Journal of Hypertension: Open Access

Background: Both diagnostic and therapeutic inertia are important barriers to Blood Pressure (BP) control. BP readings are routinely measured and recorded at most healthcare visits. Thus, there are many opportunities to diagnose hypertension and improve BP control. The objective of this study was to determine the percentage of patients with elevated BP measurements where BP or hypertension is mentioned in the clinical notes.

Methods: We randomly selected outpatient visits for 10,000 patients in Internal Medicine clinics (1-1-2017 to 6-30-2021) and recorded if there was a BP value ≥ 140/90 mm Hg. The Assessment and Plans (A/Ps) from these clinic visits were extracted using a rule-based pattern-matching algorithm. A/Ps with no matching text pattern indicating BP or hypertension was considered not to have addressed hypertension. The percentage of visits where BP was mentioned was calculated for each specialty.

Results: Among the 10,000 patients, we found 5,674 clinic visits where patients had elevated BP. A/Ps from nephrology, cardiology and general internal medicine visits mentioned elevated BP at least 50% of the time. In contrast, A/Ps from encounters with allergy/immunology, endocrinology (not diabetes clinic) and rheumatology specialists referenced the patient’s BP less than 10% of the time.

Conclusions: We demonstrate widespread deficiencies in the discussion of hypertension and BP in clinical notes across medical specialties.

Hypertension, characterized by elevated blood pressure, is a major risk factor for cardiovascular diseases and is often associated with neuroinflammation, contributing to the progression of vascular dysfunction. Recent studies have elucidated the therapeutic potential of cannabinoid receptor activation in mitigating hypertension-related neuroinflammation. Specifically, activation of the Cannabinoid Type 2 Receptor (CB2R) in microglia, the resident immune cells of the central nervous system, has emerged as a promising strategy for alleviating neuroinflammatory responses. This review highlights the molecular mechanisms underlying the anti-inflammatory effects of CB2R activation in microglia, focusing on the inhibition of aerobic glycolysis, a metabolic pathway implicated in the pathogenesis of neuroinflammation. By targeting key enzymes and transporters involved in aerobic glycolysis, CB2R activation effectively suppresses the pro-inflammatory phenotype of microglia, thereby attenuating neuroinflammation and mitigating the progression of hypertension. Furthermore, the therapeutic implications of CB2R activation extend beyond neuroinflammation to encompass broader cardiovascular effects, including vasodilation and cardio protection. Future research efforts aimed at delineating the specific molecular targets and cellular interactions involved in CB2R-mediated neuroprotection hold promise for the development of innovative therapeutic strategies for hypertension and related cardiovascular diseases.

The Renin-Angiotensin-Aldosterone System (RAAS) plays a pivotal role in regulating blood pressure and fluid balance, with both classical and alternative pathways contributing to its physiological effects. This review examines the involvement of RAAS pathways in the pathogenesis of hypertension and obesity in adolescents. Classical RAAS activation involves the conversion of angiotensinogen to Angiotensin II (Ang II), leading to vasoconstriction and aldosterone release, while alternative pathways, such as the Angiotensin-Converting Enzyme 2 (ACE2)/angiotensin-(1-7)/ Mas receptor axis, counterbalance these effects by promoting vasodilation and natriuresis. In obese adolescents, dysregulation of RAAS pathways contributes to hypertension through mechanisms including adipocyte-derived angiotensinogen, insulin resistance and sympathetic nervous system activation. Understanding the interplay between classical and alternative RAAS pathways is crucial for developing targeted interventions to manage hypertension and obesity-related complications in adolescents.

Nature exposure therapies have garnered attention as potential interventions for alleviating stress, depression and anxiety levels. This systematic review aims to assess the effects of nature exposure therapies on mental health outcomes. A comprehensive search of electronic databases was conducted to identify relevant studies. Eligible studies were Randomized Controlled Trials (RCTs) and quasi-experimental studies that evaluated the effects of nature exposure therapies on stress, depression and anxiety levels compared to control conditions. A total of insert number studies met the inclusion criteria and were included in the review. The findings suggest that nature exposure therapies, including forest bathing, nature walks, gardening and horticultural therapy, are associated with significant reductions in stress, depression and anxiety levels. However, variations in study designs, interventions and outcome measures limit the generalizability of the findings. Further research utilizing standardized methodologies and larger sample sizes is needed to elucidate the mechanisms underlying the therapeutic effects of nature exposure and to inform the development of evidence-based interventions for improving mental health outcomes.