Society Of Hypertension Guidelines Research Articles

IDENTIFYING HYPERTENSION IN TEENAGERS: DIFFERENCES BETWEEN EUROPEAN AND AMERICAN GUIDELINES

Objective: Since the measurement of blood pressure is an element in the qualification of volunteers presenting for blood donation, there is an opportunity to identify, in these ostensibly healthy individuals, those who might be at heightened risk of hypertensive heart disease. Since the classification of blood pressure differs when using the American College of Cardiology/American Heart Association and European Society of Cardiology/European Society of Hypertension guidelines, we took this opportunity to compare the prevalence of suspected hypertension in teenagers as differently identified by the two systems. Design and method: Participants in the study were American volunteer blood donors, age 16 to 19, who donated between the years 2015 and 2021 at an independent, community blood program serving some 200 hospitals. There were 87,051 females and 59,498 males. Systolic (SBP) and diastolic (DBP) blood pressures were measured using automated equipment (Welch Allyn, ProBP). The cut points chosen for hypertension were, by ACC/AHA criteria, > = 130 (SBP) or > = 80 mmHg (DBP). The ESC/ESH criteria for hypertension were > = 140 (SBP) and/or > = 90 mmHg (DBP). Results: The table shows percentages of male and female teenagers considered hypertensive by American and European guidelines. Conclusions: There are significant differences between the American and European guidelines in the diagnosis of hypertension in teenagers, with a higher prevalence by American guidelines. The risk for hypertension is higher in males than females by both guidelines.

Considerations for Optimal Blood Pressure Target of Hypertension

Hypertension is a major risk factor for cardiovascular morbidity and mortality that has led to a huge public health burden. The optimal target of blood pressure (BP) to prevent cardiovascular complications remains unclear. Based on the results of the Systolic BP Intervention Trial (SPRINT) in 2015, the 2017 American College of Cardiology/American Heart Association guidelines for diagnosis and management of high BP in adults has changed the diagnostic threshold from 140/90 to 130/80 mmHg, and the target BP to 130/80 mmHg for nearly all hypertensive patients diagnosed using the new criteria. However, the findings from the SPRINT trial were to an extent contrasting with the results of previous large randomized controlled trials, namely Action to Control Cardiovascular Risk in Diabetes (ACCORD) and Secondary Prevention of Small Subcortical Strokes (SPS3). Besides, the 2018 European Society of Cardiology/European Society of Hypertension guidelines and the 2018 Chinese guidelines have maintained the conventional threshold and recommended target of 140/90 mmHg for most hypertensive patients. Given the special measurement of BP in the SPRINT trial and using an automated measurement system, the intensive systolic BP target of 120 mmHg provided by the SPRINT trial was not widely adopted. Most recently, the Strategy of BP Intervention in the Elderly Hypertensive Patients (STEP) trial, with a higher systolic BP target of 110 to 130 mmHg in the intensive group, confirmed the benefit and safety of intensive BP control in patients with hypertension, in accordance with the SPRINT trial. Here, the results from randomized controlled trials, meta-analyses, and other observational research studies, have been reviewed to evaluate the optimal target of BP treatment and the threshold of diagnostic criteria for hypertension.

Individualized Beta-Blocker Treatment for High Blood Pressure Dictated by Medical Comorbidities: Indications Beyond the 2018 European Society of Cardiology/European Society of Hypertension Guidelines.

Several hypertension guidelines have removed beta-blockers from their previous position as first-choice drugs for the treatment of hypertension. However, this downgrading may not be justified by available evidence because beta-blockers lower blood pressure as effectively as other major antihypertensive drugs and have solid documentation in preventing cardiovascular complications. Suspected inconveniences of beta-blockers such as increased risk of depression or erectile dysfunction may have been overemphasized, while patients with chronic obstructive pulmonary disease or peripheral artery disease, that is, conditions in which their use was previously restricted, will benefit from beta-blocker therapy. Besides, evidence that from early to late phases, hypertension is accompanied by activation of the sympathetic nervous system makes beta-blockers pathophysiologically an appropriate treatment in hypertension. Beta-blockers have favorable effects on a variety of clinical conditions that may coexist with hypertension, making their use either as specific treatment or as co-treatment potentially common in clinical practice. Guidelines typically limit recommendations on specific beta-blocker use to cardiac conditions including angina pectoris, postmyocardial infarction, or heart failure, with little or no mention of the additional cardiovascular or noncardiovascular conditions in which these drugs may be needed or preferred. In the present narrative review, we focus on multiple additional diseases and conditions that may occur and affect patients with hypertension, often more frequently than people without hypertension, and that may favor the choice of beta-blocker. Notwithstanding, beta-blockers represent an in-homogenous group of drugs and choosing beta-blockers with documented effect in prevention and treatment of disease is important for first choice in guidelines.

MO891: Poor Tolerability of the Standard, Extended, 48h Ambulatory Blood Pressure Monitoring in Haemodialysis Patients

Abstract BACKGROUND AND AIMS Ambulatory blood pressure monitoring (ABPM), extended to 44h or 48h for the diagnosis of hypertension in end-stage kidney disease (ESKD) patients, is recommended by Consensus Documents of the American Society of Nephrology and the European Renal Association. About 10%–20% of individuals in the general population report sleeping problems and other symptoms during 24 h ABPM. Because the longer recording period (44 or 48 h versus 24 h), the notorious sleeping disturbances and the high symptom burden of the ESKD population, the feasibility of the technique may be limited in this population. However, the large-scale tolerability of ABPM in the haemodialysis population, has never been investigated. METHOD We performed an international survey of feasibility and tolerability of 48 h ABPM in six centres in three European countries. These centres are led by motivated clinical nephrologists, all members of the EURECA-m working group. 48 h ABPM recording was proposed to a large, representative sample of the whole dialysis population of these centres. Well validated instruments (AAMI/ESH/ISO) were applied in all centres. As recommended by the European Society of Hypertension guidelines, recordings were made at 15-min intervals during the day and 30 min during the night. Reasons for refusal to undergo the test were accurately registered. A tolerability (symptoms) questionnaire and a specific questionnaire for sleep evaluation were administered to all participants who underwent 48h ABPM. Reasons for not completing of the ABPM monitoring were systematically recorded. RESULTS In the whole haemodialysis population of participating centres including 735 patients, 440 (60%) were invited to participate in the study. Among these patients, 119 (27%) refused to undergo ABPM recording. Reasons for refusal were fear of discomfort (n = 30, 25%), measurement too long (n = 22, 18%), logistic problems (n = 17, 14%), previous negative experience (n = 13, 11%), clinical reasons (n = 12, 10%), other reasons (n = 25). Among the 321 patients who performed the 48h ABPM recording, 29 (9%) did not complete it and the main reason for interrupting the recording were discomfort [12 patients (41%)], followed by device failure [10 patients (34%)]. Among symptoms developed during the ABPM study, frequent interruption of sleeping because of noise or discomfort was reported by 32% of patients, followed by itching (24%) and pain during the measurements (20%). The detailed list of symptoms, is reported in the Table 1. CONCLUSION Overall, about 25% of haemodialysis patients consider 48h ABPM a laborious and discomforting test and prejudicially refuse to undergo it. Among patients who undergo 48h ABPM, itching and interruption of sleeping are complained by about 1/3 of patients. These figures are substantially higher than those reported in studies in the general population and in hypertensive patients and point to peculiar barriers at applying extended ABPM recordings in the haemodialysis population. Studies applying more tolerable instruments and a minimum set of measurements over a shorter time, with a reduced number of measurements overnight, are clinical research priority for extending the use of ABPM in the haemodialysis population.

The quality of patients\u2019 self-blood pressure measurements: a cross-sectional study

BackgroundThe accurate and independent measurement of blood pressure (BP) by patients is essential for home BP monitoring (HBPM) and determining the quality of hypertension (HTN) control. This study aimed to evaluate the BP self-measurement techniques of hypertensive patients and their accuracy in accordance with established guidelines. We sought to identify the common errors that patients make and suggest improvements that can be implemented in the primary healthcare setting to increase the reliability of HBPM conducted by hypertensive patients.MethodsOne hundred patients diagnosed with HTN completed a questionnaire inquiring about their health and demographic data and BP monitoring practices. Patients were then observed and filmed while measuring their BP on their own devices in five primary healthcare centres in Kraków, Poland. The correctness of their techniques was assessed in accordance with the European Society of Hypertension guidelines on HBPM.ResultsOnly 3% of patients measured their BP without error; 60% made three or more errors. The most frequent error, made by 76% of subjects, was incorrect sphygmomanometer cuff placement (above or below heart level, or/and the indicator mark was not aligned with the brachial artery). Regarding patients’ previous instruction for the correct use of their devices, 36% of patients referred to their monitor’s user manual, 22% did not receive any prior assistance, and only 29% were adequately counselled by physicians on how to measure their BP correctly.ConclusionsOur findings suggest that primary healthcare physicians and their personnel often do not adequately instruct patients on how to measure their BP correctly. Therefore, healthcare systems must provide patients with more adequate training and reference materials on the best practices of BP monitoring.

Association of blood pressure after peritoneal dialysis initiation with the decline rate of residual kidney function in newly-initiated peritoneal dialysis patients.

BackgroundLower blood pressure (BP) levels are linked to a slower decline of kidney function in patients with chronic kidney disease (CKD) without kidney replacement therapy. However, there are limited data on this relation in peritoneal dialysis (PD) patients. Here we evaluated the association of BP levels with the decline of residual kidney function (RKF) in a retrospective cohort study.MethodsWe enrolled 228 patients whose PD was initiated between 1998 and 2014. RKF was measured as the average of creatinine and urea clearance in 24-hr urine collections. We calculated the annual decline rate of RKF by determining the regression line for individual patients. RKF is thought to decline exponentially, and thus we also calculated the annual decline rate of logarithmic scale of RKF (log RKF). We categorized the patients’ BP levels at 3 months after PD initiation (BP3M) into four groups (Optimal, Normal & High normal, Grade 1 hypertension, Grade 2 & 3 hypertension) according to the 2018 European Society of Cardiology and European Society of Hypertension Guidelines for the management of arterial hypertension.ResultsThe unadjusted, age- and sex-adjusted, and multivariable-adjusted decline rate of RKF and log RKF decreased significantly with higher BP3M levels (P for trend <0.01). Compared to those of the Optimal group, the multivariable-adjusted odds ratios (95% confidence interval) for the faster side of the median decline rate of RKF and log RKF were 4.04 (1.24–13.2) and 5.50 (1.58–19.2) in the Grade 2 and 3 hypertension group, respectively (p<0.05).ConclusionsHigher BP levels after PD initiation are associated with a faster decline in RKF among PD patients.

Effectiveness of Telmisartan on Blood Pressure Control in Hypertensive Patients in India: A Real-World Retrospective Study from Electronic Medical Records.

IntroductionThe effectiveness of telmisartan has been reported in Indian clinical trials; however, real-world data are limited. We aimed to provide real-world evidence regarding the effectiveness of telmisartan as monotherapy or in combination with other antihypertensive drugs (AHDs) in Indian patients with essential hypertension.MethodsElectronic medical record data of adult patients diagnosed with essential hypertension (≥ 140/90 mmHg) and who were prescribed telmisartan as mono- or add-on therapy were retrospectively analyzed. Patients were classified according to the number of AHD classes prescribed on initiating telmisartan. Change in systolic and diastolic blood pressure (SBP and DBP) after a month of treatment and the proportion of patients who achieved treatment goals according to the 2018 European Society of Cardiology/European Society of Hypertension guidelines were evaluated.ResultsA majority (90.6%) of the 1304 patients included in the study were on telmisartan monotherapy or telmisartan + 1 AHD. The mean (95% confidence interval [CI]) change in the telmisartan monotherapy group was SBP (−13.3 [−14.6, −12.0] mmHg) and DBP (−7.2 [−7.9, −6.5] mmHg), and the mean (95% CI) change in the telmisartan + 1 AHD group was SBP (−10.8 [−13.1, −8.5] mmHg) and DBP (−6.5 [−7.7, −5.3] mmHg) (P < 0.001 for all). SBP and DBP goals were achieved by 35.9% and 47.3% of patients on telmisartan monotherapy and by 35.9% and 46.8% of patients on telmisartan + 1 AHD. Among patients with comorbid diabetes, the mean (95% CI) change in the telmisartan monotherapy group was SBP (−13.3 [−15.0, −11.6] mmHg) and DBP (−7.3 [-8.2, −6.5] mmHg), and the mean (95% CI) change in the telmisartan + 1 AHD group was SBP (−13.0 [−16.5, −9.5] mmHg) and DBP (−6.9 [−8.7, −5.1] mmHg) (P < 0.001 for all). SBP and DBP goals were achieved by 31.7% and 39.7% of patients on telmisartan monotherapy and by 31.9% and 41.8% of patients on telmisartan + 1 AHD.ConclusionTelmisartan may be a good candidate for blood pressure control in Indian patients with essential hypertension and comorbidities.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40119-021-00217-7.

Investigation of Blood Pressure Control in Hypertensive Patients with and without Antithrombotic Therapy in a Real-World Setting

ABSTRACT Background Although numerous studies have demonstrated a strong association between blood pressure (BP) and hemorrhagic complications of antithrombotic therapy, there is still a paucity of information regarding the status of BP control in hypertensive patients on antithrombotic therapy. Methods This cross-sectional, retrospective study was conducted at an outpatient clinic to examine BP control and its associated factors in hypertensive patients receiving or not receiving antithrombotic therapy. Results Of 26,803 outpatients who had scheduled visits in 2018, 7,800 hypertensive patients met the inclusion criteria, of whom 1,727 cases were on oral antithrombotic drugs. Then, target BP values were defined according to the Japanese Society of Hypertension Guidelines for the Management of Hypertension 2019. While BP values <140/90 mmHg were observed in 63.0% and 61.6% of patients with and without antithrombotic therapy, respectively, only 31.1% and 23.4% of them displayed BP values <130/80 mmHg. Multivariable logistic analysis indicated that comorbidity with obesity was a significant correlate of insufficient BP control (target BP <130/80 mmHg) in hypertensive patients, irrespective of antithrombotic therapy (patients with antithrombotic therapy, odds ratio (OR) = 1.690, 95% confidence interval (CI) = 1.351–2.113; patients without antithrombotic therapy, OR = 1.475, 95% CI = 1.290–1.687). Conclusion The majority of patients exhibited BP values <140/90 mmHg, whereas BP values <130/80 mmHg were achieved only in a small proportion of the patients. Furthermore, obesity appeared to be one of the factors contributing to insufficient BP control in a real-world setting.

Effectiveness of Amlodipine on Blood Pressure Control in Hypertensive Patients in India: A Real-World, Retrospective Study from Electronic Medical Records.

BackgroundThe effectiveness of amlodipine has been reported in clinical trials in India. However, real-world data on the effectiveness of amlodipine in India is limited.ObjectiveTo provide real-world evidence regarding the effectiveness of amlodipine as monotherapy or in combination with other antihypertensive drugs (AHDs) in Indian patients with essential hypertension.MethodsElectronic medical record data of adult patients who were diagnosed with essential hypertension (≥ 140/90 mmHg) and were prescribed amlodipine as monotherapy or add-on therapy were retrospectively analyzed. Patients were classified based on the number of AHD classes prescribed on initiation of amlodipine. Change in systolic (SBP) and diastolic (DBP) blood pressure from baseline was the primary endpoint. Evaluation of proportion of patients who achieved treatment goals as per 2018 European Society of Cardiology/European Society of Hypertension guidelines was the secondary endpoint. Readings were obtained before initiating amlodipine and after at least a month of therapy with amlodipine.ResultsAmong the 462 included patients, the majority (90.7%) were on amlodipine monotherapy or amlodipine + 1AHD. Mean (95% confidence interval [CI]) change in the amlodipine monotherapy group was: SBP (− 12.1 [− 14.9, − 9.3] mmHg) and DBP (− 7.5 [− 8.9, − 6.1] mmHg) and mean (95% CI) change in the amlodipine + 1AHD group was: SBP (− 17.8 [− 21.0, − 14.6] mmHg) and DBP (− 9.5 [− 11.0, − 8.0] mmHg) (P < 0.001 for all). SBP and DBP goals were achieved by 31.4% and 42.9% of patients on amlodipine monotherapy and by 38.9% and 51.8% of patients on amlodipine + 1AHD, respectively. Among patients aged ≤ 45 years, mean (95% CI) change in the amlodipine monotherapy group was: SBP (− 11.7 [− 16.0, − 7.4] mmHg; P < 0.001) and DBP (− 7.2 [− 9.7, − 4.7] mmHg; P < 0.001) and mean (95% CI) change in the amlodipine + 1AHD group was: SBP (− 14.6 [− 21.9, − 7.3] mmHg; P < 0.05) and DBP (− 10.6 [− 14.8, − 6.4] mmHg; P < 0.01). SBP and DBP goals were achieved by 35.4% and 33.8% of patients on amlodipine monotherapy and by 48.0% and 56.0% of patients on amlodipine + 1AHD, respectively. Among patients aged ≥ 65 years, mean (95% CI) change in the amlodipine monotherapy group was: SBP (− 13.9 [− 20.2, − 7.6] mmHg; P < 0.01) and DBP (− 8.5 [− 11.4, − 5.7] mmHg; P < 0.001) and mean (95% CI) change in the amlodipine + 1AHD group was: SBP (− 22.4 [− − 28.8, − 16.0] mmHg; P < 0.001) and DBP (− 10.8 [− 14.0, − 7.6] mmHg; P < 0.001). SBP and DBP goals were achieved by 25.5% and 13.7% of patients on amlodipine monotherapy and by 29.8% and 14.0% of patients on amlodipine + 1AHD.ConclusionAmlodipine prescribed as monotherapy or add-on therapy during routine clinical practice significantly reduced BP in ≤ 45- and ≥ 65-year-old Indian patients with mild to moderate hypertension, emphasizing that amlodipine may be a good candidate for BP control in Indian patients with essential hypertension in these age groups.

Identification of cardiac organ damage in arterial hypertension: insights by echocardiography for a comprehensive assessment.

: Arterial hypertension, a widespread disease, whose prevalence increases with age, represents a major risk factor for cardiovascular events, causing damage in several organs, including the heart. In this context, echocardiography has a clear and pivotal role, being able to assess cardiac morphology and detect haemodynamic changes induced by this disease. 2018 European Society of Cardiology/European Society of Hypertension guidelines on AH identified main echo parameters such as left ventricular mass, relative wall thickness and left atrial volume, for detecting cardiac organ damage. The present review highlights the advantage of additional echocardiographic parameters such as diastolic measurement and both thoracic and abdominal aortic dimensions. An overlook on aortic valve should also be suggested to detect aortic regurgitation and stenosis, both frequent complications in hypertensive patients. In this kind of comprehensive assessment, the combination of standard and advanced echocardiography (speckle tracking echocardiography and, with a lesser extent, three-dimensional echocardiography) could be considered to improve the diagnostic accuracy, stratify prognosis and address management in arterial hypertension.

Potential impact of 2018 Korean Society of Hypertension guidelines on Korean population: a population-based cohort study

BackgroundThe Korean Society of Hypertension (KSH) revised the local guidelines for hypertension in 2018. The present study sought to evaluate the potential impact of the 2018 KSH guidelines on hypertension management status among the Korean population in terms of prevalence of hypertension, antihypertensive medical treatment recommendations, and control status in Korean adults.MethodsWe used data from the Korea National Health and Nutrition Examination Survey to estimate the number and percentage of Korean adults who have hypertension according to blood pressure (BP) classification, are recommended to receive antihypertensive medical treatment, and are receiving medical treatment and have BP in the optimal range according to the new recommendations. Adults aged 30 years or older who participated in the survey between 2013 and 2015 were selected for this study.ResultsThe prevalence of hypertension was 30.5% among Korean adults aged 30 years or older. The percentage of subjects who are recommended to be treated with antihypertensive medications substantially increased from 32.5 to 37.8%, which translates to 1.6 million adults. Among the hypertensive patients who were receiving medical treatment, 38.6% were shown to have adequate BP levels as recommended by the 2018 KSH guidelines compared with 51.8% according to the previous 2013 guidelines.ConclusionsThe present study reports the potential impact of the 2018 KSH guidelines on the prevalence of hypertension, antihypertensive medical treatment recommendations, and control status for Korean adults. The 2018 KSH guidelines recommend more intensive BP control compared with previous guidelines. This study suggests that there is large scope for improvement in hypertension management in the Korean population.

Asian management of hypertension: Current status, home blood pressure, and specific concerns in Thailand.

The prevalence of hypertension is increasing, but rates of awareness, treatment, and blood pressure (BP) control are also increasing. In terms of cardiovascular disease, the prevalence of coronary artery disease (CAD) and stroke is similar, but stroke mortality is higher than that from CAD. Home BP monitoring (HBPM) is an important tool for determining the presence of white-coat or masked hypertension, facilitating drug cost savings or effective cardiovascular risk management strategies, respectively. However, there are a number of barriers to use of HBPM in Thailand. These include lack of availability (particularly in lower socioeconomic groups), lack of awareness of the importance of white-coat and masked hypertension, and concerns about device reliability. The latest Thai Hypertension Society guidelines recommend that physicians and nurses encourage their patients to use their HBPM devices, and these are increasingly being utilized in clinical practice for both diagnostic purposes and therapeutic monitoring. Calcium channel blockers are the most commonly used antihypertensive agents in Thailand, followed by angiotensin receptor blockers, ß-blockers, and diuretics. Angiotensin-converting enzyme inhibitors are used less often due to drug-related cough, and the use of fixed drug combinations is low because of their high cost and more complex reimbursement process. Ongoing work is needed to improve the primary prevention and effective treatment of hypertension in Thailand.

METABOLICALLY HEALTHY AND UNHEALTHY OBESITY IN CHILDREN FROM THE POINT OF VIEW OF EVIDENCE-BASED MEDICINE

Introduction. Childhood obesity and associated metabolic comorbidities is a major global health concern. Metabolic syndrome (MS) is a cluster of metabolic abnormalities that confers a substantial increase in cardiovascular disease risk. In the context of the childhood obesity pandemic, a distinct subgroup of youth with obesity less prone to the development of metabolic disturbances, called “metabolically healthy obese” (MHO), recently has come into focus. However, the diagnostic criteria of both conditions are still controversial in children. Therefore, the purpose of our research is to estimate the prevalence of metabolic syndrome and metabolically healthy obesity in school-age boys using international reference standards and to recognize the most sensitive metabolic markers. Materials and methods. This study was carried out at the Ternopil regional hospital (Western Ukraine) and involved randomly chosen 112 boys from rural and urban population; aged 10–17 years (mean ± SD, 14.6 ± 0.25). Height, weight and waist and hip circumferences were measured by standard methods in each patient. Body mass index (BMI, kg/m2), waist-to-height ratio (WtHR), waist-to-hip ratio (WHR) were calculated by common formulas. Obesity was defined as a BMI ≥ 2SD for age and gender. Blood pressure was measured and estimated according to European Society of Hypertension guidelines (2016). Biomarkers of carbohydrate and lipid metabolism were tested. Discussion. The study identified prominent physical and metabolic differences in groups of patients with MHO and manifested MS, as well as in the high-risk group for the realization of MS. As a result of this project, MHO and MS were confirmed in 49.11 % and 9.82 % surveyed boys, respectively. The rest of teenagers (32.14 %) based on metabolic disturbances, formed a cluster of the high-risk realization of MS. Moreover, fasting hyperglycemia and glucose intolerance were identified only in patients with manifested MS in 10.91 % and 5.45 % cases, respectively. It was found that the waist-to-height ratio &gt; 0.5 is an informative test of obesity in general, and the waist-to-hip ratio &gt; 0.9 is a sensitive screening tool for abdominal obesity in boys in our population. Based on the results, the triglyceride index is the most sensitive biomarker of insulin resistance compared to triglyceride-to-high density lipids cholesterol ratio and atherogenic coefficient in school-age boys. The results can be applied in pediatric practice for early identification of patients with metabolically unhealthy obesity with WHR and the triglyceride index at the early preclinical stage of MS manifestation. Keywords children, metabolically healthy obesity, metabolic syndrome, triglyceride index.

P1556Cardiovascular risk in white-coat hypertension individuals stratified by their nocturnal blood pressure dipping status

Abstract Background/Introduction Nocturnal blood pressure (BP) dipping status, defined by the night-to-day BP ratio, has been correlated with the cardiovascular (CV) risk in patients with arterial hypertension. The risk is higher in those with less than normal or no drop in nocturnal BP while data in extreme dippers are inconsistent. On the other hand, white-coat hypertension (WCHT), defined as an elevated office BP despite a normal out-of-office BP, is characterized by a lower CV risk than that of sustained hypertension and rather comparable with that of true normotension. Purpose The present study assessed the possible relation between the nocturnal BP dipping status and the underlying CV risk in WCHT individuals. Methods Among all individuals examined in our outpatient anti-hypertensive units over the past 15 years, 2310 (42% men, 52.2±13.1 years of age) were diagnosed with WCHT (increased office BP: 156.4±10.0/99.6±6.2 mmHg and normal 24-hour ambulatory BP: 122.4±6.3/75.3±5.4 mmHg) and were enrolled in the study. A night-to-day BP ratio (from the 24-hour ambulatory BP monitoring) 0.8–0.9 defined Normal nocturnal BP Dipping, &lt;0.8 Extreme Dipping, 0.9–1 Mild Dipping and &gt;1 Absence of Dipping. The underlying 10-year CV risk of death in the studied population was calculated with the Hellenic version of the HeartScore (Hellenic Score), as proposed by the current 2018 European Society of Hypertension guidelines, based on age, gender, smoking status, systolic BP and total cholesterol levels. Results From 2310 individuals studied, 1208 (52.3%) were found with Normal Dipping, 386 (16.7%) with Extreme Dipping, 622 (26.9%) with Mild Dipping and 94 (4.1%) with Absence of Dipping. Hellenic Score was 3.21±4.67% in subjects with Normal Dipping, 3.49±4.97% in those with Extreme Dipping, 3.66±5.04% in those with Mild Dipping, 6.21±7.29%, in those with Absence of Dipping (p for trend&lt;0.05) and 3.50±4.99% in the whole cohort of the studied population. Conclusions Nocturnal BP dipping status is closely associated with the underlying CV risk of WCHT individuals. Extreme Dipping, Mild Dipping and especially Absence of Dipping increase CV risk thus necessitating closer follow-up of these individuals and possibly faster initiation of BP-lowering drug treatment.

What new will implementation of European Guidelines for managing arterial hypertension introduce into real-life clinical practice?

To analyze the effect of introducing new treatment goals in hypertension stated in the 2018 European Society of Cardiology and European Society of Hypertension Guidelines on prevalence and treatment efficacy of arterial hypertension (AH) in a representative sample of patients in the European part of the Russian Federation. A representative sample of population in the European part of Russia was evaluated in 1998, 2002, 2007, and 2017. The structure of patients with AH was compared in these samples according to the 2013 and 2018 European Guidelines. Introduction of new guidelines for the treatment of AH in 2018 resulted in increasing the prevalence of hypertension from 35.5% to 36.9% in 1998, from 39.1% to 39.9% in 2002, from 451.0% to 41.3% in 2007, and from 43.3% to 43.6% in 2017. Proportion of effectively managed patients decreased from 4.7% to 3.5% in 1998, from 7.5% to 6.2% in 2002, from 17.0 to 14.7% in 2007, and from 30.8% to 26.4%. Proportion of patients who required initiation of antihypertensive therapy increased from 59.6% to 61.1% in 1998, from 47.9% to 49.1% in 2002, from 27.9% to 28.2% in 2007, and from 17.5% to 18.2% in 2017. The new requirements to diagnostic and treatment of AH provided by the 2018 European Society of Cardiology Guidelines insignificantly influenced prevalence and treatment efficacy of AH. At the same time, the new guidelines appeared rather difficult for application due to different values of blood pressure used for diagnostics and treatment goals.

Hypertension − an update for the dental (sedation) team

Hypertension is the commonest risk factor contributing to the global burden of disease. Public Health England estimates that, in England, 24% of the population are hypertensive, with 40% possibly undiagnosed. With this in mind, dentists, in particular those undertaking sedation, are in a perfect position to screen for high blood pressure and refer on for further detailed assessment. This paper outlines when a referral to the General Medical Practitioner (GP) should be considered, when sedation should be deferred and how hypertension is diagnosed and managed in primary care based on the National Institute for Health and Care Excellence (NICE)/British Hypertension Society (BHS) guidelines. CPD/Clinical Relevance: The purpose of this article is to update General Dental Practitioners (GDPs), including those who practise IV Midazolam sedation, on how patients who present with suspected hypertension are managed by their GP. Consideration is given to what blood pressures are deemed safe to sedate and what blood pressures should be referred for further assessment, even if considered safe to sedate.

Two-Drug Combinations as First-Step Antihypertensive Treatment.

Blood pressure (BP) control in patients with hypertension is variable worldwide, and in general, it results largely unsatisfactory. Factors responsible for this phenomenon include insufficient national cardiovascular healthcare policies for prevention, poor patient compliance with prescribed treatment schedules, and the reluctance of physicians to modify treatment strategies when BP is still elevated, that is, the so-called therapeutic inertia. A further important factor favoring poor BP control is the limited use of combination drug treatment, despite evidence of its superior ability to control BP in patients with difficult-to-treat hypertension. In addition, combination treatment allows to achieve BP control more easily (and more quickly) as compared with monotherapy. This article, after briefly examining the main features of BP control, will review the importance in the treatment of hypertension of the drug combination strategy, based on the recommendations of the 2018 European Society of Cardiology/European Society of Hypertension guidelines. Empahsis will be given to the drug combination treatment as first step of the antihypertensive therapeutic intervention. The potential drawbacks and barriers to combination drug treatment as initial therapeutic strategy will also be briefly discussed.

The Unsolved Conundrum of Optimal Blood Pressure Target During Acute Haemorrhagic Stroke: A Comprehensive Analysis.

Intracerebral haemorrhage (ICH) is a devastating cerebrovascular disease, which accounts to 15% of all strokes. Among modifiable risk factors for ICH, hypertension is the most frequent. High blood pressure (BP) is detected in more than 75-80% of patients with ICH. Extremely elevated BP has been associated with early hematoma growth, a relatively frequent occurrence and powerful predictor of poor outcome in patients with spontaneous ICH. On the other hand, excessively low BP might cause cerebral hypoperfusion and ultimately lead to poor outcome. This review will analyse the most important trials that have tried to establish how far should BP be lowered during acute ICH. These trials have demonstrated either a small non-significant benefit (INTERACT-2, INTEnsive blood pressure Reduction in Acute Cerebral haemorrhage Trial) or no benefit (ATACH-2, Antihypertensive treatment of acute cerebral haemorrhage II study) when intensive systolic BP reduction was compared with modest or standard BP reduction. The more recent meta-analyses including studies investigating this issue yielded similar conclusions: aggressive BP control in the acute phase of ICH is not beneficial. For these reasons the 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the management of arterial hypertension, do not recommend treatment to immediately lowerBPin patients with acute ICH and systolic BP < 220mmHg. Careful lowering of SBP to less than 180mmHg via i.v. Infusion may be considered only in patients with SBP ≥ 220mmHg.

The present situation of home blood pressure measurement among outpatients in Japan

ABSTRACTObjective: To clarify the present situation of home blood pressure (HBP) measurement among Japanese patients.Methods: A nationwide questionnaire survey regarding HBP measurement was conducted on patients aged 20 years or older who had visited 20 community pharmacies to have their prescriptions filled.Results: In total, 76.7% of 1,103 hypertensives and 40.9% of 1,106 normotensives had their own devices for HBP measurement. Compared with normotensives, a higher proportion of hypertensives recognized the guideline-based reference values for HBP and clinic BP. Compared with hypertensives who did not have a physician’s recommendation, those who did more often had their own devices, recognized the guideline-based reference values for HBP, and measured HBP every day (70.4%, 1.5%, and 31.6% vs. 91.1%, 6.9%, and 65.4%, respectively). Among 793 hypertensives who measured HBP, a higher proportion of those with a physician’s recommendation measured HBP according to optimal guideline-based procedures compared with those without. Among 560 hypertensives who recorded HBP readings, a higher proportion of those with a physician’s recommendation (74.6%) showed all HBP readings to their physicians compared with those without (35.3%).Conclusions: Our findings suggest that physicians should recommend measuring HBP in accordance with the Japanese Society of Hypertension guidelines more aggressively, and provide more detailed explanations to patients regarding how to measure HBP.

The Impact of the 2017 American College of Cardiology/American Heart Association and the 2018 European Society of Cardiology/European Society of Hypertension Guidelines on the Asian Population: Is it Time for Our Own Asian Hypertension Guidelines?

The Impact of the 2017 American College of Cardiology/American Heart Association and the 2018 European Society of Cardiology/European Society of Hypertension Guidelines on the Asian Population: Is it Time for Our Own Asian Hypertension Guidelines?