Essential hypertension

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Hi All,

The Lancet has in Volume 361, Issue 9369 , 10 May 2003, Pages 1629-1641 a

Seminar called Essential hypertension.

Article Outline:

Epidemiology

Diagnosis

Pathophysiology

Sodium and fluid balance

Microvascular and macrovascular mechanisms

Genetics of human hypertension

Monogenic forms of blood pressure dysregulation

Blood pressure as a polygenic quantitative trait

Intervention through lifestyle

Antihypertensive drug treatment

Primary prevention

Secondary prevention

Comparative trials

Guidelines for antihypertensive drug therapy

Conclusions

Search strategy

Acknowledgements

References

Glossary

Things I liked were:

In cross-sectional and longitudinal population

studies, systolic blood pressure increases with age

until the eighth decade of life (figure 1). By

contrast, diastolic blood pressure rises only until 50

years of age, after which it either becomes

constant or even decreases slightly.

Intervention through lifestyle

In chimpanzees given a vegetarian diet with

very low sodium and high potassium content, salt

repletion (10–15 g per day for 20 months)

caused a rise in blood pressure by 33 mm Hg systolic

and 10 mm Hg diastolic.[101] Intervention

studies in man [102] produced the most convincing

evidence for the role of salt in hypertension. A

meta-analysis of 56 trials accounted for measurement

error of urinary sodium excretion. For a reduction

of the daily sodium excretion by 100 mmol

(about 6 g of salt), the decline in blood pressure

in hypertensive patients averaged 3·7 mm Hg (95%

CI 2·4–5·0) systolic and 0·9 mm Hg (-0·1 to

1·8) diastolic. [102] The corresponding decreases in

normotensive subjects were small: 1·0 mm Hg

(95% CI 0·5–1·6) and 0·1 mm Hg (-0·3 to 0·5),

respectively. In the Dietary Approaches to Stop

Hypertension (DASH) trial, [103] participants

were fed meals with varying salt levels for more

than 4 weeks. The DASH diet was rich in fresh

fruits, vegetables, and low-fat diary products.

For both the DASH and traditional diets, the lower

the salt intake, the lower was the blood pressure.

[103] In line with the concept of

pressure-natriuresis, [29] some studies demonstrated

the restoration of a dipping diurnal blood

pressure profile in non-dipping hypertensive patients

given a low-salt diet. [104] However, high

sodium intake [105, 106 and 107] associated or not

with sodium sensitivity, [105 and 107] did not

uniformly predict a worse cardiovascular outcome in

prospective studies. Furthermore, sodium

restriction does not normalise peripheral vascular resistance,

the main haemodynamic disturbance in

essential hypertension. [108]...........

Stopping excessive alcohol consumption (>30 mL

ethanol per day)[109] and restriction of caloric

intake [110] are by far the most effective lifestyle

measures that consistently reduce blood pressure.

In an overview of intervention studies, a 1 kg loss

of weight entailed an average blood pressure

decrease by 1·6 mm Hg systolic and 1·3 mm Hg

diastolic. [110] Other lifestyle measures that have

the potential to slightly diminish blood pressure

are regular dynamic exercise (30–45 min for at least

4 days per week) [111] and abstaining from smoking.

[112] These lifestyle measures are

recommendable because they reduce not only

blood pressure but also cardiovascular risk.........

Nifedipine Trial on Antiatherosclerotic Therapy,

short-acting nifedipine (n=173) compared with

placebo (n=175) reduced the number of new

coronary lesions by 28%, but the drug was associated

with higher all-cause (14 vs 2) and cardiac mortality (10 vs 2).....

JAS and WHB did ad-hoc consultancies for

pharmaceutical companies with commercial interests in

the cardiovascular field. During their lifetimes,

they have received funding for studies, seminars, and

travel from such companies. GB is an adviser

to the Prassis Sigma Tau Research Institute (Milan, Italy).

The PDF is available.

Cheers, Al.

Alan Pater, Ph.D.; Faculty of Medicine; Memorial University; St. 's, NL

A1B 3V6 Canada; Tel. No.: (709) 777-6488; Fax No.: (709) 777-7010; email:

apater@...