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Drugs 2000Hypertension is currently defined in terms of levels of blood pressure associated with increased cardiovascular risk. A cut-off of 140/90 mm Hg is accepted as a... (Review)
Review
Hypertension is currently defined in terms of levels of blood pressure associated with increased cardiovascular risk. A cut-off of 140/90 mm Hg is accepted as a threshold level above which treatment should at least be considered. This would give a prevalence of hypertension of about 20% of the adult population in most developed countries. Hypertension is associated with increased risk of stroke, myocardial infarction, atrial fibrillation, heart failure, peripheral vascular disease and renal impairment. Hypertension results from the complex interaction of genetic factors and environmental influences. Many of the genetic factors remain to be discovered, but environmental influences such as salt intake, diet and alcohol form the basis of nonpharmacological methods of blood pressure reduction. Investigation of the individual hypertensive patient aims to identify possible secondary causes of hypertension and also to assess the individual's overall cardiovascular risk, which determines the need for prompt and aggressive therapy. Cardiovascular risk can be determined from (i) target organ damage to the eyes, heart and kidneys; (ii) other medical conditions associated with increased risk; and (iii) lifestyle factors such as obesity and smoking. Secondary causes of hypertension are individually rare. Screening tests should be initially simple, with more expensive and invasive tests reserved for those in whom a secondary cause is suspected or who have atypical features to their presentation. The main determinants of blood pressure are cardiac output and peripheral resistance. The typical haemodynamic finding in patients with established hypertension is of normal cardiac output and increased peripheral resistance. Treatment of hypertension should initially use nonpharmacological methods. Selection of initial drug therapy should be based upon the strength of evidence for reduction of cardiovascular mortality in controlled clinical trials, and should also take into account coexisting medical conditions that favour or limit the usefulness of any given drug. Given this approach, it would be reasonable to use a thiazide diuretic and/or a beta-blocker as first-line therapy unless there are indications to the contrary. Individual response to given drug classes is highly variable and is related to the underlying variability in the abnormal pathophysiology. There are data to suggest that the renin-angiotensin system is more important in young patients. The targeting of this system in patients under the age of 50 years with a beta-blocker (or ACE inhibitor), and the use of a thiazide diuretic (or calcium antagonist) in patients over 50 years, may enable blood pressure to be controlled more quickly.
Topics: Adult; Animals; Humans; Hypertension
PubMed: 10678592
DOI: 10.2165/00003495-200059002-00001 -
Cleveland Clinic Journal of Medicine 1995Children have lower blood pressure than adults do, and normal values for children have been established based on age and also on height and weight. Blood pressures in... (Review)
Review
BACKGROUND
Children have lower blood pressure than adults do, and normal values for children have been established based on age and also on height and weight. Blood pressures in childhood correlate with blood pressures in adulthood, although weakly; a stronger correlation has been established between obesity in childhood and adulthood. Further, obese people are more likely to have high blood pressure than are slender people, both as children and adults. In hypertensive children, the higher the blood pressure and the earlier hypertension appears, the more likely is a secondary cause.
KEY POINTS
Physicians should measure and record children's blood pressure, just as they do their height and weight. An algorithm can help physicians decide whether a child with high blood pressure needs further workup and treatment. Nonpharmacologic therapy includes dietary sodium restriction, weight reduction (if the child is overweight), aerobic exercise, and relaxation. In some cases pharmacologic therapy may be necessary. In general, all children should be encouraged to be physically active and to eat healthy foods.
Topics: Adolescent; Algorithms; Child; Child, Preschool; Humans; Hypertension; Infant; Infant, Newborn; Obesity; Physical Examination; Sodium
PubMed: 7859399
DOI: 10.3949/ccjm.62.1.21 -
Current Hypertension Reports Apr 2014Acute hypertension (HTN) in hospitalized children and adolescents occurs relatively frequently, and in some cases, if not recognized and treated promptly, it can lead to... (Review)
Review
Acute hypertension (HTN) in hospitalized children and adolescents occurs relatively frequently, and in some cases, if not recognized and treated promptly, it can lead to hypertensive crisis with potentially significant morbidity and mortality. In contrast to adults, where acute HTN is most likely due to uncontrolled primary HTN, children and adolescents with acute HTN are more likely to have secondary HTN. This review will briefly cover evaluation of acute HTN and various age-specific etiologies of secondary HTN and provide more in-depth discussion on treatment targets, potential risks of acute HTN therapy, and available pediatric data on intravenous and oral antihypertensive agents, and it proposes treatment schema including unique therapy of specific secondary HTN scenarios.
Topics: Acute Disease; Adolescent; Age Factors; Antihypertensive Agents; Child; Child, Hospitalized; Essential Hypertension; Humans; Hypertension; Risk
PubMed: 24522943
DOI: 10.1007/s11906-014-0425-0 -
Indian Heart Journal 2022We undertook a prescription-based study to identify the provider and institution-level factors related to achieving guideline-recommended control of hypertension and...
OBJECTIVE
We undertook a prescription-based study to identify the provider and institution-level factors related to achieving guideline-recommended control of hypertension and diabetes mellitus in Kerala, India.
METHODS
This cross-sectional study in primary and secondary care hospitals in Kerala included both public and private institutions. One practitioner was selected from each institution. Data on institutional and provider factors were collected using a structured questionnaire. Prescriptions were photographically captured and data on disease status and drugs prescribed were recorded. Factors associated with disease control were identified using binary logistic regression.
RESULTS
Totally 4679 prescriptions were included for analysis. For hypertension-only patients, control levels were 31.5% and was significantly higher in public hospitals (Adjusted odds ratio (AOR) 1.96, 95% confidence intervals (CI) 1.50-2.57). Among patients with diabetes only, diabetes control was seen in 36.6%. When both conditions were present, control was achieved in only 17.0% patients. Being prescribed two or more drugs indicated lower control, whatever the respective condition. Among antihypertensive prescriptions rationality of 26.7% were questioned, such as lack of Renin Angiotensin System (RAS) inhibitor in diabetic hypertensives, dual RAS blockage, and indication for beta-blocker monotherapy.
CONCLUSIONS
In this prescription-based study in Kerala, India, a majority of hypertensive patients did not have controlled blood pressure levels, particularly if diabetes coexisted. This has serious implications as Kerala is the state with the highest burden of hypertension in India. Several prescription patterns were of questionable rationality. Further research and actions on rationality of anti-hypertensive prescriptions and barriers to treatment intensification is warranted.
Topics: Antihypertensive Agents; Cross-Sectional Studies; Diabetes Mellitus; Humans; Hypertension; India; Prescriptions; Secondary Care
PubMed: 35644270
DOI: 10.1016/j.ihj.2022.05.005 -
Journal of Hypertension Jun 2003To analyze blood pressure (BP) control in secondary prevention.
OBJECTIVE
To analyze blood pressure (BP) control in secondary prevention.
DESIGN
Individual data of two cross-sectional studies on preventive cardiology (PRATIK and ESPOIR studies conducted, respectively, in general practice and with private cardiologists) were analyzed.
SETTING
Primary care.
PARTICIPANTS
Patients both with treated hypertension and coronary disease.
MAIN OUTCOME MEASURES
Risk factors, treatments, cardiovascular history and BP were recorded. Each population was divided in three groups: group I, no other risk factor; group II, one or two risk factors; group III, three or more risk factors or diabetes.
RESULTS
A total of 1423 and 2596 patients, respectively, recruited in general practice and by cardiologists were analyzed. Of these, 473 (33.24%) and 1060 (40.83%) patients, respectively, had controlled hypertension. Among uncontrolled hypertensives, more than 50% had borderline isolated systolic hypertension. Associated risk factors negatively affect hypertension control, which had been achieved in a lower percentage of patients in group III than in group I (general practice, 26.28 versus 42.20%; cardiological practice, 32.42 versus 56.13%). In general practice, the percentage of patients receiving beta-blockers was significantly lower in group III. Among individuals with uncontrolled hypertension, only 17.58 and 26.69% received at least three-drug treatment including diuretics in general and in cardiological practice, respectively.
CONCLUSION
The negative influence of associated risk factors and the under-use of combination therapy contribute to poor BP control. In addition the high frequency of borderline isolated systolic hypertension suggests that the prerequisite to improve hypertension control should be to convince practitioners of the beneficial effect of tight systolic BP control (below 140 mmHg) in secondary prevention.
Topics: Aged; Antihypertensive Agents; Blood Pressure; Coronary Disease; Cross-Sectional Studies; Female; Humans; Hypertension; Male; Middle Aged; Risk Factors; Treatment Failure
PubMed: 12777958
DOI: 10.1097/00004872-200306000-00021 -
Current Hypertension Reports Jun 2001Wider application of the aldosterone/plasma renin activity ratio among hypertensives has facilitated the detection of primary aldosteronism at earlier stages of... (Review)
Review
Wider application of the aldosterone/plasma renin activity ratio among hypertensives has facilitated the detection of primary aldosteronism at earlier stages of evolution (with most patients normokalemic), and found prevalence rates far greater than those previously reported. Reliable detection of patients with PAL requires that 1) the diagnosis is considered in all hypertensives; 2) blood samples are collected under standardized conditions of diet, posture, and time of day; 3) medications known to alter the ratio are avoided or their effects taken into account; 4) aldosterone and plasma renin activity are measured using consistently accurate assay techniques; and 5) reliable methods (such as fludrocortisone suppression testing) are used to confirm primary aldosteronism. Adrenal venous sampling is the only dependable way to differentiate aldosterone-producing adenoma from bilateral adrenal hyperplasia. As has occurred in familial hyperaldosteronism type I, the elucidation of genetic mutations causing other forms of primary aldosteronism should further facilitate detection of this potentially curable or specifically treatable variety of hypertension.
Topics: Humans; Hyperaldosteronism; Hypertension; Renin
PubMed: 11353574
DOI: 10.1007/s11906-001-0045-3 -
The American Journal of Cardiology May 2017The aim of the present study was to evaluate the prevalence, determinants, and clinical management of systemic hypertension in a large cohort of competitive athletes:...
The aim of the present study was to evaluate the prevalence, determinants, and clinical management of systemic hypertension in a large cohort of competitive athletes: 2,040 consecutive athletes (aged 25 ± 6 years, 64% men) underwent clinical evaluation including blood test, electrocardiogram, exercise test, echocardiography, and ophthalmic evaluation. Sixty-five athletes (3%) were identified with hypertension (men = 57; 87%) including 5 with a secondary cause (thyroid dysfunction in 3, renal artery stenosis in 1, and drug induced in 1). The hypertensive athletes had greater left ventricular hypertrophy and showed more often a concentric pattern than normotensive ones. Moreover, they showed a mildly reduced physical performance and were characterized by a higher cardiovascular risk profile compared with normotensive athletes. Multivariate logistic regression analysis showed that family hypertension history (odds ratio 2.05; 95% confidence interval 1.21 to 3.49; p = 0.008) and body mass index (odds ratio 1.32; 95% confidence interval 1.23 to 1.40; p <0.001) were the strongest predictors of hypertension. Therapeutic intervention included successful lifestyle modification in 57 and required additional pharmacologic treatment in 3 with essential hypertension. Secondary hypertension was treated according to the underlying disorder. After a mean follow-up of 18 ± 6 months, all hypertensive athletes had achieved and maintained optimal control of the blood pressure, without restriction to sport participation. In conclusion, the prevalence of hypertension in athletes is low (3%) and largely related to family history and overweight. In the vast majority of hypertensives, lifestyle modifications were sufficient to achieve an optimal control of blood pressure values.
Topics: Adult; Athletes; Blood Pressure; Disease Management; Echocardiography; Electrocardiography; Exercise Test; Female; Follow-Up Studies; Humans; Hypertension; Male; Prevalence; Rome; Time Factors; Young Adult
PubMed: 28325568
DOI: 10.1016/j.amjcard.2017.02.011 -
Journal of Human Hypertension Jul 2023We aimed to describe hypertensive phenotype and demographic characteristics in children and adolescents referred to our paediatric hypertension service. We compared age,...
We aimed to describe hypertensive phenotype and demographic characteristics in children and adolescents referred to our paediatric hypertension service. We compared age, ethnicity and BMI in primary hypertension (PH) compared to those with secondary hypertension (SH) and white coat hypertension (WCH). Demographic and anthropometric data were collected for children and adolescents up to age 18 referred to our service for evaluation of suspected hypertension over a 6 year period. Office blood pressure (BP) and out of office BP were performed. Patients were categorised as normotensive (normal office and out of office BP), WCH (abnormal office BP, normal out of office BP), PH (both office and out of office BP abnormal, no underlying cause identified) and SH (both office and out of office BP abnormal, with a secondary cause identified). 548 children and adolescents with mean ± SD age of 10.1 ± 5.8 years and 58.2% girls. Fifty seven percent (n = 314) were hypertensive; of these, 47 (15%), 84 (27%) and 183 (58%) had WCH, PH and SH, respectively. SH presented throughout childhood, whereas PH and WCH peaked in adolescence. Non-White ethnicity was more prevalent within those diagnosed with PH than both the background population and those diagnosed with SH. Higher BMI z-scores were observed in those with PH compared to SH. Hypertensive children <6 years are most likely to have SH and have negligible rates of WCH and PH. PH accounted for 27% of hypertension diagnoses in children and adolescents, with the highest prevalence in adolescence, those of non-White Ethnicity and with excess weight.
Topics: Humans; Blood Pressure Monitoring, Ambulatory; Hypertension; White Coat Hypertension; Blood Pressure; Prevalence; United Kingdom
PubMed: 35933484
DOI: 10.1038/s41371-022-00732-7 -
Casopis Lekaru Ceskych 2008Diagnosis of essential hypertension is created per exclusionem--with exclusion of all, so called secondary hypertensions (nephrogenic, endocrine conditioned etc). Idea... (Review)
Review
Diagnosis of essential hypertension is created per exclusionem--with exclusion of all, so called secondary hypertensions (nephrogenic, endocrine conditioned etc). Idea and the name-essential hypertension are unclear. We have a lot of hypotheses about mechanisms of hypertension but no one is explaining satisfactorily the "fixation" of hypertension. From this point of view essential hypertension looks more like a syndrome than disease sui generis. Authors analyzed all possible pathways of hypertension origin as well as compensatory mechanisms in peripheral circulation in effort to reach relevant tissue perfusion. If these mechanisms lead to salt and water retention the best mode of the treatment would be to influence volume and blood vessels lumen. It is clear that optimization of blood pressure is advantageous for prevention of vascular catastrophes (myocardial and cerebral infarction). Nevertheless inadequate lowering of the peripheral tissue perfusion (kidney, CNS) can lead to degenerative changes in tissues and to disturbances in centrally regulated processes of blood pressure.
Topics: Hemodynamics; Homeostasis; Humans; Hypertension; Water-Electrolyte Balance
PubMed: 18323038
DOI: No ID Found -
Archives of Internal Medicine Jun 1986Episodic elevation of blood pressure was evaluated in two middle-aged men by assessing home, clinic, and 24-hour ambulatory values following exclusion of secondary forms...
Episodic elevation of blood pressure was evaluated in two middle-aged men by assessing home, clinic, and 24-hour ambulatory values following exclusion of secondary forms of hypertension. Both individuals had normotensive home and clinic readings. The 24-hour blood pressure was 125/85 +/- 12/9 mm Hg in patient 1 and 119/84 +/- 13/13 mm Hg in patient 2; however, both patients experienced large, sustained rises in blood pressure associated with panic attacks that were not abolished with prophylactic benzodiazepine therapy. Episodic blood pressure elevations were not associated with concomitant increases in heart rate. Patient 1 underwent extensive psychological investigation that diagnosed a panic disorder, and he underwent therapy that reduced the frequency and intensity of his panic-related hypertensive episodes. Because patient 2 demonstrated hypertensive readings at work, he was given a beta-blocking agent that ultimately controlled his blood pressure during episodes of anxiety and panic. These findings suggest that patients with panic attacks may present with episodic hypertension and that ambulatory blood pressure monitoring is useful in the diagnosis of this disorder and in assessment of treatment outcome.
Topics: Adult; Anxiety Disorders; Atenolol; Blood Pressure Determination; Fear; Heart Rate; Humans; Hypertension; Male; Panic; Psychotherapy
PubMed: 3718100
DOI: No ID Found