European Society Of Cardiology/European Society Of Hypertension Research Articles

Revising blood pressure classification guidelines: A call for normal lower limits in the “American college of cardiology/American heart association task force on clinical practice guidelines for hypertension”

The existing blood pressure classification guidelines established by the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology/European Society of Hypertension (ESC/ESH) lack specified lower limits for the “Normal” category. This paper underscores the imperative need for revisiting these guidelines to incorporate defined lower limits for the “Normal” classification. The absence of such lower limits hinders the precision of clinical practice and undermines the comprehensive assessment of blood pressure in individuals. By advocating for the inclusion of lower limits, this paper aims to enhance the accuracy of blood pressure categorization, thereby providing clinicians with more nuanced guidance and fostering improved cardiovascular health outcomes.

BLOOD PRESSURE MEASUREMENTS IN HYPERTENSIVE PATIENTS OVER 60 YEARS OLD IN A PRIMARY CARE HEALTH CENTER NEAR BY A BIG CITY: WHAT ABOUT THE THERAPEUTIC GOALS?

Objective: Until today we have no universal worldwide definition about the value to be used to determine if the patient have arterial hypertension or not, even worse in the elderly, such an special population with all the risk arround to not have blood pressure (BP) under control. It is that according to differents guidelines that we relies on for diagnosis and treatment. For example, for the European Society of Cardiology/European Society of Hypertension (ESC/ESH) is defined as a systolic BP (SBP) greater than or equal to 140 mmHg or a diastolic BP (DBP) greater than or equal to 90 mmHg, Against to the American College of Cardiology and the American Association of Cardiology (ACC/AHA) that define as a normal BP less than 120/80 mmHg. Meanwhile for the Argentine Society of Cardiology (SAC) BP would be less than 130 and/or 85 mmHg. To determine if the hypertensive population that participated in this study meets the therapeutic goals proposed in the guidelines or not. Design and method: We included patients older than 60 years old previusly diagnosed with arterial hypertension who where attended between march and june in 2022, retrospectively. They were classified according to age and sex and blood pressure value at the time of the evaluation, taken according to recommendations. Results: 855 hypertensive subjects were recruited (female 28%, 71,9±7,8 years); with an average SBP of 138.9±17,4 mmHg, an average DBP of 85.9±12,9 mmHg and an average mean pressure (MAP) of 103.5±13,8 mmHg. Table 1 shows the results obtained for SBP, DBP, and MAP according to age. Conclusions: No matter which guideline is taken as reference, the vast majority of the hypertensive population studied continues without controlling their BP values, finding themselves above the goals of any of the mentioned guides, knowing the great risk that this can cause in this such a special population. More universal studies are needed to achieve a global reference value.

LONG-TERM EVENT RATES, RISK FACTORS, AND TREATMENT PATTERN IN PATIENTS QUALIFYING FOR DUAL BLOOD PRESSURE-LOWERING THERAPY: AN OBSERVATIONAL STUDY IN 1.4 MILLION INDIVIDUALS

Objective: Elevated blood pressure (BP) is a major risk factor for cardiovascular (CV) morbidity and mortality. This study assessed CV event rates, their predictive factors, and treatment patterns for BP-lowering therapy in a population qualifying for dual BP-lowering therapy, over a long-term follow-up. Design and method: This study utilized the Clinical Practice Research Datalink, Hospital Episode Statistics, and Office for National Statistics databases in England. Individuals aged > = 18 years with hypertension, qualifying for dual BP-lowering therapy as per the European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines were identified during a 15-year period (2005 to 2019). Primary endpoint was composite of non-fatal myocardial infarction (MI), non-fatal stroke, hospitalization for heart failure, and CV death. Secondary endpoint was all-cause death. Main subgroups of interest were atherosclerotic cardiovascular disease (ASCVD) and diabetes. Event rates and association of risk factors with primary endpoint and all-cause death were evaluated using Kaplan-Meier method and Cox-proportional hazards model, respectively. Treatment patterns were summarized via percent of patient-time on a given therapy during each year of follow-up. Results: Overall, 1,426,079 patients were included. The mean (SD) age was 62.9 (14.1) years and ∼50% were male. The 15-year event rates for the primary composite endpoint and all-cause death were 27.1% and 32.6%, respectively (Table 1) with CV event rates being ∼2.5-fold and ∼1.5-fold in those with ASCVD and diabetes, respectively (unadjusted analyses). Risk factors strongly associated with primary composite endpoint (hazard ratio >1.50) were age > = 65 years, heart failure, atrial fibrillation, chronic kidney disease 4 – 5, chronic obstructive pulmonary disease, coronary heart disease, stroke, and peripheral arterial disease (P < 0.0001 for all). At variance with guidelines, BP-lowering monotherapy was the most common treatment pattern (42.6% – 56.7% of patient-time) over 5–year follow-up period. Conclusions: Patients with hypertension qualifying for dual BP-lowering therapy are at high risk of major CV events and death, with the risk being substantially elevated in those with ASCVD or diabetes. These findings highlight an opportunity for further risk reduction in this population via timely initiation of dual BP-lowering therapy, especially in patients with comorbidities.

Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI).

Since the publication of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guidelines for the Management of Arterial Hypertension, several high-quality studies, including randomised, sham-controlled trials on catheter-based renal denervation (RDN) were published, confirming both the blood pressure (BP)-lowering efficacy and safety of radiofrequency and ultrasound RDN in a broad range of patients with hypertension, including resistant hypertension. A clinical consensus document by the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on RDN in the management of hypertension was considered necessary to inform clinical practice. This expert group proposes that RDN is an adjunct treatment option in uncontrolled resistant hypertension, confirmed by ambulatory BP measurements, despite best efforts at lifestyle and pharmacological interventions. RDN may also be used in patients who are unable to tolerate antihypertensive medications in the long term. A shared decision-making process is a key feature and preferably includes a patient who is well informed on the benefits and limitations of the procedure. The decision-making process should take (i) the patient's global cardiovascular (CV) risk and/or (ii) the presence of hypertension-mediated organ damage or CV complications into account. Multidisciplinary hypertension teams involving hypertension experts and interventionalists evaluate the indication and facilitate the RDN procedure. Interventionalists require expertise in renal interventions and specific training in RDN procedures. Centres performing these procedures require the skills and resources to deal with potential complications. Future research is needed to address open questions and investigate the impact of BP-lowering with RDN on clinical outcomes and potential clinical indications beyond hypertension.

Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI).

Since the publication of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guidelines for the Management of Arterial Hypertension, several high-quality studies, including randomised, sham-controlled trials on catheter-based renal denervation (RDN) were published, confirming both the blood pressure (BP)-lowering efficacy and safety of radiofrequency and ultrasound RDN in a broad range of patients with hypertension, including resistant hypertension. A clinical consensus document by the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on RDN in the management of hypertension was considered necessary to inform clinical practice. This expert group proposes that RDN is an adjunct treatment option in uncontrolled resistant hypertension, confirmed by ambulatory BP measurements, despite best efforts at lifestyle and pharmacological interventions. RDN may also be used in patients who are unable to tolerate antihypertensive medications in the long term. A shared decision-making process is a key feature and preferably includes a patient who is well informed on the benefits and limitations of the procedure. The decision-making process should take (i) the patient's global cardiovascular (CV) risk and/or (ii) the presence of hypertension-mediated organ damage or CV complications into account. Multidisciplinary hypertension teams involving hypertension experts and interventionalists evaluate the indication and facilitate the RDN procedure. Interventionalists require expertise in renal interventions and specific training in RDN procedures. Centres performing these procedures require the skills and resources to deal with potential complications. Future research is needed to address open questions and investigate the impact of BP-lowering with RDN on clinical outcomes and potential clinical indications beyond hypertension.

Blood pressure per the 2017 ACC/AHA and 2018 ESC/ESH guidelines and heart failure risk: the Suita Study.

Hypertension is a significant risk factor for heart failure (HF). Since hypertension definition varies across guidelines, identifying blood pressure (BP) categories that should be targeted to prevent HF is required. We, therefore, investigated the association between hypertension per the 2017 American College of Cardiology/American Heart Association (ACC/AHA) and 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines and HF risk. This prospective cohort study included randomly selected 2809 urban Japanese people from the Suita Study. Cox regression was used to assess HF risk, in the form of hazard ratios (HRs) and 95% confidence intervals (95% CIs), for different BP categories in both guidelines, compared to a reference category defined as systolic BP (SBP) <120 mmHg and diastolic BP (DBP) <80 mmHg. Within 8 years of median follow-up, 339 HF cases were detected. Per the 2017 ACC/AHA guidelines, hypertension I and II and isolated systolic hypertension were associated with increased HF risk: HRs (95% CIs) = 1.81 (1.33-2.47), 1.68 (1.24-2.27), and 1.64 (1.13-2.39), respectively. Per the 2018 ESC/ESH guidelines, high-normal BP, hypertension I, II, and III, and isolated systolic hypertension were associated with increased HF risk: HRs (95% CIs) = 1.88 (1.35-2.62), 1.57 (1.13-2.16), 2.10 (1.34-3.29), 2.57 (1.15-5.77), and 1.51 (1.04-2.19), respectively. In conclusion, hypertension and isolated systolic hypertension per the 2017 ACC/AHA and 2018 ESC/ESH guidelines and high-normal BP per the 2018 ESC/ESH guidelines are risk factors for HF.

Frail by four different measures and new adverse events from lower blood pressure control in hypertensive older adults: a 2-year prospective study in The Irish Longitudinal Study on Ageing (TILDA)

Abstract Background The 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines for management of hypertension in adults aged ≥65 years recommend a blood pressure (BP) treatment target of 130–139/70–79 mmHg if tolerated [1]. Randomised controlled trials have advocated for lower BP, but this may lead to adverse outcomes in the frail. Yet, different operationalisations of frailty exist in the literature [2,3]. Purpose We compared four frailty classifications in their ability to predict 2-year incident adverse outcomes (falls/fractures, syncope, transient ischaemic attack/stroke, heart attack, heart failure, hospitalisation, and mortality) associated with below-target BP control (&amp;lt;130/70 mmHg) in The Irish Longitudinal Study on Ageing (TILDA). Methods Data from participants aged ≥65 years treated for hypertension in Wave 1 (W1) was analysed. Frailty was identified by Frailty Phenotype (FP) [4], the Clinical Frailty Scale-classification tree (CFS) [5], a 32-item self-reported Frailty Index (FI) [6], and the 5-item FRAIL (Fatigue, Resistance, Ambulation, Illnesses &amp; Loss of Weight) scale [7]. We formulated 16 participant groups at W1 based on frailty-BP combinations. Outcomes at wave 2 (W2) two years later were analysed with binary logistic regression models adjusted for age, sex, education, polypharmacy, classic orthostatic hypotension, Montreal Cognitive Assessment (MOCA) score and number of chronic diseases. Results Of 1920 W1 participants aged ≥65 years and treated for hypertension, 1229 had full BP/FP data, 1282 for BP/CFS, 1274 for BP/FI, and 1276 for BP/FRAIL. The non-frail groups in all 4 frailty classifications with BP treated below or above target did not have an increased risk of any of the adverse health outcomes at W2. For the frail treated below target, hospitalisation by W2 was significantly more likely in those who were frail by FP and FRAIL. The frail by FRAIL and BP treated below target were the only with increased risk of mortality by W2. The frail by FI and FRAIL with BP treated below target had increased risk of new heart failure and falls/fractures by W2. Conclusions Frailty was independently associated with adverse outcomes in hypertensive older adults treated below the ESC/ESH target. However, different frailty classifications had different prognostic implications. For those below BP target, frailty by FRAIL was associated with the highest number of risks (falls/fractures, heart failure, hospitalisation and mortality), followed by the frail by FI (falls/fractures, heart failure). Based on our results and frailty measures considered, we recommend that FRAIL and FI are regarded as the methods of choice to identify frailty when applying the ESC/ESH guideline. Models of frailty that do not explicitly measure comorbidities (such as FP and CFS) may be less useful to capture risk of adverse events from lower blood pressure control. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Irish Department of HealthIrish LifeAtlantic PhilanthropiesRoman Romero-Ortuno is funded by a grant from Science Foundation Ireland

Older adults identified as frail by Frailty Index and FRAIL scale who were intensively treated for hypertension were at increased risk of 2-year adverse health outcomes in The Irish Longitudinal Study on Ageing (TILDA)

Background: Frailty is associated with adverse health outcomes. In frail older adults, blood pressure (BP) treated intensively may result in adverse events. We hypothesised that frail older adults, with BP treated below the threshold of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guideline (&lt;130/70 mmHg), could be associated with adverse health outcomes. Methods: Data was gathered from participants in Wave 1 (W1) of The Irish Longitudinal Study on Ageing (TILDA) who were aged ≥65 years and on treatment for hypertension. Frail classifications as per a 32-item Frailty Index (FI) and FRAIL (Fatigue, Resistance, Ambulation, Illnesses &amp; Loss of Weight) scale were compared in their ability to predict W2 (2-year) adverse outcomes associated with intensive BP control (‘below threshold (BT)’: &lt;130/70 mmHg vs. ‘above threshold (AT)’: ≥130/70 mmHg). We created eight participant groups based on frailty-BP status. W2 outcomes were analysed using adjusted binary logistic regression models. Results: In W1, 1,920 participants were included. Of these 1,274 had complete FI-BP and 1,276 FRAIL-BP data. The frail by FI treated BT and frail by FRAIL treated BT had increased risk of hospitalisation, heart failure and falls/fracture by W2. The frail by FRAIL treated BT also had increased risk of mortality by W2. The frail by FI treated AT had increased risk of syncope and falls/fractures. The non-frail by FI or FRAIL did not have any increased risk of the adverse outcomes studied. Conclusions: FI and FRAIL captured increased risk of adverse health outcomes when BP was treated below the current ESC/ESH threshold. FI and FRAIL could be more useful than other frailty identification tools to signal risks associated with tighter BP control in frail older adults. Future hypertension management guidelines should consider incorporating specific frailty identification tools to help guide clinicians in making personalised BP medication treatment decisions.

Older adults identified as frail by Frailty Index and FRAIL scale who were intensively treated for hypertension were at increased risk of 2-year adverse health outcomes in The Irish Longitudinal Study on Ageing (TILDA)

Background: Frailty is associated with adverse health outcomes. In frail older adults, blood pressure (BP) treated intensively may result in side effects including orthostatic hypotension, falls or fractures. We hypothesised that frail older adults, with BP treated below the threshold of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guideline (&lt;130/70 mmHg), could be associated with adverse health outcomes. Methods: Data was gathered from participants in Wave 1 (W1) of The Irish Longitudinal Study on Ageing (TILDA) who were aged ≥65 years and on treatment for hypertension. Frail classifications as per a 32-item Frailty Index (FI) and FRAIL (Fatigue, Resistance, Ambulation, Illnesses &amp; Loss of Weight) scale were compared in their ability to predict W2 (2-year) adverse outcomes associated with intensive BP control (‘low’: &lt;130/70 mmHg vs. ‘high’: ≥130/70 mmHg). We created eight participant groups based on frailty-BP status. W2 outcomes were analysed using adjusted binary logistic regression models. Results: In W1, 1,920 participants were included. Of these 1,274 had complete FI-BP and 1,276 FRAIL-BP data. The frail by FI treated low and frail by FRAIL treated low had increased risk of hospitalisation, heart failure and falls/fracture by W2. The frail by FRAIL treated low also had increased risk of mortality by W2. The frail by FI treated high had increased risk of syncope and falls/fractures. The non-frail by FI or FRAIL did not have increased risk of any of the adverse outcomes studied. Conclusions: FI and FRAIL captured increased risk of adverse health outcomes when BP was treated below the current ESC/ESH threshold. FI and FRAIL could be more useful than other frailty identification tools to signal risks associated with tighter BP control in frail older adults. Hypertension management guidelines should specify which frailty identification tools clinicians should use to help them make personalised treatment decisions.

A COMPARISON OF EUROPEAN AND AMERICAN GUIDELINES TO GAUGE THE PREVALENCE OF HYPERTENSION IN 16–19 YEAR OLD BLOOD DONORS

Objective: Against the background of increasing risk for hypertension in adolescents, we decided to investigate blood donation as an opportunity to compare national guidelines for identification of individuals, between 16–19 years of age, meeting hypertension criteria. Design and method: 16–19 year old volunteers donating blood between 2015 and 2020 were enrolled. They were asked to identify their ethnicity. Those declining were identified as “other’’. Blood pressure was measured using automated equipment (Welch Allyn, ProBP). We compared the European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines for hypertension (&gt; = 140/90 mmHg) with the American College of Cardiology/American Heart Association (ACC/AHA) guidelines for hypertension (&gt; = 130/80 mmHg). Results: There were 71912 participants, 63.2% (45441) and 36.8% (26471) were female and male respectively. Conclusions: More males, by comparison with females, met hypertension guideline criteria in all ethnicities. The prevalence of hypertension was highest in African Americans. Depending on which international hypertension criteria are chosen, there are significant differences in the size of population of 16–19 year olds identified for attention. Determining a suitable threshold that will justify investigation their investigation and treatment will require long term clinical trials.

Polysomnographic Evaluation of Sleep Bruxism Intensity and Sleep Architecture in Nonapneic Hypertensives: A Prospective, Observational Study.

Sleep bruxism (SB) is a repetitive jaw muscle activity characterized by clenching or grinding of the teeth, which is classified under sleep-related movement disorders in the International Classification of Sleep Disorders—Third Edition. Because the potential common pathomechanism of SB and arterial hypertension is the activation of the sympathetic system as well as an increase in inflammatory factors, we aimed to examine the intensity of SB and the sleep architecture among patients with arterial hypertension. The study included a total of 91 Caucasian adult patients, among whom 31 had arterial hypertension diagnosed according to the current European Society of Cardiology/European Society of Hypertension (ESC/EHS) hypertension guidelines. The control group consisted of 61 normotensive patients. Patients with obstructive sleep apnea were excluded. A single full-night polysomnographic examination was conducted in the Sleep Laboratory, and then the results were analyzed based on the guidelines of the American Academy of Sleep Medicine. Bruxism episode index (BEI) was higher in the hypertensive group compared to normotensives. The groups also showed statistically significant differences in polysomnographic sleep indexes. Similar to BEI, arousal index, apnea–hypopnea index, and snoring were higher in hypertensives compared to normotensives. On the other hand, the mean and minimal oxygen saturation were lower in hypertensives compared to normotensives. A statistically significant positive correlation was observed between oxygen desaturation index and BEI in the hypertensive group, whereas this correlation was not statistically significant in the case of normotensives. In summary, nonapneic hypertensives had higher SB intensity, altered sleep architecture, decreased mean oxygen saturation, and increased snoring compared to normotensives. The results suggest that dental screening is necessary for patients with arterial hypertension, especially those presenting with the symptoms of SB.

Thiazides and mineralocorticoid receptor antagonists in chronic kidney disease

The latest treatment guidelines for patients with arterial hypertension continues to indicate as the first line therapy a minimal association between renin-angiotensin system (RAS) blockers and a thiazide-type or a thiazide-like diuretic. In addition, according to 2018 ESC/ESH (European Society of Cardiology/European Society of Hypertension) guidelines for the management of arterial hypertension, a mineralocorticoid receptor antagonist may be added in resistant hypertension cases (uncontrolled hypertension under at least 3 classes of antihypertensive drugs including a RAS blocker, thiazide diuretic and a calcium channel blocker) for general population. For chronic kidney disease (CKD) patients, achieving the optimal blood pressure (BP) level can be difficult because high complication rates can be encountered in any antihypertensive class mentioned, especially for RAS blockers and mineralocorticoid receptor inhibitors. This brief review aims to highlight the importance of diuretics use in CKD patients and the boundaries of their usage.

Do the frail experience more adverse events from intensive blood pressure control? A 2-year prospective study in the Irish Longitudinal Study on Ageing (TILDA).

SummaryBackgroundThe 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines for management of hypertension in adults aged ≥65 years recommend a blood pressure (BP) treatment target of 130–139/70–79 mmHg if tolerated. Randomised controlled trials have advocated for lower BP, but this may have adverse outcomes in the frail. Yet, definitions of frailty vary.MethodsUsing a prospective, observational study design, we compared two frailty classifications in their ability to predict short-term adverse outcomes associated with intensive BP control (<130/70 mmHg) in The Irish Longitudinal Study on Ageing (TILDA). Data from participants aged ≥65 treated for hypertension in Wave 1 (W1) between October 2009 and June 2011 were analysed. Frailty was identified by Frailty Phenotype (FP) and the Clinical Frailty Scale (CFS). We formulated 8 participant groups based on frailty-BP combinations. Outcomes at wave 2 (W2) in 2012–2013 were analysed with adjusted binary logistic regression models.FindingsOf 1920 W1 participants aged ≥65 and treated for hypertension, 1229 had full BP/FP and 1282 BP/CFS data. While the FP only identified risk of hospitalisation associated with intensive BP treatment, intensively treated frail-by-CFS participants had no increased or decreased risk of adverse outcomes, but those treated above the target had a higher risk of falls/fractures. In the non-frail by FP, intensive blood pressure treatment was associated with reduced risk of falls/fractures.InterpretationDifferent frailty classifications may have different prognostic implications for the purpose of the application of hypertension management guidelines. Our study had limited power due to low frailty prevalences, so further research is needed. Guidelines should specify the recommended frailty identification method/s. In the frail, therapy personalisation is needed.

Adequacy of blood pressure control in high-risk hypertensive patients: The DEGREE study

IntroductionHypertension is a modifiable risk factor in patients at the highest risk for cardiovascular events. New invasive treatment options are becoming available that might be particularly appealing for high-risk patients. Therefore, the aim of this study was to determine the prevalence of high-risk patients on routine therapy that do not meet guideline recommended ambulatory blood pressure (ABP) targets. MethodsThis single-center, cross-sectional study was conducted at the Erasmus University Medical Center (Rotterdam, The Netherlands). Inclusion criteria were: (1) age 18–80 years, (2) drugs prescribed for hypertension or history of hypertension and (3) high cardiovascular risk as defined according to the European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines. Patients underwent standardized office blood pressure (OBP) and same-day 24-h ABP measurements. Blood pressure (BP) control was defined according to the 2018 ESC/ESH and 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. ResultsA total of 100 patients were enrolled (median age 71 years, 35% female). Mean OBP was 142.2/81.9 ± 18.6/12.6 mmHg and mean 24-h ABP was 126.1/70.1 ± 14.3/9.2 mmHg. Patients were on 2.0 [25th–75th percentile: 1.0–3.3] Defined Daily Doses of antihypertensive drugs. ESC/ESH guideline 24-h ABP and OBP targets were not met in 41.8% (95%CI: 31.5–52.6%) and 52.7% (95%CI: 42.0–63.3%), respectively. ACC/AHA guideline 24-h ABP and OBP targets were not met in 59.3% (95%CI: 48.5–69.5%) and 79.1% (95%CI: 69.3–86.9%), respectively. ConclusionsBP remains uncontrolled in 40–60% of high-risk hypertensive patients despite routine use of guideline-recommended therapy. Our findings support the search towards novel invasive BP lowering treatment options.

Isolated diastolic hypertension is not associated with endothelial dysfunction.

Hypertension is associated with an impairment of endothelial function. However, it is unclear whether isolated diastolic hypertension is associated with endothelial dysfunction. The purpose of this study was to investigate the association of endothelial function with isolated diastolic hypertension diagnosed by using two major hypertension guidelines: systolic blood pressure (BP) < 130 mmHg and diastolic BP ≥ 80 mmHg according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline and systolic BP < 140 mmHg and diastolic BP ≥ 90 mmHg according to the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) hypertension guideline. We measured the flow-mediated vasodilation (FMD) of the brachial artery in subjects without systolic hypertension who were not treated with antihypertensive drugs. Of 3727 subjects (2813 men; mean age: 41.3 ± 10.9 years), 749 (20.1%) had isolated diastolic hypertension according to the 2017 ACC/AHA definition. Multiple logistic regression analysis revealed that isolated diastolic hypertension was not associated with endothelial dysfunction, defined as FMD < 7.0% (OR, 1.15; 95% CI, 0.98-1.35; P = 0.09). Of 4747 subjects (3727 men; mean age: 45.1 ± 10.8 years), 314 subjects (6.6%) had isolated diastolic hypertension according to the ESC/ESH definition. Multiple logistic regression analysis revealed that isolated diastolic hypertension was not associated with endothelial dysfunction after adjusting for age and sex (OR, 1.04; 95% CI, 0.82-1.32; P = 0.76). Isolated diastolic hypertension was not associated with endothelial dysfunction in individuals who were not treated with antihypertensive drugs regardless of the major hypertension guideline definition used.

Актуализация данных по артериальной гипертензии к 2020 году (часть 1)

Артериальная гипертензия (АГ) — это хроническое повышение артериального давления (АД). АД — сила, которой кровь воздействует на стенки кровеносных сосудов, в частности артерий, когда она выбрасывается сердцем. Чем выше АД, тем больше усилий нужно сердцу для того, чтобы перекачивать кровь. Последние рекомендации по АГ — ACC/AHA 2017, ESC/ESH 2018 и NICE 2019 — подробнее всего освещают вопросы, связанные с данным широко распространенным во всем мире заболеванием. В рекомендациях ACC/AHA 2017 г. и ESH/ERC 2018 г. применительно к сегодняшней медицинской работе в Украине можно заметить отличие в классификации АГ. Такое отличие, по-видимому, обусловлено особым вниманием профессионалов отрасли к специфике и территории исследования и является ярким показателем того, что невозможно автоматическое внедрение неких универсальных международных протоколов и стандартов (они могут носить лишь рекомендательный характер). Вероятно, тут не лишним будет упомянуть принципы современной медицины как профессии (наука и искусство в рамках закона), основы которой изложены Всемирной медицинской ассоциацией и ВОЗ. В результате высокого или повышенного АД, тем более если оно уже перешло в АГ и не контролируется врачом, отрицательные последствия для здоровья могут усугубляться следующими факторами риска, которые повышают вероятность развития осложнений и прогрессирования данного состояния: потребление табака, неправильное питание, злоупотребление алкоголем, незначительная физическая активность и воздействие непрерывного стресса, так же как и ожирение, высокий уровень холестерина и сахарный диабет. В условиях украинской первичной медико-санитарной помощи собственный опыт авторов работы в экстренной медицине показывает, что по болезням органов кровообращения фиксируется до 41 % вызовов (АГ, чаще всего в виде сопутствующего диагноза, отмечается практически во всех этих вызовах), основную часть которых составляют вызовы по АГ с кризами.

Diagnostic Performance of Office versus Ambulatory Blood Pressure in Kidney Transplant Recipients

Introduction: Hypertension is the most prominent risk factor in kidney transplant recipients (KTRs). No study so far assessed in parallel the prevalence, control, and phenotypes of blood pressure (BP) or the accuracy of currently recommended office BP diagnostic thresholds in diagnosing elevated ambulatory BP in KTRs. Methods: 205 stable KTRs underwent office BP measurements and 24-h ambulatory BP monitoring (ABPM). Hypertension was defined as follows: (1) office BP ≥140/90 mm Hg or use of antihypertensive agents following the current European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines, (2) office BP ≥130/80 mm Hg or use of antihypertensive agents following the current American College of Cardiology/American Heart Association (ACC/AHA) guidelines, (3) ABPM ≥130/80 mm Hg or use of antihypertensive agents, and (4) ABPM ≥125/75 mm Hg or use of antihypertensive agents. Results: Hypertension prevalence by office BP was 88.3% with ESC/ESH and 92.7% with ACC/AHA definitions compared to 94.1 and 98.5% at relevant ABPM thresholds. Control rates among hypertensive patients were 69.6 and 43.7% with office BP compared to 38.3 and 21.3% with ABPM, respectively. Both for prevalence (κ-statistics = 0.52, p < 0.001 and 0.32, and p < 0.001) and control rates (κ-statistics = 0.21, p < 0.001 and 0.22, and p < 0.001, respectively), there was moderate or fair agreement of the 2 techniques. White-coat and masked hypertension were diagnosed in 6.7 and 39.5% of patients at the 140/90 threshold and 5.9 and 31.7% of patients at the 130/80 threshold. An office BP ≥140/90 mm Hg had 35.3% sensitivity and 84.9% specificity for the diagnosis of 24-h BP ≥130/80 mm Hg. An office BP ≥130/80 mm Hg had 59.7% sensitivity and 73.9% specificity for the diagnosis of 24-h BP ≥125/75 mm Hg. Receiver operating curve analyses confirmed this poor diagnostic performance. Conclusions: At both corresponding thresholds studied, ABPM revealed particularly high hypertension prevalence and poor BP control in KTRs. Misclassification of KTRs by office BP is substantial, due to particularly high rates of masked hypertension. The diagnostic accuracy of office BP for identifying elevated ambulatory BP is poor. These findings call for a wider use of ABPM in KTRs.

Quality of systematic reviews supporting the 2017 ACC/AHA and 2018 ESC/ESH guidelines for the management of hypertension

ObjectiveTo assess the methodological and reporting quality of systematic reviews (SRs) that informed recommendations in the recent American and European hypertension guidelines.Design and settingsMeta-epidemiological study. We identified SRs that were...

ASSOCIATION OF HYPERTENSION WITH QUALITY OF LIFE AND MEASURES OF MENTAL AND PHYSICAL HEALTH IN PATIENTS WITH RHEUMATIC DISEASES

Abstract Objective: Increased prevalence of hypertension has been reported among patients with rheumatic diseases implicating autoimmune pathways and chronic inflammation. However, these patients commonly present mental health disorders, physical disability and impaired quality of life, which may as well interfere with hypertension. In the present study, we investigated the association of hypertension with quality of life and measures of mental and physical health in a large cohort of patients with rheumatic diseases. Design and method: Among consecutive patients attending the outpatient Rheumatology Clinic, health-related quality of life and anxiety were evaluated using the EuroQol 5D (EQ-5D) utility index and the Hamilton Anxiety Scale (HAM-A), respectively. The Health Assessment Questionnaire Disability Index (HAQ-DI), and the HAQ Pain Visual Analogue Scale (VAS-Pain) were used as measures of physical disability and arthritis-related pain, respectively. Hypertension was defined according to the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines. Results: A total of 464 individuals (81.7% females) with a mean age of 55.5 ± 13.8 years were included. Rheumatoid arthritis was the most common rheumatic disease (32.8%), followed by osteoarthritis (17.0%) and seronegative spondyloarthropathies (11.4%). Mean systolic/diastolic blood pressure (BP) was 130.3 ± 19.9/79.5 ± 10.5 mmHg and prevalence of hypertension reached 58.6% and. Patients with hypertension presented significantly higher HAM-A levels [16 (10–23) vs 13 (9–20.5), p = 0.014), higher HAQ-DI score (0.94 ± 0.79 vs 0.60 ± 0.61, p &lt; 0.001), lower EQ-5D score (0.50 ± 0.24 vs 0.59 ± 0.24, p &lt; 0.001), and higher VAS-pain [50 (25–75) vs 44.5 (10–70) %, p = 0.017], compared to normotensive patients. Multivariate analysis accounting for cardiovascular risk factors and disease-related parameters revealed an independent inverse association between systolic BP and quality of life (beta = –0.224, p = 0.022). Conclusions: Patients with rheumatic diseases and comorbid hypertension presented increased levels of anxiety, disability and pain and diminished quality of life compared to their normotensive counterparts. The association between BP and quality of life remained significant even after adjustment for other factors, revealing the complexity of the psycho-physical mode. Whether hypertension negatively affects quality of life in patients with chronic rheumatic disorders or vice versa impaired quality of life leads to increased BP, warrants further investigation.

Resolution of drug-resistant hypertension by adrenal vein sampling-guided adrenalectomy: a proof-of-concept study.

Drug-resistant hypertension (RH) is a very high-risk condition involving many hypertensive patients, in whom primary aldosteronism (PA) is commonly overlooked. Hence, we aimed at determining if (1) adrenal vein sampling (AVS) can identify PA in RH patients, who are challenging because of receiving multiple interfering drugs; (2) AVS-guided adrenalectomy can resolve high blood pressure (BP) resistance to treatment in these patients. Based on a pilot study we selected from 1016 consecutive patients referred to our Centre for 'difficult-to-treat' hypertension those with RH, for an observational prospective cohort study. We excluded those non-adherent to treatment (by therapeutic drug monitoring) and those with pseudo-RH (by 24-h BP monitoring), which left 110 patients who met the European Society of Cardiology/European Society of Hypertension (ESC/ESH) 2013 definition for RH. Of these patients, 77 were submitted to AVS, who showed unilateral PA in 27 (mean age 55 years; male/female 19/8). Therefore, these patients underwent AVS-guided laparoscopic unilateral adrenalectomy, which resolved RH in all: 20% were clinically cured in that they no longer needed any antihypertensive treatment; 96% were biochemically cured. Systolic and diastolic BP fell from 165/100 ± 26/14 mmHg at baseline, to 132/84 ± 14/9 mmHg at 6 months after surgery (P<10-4 for both) notwithstanding the fall of number and defined daily dose (DDD) of antihypertensive drugs required to achieve BP control (P<10-4 for both). A prominent regression of cardiac and renal damage was also observed. Thus, the present study shows the feasibility of identifying PA by AVS in RH patients, and of resolving high BP resistance to treatment in these patients by AVS-guided adrenalectomy.