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Heart rate (HR) is strongly associated with both peripheral and central blood pressures. This association has implications in hypertension (HTN) prognosis and management. Elevated HR in HTN further elevates the risk of adverse outcomes. Evidence suggests that HR is an independent risk factor for cardiovascular (CV) and total mortality in patients with HTN. With objective to engage physicians and researchers in India to identify and discuss the implications related to HR management in HTN, experts in the HTN management provided consensus recommendations. The key expert recommendations included the following. (i) Heart rate (HR) has inverse relationship with the central aortic pressure, whereby reduction in HR is associated with an increase in central aortic pressure. This counter-balances the benefit of HR reduction with the harmful effects of rising central aortic pressure. (ii) Increase in the resting HR is associated with increased risk of incident HTN. A linear association between the two is observed especially in individuals with HR >80 bpm. (iii) A reduced HR variability further adds to the propensity for the development of HTN, especially in men. (iv) Each 10 beats per minute increase in the resting HR can substantially increase the risk of adverse CV and mortality outcomes. On treatment HR provides a better prognostic guide. (v) Ambulatory HR with day-time and night-time HR evaluation may also suggest different impact on outcomes. (vi) Target HR in patients with HTN remains unclear. Generally, HR symptomatic cases with elevated HR beyond 80-85 mmHg. BBs are expected to benefit by lowering HR by nearly 10 bpm. Preference should be given to newer beta-blockers which reduce HR and both peripheral and central blood pressure to derive comprehensive advantage of this dual action. (ix) It still remains unclear whether reducing HR in HTN without comorbidities alters the CV and mortality outcomes.

Pediatric hypertension is an emerging problem in the developed and developing countries alike. I would like to congratulate the authors of the article titled “evaluation of sustained blood pressure elevation in children” for doing a commendable job of shedding light on this important topic.1 Along the same lines we would like to highlight some important points. First and foremost, the statistical analysis section mentions that the p value is 0.5 which we consider is quite unusual taking into consideration that it is usually set at 0.05 or 0.001 at the discretion of the investigator of the study.1 Yet, if this is the p value considered then the values mentioned in Table 3 and the textual interpretation of the same do not match. In the text, authors have mentioned that of all the variables considered only age and weight showed significant association to hypertension. Interpretation of Table 3 shows that the variables socioeconomic status (p = 0.408) and weight (p = 0.01) are significantly associated with hypertension and other variables of height (p = 0.83), sex (p = 0.83) and age (p = 0.74 for boys and p = 0.56 for girls) are not significantly associated with hypertension. This would definitely reflect on the discussion. Secondly, as mentioned by authors most of the cases of hypertension detected belonged to age group 13–15 years. This is the age when pubertal growth starts occurring and this might have influenced the changes in the blood pressure. Such a change has been attributed to the increase in gonadal hormones. Increased hormone secretion during puberty might interfere with known pressor systems as has been mentioned in the literature. This also can be the reason for the gender differences seen in this study as the pubertal changes in males lead to more profound change in BP levels compared to females.2,3 The gender difference in prevalence of hypertension in pubertal age has been well documented. Boys were 10% more likely than girls to develop high SBP as adults.2 High SBP has been reported to be more prevalent among boys than girls in several cross-sectional studies. This suggests that sex steroids may have an important impact on blood pressure levels.4 This factor warrants consideration when we consider such age groups for study. This implies that such adolescents are at higher risk of hypertension as adults. These adolescents can take appropriate precautions so as to prevent complications in terms of its severity and time of onset in the future.

Objectives: This study investigated the effect of catheter-based renal sympathetic denervation (RD) on left ventricular hypertrophy (LVH) and systolic and diastolic function in patients with resistant hypertension. Background: LVH and diastolic dysfunction are associated with elevated sympathetic activity and increased morbidity and mortality. The effect of RD on LVH and LV function is unclear. Methods: Forty-six patients underwent bilateral RD, and 18 patients served as controls. Transthoracic echocardiography was performed at baseline, and after 1 month and 6 months. Results: Besides significant reduction of systolic and diastolic blood pressure at 1 month and 6 months, RD significantly reduced mean interventricular septum thickness from 14.1 ± 1.9 mm to 13.4 ± 2.1 mm and 12.5 ± 1.4 mm (p = 0.007), and LV mass index from 53.9 ± 15.6 g/m2 (112.4 ± 33.9 g/m2) to 47.0 ± 14.2 g/m2 (103.6 ± 30.5 g/m2) and 44.7 ± 14.9 g/m2 (94.9 ± 29.8 g/m2) (p