3^rd Annual Conference on
Hypertension and Cardiovascular Diseases

The hypertensive people will never be aware of their elevated level of blood pressure until the pressure reaches a peak level. Thus, constant monitoring of the blood pressure is required. Adults above 25 age group should have a constant check-up of their blood pressure levels. The hypertensive people go through various tests to find out their blood pressure levels. Initially, normal screening is done to check the blood pressure level then the patient's previous medical history is referred. If the patient is hypertensive then they undergo a physical examination. After which the person is checked whether he has any risk of Cardiovascular Diseases. 

One of the strongest muscle in the human body is the heart which is just the size of a fist. In general, the heart is a pump that supplies blood to the entire human body. The average heart beat per minute is 70 times and this rate can double during exercise or during extreme emotions. This heart is vulnerable to breakdowns and failures. This heart failure leads to numerous diseases together known as Cardiovascular diseases. Some of the CVD are coronary heart disease, rheumatic heart disease, hypertensive heart disease, congenital heart disease and inflammatory heart disease.

Cerebro refers to the brain and vascular refers to arteries and veins. Cerebrovascular means blood flow to the brain. Cerebrovascular disease is a combination of defects in two places as brain and blood. Cerebrovascular diseases include all disorders that affect the brain temporarily or permanently. Cerebrovascular diseases include stroke, stenosis, deep vein thrombosis, atherosclerosis, transient ischemic attack (TIA) and aneurysm. A stroke occurs commonly with little or no warning. The most common form of stroke is ischemic stroke and the dreadful stroke is known as hemorrhagic stroke. TIA is a temporary event and it doesn’t cause any permanent damage to the body. When there is a build-up of fat and cholesterol in the arteries it leads to plaque formation. This plague is known as atherosclerosis and when this blockage is severe it is known as stenosis. An aneurysm is an effect which develops because of HTN or atherosclerosis in which the blood vessel to the brain weakens which causes bulging up of the blood vessel in that area. 

Target organ damage usually refers to the damage caused to the organs wherever the circulatory system feeds. The main target organs are kidney, heart, brain, and eyes. Hypertension causes early changes in organ systems as left ventricular hypertrophy, proteinuria, renal failure, retinopathy and vascular dementia. There are many steps involved in the act of target organ damage as platelet activation, endothelial activation, increased thermogenesis, changes in the renin-aldosterone-angiotensin system (RAAS) and collagen turnover. 

Aldosteronism is a hormonal disorder that leads to hypertension. The excessive secretion of the hormone aldosterone disturbs the balance of sodium, potassium, and water in the blood. The production of excess secretion of aldosterone in the adrenal gland causes the loss of potassium and retaining of sodium alone. The excess sodium takes in water which increases blood volume and blood pressure. This can be cured by taking proper medications, change of lifestyles and surgery when required. The decrease in potassium level leads to weakness in the body, excess secretion of the urine and also muscle cramps. The important cause for aldosteronism is Conn’s syndrome. In children and young adults, there is a type of primary aldosteronism called glucocorticoid-remediable aldosteronism which causes high blood pressure. It is confirmed as aldosteronism if the High blood pressure is associated with low potassium levels in the screening.  

Aortic coarctation means narrowing of the aorta which is the large blood vessel that leaves from the heart. When narrowing occurs the heart must pump the blood very fast for it to flow through the narrowed part of the aorta. This is a condition from childbirth (congenital) and it leads to other heart defects. This case doesn’t have symptoms in most cases and not known until adulthood. The important symptom seen in adulthood is High Blood Pressure. A rare case of aortic coarctation if severe is heart failure in babies. 

The adult can be categorized as young age adults (age: 18-35), middle age adults (age: 36-55) and old age adults (age: 55 years and above). All the three groups are prone to hypertension.  Nowadays hypertension has become one of the major factors for causing death. Globally the prevalence rate of high blood pressure as of reported by WHO for age group above 25 is 40% as of 2008 and it tends to increase every year. Men are more prone to Hypertension than women in almost all areas. However, in Africa, the statistics are equally distributed. Managing this High Blood Pressure range has become a difficult task. The understanding of blood pressure chart and reading can reduce the risk of Hypertension. Maintaining a proper dietary control after a certain age limit also reduces the risk.

In order to reduce the morbidity and mortality due to hypertensive cases, the anti-hypertensive therapy is followed for almost 40 years. The anti-hypertensive treatment is less cost-effective. The benefits of treating different stages of hypertension are well established. The benefits of therapy will be greater for younger individuals with any range of elevated blood pressure than older individuals. It is because the vascular complications will be more prone to older individuals. The effect of the drug can be shown clearly in younger individuals with mild hypertension and absolutely low risk of developing cardiovascular diseases risks. Strokes, Coronary artery diseases, Congestive cardiac failure and Renal failure tend to reduce with the use of drugs.  The commonly used drugs for the therapy are diuretics, calcium chloride blockers, ACE inhibitors, angiotensin II receptor antagonists, adrenergic receptor antagonists, vasodilators, renin inhibitors, aldosterone receptor antagonists, alpha-2 adrenergic receptor agonists, and endothelin receptor blockers. 

At the entrance of the glomeruli of the kidney, there are certain sets of specialized cells that encircle the arterioles which secrete an enzyme called Renin into the blood. Renin secreting cells composing of juxtaglomerular apparatus are sensitive to change in blood pressure. When the blood flow to the kidneys reduce the secretion of renin is high. This may lead from loss of sodium and water or by narrowing of the renal artery. During this process renin acts as a catalyst in the formation of a plasma protein called angiotensinogen into a decapeptide (consisting of 10 amino acids) called as Angiotensin I. Another enzyme in the serum converts this decapeptide enzyme into an octapeptide enzyme called Angiotensin II that stimulates the secretion of Aldosterone that in turn stimulates salt and water reabsorption by the kidneys and also constricts the small arteries. ACE inhibitors which block the formation of Angiotensin II are used for the treatment of high blood pressure. 

Non-pharmacological interventions mainly focus on weight reduction, discontinuation of tobacco, restriction of caffeine, salt restriction, moderation of alcohol consumption, reduction of cholesterol intake and exercise which helps to reduce the elevated blood pressure and improve the efficacy of pharmacological agents. For further treatment of hypertension in future Non-pharmacologic therapy is stressed on. This therapy can be tried upon if the person is not prone to previous myocardial infarction or stroke, kidney disease, Diabetes mellitus, left ventricular hypertrophy and other CVD risks. Excess intake of salt, sodium, reduced intake of potassium, reduced intake of calcium, lower intake of magnesium, excess intake of fats are the main causes of hypertension as per the study. There is no surgical cure for hypertension but there can only be dietary control and medications. The psychological factors that increase blood pressure are, increase verbal confrontation, job stress, lying and decrease slow talk, pets, laughing, visual, scent therapy, biofeedback, and relaxation therapy. 

Hypertensive patients tend to develop many other diseases in their body. Comorbidities included the combination of two or more diseases other than hypertension. These diseases include heart diseases, kidney diseases, diabetes mellitus and blood vessel diseases. Inclusive of all the major effects of hypertension is cardiovascular diseases and cerebrovascular diseases. The patients with diabetes and hypertension are insulin resistant. The complication of hypertension is mainly categorized under two as macrovascular and microvascular. There are various organizations working on the medications to be followed for hypertensive patients to reduce the effects of other diseases. These organizations work on statistics in order to identify the patient's adherence to the medications. There are certain guidelines provided by National Institute for Healthcare and Excellence to be followed for the comorbidities patients. 

In order to improve the everyday functioning of a person wide spectrum of techniques and psychotherapies are used for managing the stress, a person is undergoing. Usually, the term ‘stress’ has a negative impact thus stress management is referred to as ‘eustress’ which means helpful. Smoking and consumption of alcohol increase stress which in turn increases the blood pressure level. Stress in simple terms can be referred to as a persons physical and emotional effect towards change. There are both positive and negative sources of stress. Mostly stress refers to tending ourselves through a threatening situation. Stress is developed when we think demands are more than our coping abilities. Stress wouldn’t allow us to take any decision properly. Stress can be managed by changing the situation, the way we think (cognitive restructuring) and by the way we respond. Meditation and mindfulness are the best practices for stress management. 

Some type of kidney diseases can cause High blood pressure. But, in most cases, it is High Blood Pressure that causes Kidney diseases. High blood pressure speeds up the loss of kidney in patients with kidney disorders. A simple blood test will give all the details about how much the kidney is damaged because of Hypertension. Nephrology includes acute kidney failure, chronic kidney failure, acute care nephrology, kidney stones, pediatric kidney disorders, polycystic kidney disorders but not limited to these alone. In patients with acute cases, there are transplantations of kidney or dialysis is advised. The transfer of organs is necessary when the kidney diseases have caused for the failure of kidneys completely. If the patient is not able to undergo transplantation then they are advised to undergo comprehensive renal replacement therapy known as dialysis. The doctors use many kinds of medication to help the people from hypertension and other allied diseases. 

The systolic and diastolic pressures are measured using a device known as Sphygmomanometer. In general, a person is said to have High Blood Pressure if the systolic pressure is greater than or equal to 140mm Hg and diastolic pressure greater than or equal to 90mm Hg. It is necessary to maintain a lower pressure because for every 20mm Hg of systolic pressure raises above 115 and for every 10mm Hg of diastolic pressure raises above 75. The different Hypertensive stages are normal, pre-hypertension, stage-1, and stage-2. In case of normal the systolic pressure remains below 120mm Hg and diastolic pressure remains below 80mm Hg and no treatment is required but regular check-up is needed so that the blood pressure is not raised. Pre-hypertension is a case where the systolic pressure is between 120-139m Hg and diastolic pressure is between 80-89mm Hg and it is a stage where the risk for developing hypertension is high. Stage-1, is where the systolic pressure is between 140-159mm Hg and the diastolic pressure is between 90-99mm Hg, the medications are followed as per pre-hypertension but also the use of drugs is advised in order to reduce the risk of developing heart diseases. Stage-2 is the severe case where the systolic pressure is 160mm Hg or higher and the diastolic pressure is 100mm Hg or higher. A very high dosage level of drugs is used in order to bring the blood pressure down in this case. 

Acute hypertension - when the blood pressure is greater than 180/120mm Hg. This is classified as hypertension urgencies and hypertension emergencies. Hypertension urgency is not target organ damage oriented whereas hypertension emergency affects neurologic, aortic, renal, cardiac and pregnancy-related damages. As far now, hypertension emergency has been treated using intravenous antihypertensive pharmacotherapy based on the type of organ that is damaged. Hypertension urgency is also known as asymptomatic elevated blood pressure. Hypertensive emergency patients should be maintained in Intensive Care Unit (ICU) where they are closely monitored for signs of iatrogenic target organ damage. The neurologic damage in acute hypertension emergencies is acute stroke, seizure, and retinopathy. Depending on the presence or absence of the target organ damage acute hypertension is categorized as hypertensive emergency and hypertensive urgency. 

Microalbuminuria means a term to describe a moderate increase in the level of urine albumin. Normally, kidney filters albumin, if there is presence of albumin in urine then it a sign of presence of kidney diseases. The term microalbuminuria is replaced as moderately increased albuminuria by KDIGO (Kidney Disease Improving Global Outcomes). The collection of conditions involving problems the body have with the hormone insulin is known as Diabetes. Diabetes occurs when the pancreas does not produce any insulin or produces very less insulin and when the body doesn’t respond properly to insulin. Diabetes is of two types as type 1 diabetes and type 2 diabetes, the kind of diabetes seen in women during pregnancy is Gestational diabetes. A person affected with type 1 diabetes will not be able to produce insulin themselves and insulin must be supplied externally in order to maintain the blood sugar level. Most common type of diabetes affecting people is type 2 diabetes, where the person is insulin resistant or find any problem in producing enough insulin. This increased blood sugar level increases the blood pressure level. Thus, maintaining the blood sugar level is very important. Medications include balancing with foods and drinks of choice based on the individual. Depending on the type of diabetes and the insulin level in the blood the supply and medications about external insulin supply are decided. 

Blood pressure is determined by two factors as the amount of blood the heart pumps and the amount of resistance to blood flow in the arteries. The more the blood is pumped by the heart and narrower is the artery the blood pressure is increased. High Blood Pressure is caused based on many risk factors as age, race, family history, being overweight or obese, not being physically active, using tobacco, addition of excess sodium (salt) in the diet, decreased amount of potassium in the diet, little amount of Vitamin D in the diet, consuming too much alcohol, and high stress. This High Blood Pressure leads to many complications such as heart attack or stroke, aneurysm, heart failure, weekend or narrowed blood vessels in kidneys, thickened narrowed or torn blood vessels in the eyes, metabolic syndrome, and trouble with memory and understanding. Important medications followed to treat high blood pressure are Thiazide diuretics, beta blockers, ACE inhibitors, Angiotensin II receptor blockers, Calcium channel blockers, and Renin inhibitors. Additional medications used for treating are alpha blockers, alpha-beta blockers, Central-acting agents, Vasodilators, Aldosterone antagonists.  Dietary control can help in managing the risk of High Blood Pressure and make the body suitable for taking in of medicine. 

Pulmonary Hypertension (PH), is complex and often misunderstood. Pulmonary Hypertension is high blood pressure in “lungs”. Hypertension is the case of high blood pressure in the arteries all over the body than the normal level. This is measured using a blood pressure cuff. In Pulmonary Hypertension, the blood vessels, especially in the lungs, are affected. They become stiff, narrow or wider which leads to an increase in pressure on the right side of the heart. Early identification and treatment of PH are referred to in most cases. Since it is a complex and misunderstood diseases, researches are going on till date to improve the treatment plans for this disease.  

In recent years the growth of athletes and sports person's has been increased more than double the rate. In general, we all know that the physical exercise reduces the risk of heart diseases and blood pressure. The desire of sports is raised in children and adult with heart disease. But, at the same situation vigorous physical exercise increases the risk of CV outcomes in competitive athletes and high outcome people (CAHOP). These CAHOP people are always at an intense risk of adverse CV outcomes and also inherited CV Diseases. A multidisciplinary team of trained coaches, trainers, physical therapists, primary care sports medicine physician and orthopedic surgeon functions with CAHOP people. In recent days the situation arose for a demand of CV specialist in the team. These members must have the essential skills necessary to practice sports cardiology. By seeing the demand a separate council has been started at American College of Cardiology - Sports and Exercise Council. In just a short span of 2 years, this council has reached up to 4000 members which show the increased interest of people in the emerging risks and innovations. This CV attack is also termed as sports-related sudden cardiac death. Commonly, sudden cardiac death is triggered by a malignant tachyarrhythmia such as ventricular fibrillation (VF) or ventricular tachycardia degenerating into VF. There is typically an underlying substrate for arrhythmia trigger, such as hypertrophic cardiomyopathy, channelopathies, arrhythmogenic cardiomyopathy, or coronary congenital abnormalities, among others.

Pediatricians are generally doctors, who deal with the new-born babies. Pediatric cardiologists are doctors who are specialized in treating heart disease related to new-born. Neonatology refers to a section of pediatrics that consists of the medical care of the new-born especially to those babies that are ill or in premature condition. In a hospital environment, a section called Neonatal Intensive Care Units (NICUs) are available for the special care of these babies. Neonatal Cardiology is also referred to as the Neonatal Cardiac Physiology. The neonatal cardiac physiology is unique, starting with the transition from fetal circulation and including differences in calcium metabolism and myocardial microscopic structure and function, it serves the pediatric surgeon well to have a sound understanding of these principles and how they, directly and indirectly, affect their plans and treatments. The pediatric surgeon is often called upon to treat conditions and complications associated with complex congenital heart diseases such as feeding difficulties, bowel perforations, and malrotation in heterotaxy syndromes. They may also act as general pediatricians, providing well new-born evaluation and care in the hospital where they are based. Some neonatologists, particularly those in academic settings, may follow infants for months or even years after hospital discharge to better assess the long-term effects of health problems early in life. Some neonatologists perform clinical and basic science research to further our understanding of this special population of patients.

Neuro cardiology is the specialty that deals with the brain-heart connection. Neuro cardiology is the study of neurophysiological, neuroanatomical, and neurological aspects of cardiology. Neuro cardiology is also referred to as the pathophysiology of circulatory and nervous systems. A clear understanding of the baroreflex sensitivity and heart rate variability is required to understand the influence of autonomic nervous system on both heart and brain activity. Than, in the past, the recent history records a number of incidents of heart-brain connection. Cerebrovascular Accidents (CVAs) and Transient Ischemic Attack (TIAs) are frequently caused by cardiac arrhythmias or congestive heart failure. On the other hand, cerebrovascular dysfunction leads to electrocardiographic disorders and cardiac rhythm disturbances. The future of therapeutic approaches in neuro cardiology lies both in novel treatment as in applying scientific integrative medical ideas that consider concurrent chronic degenerative and vascular disorders and interactions of multiple drug and non-drug treatments. In many cases, heart disease patients show a high incidence of neurological symptoms including depression, epilepsy, and forgetfulness.