Talk:Hypertension

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Huh?

Ambulatory monitoring may help determine whether traffic and ticket inspectors produce similar sustained rises.

I don't get it. --Bri 11:53, 23 December 2005 (UTC)


Treatment

The statements in this section are wrong. The biggest error is in saying ACE and CCB provided no benefit. That is impossible to say from ALLHAT as there was no placebo used in ALLHAT! There are studies that certainly show a benefit for both ACEi and CCB to prevent both heart attacks and strokes. The purpose of ALLHAT was to compare these meds head-to-head, not to placebo. The author completely missed the point.

ALLHAT did show a small advantage to a thiazide diuretic vs ACEi. HCTZ was not even used in the study, chlothiazide was. Also the difference (which was very small) was in two secondary outcomes: stroke and onset of heart failrure. The ANBP2 study, published just after ALLHAT, did not show a difference. Actually, it showed a preference to ACEi. There are many reasons that are thought to account for this, but the bottom line is there is very little difference, if any, between a thiazide diuretic vs ACEi for single therapy in HTN.


John, your paragraph is really okay in its condensed form. All you're giving is dull statistic, while I want to know:

  • What alternative treatments are there, e.g. which herbs or practices?
  • Have any of these treatments been significantly effective?
  • Are there known interactions between alternative and mainstream antihypertensive measures?

Your edit summary was rather inflammatory. Erich was not even trying to play God. JFW | T@lk 02:44, 24 Jun 2004 (UTC)

I will be following the edits of you guys, making sure that they meet my standards. It wont be a problem at all. Feel free to write the above. -- [[User:Mr-Natural-Health|John Gohde | Talk]] 09:11, 24 Jun 2004 (UTC)

Contents

[edit] Alternative medicine

User:210.246.51.132 changed this:

Furthermore, relaxation therapy and biofeedback do little if anything to control blood pressure.

into this:

Relaxation therapy, cognitive therapy and biofeedback may significantly reduce blood pressure in some individuals.

I think both these statements might need some references to back them up, so I have removed them. Rasmus (talk) 11:17, 19 Nov 2004 (UTC)

Funny, the one "alternative" (or more appropriately, non-pharmaceutical) treatment outside of diet and exercise that actually works wasn't mentioned once! Increasing Potassium can be quite effective in decreasing blood pressure-- nowhere near as effective as drugs or losing weight, of course, but enough to potentially reverse a diagnosis of hypertension. I mentioned it briefly under diet, but really, if we're talking about biofeedback, potassium might deserve a bit more in-depth treatment. I don't have the medline time right now to dredge up studies, but the mechanism for potassium's effects on blood pressure is an exercise in basic renal (kidney) physiology and ion balance, really...

[edit] Chronic stress and anxiety

Denollet (Journal of Psychosomatic Research 49 (2000) pp. 255-266) report on a "Type D" personality which is found to be correlated to hypertension. The defining features of the personality are "Negative Affectivity" (NA) coupled with "Social Inhibition" (SI). NA refers to a state of dysphoria (down in the dumps, unhappy, gloomy) combined with chronic tension and worry. SI refers to difficulties concerning inter-personal communication. The paper proposes that, in these individuals, hypertension is caused as a result of sustained mental tension and stress. Subsequent studies have found that cognitive therapy, when applied to Type D individuals, has a therapeutic effect on elevated BP.

Therefore, I propose that the sentence,

"Hypertension is often confused with mental tension, stress and anxiety. While chronic anxiety is associated with poor outcomes in people with hypertension, it alone does not cause it."

be removed or revised accordingly.

It is perhaps best to state hypertension as simply being the presence of elevated BP and not, in the initial definition, discuss connections to stress or anxiety. Unsigned by User:P rynhart

You may include something like this, but the correllation is quite poor. JFW | T@lk 01:33, 21 Nov 2004 (UTC)

[edit] Etiology - missing

You forgot something important: etiology. --Eleassar777 20:07, 24 Mar 2005 (UTC)

[edit] white coat effect

White coat effect is much more commonly used: Google returns 2,200,000 results vs. 138,000 for "white coat hypertension". The lead in refers to "the colloquial term". Colloquial= used in or characteristic of familiar and informal conversation (M-W.com); the term hypertension is certinaly not the layman's term.

Quite the opposite. Merely searching for the words finds any article with those words - in any combination - and the word "effect" is obviously in a lot more articles than hypertension. If you search for them as an exact phrase (in quotation marks), "white coat effect" finds 36,800 results, and "white coat hypertension" finds 126,000. 69.85.180.179 10:08, 7 November 2006 (UTC)

[edit] Exercise Hypertension

Do we need something on this effect (most recently reported in a Johns Hopkins paper, but similar effects are well known from earlier studies I think). (Personal interest at present alas - I've been blowing my recently acquired Braun BP meter offscale running up the hill at the back. :-()80.177.213.144_

I think we need a separate article on Exercise hypertension. I need it for Exercise and Training effect. I found four references, [1] [2] [3] and [4] - I'll write a stub in a couple of days if no one steps up, but really a medical person should write an article. Please post in Training effect if you do. Simesa 18:33, 26 August 2005 (UTC)

[edit] Cinnamon...

Lets hear the anecdote about CInnamon then, or have a pointer to the trials going on. It is a story I had not heard, and still have not. Midgley 21:25, 15 December 2005 (UTC)

[edit] cinnamom

--59.95.11.186 16:10, 5 January 2006 (UTC)does cinnamon has preventive role if yes what doses?

According to the article, "There is also anecdotal evidence that consumption of cinnamon is very effective in lowering blood pressure. The USDA has three ongoing studies that are monitoring this effect." However, the only study on cinnamon I found was Clinical trial NCT00237640. Here's a couple of studies: PMID 14709014 and PMID 14633804. Though the studies focus on diabetes, much of it would still apply to hypertension. And here is a site that is commercial, so judge it critically, but it contains references to more studies. But the short answer is that we don't know for sure right now, but should have a better idea in a couple of years. --Arcadian 16:25, 5 January 2006 (UTC)

I removed it from the treatment section, as anecdotal evidence I think is not enough to mention it there. If anybody wants it back in it should be under a current research section along with other treatments under research. --WS 17:59, 5 January 2006 (UTC)

Judging simply by the evidence I would not encourage cinnamon just because of the above. Sour milk is supposed to have ACE inhibitor activity. Same problem. Wouldn't it be lovely if there were tasty food-based antihypertensives? JFW | T@lk 18:05, 5 January 2006 (UTC)


[edit] Continuous variable and degree of risk

"Blood pressure is a continuous variable, and risks of various adverse outcomes rise with it. A blood pressure of less than 120/80 mmHg is defined as "normal" in adults."

Was taken out. It looks good to me. (Did I write it?)

A bit on pre-hypertension was added. So we go from a continuum to three separate conditions. I don't think that is a good description. Midgley 20:32, 31 January 2006 (UTC)

Concur. The continuum needs to be clarified, but we do definitely need to mention abnormal BP and up-to-date classification systems. JFW | T@lk 17:14, 1 February 2006 (UTC)
There is also the balance between benefit and harm, which has changed progressively toward treating lower but raised BP as time and Pharmaceuticals go on. Midgley 02:10, 11 February 2006 (UTC)

[edit] Re: Hypertension Treatment: Medications

As this article is intended for the general public, I believe it is necessary to note that the National Heart, Lung, and Blood Institute's Seventh Joint National Committee on High Blood Pressure (JNC-7) recommends that the physician not only monitor for response to treament but should also assess for any untoward reaction resulting from the medication(s).

[edit] ETIOLOGY

I think we should better redact this section as we are talking about a physiologic alteration of blood pressure management and not anectdotal incidents that may temporarly increasy blood pressere values without altering the hemodynamics of the blood pressure regulation. For example enviromental noise may raise your bloos pressure through increasing heart rate because of the stress, but once you remove the noise the stress is gone. That does not happen in essential hypertension or in secondary hypertension (where there is a primary physiological alteration that as a side effect produce an increase in blood pressure for ex Diabetes).Dr. Guillermo A. Sanz-Berney 03:27, 19 August 2006 (UTC)


I have divided the etiology in the two forms of hypertension; Essential and Secondary. I have alsod eleted the etiologies mentioned before as they ar emore risk factors for cardiovascular disease and not hypertension. Those diseases mentioned (like Diabetes) dont per se cause HTN but they do it through the secondary mechanism mentioned under 2ry HTN.Dr. Guillermo A. Sanz-Berney 23:45, 20 August 2006 (UTC)

[edit] Salt sensitivity

With regard to salt sensitivity i think it is a 3rd of all patients not 60%. See-KATORI, M. & MAJIMA, M. (2006). A Missing Link Between a High Salt Intake and Blood Pressure Increase. Journal of Pharmacological Sciences, 100, 370-390. - Tom

[edit] Pulmonary hypertension

I thought pulmonary hypertension would be mentioned or linked under hypertension, though I did find a separate article for it. Maybe someone could follow up?69.6.162.160 01:31, 9 October 2006 (UTC)Brian Pearson

we usually refer to systemic high blood pressure when we talk of hypertension. PHT is usually understood to be a separate pathological entity. DrCito 00:34, 23 October 2006 (UTC)

[edit] Possible addition to Medicines?

A beta blocker called Nebivolol which, "besides lowering blood pressure, nebivolol also restored the function of the nitric oxide system in the cell samples."[5]

[edit] Natriuretic Factor

I removed the bit about natriuretic factors being theoretical. Call me a rebel, but when someone has sequenced a protein and proven its function in vivo, it is no longer theoretical. Atrial Natriuretic Factor and Brain Natriuretic Factor are both about as real as insulin. Kajerm 05:53, 16 November 2006 (UTC)

[edit] "Steroids" as a cause of hypertension

To quote a sentence in the existing article:

"Certain medications, especially NSAIDS (Motrin/ibupofen) and steroids can cause hypertension."

The word "steroids" is not specific enough. What type of steroids? Anabolic steroids? Corticosteroids? If it is both, then they should probably both be listed separately, as the mechanisms of cause are surely different. Also, to be accurate, I think that it is reasonable that a more specific relationship be defined. For example, does a linear increase in serum steroids provide for an linear increase in hypertension? Iambk 22:15, 24 November 2006 (UTC)

hi Iambk, i'm just visiting... to answer your question... it happens that both corticosteroids and anabolic steroids both can cause hypertension by exerting a mineralocorticoid (aldosterone)type effect. The only other group are the female sex steroids and I think they can too, but to a much less extent. Also the relationship is complex, and not overly predictable... (dose, duration, patient susceptability etc) cheers Erich 23:16, 24 November 2006 (UTC)

[edit] Category

Can this article be added to Category:Cardiovascular diseases?--Knakts 09:39, 23 February 2007 (UTC)

[edit] Medically induced hypertension

This article discusses only the disease aspects of hypertension. Like hypothermia, controlled hypertension has certain medical uses. For example, Hypertension + hemodilution is an experimental treatment to help minimize brain cell death after trauma -- see [6] Cerebral Resuscitation After Global Brain Ischemia: Linking Research to Practice. Also see [7] Sterz F. Leonov Y. Safar P. Radovsky A, Tisherman S. Oku K. Hypertension with or without hemodilution after cardiac arrest in dogs. Stroke 1990;21:1178-1184.

I also just found a citation for the use of medically induced hypertension as a treatment for vasospasm. See [8] E.M. Manno et al. Effects of Induced Hypertension on Transcranial Doppler Ultrasound Velocities in Patients After Subarachnoid Hemorrhage in Stroke. 1998;29:422-428.

Are there other examples? Egfrank 04:01, 21 March 2007 (UTC)

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