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Concept: Prehypertension

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TY-0201 (TY) is a new drug absorbed by the transdermal delivery system developed for the treatment of hypertension, which contains the free base of bisoprolol fumarate that is widely used. An 8-week randomized, double-blind, placebo-controlled study was conducted in hypertensive patients to evaluate the superiority of TY 8 mg to placebo and the noninferiority of TY 8 mg to bisoprolol fumarate oral formulation (BO) 5 mg. Changes in diastolic blood pressure (BP) (primary endpoint) from baseline in the TY 8 mg group, the BO 5 mg group, and the placebo group were -12.2 mm Hg, -11.8 mm Hg, and -3.7 mm Hg, respectively, with TY 8 mg demonstrating superiority to placebo and noninferiority to BO 5 mg. Changes from baseline for systolic BP and pulse rate produced significant reductions compared with placebo. TY is expected to serve as a new treatment approach for hypertensive patients.

Concepts: Myocardial infarction, Hypertension, Cardiology, Blood pressure, Pulse, Orthostatic hypotension, Prehypertension, Beta blocker

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Physiological studies have long documented the key role played by the autonomic nervous system in modulating cardiovascular functions and in controlling blood pressure values, both at rest and in response to environmental stimuli. Experimental and clinical investigations have tested the hypothesis that the origin, progression, and outcome of human hypertension are related to dysfunctional autonomic cardiovascular control and especially to abnormal activation of the sympathetic division. Here, we review the recent literature on the adrenergic and vagal abnormalities that have been reported in essential hypertension, with emphasis on their role as promoters and as amplifiers of the high blood pressure state. We also discuss the possible mechanisms underlying these abnormalities and their importance in the development and progression of the structural and functional cardiovascular damage that characterizes hypertension. Finally, we examine the modifications of sympathetic and vagal cardiovascular influences induced by current nonpharmacological and pharmacological interventions aimed at correcting elevations in blood pressure and restoring the normotensive state.

Concepts: Hypertension, Blood pressure, Acetylcholine, Autonomic nervous system, Sympathetic nervous system, Prehypertension, Parasympathetic nervous system, Enteric nervous system

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Objective: The present study was planned to study comparative effects of telmisartan vs lisinopril on blood pressure in patients of metabolic syndrome Methods: The study was carried out on 62 patients of metabolic syndrome from Dec 2010 to Oct 2012 in OPD of Institute. There were two groups, A and B. Group A- Telmisartan (31 patients) and Group B- Lisinopril (31 patients) receiving Telmisartan 40 mg and lisinopril 5 mg orally once a day respectively for 12 weeks. The diagnosis of essential hypertension was made by the physician based on two measurement of blood pressure on two different occasions using auscultatory method and was done at initial stage and repeated after 6 weeks and 12 weeks of treatment in Group A and Group B patients. Key findings: Our study found that telmisartan or lisinopril treatment for 12 weeks leads to statistically significant (p<0.001) reduction in both SBP and DBP at 6 and 12 weeks when compared with baseline, whereas comparison between telmisartan and lisinopril treatment failed to show any statistically significant effect. Conclusion: Treatment of metabolic patients with telmisartan or lisinopril for management of hypertension reduced both Systolic blood pressure (SBP) as well as Diastolic blood pressure (DBP) statistically significantly during 12 weeks treatment. However, telmisartan and lisinopril treatment found effective.

Concepts: Atherosclerosis, Hypertension, Blood pressure, Artery, Orthostatic hypotension, Prehypertension, Cardiac cycle, Systole

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Increased dietary potassium intake is thought to be associated with low blood pressure (BP). Whether potassium supplementation may be used as an antihypertensive agent is a question that should be answered.

Concepts: Myocardial infarction, Hypertension, Randomized controlled trial, Blood pressure, Artery, Potassium, Orthostatic hypotension, Prehypertension

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More than 70 million people in the United States and more than 1 billion worldwide have hypertension - defined by a systolic blood pressure of at least 140 mm Hg and a diastolic blood pressure of at least 90 mm Hg - and the numbers are increasing steadily. Despite remarkable advances in pharmacotherapy, which have given us the ability to lower elevated blood pressure in almost everyone, hypertension remains a major public health problem as a critically important risk factor for cardiovascular and renal disease. Benefits of antihypertensive drug therapy were first demonstrated in the late 1950s in patients with . . .

Concepts: Kidney, Hypertension, Blood pressure, Renin-angiotensin system, Orthostatic hypotension, Prehypertension, Renin, Hypotension

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BACKGROUND/OBJECTIVES:Hypertension affects about 30% of adults worldwide. Garlic has blood pressure-lowering properties and the mechanism of action is biologically plausible. Our trial assessed the effect, dose-response, tolerability and acceptability of different doses of aged garlic extract as an adjunct treatment to existing antihypertensive medication in patients with uncontrolled hypertension.SUBJECTS/METHODS:A total of 79 general practice patients with uncontrolled systolic hypertension participated in a double-blind randomised placebo-controlled dose-response trial of 12 weeks. Participants were allocated to one of three garlic groups with either of one, two or four capsules daily of aged garlic extract (240/480/960 mg containing 0.6/1.2/2.4 mg of S-allylcysteine) or placebo. Blood pressure was assessed at 4, 8 and 12 weeks and compared with baseline using a mixed-model approach. Tolerability was monitored throughout the trial and acceptability was assessed at 12 weeks by questionnaire.RESULTS:Mean systolic blood pressure was significantly reduced by 11.8±5.4 mm Hg in the garlic-2-capsule group over 12 weeks compared with placebo (P=0.006), and reached borderline significant reduction in the garlic-4-capsule group at 8 weeks (-7.4±4.1 mm Hg, P=0.07). Changes in systolic blood pressure in the garlic-1-capsule group and diastolic blood pressure were not significantly different to placebo. Tolerability, compliance and acceptability were high in all garlic groups (93%) and highest in the groups taking one or two capsules daily.CONCLUSIONS:Our trial suggests aged garlic extract to be an effective and tolerable treatment in uncontrolled hypertension, and may be considered as a safe adjunct treatment to conventional antihypertensive therapy.European Journal of Clinical Nutrition advance online publication, 21 November 2012; doi:10.1038/ejcn.2012.178.

Concepts: Myocardial infarction, Hypertension, Blood pressure, Artery, Ventricle, Orthostatic hypotension, Prehypertension, Systole

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Elevated blood pressure (BP) during early life years is associated with future risk of hypertension and cardiovascular morbidity and mortality. This study aimed to determine the prevalence and lifestyle factors associated with prehypertension (systolic BP (SBP) 120-139mm Hg and/or diastolic BP (DBP) 80-89mm Hg) or hypertension (SBP ≥ 140mm Hg and/or DBP ≥ 90mm Hg or on antihypertensive medications) among young adults at a Singapore university.

Concepts: Blood, Myocardial infarction, Hypertension, Stroke, Blood pressure, Orthostatic hypotension, Prehypertension, Essential hypertension

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Mind-body practices that elicit the relaxation response (RR) have been demonstrated to reduce blood pressure (BP) in essential hypertension (HTN) and may be an adjunct to antihypertensive drug therapy. However, the molecular mechanisms by which the RR reduces BP remain undefined.

Concepts: Myocardial infarction, Hypertension, Stroke, Blood pressure, Nitrogen, Orthostatic hypotension, Prehypertension, Essential hypertension

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Previous studies examining blood pressure change over time have modeled an average population trajectory. Recent research among older adults suggests there may be subgroups with different blood pressure trajectories. Identifying subgroups at risk of developing adult hypertension early in life can inform effective risk reduction efforts. We sought to identify different systolic blood pressure trajectories from childhood, their correlated risk factors, and early-midlife cardiovascular outcomes. Blood pressure data at ages 7, 11, 18, 26, 32, and 38 years from a longitudinal, representative birth cohort study (n=975) were used to identify 4 distinct trajectory groups via group-based trajectory modeling: normal (21.8%), high-normal (43.3%), prehypertensive (31.6%), and hypertensive (4.2%). The categories refer to blood pressure beginning at the age of 7 years and most recently measured at the age of 38 years. Family history of high blood pressure (odds ratio [OR], 43.23; 95% confidence interval [CI], 5.27-354.65), male sex (OR, 109.48; 95% CI, 26.82-446.96), being first born (OR, 2.5; 95% CI, 1.00-8.69) and low birth weight (OR, 2.79; 95% CI, 2.49-3.09) were associated with hypertensive group membership (compared with the normal group). Higher body mass index and cigarette smoking resulted in increasing blood pressure across trajectories, particularly for the higher blood pressure groups. Prehypertensive and hypertensive trajectory groups had worse cardiovascular outcomes by early midlife. Harmful blood pressure trajectories are identifiable in childhood, associated with both antecedent and modifiable risk factors over time, and predict adult cardiovascular disease risk. Early detection and subsequent targeted prevention and intervention may reduce the lifecourse burden associated with higher blood pressure.

Concepts: Cohort study, Myocardial infarction, Atherosclerosis, Hypertension, Stroke, Blood pressure, Orthostatic hypotension, Prehypertension

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To assess the prevalence of obesity and hypertension-level blood pressures in an urban, athletic adolescent population using preparticipation physical evaluation (PPE) data.

Concepts: Myocardial infarction, Hypertension, Stroke, Blood pressure, Artery, Orthostatic hypotension, Prehypertension