Talk:Hypertension

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[edit] 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)

[edit] 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)

[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...

There are studies showing the relationship of Magnesium and Hypertension *[1] —Preceding unsigned comment added by WSNRFN (talk • contribs) 21:56, 14 October 2008 (UTC)

[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, [2] [3] [4] and [5] - 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)

I thought it would be a good idea to add it, since most people reading these articles are unaware of the finer distinctions. 69.6.163.35 (talk) 04:49, 29 July 2008 (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."[6]

[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 [7] Cerebral Resuscitation After Global Brain Ischemia: Linking Research to Practice. Also see [8] 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 [9] 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)

[edit] Hypertension is Heart Failure??

In the first paragraph of this article it is stated that hypertension is "commonly referred to as heart failure"?? I myself have been battling high blood pressure unsuccessfully for almost a year now but have thankfully not yet suffered actual heart failure. According to my doctors and my own research "congestive heart failure" can certainly be an ultimate result of but is NOT the same as hypertension. Have I been misinformed? On a semi-related note, after reading the various subjects in dispute on this article and considering the seriousness of this topic is it really worth it to post questionable information? --Jasap 13:17, 25 April 2007 (UTC)

Much thanks to the anonymous editor who changed (among other things) "heart failure" to "high blood pressure", a perfect replacement. This editor appears to have more medical knowledge then me; I was hesitant to edit the article myself. By the way, to this editor: regarding your summary text I am fairly certain TIMMY!! is a reference to the like-named character on South Park. My apologies if you were simply stating you had done your due diligence. --Jasap 20:36, 26 April 2007 (UTC)

[edit] Rapid Breathing

People say "Rapid Breathing," which causes numbness in the lungs, and a strange tingling sensation in the nose is related, and may be called Hypertension. I was wondering if this was true. --76.204.88.32 (talk) 02:41, 21 November 2007 (UTC)

I'm not aware of any connection between intentional rapid breathing and hypertension. There may be medical events that cause you to feel the need to breathe rapidly, and these may be related to pulmonary hypertension. Is that what you're thinking about? Antelan ^talk 17:04, 15 December 2007 (UTC)

I think you may be confusing the terms hypertension and hyperventilation. The latter is rapid breathing. Aleta (talk) 18:34, 15 December 2007 (UTC)

Now that makes more sense :-) Antelan ^talk 18:58, 15 December 2007 (UTC)

[edit] Epidemiology!

The epidemiology section is lacking.

It doesn't mention the type of people who are most vulnerable, or any statistics as to prevalence.

Male vs female incidence
Increasing risk with age
Ethnic variations

These should all come under the epidemiology section. They're basic pieces of information.

Apologies if they're mentioned elsewhere in the article; but thats where they should really be. Maybe also a bit in the introduction.DHAR3070 (talk) 15:47, 15 December 2007 (UTC)

[edit] Citation need for shortened life expectancy associated with elevated ABP

Even moderate elevation of arterial blood pressure leads to shortened life expectancy. There needs to be a citation for this, or else is should be removed. In addition, it should include the shortness of the new life expectancy, preferably with the mean and std. Rhetth (talk) 01:48, 3 January 2008 (UTC)

[edit] Imported licorice

I removed the word "imported" from the mention of licorice, since it depends on the reader's location whether that species of licorice is imported or not.--HarryHenryGebel (talk) 14:57, 10 January 2008 (UTC)

[edit] noise/over-illumination

"Relaxation therapy, such as meditation, that reduces environmental stress, high sound levels and over-illumination can be an additional method of ameliorating hypertension." ...what?? the pages for noise pollution and over-illumination say that those things are bad for hypertension. I'm going to change this in a couple of days unless someone can point out where my reasoning is messing up ;) Perwfl (talk) 02:59, 15 January 2008 (UTC)

The environmental stress referred to is the high noise / high light. —Preceding unsigned comment added by 125.237.0.254 (talk) 05:51, 23 July 2008 (UTC)

[edit] Sodium ≠ Salt

This misconception is repeated many times in this article. Sodium is a metal, whereas a salt is a compound consisting of anion(s) and cation(s) in a specific ratio (For instance, dry DNA is refered to as a salt as it is complexed with sodium). The nutrition facts label found on all US food gets this distinction right. Why can't wikipedia? —Preceding unsigned comment added by 204.52.215.17 (talk) 18:41, 15 January 2008 (UTC)

[edit] Racism

Why is racism singled out as a stress that can elevate BP. Would it not be more encyclopedic to cite articles discussing how many strong emotional stresses can cause HTN. —Preceding unsigned comment added by 24.165.188.30 (talk) 21:54, 25 January 2008 (UTC)

[edit] Encyclopedic style

Informal language is often used ("you should", "this means that you...", etc.) in the article. At least one reference is in the text. A thorough review is probably needed.208.102.122.87 (talk) 17:58, 1 April 2008 (UTC)

[edit] Licorice is the preferred spelling

1,160,000 Google hits Liquorice, 4,900,000 hits Licorice.

[edit] This article needs a lot of work

For starters, many statements lack references. Unreferenced works should not be trusted, particularly since Wikipedia is written anonymously and can be changed by anyone. Once I get verification by a known Wikipedian (a checkuser, for example), I will begin getting references for every single sentence. Doctor Wikipedian (talk) 18:53, 7 May 2008 (UTC)

More references (to reliable sources) are always a good thing. Go for it! I'm not sure what you mean by "get[ting] verification by a known Wikipedian (a checkuser, for example)". Are you asking for permission to add references? Aleta ^Sing 19:06, 7 May 2008 (UTC)

Although there is a "no original research" policy, everyone must use some judgement in editing. Otherwise, one could search every textbook, journal article and even anti-medicine sources that has the word "hypertension" and add it to the article. The end result would be a useless mass of text.

If a checkuser verifies that my IP suggests with reasonable certainty that I am a doctor, then people will know what sort of judgement has been used in medical edits. Of course, Wikipedia is supposed to be anonymous so anything that is written has to take that into consideration. However, this kind of verification offers some benefits. The fact that my username has the word "doctor" now adds importance that some sort of verification is needed and it's too late to change the name now. Doctor Wikipedian (talk) 19:59, 7 May 2008 (UTC)

You do not, I think, fully understand just what "checkuser" means. We do not, in wikipedia, ever attempt to establish an editor's authority, bonar fides or identity. We are concernede only with the text submitted in articles, which itself needs to be appropriately referenced. The soundness of your personal judgement is therefore of no direct concern. But your considered medical opinion does not carry weight in the encyclopedia without quotable references. For the record, I am also a Medical Doctor, and also edit under this limitation. Checkuser ability, which I do not have and which is held only by a very few wikipedians, is a software skill which enables the identification of the IP initiating an edit, and is used to help in identifying sockpuppetry. --Anthony.bradbury^"talk" 20:28, 7 May 2008 (UTC)

You and I then agree that a checkuser can identify an IP. I wish the checkuser to privately identify the IP and publically verify that I am a doctor. At the very least, there are indications that I am. Identification of my IP will eliminate the possibility that I am an angry patient. Doctor Wikipedian (talk) 20:55, 7 May 2008 (UTC)

Angry patients have exactly the same rights on Wikipedia as doctors (angry or otherwise), and I've seen them make excellent contributions. So if you are really an angry patient, the same applies: go ahead and add those references! (By the way, being a medical doctor does not protect you from illness.) Guido den Broeder (talk) 23:15, 14 May 2008 (UTC)

[edit] Prevention?

Please could there be a section on preventing future hypertension. Thanks. 80.2.206.140 (talk) 11:42, 10 June 2008 (UTC)

[edit] Chiropractic is pseudoscientific bullshit.

I just removed a bunch of bullshit in this article about a Chirotard study called "Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study", J Hum Hypertens. 2007 May;21(5):347-52, which concluded "that restoration of Atlas alignment is associated with marked and sustained reductions in BP similar to the use of two-drug combination therapy."

The conclusion is ridiculous even prima facie, but it has also been specifically debunked:

http://www.quackcast.com/spodcasts/files/97017a90c558a66d6c6217831f6b045e-16.html

"The basic biologic plausibility and underpinning science [of this study] is quackery at worst and marginal at best."

To save you the trouble of listening to the whole podcast:

There is a particular subtype of hypertension (which is numerically insignificant in the general population of hypertensive patients), which is caused by medullary vascular compression (neurovascular hypertension), and could at least theoretically be relieved by yutzing around near the C1 vertebra. The study claims it did not select hypertension patients who specifically had this subtype of hypertension, but the results imply otherwise. If they did select patients in a deceptive way, this article is not only misleading, but fraudulent.

NUCCA, the origin of this study (it is an organization, not a procedure as the study implies), proceeds from the assumption that neurovascular hypertension is caused by subluxation of the C1 vertebra, which can be trivially demonstrated to be false.

To refer to this study in any amount of seriousness as "double-blind" and "placebo-controlled" is patently ridiculous, since the (one, single, 85-year old) Chirotard practitioner was not ignorant of which treatment he was providing (meaning it's not double-blind), and both treatments are in fact placebos (as any of a dozen other articles outside dedicated Chirotard journals can show). There is no quantitative differentiation in technique between the placebo group and the so-called non-placebo group, except that the study asserts that the (one, single, 85-year old) Chirotard practitioner "intentionally" did it wrong on the placebo group -- without explaining in quantitative terms how, and without bothering to physically check and see if there was any real measurable difference in technique. Even the placebo group's blood pressure went down significantly. The study merely claims that the so-called non-placebo group's BP went down more, and that decrease is attributable to the Chirotardic technique. The variation in placebo effect between the control group and the... other control group... can be explained purely by the fact that the study was not double-blind. One man, the one who provided every single one of the treatments, knew which patients had received which treatments. He knew before he did the treatments which ones he would give the "real" treatment to, he knew during the treatment, and he knew after the treatment. The BP tests after the treatment, aka the measure of success, was not done by a machine (for undeniable results, and this would be the standard procedure in such a situation), but rather a human being (and of course it cannot be truly evaluated whether this person was blinded, since even the person providing the treatment wasn't).

v--75.58.83.74 (talk) 21:33, 1 July 2008 (UTC)

I can't believe your using a resource like quackcast.com as a reference. WSNRFN (talk) 21:50, 14 October 2008 (UTC)WSNRFN

[edit] Hyper/Hypo is High/Low not Low/High

Changed low to high in the first sentence and de-elevated to elevated. Hypo is low and Hyper is High. Also fixed Hypotension the same way in the same spot. Garth 66.74.147.147 (talk) 11:24, 18 July 2008 (UTC)

[edit] Relaxation as a Lifestyle Modification

I am asking for help and thoughts! I posted an entry on the benefits of mindbody relaxation that was removed and labeled as advertisement. Please look at the undo on 15:15, 4 August 2008 by the anonymous writer, 72.70.66.217.

The material that removed was a reference to peer-reviewed research. It added information that was not covered elsewhere. It did not make bold or unsubstantiated claims.

The deletion was reversed by Ukexpat but then the same anonymous writer deleted it. I don't want to get into a revert war. Therefore I am asking for help and opinions. --Emily29G (talk) 21:57, 7 August 2008 (UTC)

Per JNC VII guidelines, therapeutic lifestyle changes (TLC!) are always encouraged, but they are not recommended as the only treatment for hypertension. Prehypertension, yes. Antelan 22:03, 7 August 2008 (UTC)

Help with Anonymous Vandalism! I am asking for your thoughts and help. I posted an entry on the benefits of mindbody relaxation that was removed and labeled as advertisement. Please look at 15:15, 4 August 2008 by the anonymous writer, 72.70.66.217.

The material that removed was a reference to peer-reviewed research. It added information that was not covered elsewhere. It did not make bold or unsubstantiated claims. The deletion was reversed by Ukexpat but then the same anonymous writer deleted it.

This is my question. Do writers and administrators of this hypertension article feel comfortable with the material below? If so please help me reinstate it, because this anonymous writer keeps on deleting it.

Mindbody Relaxation has been proven to have long-lasting benefits in reducing hypertension. Mindbody relaxation reduces the risk of fatal heart attacks by up to 30%, and also reverses hardening of the arteries or atherosclerosis. In fact mindbody relaxation has been proven to increase life expectancy. Reference: Steven M. Melemis (2008). Make Room for Happiness: 12 Ways to Improve Your Life By Letting Go of Tension. Better Health, Self-Esteem and Relationships. Chapter 14: Improve Your Health. Modern Therapies. --Emily29G (talk) 15:19, 9 August 2008 (UTC)

The way that's written, it does sound like advertising-speak. The article on MBR seems well-referenced, which makes me curious as to why the only reference given is a pop-therapy book. Really, this could be reduced to a one-sentence description which links to the MBR article. — The Hand That Feeds You:^Bite 18:53, 10 August 2008 (UTC)