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Pilz N, Picone DS, Patzak A, Opatz OS, Lindner T, Fesseler L, Heinz V, Bothe TL. Cuff-based blood pressure measurement: challenges and solutions. Blood Press 2024; 33:2402368. [PMID: 39291896 DOI: 10.1080/08037051.2024.2402368] [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: 05/17/2024] [Revised: 09/03/2024] [Accepted: 09/04/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVE Accurate measurement of arterial blood pressure (BP) is crucial for the diagnosis, monitoring, and treatment of hypertension. This narrative review highlights the challenges associated with conventional (cuff-based) BP measurement and potential solutions. This work covers each method of cuff-based BP measurement, as well as cuffless alternatives, but is primarily focused on ambulatory BP monitoring. RESULTS Manual BP measurement requires stringent training and standardized protocols which are often difficult to ensure in stressful and time-restricted clinical office blood pressure monitoring (OBPM) scenarios. Home Blood pressure monitoring (HBPM) can identify white-coat and masked hypertension but strongly depends on patient adherence to measurement techniques and procedure. The widespread use of nonvalidated automated HBPM devices raises further concerns about measurement accuracy. Ambulatory blood pressure measurement (ABPM) may be used in addition to OBPM. It is recommended to diagnose white-coat and masked hypertension as well as nocturnal BP and dipping, which are the BP values most predictive for major adverse cardiac events. Nonetheless, ABPM is limited by its non-continuous nature and susceptibility to measurement artefacts. This leads to poor overall reproducibility of ABPM results, especially regarding clinical parameters such as BP variability or dipping patterns. CONCLUSIONS Cuff-based BP measurement, despite some limitations, is vital for cardiovascular health assessment in clinical practice. Given the wide range of methodological limitations, the paradigm's potential for improvement is not yet fully realized. There are impactful and easily incorporated opportunities for innovation regarding the enhancement of measurement accuracy and reliability as well as the clinical interpretation of the retrieved data. There is a clear need for continued research and technological advancement to improve BP measurement as the premier tool for cardiovascular disease detection and management.
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Affiliation(s)
- N Pilz
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - D S Picone
- Sydney School of Health Sciences, University of Sydney, Sydney, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - A Patzak
- Institute of Translational Physiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - O S Opatz
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Lindner
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - L Fesseler
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - V Heinz
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T L Bothe
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Sydney School of Health Sciences, University of Sydney, Sydney, Australia
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2
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Bothe TL, Kreutz R, Glos M, Patzak A, Pilz N. Simultaneous 24-h ambulatory blood pressure measurement on both arms: a consideration for improving hypertension management. J Hypertens 2024; 42:828-840. [PMID: 38088417 DOI: 10.1097/hjh.0000000000003632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Arterial hypertension is one of the common treatment goals in today's medicine. 24-h ambulatory blood pressure measurement (ABPM) performed by oscillometric cuff-based devices is considered as the gold standard in hypertension diagnostics. This study aims at examining the measurement accuracy of a widely used, ABPM device. METHODS Fifty-two young and healthy participants underwent simultaneous 24-h ABPM on the left and the right upper arm using two Boso/A&D TM-2430 oscillometric cuff-based devices. Pressure curves of the cuffs, as well as hydrostatic pressure difference between the cuffs were recorded. RESULTS The mean differences between both simultaneous measurements were 1.16 mmHg with limits of agreement of 36.23 mmHg for SBP and 1.32 mmHg with limits of agreement of 32.65 mmHg for DBP. Excluding measurements where the pressure curves were disturbed and correcting for hydrostatic pressure difference between the cuffs, reduced the measurement error. However, limits of agreement remained around 20 mmHg. There were large differences in hypertension grading and dipping pattern classification between simultaneous measurements on the left and right arm. CONCLUSION The cuff-based ABPM device reveals notable measurement uncertainties, influencing hypertension grading, dipping pattern classification and blood pressure variability. These effects are attributed in part to disturbances during cuff deflation and hydrostatic influences. Nonetheless, ABPM has shown its clinical values in several studies, while this study underscores its still unlocked potential to improve hypertension management.
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Affiliation(s)
- Tomas L Bothe
- Charité - Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology
| | - Martin Glos
- Charité - Universitätsmedizin Berlin, Interdisciplinary Center of Sleep Medicine
| | - Andreas Patzak
- Charité - Universitätsmedizin Berlin, Institute of Translational Physiology, Berlin, Germany
| | - Niklas Pilz
- Charité - Universitätsmedizin Berlin, Institute of Translational Physiology, Berlin, Germany
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3
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Salazar MR, Espeche WG, Minetto J, Carrera PR, Cerri G, Leiva Sisnieguez CB, Leiva Sisnieguez CE, Balbín E, Soria A, Torres S, Grassi F, Santillan C, Carbajal HA. Uncontrolled and masked uncontrolled blood pressure in treated pregnant women with chronic hypertension and risk for preeclampsia/eclampsia. Hypertens Res 2023; 46:2729-2737. [PMID: 37783769 DOI: 10.1038/s41440-023-01443-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/31/2023] [Accepted: 08/23/2023] [Indexed: 10/04/2023]
Abstract
To analyze the relationship between the level of BP achieved with treatment and the risk for development of preeclampsia/eclampsia (PE), we conducted a historical cohort study on 149 consecutive pregnant women with treated chronic hypertension, evaluated between January 1, 2016, and November 31, 2022. According to office BP readings and ambulatory blood pressure monitoring (ABPM) performed after 20 weeks of gestation, the cohort was classified in controlled hypertension, white-coat uncontrolled hypertension, masked uncontrolled hypertension and sustained hypertension. Risks for the development of PE were estimated using logistic regression. One hundred and twenty-four pregnant women with a control BP evaluation were included in this analysis. The rates of PE were 19.4%, 27.3%, 44.8% and 47.1% for controlled, white-coat uncontrolled, masked uncontrolled and sustained uncontrolled hypertension, respectively. Compared with women with controlled hypertension, the relative risk for PE increased markedly in women with sustained uncontrolled (OR 3.69, 95% CI, 1.19-11.45) and masked uncontrolled (OR 3.38, 95% CI, 1.30-11.45) hypertension, but not in those with white-coat uncontrolled (OR 1.56 95% CI, 0.36-6.70); adjustment for covariates did not modify the results. Each mmHg higher of systolic and diastolic daytime ABPM increased the relative risk for PE ~4% and ~5%, respectively. Each mmHg higher of systolic and diastolic nocturnal BP increased the risk ~5% and ~6%, respectively. When these risks were adjusted for ABPM values in opposite periods of the day, only nocturnal ABPM remained as a significant predictor. In conclusion, masked uncontrolled hypertension implies a substantial risk for the development of PE, comparable to those of sustained uncontrolled. The presence of nocturnal hypertension seems important.
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Affiliation(s)
- Martin R Salazar
- Unidad de Enfermedades Cardiometabólicas, Servicio de Clínica Médica, Hospital Gral. San Martín, La Plata, Argentina.
- Facultad de Ciencias Médicas, UNLP, La Plata, Argentina.
| | - Walter G Espeche
- Unidad de Enfermedades Cardiometabólicas, Servicio de Clínica Médica, Hospital Gral. San Martín, La Plata, Argentina
- Facultad de Ciencias Médicas, UNLP, La Plata, Argentina
| | - Julián Minetto
- Unidad de Enfermedades Cardiometabólicas, Servicio de Clínica Médica, Hospital Gral. San Martín, La Plata, Argentina
- Facultad de Ciencias Médicas, UNLP, La Plata, Argentina
| | - Patricia Ramos Carrera
- Unidad de Enfermedades Cardiometabólicas, Servicio de Clínica Médica, Hospital Gral. San Martín, La Plata, Argentina
| | - Gustavo Cerri
- Unidad de Enfermedades Cardiometabólicas, Servicio de Clínica Médica, Hospital Gral. San Martín, La Plata, Argentina
| | - Cecilia B Leiva Sisnieguez
- Unidad de Enfermedades Cardiometabólicas, Servicio de Clínica Médica, Hospital Gral. San Martín, La Plata, Argentina
- Facultad de Ciencias Médicas, UNLP, La Plata, Argentina
| | - Carlos E Leiva Sisnieguez
- Unidad de Enfermedades Cardiometabólicas, Servicio de Clínica Médica, Hospital Gral. San Martín, La Plata, Argentina
- Facultad de Ciencias Médicas, UNLP, La Plata, Argentina
| | | | - Adelaida Soria
- Servicio de Obstetricia, Hospital Gral. San Martín, La Plata, Argentina
| | - Soledad Torres
- Servicio de Obstetricia, Hospital Gral. San Martín, La Plata, Argentina
| | - Florencia Grassi
- Servicio de Obstetricia, Hospital Gral. San Martín, La Plata, Argentina
| | - Claudia Santillan
- Servicio de Obstetricia, Hospital Gral. San Martín, La Plata, Argentina
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Ferreira MLV, Castro A, Nunes SGO, Santos MVMA, Cavaglieri CR, Chacon-Mikahil MPT. Hemodynamic Predictors of Blood Pressure Responsiveness to Continuous Aerobic Training in Postmenopausal Hypertensive Women. Metab Syndr Relat Disord 2023; 21:517-525. [PMID: 37672611 DOI: 10.1089/met.2023.0032] [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] [Indexed: 09/08/2023] Open
Abstract
Blood pressure (BP) responses to recommended aerobic training can vary widely between individuals. Although studies demonstrate the role of exercise training in regulating BP responsiveness, predictive models are still unknown. This study aimed to identify hemodynamic predictive markers for the diagnosis of BP responsiveness based on baseline characteristics and postexercise ambulatory blood pressure (ABP) before an aerobic training program in postmenopausal women. Sixty-five postmenopausal women with essential hypertension were randomly allocated into the continuous aerobic training (CAT, n = 51) and nonexercising control (CON, n = 14) groups. CAT group cycled at moderate intensity three times a week for 12 weeks. Individuals who failed to decrease systolic blood pressure (SBP) were classified as nonresponders (NRs; n = 34) based on typical error of measurement. Baseline anthropometric, metabolic, cardiovascular, hemodynamic variables, and postexercise ABP was measured to predict BP responsiveness. A logistic regression model based on Baseline SBP [odds ratio (OR) = 1.202; 95% confidence interval (CI) = 1.080-1.338], SBP Nighttime (OR = 0.889; 95% CI = 0.811-0.975), and heart rate (HR) Nighttime (OR = 1.127; 95% CI = 1.014-1.254) were able to diagnose responders and NR individuals to BP reduction in response to CAT with 92.6% accuracy (P < 0.001; Sensitivity = 94.1%; Specificity = 79.4%). The findings highlight the potential value of baseline clinical characteristics as Baseline SBP, SBP, and HR Nighttime as markers for diagnosing BP responsiveness to recommended CAT in hypertension postmenopausal women. Clinical Trial Registration number: RBR-3xnqxs8.
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Affiliation(s)
- Marina L V Ferreira
- Laboratory of Exercise Physiology, School of Physical Education, University of Campinas, Campinas, São Paulo, Brazil
| | - Alex Castro
- Laboratory of Exercise Physiology, School of Physical Education, University of Campinas, Campinas, São Paulo, Brazil
| | - Silas G O Nunes
- Laboratory of Exercise Physiology, School of Physical Education, University of Campinas, Campinas, São Paulo, Brazil
| | - Marcus V M A Santos
- Laboratory of Exercise Physiology, School of Physical Education, University of Campinas, Campinas, São Paulo, Brazil
| | - Cláudia R Cavaglieri
- Laboratory of Exercise Physiology, School of Physical Education, University of Campinas, Campinas, São Paulo, Brazil
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Barochiner J, Díaz RR, Martínez R. Prevalence and Characteristics of Isolated Nocturnal Hypertension and Masked Nocturnal Hypertension in a Tertiary Hospital in the City of Buenos Aires. Diagnostics (Basel) 2023; 13:1419. [PMID: 37189519 PMCID: PMC10138072 DOI: 10.3390/diagnostics13081419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Isolated nocturnal hypertension (INH) and masked nocturnal hypertension (MNH) increase cardiovascular risk. Their prevalence and characteristics are not clearly established and seem to differ among populations. We aimed to determine the prevalence and associated characteristics of INH and MNH in a tertiary hospital in the city of Buenos Aires. We included 958 hypertensive patients ≥ 18 years who underwent an ambulatory blood pressure monitoring (ABPM) between October and November 2022, as prescribed by their treating physician to diagnose or to assess hypertension control. INH was defined as nighttime BP ≥ 120 mmHg systolic or ≥70 diastolic in the presence of normal daytime BP (<135/85 mmHg regardless of office BP; MNH was defined as the presence of INH with office BP < 140/90 mmHg). Variables associated with INH and MNH were analyzed. The prevalences of INH and MNH were 15.7% (95% CI 13.5-18.2%) and 9.7 (95% CI 7.9-11.8%), respectively. Age, male sex, and ambulatory heart rate were positively associated with INH, whereas office BP, total cholesterol, and smoking habits showed a negative association. In turn, diabetes and nighttime heart rate were positively associated with MNH. In conclusion, INH and MNH are frequent entities, and determination of clinical characteristics such as those detected in this study is critical since this might contribute to a more appropriate use of resources.
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Affiliation(s)
- Jessica Barochiner
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina; (R.R.D.); (R.M.)
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de Triple Dependencia CONICET-Instituto Universitario del Hospital Italiano (IUHI)-Hospital Italiano (HIBA), Buenos Aires C1199, Argentina
| | - Romina R. Díaz
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina; (R.R.D.); (R.M.)
| | - Rocío Martínez
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina; (R.R.D.); (R.M.)
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de Triple Dependencia CONICET-Instituto Universitario del Hospital Italiano (IUHI)-Hospital Italiano (HIBA), Buenos Aires C1199, Argentina
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6
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Campbell NRC, Paccot Burnens M, Whelton PK, Angell SY, Jaffe MG, Cohn J, Espinosa Brito A, Irazola V, Brettler JW, Roccella EJ, Maldonado Figueredo JI, Rosende A, Ordunez P. [2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the region of the AmericasDiretrizes de 2021 da Organização Mundial da Saúde sobre o tratamento medicamentoso da hipertensão arterial: repercussões para as políticas na região das Américas]. Rev Panam Salud Publica 2022; 46:e54. [PMID: 35573116 PMCID: PMC9097923 DOI: 10.26633/rpsp.2022.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 12/02/2022] Open
Abstract
Las enfermedades cardiovasculares son la principal causa de muerte en la Región de las Américas y la hipertensión es la causa de más del 50% de ellas. En la Región, más de una cuarta parte de las mujeres adultas y cuatro de cada diez hombres adultos tienen hipertensión y su diagnóstico, tratamiento y control son deficientes. En el 2021, la Organización Mundial de la Salud (OMS) publicó directrices actualizadas sobre el tratamiento farmacológico de la hipertensión en personas adultas. En este artículo se destaca el papel facilitador de la iniciativa mundial HEARTS de la OMS y la iniciativa HEARTS en las Américas para catalizar la implementación de estas directrices, a la vez que se proporciona asesoramiento específico sobre políticas para dicha implementación y se destaca la necesidad de adoptar un enfoque estratégico general para el control de la hipertensión. Los autores instan a quienes abogan por la salud y a los responsables de las políticas a priorizar la prevención y el control de la hipertensión para mejorar la salud y el bienestar de la población, y a reducir las disparidades de salud en relación con las enfermedades cardiovasculares dentro de la población y entre las poblaciones de la Región de las Américas.
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Affiliation(s)
- Norm R C Campbell
- Departamento de Medicina Fisiología y Farmacología y Ciencias de Salud de la Comunidad Instituto Cardiovascular Libin de Alberta Universidad de Calgary Calgary Canadá Departamento de Medicina, Fisiología y Farmacología y Ciencias de Salud de la Comunidad, Instituto Cardiovascular Libin de Alberta, Universidad de Calgary, Calgary, Canadá.,Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de la Salud Washington, DC Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
| | - Melanie Paccot Burnens
- Departamento de Enfermedades no Transmisibles Ministerio de Salud de Chile Santiago de Chile Chile Departamento de Enfermedades no Transmisibles, Ministerio de Salud de Chile, Santiago de Chile, Chile
| | - Paul K Whelton
- Departamento de Epidemiología Escuela de Salud Pública y Medicina Tropical de la Universidad de Tulane Nueva Orleans Estados Unidos de América Departamento de Epidemiología, Escuela de Salud Pública y Medicina Tropical de la Universidad de Tulane, Nueva Orleans, Estados Unidos de América
| | - Sonia Y Angell
- Departamento de Medicina Universidad de Columbia Colegio de Médicos y Cirujanos Vagelos Nueva York Estados Unidos de América Departamento de Medicina, Universidad de Columbia, Colegio de Médicos y Cirujanos Vagelos, Nueva York, Estados Unidos de América
| | - Marc G Jaffe
- Departamento de Endocrinología Centro Médico Kaiser Permanente de San Francisco San Francisco Estados Unidos de América Departamento de Endocrinología, Centro Médico Kaiser Permanente de San Francisco, San Francisco, Estados Unidos de América
| | - Jennifer Cohn
- Departamento de Medicina Interna Escuela de Medicina Universidad de Pensilvania Filadelfia Estados Unidos de América Departamento de Medicina Interna, Escuela de Medicina, Universidad de Pensilvania, Filadelfia, Estados Unidos de América
| | - Alfredo Espinosa Brito
- Departamento de Medicina Interna Hospital "Dr. Gustavo Aldereguía Lima", Cienfuegos Cienfuegos Cuba Departamento de Medicina Interna, Hospital "Dr. Gustavo Aldereguía Lima", Cienfuegos, Cuba
| | - Vilma Irazola
- Departamento de Investigación en Enfermedades Crónicas Centro de Excelencia en Salud Cardiovascular para América del Sur Instituto de Efectividad Clínica y Sanitaria Buenos Aires Argentina Departamento de Investigación en Enfermedades Crónicas, Centro de Excelencia en Salud Cardiovascular para América del Sur, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Jeffrey W Brettler
- Departamento de Ciencias de Sistemas de Salud Grupo Médico Permanente del Sur de California Escuela de Medicina Kaiser Permanente Bernard J. Tyson Los AngelesPasadena Estados Unidos de América Departamento de Ciencias de Sistemas de Salud, Grupo Médico Permanente del Sur de California, Los Ángeles, California, Escuela de Medicina Kaiser Permanente Bernard J. Tyson, Pasadena, Estados Unidos de América
| | - Edward J Roccella
- Programa Nacional de Educación sobre la Hipertensión Arterial de los Estados Unidos (Ret.) Instituto Nacional del Corazón los Pulmones y la Sangre Institutos Nacionales de Salud Bethesda Estados Unidos de América Programa Nacional de Educación sobre la Hipertensión Arterial de los Estados Unidos (Ret.) Instituto Nacional del Corazón, los Pulmones y la Sangre, Institutos Nacionales de Salud, Bethesda, Estados Unidos de América
| | | | - Andres Rosende
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de la Salud Washington, DC Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
| | - Pedro Ordunez
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de la Salud Washington, DC Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
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7
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Campbell NRC, Paccot Burnens M, Whelton PK, Angell SY, Jaffe MG, Cohn J, Espinosa Brito A, Irazola V, Brettler JW, Roccella EJ, Maldonado Figueredo JI, Rosende A, Ordunez P. [2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the Region of the AmericasDirectrices de la Organización Mundial de la Salud del 2021 sobre el tratamiento farmacológico de la hipertensión: implicaciones de política para la Región de las Américas]. Rev Panam Salud Publica 2022; 46:e55. [PMID: 35573114 PMCID: PMC9097927 DOI: 10.26633/rpsp.2022.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A doença cardiovascular (DCV) é a principal causa de morte nas Américas, e a pressão arterial elevada é responsável por mais de 50% dos casos de DCV. Nas Américas, mais de um quarto das mulheres adultas e quatro de cada dez homens adultos têm hipertensão arterial, sendo que diagnóstico, tratamento e controle estão abaixo do ideal. Em 2021, a Organização Mundial da Saúde (OMS) divulgou uma atualização das diretrizes para o tratamento medicamentoso da hipertensão arterial em adultos. Esta publicação ressalta o papel facilitador da iniciativa Global HEARTS da OMS e da iniciativa HEARTS nas Américas para catalisar a implementação dessas diretrizes, oferece recomendações específicas de políticas para sua implementação e enfatiza a necessidade de uma abordagem estratégica abrangente para o controle da hipertensão arterial. Os autores clamam para que tanto as pessoas que advogam pela Saúde, quanto as autoridades responsáveis, priorizem a prevenção e o controle da hipertensão arterial como forma de melhorar a saúde e o bem-estar das populações e reduzir as disparidades de saúde cardiovascular dentro das populações das Américas e entre elas.
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Affiliation(s)
- Norm R C Campbell
- Departamento de Medicina Fisiologia e Farmacologia e Ciências da Saúde Comunitária Libin Cardiovascular Institute of Alberta University of Calgary Calgary Canadá Departamento de Medicina, Fisiologia e Farmacologia e Ciências da Saúde Comunitária, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canadá.,Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, EUA
| | - Melanie Paccot Burnens
- Chefe do Departamento de Doenças Não Transmissíveis Ministério da Saúde do Chile Santiago Chile Chefe do Departamento de Doenças Não Transmissíveis, Ministério da Saúde do Chile, Santiago, Chile
| | - Paul K Whelton
- Departamento de Epidemiologia Tulane University School of Public Health and Tropical Medicine Nova Orleans EUA Departamento de Epidemiologia, Tulane University School of Public Health and Tropical Medicine, Nova Orleans, EUA
| | - Sonia Y Angell
- Departamento de Medicina Columbia University Vagelos College of Physicians and Surgeons Nova York EUA Departamento de Medicina, Columbia University Vagelos College of Physicians and Surgeons, Nova York, EUA
| | - Marc G Jaffe
- Departamento de Endocrinologia Kaiser Permanente San Francisco Medical Center San Francisco EUA Departamento de Endocrinologia, Kaiser Permanente San Francisco Medical Center, San Francisco, EUA
| | - Jennifer Cohn
- Departamento de Medicina Interna Escola de Medicina University of Pennsylvania Filadélfia EUA Departamento de Medicina Interna, Escola de Medicina, University of Pennsylvania, Filadélfia, EUA
| | - Alfredo Espinosa Brito
- Departamento de Medicina Interna Hospital "Dr. Gustavo Aldereguía Lima" Cienfuegos Cuba Departamento de Medicina Interna, Hospital "Dr. Gustavo Aldereguía Lima", Cienfuegos, Cuba
| | - Vilma Irazola
- Departamento de Pesquisa em Doenças Crônicas Centro de Excelencia en Salud Cardiovascular para América del Sur, CESCAS Instituto de Efectividad Clínica y Sanitaria, IECS Buenos Aires Argentina Departamento de Pesquisa em Doenças Crônicas, Centro de Excelencia en Salud Cardiovascular para América del Sur, CESCAS, Instituto de Efectividad Clínica y Sanitaria, IECS, Buenos Aires, Argentina
| | - Jeffrey W Brettler
- Departamento de Ciências de Sistemas de Saúde Southern California Permanente Medical Group Kaiser Permanente Bernard J. Tyson School of Medicine Los AngelesPasadena EUA Departamento de Ciências de Sistemas de Saúde, Southern California Permanente Medical Group, Los Angeles; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, EUA
| | - Edward J Roccella
- Programa Nacional de Educação em Hipertensão Arterial dos Estados Unidos (emérito) Instituto Nacional do Coração Pulmão e Sangue, Institutos Nacionais de Saúde Bethesda EUA Programa Nacional de Educação em Hipertensão Arterial dos Estados Unidos (emérito), Instituto Nacional do Coração, Pulmão e Sangue, Institutos Nacionais de Saúde, Bethesda, EUA
| | | | - Andres Rosende
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, EUA
| | - Pedro Ordunez
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, EUA
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Campbell NRC, Paccot Burnens M, Whelton PK, Angell SY, Jaffe MG, Cohn J, Espinosa Brito A, Irazola V, Brettler JW, Roccella EJ, Maldonado Figueredo JI, Rosende A, Ordunez P. 2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the region of the Americas. LANCET REGIONAL HEALTH. AMERICAS 2022; 9:None. [PMID: 35711684 PMCID: PMC9107389 DOI: 10.1016/j.lana.2022.100219] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the Americas and raised blood pressure accounts for over 50% of CVD. In the Americas over a quarter of adult women and four in ten adult men have hypertension and the diagnosis, treatment and control are suboptimal. In 2021, the World Health Organization (WHO) released an updated guideline for the pharmacological treatment of hypertension in adults. This policy paper highlights the facilitating role of the WHO Global HEARTS initiative and the HEARTS in the Americas initiative to catalyze the implementation of this guideline, provides specific policy advice for implementation, and emphasizes that an overarching strategic approach for hypertension control is needed. The authors urge health advocates and policymakers to prioritize the prevention and control of hypertension to improve the health and wellbeing of their populations and to reduce CVD health disparities within and between populations of the Americas.
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Affiliation(s)
- Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, North Tower, 9th Floor, 1403 - 29th Street NW, Calgary, AB T2N 2T9, Canada.,Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Melanie Paccot Burnens
- Head of the Department of Non-Communicable Diseases, Ministry of Health in Chile, Santiago, Chile
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Sonia Y Angell
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Marc G Jaffe
- Department of Endocrinology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Jennifer Cohn
- Department of Internal Medicine, School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Alfredo Espinosa Brito
- Department of Internal Medicine, Hospital "Dr. Gustavo Aldereguía Lima", Cienfuegos, Cuba
| | - Vilma Irazola
- Department of Research in Chronic Diseases, Center of Excellence for Cardiovascular Health, CESCAS, Institute for Clinical Effectiveness and Health Policy, IECS, Buenos Aires, Argentina
| | - Jeffrey W Brettler
- Department of Health Systems Science, Southern California Permanente Medical Group, Los Angeles, California, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Edward J Roccella
- United States National High Blood Pressure Education Program (Ret.) National Heart, Lung and Blood Institute National Institutes of Health Bethesda, MD, USA
| | | | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
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9
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Vazquez-Agra N, Marques-Afonso AT, Cruces-Sande A, Novo-Veleiro I, Lopez-Paz JE, Pose-Reino A, Hermida-Ameijeiras A. Are Differences in Inflammatory Markers between Patients with and without Hypertension-Mediated Organ Damage Influenced by Circadian Blood Pressure Abnormalities? J Clin Med 2022; 11:jcm11051252. [PMID: 35268342 PMCID: PMC8911066 DOI: 10.3390/jcm11051252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/13/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023] Open
Abstract
We aimed to explore the influence that the circadian blood pressure (BP) profile could exert on the correlation between some inflammatory markers and hypertension-mediated organ damage (HMOD). This was a cross-sectional study that included patients with primary arterial hypertension older than 18 years old. We included some parameters of 24 h ambulatory blood pressure monitoring collection and several inflammatory markers, as follows: platelet count (PTC), erythrocyte sedimentation rate (ESR), ultrasensitive C-reactive-protein, ferritin, fibrinogen, and uric acid. Myocardial hypertrophy, albuminuria, carotid intima-media thicknesses and ankle brachial index were assessed as HMOD presentations. Individuals were divided into two groups: patients with and without HMOD. We included 522 patients (47% women, mean age of 54 years). Multivariate logistic regression analysis showed that male patients older than 50 years old with uric acid levels above 7 mg/dL, ESR higher than 20 mm/h, fibrinogen greater than 320 mg/dL and PTC lower than 275 × 103/µL were associated with HMOD (p < 0.05). The circadian BP profile (dipper versus non-dipper pattern) did reach neither statistical significance nor influence the odds ratio of those inflammatory markers for HMOD. We found that differences in some inflammatory markers between patients with and without HMOD were not explained by a different circadian BP profile.
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Affiliation(s)
- Nestor Vazquez-Agra
- Department of Internal Medicine, University Hospital of Santiago de Compostela, 15706 A Coruña, Spain; (A.-T.M.-A.); (I.N.-V.); (J.-E.L.-P.); (A.P.-R.); (A.H.-A.)
- Correspondence: (N.V.-A.); (A.C.-S.)
| | - Ana-Teresa Marques-Afonso
- Department of Internal Medicine, University Hospital of Santiago de Compostela, 15706 A Coruña, Spain; (A.-T.M.-A.); (I.N.-V.); (J.-E.L.-P.); (A.P.-R.); (A.H.-A.)
| | - Anton Cruces-Sande
- Department of Biochemistry and Molecular Biology, University of Santiago de Compostela, 15782 A Coruña, Spain
- Correspondence: (N.V.-A.); (A.C.-S.)
| | - Ignacio Novo-Veleiro
- Department of Internal Medicine, University Hospital of Santiago de Compostela, 15706 A Coruña, Spain; (A.-T.M.-A.); (I.N.-V.); (J.-E.L.-P.); (A.P.-R.); (A.H.-A.)
| | - Jose-Enrique Lopez-Paz
- Department of Internal Medicine, University Hospital of Santiago de Compostela, 15706 A Coruña, Spain; (A.-T.M.-A.); (I.N.-V.); (J.-E.L.-P.); (A.P.-R.); (A.H.-A.)
| | - Antonio Pose-Reino
- Department of Internal Medicine, University Hospital of Santiago de Compostela, 15706 A Coruña, Spain; (A.-T.M.-A.); (I.N.-V.); (J.-E.L.-P.); (A.P.-R.); (A.H.-A.)
| | - Alvaro Hermida-Ameijeiras
- Department of Internal Medicine, University Hospital of Santiago de Compostela, 15706 A Coruña, Spain; (A.-T.M.-A.); (I.N.-V.); (J.-E.L.-P.); (A.P.-R.); (A.H.-A.)
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10
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Thompson B, McEvoy JW. Establishing target systolic and diastolic blood pressure in diabetic patients with hypertension: what do we need to consider? Expert Rev Cardiovasc Ther 2021; 19:993-1003. [PMID: 34878361 DOI: 10.1080/14779072.2021.2013814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The optimum target for systolic and diastolic blood pressure remains divisive. In particular, the conflicting outcomes of the SPRINT and ACCORD trials have led to a divergence of guideline-recommended blood pressure targets for adults with diabetes. AREAS COVERED Here, we review the existing recommendations for blood pressure targets in diabetes, discussing the evidence base behind them and their limitations. We start by outlining the risks and benefits of lower systolic blood pressure targets among diabetics. We then follow with a separate appraisal of diastolic blood pressure targets, which necessitates examination of the 'J curve' and isolated diastolic hypertension. EXPERT OPINION Current and emerging evidence supports, on balance, a blood pressure therapeutic target of < 130/90 mmHg in adults at increased risk for cardiovascular disease, including diabetics. Whether certain diabetics with systolic BPs of 120-130 and/or diastolic BPs 80-90 mmHg require drug treatment to a target of <120/80 mmHg is less clear and requires more research.
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Affiliation(s)
- Brian Thompson
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - John W McEvoy
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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11
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Camafort M, Alcocer L, Coca A, Lopez-Lopez J, López-Jaramillo P, Ponte-Negretti C, Sebba-Barroso W, Valdéz O, Wyss F. Registro Latinoamericano de monitorización ambulatoria de la presión arterial (MAPA-LATAM): una necesidad urgente. Rev Clin Esp 2021. [DOI: 10.1016/j.rce.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Camafort M, Alcocer L, Coca A, Lopez-Lopez JP, López-Jaramillo P, Ponte-Negretti CI, Sebba-Barroso W, Valdéz O, Wyss F. Latin-American Ambulatory Blood Pressure Registry (MAPA-LATAM): An urgent need. Rev Clin Esp 2021; 221:547-552. [PMID: 34509417 DOI: 10.1016/j.rceng.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/02/2021] [Indexed: 11/27/2022]
Abstract
Hypertension (HT) is one of the main risk factors for cardiovascular disease (CVD). Although it is a global problem, independently of economic situation, region, race or culture, the data available on Latin America are limited. Clinical guidelines emphasise the importance of obtaining reliable blood pressure readings. For this reason, the use of ambulatory blood pressure monitoring (ABPM) is recommended. This improves precision and reproducibility, resulting in better diagnosing and therapeutic decision-making, and constitutes a better estimation of prognosis than office measurements. Unfortunately, there is no global prospective ABPM registry for all of Latin America that analyses HT prevalence, the level of knowledge about it, treatment percentage and the degree of control. Consequently, the authors of this article consider its implementation a priority.
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Affiliation(s)
- M Camafort
- Unidad de Hipertensión y Riesgo Vascular, Servicio de Medicina Interna, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
| | - L Alcocer
- Instituto Mexicano de Salud Cardiovascular, Hospital General de México, Instituto Superior de Estudios en Salud Pública, Ciudad de México, Mexico
| | - A Coca
- Unidad de Hipertensión y Riesgo Vascular, Servicio de Medicina Interna, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - J P Lopez-Lopez
- Centro Integral para la Prevención Cardiometabólica (CIPCA), FOSCAL Internacional, Floridablanca, Santander, Colombia
| | - P López-Jaramillo
- Instituto Masira, Escuela de Medicina, Universidad de Santander, Bucaramanga, Santander, Colombia
| | - C I Ponte-Negretti
- Unidad de Medicina Cardiometabólica, Instituto Clínico La Floresta, Caracas, Venezuela
| | - W Sebba-Barroso
- Departamento de Clínica Médica, Universidad Federal de Goiás, Goiás, Brasil
| | - O Valdéz
- Centro Médico Central Romana, La Romana, Dominican Republic
| | - F Wyss
- Servicios y Tecnología Cardiovascular de Guatemala-Cardiosolutions, Ciudad de Guatemala, Guatemala
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13
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Parati G, Stergiou GS, Bilo G, Kollias A, Pengo M, Ochoa JE, Agarwal R, Asayama K, Asmar R, Burnier M, De La Sierra A, Giannattasio C, Gosse P, Head G, Hoshide S, Imai Y, Kario K, Li Y, Manios E, Mant J, McManus RJ, Mengden T, Mihailidou AS, Muntner P, Myers M, Niiranen T, Ntineri A, O’Brien E, Octavio JA, Ohkubo T, Omboni S, Padfield P, Palatini P, Pellegrini D, Postel-Vinay N, Ramirez AJ, Sharman JE, Shennan A, Silva E, Topouchian J, Torlasco C, Wang JG, Weber MA, Whelton PK, White WB, Mancia G. Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension. J Hypertens 2021; 39:1742-1767. [PMID: 34269334 PMCID: PMC9904446 DOI: 10.1097/hjh.0000000000002922] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 02/06/2023]
Abstract
The present paper provides an update of previous recommendations on Home Blood Pressure Monitoring from the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring and Cardiovascular Variability sequentially published in years 2000, 2008 and 2010. This update has taken into account new evidence in this field, including a recent statement by the American Heart association, as well as technological developments, which have occurred over the past 20 years. The present document has been developed by the same ESH Working Group with inputs from an international team of experts, and has been endorsed by the ESH.
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Affiliation(s)
- Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - George S. Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Grzegorz Bilo
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Martino Pengo
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
| | - Juan Eugenio Ochoa
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
| | - Rajiv Agarwal
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | | | - Michel Burnier
- Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland
| | - Alejandro De La Sierra
- Hypertension Unit, Department of Internal Medicine, Hospital Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Cristina Giannattasio
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Cardiology IV, ‘A. De Gasperis” Department, ASTT GOM Niguarda Ca’ Granda
| | - Philippe Gosse
- Cardiology/Hypertension Unit Saint André Hospital. University Hospital of Borfeaux, France
| | - Geoffrey Head
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yutaka Imai
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yan Li
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Thomas Mengden
- Kerckhoff Clinic, Rehabilitation, ESH Excellence Centre, Bad Nauheim, Germany
| | - Anastasia S. Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Paul Muntner
- Hypertension Research Center, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Martin Myers
- Schulich Heart Program, Sunnybrook Health Sciences Centre and Department of Medicine, University of Toronto, Toronto, Canada
| | - Teemu Niiranen
- Department of Medicine, Turku University Hospital and University of Turku
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Eoin O’Brien
- The Conway Institute, University College Dublin, Dublin, Ireland
| | - José Andres Octavio
- Experimental Cardiology, Department of Tropical Medicine Institute, Universidad Central de Venezuela, Venezuela
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Department of Cardiology, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Paul Padfield
- Department of Medical Sciences, University of Edinburgh, Edinburgh, UK
| | - Paolo Palatini
- Studium Patavinum, Department of Medicine. University of Padova, Padua
| | - Dario Pellegrini
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Agustin J. Ramirez
- Arterial Hypertension and Metabolic Unit, University Hospital, Fundacion Favaloro, Argentina
| | - James E. Sharman
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Andrew Shennan
- Department of Women and Children's Health, School of Life Course Sciences, FoLSM, Kings College London, UK
| | - Egle Silva
- Research Institute of Cardiovascular Diseases of the University of Zulia, Venezuelan Foundation of Arterial Hypertension. Maracaibo, Venezuela
| | - Jirar Topouchian
- Diagnosis and Therapeutic Center, Paris-Descartes University, AP-HP, Hotel Dieu, Paris, France
| | - Camilla Torlasco
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
| | - Ji Guang Wang
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Michael A. Weber
- Division of Cardiovascular Medicine, Downstate College of Medicine, State University of New York, Brooklyn, New York, USA
| | - Paul K. Whelton
- Department of Epidemiology, Tulane University, School of Public Health and Tropical Medicine, New Orleans, Lousiana
| | - William B. White
- Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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14
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Barroso WKS, Rodrigues CIS, Bortolotto LA, Mota-Gomes MA, Brandão AA, Feitosa ADDM, Machado CA, Poli-de-Figueiredo CE, Amodeo C, Mion Júnior D, Barbosa ECD, Nobre F, Guimarães ICB, Vilela-Martin JF, Yugar-Toledo JC, Magalhães MEC, Neves MFT, Jardim PCBV, Miranda RD, Póvoa RMDS, Fuchs SC, Alessi A, Lucena AJGD, Avezum A, Sousa ALL, Pio-Abreu A, Sposito AC, Pierin AMG, Paiva AMGD, Spinelli ACDS, Nogueira ADR, Dinamarco N, Eibel B, Forjaz CLDM, Zanini CRDO, Souza CBD, Souza DDSMD, Nilson EAF, Costa EFDA, Freitas EVD, Duarte EDR, Muxfeldt ES, Lima Júnior E, Campana EMG, Cesarino EJ, Marques F, Argenta F, Consolim-Colombo FM, Baptista FS, Almeida FAD, Borelli FADO, Fuchs FD, Plavnik FL, Salles GF, Feitosa GS, Silva GVD, Guerra GM, Moreno Júnior H, Finimundi HC, Back IDC, Oliveira Filho JBD, Gemelli JR, Mill JG, Ribeiro JM, Lotaif LAD, Costa LSD, Magalhães LBNC, Drager LF, Martin LC, Scala LCN, Almeida MQ, Gowdak MMG, Klein MRST, Malachias MVB, Kuschnir MCC, Pinheiro ME, Borba MHED, Moreira Filho O, Passarelli Júnior O, Coelho OR, Vitorino PVDO, Ribeiro Junior RM, Esporcatte R, Franco R, Pedrosa R, Mulinari RA, Paula RBD, Okawa RTP, Rosa RF, Amaral SLD, Ferreira-Filho SR, Kaiser SE, Jardim TDSV, Guimarães V, Koch VH, Oigman W, Nadruz W. Brazilian Guidelines of Hypertension - 2020. Arq Bras Cardiol 2021; 116:516-658. [PMID: 33909761 PMCID: PMC9949730 DOI: 10.36660/abc.20201238] [Citation(s) in RCA: 297] [Impact Index Per Article: 99.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Weimar Kunz Sebba Barroso
- Universidade Federal de Goiás , Goiânia , GO - Brasil
- Liga de Hipertensão Arterial , Goiânia , GO - Brasil
| | - Cibele Isaac Saad Rodrigues
- Pontifícia Universidade Católica de São Paulo , Faculdade de Ciências Médicas e da Saúde , Sorocaba , SP - Brasil
| | | | | | - Andréa Araujo Brandão
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
| | | | | | | | - Celso Amodeo
- Universidade Federal de São Paulo (UNIFESP), São Paulo , SP - Brasil
| | - Décio Mion Júnior
- Hospital das Clínicas da Faculdade de Medicina da USP , São Paulo , SP - Brasil
| | | | - Fernando Nobre
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo , Ribeirão Preto , SP - Brasil
- Hospital São Francisco , Ribeirão Preto , SP - Brasil
| | | | | | | | - Maria Eliane Campos Magalhães
- Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro , RJ - Brasil
| | - Mário Fritsch Toros Neves
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
| | | | | | | | - Sandra C Fuchs
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre , RS - Brasil
| | | | | | - Alvaro Avezum
- Hospital Alemão Oswaldo Cruz , São Paulo , SP - Brasil
| | - Ana Luiza Lima Sousa
- Universidade Federal de Goiás , Goiânia , GO - Brasil
- Liga de Hipertensão Arterial , Goiânia , GO - Brasil
| | | | | | | | | | | | | | | | - Bruna Eibel
- Instituto de Cardiologia , Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre , RS - Brasil
- Centro Universitário da Serra Gaúcha (FSG), Caxias do Sul , RS - Brasil
| | | | | | | | | | | | | | - Elizabete Viana de Freitas
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
- Departamento de Cardiogeriatria da Sociedade Brazileira de Cardiologia , Rio de Janeiro , RJ - Brasil
| | | | | | - Emilton Lima Júnior
- Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba , PR - Brasil
| | - Erika Maria Gonçalves Campana
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
- Universidade Iguaçu (UNIG), Rio de Janeiro , RJ - Brasil
| | - Evandro José Cesarino
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto da Universidade de São Paulo , Ribeirão Preto , SP - Brasil
- Associação Ribeirãopretana de Ensino, Pesquisa e Assistência ao Hipertenso (AREPAH), Ribeirão Preto , SP - Brasil
| | - Fabiana Marques
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo , Ribeirão Preto , SP - Brasil
| | | | | | | | - Fernando Antonio de Almeida
- Pontifícia Universidade Católica de São Paulo , Faculdade de Ciências Médicas e da Saúde , Sorocaba , SP - Brasil
| | | | | | - Frida Liane Plavnik
- Instituto do Coração (InCor), São Paulo , SP - Brasil
- Hospital Alemão Oswaldo Cruz , São Paulo , SP - Brasil
| | | | | | | | - Grazia Maria Guerra
- Instituto do Coração (InCor), São Paulo , SP - Brasil
- Universidade Santo Amaro (UNISA), São Paulo , SP - Brasil
| | | | | | | | | | | | - José Geraldo Mill
- Centro de Ciências da Saúde , Universidade Federal do Espírito Santo , Vitória , ES - Brasil
| | - José Marcio Ribeiro
- Faculdade Ciências Médicas de Minas Gerais , Belo Horizonte , MG - Brasil
- Hospital Felício Rocho , Belo Horizonte , MG - Brasil
| | - Leda A Daud Lotaif
- Instituto Dante Pazzanese de Cardiologia , São Paulo , SP - Brasil
- Hospital do Coração (HCor), São Paulo , SP - Brasil
| | | | | | | | | | | | - Madson Q Almeida
- Hospital das Clínicas da Faculdade de Medicina da USP , São Paulo , SP - Brasil
| | | | | | | | | | | | | | | | | | | | | | | | - Roberto Esporcatte
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
- Hospital Pró-Cradíaco , Rio de Janeiro , RJ - Brasil
| | - Roberto Franco
- Universidade Estadual Paulista (UNESP), Bauru , SP - Brasil
| | - Rodrigo Pedrosa
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife , PE - Brasil
| | | | | | | | | | | | | | - Sergio Emanuel Kaiser
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
| | | | | | - Vera H Koch
- Universidade de São Paulo (USP), São Paulo , SP - Brasil
| | - Wille Oigman
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
| | - Wilson Nadruz
- Universidade Estadual de Campinas (UNICAMP), Campinas , SP - Brasil
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15
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Parati G, Lombardi C, Pengo M, Bilo G, Ochoa JE. Current challenges for hypertension management: From better hypertension diagnosis to improved patients' adherence and blood pressure control. Int J Cardiol 2021; 331:262-269. [PMID: 33548384 DOI: 10.1016/j.ijcard.2021.01.070] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/09/2021] [Accepted: 01/27/2021] [Indexed: 12/24/2022]
Abstract
Hypertension control still remains a largely unmet challenge for public health systems. Despite the progress in blood pressure (BP) measurement techniques, and the availability of effective and safe antihypertensive drugs, a large number of hypertensive patients are not properly identified, and a significant proportion of those who receive antihypertensive treatment fail to achieve satisfactory control of their BP levels. It is thus not surprising that hypertension is still a major contributor to disease burden and disability worlwide, even in developed countries. This paper will address current challenges in hypertension management and potential strategies for an improvement in this field. In its first part relevant issues related to hypertension diagnosis will be addressed, in particular how to improve identification of sustained BP elevation and specific BP phenotypes such as white coat and masked hypertension trough the combined use of office and out-of-office BP monitoring techniques. In its second part focus will be on how to improve achievement of hypertension control in treated patients by optimization and simplification of medication regimens, including more efficient selection and titration of antihypertensive drugs and their combinations, aimed at achieving a more consistent 24hBP control; and by favoring a more active patients' and physicians' involvement in hypertension management also through BP telemonitoring and mobile health technologies.
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Affiliation(s)
- Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Martino Pengo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Milan, Italy
| | - Grzegorz Bilo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Juan Eugenio Ochoa
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Milan, Italy
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Tepe D, Yılmaz S. Is Office Blood Pressure Measurement Reliable in Obese Adolescents? Diabetes Metab Syndr Obes 2021; 14:3809-3817. [PMID: 34511954 PMCID: PMC8421040 DOI: 10.2147/dmso.s329273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although it is not reflected in the OBP measurement in obese children, ambulatory BP changes are known to occur. MH, non-dipper pattern and nocturnal hypertension have been reported to increase in obese children. On the other hand, the factors that indicate a high risk of hypertension are still unclear. The aim of our study is to especially detect masked hypertension by 24-hour BP measurement in obese adolescents and to evaluate the relationship of masked hypertension with metabolic syndrome parameters, anthropometric measurements and hepatosteatosis in these patients. METHODS A total of 63 adolescents diagnosed with obesity were evaluated between January 2019 and December 2019. Office blood pressure was measured for all children, and all of them underwent ABPM. Patients with and without hypertension in ABPM were compared in terms of clinical and laboratory findings. RESULTS The mean age was 14.0 ± 1.7 years, females composed 49.2% of the study population. Office blood pressure measurement revealed hypertension in 4 (6.3%) patients and prehypertension in 15 (23.8%) patients. Thirteen patients (20.9%) were diagnosed with masked hypertension, white coat hypertension was diagnosed in 3 (4.7%) patients. Abnormal ABPM patterns were found to be significantly more frequent in patients with severely obesity (with obesity: 26.4% vs severe obesity: 55.6%, p = 0.03) and patients with a higher waist circumference and waist circumference/height ratio. CONCLUSION The prevalence of masked hypertension in obese adolescents has been found to be quite high. Therefore, we recommend ABPM in adolescents with high waist circumference/height ratio and severe obesity, even if their office blood pressure measurements are normal.
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Affiliation(s)
- Derya Tepe
- Department of Pediatric Endocrology, Ankara Yıldırım Beyazıt Üniversity, Yenimahalle Education and Research Hospital, Ankara, Turkey
| | - Songül Yılmaz
- Department of Pediatric Nephrology, Ankara Yıldırım Beyazıt Üniversity, Yenimahalle Education and Research Hospital, Ankara, Turkey
- Correspondence: Songül Yılmaz Department of Pediatric Nephrology, Ankara Yıldırım Beyazıt Üniversity, Yenimahalle Education and Research Hospital, Ankara, TurkeyTel +90 533 3558677Fax +90 312 587377 Email
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