Management Of Arterial Hypertension Research Articles

Mechanisms and treatment of pulmonary arterial hypertension.

Substantial progress has been made in the management of pulmonary arterial hypertension (PAH) in the past 25 years, but the disease remains life-limiting. Established therapies for PAH are mostly limited to symptomatic relief by correcting the imbalance of vasoactive factors. The tyrosine kinase inhibitor imatinib, the first predominantly non-vasodilatory drug to be tested in patients with PAH, improved exercise capacity and pulmonary haemodynamics compared with placebo but at the expense of adverse events such as subdural haematoma. Given that administration by inhalation might reduce the risk of systemic adverse effects, inhaled formulations of tyrosine kinase inhibitors are currently in clinical development. Other novel therapeutic approaches for PAH include suppression of activin receptor type IIA signalling with sotatercept, which has shown substantial efficacy in clinical trials and was approved for use in the USA in 2024, but the long-term safety of the drug remains unclear. Future advances in the management of PAH will focus on right ventricular function and involve deep phenotyping and the development of a personalized medicine approach. In this Review, we summarize the mechanisms underlying PAH, provide an overview of available PAH therapies and their limitations, describe the development of newer, predominantly non-vasodilatory drugs that are currently being tested in phase II or III clinical trials, and discuss future directions for PAH research.

Four-Strata Risk Assessment in Patients with Pulmonary Arterial Hypertension Treated with Selexipag in Real-World Settings (EXPOSURE Study).

Risk assessment can aid management of pulmonary arterial hypertension (PAH) and clinical decision-making. This analysis describes characteristics, treatment patterns and outcomes of patients with PAH, categorised by risk status at time of treatment escalation with selexipag in clinical settings. Patients initiating selexipag in the ongoing multicentre, prospective EXPOSURE (EUPAS19085) study were grouped as low, intermediate-low, intermediate-high or high risk of 1-year mortality according to the ESC/ERS 4-strata method. As of November 2022, 77% (535/698) of patients initiating selexipag had data allowing for risk calculation; 14% (N = 76) were low, 31% (N = 168) intermediate-low, 34% (N = 182) intermediate-high and 20% (N = 109) high risk of 1-year mortality. Overall, patients were predominantly female (71%), with idiopathic/heritable PAH (56%) or PAH associated with connective tissue disease (CTD-PAH; 27%), median age of 60years and prevalent (2years) disease. From low to high risk, proportion of CTD-PAH and age increased (from 12%-40% and 46-68years, respectively); time from diagnosis decreased and presence of cardiovascular risk factors increased. Most patients across risk groups (74-81%) initiated selexipag as part of triple oral combination therapy. Overall median (Q1, Q3) selexipag exposure duration was 10.1 (3.5, 24.1) months. Proportions of hospitalised patients increased with increasing risk group (16-42% from low to high, respectively); more hospitalisations were PAH-related for the high risk (71%) versus other risk groups (47-54%). Kaplan-Meier survival estimates were 98%, 98%, 93% and 80% at 1-year and 98%, 92%, 81% and 67% at 2-years, from low to high risk, respectively. In clinical settings, selexipag is initiated across all risk groups, predominantly as triple therapy. Only 45% of patients being at low/intermediate-low risk at selexipag initiation suggests an opportunity for more frequent patient monitoring and earlier treatment escalation, given that 4-strata risk assessment was prognostic for hospitalisations and survival in this contemporary PAH cohort. A graphical abstract is available with this article.

Diagnostic and Therapeutic Advances in Pulmonary Arterial Hypertension Management - A Literature Review

Diagnostic and Therapeutic Advances in Pulmonary Arterial Hypertension Management - A Literature Review

Office or home versus 24-hour blood pressure measurement in stable kidney transplant recipients.

The aim of this study was to quantify hypertension control and evaluate concordance between all commonly available blood pressure modalities in kidney transplant recipients (KTR). For this prospective cross-sectional study 89 stable KTR were recruited at the Charité Transplant Outpatient Clinic. For each study participant office (manual office blood pressure 'MOBP' and automated office blood pressure 'AOBP'), 7-day home (HBPM) and 24-hour ambulatory blood pressure measurement (24h-ABPM) were performed. 80 of the 89 patients recruited had sufficient blood pressure recordings. Mean blood pressure for MOBP, AOBP, HBPM and 24h-ABPM was 129/73, 126/71, 131/85 and 130/81mmHg, respectively. Uncontrolled hypertension, as defined by 24h-ABPM (mean≥130/80mmHg), was present in 53 (66%) patients. MOBP, AOBP and HBPM classified 19 (24%), 22 (28%) and 41 (51%) patients respectively as 'uncontrolled hypertensive'. The Bland-Altman plot showed good agreement between systolic MOBP, AOBP, HBPM and Daytime-ABPM (mean bias±SD: -1±13mmHg, -4±13mmHg, 1±10mmHg, respectively). Uncontrolled nighttime hypertension was present in 74 (93%) KTR, with 71 (89%) patients showing a non-physiological dipping pattern. Moderate positive correlation between Daytime-ABPM/HBPM and Nighttime-ABPM (Pearson Correlation Coefficients: 0.62-0.73), followed by MOBP/AOBP (Pearson Correlation Coefficients: 0.49-0.59) was noted. eGFR and proteinuria displayed weak correlation with 24h-, Daytime- and Nighttime-ABPM (absolute values of Pearson Correlation Coefficients: 0.04-0.41). No robust association with either 24h-, Daytime- or Nighttime-ABPM was observed for volume status exams. Masked hypertension is highly prevalent in KTR, especially due to high rates of uncontrolled nighttime hypertension. HBPM shows the narrowest limits of agreement with Daytime-ABPM. Daytime-ABPM and HBPM show the highest, albeit clinically insufficient, correlation with Nighttime-ABPM. Systematic integration of 24h-ABPM into clinical practice, as proposed by the '2023 ESH Guidelines for the Management of arterial hypertension', should not be withheld for the KTR population. Clinical trials evaluating treatment of hypertension in KTR are urgently needed.

Comparison Between REVEAL Lite 2 and COMPERA 2.0 for Risk Stratification in Pulmonary Arterial Hypertension

BackgroundRisk stratification is the cornerstone of the management of pulmonary arterial hypertension (PAH). Current ESC/ERS guidelines recommend using the COMPERA 3-strata risk model at baseline, and the COMPERA 2.0 4-strata model at follow-up. However, the guidelines did not take into consideration other available risk scores such as REVEAL Lite 2. Research QuestionIs REVEAL Lite 2 better at discriminating risk than the COMPERA risk assessment models at baseline or follow up evaluations? Study Design and MethodsWe analyzed data from the consecutively enrolled PAH patients between the period of June 2011 to February 2022 in the PAH registry at our expert Pulmonary Hypertension Center. Patients were stratified according to REVEAL Lite 2, COMPERA 3-, and 4-strata risk scores at baseline and follow up to predict the composite outcome for lung transplantation or death. ROC curves in predicting the binary outcome at 3, 5 and 7 years were plotted. Areas under the curve (AUC) of the scores were compared by the chi-square test. The performance of the scores was determined by Harrel’s C-statistic. Results296 patients were included for baseline and 196 for follow up evaluation. The overall transplant-free survival in our patient population at 1, 3, 5, and 7 years was 93.6%, 81.3%, 75.1%, and 68.8% respectively. At baseline, the C-statistic of REVEAL Lite 2 was 0.74 (0.69, 0.80), compared to 0.68 (0.63, 0.74) for the COMPERA 4-strata model, and 0.63 (0.58, 0.69) for the COMPERA 3-strata model. All C-statistic differences between REVEAL Lite 2 and the other models were statistically significant at baseline. InterpretationOur analysis showed that REVEAL Lite 2 was better at baseline at discriminating risk in our patient population. Future guidelines should consider including REVEAL Lite 2 in the management algorithm to help clinicians to make informed decisions. Further analysis in larger cohorts could help validate these findings.

A European Renal Association (ERA) synopsis for nephrology practice of the 2023 European Society of Hypertension (ESH) Guidelines for the Management of Arterial Hypertension.

In June 2023, the European Society of Hypertension (ESH) presented and published the new 2023 ESH Guidelines for the Management of Arterial Hypertension, a document that was endorsed by the European Renal Association (ERA). Following the evolution of evidence in recent years, several novel recommendations relevant to the management of hypertension in patients with chronic kidney disease (CKD) appeared in these Guidelines. These include recommendations for target office blood pressure (BP) <130/80mmHg in most and against target office BP <120/70mmHg in all patients with CKD; recommendations for use of spironolactone or chlorthalidone for patients with resistant hypertension with estimated glomerular filtration rate (eGFR) higher or lower than 30mL/min/1.73m2, respectively; use of a sodium-glucose cotransporter 2 inhibitor for patients with CKD and estimated eGFR ≥20mL/min/1.73m2; use of finerenone for patients with CKD, type 2 diabetes mellitus, albuminuria, eGFR ≥25mL/min/1.73m2 and serum potassium <5.0mmol/L; and revascularization in patients with atherosclerotic renovascular disease and secondary hypertension or high-risk phenotypes if stenosis ≥70% is present. The present report is a synopsis of sections of the ESH Guidelines that are relevant to the daily clinical practice of nephrologists, prepared by experts from ESH and ERA. The sections summarized are those referring to the role of CKD in hypertension staging and cardiovascular risk stratification, the evaluation of hypertension-mediated kidney damage and the overall management of hypertension in patients with CKD.

Hypertension in pregnancy - What´s new in the 2023 ESH Guidelines for the management of arterial hypertension.

Hypertension in pregnancy - What´s new in the 2023 ESH Guidelines for the management of arterial hypertension.

Possibilities of Using the National Electronic Data Syetstem in Assessing the Control of Arterial Hypertension at The Primary Health Care Level in the Kyrgyz Republic Using the Example of a Single Family Medicine Center.

To determine the capabilities of the National Electronic System for collecting quantitative data necessary to assess the quality of management and effectiveness of arterial hypertension (AH) control at the primary health care (PHC) level and to develop indicators and possibilities of their use for a standardized report on the quality of AH management and control at the PHC level in the Kyrgyz Republic. Data from electronic outpatient records were processed for all registered patients of a pilot family medicine center (FMC) that was selected randomly. The registered patient group consisted of 91,226 people older than 18 years, including 37,740 men and 53,486 women. The data obtained during contact with a patient was entered by the family doctor into the electronic outpatient record and automatically forwarded to the center that collected and aggregated the data. To monitor AH control, 11 indicators were developed and evaluated. The indicators were divided into 3 groups: indicators for identifying AH, indicators for the quality of AH patient management, and indicators for the effectiveness of AH control. In total, 26,206 patients (7,933 men and 18,273 women) visited the FMC during a year, and blood pressure (BP) was measured in 71.4% of them. In 2022, 5,072 patients (5.6% of the registered group) visited the FMC for AH, including 1,539 men and 3,533 women (4.1 and 6.6% of the registered patient group, respectively; p&lt;0.001). The proportion of patients with AH who, according to the clinical protocol, had their BP measured 2 times a year or more, was 81.4% and was slightly higher for women than for men (82.3% and 79.1%, respectively; p&lt;0.01). 38.7% of AH patients received antihypertensive drugs. Lipid-lowering therapy was prescribed to 23.5% of AH patients. The proportion of AH patients taking acetylsalicylic acid was higher, 36.3% for the whole group, including 34.1% for men and 37.2% for women (p&lt;0.05). The efficacy of AH treatment was 62.8%. Any monitoring system has limitations for the amount of useful data that can be obtained ensuring their proper quality. Taking this into account, two major indicators are suggested to use for evaluating the effectiveness of AH control at the PHC level: 1) the number of AH patients who have achieved the BP goal; 2) the number of AH patients who visited a medical institution (health care facility) during a calendar year relative to the number of registered patients (AH detectability).

Concurrent exercise training potentiates the effects of angiotensin-converting enzyme inhibitor on regulatory systems of blood pressure control in ovariectomized hypertensive rats.

Enalapril has shown satisfactory potential in controlling increased and sustained blood pressure (BP). However, multiple dysregulated mechanisms that interact with each other and are involved in the pathophysiology of arterial hypertension may not be affected, contributing to the remaining cardiovascular risk. Using an exercise training protocol, we investigated whether adding both approaches to arterial hypertension management could promote higher modulation of regulatory mechanisms of BP in postmenopausal rats. Spontaneously hypertensive rats were allocated into sedentary (S) and ovariectomized groups: sedentary (OS), sedentary treated with enalapril maleate (OSE) and trained treated with enalapril maleate (OTE). Both the pharmacological and exercise training protocols lasted for 8 weeks. The BP was directly recorded. Inflammation and oxidative stress were evaluated in the cardiac tissue. Although BP reduction was similar between OSE and OTE, trained group showed lower vasopressor systems outflow after sympathetic ganglion blocking by hexamethonium (mean BP) (OTE: -53.7 ± 9.86 vs. OS: -75.7 ± 19.2 mmHg). Bradycardic and tachycardic response were increased in OTE group (-1.4 ± 0.4 and -2.6 ± 0.4 vs. OS: -0.6 ± 0.3 and -1.3 ± 0.4 bpm/mmHg, respectively), as well as BP variability. In addition, the combination of approaches induced an increase in interleukin 10, antioxidant defense (catalase and glutathione peroxidase) and nitrite levels compared with the OS group. Despite similar BP, the inclusion of exercise training in antihypertensive drug treatment exacerbates the positive adaptations induced by enalapril alone on autonomic, inflammatory and oxidative stress profiles, probably affecting end-organ damage and remaining risk.

Vessels and pressures: Update on the management of pulmonary arterial hypertension

Vessels and pressures: Update on the management of pulmonary arterial hypertension

A Single Center Experience of Pulmonary Arterial Hypertension Management in Korea: A 25-Year Comparative Analysis Following the Introduction of Targeted Therapy

A Single Center Experience of Pulmonary Arterial Hypertension Management in Korea: A 25-Year Comparative Analysis Following the Introduction of Targeted Therapy

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA): Erratum.

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA): Erratum.

Assessing the accuracy of an online chat-based artificial intelligence model in providing recommendations on arterial hypertension in accordance with the 2018 ESC/ESH guidelines

Abstract Background The rise of online chat-based artificial intelligence (AI) models has opened up new possibilities in the field of medicine. One of the promising contributions of AI chatbots could be their ability to provide accurate and accessible medical information to patients. This could help bridge the gap between patients and healthcare providers, especially in under-resourced areas where access to medical information and care is limited. Purpose We aimed to evaluate the ability of a commercially available AI-based online chat to provide answers to commonly asked questions related to arterial hypertension in accordance with the latest 2018 ESC/ESH guidelines (1). Methods We selected 30 commonly asked questions covering a range of arterial hypertension topics, including risk factors, symptoms, diagnosis, and treatment. These questions were submitted to the online AI interface, and the responses were recorded and evaluated by a team of four experienced cardiologists from our institution. To ensure consistency, each question was asked three times. All questions – except question 2 – were preceded by "according to the 2018 ESC/ESH Guidelines for the management of arterial hypertension". Each answer was rated as "accurate," "inaccurate," or "incomplete" based on the specialists’ clinical judgment, the 2018 ESC/ESH guidelines, and the content of the response. A response was considered "accurate" if it included all essential information, "inaccurate" if information provided was not in accordance with the guidelines, and "incomplete" if any essential information was missing. Results The AI model's responses to 24 out of the 30 questions (80%) were deemed accurate by cardiologists. Three responses were rated as incomplete (10%) and three responses were found to be inaccurate (10%). The AI responses were consistent in 28 out of the 30 questions (93%) (Tables 1-2). Conclusion We found that a popular online AI model provided largely accurate responses to commonly asked arterial hypertension questions. These answers were mostly in accordance with the 2018 ESC/ESH guidelines on the management of arterial hypertension. While the use of chat-based AI in medicine is still in its early stages and current models are not intended for medical use, the potential for such technology to improve the healthcare experience for patients is significant.Table 1:(1) Assessment of AnswersTable 2:(2) Assessment of Answers

Risk assessment according to the presence of left heart disease phenotype in pulmonary arterial hypertension patients: a multicenter cohort study

Abstract Introduction Subclinical left heart disease (LHD) may impact the management of pulmonary arterial hypertension (PAH) [1]. Purpose To evaluate the influence of a LHD phenotype on PAH risk stratification. Methods We retrospectively reviewed the data of consecutive PAH patients followed at 7 tertiary centers from 2001 to 2021, and selected those with all parameters available to determine risk of death by means of the COMPERA and COMPERA 2.0 scores, both at baseline and at the first disease reassessment including right heart catheterization. These subjects were classified as no-LHD or LHD according to the AMBITION trial criteria, i.e. absence or presence, respectively, of ≥ 3 among body mass index ≥ 30 kg/m2, systemic hypertension, diabetes mellitus, and coronary artery disease; and/or pulmonary vascular resistance between 3 and 3.75 WU or between 3.75 and 6.25 WU together with pulmonary artery wedge pressure (PAWP) between 13 and 15 mmHg [2,3]. The characteristics between the 2 groups were compared by chi-square test, T-test, or Mann-Whitney test, and Kaplan-Meier curves for overall survival by log-rank test. Results Of 286 patients included in the analysis, 57 (20%) had a LHD phenotype. The first complete reassessment was performed 7 ± 5 months after baseline. Compared with no-LHD, subjects with LHD were older, had more often cardiovascular comorbidities, and had higher E/e’ ratio, left atrial area and PAWP, but had lower brain natriuretic peptide concentrations and better right ventricular function and pulmonary hemodynamics (Figure 1). They were also less commonly treated with phosphodiesterase inhibitors or riociguat (54% vs 70%, P=0.03) and dual oral therapy (26% vs 43%, P=0.03), while they used more beta-blockers (47% vs 16%, P&amp;lt;0.001) and ACE inhibitors or angiotensin receptor blockers (40% vs 21%, P=0.004). At baseline, the proportion of patients with low vs high risk was greater in LHD than in no-LHD with COMPERA, but not with COMPERA 2.0. Moreover, risk profile significantly improved during follow-up only in no-LHD with COMPERA, but in both groups with COMPERA 2.0 (Figure 1). While all-cause mortality was significantly different across baseline COMPERA and COMPERA 2.0 risk strata in no-LHD, either approach for risk stratification failed to discriminate LHD subgroups with different prognosis (Figure 2). However, both COMPERA and COMPERA 2.0 risk categories differentiated mortality in LHD at the first disease reassessment (log-rank P &amp;lt;0.001, not shown). Conclusions This study suggests that the performance of risk stratification scores COMPERA and COMPERA 2.0 in PAH subjects with a LHD phenotype is limited, although the former may retain value during follow-up. Alternative tools may be needed for prognostication in this patient subset.

Macitentan tadalafil Fixed Dose Combination (FDC) in treatment-naive and prior monotherapy patients with Pulmonary Arterial Hypertension (PAH): insights from A DUE

Abstract Background Combination therapy is recommended for the management of pulmonary arterial hypertension (PAH). The A DUE study showed that M/T FDC, a fixed dose combination (FDC) of the endothelin receptor antagonist (ERA) macitentan 10mg (M) and the phosphodiesterase type 5 inhibitor (PDE5i) tadalafil 40mg (T), led to a clinically relevant improvement in pulmonary vascular resistance (PVR) vs macitentan and tadalafil monotherapies in PAH patients. A clinically meaningful trend for improvement in 6-minute walk distance (6MWD) in favor of M/T FDC vs macitentan and tadalafil was observed. Purpose Here we analysed the effect of M/T FDC in the subgroups of treatment-naïve and prior monotherapy patients. Methods In A DUE 187 adult PAH patients in WHO functional class II / III were randomised 2:1:1 to M/T FDC, macitentan or tadalafil if treatment-naïve, 2:1 to M/T FDC or macitentan if on prior ERA, and 2:1 to M/T FDC or tadalafil if on prior PDE5i. The treatment effect of M/T FDC vs macitentan and M/T FDC vs tadalafil was calculated using ANCOVA models for PVR (geometric mean ratios [95% CL]) and for 6MWD (mean change [95% CL]) in treatment-naïve patients and in patients on prior monotherapy (ERA or PDE5i) at randomisation. Results Treatment effects for M/T FDC versus macitentan and versus tadalafil on the change in PVR and 6MWD are reported in the table for each subgroup, along with those for the overall population. The safety profile of M/T FDC was in line with the safety profiles of macitentan and tadalafil. Conclusions In A DUE, the effect of M/T FDC vs both monotherapies on PVR and 6MWD in treatment-naïve and prior ERA/PDE5i patients was consistent with that observed in the overall population.

Evaluation of patients engagement with a digital intervention for daily disease management in pulmonary arterial hypertension

Abstract Introduction Pulmonary arterial hypertension (PAH) is a chronic rare disease with a complex treatment that affects the daily life of patients and requires ongoing monitoring and assessment. In comparison with other chronic diseases, the application of digital health approaches to address patients’ needs in disease self-management has not been comprehensively studied [1], [2]. Within the framework of a clinical study, PAH patients’ engagement level and adherence to using a digital health platform have been studied. The platform allows patients to log health and lifestyle information while also providing structured content for patient education, medication reminders, and lifestyle coaching from a remote HC. Purpose The study aimed to measure the impact of the use of the platform on the Health-Related Quality of Life of the patients (HRQoL) and other clinical endpoints (patient’s functional status, signs and symptoms of PAH, patient costs and healthcare resource utilization) and also to assess patients’ engagement and satisfaction with the use of the platform. Method 53 PAH patients enrolled in a prospective, single cohort, multicentre study [3] from 5 specialized PAH units of reference public Spanish hospitals. The duration of the study was 6 months and to avoid interferences with routine clinical practice, clinical investigation visits matched the clinical guidelines for PAH patients in Spain, which recommend scheduling monitoring visits every 3-6 months. Questionnaires were administered to assess the QoL and satisfaction and for assessing the engagement levels, the app usage data has been analysed. Results Regarding the impact of platform usage for 6 months on the HRQoL and clinical endpoints of PAH patients, no statistically significant changes have been observed. However, as per the engagement, patients showed a great interest in using the app and connecting to the Health Coach (HC). More than 45% of patients finished 2 out of 4 levels of the structured educational content, 96.1% of patients used the activity logging feature. Over 79% of patients visited the app monthly and on average, the app was launched 1500 times per month. The communication between the patients and HC was steady during the study, another indication of adherence to the program. As per user experience, the overall outcomes of the questionnaire showed that 84.2% of patients considered that their needs have been met suggesting that the purpose of the program is well addressed. Additionally, 92.1% of patients were satisfied with the program and would use it again. Moreover, 94.7% of patients expressed that they would recommend the program to a PAH patient. Conclusion Elevated satisfaction and engagement levels of patients demonstrate that the digital intervention is useful for the patients and supports companionship and knowledge. In this context, the development of digital solutions provides opportunities to ensure continuous PAH patient care and patient empowerment.

Adherence to ESC guidelines for antihypertensive drug therapy: real-world survey from an EU country

Abstract Background Achieving optimal BP control in hypertensive patients (pts) remains a continuous challenge worldwide. Multiple factors are responsible for the low rates of BP control with suboptimal drug choice playing a key role. Practice guidelines should serve as evidence based foundation for optimal antihypertensive drug therapy but their impact in the real-world is variable. Purpose This retrospective study aimed: 1. To assess the prescription pattern of main classes of antihypertensive drugs and its association with comorbidities. 2. To compare prescription before and after the publication of the 2018 ESC/ESH guidelines for management of arterial hypertension, translated into local language (in 2019). Thus, prescriptions in the years 2018 and 2020 were compared. Dual combination of ACEi/ARB + CCB/thiazide-like diuretics (THI) or triple combination of ACEi/ARB + CBB + THI were considered as guidelines directed first line drugs (FLAD) i.e. adherence to guideline. Spironolactone (MRA) was considered as recommended drug for patients requiring ≥4 drugs. Methods We analysed prescribed drug therapy in a large patient cohort from the years 2018 and 2020 with 264 237 and 272 934 hypertensive pts, respectively. Pts were considered hypertensive after meeting at least one of two criteria: 1. Having been prescribed ≥ 121 standard drug doses of antihypertensive drugs in the year before the studied period. 2. Having at least 2 medical visits with the diagnosis of hypertension within 2 years before the studied period. Following comorbidities were considered as potential modifiers of drug therapy: ischemic heart disease (IHD), chronic heart failure (CHF), atrial fibrillation (AF), diabetes (DM) and chronic kidney disease (CKD). Results Overall, first line therapy was prescribed to 21.5% and 22.4% of pts in the year 2018 and 2020, respectively (p&amp;lt;0.0001). In pts taking ≥3 drugs 30.4% did not use THI, in those taking ≥4 drugs only 10.7% used spironolactone (MRA). Selected results are in the attached table. Conclusion Adherence to guideline recommended FLAD in this large survey improved but remained low during the first year after publishing ESC 2018 guidelines: only 22.4% of pts received FLAD in this cohort where 58.6% were free of comorbidities. In pts with AF, the use of FLAD was the lowest with 7.3%. Preferred use of BB and low use of THI and MRA were mostly behind this trend. BB (alone or in combination) were the most prescribed drug group – to 57.3% of pts both in 2018 and 2020. Their prescription was high in all pts with comorbidities, notably worrisome for diabetic pts (66.0%). Continuous efforts to improve dissemination of knowledge of FLAD according to guidelines appear mandatory.Attached table

Efficacy and safety aspects of renal denervation in treatment of arterial hypertension: a systematic review and meta-analysis

Abstract Introduction Current guidelines for the management of arterial hypertension 2018 of European Society for Cardiology (ESC) do not recommend use of renal denervation (RDN) (as device-based therapy) for treatment of hypertension except as part of clinical studies. However, in the meantime several randomized sham-controlled clinical trials were designed using second generation radiofrequency (RF) (SPYRAL HTN-OFF MED, SPYRAL HTN-ON MED), ultrasound (RADIANCE-HTN SOLO, RADIANCE-HTN TRIO) or alcohol-mediated renal denervation (TARGET BP-OFF) devices. We aimed to perform a comprehensive meta-analysis from all published and unpublished randomized, sham-controlled clinical trials which explored the effects of renal denervation on blood pressure across different devices. Methods We searched MEDLINE and Embase via OVID@ for eligible trials. Of note, we also included unpublished data from the SPYRAL-ON Extension and TARGET BP OFF trials. Pooling the data from all studies, we explored the efficacy (ambulatory and office systolic and diastolic BP) and safety (all cause death, vascular complication, renal artery stenosis &amp;gt;70%, hypertensive crisis) of RDN. Results Analysis included 9 eligible trials (i.e. SYMPLICITY HTN-3, ReSET, SPYRAL HTN OFF MED, Desch et al., RADIANCE-HTN SOLO, RADIANCE-HTN TRIO, RADIANCE, TARGET BP OFF, SPYRAL HTN ON MED extension) comprising 2,091 patients (Table 1). RDN reduced ambulatory systolic (-3.10 mmHg, 95% CI -4.22, -1.97, p&amp;lt;0.00001) and office systolic (-5.15 mmHg, 95% CI -6.65, -3.66, p&amp;lt;0.00001) BP and ambulatory diastolic (-1.58 mmHg, 95% CI -2.54, -0.63, p=0.001) and office diastolic (-2.74 mmHg, 95% CI -3.65, -1.83, p&amp;lt;0.00001) BP compared with sham groups. There was no difference concerning ambulatory SBP reduction between trials with ON medication design (-2.94 mmHg, p&amp;lt;0.0001) and those with OFF medication design (-3.37 mmHg, p&amp;lt;0.0001) (p for interaction 0.69). Similarly, office SBP reduction was comparable between trials with (-4.38 mmHg, p&amp;lt;0.0001) and without concomitant antihypertensive drugs prescription (-6.27 mmHg, p&amp;lt;0.00001) (p for interaction 0.22). The rate of vascular complications (OR 1.21, 95% CI 0.28, 5.25, p=0.80), renal artery stenosis (OR 1.50, 95% CI 0.06, 36.97, p=0.80), hypertensive crisis (OR 1.39, 95% CI 0.50, 3.92, p=0.53) and all cause death (OR 0.52, 95% CI 0.10, 2.83, p=0.45) was not different between treatment and sham groups. Conclusions RDN is associated with clinically significant reductions in ambulatory and office SBP as compared with sham in the presence and absence of antihypertensive medication. The procedure use was not associated with an excess in safety events compared with sham group.

Postpartum diagnosis and management of pulmonary arterial hypertension

A 38-year-old female who was found to have severe pulmonary arterial hypertension (PAH) secondary to HIV in the postpartum period. This case illustrates the treatment and challenges of postpartum PAH. It also demonstrates the need for expert guidance and additional research on the optimal management of PAH in pregnancy and postpartum.

Self-care behaviour among arterial hypertension patients: role of a general practitioner in Latvia

Abstract Background Engagement in self-care behaviours is a crucial part of arterial hypertension (AH) management. Yet, now patients practice self-care selectively and with low adherence. This study aimed to determine the association between patients’ experience with a general practitioner (GP) and positive self-care behaviours among people with arterial hypertension in Latvia. Methods A cross-sectional study of 950 participants aged 15-74 (median 62, 38.7% male) with AH from a population survey in Latvia in 2022 was conducted. Logistic regression was used to determine respondents’ experience with a GP (overall attitude, providing information and counselling on a lifestyle change) in relation to having positive self-care behaviour (use of medication, weight loss, physical activity (PA), salt intake, smoking cessation) adjusting for age, sex and education. Results Most of the participants reported being satisfied with their GP (94.1%) and the information provided about their disease (84.8-89.4%). Regular use of AH medications was reported by 83.6%, and lifestyle change attempts by 5.2-16.1%. Regular medication use increased by receiving information about complications of AH (aOR=4.43, p ≤ 0.001), and being satisfied with the provided information about the treatment plan (aOR=1.91, p = 0.011), and alternative treatment methods (aOR=2.21, p ≤ 0.001). Receiving advice to change eating habits increased adhering to a diet for weight loss (aOR=4.16, p ≤ 0.001), reducing salt intake (aOR=4.64, p ≤ 0.001), and increasing PA (aOR=4.33, p ≤ 0.001). Similarly, advice to increase PA or reduce weight was statistically significantly associated with other self-care behaviours. None of the factors had a statistically significant impact on smoking cessation. Conclusions Patients’ experiences with a GP are important factors in determining engagement in positive self-care behaviour regarding medication use, PA, and changes in eating habits. The GP's role in smoking cessation requires to be strengthened. Key messages • Arterial hypertension patients are more engaged in self-care when supported by a general practitioner. Yet patients are more focused on medication use than lifestyle change. • Strengthening the communication skills of general practitioners is crucial for improving the disease-related health literacy of arterial hypertension patients and their ability to practice self-care.