Recent Advances in the Pathogenesis and Management of Hypertension

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Authors: Ram B Singh, Oleg Medvedev, Saibal Chakravorty, Meenakshi Jain, AK Shukla, Amitabh Yaduvanshi, Aditya Chakravorty, Vikas K Patel, and Gushchina Yulia
Page Range: 107-126
Published in: World Heart Journal, 15#2 (2023)
ISSN: 1556-4002

Table of Contents

ABSTRACT

Despite the availability of safe blood pressure (BP)-lowering drugs, only <14% of adults with hypertension have BP controlled to a systolic/diastolic BP of <140/90 mmHg. This review aimed to highlight the role of non-pharmacological measures in patients with hypertension. Obesity, diabetes mellitus, sedentary behavior, alcoholism, tobacco intake, and increased salt (> 5.0 g/day) are common risk factors for hypertension. However, mental stress, night shift work, sleep disruption, western diet, no regular breakfast, and nighttime eating are also risk factors for high BP. In the development of hypertension, BP regulation involves combined functions of the heart, blood vessels, and kidney. These new concepts indicate that risk factors cause oxidative stress and inflammation, which may influence genetics, sodium homeostasis, and the microbiome, thereby leading to hypertension. Regular practice of meditation and yoga, physical training, weight loss, Tai Chi, acupuncture, mind-fulness-based stress reduction programs, and relaxation techniques of Yoga and Transcendental Meditation may decrease the risk of hypertension. Current antihypertensive drugs, diuretics, calcium channel blockers, ACE inhibitors or ARBs, and beta blockers, which are freely available for treatment, are well tolerated by most patients. Newer antihypertensive drugs, such as ARNI and SGLT2 inhibitors, also prevent heart failure more efficiently than older drugs. It is possible that lifestyle modification by regular practice of certain techniques related to protective health behavior in conjunction with drug therapy may decrease BP, target organ damage, and cardiovascular diseases (CVDs).

Keywords: Blood pressure, cardiovascular disease, risk factors, diet, and exercise

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