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Mancia G, Cappuccio FP, Burnier M, Coca A, Persu A, Borghi C, Kreutz R, Sanner B. Perspectives on improving blood pressure control to reduce the clinical and economic burden of hypertension. J Intern Med 2023; 294:251-268. [PMID: 37401044 DOI: 10.1111/joim.13678] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
The clinical and economic burden of hypertension is high and continues to increase globally. Uncontrolled hypertension has severe but avoidable long-term consequences, including cardiovascular diseases, which are among the most burdensome and most preventable conditions in Europe. Yet, despite clear guidelines on screening, diagnosis and management of hypertension, a large proportion of patients remain undiagnosed or undertreated. Low adherence and persistence are common, exacerbating the issue of poor blood pressure (BP) control. Although current guidelines provide clear direction, implementation is hampered by barriers at the patient-, physician- and healthcare system levels. Underestimation of the impact of uncontrolled hypertension and limited health literacy lead to low adherence and persistence among patients, treatment inertia among physicians and a lack of decisive healthcare system action. Many options to improve BP control are available or under investigation. Patients would benefit from targeted health education, improved BP measurement, individualized treatment or simplified treatment regimens through single-pill combinations. For physicians, increasing awareness of the burden of hypertension, as well as offering training on monitoring and optimal management and provision of the necessary time to collaboratively engage with patients would be useful. Healthcare systems should establish nationwide strategies for hypertension screening and management. Furthermore, there is an unmet need to implement more comprehensive BP measurements to optimize management. In conclusion, an integrative, patient-focused, multimodal multidisciplinary approach to the management of hypertension by clinicians, payers and policymakers, involving patients, is required to achieve long-term improvements in population health and cost-efficiency for healthcare systems.
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Affiliation(s)
- G Mancia
- University of Milano-Bicocca, Milan, Italy
| | - F P Cappuccio
- University of Warwick, Warwick Medical School, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - M Burnier
- Service of Nephrology and Hypertension, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - A Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - A Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - C Borghi
- Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - R Kreutz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - B Sanner
- Department of Internal Medicine, Agaplesion Bethesda, Wuppertal, Germany
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Hitij JB. A commentary on the article 'Antihypertensive drug treatment in white-coat hypertension: data from the Plaque Hypertension Lipid-Lowering Italian Study'. J Hypertens 2022; 40:1897-1898. [PMID: 36052519 DOI: 10.1097/hjh.0000000000003251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jana Brguljan Hitij
- University Medical Centre Ljubljana, Department of Hypertension, Medical University Ljubljana, Slovenia
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Mancia G, Facchetti R, Quarti-Trevano F, Grassi G. Antihypertensive drug treatment in white-coat hypertension: data from the Plaque HYpertension Lipid-Lowering Italian Study. J Hypertens 2022; 40:1909-1917. [PMID: 35881420 PMCID: PMC10860885 DOI: 10.1097/hjh.0000000000003176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/03/2022] [Indexed: 01/05/2023]
Abstract
AIM Little evidence is available on whether antihypertensive treatment lowers cardiovascular risk in white-coat hypertension (WCH). Protection might be indirectly inferred, however, from the blood pressure (BP) effects of treatment as in trials BP reduction is linearly related to outcome reduction. We analyzed the effect of antihypertensive treatment on office and ambulatory BP in WCH using data from the Plaque HYpertension Lipid-Lowering Italian Study (PHYLLIS). METHODS : Office and ambulatory blood pressure were measured in 470 hypertensive patients randomized to fosinopril or hydrochlorothiazide alone or combined with a statin before treatment and at 6 month or yearly intervals during 2.6 years of follow-up. Patients were divided into two groups according to whether before randomization to treatment office and 24-h mean BP were elevated (sustained hypertension) or office BP was elevated but 24-h BP values were normal (WCH). RESULTS : In both sustained hypertension and WCH antihypertensive treatment was associated with an early marked office BP reduction, which persisted virtually unchanged throughout the treatment period. In contrast, 24-h (and day and night) BP showed a marked and persistent treatment-related fall in sustained hypertension but no change in WCH. The results were similar when data were separately analyzed in patients under fosinopril or diuretic, with or without statin treatment. CONCLUSION : In WCH, antihypertensive treatment can effectively and durably reduce office BP. This reduction is accompanied by the inability to lower ambulatory BP from the normal values characterizing this condition at baseline. This appears to be unrelated to the type of treatment employed.
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Affiliation(s)
| | | | | | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery
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Mancia G, Facchetti R, Bombelli M, Quarti-Trevano F, Cuspidi C, Grassi G. Short- and Long-Term Reproducibility of Nighttime Blood Pressure Phenotypes and Nocturnal Blood Pressure Reduction. Hypertension 2021; 77:1745-1755. [PMID: 33745303 DOI: 10.1161/hypertensionaha.120.16827] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Giuseppe Mancia
- Policlinico di Monza (G.M.), University of Milano-Bicocca, Italy.,University Milano-Bicocca, Milan (G.M.), University of Milano-Bicocca, Italy
| | - Rita Facchetti
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., F.Q.-T., C.C., G.G.), University of Milano-Bicocca, Italy
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., F.Q.-T., C.C., G.G.), University of Milano-Bicocca, Italy
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., F.Q.-T., C.C., G.G.), University of Milano-Bicocca, Italy
| | - Cesare Cuspidi
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., F.Q.-T., C.C., G.G.), University of Milano-Bicocca, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., F.Q.-T., C.C., G.G.), University of Milano-Bicocca, Italy
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Wang Y, Li Y, Huo Y, Wang JG. Treatment effect of lacidipine and amlodipine on clinic and ambulatory blood pressure and arteria stiffness in a randomised double-blind trial. Blood Press 2020; 30:108-117. [PMID: 33135429 DOI: 10.1080/08037051.2020.1840915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE In a randomised, double-blind trial, we investigated effects of lacidipine on clinic and ambulatory blood pressure (BP) and arterial stiffness in patients with mild-to-moderate hypertension, as compared with amlodipine. MATERIALS AND METHODS Previously untreated and treated patients (n = 269, 50-80 years of age) with clinic hypertension (a clinic systolic/diastolic BP 140-180/<110 mmHg and <160/100 mmHg, respectively) were randomly assigned to double-dummy treatment with lacidipine (4-6 mg/day) or amlodipine (5-7.5 mg/day) for 20 weeks. The primary efficacy variable was the change in 24-h ambulatory systolic BP at 20 weeks of treatment. Arterial stiffness was measured as brachial-ankle pulse wave velocity (PWV). RESULTS After 20 weeks of treatment, 24-h systolic BP decreased from 141.3 ± 14.0 and 138.3 ± 12.8 mmHg at baseline, respectively, in the lacidipine (n = 134) and amlodipine groups (n = 135), by a least square mean (±SE) change of 15.2 ± 1.3 and 15.5 ± 1.3 mmHg, respectively, with a between-group difference (95% confidence interval [CI]) of 0.3 mmHg (-3.4 to 4.1, p = 0.86). Similar results were observed for other ambulatory BP components and clinic BP. Clinic and ambulatory pulse rate did not significantly change in either group (p ≥ 0.21). PWV decreased significantly (p < 0.001) from baseline in both groups, with a non-significant between-group difference of 0.24 m/s (p = 0.45). The incidence rate of adverse events was 30.3% (n = 40) and 27.5% (n = 36) in the lacidipine and amlodipine groups, respectively (p = 0.61). No serious adverse event occurred in the trial. CONCLUSIONS Lacidipine effectively lowers clinic and ambulatory BP in patients with mild-to-moderate hypertension and significantly improves arterial stiffness, similarly as amlodipine.
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Affiliation(s)
- Ying Wang
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Dizdar OS, Yeşiltepe A, Dondurmaci E, Ozkan E, Koç A, Gunal AI. Hydration status and blood pressure variability in primary hypertensive patients. Nefrologia 2020; 40:522-530. [PMID: 32536454 DOI: 10.1016/j.nefro.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Increased blood pressure variability (BPV) is associated with higher cardiovascular risk. The association between BPV and fluid status in hypertensive patients has not been investigated so far. The aim of the present study was to determine the contribution of fluid balance to BPV and impact on endothelial and cardiac functions among primary hypertensive patients. METHODS This is a prospective interventional study conducted in primary hypertensive patients with one-year follow-up. Volume status measurements by a body composition monitor, ambulatory blood pressure (BP) monitoring, echocardiographic and carotid intima-media thickness (CIMT) measurements were performed at enrollment and at twelfth. Patients in one of the two groups were kept negative hydrated during trial with diuretic treatment. Patients in other group were positively hydrated (hypervolemic) at enrollment, antihypertensive drugs other than diuretics (vasodilator agents) were added or intensified according to the BP monitoring. Average real variability (ARV) index was used for establishing the prognostic significance of BPV. RESULTS The study population consisted of 50 patients with a mean age of 54.5±8.8 years. At the end of one-year follow-up, patients in negative hydrated group were found to have significantly lower BP, CIMT, left ventricle mass index (LVMI) and systolic and diastolic ARV. More weight gain and higher systolic BP were major risk factors of high systolic ARV. Patients who have improvement in CIMT and LVMI were considered as target organ damage (TOD) recovery present. In negatively hydrated group, TOD significantly reduced during trial. In patients who have TOD recovery, BPV significantly more reduced like systolic and diastolic BP. Significant risk factors associated with the presence of TOD were 24h systolic BP and daytime and night time diastolic ARV and night time diastolic BP. CONCLUSION Addition of diuretic to established treatment or intensified diuretic treatment and keeping patients in negative hydration status resulted in reduction in BPV at twelfth month of follow-up. More weight gain and higher systolic BP are major risk factors of high systolic ARV, but not hypervolemia. BPV, especially diastolic ARV, was significantly associated with TOD.
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Affiliation(s)
- Oguzhan Sıtkı Dizdar
- Department of Internal Medicine and Clinical Nutrition, Kayseri City Training and Research Hospital, Kayseri, Turkey.
| | - Ali Yeşiltepe
- Department of Internal Medicine, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Engin Dondurmaci
- Department of Cardiology, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Eyup Ozkan
- Department of Cardiology, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Ali Koç
- Department of Radiology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ali Ihsan Gunal
- Department of Internal Medicine Division of Nephrology, Kayseri City Training and Research Hospital, Kayseri, Turkey
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Mancia G, Facchetti R, Cuspidi C, Bombelli M, Corrao G, Grassi G. Limited reproducibility of MUCH and WUCH: evidence from the ELSA study. Eur Heart J 2019; 41:1565-1571. [DOI: 10.1093/eurheartj/ehz651] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/21/2019] [Accepted: 09/12/2019] [Indexed: 12/21/2022] Open
Abstract
Abstract
Aims
To evaluate the long-term reproducibility of masked (MUCH) and white-coat uncontrolled hypertension (WUCH), an information crucial for determining the long-term prognostic impact of these conditions.
Methods and results
Reproducibility of MUCH and WUCH was assessed in 1664 hypertensive patients recruited for the European Lacidipine Study on Atherosclerosis and treated with atenolol or lacidipine (±additional drugs) during a 4-year period. Office and 24 h blood pressure (BP) was measured at baseline and every year during treatment, allowing repeated classification of either condition. After 1 year of treatment 21.1% and 17.8% of the patients were classified as MUCH and WUCH, respectively. For both conditions the prevalence was similar in the following years, although with a large change in patients composition because only about 1/3 of patients classified as MUCH or WUCH at one set of office and ambulatory BP measurements maintained the same classification at a subsequent set of measurements. In only 4.5% and 6.2% MUCH and WUCH persisted throughout the treatment period. MUCH and WUCH reproducibility was worse than that of patients showing control or lack of control of both office and ambulatory BP, i.e. controlled and uncontrolled hypertension, respectively.
Conclusion
Both MUCH and WUCH display poor reproducibility over time. This should be taken into account in studies assessing the long-term prognostic value of these conditions based on only one set of BP measurements.
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Affiliation(s)
- Giuseppe Mancia
- University of Milano-Bicocca, Milan, Italy
- Policlinico di Monza, Monza, Italy
| | - Rita Facchetti
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Cesare Cuspidi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Different effects of antihypertensive treatment on office and ambulatory blood pressure. J Hypertens 2019; 37:467-475. [DOI: 10.1097/hjh.0000000000001914] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Grassi G, Seravalle G, Brambilla G, Dell'Oro R, Trevano FQ, Fici F, van Bortel L, Mancia G. Multicenter Randomized Double-Blind Comparison of Nebivolol plus HCTZ and Irbesartan plus HCTZ in the Treatment of Isolated Systolic Hypertension in Elderly Patients: Results of the NEHIS Study. Adv Ther 2017; 33:2173-2187. [PMID: 27771847 DOI: 10.1007/s12325-016-0427-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The present study was aimed at comparing the antihypertensive efficacy, tolerability, and side effects profile of nebivolol/hydrochlorothiazide (NH) vs irbesartan/hydrochlorothiazide (IH) combination in elderly patients with isolated systolic hypertension (ISH). METHODS 124 ISH patients aged 69.1 ± 5.1 years (mean ± SD) were enrolled by 13 general practitioners in Netherlands and Belgium and randomized in a double-blind fashion to receive either NH (5/12.5 mg day, n = 62) or IH (150/12.5 mg day, n = 62) for a 12-week period. The primary efficacy endpoint of the study was the comparison of the two combinations in terms of sitting office systolic blood pressure (BP) reduction after 12 weeks of treatment. In addition ambulatory BP, 24-h BP variability, tolerability, and safety profile were also investigated. RESULTS 122 patients were included in the intention-to-treat analysis. After 12 weeks of treatment the reduction of systolic BP with NH was significantly greater than IH (-25.8 ± 12 vs -21.2 ± 14 mm Hg, P < 0.03). Diastolic BP reduction was significantly greater with NH after 4 and 8 weeks of treatment but similar at the end of the study (or after 12 weeks). In contrast, the magnitude of the 24-h, daytime, and nighttime systolic and diastolic BP reduction was almost similar in the two groups, while heart rate reduction induced by NH was significantly (P < 0.001) greater during the 24-h, daytime, and nighttime period than that induced by IH. NH caused a reduction in 24-h BP variability significantly greater than IH (standard deviation -4.4 ± 2.7 vs -2.2 ± 5.1 mm Hg, P < 0.02, variation coefficient -2.0 ± 2.6 vs -0.3 ± 3.4%, P < 0.01). Both treatment regimens were well tolerated. CONCLUSIONS These data provide evidence that NH reduces office BP more than IH but has similar effects on 24-h BP. NH reduces 24-h systolic and diastolic BP variability more than IH, suggesting a greater protective effect on a variable known to adversely affect prognosis. TRIAL REGISTRATION EU clinical Trials Register identifier, 2010-023104-28. FUNDING Menarini International Operations Luxembourg.
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Affiliation(s)
- Guido Grassi
- Clinica Medica, Università Milano-Bicocca, Milan, Italy.
- Clinica medica, Università Milano- Bioccca, Milan Italy and Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
| | | | | | | | | | | | - Luc van Bortel
- Clinical Pharmacology Research Unit, Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
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Eguchi K, Imaizumi Y, Kaihara T, Hoshide S, Kario K. Comparison of valsartan and amlodipine on ambulatory blood pressure variability in hypertensive patients. Clin Exp Hypertens 2016; 38:721-724. [DOI: 10.1080/10641963.2016.1200609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kazuo Eguchi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Yuki Imaizumi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Toshiki Kaihara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
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Pengo MF, Rossitto G, Bisogni V, Piazza D, Frigo AC, Seccia TM, Maiolino G, Rossi GP, Pessina AC, Calò LA. Systolic and diastolic short-term blood pressure variability and its determinants in patients with controlled and uncontrolled hypertension: a retrospective cohort study. Blood Press 2015; 24:124-9. [PMID: 25555153 DOI: 10.3109/08037051.2014.992187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Absolute blood pressure (BP) values are not the only causes of adverse cardiovascular consequences. BP variability (BPV) has also been demonstrated to be a predictor of mortality for cardiovascular events; however, its determinants are still unknown. This study considers 426 subjects with ambulatory BP monitoring (ABPM) measuring 24-h, diurnal and nocturnal absolute BP values and their standard deviations of the mean, along with nocturnal fall, age, sex and current treatment. Patients were divided in two subgroups, controlled and uncontrolled BP, and BPV of patients with "true" and "false" resistant hypertension was also analyzed. Nocturnal and 24-h BPV were higher in the group with uncontrolled hypertension. Multiple regression analysis showed that absolute BP, age, nocturnal fall, but not sex predicted BPV. Patients with "true" resistant hypertension had greater BPV than "false" resistant hypertension patients. Absolute BP resulted as the main determinant of 24-h and nocturnal BPV but not daytime BPV. Also nocturnal BP fall and age resulted as predictors of BPV in treated and untreated patients. Patients with "true" resistant hypertension have a higher BPV, suggesting a higher sympathetic activation. Evidence is still limited regarding the importance of short-term BPV as a prognostic factor and assessment of BPV cannot yet represent a parameter for routine use in clinical practice. Future prospective trials are necessary to define which targets of BPV can be achieved with antihypertensive drugs and whether treatment-induced reduction in BPV is accompanied by a corresponding reduction in cardiovascular events.
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Redon J, Lurbe E. Ambulatory Blood Pressure Monitoring Is Ready to Replace Clinic Blood Pressure in the Diagnosis of Hypertension. Hypertension 2014; 64:1169-74; discussion 1174. [DOI: 10.1161/hypertensionaha.114.03883] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Josep Redon
- From the Hypertension Clinic, Hospital Clinico, Research Institute INCLIVA (J.R.), and Pediatric Department, Consorcio Hospital General (E.L.), University of Valencia, Valencia, Spain; and CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain (J.R., E.L.)
| | - Empar Lurbe
- From the Hypertension Clinic, Hospital Clinico, Research Institute INCLIVA (J.R.), and Pediatric Department, Consorcio Hospital General (E.L.), University of Valencia, Valencia, Spain; and CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain (J.R., E.L.)
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European Society of Hypertension position paper on ambulatory blood pressure monitoring. J Hypertens 2014; 31:1731-68. [PMID: 24029863 DOI: 10.1097/hjh.0b013e328363e964] [Citation(s) in RCA: 977] [Impact Index Per Article: 97.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ambulatory blood pressure monitoring (ABPM) is being used increasingly in both clinical practice and hypertension research. Although there are many guidelines that emphasize the indications for ABPM, there is no comprehensive guideline dealing with all aspects of the technique. It was agreed at a consensus meeting on ABPM in Milan in 2011 that the 34 attendees should prepare a comprehensive position paper on the scientific evidence for ABPM.This position paper considers the historical background, the advantages and limitations of ABPM, the threshold levels for practice, and the cost-effectiveness of the technique. It examines the need for selecting an appropriate device, the accuracy of devices, the additional information and indices that ABPM devices may provide, and the software requirements.At a practical level, the paper details the requirements for using ABPM in clinical practice, editing considerations, the number of measurements required, and the circumstances, such as obesity and arrhythmias, when particular care needs to be taken when using ABPM.The clinical indications for ABPM, among which white-coat phenomena, masked hypertension, and nocturnal hypertension appear to be prominent, are outlined in detail along with special considerations that apply in certain clinical circumstances, such as childhood, the elderly and pregnancy, and in cardiovascular illness, examples being stroke and chronic renal disease, and the place of home measurement of blood pressure in relation to ABPM is appraised.The role of ABPM in research circumstances, such as pharmacological trials and in the prediction of outcome in epidemiological studies is examined and finally the implementation of ABPM in practice is considered in relation to the issue of reimbursement in different countries, the provision of the technique by primary care practices, hospital clinics and pharmacies, and the growing role of registries of ABPM in many countries.
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Levi-Marpillat N, Macquin-Mavier I, Tropeano AI, Parati G, Maison P. Antihypertensive drug classes have different effects on short-term blood pressure variability in essential hypertension. Hypertens Res 2014; 37:585-90. [DOI: 10.1038/hr.2014.33] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 11/07/2013] [Accepted: 12/15/2013] [Indexed: 11/09/2022]
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Use of ambulatory blood pressure monitoring to guide hypertensive therapy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:746-60. [PMID: 23839274 DOI: 10.1007/s11936-013-0255-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OPINION STATEMENT With the advent of noninvasive 24-hour ambulatory blood pressure monitoring (ABPM), clinicians have access to a wealth of individualized data for the hypertensive patient. This has led to a greater understanding of the pathophysiology of hypertension and its complications. This tool has provided more precise diagnostic criteria for hypertension and helped discover those with white coat and masked hypertension. Patterns noted on ABPM and correlated with outcomes have allowed for more accurate identification of patients at high risk of cardiovascular (CV) events, and have offered an additional prognostic tool. In addition, ABPM allows for the assessment of the efficacy and adequacy of blood pressure treatment. In the current paper, we will describe the essential components of ABPM, review the evidence detailing the prognostic information that can be derived from its use, highlight clinical scenarios wherein ABPM can offer invaluable diagnostic information, and describe applications of ABPM that evaluate the efficacy of treatment of the hypertensive patient.
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Erdogan D, Icli A, Aksoy F, Akcay S, Ozaydin M, Ersoy I, Varol E, Dogan A. Relationships of different blood pressure categories to indices of inflammation and platelet activity in sustained hypertensive patients with uncontrolled office blood pressure. Chronobiol Int 2013; 30:973-80. [PMID: 23834704 DOI: 10.3109/07420528.2013.790045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Failure to decrease blood pressure (BP) normally during nighttime (non-dipping) in hypertension is associated with higher cardiovascular morbidity and mortality. In addition, non-dipping BP is associated with increased platelet activity and inflammatory response; however, there has been no study to evaluate the relationship of non-dipping BP to indices of platelet activity and inflammation in uncontrolled hypertensive patients. In the present study, hypertensive subjects with uncontrolled office BP were firstly divided into three groups: 84 subjects with white coat effect and 365 subjects with true uncontrolled hypertension. Then, true uncontrolled hypertensive patients were divided into two groups: 158 patients with dipping and 207 patients with non-dipping. Mean platelet volume (MPV), uric acid (UA), γ-glutamyltransferase (GGT), C-reactive protein (CRP), and high-sensitivity CRP (hs-CRP) levels were studied. The general characteristics and risk factors for coronary artery disease (CAD) of the study population were similar among the groups. MPV, UA, GGT, CRP, and hs-CRP levels were significantly higher in non-dipper group than both dipper and white coat effect groups, and were significantly higher in dipper group than in white coat effect group (MPV: 9.1 ± 1.3, 8.7 ± 1.1, and 8. ± 0.9 fL; UA: 6.9 ± 1.2, 5.9 ± 1.4, and 4.1 ± 0.8 mg/dL; GGT: 38.9 ± 11.1, 33.6 ± 14.9, and 25.2 ± 9.2 U/L; CRP: 7.1 ± 2.4, 6.2 ± 1.9, and 3.9 ± 0.8 mg/dL; hs-CRP: 3.8 ± 1.5, 3.3 ± 1.2, and 2.0 ± 0.6, non-dipper, dipper, and white coat effect groups, respectively, all p values <0.01). All study parameters strongly correlated with each other. In conclusion, in hypertensive patients with uncontrolled office BP, presence of non-dipping BP is associated with increased platelet activity and inflammation, which can be one of the underlying plausible mechanisms of non-dipping BP status.
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Affiliation(s)
- Dogan Erdogan
- Department of Cardiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey.
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Możdżan M, Wierzbowska-Drabik K, Kurpesa M, Trzos E, Rechciński T, Broncel M, Kasprzak JD. Echocardiographic indices of left ventricular hypertrophy and diastolic function in hypertensive patients with preserved LVEF classified as dippers and non-dippers. Arch Med Sci 2013; 9:268-75. [PMID: 23671437 PMCID: PMC3648830 DOI: 10.5114/aoms.2013.34534] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 07/26/2011] [Accepted: 10/17/2011] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Long-lasting arterial hypertension causes left ventricular hypertrophy (LVH) and impairs left ventricular diastolic function. Our aim was to compare echocardiographic parameters between hypertensive patients defined as dippers and non-dippers during ambulatory blood pressure (BP) monitoring. MATERIAL AND METHODS We analysed 61 consecutive subjects with treated hypertension undergoing 24-h BP monitoring and transthoracic echocardiographic examination and included in the study patients with preserved left ventricular ejection fraction (EF ≥ 50%). Echocardiographic and arterial pressure parameters were compared between the group classified as dippers (n = 26, 57 ±13 years, 16 males) and non-dippers (n = 35, 60 ±12 years, 24 males) according to present or absent decrease of BP during the night > 10%. Echocardiographic data were compared between both groups and control subjects without hypertension. RESULTS Dippers had lower average systolic, diastolic and mean arterial pressure during the night hours but did not differ according to the mean pressure calculated from a 24-hour period. All echocardiographic parameters were similar in dippers and non-dippers. All patients with arterial hypertension presented with larger dimension of both ventricles and left atrium, thicker left ventricular walls, higher LV mass and mass index and preserved EF and E/A ratio as compared with normotensive controls. Normal geometry, concentric remodelling and eccentric hypertrophy were similarly distributed in both groups. Concentric hypertrophy was more prevalent in non-dippers as compared to the dippers (71.4% vs. 38.5%, p < 0.043). CONCLUSIONS The concentric type of LVH is the prevalent pattern in non-dippers. Non-dipping blood pressure pattern may be responsible for the development of left ventricular concentric hypertrophy secondary to hypertension.
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Affiliation(s)
- Monika Możdżan
- 2 Chair and Department of Cardiology, Medical University of Lodz, Poland
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Lodz, Poland
| | | | - Małgorzata Kurpesa
- 2 Chair and Department of Cardiology, Medical University of Lodz, Poland
| | - Ewa Trzos
- 2 Chair and Department of Cardiology, Medical University of Lodz, Poland
| | - Tomasz Rechciński
- 2 Chair and Department of Cardiology, Medical University of Lodz, Poland
| | - Marlena Broncel
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Lodz, Poland
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Mancia G, Parati G, Bilo G, Gao P, Fagard R, Redon J, Czuriga I, Polák M, Ribeiro JM, Sanchez R, Trimarco B, Verdecchia P, van Mieghem W, Teo K, Sleight P, Yusuf S. Ambulatory Blood Pressure Values in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET). Hypertension 2012; 60:1400-6. [DOI: 10.1161/hypertensionaha.112.199562] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial, telmisartan (T; 80 mg daily) and ramipril (R; 10 mg daily) caused similar clinic blood pressure (BP) reductions, with a similar incidence of cardiovascular and renal events. The R+T combination lowered clinic BP somewhat more with no further cardiovascular or renal protection. The aim of this substudy was to see whether these clinic BP changes reflected the changes of 24-hour BP, a BP with a better prognostic value. In 422 patients in whom 24-hour BP monitoring was performed either before or after 6 to 24 months of treatment, demographic and clinical characteristics were similar in the 3 treated groups. Twenty-four-hour systolic BP was similarly reduced by R (−2.0 mm Hg) and T (−2.1 mm Hg), whereas the reduction was more than twice as large in the T+R group (−5.3 mm Hg), which showed a lower on-treatment 24-hour BP also in additional patients (n=408) in whom ambulatory BP was performed only on-treatment. Twenty-four-hour systolic BP was ≈14 mm Hg lower than clinic systolic BP at baseline, whereas during treatment the 2 values became progressively closer as clinic systolic BP was more tightly controlled and superimposable when clinic systolic BP was <120 mm Hg. Similar results were obtained for diastolic BP. These findings provide evidence on the relationship of clinic and ambulatory BP target drug treatment. They also show that in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial, failure of the R+T combination to enhance cardiovascular and renal protection was not because of inability to more effectively control daily life BP.
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Affiliation(s)
- Giuseppe Mancia
- From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo
| | - Gianfranco Parati
- From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo
| | - Grzegorz Bilo
- From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo
| | - Peggy Gao
- From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo
| | - Robert Fagard
- From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo
| | - Josep Redon
- From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo
| | - Istvan Czuriga
- From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo
| | - Martin Polák
- From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo
| | - Josè M. Ribeiro
- From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo
| | - Ramiro Sanchez
- From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo
| | - Bruno Trimarco
- From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo
| | - Paolo Verdecchia
- From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo
| | - Walter van Mieghem
- From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo
| | - Koon Teo
- From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo
| | - Peter Sleight
- From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo
| | - Salim Yusuf
- From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo
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Twenty-four hour and early morning blood pressure control of olmesartan vs. ramipril in elderly hypertensive patients. J Hypertens 2012; 30:1468-77. [DOI: 10.1097/hjh.0b013e32835466ac] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Affiliation(s)
- Giuseppe Mancia
- Department of Medicine, University of Milano-Bicocca, St Gerardo Hospital, via Pergolesi 33, 20900 Monza, Italy.
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22
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Visit-to-visit blood pressure variability in the European Lacidipine Study on Atherosclerosis. J Hypertens 2012; 30:1241-51. [DOI: 10.1097/hjh.0b013e32835339ac] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Sabater-Hernández D, De La Sierra A, Sánchez-Villegas P, Santana-Pérez FM, Merino-Barber L, Faus MJ. Agreement Between Community Pharmacy and Ambulatory and Home Blood Pressure Measurement Methods to Assess the Effectiveness of Antihypertensive Treatment: The MEPAFAR Study. J Clin Hypertens (Greenwich) 2012; 14:236-44. [DOI: 10.1111/j.1751-7176.2012.00598.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Grassi G. The TALENT Study. Expert Opin Pharmacother 2012; 13:607-11. [DOI: 10.1517/14656566.2012.658772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Exactly how hypertension causes end organ damage and vascular events is poorly understood. Yet the concept that underlying "usual" blood pressure (BP) accounts for all BP-related risk of vascular events and for the benefits of BP-lowering drugs has come to underpin clinical guidelines on the diagnosis and treatment of hypertension. This article reviews evidence that variability in BP also predicts risk of stroke and other vascular events independently of mean BP and evidence that drug-class effects on variability in BP explain differences in the effectiveness of BP-lowering drugs in preventing stroke.
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Affiliation(s)
- Peter M Rothwell
- University Department of Clinical Neurology, John Radcliffe Hospital, Level 6, West Wing, Headington, Oxford OX3 9DU, UK.
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26
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Affiliation(s)
- Giuseppe Schillaci
- From the Unit of Internal Medicine, Angiology and Arteriosclerosis Disease (G.S., G.Pu.), University of Perugia, Perugia, Italy; Department of Clinical Medicine and Prevention (G.Pa.), University of Milano-Bicocca and Department of Cardiology, San Luca Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico, Istituto Auxologico Italiano, Milan, Italy
| | - Giacomo Pucci
- From the Unit of Internal Medicine, Angiology and Arteriosclerosis Disease (G.S., G.Pu.), University of Perugia, Perugia, Italy; Department of Clinical Medicine and Prevention (G.Pa.), University of Milano-Bicocca and Department of Cardiology, San Luca Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico, Istituto Auxologico Italiano, Milan, Italy
| | - Gianfranco Parati
- From the Unit of Internal Medicine, Angiology and Arteriosclerosis Disease (G.S., G.Pu.), University of Perugia, Perugia, Italy; Department of Clinical Medicine and Prevention (G.Pa.), University of Milano-Bicocca and Department of Cardiology, San Luca Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico, Istituto Auxologico Italiano, Milan, Italy
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Zhang Y, Agnoletti D, Safar ME, Blacher J. Effect of antihypertensive agents on blood pressure variability: the Natrilix SR versus candesartan and amlodipine in the reduction of systolic blood pressure in hypertensive patients (X-CELLENT) study. Hypertension 2011; 58:155-60. [PMID: 21747047 DOI: 10.1161/hypertensionaha.111.174383] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To investigate the effect of different antihypertensive agents on blood pressure (BP) variability (BPV) and the underlying mechanism, we analyzed the ambulatory BP monitoring data of 577 patients before and after 3-month antihypertensive treatment, in the Natrilix SR Versus Candesartan and Amlodipine in the Reduction of Systolic Blood Pressure in Hypertensive Patients (X-CELLENT) Study, a multicenter, multinational, randomized, double-blind, placebo-controlled study with 4 parallel treatment arms (placebo, candesartan, indapamide sustained release, and amlodipine). Within-subject mean and SD of 24-hour BP, weighted by time interval between consecutive readings, were calculated in 3 time frames (daytime, nighttime, and 24 hours) to evaluate BP and BPV. The mean 24-hour heart rate (HR) and HR variability were calculated with the same algorithms. We found that the 3 antihypertensive drugs had a similar BP-lowering effect (P<0.001 for all), but amlodipine (P<0.007) and indapamide sustained release (P<0.04) were the only agents associated with a significantly decreased BPV after 3-month treatment. On the other hand, the major determinants of BPV at baseline were age, mean BP, and the corresponding HR variability. However, the reduction in BPV by amlodipine was significantly associated with the reduction in BP (P<0.006) and the reduction in HR variability (P<0.02), whereas the corresponding reduction by indapamide sustained release was only associated with the reduction in HR variability at night (P=0.004). In summary, 3-month amlodipine or indapamide sustained release treatment was associated with a significant reduction in BPV, and the mechanism of those reductions was possibly attributable to lowering BP or ameliorating the autonomic nervous system regulation or both. The combination of the 2 agents might help to optimize such properties.
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Affiliation(s)
- Yi Zhang
- Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu, 1, Place du Parvis Notre-Dame, 75181 Paris Cedex 04, France
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Grassi G, Quarti-Trevano F, Brambilla G, Seravalle G. Blood pressure control in resistant hypertension: new therapeutic options. Expert Rev Cardiovasc Ther 2011; 8:1579-85. [PMID: 21090933 DOI: 10.1586/erc.10.138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Resistant hypertension, namely the hypertensive state characterized by the inability of multiple antihypertensive drug interventions to lower blood pressure to goal levels, represents a condition frequently detected in clinical practice. Its main features are represented by its heterogeneous etiology as well as its very high cardiovascular risk. This latter peculiarity has implemented the research for new approaches to the treatment of the disease. This article will focus on two of them, namely carotid baroreceptor electric stimulation and the renal denervation procedure. Clinical studies and large-scale clinical trials are presently ongoing with the aim of defining the long-term efficacy and safety profile of the two interventions.
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Affiliation(s)
- Guido Grassi
- Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Ospedale San Gerardo, Via Pergolesi 33, 20052 Monza, Milan, Italy.
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Abstract
Guidelines on hypertension diagnosis and treatment have been issued in 2007. Since then, a number of major intervention clinical trials have been designed, carried out, and completed with the aim of investigating unsolved issues related to the impact of the blood pressure-lowering intervention on cardiovascular risk and events. These include, among others, the nephroprotective properties of antihypertensive drugs, the blood pressure targets to be achieved during treatment in uncomplicated and more so in complicated hypertensive patients, the advantages of one drug combination versus another, and the benefits of antihypertensive drugs in the very elderly. All these questions have received a clear-cut answer by the results of recently performed clinical trials, which have been included in the 2009 update document of the European guidelines. This paper will be focused on the 2007 guidelines document and the 2009 update paper, highlighting the new concepts and recommendations provided by the most recent intervention trials.
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Affiliation(s)
- Giuseppe Mancia
- Clinica Medica, Ospedale San Gerardo dei Tintori (Monza), Università Milano-Bicocca, Milan, Italy.
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Left ventricular hypertrophy increases cardiovascular risk independently of in-office and out-of-office blood pressure values. J Hypertens 2010; 27:2458-64. [PMID: 19654559 DOI: 10.1097/hjh.0b013e328330b845] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Previous studies have shown that left ventricular hypertrophy (LVH) represents a cardiovascular risk factor independently of clinic blood pressure (BP). The present study was aimed at determining the impact of LVH on the incidence of cardiovascular morbid and fatal events taking into account not only classical risk factors but also home and ambulatory BP values, which have been shown to have an important independent prognostic impact. METHODS In 1716 patients belonging to the 'Pressioni Arteriose Monitorate E Loro Associazioni' population of Monza, we quantified left ventricular mass index and identified LVH by standard cutoff values. We also measured clinic, home and 24-h ambulatory BPs together with serum glucose and lipids. RESULTS During a follow-up of 148 months, the rate of fatal and nonfatal (hospitalizations) cardiovascular events as well as of all-cause death was markedly greater (four-fold to five-fold) in patients as compared with those without LVH. In LVH individuals, the increased risk remained significant even when data were adjusted for a large number of other confounding factors including home BP, 24-h mean BP and ambulatory BP. Results were similar when left ventricular mass was indexed by height and body surface area. A 10% increase in left ventricular mass index was associated with a significant increase in cardiovascular risk or all-cause deaths. In multivariate analysis, left ventricular mass index was always an independent predictor of cardiovascular events and death for any cause. CONCLUSION Our data provide evidence that LVH is an important risk factor even when the contribution of different BPs to risk is fully taken into account.
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Mancia G, Corrao G. Targeting blood pressure in the management of total cardiovascular risk. Eur Heart J Suppl 2009. [DOI: 10.1093/eurheartj/sup029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
Hypertension is a highly prevalent cardiovascular risk factor in the world and particularly overwhelming in low and middle-income countries. Recent reports from the WHO and the World Bank highlight the importance of chronic diseases such as hypertension as an obstacle to the achievement of good health status. It must be added that for most low and middle-income countries, deficient strategies of primary healthcare are the major obstacles for blood pressure control. Furthermore, the epidemiology of hypertension and related diseases, healthcare resources and priorities, the socioeconomic status of the population vary considerably in different countries and in different regions of individual countries. Considering the low rates of blood pressure control achieved in Latin America and the benefits that can be expected from an improved control, it was decided to invite specialists from different Latin American countries to analyze the regional situation and to provide a consensus document on detection, evaluation and treatment of hypertension that may prove to be cost-utility adequate. The recommendations here included are the result of preparatory documents by invited experts and a subsequent very active debate by different discussion panels, held during a 2-day sessions in Asuncion, Paraguay, in May 2008. Finally, in order to improve clinical practice, the publication of the guidelines should be followed by implementation of effective interventions capable of overcoming barriers (cognitive, behavioral and affective) preventing attitude changes in both physicians and patients.
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Mansia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Struijker Boudier HA, Zanchetti A. 2007 ESH‐ESC Guidelines for the management of arterial hypertension. Blood Press 2009; 16:135-232. [PMID: 17846925 DOI: 10.1080/08037050701461084] [Citation(s) in RCA: 238] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Giuseppe Mansia
- Clinica Medica, Ospedale San Gerardo, Universita Milano-Bicocca, Via Pergolesi, 33 - 20052 MONZA (Milano), Italy.
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Abstract
Reducing blood pressure (BP) to guideline-recommended goals associated with reductions in cardiovascular risk is central to effective hypertension management. In addition to measuring BP reduction, clinical trials of antihypertensive agents should assess the percentage of patients responding to treatment. The Food and Drug Administration's defined rate of response required for drug approval is a reduction in diastolic BP (DBP) to <90 mmHg and/or a DBP reduction of > or = 10 mmHg. Consequently, some patients may be counted as responders even if they have not reached DBP <90 mmHg. An antihypertensive agent's effectiveness may be better assessed by the proportion of patients who achieve recommended BP goals. This article analyzes the frequency of response rates versus goal rates as endpoints in randomized trials since January 2001. Data showed that goal rates, especially combined systolic BP (SBP)/DBP goal rates, are consistently lower than response rates in studies evaluating both endpoints. Goal rates incorporating both SBP and DBP, or having a focus on SBP for individuals >50 years of age, provide the most clinically relevant information and are a more clinically relevant metric of an agent's ability to reduce BP than DBP alone.
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Affiliation(s)
- Jan Basile
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
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Protective effects of renin–angiotensin blockade beyond blood pressure control. J Hum Hypertens 2009; 23:570-7. [DOI: 10.1038/jhh.2008.171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Giannattasio C, Salvi P, Valbusa F, Kearney-Schwartz A, Capra A, Amigoni M, Failla M, Boffi L, Madotto F, Benetos A, Mancia G. Simultaneous Measurement of Beat-to-Beat Carotid Diameter and Pressure Changes to Assess Arterial Mechanical Properties. Hypertension 2008; 52:896-902. [DOI: 10.1161/hypertensionaha.108.116509] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Cristina Giannattasio
- From the Clinica Medica (C.G., A.C., M.A., M.F., L.B., F.M., G.M.), University of Milano-Bicocca and S. Gerardo Hospital, Monza, Milano, Italy; Department of Geriatrica (P.S., F.V., A.K.-S., A.B.), University of Nancy, France; and Istituto Auxologico Italiano (C.G., G.M.), Osp. S. Luca, Milano, Italy
| | - Paolo Salvi
- From the Clinica Medica (C.G., A.C., M.A., M.F., L.B., F.M., G.M.), University of Milano-Bicocca and S. Gerardo Hospital, Monza, Milano, Italy; Department of Geriatrica (P.S., F.V., A.K.-S., A.B.), University of Nancy, France; and Istituto Auxologico Italiano (C.G., G.M.), Osp. S. Luca, Milano, Italy
| | - Filippo Valbusa
- From the Clinica Medica (C.G., A.C., M.A., M.F., L.B., F.M., G.M.), University of Milano-Bicocca and S. Gerardo Hospital, Monza, Milano, Italy; Department of Geriatrica (P.S., F.V., A.K.-S., A.B.), University of Nancy, France; and Istituto Auxologico Italiano (C.G., G.M.), Osp. S. Luca, Milano, Italy
| | - Anna Kearney-Schwartz
- From the Clinica Medica (C.G., A.C., M.A., M.F., L.B., F.M., G.M.), University of Milano-Bicocca and S. Gerardo Hospital, Monza, Milano, Italy; Department of Geriatrica (P.S., F.V., A.K.-S., A.B.), University of Nancy, France; and Istituto Auxologico Italiano (C.G., G.M.), Osp. S. Luca, Milano, Italy
| | - Anna Capra
- From the Clinica Medica (C.G., A.C., M.A., M.F., L.B., F.M., G.M.), University of Milano-Bicocca and S. Gerardo Hospital, Monza, Milano, Italy; Department of Geriatrica (P.S., F.V., A.K.-S., A.B.), University of Nancy, France; and Istituto Auxologico Italiano (C.G., G.M.), Osp. S. Luca, Milano, Italy
| | - Maria Amigoni
- From the Clinica Medica (C.G., A.C., M.A., M.F., L.B., F.M., G.M.), University of Milano-Bicocca and S. Gerardo Hospital, Monza, Milano, Italy; Department of Geriatrica (P.S., F.V., A.K.-S., A.B.), University of Nancy, France; and Istituto Auxologico Italiano (C.G., G.M.), Osp. S. Luca, Milano, Italy
| | - Monica Failla
- From the Clinica Medica (C.G., A.C., M.A., M.F., L.B., F.M., G.M.), University of Milano-Bicocca and S. Gerardo Hospital, Monza, Milano, Italy; Department of Geriatrica (P.S., F.V., A.K.-S., A.B.), University of Nancy, France; and Istituto Auxologico Italiano (C.G., G.M.), Osp. S. Luca, Milano, Italy
| | - Lucia Boffi
- From the Clinica Medica (C.G., A.C., M.A., M.F., L.B., F.M., G.M.), University of Milano-Bicocca and S. Gerardo Hospital, Monza, Milano, Italy; Department of Geriatrica (P.S., F.V., A.K.-S., A.B.), University of Nancy, France; and Istituto Auxologico Italiano (C.G., G.M.), Osp. S. Luca, Milano, Italy
| | - Fabiana Madotto
- From the Clinica Medica (C.G., A.C., M.A., M.F., L.B., F.M., G.M.), University of Milano-Bicocca and S. Gerardo Hospital, Monza, Milano, Italy; Department of Geriatrica (P.S., F.V., A.K.-S., A.B.), University of Nancy, France; and Istituto Auxologico Italiano (C.G., G.M.), Osp. S. Luca, Milano, Italy
| | - Athanasios Benetos
- From the Clinica Medica (C.G., A.C., M.A., M.F., L.B., F.M., G.M.), University of Milano-Bicocca and S. Gerardo Hospital, Monza, Milano, Italy; Department of Geriatrica (P.S., F.V., A.K.-S., A.B.), University of Nancy, France; and Istituto Auxologico Italiano (C.G., G.M.), Osp. S. Luca, Milano, Italy
| | - Giuseppe Mancia
- From the Clinica Medica (C.G., A.C., M.A., M.F., L.B., F.M., G.M.), University of Milano-Bicocca and S. Gerardo Hospital, Monza, Milano, Italy; Department of Geriatrica (P.S., F.V., A.K.-S., A.B.), University of Nancy, France; and Istituto Auxologico Italiano (C.G., G.M.), Osp. S. Luca, Milano, Italy
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Grassi G, Quarti-Trevano F, Mancia G. Review: Cardioprotective effects of telmisartan in uncomplicated and complicated hypertension. J Renin Angiotensin Aldosterone Syst 2008; 9:66-74. [DOI: 10.3317/jraas.2008.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
The development of angiotensin II receptor blockers (ARB) as a new class of drugs for the management of hypertension has elicited the attention of many clinicians worldwide with the aim of improving blood pressure (BP) control as well as cardiovascular protection.AmongARB telmisartan has been shown to be characterised by an antihypertensive efficacy fully covering the 24-hour period, thereby allowing to antagonise the adverse effects of early morning BP rise on cardiovascular risk. Other specific effects of the drug are represented by its favourable metabolic profile (particularly on insulin sensitivity) and neutral effects on sympathetic cardiovascular function.These properties are coupled with cardioprotective effects, documented by the evidence that the drug: 1) is effective in favouring the regression of cardiac and vascular organ damage, 2) reduces arterial stiffness and improves vascular distensibility and 3) reverses the endothelial dysfunction typical of the hypertensive state particularly when complicated by renal failure, diabetes, obesity or metabolic syndrome. Several of these properties can account for the results of the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET), documenting the beneficial effects on the drug on cardiovascular morbidity and mortality.
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Affiliation(s)
- Guido Grassi
- Department of Internal Medicine and Cardiovascular Prevention, S Gerardo Hospital, University of Milano-Bicocca, Monza Milan, Center of Clinical Physiology and Hypertension, Milan, Italy,
| | - Fosca Quarti-Trevano
- Department of Internal Medicine and Cardiovascular Prevention, S Gerardo Hospital, University of Milano-Bicocca, Monza Milan, Center of Clinical Physiology and Hypertension, Milan, Italy
| | - Giuseppe Mancia
- Department of Internal Medicine and Cardiovascular Prevention, S Gerardo Hospital, University of Milano-Bicocca, Monza Milan, Center of Clinical Physiology and Hypertension, Milan, Italy
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Update the set of principles and beliefs. J Hypertens 2008; 26:374; author reply 374-5. [DOI: 10.1097/hjh.0b013e3282efeb96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Boudier HAJS, Zanchetti A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Erdine S, Kiowski W, Agabiti-Rosei E, Ambrosion E, Fagard R, Lindholm LH, Manolis A, Nilsson PM, Redon J, Viigimaa M, Adamopoulos S, Agabiti-Rosei E, Bertomeu V, Clement D, Farsang C, Gaita D, Lip G, Mallion JM, Manolis AJ, Nilsson PM, O'Brien E, Ponikowski P, Ruschitzka F, Tamargo J, van Zwieten P, Viigimaa M, Waeber B, Williams B, Zamorano JL. [ESH/ESC 2007 Guidelines for the management of arterial hypertension]. Rev Esp Cardiol 2007; 60:968.e1-94. [PMID: 17915153 DOI: 10.1157/13109650] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Grassi G, Whitworth JA. Resistant hypertension and aldosterone excess: new insights from ambulatory blood pressure monitoring. J Hypertens 2007; 25:2006-7. [PMID: 17885540 DOI: 10.1097/hjh.0b013e3282ef6ce5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mancia G, Messerli F, Bakris G, Zhou Q, Champion A, Pepine CJ. Blood pressure control and improved cardiovascular outcomes in the International Verapamil SR-Trandolapril Study. Hypertension 2007; 50:299-305. [PMID: 17606861 DOI: 10.1161/hypertensionaha.107.090290] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Uncontrolled blood pressure (BP) increases cardiovascular risk, independent of type of treatment. In this posthoc International Verapamil SR-Trandolapril Study analysis, we determined whether adverse outcomes are related to consistency of BP control, defined as the proportion of visits in which BP was in control. A total of 22 576 patients with hypertension and coronary artery disease were divided into 4 groups according to the proportion of visits in which BP was in control (<140/90 mm Hg): <25%, 25% to <50%, 50% to <75%, and >or=75%. Risk of primary outcome (first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke), myocardial infarction, and stroke decreased progressively from the group with <25% to the group with >or=75% of visits with BP control. Adjusted risks of primary outcome (heart rate: 0.60; 95% CI: 0.53 to 0.67), myocardial infarction (heart rate: 0.58; 95% CI: 0.48 to 0.70), and stroke (heart rate: 0.50; 95% CI: 0.37 to 0.67) were less in the group with >or=75% of visits with BP control compared with the group with <25% of visits with BP control. Baseline BP was not predictive of outcomes. Proportion of visits with BP control was associated with mean follow-up systolic BP (r(2)=0.64), both being independently related to primary outcome. As proportion of visits with BP control increases, there is an associated steep reduction in cardiovascular risk, independent of baseline characteristics and mean on-treatment BP. Consistency of BP control during treatment provides additional information on the protective effect of antihypertensive treatment. Physicians need to be concerned at each visit if BP is not controlled.
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Affiliation(s)
- Giuseppe Mancia
- Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione, Università Milano Bicocca, Milan, Italy.
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