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Abstract
Hypertension is a widespread and deadly medical condition in both the United States and around the world. This is particularly true for certain subgroups of the population, such as African Americans, older individuals, and those with poor access to healthcare or to treatments that can lower blood pressure (BP). Psychological, social, behavioral, cultural, and environmental risk factors for hypertension are now well-known, and controlling these risk factors can help to lower BP and prevent hypertension. This chapter examines the many reasons why religious involvement might affect BP or influence the development of hypertension. Systematic research is reviewed on the relationship between religion, religiosity, and blood pressure. Likewise, religious/spiritual interventions that have potential for lowering BP are reviewed. The relationship between religiosity and BP, however, is a complex one that is affected by many factors. Practical applications in the clinic and community are described.

Current advances in hypertension are examined from the perspectives of both the individual patient and the community at large. Great progress has been made in the control of hypertension using a multipronged approach beginning with public and professional education. The recent nationwide fall in cardiovascular mortality is due at least in part to progress in hypertension control. There remain, however, segments of our population that are hard to reach and will continue to require community screening and special treatment programs. Governmental budgeting restraints should not be permitted to jeopardize our highly successful hypertension control and research programs.

<p>Treatment resistant hypertension (TRH) is defined by office blood pressure (BP) uncontrolled on ≥3 or controlled on ≥4 antihypertensive medications, preferably at optimal doses and including a diuretic. Apparent (a)TRH is used when optimal therapy, adherence, and measurement artifacts are unknown. Among treated hy­pertensives, ~30% of uncontrolled and 10% of controlled individuals have aTRH, with a higher prevalence in Blacks than other race-ethnicity groups. In ≥50% of aTRH patients, BP measurement artifacts ('office' TRH), suboptimal regimens, or suboptimal adher­ence are present, ie, pseudo-resistance. While patients with 'office' TRH have fewer cardiovascular events than those with 'true' TRH, no evidence confirms that patients with suboptimal regimens or adherence are spared. Averaging several office BPs obtained with an automated monitor can reduce 'office' TRH. Home or ambulatory BP monitoring can identify office resistance. Prescribing ≥3 different antihypertensive medication classes, eg, thiazide-type diuret­ic, renin-angiotensin blocker and calcium antagonist at ≥50% of maximum recom­mended doses reasonably defines optimal therapy. Intensifying diuretic therapy, eg, adding an aldosterone antagonist, is effec­tive for many TRH patients who are volume expanded. Clinical information, hemody­namic and renin-guided therapeutics can inform other treatment options. Attention to adverse effects, medication costs, and pill burden can improve adherence and control. Patients with aTRH and suspected second­ary hypertension should be evaluated. Inter­fering substances or medications should be discontinued. These approaches will identify or correct the problem in ~80% of aTRH patients. Referral to a hypertension special­ist and newer therapeutic approaches are options for TRH patients who cannot take or do not respond to optimal therapy. <em>Ethn Dis. </em>2015;25(4):495-498; doi:10.18865/ ed.25.4.495</p>

The imbalance between energy intake and expenditure is the main cause of excessive overweight and obesity. Technically, obesity is defined as the abnormal accumulation of ≥20% of body fat, over the individual's ideal body weight. The latter constitutes the maximal healthful value for an individual that is calculated based chiefly on the height, age, build and degree of muscular development. However, obesity is diagnosed by measuring the weight in relation to the height of an individual, thereby determining or calculating the body mass index. The National Institutes of Health have defined 30 kg/m2 as the limit over which an individual is qualified as obese. Accordingly, the prevalence of obesity in on the increase in children and adults worldwide, despite World Health Organization warnings. The growth of obesity and the scale of associated health issues induce serious consequences for individuals and governmental health systems. Excessive overweight remains among the most neglected public health issues worldwide, while obesity is associated with increasing risks of disability, illness and death. Cardiovascular diseases, the leading cause of mortality worldwide, particularly hypertension and diabetes, are the main illnesses associated with obesity. Nevertheless, the mechanisms underlying obesity-associated hypertension or other associated metabolic diseases remains to be adequately investigated. In the present review, we addressed the association between obesity and cardiovascular disease, particularly the biological mechanisms linking obesity and hypertension.

Purpose of review Arterial hypertension is the leading preventable cause of cardiovascular disease worldwide. Effective European programs aiming to improve awareness, treatment, and control of hypertension are lacking. Recent findings Europe is heading the statistics for hypertension prevalence and cardiovascular disease. On the one hand this predominance reflects the increasing life expectancy in European population, whereas on the other hand, it can be attributed to the sedentary lifestyle and the nutritional habits of wealthy societies. Despite its economic power, Europe also ranges among the regions with the lowest rates of hypertension awareness and control worldwide. Summary The present study discusses the influence of medical inertia, insufficient patient education, contradictory recommendations from the European and independent national societies, the need for hypertension programs, as well as differences in health policies in Europe as potential factors that may contribute to this discrepancy.

Les nouvelles guidelines de l'ESC/ESH recommandent le recours au monitoring ambulatoire ou à l'auto-mesure pour le diagnostic de l'hypertension et plaident pour un traitement médicamenteux précoce au moyen d'une combinaison fixe associant un bloqueur du système rénine-angiotensine et un antagoniste calcique ou un diurétique thiazide. L'objectif est d'obtenir une pression artérielle de 120-129/70-79 mmHg chez les patients de moins de 65 ans qui le tolèrent. Chez les sujets de plus de 65 ans on visera une pression artérielle de 130-139/70-79 mmHg. La rédaction de guidelines est un peu l'irruption de la politique dans l'evidence-based medicine (EBM) : des experts font le point des données de la littérature et des résultats des essais cliniques publiés pour formuler des recommandations de bonne pratique. L'EBM n'ayant pas réponse à tout, la rédaction de ces guidelines peut donner lieu à des débats vigoureux qui ne sont pas tranchés de la même manière par tous les groupes d'experts. C'est précisément ce qui est arrivé en 2018 avec les guidelines américaines (1) et européennes (2) concernant l'hypertension artérielle.

Les nouvelles guidelines de l'ESC/ESH recommandent le recours au monitoring ambulatoire ou à l'auto-mesure pour le diagnostic de l'hypertension et plaident pour un traitement médicamenteux précoce au moyen d'une combinaison fixe associant un bloqueur du système rénine-angiotensine et un antagoniste calcique ou un diurétique thiazide. L'objectif est d'obtenir une pression artérielle de 120-129/70-79 mmHg chez les patients de moins de 65 ans qui le tolèrent. Chez les sujets de plus de 65 ans on visera une pression artérielle de 130-139/70-79 mmHg. La rédaction de guidelines est un peu l'irruption de la politique dans l'evidence-based medicine (EBM) : des experts font le point des données de la littérature et des résultats des essais cliniques publiés pour formuler des recommandations de bonne pratique. L'EBM n'ayant pas réponse à tout, la rédaction de ces guidelines peut donner lieu à des débats vigoureux qui ne sont pas tranchés de la même manière par tous les groupes d'experts. C'est précisément ce qui est arrivé en 2018 avec les guidelines américaines (1) et européennes (2) concernant l'hypertension artérielle.

Abstract Background A Reference Framework for Hypertension Care was recently developed by Hong Kong government to emphasise the importance of primary care for subjects with high blood pressure (BP). The Dietary Approaches to Stop Hypertension (DASH) interventional regime was recommended for patients aged 40–70 years with grade 1 hypertension (having systolic BP of 140-159 mmHg and/or diastolic BP of 90-99 mmHg). This study explored factors associated with grade 1 hypertension among subjects screened in primary care settings. Methods The study sample consisted of community dwellers (N = 10,693) enrolled in a primary care programme in which participants overall had similar characteristics when compared to the Hong Kong population census. Invitation phone calls were given by trained researchers to a randomly selected subjects (N = 2,673, [50% of total subjects aged 40–70 years]) between January and June 2013. BP and body mass index (BMI) were measured by trained clinical professionals according to a standard protocol. Interviewer-administered survey questionnaires were used to collect self-report information on socio-demographics, family history, and lifestyle characteristics. Multiple logistic regression analysis was performed to explore factors associated with grade 1 hypertension. Adjusted odds ratios (aORs) were estimated with 95% confidence intervals (CI). Results A total of 679 out of 2,673 subjects agreed to participate in the screening and completed the baseline assessment (100% completion rate), among which, 320 subjects (47.1%, [320/679]) were grade 1 hypertensive. Unhealthy diet (aOR = 2.19, 95%CI 1.04-4.62), irregular meals (aOR = 1.47, 95%CI 1.11-1.95), BMI >27.5 kg/m 2 (aOR = 1.87, 95%CI 1.53-2.27), duration of cigarette smoking (aOR = 1.83 per year), increased daily cigarette consumption (aOR = 1.59 per pack [20 cigarettes per pack]), duration of alcohol drinking (aOR = 1.65 per year), and higher frequency of weekly binge drinking (aOR = 1.87 per occasion) were independently associated with grade 1 hypertension. The increase in the number of risk factors combined significantly correlated with higher predicted probability of grade 1 hypertension. Conclusions Dietary-intake factors were significantly associated .

IntroductionIdiopathic Intracranial Hypertension (IIH) is a condition of unknown aetiology that is strongly associated with obesity. IIH predominantly affects women of childbearing age and causes chronic disabling headaches, visual disturbance and, in a minority of patients, permanent visual loss.
Objectives and ApproachWe characterised the IIH population, epidemiological trends and healthcare outcomes in Wales using routinely collected healthcare data. We used primary and secondary care healthcare diagnosis codes within the Secure Anonymised Information Linkage databank to ascertain IIH cases and controls in a retrospective cohort study between 2003 and 2017. We validated IIH diagnosis codes using anonymised secondary care lists of IIH cases.
ResultsWe analysed 35 million patient years of data (2003–2017). There were 1765 cases of IIH in 2017 (85% female). The prevalence and incidence of IIH in 2017 was 76/100,000 and 7.8/100,000/year, a significant increase from 2003 (corresponding figures=12/100,000 and 2.3/100,000/year). The odds ratio for developing IIH in the least deprived quintile compared to the most deprived quintile, adjusted for gender and Body Mass Index (BMI), was 0.65 (95% CI=0.55–0.76). 9% of people with IIH had CSF shunts with less than 0.2% having bariatric surgery. Unscheduled hospital admissions were significantly higher in the IIH cohort compared to controls (rate ratio=5.28, p<0.001) and in the people with IIH with CSF shunts compared to those without (rate ratio=2.02, p<0.01).
Conclusion / ImplicationsIIH incidence and prevalence is increasing significantly, corresponding to population increases in BMI, and is associated with increased deprivation. This has important implications for healthcare professionals and policy makers given the comorbidities, complications and increased healthcare utilisation associated with IIH.

AbstractChanges in the diagnostic criteria for essential hypertension and the development of effective behavior change approaches to its treatment raise new issues concerning the place of nonpharmacologic approaches in the management of high blood pressure.