Common Form Of Hypertension Research Articles

Isolated systolic hypertension in young adults and its relationship with ambulatory blood pressure measurements

Introduction: The definition of Isolated Systolic Hypertension (ISH) is accepted by guidelines, which adopt a blood pressure (BP) cutoff point of 140/90 mmHg, with elevated Systolic Blood Pressure (SBP) and normal diastolic blood pressure (DBP) in the clinic. This phenotype represents the most common form of Hypertension (HT) in young individuals. The prognosis of ISH differs according to various explanatory mechanisms. Some associations of this phenotype with Ambulatory Blood Pressure Monitoring (ABPM) have been described, but little emphasis has been placed on its association with nocturnal BP values. To the best of our knowledge, there is no epidemiological data on young patients establishing this relationship in Latin America. Objective: To describe the characteristics of ISH in our population of young patients and analyze its relationship with different ABPM phenotypes. Materials and methods: Consecutive adult individuals between 16 and 40 years of age, without antihypertensive treatment, were evaluated in a cross-sectional study. They were referred for ABPM to a tertiary hospital between July 2013 and August 2022. Each individual underwent an initial interview, three BP measurements using current standards with OMROM HEM 705 devices, and subsequent ABPM with Spacelabs 90207. A general description of the sample was provided, and an analysis was conducted based on different patient phenotypes determined by clinic BP measurements in relation to various ABPM phenotypes. Results: A total of 395 individuals (69% women, 29 ± 6.5 years) were finally evaluated. The frequencies according to clinic phenotypes were as follows: Normotensive = 77%, ISH = 6%, HT = 17%. Among the ISH group, 29.2% had white coat hypertension (WCH). The Kappa agreement was 31% for clinic phenotypes vs. ABPM. Among ISH patients, 37% had at least one elevated period (daytime or nighttime), and 12.5% had elevated BP only during the nighttime.

Protocolo terapéutico de la hipertensión esencial

Hypertension (HT) is the main risk factor for disease and death in the world, and properly controlling it reduces the risk of associated morbimortality. Essential HT is the most common form of HT (90%-95%), and genetic as well as environmental factors are implicated in its development. When considering a therapeutic protocol in a hypertensive patient it is important to quantify the vascular risk and define a control target. Following the 2018 recommendations of the European Society of Hypertension and the European Society of Cardiology, in the majority of cases it is indicated to simultaneously commence with lifestyle modifications and pharmacological treatment. The recommendation is to always start treatment with a combined therapy, except in patients with BP close to the target and in patients who are frail or over the age of 80 years. For the majority of patients a combination of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist II (ARA II) with a calcium antagonist or a thiazide will be preferable, although we should always individualize the treatment and control targets according to the patient's profile, while also considering special situations such as heart failure, auricular fibrillation, heart disease, chronic kidney disease or resistant HT.

Hipertenzija kod dece i adolescenata

Until recently, secondary hypertension used to be the most common form of hypertension in the paediatric population. Due to the increasing prevalence of obesity-related hypertension in children and adolescents, the share of secondary hypertension has decreased from 85% to 9%. Today, primary hypertension has become the dominant form of hypertension in the paediatric population. The purpose of this paper is to show the prevalence of various forms of hypertension and the prevalence of primary hypertension in children and adolescents relative to sex, age and body weight category in the General Hospital "Dr. Laza K. Lazarević" in Šabac. In children with secondary hypertension, the impact of body weight was not assessed since an organic cause of hypertension had been identified in these patients. All children from the age of a new-born to the age of 18 years with a diagnosis of hypertension (International Classification of Diseases, tenth revision (IDC-10), code I10-I15) in the period from 1 January 2013 to 31 December 2022 were selected from the medical digital database. This analysis included all children who showed blood pressure values above 95th percentile for age, sex and height in children under 13 and above 120/80 mmHg in children over 13, upon repeated measurements of blood pressure in the General Hospital, who were presumed to have hypertension. These children were referred to further evaluation at tertiary healthcare institutions, where a diagnosis of hypertension was made. Of the 134 children referred to the General Hospital due to elevated blood pressure levels measured in the primary care physician's office, hypertension was diagnosed in almost one in four subjects (24.6%). Primary hypertension was diagnosed in 18 (54.5%), secondary hypertension in 8 (24.2%) and white coat hypertension in 7 (21.2%) children. Primary hypertension was more common in boys (70.6%) than girls (37.5%). Among children with primary hypertension, overweight and obese children represented 66.7% of the group at the time of diagnosis. Statistical data analysis did not find a statistically significant difference in the prevalence of primary hypertension among the body weight or age categories. Since primary hypertension is the most significant and potentially reversible factor for the development of cardiovascular disease, early detection and treatment of primary hypertension in children is crucial in the prevention of cardiovascular disease in adults.

Isolated systolic hypertension and its associated risk factors in Iranian middle age and older population: a population-based study

BackgroundIsolated systolic hypertension (ISH), is the most common form of hypertension in older adults. However, the ISH prevalence is not well known in many developing countries such as Iran. This study was conducted to determine the ISH prevalence and its related risk factors in an Iranian population.MethodsData were obtained from the second phase of the Shahroud eye cohort study (ShECS) in 2014. ShECS is a longitudinal population-based study which the first phase had been conducted in 2009 using the stratified multistage cluster sampling design on 5190 people aged 40 to 70 years. The ISH prevalence was determined based on the eighth Joint National Commission guidelines for different demographic variables. The associated risk factors were estimated by multiple logistic regression and a two-tailed p-value less than 0.05 was considered significant.ResultsThe ISH prevalence was 15.89% (95% CI: 14.88–16.96). It was 15.68% (14.12–17.39) and 15.87% (14.54–17.29) for men and women, respectively. The prevalence of ISH increased significantly with increasing age. The 65–70 compared to 45–69 year age group (OR = 4.21), body mass index (OR = 1.03), diabetes (OR = 1.64), retirement, compared to practitioner job (OR = 1.53), and waist to hip ratio (WHR) (OR = 9.81) were significantly associated with ISH prevalence.ConclusionsISH is highly prevalent among the older adult population in Iran. Given the risk of cardiovascular disease associated with ISH, it is recommended to conduct education and public health interventions to improve the detection, prevention, and treatment of ISH.

General practitioner perspectives and experiences when screening for primary aldosteronism in hypertensive patients.

Context: Primary aldosteronism (PA) is a common form of hypertension caused by excess production of the adrenal hormone aldosterone. Screening hypertensive patients with a simple blood test enables early detection and targeted treatment of PA, leading to fewer cardiovascular complications. Australian family physicians (FPs) rarely screen for PA, and screening rates are equally low among North American FPs. Limited awareness of PA is thought to explain the low screening rates in family practice. Objective: To understand the factors that influence an FP's decision to screen for PA in hypertensive patients. Study Design: Qualitative study using phenomenology to explore the experiences of FPs when screening for PA. Setting/Population: Set in South-East Melbourne, participating FPs had received an educational session on PA from an endocrinologist. We conducted semi-structured interviews with FPs who had screened at least one patient following the teaching session. Interviews were transcribed verbatim, entered into NVivo for coding, and analyzed for emerging themes. Results: The 16 participants varied by clinical experience (1-35 years), practice location (3 regional, 13 urban), and the number of patients screened for PA (1-44 patients). FPs overwhelmingly preferred screening newly diagnosed hypertensive patients over those already being managed with antihypertensive medications. Only a few FPs opted to screen all hypertensive patients, while the majority questioned the necessity of screening patients whom they thought fitted their clinical impression of essential hypertension. Many FPs found it challenging to both comply with testing requirements and interpret screening results within the existing organizational constraints of their practice. FPs that had diagnosed at least one patient with PA acknowledged the positive impact that targeted treatment had on patient wellbeing and this reinforced their role in assisting with the detection of PA. Knowledge and convenience of the screening process, the conceptualization of risk, and the perceived impacts of detecting PA were influencing factors that modified the FP screening experience. Conclusion: This study demonstrates that additional factors, other than limited awareness, influence a FP's decision to screen for PA. Our findings have the potential to inform future policy, practice, and training interventions to improve the detection of PA in family practice.

Isolated systolic hypertension of the young and sodium intake.

Isolated systolic hypertension is associated with higher risk of cardiovascular disease and all-cause mortality. Despite being the most common form of hypertension in the elderly, it is also detectable among young and middle-aged subjects. Dietary salt (sodium chloride) intake is an important determinant of blood pressure, and high salt intake is associated with greater risk of hypertension and cardiovascular events. In most countries, habitual salt intake at all age categories largely exceeds the international recommendations. Excess salt intake, often interacting with overweight and insulin resistance, may contribute to the development and maintenance of isolated systolic hypertension in young individuals by causing endothelial dysfunction and promoting arterial stiffness through a number of mechanisms, namely increase in the renin-angiotensin-aldosterone system activity, sympathetic tone and salt-sensitivity. This short review focused on the epidemiological and clinical evidence, the mechanistic pathways and the cluster of pathophysiological factors whereby excess salt intake may favor the development and maintenance of isolated systolic hypertension in young people.

Identifying Isolated Systolic Hypertension From Upper-Arm Cuff Blood Pressure Compared With Invasive Measurements.

Isolated systolic hypertension (ISH) is the most common form of hypertension and is highly prevalent in older people. We recently showed differences between upper-arm cuff and invasive blood pressure (BP) become greater with increasing age, which could influence correct identification of ISH. This study sought to determine the difference between identification of ISH by cuff BP compared with invasive BP. Cuff BP and invasive aortic BP were measured in 1695 subjects (median 64 years, interquartile range [55-72], 68% male) from the INSPECT (Invasive Blood Pressure Consortium) database. Data were recorded during coronary angiography among 29 studies, using 21 different cuff BP devices. ISH was defined as ≥130/<80 mm Hg using cuff BP compared with invasive aortic BP as the reference. The prevalence of ISH was 24% (n=407) according to cuff BP but 38% (n=642) according to invasive aortic BP. There was fair agreement (Cohen κ, 0.36) and 72% concordance between cuff and invasive aortic BP for identifying ISH. Among the 28% of subjects (n=471) with misclassification of ISH status by cuff BP, 20% (n=96) of the difference was due to lower cuff systolic BP compared with invasive aortic systolic BP (mean, -16.4 mm Hg [95% CI, -18.7 to -14.1]), whereas 49% (n=231) was from higher cuff diastolic BP compared with invasive aortic diastolic BP (+14.2 mm Hg [95% CI, 11.5-16.9]). In conclusion, compared with invasive BP, cuff BP fails to identify ISH in a sizeable portion of older people and demonstrates the need to improve cuff BP measurements.

P112 Influence of Cuff Blood Pressure Accuracy on Identification of Isolated Systolic Hypertension

IntroductionIsolated systolic hypertension (ISH) is the most common form of hypertension in older people. However, accurate identification of ISH may be hindered because cuff blood pressure (BP) underestimates systolic BP (SBP) and overestimates diastolic BP (DBP). This study aimed to determine the influence of cuff BP accuracy on the identification of ISH.MethodsCuff BP and invasive aortic BP were measured simultaneous (or near-simultaneously) in 1737 subjects (63 ± 12 years, 68% male) during coronary angiography. Data was derived from 32 studies, using 20 different cuff BP devices, from the Invasive Blood Pressure Consortium (INSPECT). ISH was defined as ≥140/<90 mmHg according to cuff BP and invasive aortic BP.ResultsAccording to cuff BP, 25% of subjects (n = 430) had ISH, however, 37% (n = 648) were identified with ISH from invasive aortic BP. There was 77% concordance between cuff and invasive BP for identifying ISH. Among the 23% (n = 408) of subjects misclassified by cuff BP, 38% (n = 155) of misclassification was from SBP underestimation (mean: −16.6, 95% CI: −18.9 to −13.9 mmHg), whereas 35% (n = 143) was from DBP overestimation (15.6, 11.9 to 19.0 mmHg) and 20% (n = 83) from SBP overestimation (17.6, 14.4 to 20.5 mmHg). Subjects misclassified were on average 2.7 years older and had greater body mass index (0.8 kg/m2) than those correctly classified.ConclusionApproximately one quarter of older subjects have ISH misclassified, mostly because of underestimation of cuff SBP and overestimation of cuff DBP. This demonstrates a need to improve the accuracy of cuff BP methods for greater precision in identifying ISH.

The role of a captopril renal scintigraphy in examination of children with hypertension: A case report

Introduction. Secondary hypertension is a relatively common form of hypertension in childhood with renovascular hypertension being responsible for 5%?10% of all arterial hypertensions in children. An early diagnosis of renovascular hypertension is important when considering an appropriate treatment of hypertension that may prevent or slow further progression of kidney damage. To validate the usefulness of a captopril renal scintigraphy in hypertensive children, we report a case of a 16-year-old female patient with a history of hypertension as a result of fibromuscular dysplasia. Case report. The patient was asymptomatic with elevated blood pressure revealed by a routine physical examination. Laboratory tests showed the increased levels of plasma renin activity with the normal levels of aldosteron. The renal ultrasound was normal. The Doppler of the renal arteries showed no significant differences of resistive index. A renal captopril scintigraphy was performed, including two day study protocol, the baseline study followed by another captopril study several days later. The scintigraphy showed the abnormal baseline and captopril renogram curve of the right kidney with significant cortical retention of radiotracer after angiotensin-converting enzyme inhibition. Following the captopril scintigraphy a renovasography was obtained confirming the presence of a 2 mm long circular narrowing of the right renal artery. It was immediately treated resulting in a significant expansion of the lumen. Conclusion. The captopril renal scintigraphy allows non-invasive functional testing in a selected group of hypertensive children, which can either confirm or rule out the existence of hemodynamically significant renal artery stenosis.

Excess Body Weight, Insulin Resistance and Isolated Systolic Hypertension: Potential Pathophysiological Links.

Isolated systolic hypertension, the most common form of hypertension in the elderly, but also detectable among young and middle-aged subjects, is independently associated with higher risk of cardiovascular events and all-cause mortality. Among various pathophysiological changes associated with aging, excess body weight and insulin resistance may predispose to this type of hypertension. Overweight or frank obesity and their frequent companion insulin resistance could mediate the development of isolated systolic hypertension through increase in the renin-angiotensin-aldosterone system activity, in the sympathetic tone and in salt-sensitivity, all in turn leading to endothelial dysfunction, arterial stiffness and increase in blood pressure. This review will focus on this cluster of pathophysiological factors and on the mechanistic pathways whereby they may favor the development of isolated systolic hypertension.

Effects of pentoxifylline on hemodynamic, hemorheological, and microcirculatory parameters in young SHRs during arterial hypertension development

ABSTRACTThe most common form of hypertension in young adults is isolated diastolic hypertension. Diastolic arterial pressure is determined by the total peripheral resistance and depends on both vascular hindrance and blood viscosity. The aim of our work was to study the efficiency of pentoxifylline (PTX) in young spontaneously hypertensive rats (SHRs) during the development of arterial hypertension. The effects of a treatment course with PTX (100 mg/kg/day p.o. for 6 weeks, from 5 to 11 weeks old) on the mean, systolic, and diastolic blood pressure (BP); stroke volume; cardiac output; total peripheral resistance (TPR); whole blood viscosity (BV); plasma viscosity; hematocrit; RBC aggregation and deformability; local cerebral blood flow (lCBF); and microvascularization of the visual cortex were studied in SHRs in comparison with control SHRs and Wistar Kyoto rats. PTX-treated SHRs had significantly lower systolic, diastolic, and mean BP (by 24%, 26%, and 15%, respectively) and BV (by 5–9%) and a higher erythrocyte deformability index (by 1.5–2%), lCBF (by 42%), average diameter of capillaries (by 11%), density of the capillary network (by 23%), and percentage of capillaries with a diameter of 3–7 µm in comparison with control SHRs. In conclusion, PTX exerted positive effects on the hemodynamic, hemorheological, and microcirculatory parameters in SHRs during the development of arterial hypertension.

The effect of slow-loaded breathing training on the blood pressure response to handgrip exercise in patients with isolated systolic hypertension.

Isolated systolic hypertension (ISH) is the most common form of hypertension in older people. It is characterized by increased resting systolic blood pressure (sBP) and increased sBP in response to exercise. It has previously been shown that slow breathing training reduces resting sBP, and the objective of the present study was to determine whether it also reduced the blood pressure response to static handgrip exercise. ISH patients aged between 60 and 74 years were randomly divided into a control group (10 subjects, 4 of which were male) that breathed normally and a trained group (10 subjects, 4 of which were male) that trained daily for 8 weeks by slow breathing against an inspiratory resistance of 18 cmH2O. Before and immediately after training, subjects underwent a 2-min handgrip test (30% max) followed by 2 min of post-exercise circulatory occlusion (PECO) to assess metaboreflex activity. Training reduced sBP by 10.6 mm Hg (95% confidence interval (CI), -16 to -5 mm Hg, P=0.004), but changes were not observed in the control group. The peak exercise sBP was reduced by 23 mm Hg (95% CI, -16 to -31 mm Hg, P<0.001), while the increase in the sBP above resting was reduced by 12.6 mm Hg (95% CI, -6.9 to -18.2 mm Hg, P=0.002). The sBP during PECO was reduced by 8.9 mm Hg (95% CI, -4 to -14 mm Hg, P=0.008), which is indicative of reduced metaboreflex activity; no such change was observed in the control group. The results demonstrate that conventional treatment of older patients with ISH may be improved in two ways by slow breathing training: resting sBP may be reduced by 10 mm Hg, more than can be achieved by conventional pharmacological therapies, while the response to static exercise may be reduced by approximately twice this value.

Isolated Systolic Hypertension in Young Individuals: Pathophysiological Mechanisms, Prognostic Significance, and Clinical Implications.

Isolated systolic hypertension (ISH) is the most common form of hypertension in older persons and its predictive value for adverse outcome is well known. However, ISH can be frequently found also in young individuals, especially among males, but its prognostic significance in this setting is still controversial. Increased large artery stiffness is the main determinant of ISH in elderly patients whereas the mechanisms that lead to ISH in the young are still debated. According to some authors ISH in youth is a totally benign condition that can be called "spurious hypertension" a phenomenon due to enhanced pulse pressure amplification of the pulse wave from central to peripheral sites. According to others the main determinant of ISH in young individuals is increased sympathetic activity and the consequent hyperkinetic state characterized by elevated heart rate and stroke volume. This phenomenon is often amplified by a powerful alarm reaction to the medical visit. However, recent research has shown that ISH in the young is a heterogeneous condition and that in some individuals also increased arterial stiffness can play a role. Although ISH seems to be a benign condition chiefly in young men, only few longitudinal data assessing the association with adverse outcomes are available. Future studies with long term follow-up are needed to better understand the clinical significance of this condition.

Isolated Systolic Hypertension in Young People Is Not Spurious and Should Be Treated: Pro Side of the Argument.

Essential hypertension is a common condition, affecting ≈ 25% of the population1,2 and is the leading cause of death and disability worldwide.3 No longer viewed as a single disorder, essential hypertension has many different forms, including isolated systolic hypertension (ISH), the most common form of hypertension in older adults, affecting ≈50% of those aged ≥60 years.4 Historically, ISH in older individuals was viewed as benign and merely part of the natural ageing process. However, evidence from epidemiological and intervention studies now demonstrates that older individuals with ISH have a substantially increased risk of cardiovascular disease5 and benefit substantially from antihypertensive therapy.6–8 The predominant hemodynamic mechanism contributing to ISH in older individuals is increased aortic pulse wave velocity,9,10 a robust marker of arterial stiffness, and a key determinant of cardiovascular mortality.11 Arterial stiffening leads to an increase in pulse pressure (PP) and a vicious cycle of further stiffening and end-organ effects driving the increased cardiovascular risk.12 Interestingly, ISH is not limited to older individuals. Many population and observation studies demonstrate that ISH is also the most common form of hypertension in adolescents and young adults.13–15 Moreover, data from the 1999 to 2004 National Health and Nutrition Examination Survey demonstrate that ISH in young adults is increasing in prevalence, particularly in men.16 However, large artery stiffening is not thought to underlie the condition in younger individuals, although the precise mechanisms, and longer-term risks associated with ISH in young people, have been the subject of continued debate.17,18 Indeed, the terms spurious and pseudo have been applied to ISH in young subjects. We think that ISH in young people is associated with increased future risk and requires careful evaluation and treatment. As such, …

Isolated Systolic Hypertension in Young People Is Not Spurious and Should Be Treated: Con Side of the Argument.

Isolated systolic hypertension (ISH) in young people, defined on the basis of brachial blood pressure (BP) as a systolic BP (SBP) of at least 140 mm Hg with a diastolic BP (DBP) of <90 mm Hg, is not an unusual condition and is increasing in prevalence.1–3 To date, this concept has been confronted with challenges in the mechanisms, clinical relevance, and consequences. Parameters other than brachial BP, such as noninvasive central hemodynamics, have introduced new insights to the condition. Nevertheless, grounded information supporting the long-term consequences is still lacking; therefore, the necessity to decide to treat or not to treat is a matter of concern in clinical practice.4 The current knowledge of ISH in young people is presented with an emphasis on the elements that are relevant to deciding that treatment is not needed. The prevalence of ISH reported among the young ranges widely, from 2% to 8% in population studies, and between 14% and 50% in patients with hypertension.3 This is a result of the differences in population characteristics, such as age, ethnicity, and obesity. The Enigma study in the UK confirmed that ISH is the most common form of hypertension (HTN) in young adults aged 17 to 27 years, with a prevalence of 8%.1 Data from the National Health and Nutrition Examination Survey indicate that among younger and middle-aged adults in the US, aged 18 to 39 years, the overall prevalence of ISH between 1988 and 1994 was 0.7%. This reached 1.6% (2.23% in males and 0.92% in females) between 1999 and 2004. Obesity, smoking, and low socioeconomic status seem to be important determinants of ISH among young adults.2 In a United States pediatric population of 12- to 16-year olds, the most prevalent hypertensive subtype was ISH.5 Similarly, in Spanish obese youths, …

Gestational hypertension and preeclampsia: are they the same disease?

P complicating 5% to 8% of pregnancies, has been traditionally defined by an elevated blood pressure (over 140/90 mmHg on at least 2 occasions at least 6 hours apart) and proteinuria, at or beyond 20 weeks’ gestation.1,2 In 2013, the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy recommended that the definition of PE should be extended to include cases without evidence of proteinuria, provided that the hypertension is accompanied by evidence of end-organ involvement.2 PE is associated with an increased risk of adverse pregnancy outcome, including prematurity, placental abruption, and intrauterine growth restriction.3 In contrast, gestational hypertension is defined by an elevated BP at or beyond 20 weeks’ gestation in the absence of proteinuria1,2 and is considered to be a transient condition (Figure 1).1 The development of proteinuria later in pregnancy changes the final diagnosis to preeclampsia. Otherwise, the final diagnosis is determined according to a re-evaluation of BP recordings at approximately three months postpartum. For women who are then normotensive (the most common scenario4), the final diagnosis is transient HTN of pregnancy (Figure 1). Persistence of GHTN for more than three months postpartum is consistent with a diagnosis of chronic hypertension. For clinicians who provide management for women with hypertension in pregnancy, several issues are of interest with respect to the importance of distinguishing between GHTN and PE. The first is the long-standing controversy of whether GHTN is an independent clinical entity or merely a mild or pre-onset form of PE. A second and more practical issue is determining the risk of progression of GHTN to PE. A third issue is quantifying the degree to which GHTN is associated with adverse pregnancy outcomes. Although GHTN is the most common form of hypertension in pregnancy,5 most researchers have focused their efforts on PE because of its implications for maternal–fetal health, whereas information about the implications of a diagnosis of GHTN is much more limited. Herein, we attempt to summarize the most up to date information available to address these important clinical questions.

English

AIM: It was thought previously that morbidity and mortality are directly related to both Systolic and Diastolic blood pressure. However evidences from different studies suggest that systolic hypertension deserves more importance especially due to its profound effect on cardiovascular disease progression. Isolated systolic hypertension (ISH) has now increased amongst the elderly population due to increased longevity. METHOD: Total 240 patients of 65 - 89 years age group were taken as study group at the out-patient and in-door department of CNMC Kolkata and NBMC, Siliguri. All patients were divided into three groups based on systolic blood pressure: Gr A=SBP-140—159 mmHg, Gr B=SBP-160-179 mmHg & Gr C=SBP>180 mmHg with each group having age and sex matched 100 healthy normotensive control subjects. History, Clinical examination, ECG and Echocardiographic studies were done in the selected patients. Sophisticated tests were not done due to nonavailability. RESULTS: Major Electrocardiogram changes are left atrial enlargement, left ventricular hypertrophy with systolic strain, Inferior wall ischemia, both bundle branch blocks, bifascicular block, left axis deviation. Other minor changes were: antero- septal ischemia, septal wall ischemia, lateral wallischemia, right axis deviation, arrhythmia, and low voltage were also noted. Echocardiography in 2-D and M-ModeandEcho-Doppler assessment showed increased Intraventricular septal thickness (IVST), Left ventricular posterior wall Thickness (LVPWT) and Left ventricular mass index were the major changes. Left ventricular functional abnormality like diastolic dysfunction was another significant abnormality. CONCLUSION: Different anatomical & functional changes in ISH are more prevalent in higher SBP group, and strong risk factor for future catastrophic cardiac events. It is an independent risk factor for CVS morbidity and mortality. Early therapeutic intervention along with life style modification therefore can prevent long term CVS complications. INTRODUCTION: Isolated systolic hypertension (ISH) is a common form of hypertension in elderly person of both sex and it affects 2/3 rd of all individuals of hypertension between the ages of 65-89 years 1 . During the recent decades the importance of perceiving ISH has changed from a relatively benign condition to major cardiovascular risk factor and more recent data from Framingham study reinforces the prognostic significance of raised SBP and wide pulse pressure as independent risk factor2. According to JNC 7th report in person older than 50years, systolic BP>140 is much more important CVS risk factor than diastolic BP. ISH is also a common antecedent of heart failure, kidney damage, blindness and other conditions. Heart failure may be due to LVH with resulting diastolic dysfunction with or without concomitant systolic dysfunction or myocardial infarction4. Though it was thought previously that morbidity and mortality from hypertension are directly related to both SBP and DBP, it is now

Hypertension in children, not a “small” problem

Hypertension in children, not a “small” problem

Essential hypertension in adolescents and children: Recent advances in causative mechanisms

Essential hypertension is the most common form of hypertension in adults, and it is recognized more often in adolescents than in younger children. It is well known that the probability of a diagnosis of essential hypertension increases with age from birth onward. The initiation of high blood pressure burden starts in childhood and continues through adolescence to persist in the remaining phases of life. The genesis of essential hypertension is likely to be multifactorial. Obesity, insulin resistance, activation of sympathetic nervous system, sodium homeostasis, renin-angiotensin system, vascular smooth muscle structure and reactivity, serum uric acid levels, genetic factors and fetal programming have been implicated in this disorder. In addition, erythrocyte sodium transport, the free calcium concentration in platelets and leukocytes, urine kallikrein excretion, and sympathetic nervous system receptors have also been investigated as other possible mechanisms. Obesity in children appears to be the lead contributor of essential hypertension prevalence in children and adolescents. Suggested mechanisms of obesity-related hypertension include insulin resistance, sodium retention, increased sympathetic nervous system activity, activation of renin-angiotensin-aldosterone, and altered vascular function. The etiopathogenesis of essential hypertension in children and adolescents appears to closely resemble that of adults. The minor variations seen could probably be due to the evolving nature of this condition. Many of the established mechanisms that are confirmed in adult population need to be replicated in the pediatric age group by means of definitive research for a better understanding of this condition in future.

The Hypertension Paradox

In the August 27 issue of The New England Journal of Medicine, Dr Aram Chobanian discusses what he calls the hypertension paradox—the fact that while therapy and outcome in hypertensive patients has improved dramatically, the total number of hypertensive patients and the numbers who are uncontrolled have increased over the past 20 to 30 years.1 But perhaps the paradox is less than Dr Chobanian claims. He reviews initial therapies in the 1940s and 1950s that lowered blood pressure (BP) but were difficult to administer and produced annoying and often dangerous side effects. He notes the dramatic decrease in cardiovascular and cerebrovascular events in hypertensive patients whose BP has been controlled but notes that, despite these advances, the number of hypertensive patients has increased from 50 million in the 1988–1994 period to 65 million in the latest analyses in 2004. He neglects to mention that major reasons for this increase may be that reporting and screening for elevated BP have improved considerably over the past 20 to 30 years and that the definition of the most common form of hypertension, ie, isolated systolic hypertension, was changed during this period. When the First Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure was published in 19772 and during the next 5 to 10 years, isolated systolic hypertension in the elderly was defined as >160/<90 mm Hg. During subsequent years the definition was changed. Isolated systolic hypertension is now defined as >140/<90 mm Hg. Needless to say, this change in definition dramatically increased the number of patients classified as hypertensive. When the criterion for the diagnosis of diabetes was changed from a blood sugar level of 140 mg/dL to 126 mg/dL, the number of patients classified as diabetic increased dramatically as well. The statistics quoted in Dr Chobanian’s article that only one third of hypertensive patients have achieved goal levels of 140/90 mm Hg and that 39% are not receiving any therapy, are more than 5 years old. Recent statistics from a Harris Poll in 20073 and from the Behavioral Risk Factor Surveillance Survey4 report that more than 90% of hypertensive patients are being treated with specific medications and that more than 50% are controlled. We indeed are making progress. Do we have to improve treatment? Of course. We should continue to foster more efforts to control BP in more people and reduce cardiovascular events still further, but we should not forget the progress that has been made.5 The positive should be emphasized. The trend for improvement in outcome as well as control is clearly a positive one. Thus, the paradox may not be nearly as great as Dr Chobanian suggests.