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

Managing hypertension in the very elderly: effect of adverse drug reactions (ADRs) on achieving targets (Journal of Human Hypertension 2010)

Drugs

Expensive New Blood Pressure Meds No Better Than Generics, According to Long-Term Data “But the diuretic still was superior in two measures: Compared with the diuretic group, the ACE inhibitor group had a 20 percent higher death rate from stroke, and the calcium channel blocker group had a 12 percent higher rate of hospitalizations and deaths due to heart failure. Diuretics, sometimes called "water pills," are the traditional medications for high blood pressure. They cause kidneys to remove sodium and water from the body, thereby relaxing blood vessel walls. ACE inhibitors such as lisinopril (brand names, Prinivil® and Zestril®) decrease chemicals that tighten blood vessels. Calcium channel blockers such as amlodipine (brand name, Norvasc®) relax blood vessels. Diuretics cost $25 to $40 per year, while newer brand-name hypertension drugs can cost $300 to $600 per year. The National Heart, Lung and Blood Institute recommends patients control their blood pressure by first controlling their weight, exercising, reducing sodium, increasing potassium and drinking alcohol in moderation. The institute says that if lifestyle changes are not sufficient, diuretics then normally should be the drug of first choice. However, newer, higher-priced drugs are heavily marketed, and diuretics account for only about 30 percent of prescriptions written for high blood pressure medications, Whelton said.”

Blood pressure lowering efficacy of beta-blockers as second-line therapy for primary hypertension. (Cochrane Database Syst Rev. 2010)

Exercise

General Information

Practical recommendations for treatment of hypertension in older patients. (Vasc Health Risk Manag. 2010) “Thiazide diuretics should be the first-line agents in uncomplicated, isolated systolic hypertension. Starting at low doses and proceeding in a gradual manner, these agents have proven efficacy in decreasing the risk of stroke and cardiovascular events. It is now recommended that these agents be used in low-dose combinations with other antihypertensive drug classes in patients who do not achieve target blood pressure (<140/90 mmHg).”

Treatment of hypertension in patients 80 years and older: the lower the better? A meta-analysis of randomized controlled trials. (J Hypertens. 2010)

High Blood Pressure Aftermath “Side effects to treating high blood pressure can be annoying, but they don't have to ruin your life if you take charge.”

Effects of the DASH Diet Alone and in Combination With Exercise and Weight Loss on Blood Pressure and Cardiovascular Biomarkers in Men and Women With High Blood Pressure: The ENCORE Study (Arch Intern Med 2010)

Guidelines

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

Does chocolate reduce blood pressure? A meta-analysis (BMC Medicine 2010)

Beet Juice Beats High Blood Pressure “The nitrate content of beet juice will lower your blood pressure, and it takes only a small amount -- 250 milliliters -- to do it. A recent study found that people who drank beetroot juice experienced the same lowered blood pressure benefits within 24 hours as those who took nitrate tablets. The research will be welcome news to patients with high blood pressure who might now have a natural approach to reducing their risk of cardiovascular disease, including stroke and heart attack.”

Effect of Nutrition on Blood Pressure (Annual Review of Nutrition 2010) “Higher intakes of potassium, PUFA, protein, exercise, and possibly vitamin D may reduce blood pressure. Less conclusive studies suggest that amino acids, tea, green coffee bean extract, dark chocolate, tea, and foods high in nitrates may reduce blood pressure. Short-term studies indicate that specialized diets may prevent or ameliorate mild hypertension, most notably the DASH diet, which is high in fruits, vegetables, and low-fat dairy products, and the DASH low-sodium diet. Long-term compliance to these diets remains a major concern.”

Other

Other Treatments

Radiotherapy

Supplements-Vitamins-CAM

Omega-3 fatty acids and blood pressure. (Cell Mol Biol (Noisy-le-grand). 2010) “There is substantial evidence that omega-3 fatty acids reduce blood pressure, with a greater effect in hypertensive patients and those with high-normal blood pressure. The dose of omega-3 fatty acids required to achieve a blood pressure reduction is likely to be at least 3-4 g/day. However, the magnitude of the blood pressure change can be increased by salt restriction or when omega-3 fatty acids are incorporated into a weight reducing program.”

Surgery

Transplantation

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