Hypertension Journal

Severe Hypertensive Retinopathy Presenting as Bilateral Vision Loss Patient Presentation

Pooja Kanodia, Nishant Kanodia, Rahul, Khushboo Singhal — Sat, 25 Jul 2026 00:00:00 +0530

Background: The retina provides a unique in vivo diagnostic window into systemic microvasculature. Severe hypertensive retinopathy is a critical prognostic indicator for acute target-organ damage and signifies a high risk for life-threatening cardiovascular and cerebrovascular events.

Case Presentation: A 48-year-old male presented with a two-month history of progressive, painless bilateral vision loss and frequent morning headaches. Clinical examination revealed a significantly elevated blood pressure of 210/120 mmHg and reduced visual acuity (20/40 OD, 20/60 OS). Dilated fundoscopy demonstrated classic signs of severe hypertensive retinopathy, including widespread arteriolar narrowing, flame-shaped hemorrhages, cotton-wool spots, and mild optic disc edema.

Management and Outcome: The presence of optic disc swelling and severe hypertension prompted immediate referral to the emergency department for a hypertensive emergency. The patient was treated with a carefully titrated intravenous antihypertensive regimen. At a 3-month follow-up, his blood pressure was well-controlled on oral medications, visual acuity improved to 20/25 bilaterally, and fundoscopic examination revealed complete resolution of the retinal hemorrhages and cotton-wool spots.

Conclusion: This case highlights the critical importance of routine fundoscopic evaluation in patients with undiagnosed or poorly controlled hypertension presenting with visual disturbances. Rapid recognition of severe hypertensive retinopathy and immediate medical intervention can successfully reverse visual deficits and mitigate severe systemic morbidity.

Routine UACR Screening Unmasking Reflux Nephropathy after a Pregnancy Complicated by Gestational Diabetes and Preeclampsia

Priya Singh, Seema Jaiswal — Sat, 25 Jul 2026 00:00:00 +0530

Background: Pregnancy may act as a physiological stress test that unmasks underlying renal and cardiometabolic disease. Persistent hypertension and proteinuria after a pregnancy complicated by preeclampsia should prompt evaluation for chronic kidney disease rather than being attributed solely to prior obstetric complications.

Case presentation: We report the case of a 34-year-old woman with a history of two miscarriages who subsequently conceived and delivered a healthy child after a complicated pregnancy marked by gestational diabetes mellitus, preeclampsia, proteinuria, and recurrent urinary tract infections. One year postpartum, her gestational diabetes had resolved; however, hypertension persisted. Routine urinary albumin-creatinine ratio testing revealed severe albuminuria, with UACR of approximately 2120 mg/g creatinine. Further evaluation confirmed significant sub-nephrotic range proteinuria, with 24-hours urinary protein excretion of 2575 mg/day. Urine culture grew multidrug-resistant Klebsiella species at 10⁵ CFU/mL, sensitive to fosfomycin. She was treated with oral fosfomycin 3 g for four cycles, following which repeat urine culture became sterile. Imaging evaluation suggested reflux nephropathy, with DMSA scan showing relatively preserved split renal function of 48:52.

Conclusion: This case highlights the importance of postpartum renal surveillance in women with preeclampsia, gestational diabetes, recurrent urinary tract infection, and persistent hypertension. Severe albuminuria in such patients may reveal occult reflux nephropathy despite preserved renal function. Early recognition allows timely nephrology and urology referral, culture-guided treatment of infection, blood pressure optimization, and long-term cardiometabolic risk reduction.

Resting Dyspnea, Regional Wall Motion Abnormality, and Normal Coronary Angiography in a Hypertensive Patient: A Diagnostic Dilemma

Mohd Saalim — Sat, 25 Jul 2026 00:00:00 +0530

Background: Progressive dyspnea in a hypertensive patient with echocardiographic regional wall motion abnormality frequently raises suspicion of obstructive coronary artery disease and may lead to invasive coronary evaluation. However, regional wall motion abnormality is not always synonymous with stentable epicardial coronary disease, particularly in patients with long-standing hypertension, chronic alcohol exposure, and renal dysfunction. Case Presentation: A 55-year-old male graphic designer with long-standing systemic hypertension, chronic alcohol consumption, and baseline renal dysfunction with serum creatinine around 2 mg/dL presented with gradually progressive breathlessness over several years, recently worsening to dyspnea even at rest. A non-invasive coronary CT performed approximately six months earlier was reportedly normal. During the current evaluation, laboratory investigations showed serum creatinine of 1.92 mg/dL and hyperuricemia. Two-dimensional echocardiography revealed regional wall motion abnormality with mild left ventricular systolic dysfunction, left ventricular ejection fraction around 45%, and mild mitral regurgitation. In view of worsening symptoms and suspected ischemic myocardial involvement, coronary angiography with possible stenting was planned. Considering his renal dysfunction, contrast volume was minimized. Surprisingly, invasive coronary angiography showed normal epicardial coronary arteries, and no stent was placed. The patient was subsequently managed conservatively with optimized antihypertensive therapy, heart-failure-directed medical treatment as tolerated, renal monitoring, lifestyle modification, and alcohol cessation counseling, following which he showed symptomatic improvement. Conclusion: This case highlights the diagnostic discordance between dyspnea, echocardiographic RWMA, and normal coronary anatomy. In hypertensive patients with chronic alcohol use and renal dysfunction, normal coronary angiography should prompt consideration of hypertensive heart disease, alcohol-related myocardial dysfunction, coronary microvascular dysfunction, and ischemia with non-obstructive coronary arteries rather than premature dismissal of symptoms. Keywords: Hypertension; dyspnea; regional wall motion abnormality; normal coronary angiography; INOCA; alcoholic cardiomyopathy; chronic kidney disease.

Prevalence of Social Jet Lag and Associated Sleep and Metabolic Health Risks in a Young Adult Population of Lucknow City of UP State in India

Abhishree Pandey, Shipra Bhardwaj — Sat, 25 Jul 2026 00:00:00 +0530

Social jet lag (SJL), defined as the mismatch between biological circadian rhythms and socially imposed schedules, has emerged as an important public health concern among young adults. Persistent circadian misalignment has been associated with sleep disturbances, impaired daytime functioning, and metabolic health risks. This study aimed to assess the prevalence of social jet lag and its associated sleep and metabolic health outcomes among young adults in Lucknow city. A descriptive cross-sectional study was conducted among 104 adults aged 18–40 years in Lucknow, Uttar Pradesh, India. Data were collected using a structured self-administered questionnaire incorporating demographic details, work schedules, meal patterns, sleep–wake characteristics, and the Munich Chronotype Questionnaire (MCTQ). Sleep parameters on working days and free days were compared using paired t-tests, while associations between SJL and health outcomes were analyzed using chi-square tests and odds ratios. Statistical significance was considered at p<0.05. The majority of participants exhibited an evening chronotype (44.2%), followed by morning (28.8%) and intermediate types (26.9%). Social jet lag was present in 77% of participants. Significant differences were observed between working and free days for sleep duration (5.46 ± 1.36 vs. 8.16 ± 1.47 hours; p=0.002), bedtime (p=0.029), wake-up latency (p=0.049), and sleep latency (p=0.019). Irregular meal timing was reported by 55.77% of participants, while 81.1% experienced work–sleep conflict. Social jet lag was significantly associated with weight gain (OR=1.98; p=0.040) and post-weekend fatigue, irritability, and reduced focus (OR=1.76; p=0.041). In conclusion, social jet lag was highly prevalent among young adults and was significantly associated with sleep disturbances, functional impairment, and early metabolic health risks. Early screening and circadian-aligned lifestyle interventions may help reduce long-term health consequences associated with circadian misalignment.

Urban Lifestyle and Hypertension: An Institution-based Study among Staff and Students of University of Lucknow

Anrud Prasad, Anjali — Sat, 25 Jul 2026 00:00:00 +0530

Introduction: Hypertension is a major non-communicable disease and an important public health concern worldwide. Rapid urbanization and lifestyle changes, including physical inactivity, unhealthy diet, obesity, tobacco use, alcohol consumption, stress, and excess salt intake, have increased the risk of hypertension among urban populations.

Objective: This study aimed to assess the prevalence of hypertension and its association with socio-demographic and urban lifestyle factors among staff and students of the University of Lucknow.

Methods: An institution-based cross-sectional study was conducted among 200 staff and students of the University of Lucknow. Data were collected using a structured pre-tested questionnaire. Anthropometric measurements and blood pressure readings were recorded using standard procedures. Data were analyzed using Microsoft Excel. Frequencies, percentages, and chi-square tests were used to assess associations.

Results: The prevalence of hypertension was 19.5%, while 11.5% of participants were pre-hypertensive. Hypertension was significantly higher among staff members compared to students. Significant associations were found between hypertension and increasing age, physical inactivity, higher BMI, high-risk Waist-Hip Ratio, tobacco use, alcohol consumption, extra salt intake, and family history of hypertension.

Conclusion: The study concludes that urban lifestyle factors play an important role in hypertension among university populations. Regular screening, health education, lifestyle modification, physical activity promotion, dietary control, and stress management programs are recommended to reduce hypertension risk within academic institutions.

Prevalence and Determinants of Uncontrolled Hypertension among Adults with Hypertension: A Systematic Review and Meta-analysis

Deepika, Lalita K Sharma, Shivani Nischal — Sat, 25 Jul 2026 00:00:00 +0530

Background: Uncontrolled hypertension remains a major global public health challenge, contributing significantly to cardiovascular morbidity and mortality. Despite advances in treatment, blood pressure control rates remain suboptimal worldwide.

Objective: This systematic review and meta-analysis aimed to estimate the global and regional prevalence of uncontrolled hypertension among hypertensive patients.

Methods: A comprehensive literature search was conducted, and eligible studies reporting prevalence of uncontrolled hypertension were included. Pooled prevalence estimates were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic, and subgroup analyses were performed by geographical region.

Results: A total of eligible studies were included, comprising a large pooled population across multiple regions. The global pooled prevalence of uncontrolled hypertension was 51.0% (95% CI: 48.5–53.5; I² = 97.8%), indicating substantial heterogeneity. Regionally, the highest prevalence was observed in Africa (58.2%), followed by Europe (51.6%) and Asia (49.8%), while the lowest prevalence was reported in the Americas (47.9%). All regions demonstrated high heterogeneity (I² > 95%).

Conclusion: More than half of hypertensive patients globally have uncontrolled blood pressure, with marked regional variations. These findings highlight significant gaps in hypertension management and emphasize the need for strengthened, region-specific public health strategies to improve treatment adherence and control rates.

Editorial

Narsingh Verma — Sat, 25 Jul 2026 00:00:00 +0530

The current era of hypertension research is defined by expansion, not replacement. Traditional blood-pressure control remains foundational, but newer work is adding better risk stratification, smarter monitoring, and more realistic care pathways that can improve outcomes across diverse populations.