Arterial Hypertension Guidelines Research Articles

Predictors of the Development of Associated Clinical Conditions in Working-Age Patients With Cardiovascular Risk Factors in Conditions of High Adherence to Treatment.

To determine predictors for the development of associated clinical conditions (ACC) in patients of working age with cardiovascular risk factors (CVRFs) in the conditions of high compliance with the treatment and healthy lifestyle (HLS). The study included 364 patients with CVRFs without target organ damage and a history of ACC. Mean age was 42.24±8.08 years. Patients were examined in consistency with the Russian Society of Cardiology (RSC) 2020 guidelines for arterial hypertension and chronic heart failure. The follow-up period was 6.45±0.42 years. 350 patients completed the study, 9 patients died during the follow-up period, and 5 were lost to follow-up. Patients were divided into two groups based on the development of ACC. The first group consisted of 56 (16%) patients with verified ACC, the second group included 294 (84%) patients without ACC. Regression logistic and correlation analyses confirmed the prognostic significance for the development of ACC by 12 indicators. The risk of ACC in smokers was increased more than 7 times (odds ratio (OR) 7.44, 95% confidence interval (CI): 3.42-16.21), and when type 2 diabetes mellitus (DM) developed, more than 9 times (OR 9.47, 95% CI: 4.36-20.59); with chronic kidney disease (CKD), more than 6 times (OR 6.75, 95% CI: 3.41-13, 37); with a history of COVID-19 (COronaVIrus Disease 2019) pneumonia, 7 times (OR 7.11, 95% CI: 3.04-16.58); with left ventricular hypertrophy (LVH), 6 times (OR 6, 35, 95% CI: 3.14-12.83); with CAVI index>7.2, almost 3 times (OR 2.69, 95% CI: 1.48-4.86); with PVWcf (carotid-femoral pulse wave velocity) >13 m/s, more than 5 times (OR 5.61, 95% CI: 2.79-11.28); with R-AI index (augmentation index) >1, more than 2 times (OR 2.26, 95% CI: 1.3-3.9); and with an increase in the indexed left atrial volume (ILAV) >27 ml/m2, more than 8 times (OR 8.80, 95% CI: 4.61-16.79). In the presence of polymorphisms in the form of homozygosity for the minor allele of the AGT gene (Thr174Met, rs4762), the risk of developing ACC increased 14 times (OR 14.13, 95% CI: 4.69-42.57), the APOE gene (Cys130Arg, rs429358), 11 times (OR 11.18, 95% CI: 4.18-29.93), and in the intron of the PRARα gene (rs4253778), 8 times (OR 8.11, 95% CI: 3.75-17.53). The development of ACC in patients with high compliance with treatment and a healthy lifestyle is associated with smoking, type 2 diabetes and CKD, a history of COVID-19 pneumonia, LVH, increased ILAV >27 g/m2, more pronounced arterial stiffness assessed by an increase in CAVI indices >7.2, R-AI >1, and PWVcf >13 m/s; and with the presence of polymorphism of the AGT, APOE and PPARα genes in the form of homozygosity for the minor allele.

Susceptibility to car accidents due to sudden illness with truck drivers in northern Brazil

The prevalence of hypertension, diabetes, and obesity among truck drivers is closely related to the quality of life of this population and poses a significant vulnerability to the occurrence of car accidents. Objective: to identify the prevalence of these clinical conditions in drivers, as well as the correlation of their existence with emergency situations involving this population and the mechanisms of public health care. Methods: The QVS-80 questionnaire was applied to a sample population of 100 truck drivers in the municipality of Paraíso do Tocantins, located on the banks of the BR-153, to verify information related to quality of life and the presence or absence of Diabetes Mellitus, hypertension, and calculation of the Body Mass Index (BMI) to determine obesity according to the Brazilian Obesity Guidelines - ABESO (2016). In addition, blood pressure measurement and classification of individuals as hypertensive according to the VI Brazilian Guidelines for Arterial Hypertension of the Brazilian Society of Cardiology (2020), and as diabetics through random capillary blood glucose measurement in accordance with the guidelines of the Brazilian Society of Diabetes (2020) were performed. Results: The occurrence of car accidents involving trucks is directly related to the quality of life of their drivers, which was shown to be very poor due to the preexistence of chronic diseases such as obesity (41%), overweight (36%), diabetes (6%), and hypertension (60%). Conclusion: The work environment of truck drivers is ideal for sudden-onset events during driving and consequently the occurrence of accidents.

Editors' Commentary on the 2023 ESH Management of Arterial Hypertension Guidelines.

Clinical practice guidelines are ideally suited to the provision of advice on the prevention, diagnosis, evaluation, and management of high blood pressure (BP). The recently published European Society of Hypertension (ESH) 2023 ESH Guidelines for the management of arterial hypertension is the latest in a long series of high BP clinical practice guidelines. It closely resembles the 2018 European Society of Cardiology/ESH guidelines, with incremental rather than major changes. Although the ESH guidelines are primarily written for European clinicians and public health workers, there is a high degree of concordance between its recommendations and those in the other major BP guidelines. Despite the large number of national and international BP guidelines around the world, general population surveys demonstrate that BP guidelines are not being well implemented in any part of the world. The level of BP, which is the basis for diagnosis and management, continues to be poorly measured in routine clinical practice and control of hypertension remains suboptimal, even to a conservative BP target such as a systolic/diastolic BP <140/90 mm Hg. BP guidelines need to focus much more on implementation of recommendations for accurate diagnosis and strategies for improved control in those being treated for hypertension. An evolving body of implementation science can assist in meeting this goal. Given the enormous health, social, and financial burden of high BP, better diagnosis and management should be an imperative for clinicians, government, and others responsible for the provision of health care services. Hopefully, the 2023 ESH will help enable this.

Carotid Atherosclerosis Predicts Blood Pressure Control in Patients With Hypertension: The Campania Salute Network Registry.

BackgroundThe 2018 European Society of Cardiology/European Society of Hypertension arterial hypertension guidelines do not recommend routine carotid ultrasound as a tool to identify hypertension‐mediated organ damage, unless clinically indicated. However, carotid plaque (CP) is a strong correlate of increased arterial stiffness, which influences blood pressure (BP) control over time. Thus, we assessed whether evidence of CP at first visit could predict BP control during follow‐up.Methods and ResultsFrom the CSN (Campania Salute Network) Registry, 6684 patients with hypertension had complete carotid ultrasound examination and were categorized by the presence of CP at baseline. Optimal BP control was defined as average BP <140/90 mm Hg and <135/85 during follow‐up for office and home BP, respectively. At baseline, participants with CP (n=3061) were more likely to be men, to be older, to have diabetes, and to exhibit higher systolic BP, lower diastolic BP, worse lipid profile, and higher prevalence of left ventricular hypertrophy (all P<0.0001) than patients without CP. Optimal office BP control was adjudicated in 54% with and 62% without CP (P<0.0001), and optimal home BP in 51% with and 58% without CP (P<0.01). Presence of CP was significantly associated with the reduced probability of controlled office BP during follow‐up (both P<0.0001), independently of significant effect of older age, male sex, higher baseline BP values, classes of medication, and presence of left ventricular hypertrophy, and only attenuated by duration of hypertension.ConclusionsPresence of CP in treated patients with hypertension is associated with suboptimal BP control during follow‐up, independently of worse metabolic profile and presence of left ventricular hypertrophy.

Arterial Stiffness and Vascular Aging: Effects of Hypertension

This review highlights the relationship of age and arterial hypertension observed in the aging process. The main structural and functional changes underlying the increase in vascular stiffness are analyzed. The similarity of vascular changes in aging and arterial hypertension was noted. The negative effect of increased central blood pressure on target organs is considered. Attention is paid to the analysis of arterial stiffness as a marker of vascular aging. The parameters of the carotid-femoral pulse wave propagation velocity, the cardio-ankle vascular index (CAVI), the ankle-brachial index, the finger-brachial index, and the augmentation index were examined separately. The prognostic and clinical value of the parameters of vascular stiffness is considered. In particular, the clinical guidelines for arterial hypertension report the need to use arterial stiffness indicators to improve the accuracy of cardiovascular risk stratification, especially in medium-risk patients. Measurement of vascular stiffness and central aortic pressure should be recommended as one of the methods for stratifying cardiovascular risk in patients with intermediate SCORE risk, as well as in those whose target organ damage was not detected by routine methods. The article also notes the independent diagnostic and prognostic value of the CAVI.

Inhaled iloprost as third add‐on therapy in idiopathic pulmonary arterial hypertension

Triple combination therapy is suggested in current pulmonary arterial hypertension guidelines in case of unsatisfactory treatment with oral double combination therapy. However, there is a lack of evidence concerning some of the drug combinations currently employed. We demonstrate the clinical and hemodynamical benefits of inhaled iloprost as third add-on therapy in idiopathic pulmonary arterial hypertension.

Thiazide and Thiazide-like Diuretics in the Treatment of Arterial Hypertension: are there Any Differences?

In the current clinical guidelines for arterial hypertension, diuretics are considered one of the first line antihypertensive drugs, which are equivalent in their effectiveness to other main pharmacological classes used in the treatment of this disease. To date, much attention is paid to both the antihypertensive potential of diuretics and their safety profile and ability to influence prognosis. In this regard, a rational approach to the consideration of the clinical and pharmacological properties of these drugs is the isolation of thiazide and thiazide-like drugs among them, which is reflected in international clinical guidelines. Among thiazide-like diuretics, indapamide occupies a special place, favorably distinguished by its antihypertensive properties, metabolic neutrality, as well as the ability to improve the prognosis and favorably influence hard endpoints in the form of mortality rates in patients with hypertension. A unique feature of indapamide is also the presence, in addition to the direct diuretic effect, pleiotropic properties, including, in particular, some antagonism towards calcium and beneficial effects on arteries. This drug has been studied in a large number of studies, including such "difficult" categories of patients as the elderly and patients with diabetes mellitus, where indapamide has proven its powerful target-organ protective potential and metabolic neutrality, distinguishing it among both thiazide-like and thiazide diuretics. Indapamide provides a comprehensive target-organ protection at the level of the heart, blood vessels, kidneys and brain. Based on this, it can be expected that the widespread use of this drug as part of a first-line combination antihypertensive therapy will not only achieve target blood pressure levet in most patients with hypertension, but also provide an improved prognosis and improve the quality and duration of their life.

Temperature-adjusted hypertension prevalence and control rate: a series of cross-sectional studies in Guangdong Province, China.

Previous studies have shown negative relationships between ambient temperature and blood pressure (BP). However, few studies estimated temperature-adjusted hypertension prevalence and control rate in different population. To estimate the effects of temperature on BP, and further calculate temperature-adjusted hypertension prevalence and control rate. Meteorological and BP data in Guangdong Province from 2004 to 2015 were collected. There were 31 351 participants aged 18 years and over. Based on 2018 European society Arterial Hypertension Guidelines, participants were divided into normotensive patients (n = 23 046), known hypertensive patients (n = 2807), and newly detected hypertensive patients (n = 5498). We first used generalized additive model to establish the nonlinear relationship between daily mean temperature and BP, and then calculated the linear effects of temperature on BP among populations with different hypertension status. Finally, we calculated the temperature-adjusted hypertension prevalence and control rate. Generally, there is an inverse relationship between temperature and BP. For a 1 °C increase in temperature, the decreased SBPs for normotensive patients, newly detected hypertensive patients, and known hypertensive patients were 0.37 [95% confidence interval (CI): -0.40, -0.33] mmHg, 0.21 (95% CI: -0.32, -0.10) mmHg and 0.81 (95% CI: -1.02, -0.59) mmHg, while reduced DBPs were 0.19 (95% CI: -0.21, -0.16) mmHg, 0.01 (95% CI: -0.06,0.08) mmHg, and 0.44 (95% CI: -0.56, -0.32) mmHg, respectively. At 5, 10, 15, 20, and 25 °C, the hypertension prevalence rates were 32.5, 29.7, 27.7, 26.0, and 25.0%, respectively, and the control rates were 12.0, 17.5, 23.5, 30.1, and 37.1%, respectively. Low temperature increased BP for all populations, especially for known hypertensive patients, which makes hypertension prevalence increase and control rate decrease if temperature reduce. Our findings suggest that temperature should be considered in hypertension clinic management and epidemiological survey.

A new odissey for the clinical cardiologist: the difficult application of arterial hypertension guidelines in patients with chronic coronary syndrome

Abstract Introduction In hypertensive patients with chronic coronary syndrome (CCS), the 2018 European Society of Cardiology (ESC) arterial hypertension guidelines recommend target pressure ranges that can be difficult to apply, leading to possible medico-legal and other not insignificant problems. Methods In 2019 we evaluated blood pressure values measured according to the ESC 2018 recommendations in 2,456 patients. We focused on 505 asymptomatic patients with CCS, already undergoing antihypertensive drug treatment. Patients with secondary hypertension, heart failure, atrial fibrillation, malignancies or life expectancy &amp;lt;1 year were excluded. We analyzed the incidence of high systolic pressure coexisting with diastolic pressure lower than the indicated target and the incidence of blood pressure below the targets indicated in asymptomatic patients in the various age groups considered. Results In 24% of patients aged ≥80 years we found an office systolic blood pressure ≥140 mmHg together with a diastolic &amp;lt;70 mmHg, confirmed at the 2- and 4-week control. These values were also recorded in 18% of patients aged 65–79 years and in 5% of those aged 18–65 years. In asymptomatic patients aged 18–65 years old we found a systolic blood pressure &amp;lt;120 mmHg (considered not safe in the guidelines) in 4% of cases; SBP was &amp;lt;130 mmHg in 14% of patients aged 65–79 years and in 7% of those aged ≥80 years (considered not safe in the guidelines in these age group) (See table 1). Conclusions The daily application of the ESC 2018 guidelines is challenging, due to contradictory suggestions (is it necessary to reduce a high systolic pressure ≥140 mmHg in the presence of a diastolic below the level considered dangerous &amp;lt;70 mmHg?; in an asymptomatic patient should therapy be reduced or suspended if blood pressure levels are not within the range considered optimal and safe?). This problem does not occur in American and NICE guidelines. We think that this topic should be largely reconsidered; guidelines writers should ask themselves these questions in order not to make hypertension treatment difficult or arbitrary. Funding Acknowledgement Type of funding source: None

Isolated diastolic hypertension as defined by the 2017 American College of Cardiology/American Heart Association blood pressure guideline and incident cardiovascular events in Chinese.

The new arterial hypertension guidelines by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) changed the definition of isolated diastolic hypertension (IDH). We assessed and compared in a Chinese population the IDH prevalence, newly defined by the 2017 ACC/AHA guidelines versus the former definition by the Joint National Committee 7 (JNC7) criteria, and examined longitudinal associations of IDH with cardiovascular disease (CVD) outcomes. The prospective community-based Kailuan Study included participants aged 18-98 years who underwent a detailed medical examination at baseline in 2006/2007 and who were biennially re-examined till 2017. History of antihypertensive medication at baseline was an exclusion criterion. The study population consisted of 87 346 individuals (mean age: 50.9 years; range: 18-98 years). Prevalence of IDH was 7.79% [95% confidence interval (CI): 7.62, 7.97] by JNC7 guidelines and 24.72% (95% CI: 24.43, 25.01) by 2017 ACC/AHA criteria [difference: 19.93% (95% CI: 16.81, 17.04)]. Applying the 2017 ACC/AHA guidelines, the prevalence of IDH-recommended antihypertensive therapy was 7.73% (95% CI: 7.55, 7.90). In multivariable analysis, IDH by JNC7 criteria was significantly associated with incident myocardial infarction [n = 93 events; hazard ratio: 1.30 (95 CI: 1.02, 1.66)], cerebral hemorrhage [n = 73 events; hazard ratio: 1.79 (95% CI: 1.35, 2.38)], and total CVD [n = 373 events; hazard ratio: 1.15 (95% CI: 1.02, 1.30)], when compared with normotension. IDH based on 2017 ACC/AHA guidelines was associated with incident cerebral hemorrhage [n = 129 events; hazard ratio: 1.47 (95% CI: 1.12, 1.94)] and total CVD [n = 828 events; hazard ratio: 1.13 (95% CI: 1.02, 1.26)]. In this adult Chinese community, 2017 ACC/AHA-defined IDH was associated with the incidence of cerebral hemorrhage and total CVD, and as compared with JNC7-defined IDH, it was more prevalent.

Potential benefits and harms of various arterial hypertension guidelines

Potential benefits and harms of various arterial hypertension guidelines

P57262018 ESC/ESH guideline-recommended age categories and intensive blood pressure management in high-risk adults: insights from SPRINT

Abstract Background The 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines for arterial hypertension propose different intensities of blood pressure (BP) lowering in patients &lt;65 years, 65–79 years, and ≥80 years of age. However, it is unclear whether intensive BP management is well-tolerated and modifies risk uniformly across this age spectrum. Purpose To assess the relationship between age, treatment response to intensive BP lowering, and cardiovascular (CV) outcomes. Methods SPRINT was a randomized, controlled trial in which 9,361 individuals ≥50 years of age, at high CV risk but without diabetes who had a systolic BP (SBP) 130–180 mmHg, were randomized to intensive (target SBP &lt;120mmHg) or standard antihypertensive treatment (target SBP &lt;140mmHg). The primary efficacy endpoint was the composite of acute coronary syndromes, stroke, heart failure, or death from CV causes. The primary safety endpoint was the composite of serious adverse events (SAE). We examined the prognostic implications of age, using Cox proportional-hazards regression models adjusted for demographic, clinical, and laboratory variables. Whether a linear association was present between age and clinical endpoints was evaluated using restricted cubic splines. We further explored the effects of intensive BP lowering across the age spectrum using interaction analyses. Results Age was noted for all individuals, and 3,805 (41%), 4,390 (47%), and 1,166 (12%) were &lt;65 years, 65–79 years, and ≥80 years, respectively. Mean age was similar between the two study groups (intensive group 67.9 years vs. standard group 67.9 years; P=0.94). Median follow-up was 3.3 years (range 0–4.8), with 562 primary efficacy events (6%) and 3,529 primary safety events (38%) recorded during the study period. Age was linearly associated with the risk of stroke (test for overall trend, P&lt;0.001) and non-linearly associated with the risk of primary efficacy events, death from CV causes, death from any cause, heart failure, and SAE (test for non-linearity, P&lt;0.05; test for overall trend, P&lt;0.001). Age remained significantly associated with all tested endpoints after multivariable adjustment (P&lt;0.001). Furthermore, the risk of primary events increased over guideline-recommended age-categories (65–79 years vs. &lt;65 years; adj. HR 1.65, 95% CI 1.34–2.04; P&lt;0.001 and ≥80 years vs. 65–79 years; adj. HR 1.92, 95% CI 1.54–2.40; P&lt;0.001), as did the risk of SAE (P&lt;0.001). The safety and efficacy of intensive BP lowering was not modified by age whether tested continuously or categorically (P&gt;0.05). The Figure shows similar treatment effects (hazard ratios) across the spectrum of age. P-values are for the interaction between age and treatment effect for each endpoint. Figure 1 Conclusions In SPRINT, higher age was associated with a greater risk of both CV events and SAE. However, intensive BP lowering appeared to be associated with similar risks and benefits across the age spectrum.

How High Is Too High? Population Impact of Different Hypertension Management Guidelines

Background: Arterial hypertension guidelines strongly differ between societies. The current American College of Cardiology/American Heart Association (ACC/AHA) guideline has been shown to recommend higher proportions of the general population for antihypertensive medication than the previous American and European guidelines. How cardiovascular risk differs between persons with and without an antihypertensive medication recommendation has not been examined. Additionally, the population impact of American, European, and international guidelines has not been compared systematically within the same study population. Methods: We compared the prevalence of an antihypertensive medication recommendation according to the American (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 7 [JNC7], ACC/AHA 2017), European (European Society of Hypertension [ESH]/European Society of Cardiology [ESC] 2013/2018), and international (World Health Organization [WHO]/International Society of Hypertension [ISH] 2003) guidelines in 3092 participants of the population-based Heinz Nixdorf Recall study who received blood pressure measurements and were not taking antihypertensive medication at the baseline examination (N=3092, mean±standard deviation of age 58·1±7·5 years, 48·7% males). We furthermore compared incident cardiovascular events during the 5-year follow-up between participants with and without an antihypertensive medication recommendation. Findings: The ACC/AHA 2017 guideline recommended the highest percentage of participants for antihypertensive medication (45·8%) compared with the JNC7 (37·2%), ESH/ESC 2013 (17·8%), ESC/ESH 2018 (26·7%), or WHO/ISH 2003 (20·3%) guidelines. Participants with an antihypertensive medication recommendation had a significantly higher incidence of cardiovascular events during the 5-year follow-up compared with participants without this recommendation (2·5% vs 1·1%, p=0·003). Interpretation: Our results call for randomised controlled trials to investigate whether applying the stricter ACC/AHA 2017 recommendation for antihypertensive medication actually leads to a reduction in cardiovascular disease. Funding Statement: Heinz Nixdorf Foundation, BMBF, and DFG (projects ER 155/6-2, SI 236/8-1 and SI 236/9-1). Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: All participants gave written informed consent. The study was approved by the ethical committee of the University Duisburg-Essen, Germany.

Utility of optical coherence tomography angiography in detecting vascular retinal damage caused by arterial hypertension.

To evaluate the potential utility of perfusion density measurements to discriminate patients with arterial hypertension by cardiovascular risk category. In this cross-sectional study, one eye per subject was evaluated (N = 73). The study cohort was divided into three groups according to the clinical criteria established by the European Guidelines for Arterial Hypertension: 26 controls, 24 patients with low cardiovascular risk, and 23 patients with very high cardiovascular risk. All patients were examined using RS-3000 Advance optical coherence tomography angiography to analyze macular and peripapillary perfusion density. There were no differences among the three risk groups by sex or age. Decreased macular perfusion density was found at the level of the superficial and deep plexuses (p ⩽ 0.047). No differences were observed in peripapillary perfusion density (p = 0.18). Optical coherence tomography angiography can detect changes in macular perfusion density in patients with hypertension and high cardiovascular risk and might represent a supportive imaging method in the evaluation of the cardiovascular risk in hypertensive patients.

What's new in the ESC 2018 guidelines for arterial hypertension : The ten most important messages.

SummaryThe new guidelines on hypertension of the European Society of Cardiology (ESC) 2018 have refined the treatment cut-offs and therapy decisions in adults. This review highlights important recommendations of the guidelines and also on the situation of hypertension in Austria. The general treatment targets of blood pressure have been lowered to at least 130/80 mmHg for most patients. The definition of hypertension is specified as a repeated systolic blood pressure in the office of ≥140 and or diastolic BP ≥90 mmHg. For home blood pressure monitoring, an average value of ≥135/85 mmHg is now defined as hypertension. Ambulatory 24h-blood pressure measurement is recommended for diagnosis of hypertension and to demask lack of nocturnal blood pressure dipping. Whether drug treatment should be initiated immediately or after a delay with lifestyle intervention is focused on the individual high or low cardiovascular risk of the patients and the degree of hypertension. For most patients a combination therapy with single pill is now recommended as initial therapy for hypertension from the start. The salt consumption should be reduced in the majority of patients. The new guidelines have clarified the treatment of hypertension in different comorbidities.

Multi-level medical knowledge formalization to support medical practice for chronic diseases

Medical processes combine medical actions which are performed by health care professionals while they observe signs and symptoms and decide about interventions, prescriptions, or tests, in order to deal with the health problem that affects a particular patient.Our research was centered in the representation of knowledge for the purpose of decision making in medical processes for chronic diseases. In order to achieve this objective, we followed three steps: (1) We performed an analysis and comparison of formal languages for procedural knowledge representation from a decision-making perspective. (2) We proposed an intuitive, easy, and effective mechanism of medical knowledge formalization. And, (3) we defined a methodology to model medical processes. Our new formalism to represent knowledge is called the extended Timed Transition Diagram (eTTD) and can be used to describe three basic levels of decision making in a long-term treatment: therapy strategy, dosage, and intolerances. The methodology can be applied manually to build eTTDs from clinical practice guidelines (CPGs) or automatically to construct them using the information available in clinical records about individual, multi-level medical processes.We validated eTTDs with clinical practice guidelines for arterial hypertension. The obtained models can be used as a baseline framework for medical, procedural decision support systems development.

New АСС/AHA and ESC/ESH arterial hypertension guidelines

The American College of Cardiology and the American Heart Association updated the guideline for the prevention, detection, evaluation and management of high blood pressure in adults in 2017 The European Society of Cardiology and the European Society оf Hypertension updated guidelines for the management of arterial hypertension in 2018. This article reviews new positions of these documents, compares approaches to current issues of managing of the patients with arterial hypertension, pro and contra with previous versions of similar documents. It is necessary to update the National guidelines for management of patients with arterial hypertension, which should include the dignity of both European and American approaches.

The COMmon control of hypErtenSion and Therapeutic Attitudes in BelgIum and Luxemburg study (COME STAI)

Study aim The aim of this study was to assess hypertension management in general practice in Belgium and Luxembourg, shortly before the publication of the 2013 ESH/ESC Guidelines for arterial hypertension management.Methods A total of 516 general physicians evaluated 10,078 consecutive hypertensive patients. All used the same definitions to assess cardiovascular risk.Results Systolic (S) blood pressure (BP) was 139 ± 19 mmHg, diastolic (D) BP 80 ± 11 mmHg, patients were 64 ± 13 years old and their body mass index (BMI) was 28 ± 5 kg/m² (mean ± SD). Treatment remained unchanged in 71% of the patients with a SBP ≥ 140 mmHg. Those on ≥ 2 antihypertensive drugs were older, had higher BMI, slower HR, higher perceived cardiovascular risk, but lower BP (all P≤ 0.001 vs no and monotherapy groups). Patients in whom treatment was intensified were at higher cardiovascular risk, as substantiated by an increased prevalence of males, a higher BP, a faster HR and a larger BMI (all P≤ 0.0001). High cardiovascular risk patients underwent more frequent treatment simplifications with fixed-combination therapies or the addition of another antihypertensive class (all P≤ 0.0001 vs not at high cardiovascular risk). Among the 523 patients older than 80 years with SBP ≥ 140 mmHg, treatment intensification occurred in 32% when SBP ≥ 150 mmHg, and in 10% when SBP was between 140 and 149 mmHg (P ≤ 0.0001).Conclusion The COME STAI study suggests that there is still room for improvement in hypertension control in Belgium and Luxembourg.

Physicians’ assessment of the high blood pressure risk and their attitude towards the prevention of arterial hypertension

Aim. To study the physicians’ knowledge of the high blood pressure (BP) risk and to assess their attitude towards the prevention of arterial hypertension (AH). Material and methods. In total, 118 internal disease specialists from three Russian regions participated in an anonymous questionnaire survey on the knowledge of high BP risk and the attitude towards the prevention of AH and its complications. The mean age of participants (13 men and 105 women) was 46,53±11,64 years. The respondents’ answers were compared to the information in the current clinical AH guidelines. Results. More than one-half of the respondents demonstrated inadequate professional knowledge on prediction and prevention of AH complications. These physicians use the “traditional” disease model and do not consider elevated BP as a risk factor; predict the risk of AH complications using subjective complaints of their patients; do not realise the importance of the target organ damage (TOD) prevention; and limit their preventive strategy only to the prevention of hypertensive crises. Conclusion. The demonstrated attitude towards AH management could be a serious barrier for effective AH prevention. This group of physicians needs extensive education and training, in order to modify their attitude and to increase their commitment to preventive strategies.

Blood pressure control in primary care patients with arterial hypertension: analysing the Hypertension Register data

Aim. (1) To investigate clinical characteristics of primary care patients with arterial hypertension (AH), according to the achievement of target blood pressure (BP) levels; (2) to assess the effectiveness of therapeutic measures aimed at achieving target BP and maintaining its long-term control. Material and methods. This retrospective analysis included the data from ambulatory medical records of 5558 AH patients, who attended primary care centres in 2007. Clinical characteristics were compared in patients with achieved vs. non-achieved target BP levels. According to the national AH guidelines (2004), the completeness of examination, pharmaceutical therapy tactics, and frequency of the follow-up were assessed in both groups. Results. Based on the 2007 data, target BP levels were maintained in 28% of AH patients. Mean BP level was 144/87 mm Hg. Patients with optimal BP levels, compared to their peers with inadequate BP control, had significantly (p&lt;0,001) higher prevalence of angina pectoris (40,4% vs. 30,1%, respectively) or previous myocardial infarction (19,4% vs. 8,4%), as well as higher frequency of lipid profile assessment, creatinine measurement, and echocardiography. Mean number of prescribed antihypertensive medications was 2,08 vs. 1,60, respectively. Mean number of clinical visits per year was 4,07 vs. 2,99, while mean interval between the visits reached 72,3 vs. 62,7 days, respectively. Regardless of the target BP achievement, the quality of diagnostic and therapeutic management did not comply with the recommended standards. Conclusion. Patients with optimal BP control were characterised by a more severe clinical course, as well as by a wider scope and higher frequency of diagnostic and therapeutic procedures. At the primary care level, the quality of AH diagnostics and treatment did not comply with the recommended standards; therefore, mean BP levels in the AH Register sample were higher than the target ones.