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.' "

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

Device-guided breathing exercises in the control of human blood pressure: systematic review and meta-analysis (Journal of Hypertension 2012) “There is evidence that short-term use of DGB may reduce both DBP and DBP. However, five of the eight trials were sponsored by or involved the manufactures of the device. When these trials were excluded we found no overall effect. We conclude that longer term, independent trials are required to validate this intervention.”

Drug Side-Effects and Interactions

Drugs

Hypertension: Which Drugs for Which Patients?

Diuretics: A NEW Look at an OLD Medicine

Treating High Blood Pressure -- Are Two Drugs Better Than One?

The effect of antihypertensive treatment on headache and blood pressure variability in randomized controlled trials: a systematic review. (J Neurol. 2012)

Isometric handgrip training lowers blood pressure and increases heart rate complexity in medicated hypertensive patients. (Scand J Med Sci Sports. 2012)

Diuretics for High Blood Pressure

Thiazide

Exercise

Effect of interval training program on white blood cell count in the management of hypertension: A randomized controlled study. (Niger Med J. 2011) “It was concluded that the interval training program is an effective adjunct nonpharmacological management of hypertension and the therapeutic effect of exercise programs may be mediated through suppression of inflammatory (WBC count) reaction.”

Association of early systolic blood pressure response to exercise with future cardiovascular events in patients with uncomplicated mild-to-moderate hypertension (Hypertension Research 2012)

Hypertensive Patients Who Exercise Have Lower Death Risk “The findings revealed that all-cause and CVD mortality risks were considerably higher at all blood pressure levels in participants that did no physical exercise, as compared with those who were physically active. Furthermore, when the higher death risk due to physical inactivity was converted into a measurement of "blood pressure equivalence of physical activity", the findings demonstrated that being physically inactive was similar to a higher death risk equivalent to a 40-50 mmHg higher blood pressure.”

Exercise May Help Patients With High Blood Pressure Live Longer “The researchers also found that inactivity increased the risk of death during the study approximately the same amount as would an increase in blood pressure of 40 to 50 milligrams of mercury.”

Twenty-four hour ambulatory blood pressure monitoring to evaluate effects on blood pressure of physical activity in hypertensive patients. (Clin J Sport Med. 2007) “This reduction, evaluated with Ambulatory Blood Pressure Monitoring (ABPM), confirms that physical exercise should be a part of lifestyle changes for the management of hypertension both in untreated hypertensive patients or high-risk subjects for hypertension, and also for hypertensive patients in association with pharmacological therapy.”

Aerobic physical activity based on fast walking does not alter blood pressure values in non-dipper essential hypertensives. (Int Angiol. 2012) “In non-dipper hypertensives a light aerobic program of physical activity based on fast walking seems to be less effective to reduce blood pressure values, contrary to what has been observed in dipper ones.”

Exercise Tips for Getting Started

Exercise: A drug-free approach to lowering high blood pressure “Becoming more active can lower your systolic blood pressure — the top number in a blood pressure reading — by an average of 5 to 10 millimeters of mercury (mm Hg). That's as good as some blood pressure medications. For some people, getting some exercise is enough to reduce the need for blood pressure medication. If your blood pressure is at a desirable level — less than 120/80 mm Hg — exercise can keep it from rising as you age. Regular exercise also helps you maintain a healthy weight, another important way to control blood pressure. But to keep your blood pressure low, you need to keep exercising. It takes about one to three months for regular exercise to have an impact on your blood pressure. The benefits last only as long as you continue to exercise.”

Exercise Helpful but Not Harmless in Pulmonary Hypertension “In a prospective trial, supervised exercise training was an effective add-on therapy for chronic pulmonary hypertension, even in patients with severe disease -- although it was not completely without risk. For the most part, patients had significant improvements in quality of life, six-minute walk distance, peak oxygen consumption, World Health Organization functional class (WHO-FC), exercise capacity, oxygen pulse, and other parameters of cardiopulmonary fitness after training compared to baseline, the researchers say. During the first three weeks of training, however, nearly 14% suffered adverse events. About 4% of these events were severe, including syncope and presyncope. ”

Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients. (Eur J Cardiovasc Prev Rehabil. 2011) "This study indicates that the blood pressure reducing effect of exercise in essential hypertension is intensity dependent. Aerobic interval training is an effective method to lower blood pressure and improve other cardiovascular risk factors."

Effects of one-year swimming training on blood pressure and insulin sensitivity in mild hypertensive young patients. (Chin J Physiol. 2010) "However, when observation was restricted to the hypertensive patients, swimming training significantly lowered SBP by approximately 17 mmHg, concurrent with 41% reduction in HOMA-IR. Intriguingly, SBP in the normotensive subjects was elevated by approximately 6 mmHg after training. CONCLUSIONS: The present study found normalization rather than universal reduction effect of swimming training on BP. Furthermore, the BP-lowering effect of training in hypertensive patients appears to be associated with improvement in insulin sensitivity."

Exercise training restores hypertension-induced changes in the elastic tissue of the thoracic aorta. (J Vasc Res. 2011)

General Information

Trend of Blood Pressure Control Status in Hypertensive Outpatients: with Special Reference to Elderly Hypertensives. (Clin Exp Hypertens. 2012)

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 (Arch Intern Med. 2010) “For overweight or obese persons with above-normal BP, the addition of exercise and weight loss to the DASH diet resulted in even larger BP reductions, greater improvements in vascular and autonomic function, and reduced left ventricular mass.”

Current challenges in the clinical management of hypertension (Nature Reviews Cardiology 2012) “The effectiveness of antihypertensive therapy was initially demonstrated in patients with systolic BP >160 mmHg, and the results of early prospective trials were reviewed by Collins et al. over two decades ago.5 Around the same time, the effectiveness of antihypertensive therapy in elderly patients (aged >60 years) was also demonstrated.6 The preventive capacity of life-style changes, such as switching to a healthy diet, has been studied in the Dietary Approaches to Stop Hypertension (DASH) trial7, 8 and is established for variations of the Mediterranean diet, which has proven to reduce cardiovascular morbidity and mortality.9, 10 Results of a meta-analysis from 2011 have also shown a significant reduction in cardiovascular events associated with a diminution in salt intake.11 A complete intervention, including life-style changes and antihypertensive drugs, is usually only considered in patients who present with hypertension (grade 1 or higher) and in a small percentage of individuals with high-normal BP, if they have established cardiovascular or renal disease. All other patients with prehypertension would normally only receive advice about physical activity and diet.3, 4, 12”

Management of hypertension in the elderly (Nature Reviews Cardiology 2012)

Do angiotensin receptor blockers prevent myocardial infarctions as well as other initial therapies? (Curr Opin Cardiol. 2012) “The definitive answer of whether ARBs are effective, if at all, in preventing MI remains difficult to parse out. Current evidence from newer clinical trials and comprehensive meta-analyses suggests that ARBs, while effective antihypertensive agents that protect against risk of stroke, renal disease, diabetes, and heart failure, are likely to have a neutral effect upon reduction of MI when compared with other antihypertensive agents.”

Blood pressure change and antihypertensive treatment in old and very old people: evidence of age, sex and cohort effects (Journal of Human Hypertension 2012) “An inverted U-shaped relation was found between age and systolic blood pressure (SBP), with SBP reaching its maximum at 74.5 years. Mean SBP and DBP also decreased over time (SBP by 0.44?mm?Hg per year, P<0.001 and DBP by 0.34?mm?Hg per year, P<0.001). The proportion of participants on antihypertensive drugs increased from 39.0% in 1981 to 69.4% in 2005. In this study of people aged greater than or equal to70 years, mean SBP and DBP decreased with higher age and later investigation year. Antihypertensive drug use increased with time, which might partly explain the observed cohort effect.”

Is home blood pressure variability itself an interventional target beyond lowering mean home blood pressure during anti-hypertensive treatment? (Hypertension Research 2012) “Home BP variability is not itself an interventional target beyond lowering mean home BP during anti-hypertensive treatment.”

Choice of generic antihypertensive drugs for the primary prevention of cardiovascular disease - A cost-effectiveness analysis (BMC Cardiovascular Disorders 2012)

Diuretic use is associated with better learning and memory in older adults in the Ginkgo Evaluation of Memory study. (Alzheimers Dement. 2012)

Impact of lower achieved blood pressure on outcomes in hypertensive patients (Journal of Hypertension 2012) “Achieved SBP 130?mmHg or less is not associated with lower cardiovascular risk than SBP of 131 to 141?mmHg and is associated with a significantly increased risk of death and trend towards increased cardiovascular mortality. These findings support the need for randomized evaluation of treatment to more aggressive vs. conventional SBP targets.”

Breathing-control lowers blood pressure. (J Hum Hypertens. 2001)

Spontaneous respiratory modulation improves cardiovascular control in essential hypertension (Arq. Bras. Cardiol. 2007)

Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. (JAMA. 2003)

Case study 6 report: Management of hypertension (NPS 2000)

Target blood pressure attainment with antihypertensive therapy in Swiss primary care. (Blood Press. 2012)

Blood pressure control with medication does not prevent heart attack, stroke, or death

Non-pharmacological aspects of blood pressure management: what are the data? (Kidney Int. 2011)

Guidelines

NGC - Medical management of adults with hypertension. (2011)

WHO Hypertension Management Guidelines (2003)

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

Sodium Consumption Among Hypertensive Adults Advised to Reduce Their Intake: National Health and Nutrition Examination Survey, 1999–2004 (The Journal of Clinical Hypertension 2012) “The mean (±standard error) sodium intake among hypertensive adults was 3341±37 mg and differed by sex, age, race/ethnicity, education, and body mass index (P<.05), with the lowest intake among adults aged 65 years and older (2780±48 mg). Mean intake did not differ significantly by action status either overall or by subgroup except for one age category: among patients 65 years and older, mean intake was significantly lower among those who took action (2715±63 mg) than among those who did not (3401±206 mg; P=.0124). Regardless of action, mean intake was well above 1999–2004 recommendations for daily sodium intake and about twice as high as the current recommendation for hypertensive adults (1500 mg).”

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 (Arch Intern Med. 2010)

Soy Nutrient May Lower Blood Pressure “Here's how it might work. Isoflavones boost production of enzymes that make nitric oxide, which helps relax blood vessels and lower blood pressure, Richardson says.”

Dietary variety is a protective factor for elevated systolic blood pressure. (Arq Bras Cardiol. 2012) “The main result of this study was that dietary variety (food items = 8) offered a protective effect for alterations in SBP regardless of gender, age, BMI, and TCI. Furthermore, we observed a positive correlation between dietary variety and food sources of potassium, calcium and fibers (vegetables, fruit, dairy products) and a negative one with foods high in saturated fat, sodium and refined carbohydrates (meat and % of carbohydrate). The consumption of potassium, calcium and magnesium has been associated with attenuation of the progressive increase in blood pressure levels12. Potassium is responsible for the reduction in intracellular sodium through the sodium-potassium pump and induces the decrease in blood pressure (BP) by increasing the natriuresis, reducing renin and norepinephrine and increasing prostaglandin secretion. Calcium helps regulate the heartbeat and reduces sodium levels when in high concentrations and magnesium inhibits the contraction of vascular smooth muscle and may play a role in regulating BP as a vasodilator25,26. A study carried out recently in Japan investigated the associations of consumption of fruit, vegetables and their micronutrients with a reduced risk of SAH. The high consumption of fruit and vegetables was associated with a lower risk of developing hypertension, suggesting that the decrease in blood pressure was due to the presence of potassium and vitamin C in the foods27. A study with Australian adolescents showed that the consumption of fruit, vegetables, grains and fish was inversely associated with DBP28.”

Effect of Modest Salt Reduction on Blood Pressure, Urinary Albumin, and Pulse Wave Velocity in White, Black, and Asian Mild Hypertensives (Hypertension 2012) "These results demonstrate that a modest reduction in salt intake, approximately the amount of the current public health recommendations, causes significant falls in blood pressure in all 3 ethnic groups. Furthermore, it reduces urinary albumin and improves large artery compliance. Although both could be attributable to the falls in blood pressure, they may carry additional benefits on reducing cardiovascular disease above that obtained from the blood pressure falls alone."

Kiwifruit decreases blood pressure and whole-blood platelet aggregation in male smokers (Journal of Human Hypertension 2012)

Effects of low-sodium diet vs. high-sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride (cochrane review) (American Journal of Hypertension 2011) "Sodium reduction resulted in a significant decrease in BP of 1% (normotensives), 3.5% (hypertensives), and a significant increase in plasma renin, plasma aldosterone, plasma adrenaline, and plasma noradrenaline, a 2.5% increase in cholesterol, and a 7% increase in triglyceride."

Other

Other Treatments

Experimental

[Effects and mechanism of berberine on the hypertensive renal injury rats induced by enriched high fat-salt-fructose diet]. (Zhong Yao Cai. 2011)

Radiotherapy

Supplements-Vitamins-CAM

Potassium treatment for hypertension in patients with high salt intake. (Int J Clin Pharmacol Ther. 2012) “Conclusions: 1. Potassium treatment reduces the blood pressure substantially in hypertensive patients with salt-rich diets. 2. The difference in magnitude of blood pressure reduction between different studies is probably related to the amount of salt intake. 3. Patients with reduced salt intake benefit little from potassium treatment. 4. Major meta-analyses published to date have severely underestimated the potential benefit of potassium treatment in patients with hypertension.”

Vitamin D and Vascular Disease: The Current and Future Status of Vitamin D Therapy in Hypertension and Kidney Disease (Current Hypertension Reports 2012)

High Blood Pressure: Lower Your Blood Pressure And Reduce Your Risk Of Stroke, Diabetes And Heart Disease

Q&A: How to reduce high blood pressure and restore healthy cholesterol levels with natural health

Effect of magnesium supplementation on blood pressure: a meta-analysis. (Eur J Clin Nutr. 2012) "To conclude, magnesium supplementation appears to achieve a small but clinically significant reduction in BP, an effect worthy of future prospective large randomised trials using solid methodology."

A Randomized, Double-Blind, Placebo-Controlled Crossover Study of Coenzyme Q10 Therapy in Hypertensive Patients With the Metabolic Syndrome (American Journal of Hypertension (2012))

Surgery

Transplantation

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