Population Of Hypertensive Patients Research Articles

Контроль артеріального тиску в пацієнтів з ішемічною хворобою серця порівняно з пацієнтами без ішемічної хвороби серця

Основною умовою запобігання ускладненням артеріальної гіпертензії (АГ), у тому числі і при поєднанні з ішемічною хворобою серця (ІХС), є зниження артеріального тиску (АТ) до цільового рівня. Наявність ІХС розглядається як фактор, що може впливати на ефективність антигіпертензивної терапії. Досі майже не проводилося визначення та порівняння предикторів досягнення цільового АТ окремо в популяціях гіпертензивних пацієнтів з ІХС та без неї. Тому це стало метою нашого дослідження. У дослідження включений 9821 пацієнт (середній вік 58,90 ± 0,24 року) з АГ. Усі пацієнти залежно від наявності ознак ІХС були розподілені на дві групи: перша група — 4193 пацієнти без ознак ІХС; друга група — 5628 пацієнтів з ознаками ІХС. Діагноз ІХС встановлювався лікуючими лікарями. 531 лікар на свій розсуд призначав хворим з АГ антигіпертензивні препарати у дозах, які вважав за потрібне. Контроль ефективності лікування відбувався під час візитів — загалом 4 візити протягом 3 місяців. Пацієнтам під час візитів вимірювали офісний АТ, проводили електрокардіографію, оцінку прихильності до лікування за допомогою стандартної анкети, оцінку серцево-судинного ризику та опитування згідно з розробленою авторами дослідження анкетою. Мультифакторний регресійний аналіз застосовували для виявлення незалежних предикторів недостатньої ефективності терапії.Встановлено, що наявність ознак ІХС у пацієнтів з АГ асоціювалася з більшою частотою виявлення ускладнень (серцева недостатність, ураження нирок, інсульт) та цукрового діабету, факторів ризику (дисліпідемія, обтяжена спадковість, старший вік, високий АТ), що потребувало призначення більшої кількості антигіпертензивних препаратів. Пацієнти без ознак ІХС частіше мали шкідливі звички, а додаткова фізична активність хоча і була в переважної більшості хворих даної групи, але була недостатньою. Рівень систолічного (САТ) та діастолічного (ДАТ) АТ у другій групі був більш високим як на початку, так і в кінці спостереження, незважаючи на більш інтенсивне лікування (більшу кількість призначених антигіпертензивних препаратів). Цільового рівня АТ (< 140/90 мм рт.ст.) було досягнуто в 68,7 % пацієнтів першої групи та лише в 51,1 % пацієнтів другої групи (Р < 0,001). Групи пацієнтів з ІХС та без неї серед спільних предикторів недостатньої ефективності терапії мали лише високий рівень САТ (> 160 мм рт.ст.) і ДАТ (> 100 мм рт.ст.) на початку дослідження: імовірність збільшувалася у 3,83 і 2,81 та 3,92 і 2,5 раза відповідно для підвищених САТ і ДАТ у першій та другій групах. У пацієнтів без ІХС імовірність недосягнення цільового АТ також асоціювалася з підвищеним індексом маси тіла (β = 1,033, Р = 0,05) та більш рідким уживанням свіжих овочів та фруктів (β = 12,8, Р = 0,025). У другій групі ризик неефективного лікування збільшувався за наявності супутньої серцевої недостатності (β = 1,73, Р = 0,001) та зменшувався за наявності есенціальної, а не ренопаренхімної АГ (β = 0,76, Р = 0,05). Більш високий серцево-судинний ризик по-різному асоціювався з імовірністю недостатньої ефективності терапії: у першій групі — збільшував (β = 1,46, Р = 0,001), а у другій групі, навпаки, зменшував (β = 0,52, Р = 0,001). На початку дослідження лише 28,3 % пацієнтів першої групи та 19,5 % другої (Р < 0,001) мали високу прихильність до лікування. Висока прихильність до лікування на початку дослідження сприяла зменшенню імовірності недосягнення цільового АТ на 36 % у першій групі, тоді як для пацієнтів з ІХС вона не мала незалежного значення. Проте висока прихильність в кінці дослідження у другій групі асоціювалася зі зменшенням ризику неефективності лікування на 46 %.Таким чином, хворі на АГ з ІХС та без неї мали різний контроль АТ та різні фактори, асоційовані з досягненням його цільового рівня, що дозволяє по-різному формувати тактику ведення пацієнтів.

Association between serum uric acid and mortality in a Chinese population of hypertensive patients

Objectives: To investigate the association between serum uric acid and mortality in a Chinese population of hypertensive patients. Methods and results: A total of 2757 Chinese hypertensive patients from department of cardiology of several hospitals in Shanghai in China were followed up for about six years in this prospective study. Mortality was recorded and related factors were evaluated. Hyperuricemia was diagnosed by serum uric acid levels of >420 µmol/L in males or >357 µmol/L in females. A total of 2585 hypertensive patients with complete data were included in the final statistical analysis. Totally 709 deaths (27.4%) occurred during the six-year follow-up, of which 475 deaths were attributable to cardiovascular disease (CVD). All-cause and CVD mortality of hypertensive patients with hyperuricemia was significantly higher than that of patients without hyperuricemia. The Cox regression analysis indicated that hazards ratios (HRs) of hyperuricemia for all-cause and CVD mortality were 1.206 (95% CI: 1.002–1.453) and 1.085 (95% CI: 1.002–1.271) respectively. All-cause and CVD mortality of hypertensive patients was significantly increased (both p < 0.05) when uric acid levels increased. HRs of uric acid levels >536 µmol/L to all-cause and CVD mortality of hypertensive patients were 2.115 (95% CI: 1.596–2.801) and 1.861 (95% CI: 1.296–2.673), respectively, compared with those of uric acid levels ≤357 µmol/L. Conclusions: The data from this cohort study indicate that hyperuricemia can predict increased all-cause and CVD mortality in hypertensive patients.

P-wave duration in lead aVR and the risk of atrial fibrillation in hypertension.

Hypertension entails atrial remodeling that affect P-wave (PW) duration on electrocardiogram (ECG). PW indices (e.g., variance, dispersion, and terminal force) are associated with a higher risk for atrial fibrillation (AF), but their calculation requires multiple measurements of PW duration, limiting their use in clinical practice. We evaluated whether PW duration in specific ECG leads may identify patients with increased susceptibility to AF in a population of hypertensive patients. In a case-control study, AF and control subjects were matched for age, sex, and left atrial (LA) dimensions. PW duration was measured from digitally stored ECGs. Logistic regression was used to assess the association of PW duration and indices with AF. We enrolled 44 hypertensive AF patients (16 paroxysmal and 28 persistent) and 44 hypertensive controls. AF and control subjects were matched for sex (males, n = 27), age (67 ± 8 years), LA diameter (40 ± 5 mm), and were comparable for left ventricular mass (45 ± 11 g/m(2.7) vs 48 ± 12 g/m(2.7) , P = 0.19), ejection fraction (58 ± 7% in both groups), and prevalence of mild valvular heart disease (7% vs 5%; P = 0.64). PW duration in lead aVR was significantly higher in AF patients as compared with controls (115 ± 18 ms vs 101 ± 14 ms; P < 0.0001) and was the best independent predictor of AF in multivariable logistic regression (PW ≥ 100 ms: RR = 3.7; 95% CI: 1.3-10.3; P = 0.02). Simple measurement of PW duration in lead aVR allows effective identification of AF patients in a population of hypertensives. Confirmation of this finding in a larger population would provide a simple and effective risk marker of AF in hypertensive patients.

Blood pressure effects of glucagon-like peptide 1 analogues and sodium glucose transporter 2 inhibitors.

The growing number of obese patients with a high risk of developing hypertension and type 2 diabetes mellitus requires several drugs to treat all the associated morbidities. Ideally, one drug would help to tackle several health problems at the same time. We review available information on the blood pressure-reducing effects of the new antidiabetic drug classes, glucagon-like peptide 1 analogues and sodium glucose transporter 2 inhibitors. Blood pressure reduction with glucagon-like peptide 1 analogues or sodium glucose transporter 2 inhibitors ranges between 1 and 7 mmHg, both systolic and diastolic. As these drugs have not been sufficiently investigated in studies with office or ambulatory blood pressure as the primary efficacy measure or in prespecified hypertensive patient populations, their true efficacy in reducing blood pressure remains unclear. These studies are needed because the blood pressure-lowering effects of metabolic drugs may help to improve the clinical management of hypertensive patients with type 2 diabetes mellitus. Obese patients with type 2 diabetes mellitus and difficult to control arterial hypertension represent a clinically important patient group at high cardiovascular risk that may profit from combined cardiovascular and metabolic actions of a drug.

IL-18 predicts cardiac organ damage in a population of hypertensive patients

Objectives: Hypertensive patients (HTs) develop arterial and cardiac damage (TOD) which is a marker of cardiovascular-CV-morbidity. Inflammatory activation is also an important determinant of cardiovascular status. Interleukin-18 (IL-18), a strong predictor of CV disease and death, has been related to plaque progression and vulnerability. We investigated whether IL-18 plays a role in TOD development in the arteries and heart in an essential hypertensive population.

123 Comprehensive Cardiovascular MRI for the non-invasive Assessment of Patients with Systemic Hypertension

BackgroundHypertensive disease is a major risk factor for cardiovascular morbidity and mortality. Cardiovascular MRI not only provides a non-invasive method for the assessment of potential secondary causes of hypertension (including...

Hallazgos electrocardiográficos en pacientes hipertensos del programa de vigilancia y control de la hipertensión arterial de ASSBASALUD ESE, Manizales, Colombia

Antecedentes. La hipertension arterial sistemica es una enfermedad multifactorial que incluye la elevacion de las cifras de tension arterial, factores de riesgo cardiovascular e hipertrofia ventricular izquierda. Objetivo. Analizar los cambios electrocardiograficos en pacientes hipertensos inscritos en el programa de hipertension arterial en ASSBASALUD Empresa Social del Estado, Manizales, Colombia, 2012. Materiales y metodos. Estudio poblacional de corte transversal. 102 pacientes. Variables electrocardiograficas analizadas: indices de Cornell, Sokolow Lyon y Macruz; cambios en la onda P y cambios en el eje. Se tomo electrocardiograma. Resultados. Edad promedio de 62 anos. El 58,5% de los pacientes estudiados se clasificaron como pre-hipertensos, el 18,6% tenian frecuencia cardiaca superior a 100 latidos por minuto. Se encontraron cambios en la onda P en el 26,3%. En el 34% el eje estaba desviado. 64,6% tenian indice de Macruz anormal. 10,8% mostraron aumento en el voltaje del indice Sokolow-Lyon. En un 10,8% el voltaje de Cornell estaba elevado. En un 5,1% la fuerza terminal de onda P fue mayor a 40. Un 7,8% tenian bloqueos de rama derecha. En los pacientes con niveles altos de la presion arterial se encontro relacion significativa con la elevacion en los indices de Cornell (p=0,000) y de Sokolow-Lyon (p=0,016). Se encontro relacion significativa entre los valores elevados de la presion arterial sistolica y los cambios en los indices de Cornell (p=0,010) y Sokolow- Lyon (p=0.001), los valores de la presion arterial diastolica se asociaron mas a cambios en el Sokolow-Lyon (p=0,001). Conclusiones. Se confirma en esta poblacion de hipertensos la asociacion entre hipertension arterial y cambios electrocardiograficos, especialmente en los indices de Cornell y de Sokolow-Lyon.

Development and Validation of the Hypertension Self-care Profile

Adequate self-care is crucial for blood pressure control. A number of hypertension (HBP) self-care instruments are available, but existing tools do not capture all the critical domains of HBP self-care and have limited evidence of reliability and validity. The purpose of this study was to develop and validate a new tool--the HBP Self-Care Profile (HBP SCP)--in a sample of inner-city residents. The HBP SCP encompasses comprehensive domains of HBP self-care behaviors. Guided by 2 validated theoretical approaches--Orem's self-care model and Motivational Interviewing--the HBP SCP includes 3 scales that can be used together or independently: Behavior, Motivation, and Self-efficacy. The sample included 213 English-speaking inner-city residents with HBP (mean age, 68.6 years; 76.1% women; 81.7% African American). Item-total correlations ranged from 0.20 to 0.63 for Behavior, 0.46 to 0.70 for Motivation, and 0.40 to 0.74 for Self-efficacy, meeting the cutoff set a priori at 0.15. Internal consistency reliability coefficients ranged from 0.83 to 0.93. Concurrent and construct validities of the HBP SCP were achieved by significant correlations between HBP SCP scales and theoretically selected instruments (P < .05 for all correlation coefficients). The HBP SCP-Behavior scale also successfully discriminated between those with or without blood pressure control (P < .05). The reliability and validity of the HBP SCP were supported in this sample of inner-city residents with HBP. The high reliability estimates and strong evidence of validity should allow researchers to use the HBP SCP to assess and identify gaps in HBP self-care behavior, motivation, and self-efficacy. Future research is warranted to evaluate the HBP SCP in diverse ethnic and age samples of hypertensive patient populations.

When does low normal blood pressure become too low? The J-curve phenomenon

The J-shaped relationship between blood pressure lowering and cardiovascular morbidity and mortality has been the topic of debates in the last three decades, especially because it has been shown that this relationship is not the same in different populations of hypertensive patients. This phenomenon is very important from a clinical point of view because it determines blood pressure cut-off values in patients with different comorbidities (diabetes, coronary artery disease, kidney disease, previous stroke). There is still no consensus about the J-shaped relationship. However, the number of studies supporting the existence of the inverse relationship between blood pressure reduction, especially diastolic pressure lowering, and cardiovascular morbidity and mortality, is increasing each year. The aim of this review is to summarize current knowledge about the J curve in a different population of hypertensive patients.

Growth hormone secretagogue receptor deficiency in mice protects against obesity-induced hypertension

Growth hormone secretagogue receptor (GHS‐R) signaling has been associated with growth hormone release, increases in food intake and pleiotropic cardiovascular effects. Recent data demonstrated that acute GHS‐R antagonism leads to increases in mean arterial pressure mediated by the sympathetic nervous system in rats; a highly undesirable effect if GHS‐R antagonism was to be used as a therapeutic approach to reducing food intake in an already obese, hypertensive patient population. However, our data in conscious, freely moving GHS‐R deficient mice demonstrate that chronic absence of GHS‐R signaling is protective against obesity‐induced hypertension. GHS‐R deficiency leads to reduced systolic blood pressure variability (SBPV); in response to acute high‐fat diet (HFD)‐feeding, increases in the sympathetic control of SBPV are suppressed in GHS‐R KO mice. Our data further suggest that GHS‐R signaling dampens the immediate HFD‐mediated increase in spontaneous baroreflex sensitivity. In diet‐induced obesity, absence of GHS‐R signaling leads to reductions in obesity‐mediated hypertension and tachycardia. Collectively, our findings thus suggest that chronic blockade of GHS‐R signaling may not result in adverse cardiovascular effects in obesity.

Serum uric acid and its relationship with metabolic syndrome and cardiovascular risk profile in patients with hypertension: Insights from the I-DEMAND study

Background and aimsThe independent role of serum uric acid (SUA) as a marker of cardio-renal risk is debated. The aim of this study was to assess the relationship between SUA, metabolic syndrome (MS), and other cardiovascular (CV) risk factors in an Italian population of hypertensive patients with a high prevalence of diabetes. Methods and resultsA total of 2429 patients (mean age 62 ± 11 years) among those enrolled in the I-DEMAND study were stratified on the basis of SUA gender specific quartiles. MS was defined according to the NCEP-ATP III criteria, chronic kidney disease (CKD) as an estimated GFR (CKD-Epi) <60 ml/min/1.73 m2 or as the presence of microalbuminuria (albumin-to-creatinine ratio ≥2.5 mg/mmol in men and ≥3.5 mg/mmol in women).The prevalence of MS, CKD, and positive history for CV events was 72%, 43%, and 20%, respectively. SUA levels correlated with the presence of MS, its components, signs of renal damage and worse CV risk profile. Multivariate logistic regression analysis revealed that SUA was associated with a positive history of CV events and high Framingham risk score even after adjusting for MS and its components (OR 1.10, 95% CI 1.03–1.18; P = 0.0060; OR 1.28, 95% CI 1.15–1.42; P < 0.0001). These associations were stronger in patients without diabetes and with normal renal function. ConclusionsMild hyperuricemia is a strong, independent marker of MS and high cardio-renal risk profile in hypertensive patients under specialist care. Intervention trials are needed to investigate whether the reduction of SUA levels favorably impacts outcome in patients at high CV risk.

Echocardiographic Changes in Patients with ESRD on Maintenance Hemodialysis-A Single Centre Study

Objective: To evaluate and analyze the echocardiographic changes in end stage renal disease patients on maintenance hemodialysis. Material and methods: End stage renal disease (ESRD) patients on maintenance hemodialysis for at least 3 months were included in the study. We performed M-mode echocardiography in 35 ESRD patients during interdialytic period usually after 18 hours, without obvious clinical evidence of coronary artery disease, valvular heart disease, congenital heart disease and pericardial effusion. Results: Echocardiography revealed LV dilation and diastolic dysfunction in 18 (51.2%), left ventricular hypertrophy (LVH) in 17 (48%), systolic dysfunction and pericardial effusion in 10 (28.57%) and 6 (17.14%) patients respectively. RWMA was present in 8.5% and valvular calcification was not seen in our patient group. In sub-group of patients with Hb<10 gm%, LVH was present in 71.42% (15) vs 14.28% (2) in patient group with Hb ≥ 10 gm% (p=0.002). Hypertensive patient population also had higher prevalence of LVH (51.85%)] and systolic dysfunction and RWMA was absent in normotensive group. Conclusion: LV diastolic dysfunction and hypertrophy were most common echocardiographic findings. There was statistically significant correlation between anemia and presence of LVH and positive correlation between presence of hypertension and LVH.

The study of management of hypertensive people aged 35 and over in communities in China

To investigate the community-based management status of hypertensive patients aged 35 or over in China and provide basic data for evaluation by investigating the hypertensive patients managed in communities. The subjects in this study were recruited from the individuals of the 2010 China Non-communicable and Chronic Diseases. In September 2011, flow-up survey and a cross-section analysis has been done during the same people interviewed in 2010. Clustering sampling method was used to select 11 977 samples aged 35 or over and diagnosed by doctors from community level or above hospitals to be interviewed. A face to face questionnaire survey was carried out to collect information on general demographic characteristics, the treatment and control of blood pressure and risk factors of the hypertensive patients of community management.Sample was weighted according to complex sampling scheme and post-stratification to represent the population of Chinese hypertensive patients aged 35 or over and the rates with 95% confidence intervals (CI) were calculated for the subgroups according to different characteristics. The Rao-scott χ(2) test was performed to test for the differences of the rates of the subgroups. In the survey, there were 11 977 patients aged 35 or over diagnosed as hypertension by doctors, and among them, a total of 5120 hypertensive patients had been under management in communities. After being weighted the rate of management of hypertensive patients in communities was 43.99% (95%CI:38.17%-49.81%). There was a significant difference in the proportion of patients receiving management services when comparing different age groups (χ(2) = 21.98, P < 0.01) and sex (χ(2) = 4.18, P < 0.05), the rate of management among the patients aged 65 or over was 46.97% (95%CI:40.44%-53.50%), while among the patients aged 35 to 44 was only 37.72% (31.78%-43.65%). The rate of management was higher among females (45.37%, 95%CI:39.24%-51.50%) than males (42.50%, 95%CI:36.71%-48.30%). The overall rate of standardized management of hypertensive patients managed in communities was 35.30% (95%CI:31.78%-38.81%). The research also found differences in the proportions of patients receiving standardized management services when comparing different age groups (χ(2) = 28.66, P < 0.05), gender (χ(2) = 235.85, P < 0.01), and regions (χ(2) = 9.29, P < 0.05). The rate of receiving standardized management services among the patients aged 65 or over was 40.52% (95%CI:36.21%-44.82%), while among the patients aged 35 to 44 was only 26.18% (95%CI:20.07%-32.29%), the rate was lower among males (16.78%, 95%CI:14.13%-19.42%) than females(51.29%, 95%CI:46.41%-56.16%) , the rate of patients living in urban areas (38.53%, 95%CI:34.34%-42.72%) was higher than patients living in rural areas (33.36%, 95%CI:28.17%-38.55%) . The differences of the treatment rates of hypertensive patients managed in communities were found among different age groups (χ(2) = 26.39, P < 0.01), gender (χ(2) = 13.91, P < 0.01), and regions (χ(2) = 4.27, P < 0.05), the rate of treatment was 94.67% (93.41%-95.93%) among the patients aged 65 or over , while 86.47% (95%CI:81.05%-91.89%) among patients aged 35 to 44, the rate of treatment was higher among females (94.35%, 95%CI:93.15%-95.55%) than among males (90.84%, 95%CI:88.99%-92.70%), and it was also higher among patients living in urban regions (94.17%, 95%CI:92.62%-95.71%) than among patients living in rural regions (91.86%, 95%CI:90.20%-93.52%). The rate of control of hypertensive patients managed in communities was 33.13% (95%CI:29.50%-36.76%) and the rate was higher among the subjects living in the urban areas (45.09%, 95%CI:38.73%-51.45%) than in rural areas (25.96%, 95%CI:21.63%-30.30%) (χ(2) = 22.40, P < 0.01). Results from our study showed that community management of hypertension had been popularized across the country. And it could significantly improve the program on the treatment and control of hypertension at the community level in China.

Blood Pressure Levels and Stroke: J-curve Phenomenon?

The blood pressure J-curve discussion has been ongoing for more than 30 years, yet there are still questions in need of definitive answers. On one hand, existing antihypertensive therapy studies provide strong evidence for J-curve-shaped relationships between both diastolic and systolic blood pressure and primary outcomes in the general hypertensive patient population, as well as in high-risk populations, including subjects with coronary artery disease, diabetes mellitus, left ventricular hypertrophy, and the elderly. On the other hand, we have very limited data on the relationship between systolic and diastolic blood pressure and stroke prevention. Moreover, it seems that this outcome is more a case of “the lower the better.” Further large, well-designed studies are necessary in order to clarify this issue, especially as existing available studies are observational, and randomized trials either did not have or lost statistical power and were thus inconclusive.

Nitric oxide is less effective at inhibiting neointimal hyperplasia in spontaneously hypertensive rats

Exogenous administration of nitric oxide (NO) markedly decreases neointimal hyperplasia following arterial injury in several animal models. However, the effect of NO on neointimal hyperplasia in hypertension remains unknown. Here, we employ the spontaneously hypertensive rat (SHR) strain, inbred from Wistar Kyoto (WKY) rats, and the carotid artery balloon injury model to assess the effects of NO on neointimal hyperplasia development. 2weeks after arterial injury, we showed that both rat strains developed similar levels of neointimal hyperplasia, but local administration of NO was less effective at inhibiting neointimal hyperplasia in the SHR compared to WKY rats (58% vs. 79%, P<0.001). Interestingly, local administration of NO did not affect systemic blood pressure in either rat strain. Compared to WKY, the SHR displayed more proliferation in the media and adventitia following balloon injury, as measured by BrdU incorporation. The SHR also showed more inflammation in the adventitia after injury, as well as more vasa vasorum, than WKY rats. NO treatment reduced the vasa vasorum in the SHR but not WKY rats. Finally, while NO decreased both injury-induced proliferation and inflammation in the SHR, it did not return these parameters to levels seen in WKY rats. We conclude that NO is less effective at inhibiting neointimal hyperplasia in the SHR than WKY rats. This may be due to increased scavenging of NO in the SHR, leading to diminished bioavailability of NO. These data will help to develop novel NO-based therapies that will be equally effective in both normotensive and hypertensive patient populations.

Abstract 352: A Common Hypofunctional Genetic Variant of GPER: Increased Blood Pressure in Female Carriers and Increased Expression in Female Hypertensive Patients

Activation of the aldosterone/estrogen GPCR, GPER, has been linked to vasodepressor effects. Further, genetic deletion of GPER in one mouse model has been linked to increased blood pressure in female but not male mice. However, the significance of GPER regulation for chronic blood pressure control in humans is unknown. To examine this question we determined the functional significance of expression of a common missense single nucleotide variant of GPER, P16L, and the impact of its expression on blood pressure and in the development of hypertension. Expression of the GPER P16L variant in rat aortic vascular smooth muscle cells vs. expression of wild type (WT) GPER, was associated with a significant decrease in G1 (1μM, a GPER agonist)-mediated ERK activation and G1-mediated inhibition of apoptosis. In normotensive subjects, expression of this hypofunctional GPER variant (allele frequency=22%) paralleled an increase in mean arterial blood pressure in females [P16/P16: 80±1 mmHg (n=236) vs P16L carriers: 82±1 mmHg (n=156), p&lt;0.05] but not in males. To validate the importance of expression of the GPER P16L variant on the development of hypertension, we compared the allele frequency in normotensive vs. hypertensive subjects, the latter recruited from patients referred to a tertiary care level hypertension clinic (n=151). In this hypertensive patient population, the P16L allele frequency was increased in female patients with hypertension (1.4 fold, p&lt;0.05 vs. allele frequency in normotensives) but was not increased in hypertensive males. In summary, we have determined that the common genetic variant, P16L GPER, is hypofunctional and that expression of this missense single nucleotide polymorphism is associated with increased blood pressure in normotensive subjects and with an increased frequency in hypertensive female but not male patients. Cumulatively, these data suggest that in females, impaired GPER function is associated with increased blood pressure and risk of hypertension.

Clinical Management of Coronary Heart Disease in Hypertension

Hypertension is a major modifiable risk factor, which significantly and independently increases the risk of developing major cardiovascular (CV) complications, mostly myocardial infarction. On the other hand, an effective treatment of hypertension substantially reduces the risk of developing such complications. However, the control of blood pressure (BP) remains largely unsatisfactory in most Western countries, including Italy. Recent analysis of data collected at the European level on BP control rate have demonstrated, in fact, that only 20–30 % of treated hypertensive patients achieve the recommended BP goals [1–4]. For example, in our Country, results from observational studies conducted between 1995 and 2005 demonstrated that in more than 52,000 of treated hypertensive patients, about 39 % had grade 1 hypertension (140–159/90–99 mmHg) and about 32 % had grade 2 hypertension (160–179/100–109 mmHg) [5]. A recent update of this analysis, which took into account studies conducted in Italy from 2005 to 2011 and included approximately 160,000 patients with hypertension mainly followed in the context of General Practitioners, reported that only 57 % of patients with hypertension were adequately treated, among which only 37 % achieve effective BP control under treatment [6]. These results confirm that BP control amongst the hypertensive population is still largely unsatisfactory in Italy. Since hypertension is an ideal identifiable target to reduce global cardiovascular risk, it is clear that effective strategies, aimed at improving high BP control in the general population of hypertensive patients, represent a fundamental step of any preventive strategy in our Country, as well as in Western and Developing Countries, with subsequent beneficial effects for the National Health System. Based on these considerations, the Italian Society of Hypertension (SIIA) aims to generate, circulate and share a number of interventions to improve BP control in Italy. Among the various initiatives, which include integrated and concerted actions with General Practitioners, the implementation of hypertension awareness in the general population through a more extensive use of new media and social networks, a larger use of home BP measurements, a survey aimed at identifying all clinical and excellence centers for hypertension diagnosis and treatment distributed throughout the whole national territory, there is also the production of consensus documents [7, 8] and practical recommendations covering specific and controversial M. Volpe (&) A. Battistoni Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome ‘‘Sapienza’’, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy e-mail: massimo.volpe@uniroma1.it

The blood pressure lowering effects of renal denervation in a real world population of patients with uncontrolled hypertension: early outcomes from the Global SYMPLICITY registry

Purpose: The Global SYMPLICITY Registry was designed to assess the safety and effectiveness of low energy radiofrequency ablation of renal artery nerves using the Symplicity™ renal denervation system to lower blood pressure in a real world population of hypertensive patients. The registry will provide additional data regarding the effects of renal denervation on comorbid conditions that are postulated to be similarly influenced by increased sympathetic tone. Methods: The Global SYMPLICITY Registry is a prospective, open-label, multicentre study enrolling patients at up to 200 sites worldwide. Adult patients with uncontrolled hypertension who are considered appropriate candidates for renal denervation by their physician are treated with the Symplicity™ catheter according to the approved Instructions for Use. Office-based and ambulatory blood pressure measurements, changes in antihypertensive medications and measures of renal function, vascular complications and other protocol-defined safety events and other tests specific to the patient's clinical condition(s) are collected. Results: There are currently 752 patients enrolled with approximately half being enrolled in Germany. Based on preliminary data from 588 treated patients the mean age of patients is 60.0±12.8 years, 62.% are males, and 36.2% have at least one comorbidity (42.0% have diabetes mellitus, 8.5% have heart failure, 11.9% have a history of atrial fibrillation, 29.5% have chronic kidney disease, and 14.5% have sleep apnea). At baseline, those being treated for hypertension were taking an average of 4.2±1.3 anti-hypertensive medications and had an office systolic BP of 163.8±22.7 mm Hg. Change in office and ambulatory blood pressure at 3 and 6 month follow-up in approximately 200 real world patients treated with the Symplicity catheter will be available for presentation at ESC. Periprocedural and short-term safety will also be reported. Conclusion: Renal denervation can significantly lower blood pressure in patients with treatment-resistant hypertension. This large real world registry will provide a large body of safety and efficacy data to further guide appropriate use of RDN in diverse patient populations.

On-target antihypertensive treatment in Italy: The ISPIT (Indagine Sicoa Paziente Iperteso a Target) survey study

Hypertension represents the most important risk factor forincident cardiovascular events [1], and as such it represents a majorproblem for the National Health Care systems. However, 30–40% ofhypertensivepatientslackanadequatebloodpressure(BP)control,asdefined by BP values b140/90 mm Hg [1], in spite of therapy.Notwithstanding optimal BP control represents the goal of treatmentindependently on drugs administered, the results of recent RCT gaveindications for using specific classes of drugs in specific patients'population[1]andthisshouldbeconsidered.Inaddition,otherfactorswhich have been poorly investigated systematically might beimplicated in the lack of adequate BP control, such as the presenceof risk factors, the frequency and modalities of BP measurements, lifestyle etc. The present survey was conceived to provide an overallpicture on the extent to which BP is at target in the Italian populationof hypertensive patients, and to ascertain what are the conditionslinked to the lack (or achievement) of BP control.29 cardiology units located in different Italian areas belonging toSICOA Association (Societa Italiana Cardiologia Ospedalita Accred-itata)onlyparticipatedtothestudythatincludedconsecutivepatientsreferred in a 3-month period. All information were collected at thetime of enrollment using a questionnaire. Target BP was defined as BPb140/90 mm Hg, as measured by sphygmomanometry at the time ofenrollment [1]. Patients were considered physically active if theyreferredtoperformregularaerobicphysicalactivityforatleast30 minatleast3 daysperweek.Agewassummarizedinthreeclasses(18 –65;66–75; ≥76), and drugs assumption in three categories (1, 2 and 3 or moredrugs). Group comparisons were performed using univariate non-parametric statistics. The association between failure in achieving BPcontrol and potential explanatory variables was modelled by means ofunconditional logistic regression. All estimates were adjusted forconfounders,e.g.,age,gender,etc.[2].APvalueofb0.05wasconsideredsignificant.TheauthorscompliedwiththePrinciplesofEthicalPublishingin the International Journal of Cardiology.The population consisted in 1539 patients, 45% females and 55%males. No significant difference in BP between center–south and northItalywasfound.ThepercentageofpatientsachievingtargetBPwas60%independently on geographic distribution and age class. SBP and DBPvalues were 127.5 ± 11.7/76.7 ± 7.4 mm Hg in patients at target vs152.4 ± 16.8/87.1 ± 9.7 mmHg in patients not at target, respectively.75%ofpatientsfeaturedatleastoneriskfactor,and36%twoormoreriskfactors. The most common was the lack of physical activity (70%).Diabetes and dyslipidemia were present in 48% and 24% of patients,respectively.17%ofpatientsweresmokers. Table1 summarizessignificantassociations from logistic regression analysis. Among all variablesinvestigated, diabetes and overweight were the only predictors of thelack of BP control. Odds ratio (OR) for BP not at target was 1.44 (IC 1.13 –1.82, P = 0.003) in patients with diabetes and 1.40 (IC 1.08 –1.82,P=0.01)and1.80(IC1.32–2.39, P = 0.001) in overweight and obesepatients, respectively. The lack of physical activity showed a strong trendforBPnotattarget,(OR0.81,IC0.64–1.02, P = 0.06).Fig.1 illustrates the modality and frequency of BP measurements.The majority of patients (67%) declared to measure BP by themselves,with a most common frequency of once a week (41%). Only a smallpercentage had BP measured by a specialist and a relatively largepercentage measured BP occasionally (8%). The univariate analysisrevealed as BP self-measurement was associated to a significantlygreater probability to reach BP target (56 vs 37%, P = 0.008). Beta-blockers were the drugsmore frequently prescribed(44%),followedbyACE-inhibitors (33%), ARBs (29%) and calcium channel blockers (28%).No relationship was found between the class of drugs or their numberand the achievement of target BP.ThissurveyconfirmsthatalsoinItalytheproportionofhypertensivepatients not at target for BP is around 40% [1], without differencesrelatedtogeographicaldistribution[3].Italsoconfirmsthatcomorbidity

Does obesity influence target organ damage and outcomes in patients with malignant phase hypertension? The West Birmingham Malignant Hypertension Project

Several studies have suggested that hypertension has a stronger detrimental impact on cardiovascular outcome in lean than in obese persons, but neutral or opposite results have also been reported. We investigated the impact of baseline body mass index (BMI) at presentation with the most severe form of hypertension, that is, malignant phase hypertension (MPH) on the primary outcome of 'death or dialysis' in these patients. A total of 184 patients (overall mean (s.d.) age 48 (13) years; 61% male; 62% White-European; 20% African-Caribbean, 18% South-Asian) from the West Birmingham MPH Register were included. The patients were grouped according to their BMI (underweight, normal weight, overweight and obese groups). Ninety-three primary outcomes occurred during a median (interquartile range) follow-up of 10.7 (5.8-18.6) years. No significant baseline differences in age or ethnicity were seen between the study groups. Overweight and obese patients included a larger proportion of females, but less smokers than those underweight or of normal weight. There was no inter-group difference in retinopathy (P=0.25), proteinuria (P=0.08), haematuria (P=0.56) and left ventricular hypertrophy (P=0.14). In univariate analyses, BMI was predictive of death or dialysis (0.95 (0.90-1.00), P=0.046) but multivariate analyses showed that only baseline age (odds ratio (95% confidence intervals) 1.06 (1.03-1.09), P<0.001), smoking (2.89 (1.40-5.92), P=0.004), creatinine level (1.01 (1.01-1.02), P=0.001) and estimated glomerular filtration rates (0.99 (0.93-1.00), P=0.047) were independently associated with death or dialysis. BMI was not an independent predictor of adverse outcomes in MPH patients. Age, smoking status, creatinine levels and estimated glomerular filtration rates at diagnosis of MPH were independent predictors for death or dialysis in this high-risk population of hypertensive patients.