Talk:Hypertension/Archive 1

Addition for the First Introductory Paragraph
After the first paragraph in the introduction, add: According to American Heart Association, nearly one-third of all US adults have high blood pressure, and one-third of those people don’t know it. The resource is: http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=519911

I believe this is an important fact for readers to understand and by placing it early in the article, readers will be less likely to scan past it. It is also a highly useful addition to the content of the article because it quantifies the prevalence of the disease for readers. —Preceding unsigned comment added by 209.190.187.4 (talk) 21:30, 2 March 2009 (UTC)

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
I am stupid 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. -- John Gohde | [[User talk:Mr-Natural-Health| Talk]] 09:11, 24 Jun 2004 (UTC)

Alternative medicine

 * 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 * —Preceding unsigned comment added by WSNRFN (talk • contribs) 21:56, 14 October 2008 (UTC)

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)

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

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)

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,    and  - 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)

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)

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 . Here's a couple of studies:  and . 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)

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)

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)

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)

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)

"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)

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

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  Cerebral Resuscitation After Global Brain Ischemia: Linking Research to Practice. Also see  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 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)

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)

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? Ante  lan  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 :-) Ante  lan  talk  18:58, 15 December 2007 (UTC)

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)

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)

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)

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)

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)

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)

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)

Licorice is the preferred spelling
1,160,000 Google hits Liquorice, 4,900,000 hits Licorice.

That's because there are more Americans spelling it wrong than there are Brits spelling it right! :) Dutpar (talk) 10:44, 14 July 2009 (UTC)

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 concerned 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)

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

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

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)

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. &mdash;  The Hand That Feeds You :Bite 18:53, 10 August 2008 (UTC)

Any Comments??
Does any body have feed back on this part Etiology? please comment on my talk page or here Maen. K. A. (Replay) 07:53, 29 January 2009 (UTC)

Major edits
Given that this article received over 4,000-5,000 hits per day last month but is of shamefully low quality, I'm going to put an effort into cleaning up this article. Please, if you disagree with my edits, discuss why here. Thanks! (EhJJ)TALK 12:53, 2 February 2009 (UTC)


 * Go baby! --Steven Fruitsmaak (Reply) 13:34, 2 February 2009 (UTC)


 * Thanks. I noticed that one of your edits [(diff) reverted my changes (diff) to the lead section. Based on the MoS for medical articles, a separate "Classification" section is indicated. I think the current lead is too long and goes into too much detail about the different types of HTN and does not adequately outline the article as a whole. If it's alright with you, I'm going to split the Classification info into a separate section and then expand the lead into a good summary of the article, as it is supposed to be. (EhJJ)TALK 21:25, 3 February 2009 (UTC)


 * Having received no reply, I'm going to guess that your revert was probably a good faith accident. I'll make my changes again, broken down with their reasoning in the edit summary, so that we can always revert the ones we disagree on. (EhJJ)TALK 16:11, 4 February 2009 (UTC)


 * Thanks for assuming good faith. I'm well aware of WP:MEDMOS (since I basically was responsible for it to become a separate style guideline). I agree that classification of hypertension warrants its own section. My edit was mainly aimed at undoing some clutter introduced by another editor, but it was also a poor attempt at expanding the lead by adding the classification section to it. The introduction was only two sentences before my edit (and so didn't summarise the article). I think your idea of a separate classification section and a rewrite of the lead section that summarises the article would be fantastic, so I wholeheartedly support it. Let me know if you need any help. --Steven Fruitsmaak (Reply) 17:38, 4 February 2009 (UTC)

Initiation of treatment
I think that there should be some indication as to when pharmacological treatment should begin and what it should be based upon; BP readings, diabetes, end-organ damage etc. etc. I'm happy to write it up, but I wonder what everybody else thinks. Moreover, these would be British guidelines, and therefore I'm unsure what the American viewpoint would be. —Preceding unsigned comment added by 138.37.117.111 (talk) 10:41, 6 February 2009 (UTC)

✅ Involves, at least for UK, looking at NICE guidelines for hypertension, type1 & type2 diabetes and kidney disease guidelines (ie 4 lengthy documents). David Ruben Talk 23:51, 4 March 2009 (UTC)

Liquorice
Other culinary spices and herbs share some of the flavor of licorice: anise, fennel seed, and tarragon. Can (do) these also contribute to hypertension? --Una Smith (talk) 21:12, 4 March 2009 (UTC)

I have read in a number of sources that licorice can elevate/cause HTN; I am not familiar w/ the other herbs you mention. 70.231.239.74 (talk) 20:59, 13 November 2009 (UTC)

Does cutting off circulation cause hypertension?
I have a mostly unsupported belief that if something cuts off circulation (for example, sleeping on one side with the head on an arm), it causes increased blood pressure the day afterward. This is a hard thing to search for ... can someone point at a reference? Or is it an unheard-of idea? (Actually it's my sense that as little as having someone suck a vial of blood with a vacuum-filled tube is enough to increase blood pressure the day after, but I have no real evidence).

It's also my perception that it is possible to lower pressure by relaxing to let blood out of the main circulatory system, causing a characteristic 'swelling' with itching at the inside of the wrists, ankles and other spots, and that the blood thus filtered somehow ends up leading to an "extra" urination, but this is admittedly too wild to even start looking for. ;) Maybe there's something around somewhere about voluntarily controlling the plasma/interstitial fluid ratio?

In general, I think that expanding the information on Wikipedia about mild remedies like progressive muscle relaxation and biofeedback would be very useful. Wnt (talk) 03:11, 24 March 2009 (UTC)

Some issues on a cursory review
I thought I'd hop by and integrate the content of (Hammer & Stewart) into this article. On reviewing the article I notice a number of issues that would need to be addressed. I'm not officially reviewing it for GAC, although I might be able to do that next week.


 * Hammer & Stewart cite recent studies that Conn's is the most common cause of secondary hypertension. This is not currently reflected.
 * We need to discuss the concepts of "accelerated hypertension" and "malignant hypertension", without which the article wouldn't be complete. This needs official definitions (which I why I haven't added this yet) but also discussion of acute end-organ damage (retinal changes, proteinuria, RPLS).
 * Certain sections are completely unsourced. Others rely on unreliable sources such as the Armenian News Network and NY Times.

I might be able to help out with the GAC. JFW | T@lk  19:47, 13 April 2009 (UTC)

Good Article Review
Can anyone help and look at (and then implement) the suggestions given on the GA review page. I am too busy right now currently so I will not be able to help much. Thanks --Edward130603 (talk) 20:36, 29 May 2009 (UTC)
 * I am working on that now, thank you for notifying us :-) Maen. K. A. (talk) 06:39, 31 May 2009 (UTC)
 * Apologies for not posting the link here earlier: I meant to get back to the review and then it dropped off my to do list. My fault entirely. The GA review is here. Physchim62 (talk) 12:30, 31 May 2009 (UTC)
 * No problem, the good thing though is that we are finally working on that :-) M aen K. A. Talk 17:35, 31 May 2009 (UTC)

95%
What study/survey/data shows that more than 95% of hypertension cases are essential?

--RAC e CA12 (talk) 00:54, 5 June 2009 (UTC)

Use spell check!
There are many basic grammar errors, such as not capitalizing the first letter of a sentence, throughout the article. --RAC e CA12 (talk) 02:01, 5 June 2009 (UTC)

Hyperventilation is found in 100% of tested heart disease patients
Several clinical studies found 100% prevalence of hyperventilation in people with heart disease (breathing more than the medical norm) and breathe even more during acute episodes. These facts and references should be included in the Causes section. Breathing can be controlled by humans, using direct and indirect means, 24/7. (Artour2006 (talk) 12:44, 12 August 2009 (UTC))

GAR
This article was under going a review and was passed before a number of points were address. Therefore I have placed it up for GAR. Doc James (talk · contribs · email) 23:08, 16 December 2009 (UTC)

Illustration
What is the illustration of a patient with Growth Horman excess doing here? It's only one of the less usual cause of hypertension.  DGG ( talk ) 04:24, 23 December 2009 (UTC)


 * Feel free to remove it. Page still requires substantial work. Doc James  (talk · contribs · email) 04:26, 23 December 2009 (UTC)


 * and so it does. Some of it is a little out of date--for example, there needs to be more coverage of the controversy of at what level to begin pharmaceutical therapy.   DGG ( talk ) 05:06, 23 December 2009 (UTC)


 * Yes many thinks... Currently at GAR. Will probably delist and it can reapply once objections dealt with. Doc James  (talk · contribs · email) 15:10, 23 December 2009 (UTC)

Niacin lowers blood pressure
Bays HE, Maccubbin D, Meehan AG, Kuznetsova O, Mitchel YB, Paolini JF.

Blood pressure-lowering effects of extended-release niacin alone and extended-release niacin/laropiprant combination: a post hoc analysis of a 24-week, placebo-controlled trial in dyslipidemic patients.

Clin Ther. 2009 Jan;31(1):115-22.

Louisville Metabolic and Atherosclerosis Research Center Inc., Louisville, Kentucky, USA.

BACKGROUND: Dyslipidemia and high blood pressure are both major cardiovascular disease risk factors. Niacin is an effective lipid-altering agent that has been reported to reduce the risk of cardiovascular disease. However, the more widespread use of niacin is limited, mainly due to the occurrence of flushing. Laropiprant (LRPT) is a selective antagonist of prostaglandin D(2) receptor subtype 1 that reduces extended-release niacin (ERN)'-induced flushing without affecting its beneficial lipid effects. While the lipid effects of ERN are well known, the blood pressure effects are unclear. OBJECTIVE: The aim of this analysis was to examine the blood pressure effects of ERN and ERN/LRPT. Methods: This was a post hoc analysis of a 24-week, worldwide, multicenter, double-blind, randomized, placebo-controlled, parallel, Phase III, previously published study of dyslipidemic patients, which examined the effect of ERN and ERN/LRPT on systolic blood pressure (SBP) and diastolic blood pressure (DBP). RESULTS: A total of 1613 men and women, aged 21 to 85 years, with primary hypercholesterolemia or mixed dyslipidemia (66% on statins), were included in the original analysis. ERN alone, or in combination with LRPT, was associated with significant reductions in SBP and DBP at 24 weeks from baseline. The placebo-adjusted mean changes from baseline at week 24 in SBP were -2.2 and -3.1 mm Hg for the ERN and ERN/LRPT groups, respectively (P < 0.05 and P < 0.001). Similar changes in DBP were observed; -2.7 and -2.5 mm Hg in the ERN and ERN/ LRPT groups, respectively (both, P < 0.001). CONCLUSION: This post hoc analysis of a 24-week trial found that ERN alone, or in combination with LRPT, was associated with significant placebo-adjusted reductions from baseline in blood pressure in these hyperlipidemic hypertensive or normotensive subjects.

 

--

see also,

NIH review "Does nicotinic acid (niacin) lower blood pressure?" (A: Yes)

Does nicotinic acid (niacin) lower blood pressure? —Preceding unsigned comment added by 66.167.95.90 (talk) 02:58, 5 April 2010 (UTC)

High Fructose Corn Syrup
I deleted a line from the essential hypertension section which identified high fructose corn syrup as the culprit for hypertension and cited a youtube clip as "proof." Seriously?!199.253.203.254 (talk) 17:49, 12 April 2010 (UTC)

External Review Comments
The following comments are from an external reviewer BSW-RMH as part of the new joint Wikipedia talk:WikiProject Medicine/Google Project.

Hello Hypertension article writers and editors, This article has been marked as possibly having too much technical jargon. As part of my review I will be making changes to replace technical terms with more common terms to address this issue. In addition, I hope that I can offer some useful suggestions to enhance it further. Specific suggestions are as follows:

Introductory section
There were two blood pressure meter images. One was deleted and the retained image moved to a more appropriate section to improve the article layout. Technical language was replaced with more common terms.

BSW-RMH (talk) 16:11, 11 May 2010 (UTC)

Classification
I added a short paragraph defining systolic and diastolic blood pressure because these terms are repeatedly used throughout the article and are critical for the reader to understand. Technical jargon was reduced.

BSW-RMH (talk) 16:47, 11 May 2010 (UTC)

Signs and symptoms
Technical medical jargon was clarified with more common terms. A small amount of rearranging was done to group symptoms caused by hyptension together, and group symptoms that indicate hypertension is caused by a secondary disorder together. This sections requires some additional referencing from a medical source such as:

Mayo Clinic article on Hypertension (http://www.mayoclinic.com/health/high-blood-pressure/ds00100)

MedLine Plus article on Hypertension (http://www.nlm.nih.gov/medlineplus/ency/article/000468.htm)

BSW-RMH (talk) 18:59, 11 May 2010 (UTC)

Causes
This section factually accurate and complete, with the addition of a summary of secondary causes of hypertension. I have replaced jargon with more common terms. It can still benefit from additional referencing. The Mayo Clinic page mentioned previously is a useful source for this section.

BSW-RMH (talk) 19:26, 11 May 2010 (UTC)

Pathophysiology
As written, this section is overly technical and would be of little to no interest to the general reader. I suggest a complete rewrite, focusing on the possible underlying causes of essential hypertension. There is a great deal of information linking essential hypertension to chronic inflammation, individual variations in blood vessel architecture, chronic stress, and underlying genetic factors. A few relevant and current reviews in this area are:


 * Androulakis ES, Tousoulis D, Papageorgiou N, Tsioufis C, Kallikazaros I, Stefanadis C. Essential hypertension: is there a role for inflammatory mechanisms? Cardiol Rev. (2009);17(5):216-21.


 * Ehret GB. Genome-wide association studies: contribution of genomics to understanding blood pressure and essential hypertension. Curr Hypertens Rep. (2010);12(1):17-25.

BSW-RMH (talk) 19:58, 11 May 2010 (UTC)

Diagnosis
There may be an internal discrepancy between this section which states 'Usually this requires three separate measurements at least one week apart', and the Classification section which states 'These classifications are made after averaging a patient's resting blood pressure readings taken on two or more office visits'. The technical jargon was reduced in this section.

BSW-RMH (talk) 20:21, 11 May 2010 (UTC)

Prevention
This section appeared to discuss prehypertensive and hypertensive disease management rather than prevention of hypertension. Although there is obviously overlap in thei subject matter, I have reworded this section so that is focuses on prevention. In addition, it was written like a technical guide for physicias on disease management, so this was changed to be more accessible to readers as well.

BSW-RMH (talk) 20:39, 11 May 2010 (UTC)

Treatment
Technical jargon was reduced in this section. I recommend removing the information regarding UK hypertension guidelines as this seems overly technical and also not necessarily common practice-this change was made as a separate edit so that it can be revereted if desired.

The Biofeedback section should be expanded and updated from the current perspective on this approach. The following references will be useful for this purpose: BSW-RMH (talk) 23:40, 11 May 2010 (UTC)
 * Greenhalgh J, Dickson R, Dundar Y. The effects of biofeedback for the treatment of essential hypertension: a systematic review. 'Health Technol Assess'. (2009);13(46):1-104.
 * Moravec CS. Biofeedback therapy in cardiovascular disease: rationale and research overview. 'Cleve Clin J Med'. (2008);75 Suppl 2:S35-8.
 * Rainforth MV, Schneider RH, Nidich SI, Gaylord-King C, Salerno JW, Anderson JW. Stress reduction programs in patients with elevated blood pressure: a systematic review and meta-analysis. 'Curr Hypertens Rep'. (2007);9(6):520-8. Review.
 * I have completely rewritten the section using the above sources, moved it to the end of the treatment section, changed the title and condensed it to a few lines.--Garrondo (talk) 17:29, 12 May 2010 (UTC)

The Medications section appears to need updating or perhaps discussion as to what are the most common first line drug treatments vs. less common treatments. There are discrepancies between the lists presented here and other sources (see below). Also, the section of combination therapies should be expanded (see Erdine S. Compliance with the treatment of hypertension: the potential of combination therapy. J Clin Hypertens (Greenwich). (2010)12(1):40-6, AND Gupta AK, Arshad S, Poulter NR. Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents: a meta-analysis. Hypertension. (2010);55(2):399-407. ).


 * Mayo Clinic article on Hypertension:Treatment and drugs (http://www.mayoclinic.com/health/high-blood-pressure/ds00100/dsection=treatments-and-drugs)
 * Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev. (2010)
 * Williams B. The year in hypertension. J Am Coll Cardiol. (2009);55(1):65-73.
 * Lloyd KS. The current treatment of pulmonary hypertension. Methodist Debakey Cardiovasc J. (2009);5(2):20-3.

This section may also benefit from adding a short paragraph noting that that treatment strategies are different for particular groups such as:
 * elderly individuals (Aronow WS. Hypertension in the elderly. Clin Geriatr Med. (2009;25(4):579-90
 * adolescents (Aglony M, Acevedo M, Ambrosio G. Hypertension in adolescents. Expert Rev Cardiovasc Ther. (2009);7(12):1595-603.
 * persons with black heritage (Kola LD, Sumaili EK, Krzesinski JM. How to treat hypertension in blacks: review of the evidence. Acta Clin Belg. (2009);64(6):466-76.
 * indivduals with resistant hypertension (Czarina Acelajado M, Calhoun DA. Treatment of resistant hypertension. Minerva Cardioangiol. (2009);57(6):787-812.
 * individuals with aortic coarctation (Hager A. Hypertension in aortic coarctation. Minerva Cardioangiol. (2009);57(6):733-42.
 * individuals with diabetes (Ferdinand KC, Ferdinand DP. Trends in hypertension treatment in diabetes. Curr Hypertens Rep. (2009);11(6):437-43.

Also, the reference for renin inhibitors is an unreliable source. Suggesed reliable source: Neutel JM. Choosing among renin-angiotensin system blockers for the management of hypertension: from pharmacology to clinical efficacy. Curr Med Res Opin. (2010);26(1):213-22. Review.

BSW-RMH (talk) 03:56, 12 May 2010 (UTC)

Prognosis
This section is short and links to a secondary article on this subject. The secondary article would better serve to expand this section and complete the Hypertension article. Medical jargon was replaced with common terms and redudant information removed.

BSW-RMH (talk) 04:15, 12 May 2010 (UTC)

Epidemiology
This section is well-written. The statistics are fairly current but slightly out of date. For example, the current estimate of hypertensive individuals in 1.5 billion worldwide according to the WHO ( Chockalingam A. World Hypertension Day and global awareness. Can J Cardiol. (2008);24(6):441-4. ) and 32% of the US population (2003-2006) according to the CDC (http://www.cdc.gov/nchs/fastats/hyprtens.htm).

BSW-RMH (talk) 04:47, 12 May 2010 (UTC)

History
Either delete or expand this section. My recommendation is to delete it. However, expansion could be based on the following reference:
 * Esunge PM. From blood pressure to hypertension: the history of research. J R Soc Med. (1991);84(10):621.

BSW-RMH (talk) 04:56, 12 May 2010 (UTC)
 * I have given it a shot and written two paragraphs, since the reference provided above was easy to access, short, and easy to summarize. Bests.--Garrondo (talk) 18:26, 12 May 2010 (UTC)

Society and Culture
Economics: requries update with current information from CDC on estimated cost of $76.6 billion for indirect and direct costs of hypertension in US for 2010 (http://www.cdc.gov/features/highbloodpressure/). Otherwise in good shape.

BSW-RMH (talk) 05:29, 12 May 2010 (UTC)

Formating
We try to maintain a consistent formating between medical article. Thus the info box has been returned to the lead and removed from the section on diagnosis. It is often helpful to look at other high quality article to get a felling for the desired formating. These are a list of FA articles for WP:MED  Doc James  (talk · contribs · email) 22:43, 12 May 2010 (UTC)
 * If you add back this infobox (which in my opinion detracts from, rather than adds to the quality of the article), I highly recommend fixing the broken links and removing the duplicate image later in the article. BSW-RMH (talk) 22:47, 12 May 2010 (UTC)


 * Have done so. This is the consistent formating we use for almost all WP:MED article.  If you wish to change something like this consensus would need to be reached at WP:MED.  I personally really like the infoboxs.  Emedicine is a great free source. ICD codes are important in classification. Etc.  Doc James  (talk · contribs · email) 22:49, 12 May 2010 (UTC)


 * Great! It's all consistent now. I did check the style guidelines for med article infoboxes, but interpretted it as a suggestion rather than a requirement. I'll be sure to keep them consistent in med articles from now on. I see the infoboxes on lots of articles and always thought they just made the article look cluttered, but now that I've actually clicked through them, I agree there is useful info there. Thanks for putting it back to ensure this article is style-compliant :) BSW-RMH (talk) 01:57, 13 May 2010 (UTC)
 * You're not the only person who thinks that infoboxes are overused (although I think that this one is probably desirable, on balance). WP:DISINFOBOX summarizes the usual complaints.  WhatamIdoing (talk) 03:22, 18 May 2010 (UTC)

Removed text
Removed text as too detailed and dealt with on BP page.

Obtaining reliable blood pressure measurements relies on following several rules and understanding the many factors that influence blood pressure reading.

For instance, measurements in control of hypertension should be at least 1 hour after caffeine, 30 minutes after smoking or strenuous exercise and without any stress. Cuff size is also important. The bladder should encircle and cover two-thirds of the length of the (upper) arm. The patient should be sitting upright in a chair with both feet flat on the floor for a minimum of five minutes prior to taking a reading. The patient should not be on any adrenergic stimulants, such as those found in many cold medications.

When taking manual measurements, the person taking the measurement should be careful to inflate the cuff suitably above anticipated systolic pressure. The person should inflate the cuff to 200 mmHg and then slowly release the air while palpating the radial pulse. After one minute, the cuff should be reinflated to 30 mmHg higher than the pressure at which the radial pulse was no longer palpable. A stethoscope should be placed lightly over the brachial artery. The cuff should be at the level of the heart and the cuff should be deflated at a rate of 2 to 3 mmHg/s. Systolic pressure is the pressure reading at the onset of the sounds described by Korotkoff (Phase one). Diastolic pressure is then recorded as the pressure at which the sounds disappear (K5) or sometimes the K4 point, where the sound is abruptly muffled. Two measurements should be made at least 5 minutes apart, and, if there is a discrepancy of more than 5 mmHg, a third reading should be done. The readings should then be averaged. An initial measurement should include both arms. In elderly patients who particularly when treated may show orthostatic hypotension, measuring lying sitting and standing BP may be useful. The BP should at some time have been measured in each arm, and the higher pressure arm preferred for subsequent measurements.

BP varies with time of day, as may the effectiveness of treatment, and archetypes used to record the data should include the time taken. Analysis of this is rare at present.

Automated machines are commonly used and reduce the variability in manually collected readings. Routine measurements done in medical offices of patients with known hypertension may incorrectly diagnose 20% of patients with uncontrolled hypertension.

Home blood pressure monitoring can provide a measurement of a person's blood pressure at different times throughout the day and in different environments, such as at home and at work. Home monitoring may assist in the diagnosis of high or low blood pressure. It may also be used to monitor the effects of medication or lifestyle changes taken to lower or regulate blood pressure levels. Home monitoring of blood pressure can also assist in the diagnosis of white coat hypertension. The American Heart Association states, "You may have what's called 'white coat hypertension'; that means your blood pressure goes up when you're at the doctor's office. Monitoring at home will help you measure your true blood pressure and can provide your doctor with a log of blood pressure measurements over time. This is helpful in diagnosing and preventing potential health problems."

Some home blood pressure monitoring devices also make use of blood pressure charting software. These charting methods provide printouts for the patient's physician and reminders to take a blood pressure reading. However, a simple and cheap way is simply to manually record values with pen and paper, which can then be inspected by a doctor. Doc James (talk · contribs · email) 09:46, 5 May 2010 (UTC)


 * I think that before deleting nearly half the text on the page there should perhaps have been a discussion here on the talk page? If it is agreed that the content should be removed, you need to tidy up the references, as you have managed to create a large number of broken references.  David Biddulph (talk) 10:50, 5 May 2010 (UTC)
 * There is a bot the comes around and fixes the ref. We do not need 10 references to support an uncontroversial fact.  The rest of the content was moved except for this bit above. Doc James  (talk · contribs · email) 11:09, 5 May 2010 (UTC)
 * The bot has already done its job. What a great little bot...  Doc James  (talk · contribs · email) 11:12, 5 May 2010 (UTC)
 * The last third of this deleted section looks quite useful and interesting. I recommend adding it back in-though perhaps editing down a bit from "Routine measurements done in medical offices of patients with known hypertension may incorrectly diagnose 20% of patients with uncontrolled hypertension...." through to the end. BSW-RMH (talk) 22:56, 11 May 2010 (UTC)
 * This information is dealt with on the subpage. Controversies regarding the measurement of blood pressure on not best dealt with here. Doc James  (talk · contribs · email) 22:38, 12 May 2010 (UTC)


 * I disagree. The information about 20% of diganoses being incorrect due to blood pressure meassurement inaccuracy, and the phenomenon of 'white coat hypertension', is useful information for an article on hypertension. A summary of these points in a couple of sentences could easily be added to the end of the Classification section where it discusses hypertension related to exercise to make the article comprehensive. BSW-RMH (talk) 15:33, 26 May 2010 (UTC)

Historical source
This source provides some insight into the therapeutic advances in the 20th century:



I might work it into the historical content. JFW | T@lk  08:52, 25 July 2010 (UTC)

Simpler introductory paragraph
I came to this article from the list of preventable causes of death, wondering what hypertension is -- and I was no wiser from reading the introductory paragraph. If this is intended for a general audience, it should be more readable. The single sentence on Simple English Wikipedia gave me exactly what I was looking for. Maybe there's a happy medium? —Preceding unsigned comment added by 217.68.116.150 (talk) 19:48, 21 March 2011 (UTC)

Optimal is 115/75
Recent recognition that 120/80 is "normal" but may not ideal should be reflected here.
 * Ocdnctx (talk) 21:28, 17 May 2011 (UTC)

Thiazide diuretics
The list of medications to treat hypertension does not mention thiazide diuretics. I am not a doctor and do not know whether they are still in use - so I would rather not edit the article. ACEOREVIVED (talk) 23:28, 7 June 2011 (UTC)

Symptons
Tinnitus may be present due to HBP but I do not see it mentioned in this entry. — Preceding unsigned comment added by 98.82.133.45 (talk) 17:26, 7 October 2011 (UTC)

Normal blood pressure?
Is normal blood pressure still considered 120/80 mmHg? I believe I have seen recent reports state that 115 mmHg systolic blood pressure is now considered ideal, not 120 mmHg. — Preceding unsigned comment added by DoctorK88 (talk • contribs) 02:10, 1 October 2011 (UTC)

A range of blood pressures can be normal
"Normal blood pressure is 120/80 mm/Hg." -- surely many other readings would also be considered normal. — Preceding unsigned comment added by Jonathan.robie (talk • contribs) 18:00, 24 October 2011 (UTC)

Increased fructose associates with elevated blood pressure. --
Jalal DI, Smits G, Johnson RJ, Chonchol M.

Increased fructose associates with elevated blood pressure.

J Am Soc Nephrol. 2010 Sep;21(9):1543-9. Epub 2010 Jul 1.

Free PMC Article

http://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=20595676

http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/20595676/?tool=pubmed

Abstract

The recent increase in fructose consumption in industrialized nations mirrors the rise in the prevalence of hypertension, but epidemiologic studies have inconsistently linked these observations. We investigated whether increased fructose intake from added sugars associates with an increased risk for higher BP levels in US adults without a history of hypertension. We conducted a cross-sectional analysis using the data collected from the National Health and Nutrition Examination Survey (NHANES 2003 to 2006) involving 4528 adults without a history of hypertension. Median fructose intake was 74 g/d, corresponding to 2.5 sugary soft drinks each day. After adjustment for demographics; comorbidities; physical activity; total kilocalorie intake; and dietary confounders such as total carbohydrate, alcohol, salt, and vitamin C intake, an increased fructose intake of > or =74 g/d independently and significantly associated with higher odds of elevated BP levels: It led to a 26, 30, and 77% higher risk for BP cutoffs of > or =135/85, > or =140/90, and > or =160/100 mmHg, respectively. These results suggest that high fructose intake, in the form of added sugar, independently associates with higher BP levels among US adults without a history of hypertension. Comment in

Free PMC Article

http://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=20595676

http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/20595676/?tool=pubmed

99.190.133.143 (talk) 23:05, 1 November 2011 (UTC)
 * We need to wait until the study is reviewed in a secondary source before we can include this type of information, per our guideline for sourcing medical claims. Yobol (talk) 03:42, 2 November 2011 (UTC)

File:Cardiac cycle pressure only.png
What do "systolic" and "diastolic" in the legend at the right refer to? The example lines for both are red in this "Classification" section graphic. Is the legend correct? -- Thanks -- Jo3sampl (talk) 22:41, 2 November 2011 (UTC)

=It is clearly wrong, but I don't know how to fix it. The legend should have the red line labeled "aorta" and the blue line "left ventricle." Does anyone know how to get into the file? I actually don't see the reason it would belong in this article at all, as it doesn't clarify the meanings of "systolic" and "diastolic" as related to hypertension.Rose bartram (talk) 12:23, 1 December 2011 (UTC)

Orthostatic hypertension
I just added "orthostatic hypertension" info into the hypertension article as this form of hypertension was completely missing from the page, for some reason thou i highlighted the Orthostatic hypertension part, its saying it dont exist thou it appears okay if one searches for it on the wiki. (Is this cause the orthostatic hypertension page hasnt been taken off of stub status??) Could someone fix it so one can get to that page for the info on that from this page? Also I wasnt sure if I added the reference for that to the best place. Thanks (Im quite new to wiki still)--Taniaaust1 (talk) 03:25, 7 December 2011 (UTC)

Ignore my last post, it is working now --Taniaaust1 (talk) 04:20, 7 December 2011 (UTC)

Current state
The current state of this vital article is really quite curious. Some sections consist of brilliant prose, while others have been stuffed with the weirdest and extraordinary ideas and concepts. I have started chopping the most outrageous stuff, but there is still plenty to be done. The intro contained the right information, but contained instances of WP:YOU and talked down to the reader.

A few observations:
 * Hypertension is a subject that is so heavily researched and written about that we cannot under any circumstance justify the inclusion of non-MEDRS references.
 * Given that this article is meant to provide an overview of this complicated condition, we can only discuss the concepts on which there is widespread consensus. Subarticles may be required for the finer details.
 * The treatment of hypertension is enshrined in clinical practice guidelines, and these should be the primary sources for the "diagnosis" and "treatment" sections.

I have no idea whether I will be able to muster the energy to sort this article out, but I will certainly give it a try. As with previous work, it will hopefully be educational. JFW &#124; T@lk  20:30, 25 December 2011 (UTC)


 * 10.1136/bmj.d4697 is a recent editorial that would be useful for background reading. It emphasises the important of renin/aldosterone testing in guiding treatment. JFW &#124; T@lk  20:32, 25 December 2011 (UTC)

I have been collecting reviews to give this a go. Have this one and a couple of others.

Doc James (talk · contribs · email) 09:12, 26 December 2011 (UTC)


 * This one looks useful - it takes the long view: JFW &#124;  T@lk  18:44, 26 December 2011 (UTC)


 * It frequently discusses the 2007 EHS/ESC guidelines: JFW &#124;  T@lk  20:58, 26 December 2011 (UTC)


 * A good summary of the hypertensive emergencies: JFW &#124;  T@lk  19:03, 26 December 2011 (UTC)


 * I too will try and work on this article when time allows as I agree it's a bit of a muddle.
 * Re the BMJ editorial by Morris Brown 10.1136/bmj.d4697 referred to in JFW's comment. It is published in a high impact journal and the author is a past president of the British Hypertension Society (BHS) but it is an editorial and a personal view. As Morris writes in the article there are two studies currently underway as part of the BHS research network which will give definitive information on this issue. I would wait until they report before discussing the possible value of renin measurements here. adh (talk) 13:05, 31 December 2011 (UTC)

Exercise hypertension
The "classification" section contained the following section:

Exercise hypertension is an excessively high elevation in blood pressure during exercise. The range considered normal for systolic values during exercise is between 200 and 230 mm Hg. Exercise hypertension may indicate that an individual is at risk for developing hypertension at rest. The entire paragraph is based on 24-year old sources published back to back in a German cardiology journal. The entity does not feature in several recent reviews I have looked at (Lancet & BMB, see previous thread). Pubmed has very limited secondary sources on the subject. On the whole, I cannot currently justify including this paragraph. A single sentence based on a good single secondary source may be needed. Blood pressure goes up with exercise, particularly in those with limited reserve; what exactly defines an exaggerated response and how does one predict which of those will develop persistent hypertension? Questions, questions... JFW &#124; T@lk  20:23, 29 December 2011 (UTC)
 * Yes good call. Doc James  (talk · contribs · email) 20:41, 29 December 2011 (UTC)


 * I agree too - it is used as a research tool but not really a diagnostic approach in hypertension. Conversely BP is measured during exercise testing but to quote from a recent systematic review 'there are no recognized standards for categorizing the BP response to exercise' (Le VV, Mitiku T, Sungar G, Myers J, Froelicher V. The blood pressure response to dynamic exercise testing: a systematic review.Prog Cardiovasc Dis. 2008;51:135-60.). adh (talk) 13:13, 31 December 2011 (UTC)

History
The "history" section looks quite good, really. There might even be enough material to spin off a subarticle, but at the moment there seems to be a nice balance. I have taken the liberty of templating the references and tidying up a bit, but on the whole it gives a pretty comprehensive picture. We could still take a bit more from the current high-quality secondary sources (Kotchen, Moser, Esunge). I think the Dustan source is jolly good, but I think I have already cited most useful bits from there. JFW &#124; T@lk  23:02, 29 December 2011 (UTC)

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). —Preceding unsigned comment added by Dalsan (talk • contribs) 22:55, 5 April 2006
 * I agree I have added a comment to this effect in the section on drug treatment Adh (talk) 21:02, 4 February 2012 (UTC)

Secondary hypertension
removed the list of clinical signs/symptoms of the secondary causes of hypertension. I think we should try to put some content in here, in the sense that at diagnosis of hypertension it would be appropriate to look for clinical signs of Cushing's or acromegaly. Perhaps we should harmonise it with whatever we are listing under "Causes" (subsection "secondary hypertension"). JFW &#124; T@lk  13:33, 8 January 2012 (UTC)
 * Thanks. My reasons were that there are dozens of causes of secondary hypertension, all rare (although renal causes are probably the most common accounting for around 2-3% of all cases of hypertension) and many are associated with characteristic features; Cushing's disease for example makes up about 0.1% of cases of hypertension (Difficult hypertension: practical management and decision making. Martin J. Kendall, Norman M. Kaplan, Richard C. Horton). It seemed to me that the differential diagnosis of secondary hypertension was better dealt with on the page for secondary hypertension, but I'm a real wiki novice so happy to be guided on this. If we do include the various features that may be indicative of secondary hypertension on this page perhaps it may be more appropriate to include them in the diagnosis section? adh (talk) 21:27, 10 January 2012 (UTC)

I can see the point. But perhaps we ought to write something about the kind of physical features that should be looked for in someone with a new diagnosis of hypertension. If they had a coarctation, Cushing's, or acromegaly, this would be quite relevant. JFW &#124; T@lk  23:30, 10 January 2012 (UTC)


 * Thanks, I've taken your advice and added this. adh (talk) 08:43, 19 January 2012 (UTC)

Comments

 * This "People with blood pressures in this range may have no symptoms, but are more likely to report headaches and dizziness.[9]" is not my experience. Usually the people I see have no symptoms. Do not have access to the ref in question right now but will verify latter this week unless someone beats me to it.
 * According to hypertensive urgencies frequently present with headache (22%). Will add this reference.
 * Yes but not more likely than having no symptoms. Maybe we should change this to "more likely than the general population"-- Doc James (talk · contribs · email) 06:31, 13 March 2012 (UTC)
 * Good idea, agreed. Adh (talk) 08:36, 13 March 2012 (UTC)


 * Is this globally or just in the developed world? "It occurs in about 5% of pregnancies and is responsible for approximately 16% of all maternal deaths. " It appears as if it is global numbers.-- Doc James (talk · contribs · email) 07:05, 12 March 2012 (UTC)
 * Not sure what this means "Much of the disease burden of high blood pressure is experienced by people who are not hypertensive.[54]"-- Doc James (talk · contribs · email) 10:25, 12 March 2012 (UTC)
 * Thanks, I think what I was trying to say was that since increased blood pressure is positively related to increased risk across the whole range of blood pressures in a population, almost half of the burden of disease due to higher than optimal blood pressure affects people who are not labelled as hypertensive according to current thresholds. The implication of this is that population-level measures that lower population average blood pressure (e.g. reduction of salt addded to processed food, reduced obesity, or reduction of alcohol intake) need to be allied to therapeutic strategies targeted at individuals with blood pressure >140/190. Probably poorly worded on my part. For now I have made a minor modification to the sentence but it may need more clarification. Adh (talk) 23:57, 12 March 2012 (UTC)


 * Need hypertension be chronic as stated in the opening sentence of the article? My (admittedly unscourced) understanding is that hypertension can be acute, especially as caused by pain receptors. — Preceding unsigned comment added by 70.130.149.114 (talk) 21:29, 22 March 2012 (UTC)

Treatment
CCBs versus HCTZ. The NICE guideline recommended CCBs for those over 65 yet Cochrane (a more global enterprise) recommends HCTZ over CCBs per "Diuretics are preferred first-line over CCBs to optimize reduction of cardiovascular events" published in 2010. Not sure how to best word this section. Here is a great table comparing what different countries recommended as of 2010 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886561/table/t1-cjc26e158/ published in this review http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886561/ -- Doc James (talk · contribs · email) 11:05, 12 March 2012 (UTC)
 * This section is still a little too UK concentric IMO. While continue working on it.-- Doc James (talk · contribs · email) 11:17, 12 March 2012 (UTC)
 * Fair comment I think. The table you cite is good but unfortunately slighly out of date since revised UK 2011 guidelines ([]) now state 'Offer people aged under 55 years an ACE inhibitor or a low-cost ARB. If an ACE inhibitor is prescribed and is not tolerated (for example, because of cough), offer a low-cost ARB. Offer people aged over 55 years and black people of African or Caribbean family origin of any age a calcium-channel blocker (CCB). If a CCB is not suitable, for example because of oedema or intolerance, or if there is evidence of heart failure or a high risk of heart failure, offer a thiazide-like diuretic. If treatment with a diuretic is being started, or changed, offer a thiazide-like diuretic, such as chlortalidone (12.5–25.0 mg once daily) or indapamide (1.5 mg modified-release once daily or 2.5 mg once daily) in preference to a conventional thiazide diuretic such as bendroflumethiazide or hydrochlorothiazide..' In support of the UK guidelines (as the table indicates) they are the only ones based on an economic analysis and in some cases the cost balance has changed since various anti-hypertensive agents came off patent. However the UK guidelines have been criticised (particularly the thiazide-like comment) even in UK. Since I am UK based I think it would be good to get a non-UK perspective on this. Look forward to your revisions Adh (talk) 23:35, 12 March 2012 (UTC)
 * I was simply surprised to see how much variation there is between guidelines. While add something further. Doc James (talk · contribs · email) 06:26, 13 March 2012 (UTC)

Prospects for nutritional control of hypertension.
McCarty MF.

Prospects for nutritional control of hypertension.

Med Hypotheses. 1981 Mar;7(3):271-83.

Abstract

Sodium restriction is not the only nutritional measure likely to prove valuable in the treatment and prevention of hypertension. The hypotensive effects of central adrenergic stimulation can be promoted by supplementary tyrosine, insulin potentiation (as with GTF), and (possibly) high-dose pyridoxine. Insulin potentiators (GTF) and prostaglandin precursors (essential fatty acids) should have direct relaxant effects on vascular muscle. A high potassium, low sodium diet, coenzyme Q, and prevention of cadmium toxicity (as with dietary selenium) may act to offset renally-mediated pressor influences. Functional combinations of these measures might prove to be substantially effective, in which case they would offer considerable advantages over potentially toxic drug therapies. — Preceding unsigned comment added by 99.190.133.143 (talk) 21:44, 31 March 2012 (UTC)


 * 30 years ago in Med Hypotheses? Hahahahaha. JFW &#124; T@lk  04:31, 1 April 2012 (UTC)

pseudohypertension redirects here but there's nothing
The pseudohypertension redirect should be deleted. I was going to propose it, but I forget the procedure and I'm stuck for time.

I thought I'd at least leave a note here to ask if anyone can fix the problem in the other way: add something to this article about pseudohypertension. It's mentioned here:. Gronky (talk) 21:49, 22 May 2012 (UTC)
 * Will address. Okay created a new page. -- Doc James (talk · contribs · email) 00:44, 23 May 2012 (UTC)

Should this be in the Causes Section?
"Lifestyle factors that lower blood pressure, include reduced dietary salt intake,[23] increased consumption of fruits and low fat products (Dietary Approaches to Stop Hypertension (DASH diet)), exercise,[24] weight loss[25] and reduced alcohol intake.[26]" --203.116.243.1 (talk) 01:39, 19 July 2012 (UTC)
 * Already discussed in the article. Doc James  (talk · contribs · email) (if I write on your talk page please reply on mine) 02:37, 19 July 2012 (UTC)

Review article
Doc James (talk · contribs · email) 12:11, 12 June 2012 (UTC)

Plausibility of meditation and the use of sources.
Lets get this straight, I'm not an adherent of Transcendental Meditation; honestly, I find it ridiculous that anyone would pay 2,000 bucks to learn how to meditate. However, the fact remains that there is Gold Standard evidence that different forms of meditation, including TM, can lower blood pressure. Your objections to the new evidence is unwarranted and unnecessary.


 * Several formal systems exist for assessing the quality of available evidence on medical subjects.[4][5] "Assessing evidence quality" means that editors should determine the quality of the type of study. Editors should not perform a detailed academic peer review. Do not reject a high-quality type of study due to personal objections to the study's inclusion criteria, references, funding sources, or conclusions.

Now, I'm not aware of the pathway in which meditation lowers BP. Nevertheless, not knowing how meditation is mediated doesn't make it bullshit. Look at the history of aspirin... I really hope that you can refrain from cherry picking your sources. But if you want plausible ways that meditation can change the human body...
 * | Long-term meditation is associated with increased gray matter density in the brain stem
 * | Distinct Neural Activity Associated with Focused-Attention Meditation and Loving-Kindness Meditation
 * | Regulation of the Neural Circuitry of Emotion by Compassion Meditation: Effects of Meditative Expertise
 * | Mindfulness practice leads to increases in regional brain gray matter density
 * | Stress Reduction in the Secondary Prevention of Cardiovascular Disease
 * | Does cognitive behavioral therapy change the brain? A systematic review of neuroimaging in anxiety disorders.

Now these are mostly primary sources, but they are all peer-reviewed and on the Index Medicus, hopefully you would have the intellectual curiosity to at least entertain them. This tells us that different types of meditation activate different parts of the brain. Long term term use of different types of meditation is associated with different changes in regions of the brain. It's likely that meditation works similarly in the way that therapy, specifically CBT, works.

TM is associated with changes in the brain that could reduce potential risk-factors for cardiovascular disease. Anapanasati is associated with attention. Metta is associated with emotion. It is not reasonable at all to loop together and make some profound statement about meditation as a whole, especially when it involves blatant cherry picking of data when there is new conflicting evidence. There is a difference between reasoned skepticism and naked cynicism. And cynicism is just as much a bias as enthusiasm.

The "factual accuracy" and "point of view" of the article is still in dispute, there was another editor who agree with my position on meditation. Until a time that this is settled the tags are more than merited.Khimaris (talk) 20:59, 18 February 2013 (UTC)

This is a slight addendum but I find it interesting.
 * | Randomized controlled trial of cognitive behavioral therapy vs standard treatment to prevent recurrent cardiovascular events in patients with coronary heart disease: Secondary Prevention in Uppsala Primary Health Care project (SUPRIM).

The results are very similar to the "| Stress Reduction in the Secondary Prevention of Cardiovascular Disease" study. The question I have for Doc Elisa is how does he thinks therapy works...Khimaris (talk) 21:47, 18 February 2013 (UTC)


 * Per WP:TPG we should avoid doing this sort of general discussion of the article topic, or in this case things tangentially related to the article topic, on the article Talk page. Is there a suggestion here for an improvement to the article hypertension?    19:10, 19 February 2013 (UTC)

Sources?
What is the consensus on what sources are acceptable on this page? Are all primary sources absolutely verboten? If not, then what types would be acceptable?Khimaris (talk) 09:54, 18 February 2013 (UTC)
 * Yes generally no primary sources should be used. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 18:22, 18 February 2013 (UTC)


 * Khimaris you're probably already been pointed to it but per WP:MEDRS when we have a field of study that is well established enough that there are multiple review article, meta-analyses and statements from major medical organizations regarding it we do not cite individual primary studies.   19:12, 19 February 2013 (UTC)

Meditation and Hypertension.
I'm curious why Jmh649 reverted my addition. The wording would have people believe that mediation has not been shown to reduce hypertension at clinically significant levels. The evidence says other wise...


 * Conclusions
 * Results of meta-analyses showed that simple biofeedback, relaxation-assisted biofeedback, progressive muscle relaxation, and stress management training did not show statistically significant reductions in elevated BP. Analysis of trials of the Transcendental Meditation program showed clinically and statistically significant changes in BP (−5.0/−2.8 mm Hg). Other published research on the Transcendental Meditation program suggest complementary effects on other CVD risk factors, disease markers, and clinical events for reducing psychosocial stress, smoking, alcohol abuse, myocardial ischemia, carotid atherosclerosis, and mortality rates. Thus, there is sufficient evidence that, among stress reduction programs, the Transcendental Meditation program is effective and warrants recommendation to patients with elevated blood pressure in preventing or treating hypertension and CVD.

I'd love to see your reasoning. Khimaris (talk) 07:46, 15 February 2013 (UTC)
 * We have independent research that concludes there is no effect.,


 * The lead author of the paper in question is "Maxwell Rainforth, Assistant Professor of Physiology and Health and Statistics at Maharishi University of Management" Thus this meta analysis is not independent of this small community of religious folks. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 16:28, 15 February 2013 (UTC)


 * Biofeedback is not the same thing as as Meditation... I am afraid you are very mistaken here. Your first sourced abstract did not mention meditation at all. So I'm not sure why you would conflate the two... With your second source:
 * Meta-analyses based on low-quality studies and small numbers of hypertensive participants showed that TM(R), Qi Gong and Zen Buddhist meditation significantly reduced blood pressure.
 * There was a impact. Transcendental Meditation, the meditation technique originally stated, among others were shown to lower blood pressure at clinically significantly levels. You are more than free to discount the 'low-quality' of these studies; however, to say that they are not effective would be factually inaccurate. Being supported by 'religious folks' does not remove the proven beneficial effects of meditation. Just to clear this up, I gladly present reviews from groups independent of the TM movement:
 * Blood Pressure Response to Transcendental Meditation: A Meta-analysis
 * Current Perspectives on the Use of Meditation to Reduce Blood Pressure
 * I will refrain from editing the article any further until I receive your next response, however, I'm afraid you are wrong in this case. — Preceding unsigned comment added by Khimaris (talk • contribs) 22:14, 15 February 2013 (UTC)
 * The first one is funded by Howard Settle a practitioner of TM   Doc James  (talk · contribs · email) (if I write on your page reply on mine) 17:36, 18 February 2013 (UTC)
 * Even if this is true, which it looks like it is not from a review of the article, what is your point?
 * Do not reject a high-quality type of study due to personal objections to the study's inclusion criteria, references, funding sources, or conclusions.
 * It is a secondary source from a journal listed on the Index Medicus. This is gold standard. — Preceding unsigned comment added by Khimaris (talk • contribs) 17:51, 18 February 2013 (UTC)
 * My point is that independent sources are usually given greater weight. The paper states at the end its ties to the TM movement. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 18:13, 18 February 2013 (UTC)

Inclined to side with Doc James. I think the meta-analysis by Rainforth et al is not great - double counting of controls, no assessment of publication bias, no formal testing of heterogeneity prior to subgroup analysis - and I would be reluctant to base a definitive statement regarding transcendental meditation (TM) on this evidence. Overall I think the statement in the current version is pretty fair and I suggest it should stand; I wouldn't exclude the possibility of TM or other stress management techniques being useful in hypertension but I don't find the existing evidence compelling. Adh (talk) 05:39, 16 February 2013 (UTC)
 * I'll point you to the meta-analysis by Anderson et al, posted above, as it willy likely assuage your concerns.
 * Regarding the current statement, 'Different programs aimed to reduce psychological stress such as biofeedback, relaxation or meditation are advertised to reduce hypertension. However, in general claims of efficacy are not supported by scientific studies, which have been in general of low quality.', it is factually inaccurate. Meditation HAS been shown to reduce blood pressure. To say otherwise is simply wrong. The statement should include nuance that separates meditation from biofeedback. They are both Relaxation techniques but they are not one and the same. I hope that we can clear this issue up. Khimaris (talk) 07:41, 16 February 2013 (UTC)
 * thanks, the Anderson et al meta-analysis is much better - my only serious criticism of it is a lack of analysis of publication bias, potentially more of a problem when random effects models are used and small studies exert more net influence. The other concern is that there are only three high quality publications so there isn't a great evidence base. Nevertheless I would agree that the Anderson et al analysis does provide some credible evidence in favour of TM although I would still advise caution given the poor evidence base at present. Perhaps you could say something along the lines of 'Stress management programs are advertised to reduce hypertension. However in general claims of efficacy are not supported by scientific studies, which have been in general of low quality. Some limited evidence suggests that meditation may lower blood pressure (Anderson) although there are few good quality studies on this topic' . See what  Doc James  thinks.

I think it's fairly clear, after reading the Transcendental Meditation research talk page archive, that Doc James  doesn't like the idea of Meditation doing just about anything, even when presented evidence that conflicts with his own beliefs. Cynicism is very much a belief, by the way. I think it's fairly reasonable to ask that you recuse yourself from making edits on the matter, if you choose to continue to act in this manner. I'd like to not go into arbitration over something so simple. Khimaris (talk) 17:36, 18 February 2013 (UTC)
 * The independent AHRQ states "A few studies of overall poor methodological quality were available for each comparison in the meta-analyses, most of which reported nonsignificant results. TM® had no advantage over health education to improve measures of systolic blood pressure and diastolic blood pressure, body weight, heart rate, stress, anger, self-efficacy, cholesterol, dietary intake, and level of physical activity in hypertensive patients" There are a few things I have concerns with. One is the conflict of interest and concerns of falsification within this area of research thus why we hive greater weight to the AHRQ.  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 17:43, 18 February 2013 (UTC)
 * As much as you like to use MEDRS to reject information, you don't seem to be following it yourself.
 * [|"Assessing evidence quality" means that editors should determine the quality of the type of study. Editors should not perform a detailed academic peer review.]
 * This is not the place for per review. If you believe the studies in question are fraudulent I would suggest that you find a review article saying as much. Khimaris (talk) 17:57, 18 February 2013 (UTC)
 * The AHRQ is a good source per WP:MEDRS. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 18:09, 18 February 2013 (UTC)
 * By the way the Goldstein paper is not listed as a review article by pubmed  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 18:16, 18 February 2013 (UTC)

Normal individuals
The new text stated "can lower blood pressure in healthy individuals". Does this mean that in those with normal blood pressure it causes hypotension? Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:56, 18 February 2013 (UTC)

How best to summarize the effect of meditation on hypertension
Currently we state based on these two refs
 * Different programs aimed to reduce psychological stress such abiofeedback,relaxation or meditation are advertised to reduce hypertension. However, overall efficacy is not greater than health education, with evidence being generally of low quality.

I guess the question is what weight should we give full ref here which found a significant decrease in BP? At the bottom of the paper it states "This research was funded, in part, by the HCF Nutrition Foundation and by an unrestricted gift from Howard Settle" Some details on this person

This review shared the same "Anderson" as author and came to similar conclusions. A number of the authors are from the Maharishi University of Management and therefore cannot be described as independent.

Anyway happy to look at other wording for this content. Doc James (talk · contribs ·email) (if I write on your page reply on mine) 19:01, 18 February 2013 (UTC)


 * I'm sorry to say this but you seem to keep putting up new goal posts. There is nothing in the Use Independent Sources section of MEDRS that would preclude the addition the source. It is not a fringe concept and it obviously notable. Wikipedia is not a peer review service.   — Preceding unsigned comment added by Khimaris (talk • contribs) 23:31, 18 February 2013 (UTC)
 * Wikipedia is based on discussion and consensus which is what we are doing. We have some sources that say it is of benefit and some that say it is not of benefit. We are now discussing how to weight these sources. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 18:48, 19 February 2013 (UTC)


 * I previously wrote at the wrong place, sorry. Here there is what I think:


 * There is something I don't understand in TM, something that is not logic and when is not logic I have serious doubts. In this source it seems that "simple biofeedback, relaxation-assisted biofeedback, progressive muscle relaxation, and stress management training did not show statistically significant reductions in elevated BP" so how can TM do it??? For my understanding meditation will relax, will do a stress management... or may be I'm wrong? and if I'm wrong what is the pathway to reduce BP? and how can control carotid athereosclerosis and myocardial infarction? I would like to believe it but is hard.
 * "This research was funded, in part, by the HCF Nutrition Foundation and by an unrestricted gift from Howard Settle. During a 1-year study period J.W.A. received partial salary support from Mr Settle" WAW! very good...one year partial salary! Each person has a price, very few have no price. For me the article has no value. TM will low BP, perhaps, in cases of exclusive stress HTN Doc Elisa ✉ 20:27, 18 February 2013 (UTC)
 * Yes exactly the reason why we prefer independent sources. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 18:52, 19 February 2013 (UTC)


 * It is extremely problematic when we have a situation like we have here where we have secondary sources that are tightly connected to the thing being studied that say "there is an effect" and we have independent secondary sources that say "no statistically significant effect." The guideline says not to reject a source based on funding but that's not what is being found here.  If our goal is to have our articles represent the highest-quality evidence, and that should be our goal, when we can see a clear disagreement between connected secondary sources and independent secondary sources, per common sense it makes sense to use the independent ones.  If independent secondary sources found the same as the connected ones this wouldn't be an issue, but that's not the case.  If we have independent ones why should there be any argument to use the connected ones?  Let's just use the independent ones.    19:16, 19 February 2013 (UTC)

*Reason* for sodium's effect on hypertension?
Can someone add a section that mentions (and/or points to another article) explaining *how* sodium causes/effects hypertension? I assume it's either because of effects on the conduction system, because of problems relating to water being shifted into/out of blood vessels and tissue as an attempt by the body to "dilute" the blood, or problems related to the kidneys trying to get sodium out of the body entirely.

The second and third of those could also occur in diabetes with respect to glucose. I know some have argued that *that* problem in diabetes *causes* the hypertension, but that's a whole other can of worms. Still, it would be useful to have information on whether hypertension and diabetes (type 1 and/or 2) can make hypertension worse independent of a blood-glucose effect (especially as Type 2 is thought to perhaps be a pathology of more than just the pancreatic beta cells (I remember reading a list somewhere on Pubmed that said there might be separate pathologies of the pancreas, liver, heart, peripheral glucose metabolism/insulin resistance, and some fifth component I forget) Jimw338 (talk) 17:59, 26 March 2013 (UTC)

Why are all the alternative treatments gone
What happened to the section where people would talk about things like Coenzyme Q10, spirulina, grip exercises, chlorella, deep breathing, etc. to control hypertension? Everything other than medications and generic lifestyle changes (some of which are dubious, low sodium diets do not work nearly as well across the board as they are advertised) has been deleted. I didn't want to start another alternative section if it is just going to be deleted. — Preceding unsigned comment added by 98.214.104.239 (talk) 13:07, 30 March 2013 (UTC)
 * We need high quality sources per WP:MEDRS. They reason they would have been removed is that this content was not supported by high quality refs before. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:30, 30 March 2013 (UTC)

Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:37, 30 March 2013 (UTC)
 * Garlic insufficient evidence
 * Roselle insufficient evidence
 * Relaxation evidence is weak
 * Coenzyme Q10 uncertain effect
 * Dark chocolate may have an effect but trials of limited quality. Reasonable as a lifestyle change.
 * Also hard end point are much preferred rather than surrogate markers. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:41, 30 March 2013 (UTC)

Here is a meta study of CoQ10 from PUBMED

There are studies on chlorella, spirulina , grip exercises , deep breathing , etc.

The connections between salt and hypertension are not cut and dried — Preceding unsigned comment added by 98.214.104.239 (talk) 16:47, 30 March 2013 (UTC)

Edit request on 4 April 2013
Under "Signs and symptoms"-->"1.2 Hypertensive crisis" The sentence: "(equal to or greater than a systolic 180 or diastolic of 110 — sometime termed malignant or accelerated hypertension)" should be changed to "(equal to or greater than a systolic 180 or diastolic of 120 — sometime termed malignant or accelerated hypertension)"

The diastolic value of 120 is consistent with your own Wiki pages: http://en.wikipedia.org/wiki/Hypertensive_emergency As well as other medical sources: http://www.uptodate.com/contents/management-of-severe-asymptomatic-hypertension-hypertensive-urgencies

The older criteria for a hypertensive urgency was ≥180/110 and a hypertensive emergency was ≥180/120, but now both use ≥180/120 and the difference of end-organ damage is what seaparates the two. Both fall under the umbrella term of hypertensive crisis.

Always murmuring (talk) 20:07, 4 April 2013 (UTC)


 * Not sure, NICE guideline says 180/110. Doesn't look like there's 100% agreement, would like to have more sources on this, maybe we should say "180 over 110 or 120".    20:56, 4 April 2013 (UTC)
 * Red information icon with gradient background.svg Not done: please establish a consensus for this alteration before using the template. &mdash; KuyaBriBri Talk 15:01, 5 April 2013 (UTC)

2013 European Guidelines
Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:59, 1 August 2013 (UTC)

The Cleveland Clinic has a recent and impressive source on arterial hypertension which would be excellent as an external link

 * Hypertension Cleveland Clinic

Currently the only external link is DMOZ, which does not include the Cleveland Clinic's article on arterial hypertension.
 * IMO those who are interested in creating lists of external links should join DMOZ and do so. They are a volunteer organization aswell and I am sure would love the help. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 22:32, 2 October 2013 (UTC)

Alternative Approaches to Lowering Blood Pressure - A Scientific Statement From the AHA Part Deux
I made edits to the lifestyle section again using information from the Alternative Approaches paper. Hopefully the American Heart Association will be "high quality" enough to appease our wiki GODs. Khimaris (talk) 01:18, 9 January 2014 (UTC)
 * Yes it is a reasonable reference to use. To much text though. We need to summarize further. Have placed the text here. And summarized it in the article. Summary seems to be " It is the consensus of the writing group that it is reasonable for all individuals with blood pressure levels >120/80 mm Hg to consider trials of alternative approaches as adjuvant methods to help lower blood pressure when clinically appropriate." Doc James  (talk · contribs · email) (if I write on your page reply on mine) 12:59, 9 January 2014 (UTC)
 * What determines that proper amount of text to add to the article? Why shouldn't the interventions be described in full? I understand you're an admin but you have consistently behaved as if you own the article. You don't. This sort of behavior is why the editorship of wikipedia is in freefall. Khimaris (talk) 16:07, 9 January 2014 (UTC)
 * I understand you have a bias against things that can be considered "alternative". However, you should not allow that bias restrict the flow of information. Khimaris (talk) 16:07, 9 January 2014 (UTC)
 * Have requested further opinions for you. Had summarized the text as " Different programs aimed to reduce psychological stress such a biofeedback, relaxation or meditation may be reasonable add ons to other treatment to reduce hypertension." We do not give any other measure this much weight. TM is IIB evidence as discussed below. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 16:25, 9 January 2014 (UTC)

Text added
The mechanism by which meditation lowers blood pressure is unknown. Meditation is not known to cause any adverse effects. Transcendental Meditation modestly lowers blood pressure, systolic (−4.7 mm Hg; 95% CI, −1.9 to −7.4) and diastolic (−3.2 mm Hg; 95% CI,−1.3 to −5.4). It is not currently known if Transcendental Meditation is more efficacious than other meditation regimes. The current evidence for Transcendental Meditation allows it to be considered for clinical practice for lowering blood pressure. Nevertheless, the current level of poor evidence does not allow for the clinical consideration of other meditation regimes.
 * This can be summarized as "There is tentative evidence for meditation"

The mechanism by which biofeedback lowers blood pressure is not complete. Biofeedback is not known to cause any adverse effects. The reported ability of biofeedback in reducing blood pressure is mixed. Nevertheless, some specific biofeedback techniques may work better than others. The current evidence for biofeedback, in general, allows it to be considered for clinical practice in lowering blood pressure.
 * This can be summarized as "There is tentative evidence for biofeedback"

The mechanism by which yoga lowers blood pressure is ill studied. Noting the risk for musculoskeletal and cardiovascular damage, there have been no reported adverse events in the small number of yoga trials. Yoga's ability to lower blood pressure, if it exists, is not clear. The mixed results preclude it from clinical consideration in lowering blood pressure.
 * This can be summarized as "Yoga does not appear to have an effect"

The mechanism by which device-guided slow breathing lowers blood pressure is not adequately studied. There are, however, no known contradictions or adverse events from the therapy. Current evidence suggests that device-guided slow breathing, performed three to four times a week for fifteen minutes, has the ability to significantly lower blood pressure. Given the previous, it is opinion of the American Heart Association that it is reasonable to preform device-guided slow breathing in a clinical setting.
 * This can be summarized as "The use of device-guided slow breathing may be reasonable"

Some of the studied non-pharmacological interventions have been shown to modestly lower blood pressure. However, even a small reduction in blood pressure, on a population level, can be beneficial. It is also possible that some of the alternative regimes may have a synergistic impact on blood pressure. Therefor, it is the consensus of the American Heart Association that it is reasonable for individuals with a blood pressure higher than 120/80 mm Hg to consider an alternative regime along with conventional medicine when it is appropriate.


 * So in light of the poor quality of evidence. "The use of device-guided slow breathing may be reasonable, there is tentative evidence for meditation and biofeedback. Evidence does not support the use of yoga" Which is more or less what we already say. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:11, 10 January 2014 (UTC)

Alternative Approaches to Lowering Blood Pressure - A Scientific Statement From the AHA
I suggest to use this AHA statement to be more accurate on alternative Approaches to Lowering Blood Pressure: Beyond Medications and Diet: Alternative Approaches to Lowering Blood Pressure - A Scientific Statement From the American Heart Association

Abstract—Many antihypertensive medications and lifestyle changes are proven to reduce blood pressure. Over the past few decades, numerous additional modalities have been evaluated in regard to their potential blood pressure–lowering abilities. However, these nondietary, nondrug treatments, collectively called alternative approaches, have generally undergone fewer and less rigorous trials. This American Heart Association scientific statement aims to summarize the blood pressure–lowering efficacy of several alternative approaches and to provide a class of recommendation for their implementation in clinical practice based on the available level of evidence from the published literature.

Among behavioral therapies, Transcendental Meditation (Class IIB, Level of Evidence B), other meditation techniques (Class III, Level of Evidence C), yoga (Class III, Level of Evidence C), other relaxation therapies (Class III, Level of Evidence B), and biofeedback approaches (Class IIB,Level of Evidence B) generally had modest, mixed, or no consistent evidence demonstrating their efficacy.

Between the noninvasive procedures and devices evaluated, device-guided breathing (Class IIA, Level of Evidence B) had greater support than acupuncture (Class III, Level of Evidence B). Exercise-based regimens, including aerobic (Class I, Level of Evidence A), dynamic resistance (Class IIA, Level of Evidence B), and isometric handgrip (Class IIB, Level of Evidence C) modalities, had relatively stronger supporting evidence. It is the consensus of the writing group that it is reasonable for all individuals with blood pressure levels >120/80 mmHg to consider trials of alternative approaches as adjuvant methods to help lower blood pressure when clinically appropriate.

A suggested management algorithm is provided, along with recommendations for prioritizing the use of the individual approaches in clinical practice based on their level of evidence for blood pressure lowering, risk-to-benefit ratio, potential ancillary health benefits, and practicality in a real-world setting. Finally, recommendations for future research priorities are outlined. (Hypertension. 2013;61:00-00.) — Preceding unsigned comment added by93.20.238.141 (talk) 20:07, 19 May 2013 (UTC)
 * So for behavior therapies III is no evidence, IIB is (less well established, greater conflicting evidence, may consider). Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:07, 9 January 2014 (UTC)


 * In general, I am not keen on the word "tentative". Perhaps "weak"? Anyway, that's a minor editorial decision.

"" This can be summarized as "There is tentative evidence for meditation" ""


 * I recommend that "transcendental meditation" should be specified.

"" This can be summarized as "There is tentative evidence for biofeedback" ""


 * That looks fine.

"" This can be summarized as "Yoga does not appear to have an effect" ""


 * I disagree with that conclusion. I would call the result inconclusive. However your subsequent statement: "Evidence does not support the use of yoga" is fine.

"" This can be summarized as "The use of device-guided slow breathing may be reasonable" ""


 * That is fine too. Axl  ¤  [Talk]  14:12, 10 January 2014 (UTC)
 * Feel free to change. Right now we say "Different programs aimed to reduce psychological stress such a biofeedback, relaxation or meditation may be reasonable add ons to other treatment to reduce hypertension.[67] However, overall efficacy is not greater than health education, with evidence being generally of low quality." I did not specify TM specifically as the ref says "It is not certain whether it is truly superior to other meditation techniques in terms of BP lowering because there are few head-to-head studies." Doc James  (talk · contribs · email) (if I write on your page reply on mine) 15:40, 10 January 2014 (UTC)
 * The source indicates IIB evidence for transcendental meditation, and III evidence for other types of meditation. I think that this justifies singling out transcendental meditation. I have changed the text. Axl  ¤  [Talk]  00:23, 11 January 2014 (UTC)

JNC 8 is out
http://jama.jamanetwork.com/article.aspx?articleid=1791497 Doc James  (talk · contribs · email) (if I write on your page reply on mine) 20:40, 19 December 2013 (UTC)


 * I printed it out at work with the intention of reading it over the weekend, but managed to leave it on the printer. Nice try doc. Will have another look in the next few days. JFW &#124; T@lk  22:53, 21 December 2013 (UTC)


 * this is going to be a fair bit of work. Do you agree that we should not attempt to remove every reference to JNC7 but rather show the changes suggested by JNC8? Because it will take time for some of there recommendations to "filter down" to regular widespread practice. JFW &#124; T@lk  08:02, 25 December 2013 (UTC)
 * Agree lots of people are still going to be using JNC7. Some of what we have here already conforms to JNC8. For example the recent Cochrane reviews are now reflected in JNC8. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:37, 25 December 2013 (UTC)
 * I've inserted a table based on JNC8 document and made some minor modifications. As the table illustrates there is quite a lot of divergence now between international guidelines and (as a non US physician) I would advocate not making the article too US-centric. It also probably makes sense to wait to see what the response to JNC8 is, particularly since (as I understand it) it is no longer sanctioned by the NHLBI . Adh (talk) 10:56, 10 January 2014 (UTC)
 * Have moved it to the subpage here. It seems a little to detailed for the main page. Thoughts? Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:01, 10 January 2014 (UTC)
 * Happy with that. Adh (talk) 09:08, 11 January 2014 (UTC)

Uric acid lowering
There is a line of research looking into uric acid lowering for hypertension. 10.1111/j.1751-7176.2012.00701.x suggests a small benefit, but 10.1002/14651858.CD008652.pub2 rubbishes most of the research so far and calls for better RCTs. JFW &#124; T@lk  20:40, 13 January 2014 (UTC)

Brook
Following this discussion on my talk page, here is a summary of the conclusions from Brook.


 * Transcendental meditation: modest reduction in BP
 * Other meditation: no supportive evidence
 * Biofeedback: some techniques are effective
 * Yoga: insufficient evidence
 * Relaxation: inadequate evidence
 * Acupuncture: no supportive evidence
 * Device-guided breathing: effective
 * Dynamic aerobic exercise: effective
 * Dynamic resistance exercise: modest improvement
 * Isometric resistance exercise: effective

Axl ¤  [Talk]  12:11, 14 April 2014 (UTC)


 * I have changed the text in the "Lifestyle modifications" subsection in line with this. Axl  ¤  [Talk]  12:34, 14 April 2014 (UTC)
 * Just tweaked this slightly as there were two "However"s in a row - and the text governed by the second of them seemed to convey additional, rather than qualifying, information. Alexbrn talk 11:21, 25 April 2014 (UTC)

Table for investigations
I'm puzzled why we need all the Canadian guidelines (2005-2009) to support the list of investigations for hypertension. Surely one reference is enough? JFW &#124; T@lk  14:33, 29 April 2014 (UTC)

Text not support by ref
"It is important for many people affected by hypertension or hypotension to monitor their blood pressure regularly (typically daily, or as often as prescribed by the doctor) and report their measurements to the medical practitioner of reference. "

Thus moved here Doc James  (talk · contribs · email) (if I write on your page reply on mine) 13:53, 10 September 2014 (UTC)

Vegetarian diet
Sorry if this has been discussed, but perhaps we need to include vegetarian diet 10.1001/jamainternmed.2013.14547 as a beneficial intervention. JFW &#124; T@lk  16:01, 8 April 2014 (UTC)


 * Updated section to include this Adh (talk) 13:10, 26 December 2014 (UTC)

Depression
I'm quite surprised to find nothing about depression in this article. There's quite some research on "depression & hypertension" (controversial, but a recent meta-analysis found that "[d epression increases the risk of hypertension incidence"]... there's also research on whether treating depression can influence hypertension... well, and so on). BTW, mid-20th century, hypertension was viewed as one of the psychosomatic diseases. And so on... Moreover, given the prevalence of both diagnoses, it's a highly relevant topic. - I guess a "good" article should really include such basic info!! :o) Thanks for taking care, Ibn Battuta (talk) 11:16, 9 February 2015 (UTC)
 * Good source. Will add. Thanks Doc James  (talk · contribs · email) 12:02, 9 February 2015 (UTC)

Lancet Seminar 2015
Seminar: Hypertension Neil R Poulter, Dorairaj Prabhakaran, Mark Caulfield 29 March 2015 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961468-9/fulltext DOI: 10.1016/S0140-6736(14)61468-9 This review covers the less developed countries. It also discusses some of the contradictions among different guidelines, such as the European vs UK. --Nbauman (talk) 03:49, 3 April 2015 (UTC)
 * Excellent Doc James  (talk · contribs · email) 08:15, 3 April 2015 (UTC)

Consolidating to Improve Readability
At 100KB, this article is double wikipedia's recommended article length. Even as a medical student, I find the length and level of detail to be quite overwhelming, and I am sure it would be more so for the general public. Over the next few days, I'd like to make edits to reduce the total article length and improve readability. In particular, I notice that some of the sections are detailed descriptions of specific manifestations or subtypes of hypertension which have their own wiki pages. I feel that in these cases, we can shorten the text devoted to these sub-topics to 1-2 short paragraphs, and let readers who are interested in the details of that sub-topic go to the main page. The section "Outcomes" is an excellent example of this, with a brief summary and a link to the main article. The "treatment" section also seems long enough to merit its own page, with a summary devoid of the current level of detail. Please review my edits to make sure they are in line with what we want this article to be, and drop me a message if you have any queries or thoughts on this. Nren4237 (talk) 11:35, 25 July 2015 (UTC)
 * Agree the edits simplifies the article thanks. The Article size recommendations are based on readable prose so the article is not that long. Doc James  (talk · contribs · email) 12:59, 25 July 2015 (UTC)

Thanks for pointing this out DocJames, I'll make sure I'm editing only to improve readability rather than to reduce length. Following on from my last post, I've moved the detailed content from the "Management" section to its own sub-page, as I felt this section in particular had a lot of excessive detail. In particular, going into the difference between recommendations of various national bodies, using abbreviations like CCB and ACEI, and having sentences where the authors seemed to be arguing with each other seemed to make this a section with particularly poor readability. I've updated the information with the latest JNC-8 guidelines, and summarised and reorganised the content under subheadings like "blood pressure target" and "benefits of treatment". Please review my edits to make sure that I have summarised the most important features, and that this is the appropriate level of detail for the general reader. Nren4237 (talk) 14:32, 30 July 2015 (UTC)
 * I think simplifying the article is a good idea; however, only referring to JNC8 in management gives the article a too US-centric focus and is in danger of obscuring some genuine uncertainty - JNC8 guidelines have been criticized, even from within the committee (http://www.medscape.com/viewarticle/819078). Some reference to other national and international guidelines is warranted and some indication of discrepancies in recommendations is appropriate, I think. Adh (talk) 21:58, 2 August 2015 (UTC)
 * This is an excellent point, apologies for overlooking this. Perhaps it would be better to just mention that various bodies have targets between x and y mmHg, depending on the patient's age and other circumstances, with a link to the article on comparisons of national guidelines, rather than singling put JNC-8 for special mention. I'll have a go at making those edits later, if anyone wants to jump in first please do! Nren4237 (talk) 01:24, 4 August 2015 (UTC)
 * Edited now, please let me know if this is better. Nren4237 (talk) 02:51, 4 August 2015 (UTC)

Preventing disease and death
10.1016/S0140-6736(15)01225-8 Lancet. Targets lower than currently used are being recommended. JFW &#124; T@lk  15:20, 4 March 2016 (UTC)

Add JNC8 changes to blood pressure definitions
The "Classification of blood pressure for adults" table is outdated and should match the more current JNC8 definitions.

Regarr (talk) 18:08, 18 March 2016 (UTC)
 * From JNC8 it says "It is important to note that this evidence-based guideline has not redefined high BP, and the panel believes that the 140/90 mm Hg definition from JNC 7 remains reasonable."
 * Do they give new numbers User:Regarr? Doc James  (talk · contribs · email) 01:48, 19 March 2016 (UTC)

Yes, the goal for people under age 60 is a blood pressure less than 140/90, that definition hasn't changed; but people over age 60, the goal is now set to be less than 150/90. For details, see this algorithm: http://www.nmhs.net/documents/27JNC8HTNGuidelinesBookBooklet.pdf

Regarr (talk) 22:12, 21 March 2016 (UTC)
 * That is treatment goals not BP definitions. Doc James  (talk · contribs · email) 05:21, 22 March 2016 (UTC)

Systolic Blood Pressure Intervention Trial (SPRINT)
The findings of the Systolic Blood Pressure Intervention Trial (SPRINT) are now published with the process to issue revised guidelines soon underway. User:Fred Bauder Talk 07:59, 10 November 2015 (UTC)
 * Will be interesting to see how they effect the guidelines. Doc James  (talk · contribs · email) 08:05, 10 November 2015 (UTC)
 * See the commentary at http://www.nejm.org/doi/full/10.1056/NEJMp1513290 User:Fred Bauder Talk 08:18, 10 November 2015 (UTC)
 * And the editorial at http://www.nejm.org/doi/full/10.1056/NEJMe1513991 User:Fred Bauder Talk 09:11, 10 November 2015 (UTC)

It is now up to committees that formulate national guidelines to decide how to change their recommendations. Dr. Whelton, chairman of the heart association’s guidelines committee, said his group would meet on Monday night to consider the new data.
 * Medpage Today User:Fred Bauder Talk 21:39, 10 November 2015 (UTC)


 * Hypertension editorial User:Fred Bauder Talk 23:32, 10 November 2015 (UTC)

I've added a short paragraph on this trial to the "Blood pressure targets" section, and made a new page for this trial explaining it more fully, Systolic Blood Pressure Intervention Trial (SPRINT). I've tried to be balanced and objective, and to strike a balance between scientific accuracy and usefulness to laypeople, but since this is such an important trial I'd like others to go over my work and make sure that I'm presenting the results fairly and neutrally. I also haven't had a chance to mention any of the commentary from third parties on the trial's results and their strengths/weaknesses and implications, and would appreciate it if anyone wants to wade through that! Nren4237 (talk) 08:14, 9 February 2016 (UTC)
 * A look at SPRINT in the TI. An updated Cochrane review is in the works by the sounds of it. Doc James  (talk · contribs · email) 12:50, 9 April 2016 (UTC)

Sodium restriction....
... only helps those who have high blood pressure and a high sodium intake already 10.1016/S0140-6736(16)30467-6 JFW &#124; T@lk  23:50, 30 July 2016 (UTC)
 * Revised your comment to indicate that it is based on observational data and refers to estimated habitual sodium intake not reductions in sodium intake. Adh (talk) 10:38, 31 July 2016 (UTC)

ACP/AAFP
10.7326/M16-1785

Now recommend SBP<150 for primary prevention, SBP<140 after stroke/TIA and SBP<140 for high risk primary prevention. JFW &#124; T@lk  11:05, 17 January 2017 (UTC)

New treatment possibility if results confirmed? (Press release)
AOBiome Launches Phase 2 Clinical Trial Using Novel Bacterial Platform for Treatment of Hypertension More Than 150M People Affected by Hypertension in the US Could Benefit From Patented AOB Treatment

NEWS PROVIDED BY AOBiome Dec 16, 2016, 09:01 ET CAMBRIDGE, Mass., Dec. 16, 2016 /PRNewswire/ -- Leading microbiome company AOBiome announced today the launch of its Phase 2 clinical trial using its first-in-class live bacteria (B244) for the treatment of hypertension. This is the second indication for AOBiome's novel ammonia oxidizing bacteria following the enrollment of patients in its acne vulgaris trial earlier this fall. Once deployed on the skin, AOBiome's proprietary ammonia oxidizing bacteria (AOBs) produce nitric oxide, a signaling molecule known to regulate inflammation and vasodilation.

. ..

http://www.prnewswire.com/news-releases/aobiome-launches-phase-2-clinical-trial-using-novel-bacterial-platform-for-treatment-of-hypertension-300379483.html

-- Jo3sampl (talk) 02:37, 9 February 2017 (UTC)
 * Not a suitable source. It is simply a press release. Doc James  (talk · contribs · email) 03:09, 9 February 2017 (UTC)

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Lifestyle modifications: potassium supplementation
The current text "While potassium supplementation is useful it is unclear if a high dietary potassium intake is beneficial.[102][103]" is contradictory, vague and/or confusing. It does not properly reflect the conclusions of the two cited articles:

[102] "Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses." 2013:

"High quality evidence shows that increased potassium intake reduces blood pressure in people with hypertension and has no adverse effect on blood lipid concentrations, catecholamine concentrations, or renal function in adults. Higher potassium intake was associated with a 24% lower risk of stroke (moderate quality evidence). These results suggest that increased potassium intake is potentially beneficial to most people without impaired renal handling of potassium for the prevention and control of elevated blood pressure and stroke."

[103] "Potassium Intake, Bioavailability, Hypertension, and Glucose Control" (2016): The conclusions begin with:

"Increasing dietary potassium has a potential benefit for lowering the risk of hypertension, the major risk factor for the development of stroke, coronary heart disease, heart failure, and end-stage renal disease. In addition, adequate potassium intake may be extremely influential in glucose control and limiting the risk of diabetes, especially in those on thiazide diuretic treatment, and those already at higher risk from the development of additional co-morbidities. Increasing evidence suggests these changes in dietary habits would also have potential health benefits for the skeleton and kidneys."

The rest of the conclusion involves concerns about the difficulty of applying potassium supplementation in sufficient quantities, and suggests further research aimed at improving potassium absorption and retention. This includes a statement that potassium compounds are bitter, which is not the case for potassium gluconate. (http://www.foodbusinessnews.net/articles/news_home/Supplier-Innovations/2015/01/Potassium_promising_yet_proble.aspx?ID=%7BEFE46B8B-5647-4150-9525-F66F794BF84C%7D&cck=1)

So I changed the text before the current two references to the text I quoted above from the second article and added a further sentence on supplementation challenges, citing the Food Business News article:

"In 2014, the United States Dietary Guidelines Advisory Committee stated that potassium is under-consumed across the entire U.S. population. Potassium supplementation is challenging due to the large quantities required to achieve a substantial fraction of the 3.5 gram Daily Value  and the strong taste of many potassium compounds.  Potassium gluconate has the mildest taste of these, but the lowest potassium content, of 16.7%." — Preceding unsigned comment added by Robin Whittle (talk • contribs) 06:50, 25 April 2017 (UTC)

Doc James removed all but the first half sentence of the first section I added, which I understand since it concerns things beyond hypertension. He also removed "Potassium gluconate has the mildest taste of these, but the lowest potassium content, of 16.7%." and the foodbusinessnews.com reference, perhaps because it is not a peer-reviewed journal article. This leaves the statement "the strong taste of many potassium compounds" unsupported by references or links to any other WP articles. Both the taste and the fraction of potassium are challenges for supplementation. I can't find a journal reference via PubMed and I figure a trade journal article is a suitable reference for questions of taste, and better than no reference at all, so I reinstated the latter part of my changes.

The statement "In 2014, the United States Dietary Guidelines Advisory Committee stated that potassium is under-consumed across in the United States." was a quote from the foodbusinessnews.com reference and so was unreferenced. I replaced it with a more detailed statement and link to the report. Robin Whittle (talk) 06:44, 26 April 2017 (UTC)

Sodium/potassium ratio etiology of primary/essential/idiopathic hypertension
The distinction between "causes" and "pathophysiology" is not clear to me, and the two sections at present seems awkward and repetitive. I added some text to the end of the Pathophysiology section to match the section I added to the WP article "Pathophysiology of hypertension". Ideally I would update the WP article "Essential hypertension".

Some researchers define primary/essential/idiopathic hypertension as that with no known cause. If so, then how can we have a section on causes for this? The material I added cites researchers who demonstrate (these articles are highly cited) that the great majority of hypertension cases not caused by previously identified acute medical conditions is caused (perhaps together with genetic influences) by the radically different Na/K ratio of current Western diets compared to those of our ancestors. Robin Whittle (talk) 07:15, 26 April 2017 (UTC)
 * Sure so pathophysiology is the underlying mechanism of the disease. How does the cause create the end results of the symptoms. Doc James  (talk · contribs · email) 17:31, 26 April 2017 (UTC)

Review of studies in 2011 found slow-release melatonin significantly decreased systolic and diastolic blood pressure. PMC3180511
Ehud Grossman, Moshe Laudon, and Nava Zisapel

Effect of melatonin on nocturnal blood pressure: meta-analysis of randomized controlled trials

Vasc Health Risk Manag. 2011; 7: 577–584.

Published online 2011 September 15. doi: 10.2147/VHRM.S24603


 * ... Systolic blood pressure decreased significantly with controlled-release melatonin (−6.1 mmHg; 95% confidence interval [CI] −10.7 to −1.5; P = 0.009) ... Diastolic blood pressure also decreased significantly with controlled-release melatonin (−3.5 mmHg; 95% CI −6.1 to −0.9; P = 0.009) ...

With fast-release melatonin, in contrast, diastolic and systolic blood pressure dropped, but the average drop was small. One trial actually noted an increase. A substantial drop was shown in the other studies, but was reduced to insignificance when averaged with the study showing a rise.


 * how do you know if the journal is a wikipedia accepted reference? (Vasc Health Risk Manag. 2011; 7: 577–584.)Vegaproc (talk) 17:53, 25 May 2017 (UTC)

Effect of weight loss on people with hypertension
I (mis)read "... a Cochrane systematic review found no evidence for effects of weight loss diets on death or long-term complications and adverse events in persons with hypertension. as "... a Cochrane systematic review found (1) no evidence for effects of weight loss diets on death or long-term complications and (2) adverse events in persons with hypertension."

Please check my change to "... a Cochrane systematic review found no evidence for effects of weight loss diets on death, long-term complications or adverse events in persons with hypertension." Thincat (talk) 19:05, 31 May 2017 (UTC)

Pl follow JAC8 guidelines (2014) Previous editors were following JAC7 guidelines
. . ..

jac8 changed normal blood pressure upper level from 120/80 to 140/90, many doctors following jac7 guidelines and prescribing drugs to patients if blood pressure more than 120/80 and below 140/90, Because  due to failure of updates in Wikipedia. The issue related to millions of hypertensive patients health.. so please update. (223.182.84.103 (talk) 03:29, 9 January 2017 (UTC))

JAC8 GUIDELINES :

In the general population,treatment should be initiated when blood pressure is 150/90 mm Hg or higher in adults 60 years and older, or 140/90 mm Hg or higher in adults younger than 60 years.In patients with hypertension and diabetes, treatment should be initiated when blood pressure is 140/90 mm Hg or higher.

(223.182.95.83 (talk) 06:36, 9 January 2017 (UTC))
 * 5th ref same as 2nd. The normal and hypertensive BP levels are correctly stated in the 3rd paragraph of the lede. --Zefr (talk) 05:19, 9 January 2017 (UTC)
 * The diagnosis section still displays JNC7 definitions and should be updated to JNC8. Additionally, the section about using MDRD as the preferred method to estimate eGFR to assess renal function should be updated since that's no longer the current recommendation. I can probably make those corrections tomorrow or the day after if someone doesn't beat me to it. TylerDurden8823 (talk) 07:47, 9 January 2017 (UTC)
 * The range you refer to is called either "high normal" or "prehypertension"
 * Yes am aware that in those with risk factors treating "high normal" may result in some benfits while at the same time causing some harms. Doc James  (talk · contribs · email) 12:26, 9 January 2017 (UTC)

No ,I am apposing Doc James  opinion, because there is no word “pre-hypertension”in JAC8 guidelines. Treatment should be initiated when blood pressure is 150/90 mm Hg or higher in adults 60 years and older, or 140/90 mm Hg or higher in adults younger than 60 years.In patients with hypertension and diabetes, treatment should be initiated when blood pressure is 140/90 mm Hg or higher.I think someone strongly opposing jac8  ,so reverted some edits in talk page of hypertension,. Please see talk page history. I am so surprised for this reverts.


 * RE:Dr Priyanka - what data can you supply (other than the political publication of JNC8, as it did not include the Framingham data set) that systolic BP of 150 is safe?  You are clearly identifying the document of JNC8 as something that is useful or helpful to patients, when it is better to see the publication as as a tool to then allow "government" to reflect a better systolic blood pressure control in USA population as they have raised the goals. Prior to JNC8, only 3 of 10 patients who did seek medical treatment for blood pressure were at goal.   now afte JNC8 someone will be able to say more patients are at goal as they changed to goal.  I am open to your thoughts, yet without some evidence for or evidence against it seems futile to make a stand that JNC8 is anything helpful to any human.  Perhaps JNC8 is better viewed as a document of political nature that makes publication into journals.Vegaproc (talk) 18:10, 11 July 2017 (UTC)

If possible pl reply. Dr Priyanka MD,(49.203.108.60 (talk) 17:02, 9 January 2017 (UTC)),Asst professor,Cardiology,MGIM, (49.203.108.60 (talk) 17:02, 9 January 2017 (UTC))
 * This should be discussed on the article's talk page, not my talk page for future reference. I'll move the conversation there since I've been away all day and am not up to speed on which changes you mean. I understand the JNC8 guidelines are what should be shown. I did not revert you so I'm unclear what you mean. TylerDurden8823 (talk) 21:34, 9 January 2017 (UTC)
 * JNC8 is not the only guideline out there. Different guidelines use different terms. Pre hypertension was in JNC7. We often keep old names around for a while. Doc James  (talk · contribs · email) 09:21, 10 January 2017 (UTC)


 * seems accurate that JNC8 guidelines are irrelevant? (guidelines that the physicians who were in development even refused to allow their names to be signed off on due to a recurrent them of "no evidence to suggest" being listed time and time again - yet the authors clearly establishing the fact that "no evidence found" is not the same as "evidence against".   There has been calls to retract the JNC8 guidelines (http://www.kevinmd.com/blog/2014/01/call-retract-jnc8-hypertension-guidelines.html).   The lack of integration of excellent scientific information such as (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006742.pub2/abstract;jsessionid=6C5C0267361C5A1172351D6BF4763110.f04t04) by the JNC8 team leads many to question the motivations of the changes.  (example: since the USA is unable to get patients to a proper blood pressure goal we will just change the goal? - then the next time we look to see if we have approached the goal we will have better statistics?)  Vegaproc (talk) 18:01, 25 May 2017 (UTC)


 * as below the current guidelines are not relevant. They are better suggested to be political in nature and are not supported by any data - suggest removal of the JNC8 issues and simply reference that JNC7 was the most accurate to date.  the JNC8 guidelines did not use any new data- they only use information of "no evidence" - but as above this is not the same as evidence againts. LumenK (talk) 19:35, 8 June 2017 (UTC) agreeVegaproc (talk) 18:04, 11 July 2017 (UTC)

What is the relationship between high blood pressure and anxiety?
Should it be added? Taken from the article: "These symptoms, however, might be related to associated anxiety rather than the high blood pressure itself."
 * Ref please Doc James  (talk · contribs · email) 00:06, 12 July 2017 (UTC)

Salt-induced addiction?
Removed from article for discussion here. This is speculative at best; WP:BALL. --Zefr (talk) 19:07, 21 September 2017 (UTC) "Another article suggest that salt induced addiction to food items enriched with high-fat quantities could also lead to hypertension." PMID 28927660
 * Reference seems to be okay and from good source. It doesnt look like speculation like you said, aince it has proper cited references. MedTime  ( talk ) 21:55, 21 September 2017 (UTC)
 * It takes more than that for a trusted encyclopedia. Did you notice the word "hypothesis" in the article title? The abstract reads like an op-ed and uses words like "suggest". Further, there is no conclusive evidence that salt itself has addictive properties. This edit and source are unencyclopedic per WP:BALL, and fail WP:MEDREV and WP:MEDASSESS. Related to this discussion is this, quoting: “eating addiction” rather than “food addiction” more precisely circumscribes addictive-like food intake in affected individuals." Another quote: "There is currently no evidence that single nutritional substances can elicit a Substance Use Disorder in humans according to DSM 5 criteria." Also see in that article sections 3.1 and 4.3 (Salt addiction: "a strong salt preference is not evident across most of the life-span"). --Zefr (talk) 22:18, 21 September 2017 (UTC)
 * I would disagree on your part. This is a secondary source that has cited all relevant references which shows that salt is addictive. There have been many studies that says that salt is an addictive food item (https://www.ncbi.nlm.nih.gov/pubmed/16790320, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2491403/). This is a peoven fact by other primary articles which is shown here as a “suggestion”. It further says that sugars and fats play a role in causing htn which has now become a very important topic recently and even the major studies or meta analysis suggest that salt hardly rises the blood pressure (have a look on a recent cochrane review by graudal). So IMO, we can use this source. You may modify to make it sound better. MedTime  ( talk ) 02:19, 22 September 2017 (UTC)
 * The first reference you offer is another hypothesis and the second, although a review, provides insufficient evidence from human studies that salt is addictive or the salt-sugar-fat combination causes hypertension, not complying with WP:MEDRS as an acceptable source. As a new editor here for medical topics, you would do well to read and apply the guidance in MEDRS -- it's instructive and helps maintain the quality of WP medical articles. --Zefr (talk) 02:53, 22 September 2017 (UTC)

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Moved
Needs to be paraphrased and integrated into the existing text. Will work on it. Doc James (talk · contribs · email) 18:48, 8 December 2017 (UTC)

"High blood pressure should be treated earlier with lifestyle changes and in some patients with medication –  at 130/80 mm Hg rather than 140/90 – based on new American Collage of Cardiology (ACC) and American Heart  Association (AHA) guidelines for the detection, prevention, management and treatment  of high blood pressure."

Blood pressure categories in the new guideline published by Journal of the American College of Cardiology  as of Nov 13 2017.
 * Normal: Less than 120/80 mm Hg;
 * Elevated: Systolic between 120-129 and diastolic less than 80;
 * Stage 1: Systolic between 130-139 or diastolic between 80-89;
 * Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg;
 * Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.

Another interesting peice
AAFP decides not to endorse but go with prior guidelines. Doc James (talk · contribs · email) 05:31, 15 December 2017 (UTC)

Resistant hypertension
added under "Resistant hypertension":


 * [A]nd by urine analysis.

This is a primary research study of 208 patients. I am however aware that this can be useful in a specialised setting, and we mainly need a more robust source in line with WP:MEDRS. 10.1042/CS20160407 cites this paper as well as several others. JFW &#124; T@lk  12:47, 30 April 2018 (UTC)

Terminology
, why do you think we shouldn't briefly mention the medical terminology (i.e., striae) in addition to stretch marks? TylerDurden8823 (talk) 08:59, 29 December 2017 (UTC)
 * Most English words have a number of synonyms. Stretch marks and striae are the same. If people want to learn what the synonyms are they can look at the page on the topic.
 * It is typically sufficient to just go with the common term IMO. One does not need "shortness of breath (dyspnea)" for example. Doc James  (talk · contribs · email) 09:02, 29 December 2017 (UTC)
 * Most readers I know find that helpful (I don't assume that people will utilize the wikilinks we provide), but whatever. Don't feel strongly. TylerDurden8823 (talk) 09:04, 29 December 2017 (UTC)

"Prehypertension", I no longer see this term appear from uptodate, AHA, 2017. There are only elevated BP, Stage 1 and 2 hypertension.Elainr (talk) 20:26, 5 May 2018 (UTC)

Dental Relevance in Hypertension
Good day, I would like to add on "dental relevance in hypertension" in the "hypertension" article under the Wikipedia:WikiProject Dentistry. You may find the changes in the filter log. :) — Preceding unsigned comment added by Wikikibasic (talk • contribs) 04:21, 3 February 2020 (UTC)

"units"
There is a limit in alcohol consumption in "Prevention" chapter, defined in units/day. What is the volume of this unit in milliliters please?
 * Countries use different measures of alcohol in their public health guidance - for example, the US uses 'drinks' which is pretty meaningless if you're unfamiliar with American drinking culture. A standard UK 'unit' is 10ml of ethanol, or a 25ml standard measure of a 40% abv spirit such as whisky. There are about 2 units in an imperial pint of 3.5% abv draught beer, and about 3 units in the same amount of 5% abv beer. For a global perspective, see standard drink. --Ef80 (talk) 13:11, 4 April 2020 (UTC)

Ref says
"The results showed that cardiovascular disease and death are increased with low sodium intake (compared with moderate intake) irrespective of hypertension status, whereas there is a higher risk of cardiovascular disease and death only in individuals with hypertension consuming more than 6 g of sodium per day (representing only 10% of the population studied)"

https://www.ncbi.nlm.nih.gov/pubmed/?term=27216139

Doc James (talk · contribs · email) 07:24, 2 May 2020 (UTC)

New guideline
10.1161/HYPERTENSIONAHA.120.15026 - this probably requires at least a partial revision of this article. JFW &#124; T@lk  20:35, 9 June 2020 (UTC)

"About 90–95% of cases are primary..."
Current version: "About 90–95% of cases are primary, defined as high blood pressure due to nonspecific lifestyle and genetic factors.[5][6] "

It is 80-95% according to Harrison's 20th ed. pg 1896. But I cant find the specific edition to google books so I cant generate a proper ref. Cinadon36</b> 19:54, 22 September 2019 (UTC)
 * It is 85% in Ferri's 2019 page 729. Will try to add.--Iztwoz (talk) 21:08, 30 July 2020 (UTC)

Move to "High blood pressure"
Per WP:COMMONNAME, this article should be moved to "High blood pressure", as the CDC, American Heart Association, and Mayo Clinic use. As you'll see, these pages relegate "hypertension" to a parenthetical or appositive. So too shall we. TortillaDePapas (talk) 22:28, 27 February 2021 (UTC)
 * I support this if hypertension is included as a parenthetical or appositive. This suggestion would also be consistent with current NHS and British Heart Foundation usage, but not with UK National Institute for Health and Care Excellence (NICE) or World Health Organization where hypertension still takes precedence over high (or elevated) blood pressure. Nevertheless, I think the proposal captures the direction of change in terminology. Adh (talk) 13:54, 1 May 2021 (UTC)


 * Unfortunately "high blood pressure" is not sufficiently precise. There is a particular lay perception that "blood pressure" is a state of mind or agitation. I'd really prefer to leave it as it is. JFW &#124; T@lk  13:27, 2 May 2021 (UTC)

Wiki Education Foundation-supported course assignment
This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Stromal cell, Nessimon2022.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 00:09, 17 January 2022 (UTC)