugs for hypertension. (Cochrane Database Syst Rev. 2009)

Exercise

Exercise Prescription for the Prevention and Management of Hypertension (American Journal of Lifestyle Medicine 2009)

Acute effects of continuous and interval aerobic exercise on 24-h ambulatory blood pressure in long-term treated hypertensive patients (International Journal of Cardiology 2009) “CE and IE reduced ambulatory BP in treated HPT, increasing the number of patients reaching normal ambulatory BP values. These effects suggest that continuous and interval aerobic exercise may have a role in BP management in treated HPT.”

Effects of Low-Intensity Exercise Conditioning on Blood Pressure, Heart Rate, and Autonomic Modulation of Heart Rate in Men and Women with Hypertension. (Biol Res Nurs. 2009) "The results show that systolic and diastolic blood pressure and R-R interval decreased and spontaneous baroreflex sensitivity increased in the exercise group. The decline in blood pressure was significant statistically and clinically. The increase in spontaneous baroreflex sensitivity indicates that the ability of the cardiovascular system to respond rapidly to changing stimuli improved after the 12-week walking protocol. The low-intensity exercise conditioning program achieved a training effect in this population."

General Information

Characterization and treatment of resistant hypertension. (Curr Cardiol Rep. 2009)

Pharmacotherapy for hypertension in the elderly. (Cochrane Database Syst Rev. 2009)

Effects of Dietary Sodium Reduction on Blood Pressure in Subjects With Resistant Hypertension (Hypertension. 2009) “These results indicate that excessive dietary sodium ingestion contributes importantly to resistance to antihypertensive treatment. Strategies to substantially reduce dietary salt intake should be part of the overall treatment of resistant hypertension.”

Blood Pressure Can Be Lowered By Reducing Salt Intake

No Benefit in Lowering BP Below "Standard" 140/90 mm Hg “A new review has found that lowering blood pressure below the "standard" target of 140/90 mm Hg is not beneficial in terms of reducing mortality or morbidity [1]. … "The Lewington meta-analysis of one million patients has convincingly shown that people fare better—ie, have fewer strokes and heart attacks—when their 'usual' BP is 115/70 mm Hg compared with those with a 'usual' BP of 130/80," Messerli adds. "However there are no data and probably never will be that lowering BP from 130/80 mm Hg to 115/70 mm Hg confers any benefits," he says. Attempting to achieve lower BP targets has several consequences, the researchers note; "the most obvious is the need for large doses and increased number of antihypertensive drugs. This has inconvenience and economic costs to patients. More drugs and higher doses will also increase adverse drug effects, which if serious could negate any potential benefit associated with lower BP." There is also the potential that lowering BP too much may cause adverse cardiovascular events, the so-called "J-curve" phenomenon, they observe.”

Guidelines

Practical strategies for management of hypertension in the elderly (Geriatrics 2009)

NGF - Hypertension diagnosis and treatment. (2008)

Canadian Hypertension Guidelines Expressly Warn Against ARB/ACE-Inhibitor Combo--Should Others Follow?

NGC - Hypertension evidence-based nutrition practice guideline (2008)

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

Dealing With High-blood Pressure? Eat More Melons “Nutrition experts at UT Southwestern Medical Center say there's no better way to lower your blood pressure than by indulging in some of the season's potassium-rich fruit and vegetables. "Melons like cantaloupe and watermelon are particularly high in potassium," says Lona Sandon, assistant professor of clinical nutrition at UT Southwestern and spokesperson for the American Dietetic Association. "One fourth a cantaloupe contains 800 to 900 milligrams of potassium, roughly 20 percent of the recommended daily value." “ Two cups of watermelon contains nearly 10 percent of the daily recommended value. Ms. Sandon said that dried apricots, avocados, figs, kiwi, oranges, raisins, dates, beans, potatoes, tomatoes and even grapefruit are other good sources of potassium.”

DASH lowers blood pressure in obese hypertensives beyond potassium, magnesium and fibre. (J Hum Hypertens. 2009)

Effects of Dietary Sodium Reduction on Blood Pressure in Subjects With Resistant Hypertension (Hypertension. 2009) “These results indicate that excessive dietary sodium ingestion contributes importantly to resistance to antihypertensive treatment. Strategies to substantially reduce dietary salt intake should be part of the overall treatment of resistant hypertension.”

Other

Other Treatments

Radiotherapy

Supplements-Vitamins-CAM

Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension (The Cochrane Collaboration Cochrane Reviews 2009)

A systematic review on the influence of trial quality on the effect of garlic on blood pressure. (Neth J Med. 2009)

Vitamin D status and arterial hypertension: a systematic review. (Nat Rev Cardiol. 2009) “In general, the antihypertensive effects of vitamin D seem to be particularly prominent in vitamin-D-deficient patients with elevated blood pressure. Thus, in view of the relatively safe and inexpensive way in which vitamin D can be supplemented, we believe that vitamin D supplementation should be prescribed to patients with hypertension and 25-hydroxyvitamin D levels below target values.”

Effect of grape seed extract on blood pressure in subjects with the metabolic syndrome. (Metabolism. 2009)

Oral Magnesium Supplementation Reduces Ambulatory Blood Pressure in Patients With Mild Hypertension. (Am J Hypertens. 2009)

Ameliorating Hypertension and Insulin Resistance in Subjects at Increased Cardiovascular Risk. Effects of Acetyl-L-Carnitine Therapy (Hypertension 2009) “Acetyl-L-carnitine safely ameliorated arterial hypertension, insulin resistance, impaired glucose tolerance, and hypoadiponectinemia in subjects at increased cardiovascular risk. Whether these effects may translate into long-term cardioprotection is worth investigating.”

Surgery

Transplantation

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