1
|
Coca A, Whelton SP, Camafort M, López-López JP, Yang E. Single-pill combination for treatment of hypertension: Just a matter of practicality or is there a real clinical benefit? Eur J Intern Med 2024:S0953-6205(24)00172-9. [PMID: 38653633 DOI: 10.1016/j.ejim.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/27/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
Elevated blood pressure (BP) is the largest contributor to the incident cardiovascular disease worldwide. Despite explicit guideline recommendations for the diagnosis and management of hypertension, a large proportion of patients remain undiagnosed, untreated, or treated but uncontrolled. Inadequate BP control is associated with many complex factors including patient preference, physician's inertia, health systems disparities, and poor adherence to prescribed antihypertensive drug treatment. The primary driver for reduced cardiovascular morbidity and mortality is lowering of BP ''per se'' and not class effects of specific pharmacotherapies. The recent ESH guidelines recommend the use of four major classes of drugs including renin-angiotensin-aldosterone system (RAS) blockers (angiotensin receptor blockers (ARB) or angiotensin-converting enzyme inhibitors (ACEi)), calcium channel blockers (CCB), thiazide and thiazide-like diuretics, and betablockers. Initiation of treatment for hypertension with a two-drug regimen, preferably in a single pill combination (SPC), is recommended for most patients. Preferred combinations should comprise a RAS blocker (either an ACEi or an ARB) with a CCB or thiazide/thiazide-like diuretic. These strategies are supported by robust evidence that combination therapy produces greater BP reductions than monotherapy, reduces side effects of the individual components, improves therapeutic adherence and long-term persistence on treatment, and permits achievement of earlier BP control.
Collapse
Affiliation(s)
- A Coca
- Hypertension and Vascular Risk Unit. Department of Internal Medicine. Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - S P Whelton
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M Camafort
- Hypertension and Vascular Risk Unit. Department of Internal Medicine. Hospital Clínic (IDIBAPS, CIBER-OBN). University of Barcelona, Barcelona, Spain
| | - J P López-López
- Masira Research Institute, University of Santander (UDES), Bucaramanga, Colombia
| | - E Yang
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|
2
|
Barbosa ECD, Feitosa ADM, Sentalin MVR, Mota-Gomes MA, Barroso WS, Miranda RD, Brandão AA, Farina G, Lima-Filho JL, Albuquerque J, Nascimento MLS, Paula ICBG, Barros BC, Freitas MCV, Silva HP, Sposito AC, Camafort M, Coca A, Nadruz W. Impact of environmental temperature on blood pressure phenotypes: a nationwide home blood pressure monitoring study. Eur J Prev Cardiol 2024; 31:e35-e37. [PMID: 38091969 DOI: 10.1093/eurjpc/zwad387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/14/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
Affiliation(s)
- Eduardo C D Barbosa
- Department of Hypertension and Cardiometabolism, São Francisco Hospital, Santa Casa de Porto Alegre, FEEVALE University, Porto Alegre, Brazil
| | - Audes D M Feitosa
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Recife, PE, Brazil
| | - Monizze V R Sentalin
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária, 13083-887, Campinas, SP, Brazil
| | | | - Weimar S Barroso
- Hypertension League, Cardiovascular Section, Federal University of Goiás, Goiânia, GO, Brazil
| | - Roberto D Miranda
- Cardiovascular Section, Geriatrics Division, Paulista School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Andréa A Brandão
- School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Giovani Farina
- Department of Hypertension and Cardiometabolism, São Francisco Hospital, Santa Casa de Porto Alegre, FEEVALE University, Porto Alegre, Brazil
| | - José L Lima-Filho
- Keizo Asami Institute, Federal University of Pernambuco, Av. Prof. Morais Rego, 1235, Cidade Universitária, 50670-901, Recife, PE, Brazil
| | - Jones Albuquerque
- Keizo Asami Institute, Federal University of Pernambuco, Av. Prof. Morais Rego, 1235, Cidade Universitária, 50670-901, Recife, PE, Brazil
| | - Maria L S Nascimento
- Institute for Risk and Disaster Reduction, Federal Rural University of Pernambuco, Recife, PE, Brazil
| | - Isabel C B G Paula
- Institute for Risk and Disaster Reduction, Federal Rural University of Pernambuco, Recife, PE, Brazil
| | - Beatriz C Barros
- Institute for Risk and Disaster Reduction, Federal Rural University of Pernambuco, Recife, PE, Brazil
| | - Maria C V Freitas
- Institute for Risk and Disaster Reduction, Federal Rural University of Pernambuco, Recife, PE, Brazil
| | - Hernande P Silva
- Institute for Risk and Disaster Reduction, Federal Rural University of Pernambuco, Recife, PE, Brazil
| | - Andrei C Sposito
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária, 13083-887, Campinas, SP, Brazil
| | - Miguel Camafort
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Centro de investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid Spain
| | - Wilson Nadruz
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária, 13083-887, Campinas, SP, Brazil
- Keizo Asami Institute, Federal University of Pernambuco, Av. Prof. Morais Rego, 1235, Cidade Universitária, 50670-901, Recife, PE, Brazil
| |
Collapse
|
3
|
Sotomayor Julio AD, Montana-Jimenez LP, Bernal Torres W, López Ponce de León JD, Zambrano Franco JA, Coca A, Camafort M, Vesga Reyes C. [Ambulatory blood pressure monitoring, adult and pediatric population. A narrative review]. Hipertens Riesgo Vasc 2024; 41:104-117. [PMID: 38480108 DOI: 10.1016/j.hipert.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 04/14/2024]
Abstract
Hypertension has become a central risk factor for the development of cardiovascular disease, underscoring the importance of its accurate diagnosis. Numerous studies have established a close relationship between elevated systolic (SBP) and diastolic (DBP) blood pressure and an increased risk of cardiovascular event (CVE). Traditionally, blood pressure (BP) measurements performed in clinical settings have been the main method for diagnosing and assessing hypertension. However, in recent years, it has been recognized that BP measurements obtained outside the clinical setting, using self-monitoring blood pressure (SMBP) and ambulatory blood pressure monitoring (ABPM), offer a more realistic perspective of patients' daily lives and therefore provide more reliable results. Given the evolution of medical devices, diagnostic criteria, and the increasing relevance of certain components of ABPM in the prediction of adverse cardiovascular outcomes, a comprehensive update that is practical for daily clinical practice is required. The main objective of this article is to provide an updated review of ABPM, focusing on its importance in the evaluation of hypertension and its impact on public health in Colombia. In addition, it will discuss the implications of changes in diagnostic thresholds and provide concrete recommendations for the effective implementation of ABPM in clinical practice, allowing health professionals to make informed decisions and improve the care of their patients.
Collapse
Affiliation(s)
- A D Sotomayor Julio
- Departamento de Cardiología, Fundación Valle del Lili, Valle del Cauca, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia.
| | - L P Montana-Jimenez
- Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - W Bernal Torres
- Centro de Investigaciones Clínicas, Hospital Universitario Fundación Valle del Lili, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - J D López Ponce de León
- Centro de Investigaciones Clínicas, Hospital Universitario Fundación Valle del Lili, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - J A Zambrano Franco
- Departamento de Cardiología, Fundación Valle del Lili, Valle del Cauca, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - A Coca
- Universidad de Barcelona, Barcelona, España
| | - M Camafort
- Universidad de Barcelona, Barcelona, España
| | - C Vesga Reyes
- Departamento de Cardiología, Fundación Valle del Lili, Valle del Cauca, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| |
Collapse
|
4
|
Molina de Salazar DI, Coca A, Alcocer L, Piskorz D. The Rationale for Using Fixed-Dose Combination Therapy in the Management of Hypertension in Colombia: A Narrative Review. Am J Cardiovasc Drugs 2024; 24:197-209. [PMID: 38489104 PMCID: PMC10972912 DOI: 10.1007/s40256-024-00634-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/17/2024]
Abstract
Hypertension is a major risk factor for cardiovascular disease and the leading cause of death in Colombia. While the rate of hypertension awareness in Colombia is generally high, rates of treatment initiation, adherence, and blood pressure (BP) control are suboptimal. Major international hypertension guidelines recommend starting treatment with a combination of antihypertensive agents, and the use of a single-pill combination (SPC) to maximize adherence. In contrast, Colombian hypertension guidelines recommend starting treatment with diuretic monotherapy in most patients, and only initiating combination therapy in those with BP > 160/100 mmHg. Therefore, the aim of the current narrative review is to examine the rationale for using SPCs to treat hypertension in Colombia, in the context of the major issues for BP control there. There is evidence of widespread therapeutic inertia in hypertension management, particularly in primary care, in Colombia. Moreover, combination therapy, angiotensin-converting enzyme inhibitors, and long-acting calcium channel blockers, which are internationally recommended as first-line drug therapies, are underutilized there. Adherence to antihypertensive therapy is low in Colombia and may be enhanced by use of SPCs as well as better patient education and follow-up. While there are promising national initiatives to improve BP management, more needs to be done by individual physicians. Antihypertensive SPCs are available on the national essential medicines list and may help to overcome some of the problems with suboptimal adherence, therapeutic inertia, and low rates of BP control that contribute to the high cardiovascular death rate in Colombia.
Collapse
Affiliation(s)
| | - Antonio Coca
- Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Luis Alcocer
- Mexican Institute of Cardiovascular Health, Mexico City, Mexico
| | - Daniel Piskorz
- Cardiovascular Research Center and Cardiology Institute, Rosario British Sanatorium, Rosario, Argentina
| |
Collapse
|
5
|
Mellado-Sola I, Cobo-Vázquez E, Calvo-Fernandez A, Cervantes E, Coca A, Calderón-Llopis B, Saavedra-Lozano J, Calvo C. Mediastinitis secondary to invasive infection by group A Streptococcus in Spain. Eur J Pediatr 2024; 183:503-507. [PMID: 37889290 DOI: 10.1007/s00431-023-05288-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023]
Abstract
This study describes 5 mediastinitis cases secondary to invasive group A Streptococcus (iGAS) disease in a recent outbreak in Spain. Among 398 iGAS cases between January 2019-March 2023, 5 (1.3%) were mediastinitis, 4 occurring in December 2022, all secondary to pneumonia or deep neck infection. We outline the clinical outcome with a review of the scarce pediatric literature. Conclusion: mediastinistis is a rare but severe complication of iGAS and a high level of suspicion is required to diagnose it. What is Known: • Group A Streptococcus can cause invasive and severe infections in children. • Mediastinitis is a severe complication from some bacterial infections, mainly secondary due to deep-neck abscesses. What is New: • Mediastinitis is an unrecognized complication due to an invasive group A Streptococcus (iGAS) infection. • In cases of a deep-neck abscess or complicated pneumonia a high clinical suspicion of iGAS mediastinitis is required, especially when the clinical course is not favorable.
Collapse
Affiliation(s)
- I Mellado-Sola
- Pediatric and Infectious Diseases Department, La Paz University Hospital, Institute for Health Research (IdiPAZ), Pº Castellana, 261, Madrid, 28046, Spain.
| | - E Cobo-Vázquez
- Department of Pediatrics. Hospital, Universitario Fundación de Alcorcón, Alcorcón, Madrid, Spain
- Program in Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - A Calvo-Fernandez
- Pediatric Intensive Care Unit, La Paz University Hospital, Madrid, Spain
| | - E Cervantes
- Pediatrics and Infectious Diseases Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - A Coca
- Pediatric Intensive Care Unit, Ramón y Cajal University Hospital, Madrid, Spain
| | - B Calderón-Llopis
- Pediatric Intensive Care Unit, La Paz University Hospital, Madrid, Spain
| | - J Saavedra-Lozano
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Biomedical Research Network Centre for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
- Hospital Institute of Health Research (IiSGM), Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - C Calvo
- Pediatric and Infectious Diseases Department, La Paz University Hospital, Institute for Health Research (IdiPAZ), Pº Castellana, 261, Madrid, 28046, Spain
- Biomedical Research Network Centre for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
6
|
Prieto-Díaz MA, Pallares-Carratala V, Manuel Micó-Pérez R, Escobar-Cervantes C, Martín-Sanchez V, Coca A, Barquilla-García A, Velilla-Zancada SM, Polo-García J, Segura-Fragoso A, Ginel-Mendoza L, Hermida-Ameijerias Á, Cinza-Sanjurjo S. Clinical characteristics, treatment, and blood pressure control in patients with hypertension seen by primary care physicians in Spain: the IBERICAN study. Front Cardiovasc Med 2023; 10:1295174. [PMID: 38173815 PMCID: PMC10763308 DOI: 10.3389/fcvm.2023.1295174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
Objectives To determine the clinical profile, according to the history of hypertension, the risk of developing hypertension, current antihypertensive treatment and BP control rates in patients with hypertension from the IBERICAN cohort. Methods IBERICAN is an ongoing prospective cohort study, whose primary objective is to determine the frequency, incidence, and distribution of CVRF in the adult Spanish population seen in primary care settings. This analysis shows the baseline clinical characteristics of patients with hypertension. Adequate BP control was defined as BP <140/90 mmHg according to 2013 ESH/ESC guidelines. Results A total of 8,066 patients were consecutively included, of whom 3,860 (48.0%) had hypertension. These patients were older (65.8 ± 10.9 vs. 51.6 ± 14.7 years; p < 0.001), had more cardiovascular risk factors, target organ damage and cardiovascular disease (CVD) in comparison with those without hypertension. The risk of hypertension increased with the presence of associated CV risk factors and comorbidities, particularly diabetes, obesity and the metabolic syndrome, and decreased with the intensity of physical activity. Regarding antihypertensive treatments, 6.1% of patients did not take any medication, 38.8% were taking one antihypertensive drug, 35.5% two drugs, and 19.6% three or more antihypertensive drugs. Overall, 58.3% achieved BP goals <140/90 mmHg. A greater probability of BP control was observed with increasing age of patients and the greater number of antihypertensive drugs. Blood pressure control was lower in hypertensive patients with diabetes, obesity, the metabolic syndrome, increased urinary albumin excretion, higher pulse pressure, and lack of antihypertensive treatment. Conclusions About half of patients attended in primary care settings have hypertension in Spain. Patients with hypertension have a worse CV clinical profile than non-hypertensive patients, with greater association of CVRF and CVD. Around four out of ten patients do not achieve the recommended BP goals, and higher use of combination therapies is associated with a better BP control.
Collapse
Affiliation(s)
- Miguel A. Prieto-Díaz
- Vallobín-La Florida Health Center, Principality of Asturias Health Service, Oviedo, Spain
- Faculty of Medicine, University of Santiago de Compostela, A Coruña, Spain
| | - Vicente Pallares-Carratala
- Health Surveillance Unit, Mutual Insurance Union, Castellon, Spain
- Department of Medicine, Jaume I University, Castellon, Spain
| | | | | | - Vicente Martín-Sanchez
- Institute of Biomedicine (IBIOMED), Epidemiology and Public Health Networking Biomedical Research Centre (CIBERESP), University of León, León, Spain
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | | | - José Polo-García
- Casar de Cáceres Health Center, Extremadura Health Service, Cáceres, Spain
| | | | | | | | - Sergio Cinza-Sanjurjo
- Milladoiro Health Centre, Health Area of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
- Networking Biomedical Research, Centre-Cardiovascular Diseases (CIBERCV), Santiago de Compostela, Spain
| | | |
Collapse
|
7
|
Yaneva-Sirakova T, Coca A, Sierra C, Cunha P, Hering D. Predictive value of new cardiovascular tools for stroke risk reclassification. Blood Press 2023; 32:2237129. [PMID: 37477278 DOI: 10.1080/08037051.2023.2237129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Affiliation(s)
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Cristina Sierra
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Pedro Cunha
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital Senhora da Oilveira, Life and Health Research Institute, Minho University, Guimarães, Portugal
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
8
|
Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank JK, Cunha PG, Danser AHJ, Pinho RMD, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens 2023; 41:1874-2071. [PMID: 37345492 DOI: 10.1097/hjh.0000000000003480] [Citation(s) in RCA: 258] [Impact Index Per Article: 258.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
DOCUMENT REVIEWERS Luis Alcocer (Mexico), Christina Antza (Greece), Mustafa Arici (Turkey), Eduardo Barbosa (Brazil), Adel Berbari (Lebanon), Luís Bronze (Portugal), John Chalmers (Australia), Tine De Backer (Belgium), Alejandro de la Sierra (Spain), Kyriakos Dimitriadis (Greece), Dorota Drozdz (Poland), Béatrice Duly-Bouhanick (France), Brent M. Egan (USA), Serap Erdine (Turkey), Claudio Ferri (Italy), Slavomira Filipova (Slovak Republic), Anthony Heagerty (UK), Michael Hecht Olsen (Denmark), Dagmara Hering (Poland), Sang Hyun Ihm (South Korea), Uday Jadhav (India), Manolis Kallistratos (Greece), Kazuomi Kario (Japan), Vasilios Kotsis (Greece), Adi Leiba (Israel), Patricio López-Jaramillo (Colombia), Hans-Peter Marti (Norway), Terry McCormack (UK), Paolo Mulatero (Italy), Dike B. Ojji (Nigeria), Sungha Park (South Korea), Priit Pauklin (Estonia), Sabine Perl (Austria), Arman Postadzhian (Bulgaria), Aleksander Prejbisz (Poland), Venkata Ram (India), Ramiro Sanchez (Argentina), Markus Schlaich (Australia), Alta Schutte (Australia), Cristina Sierra (Spain), Sekib Sokolovic (Bosnia and Herzegovina), Jonas Spaak (Sweden), Dimitrios Terentes-Printzios (Greece), Bruno Trimarco (Italy), Thomas Unger (The Netherlands), Bert-Jan van den Born (The Netherlands), Anna Vachulova (Slovak Republic), Agostino Virdis (Italy), Jiguang Wang (China), Ulrich Wenzel (Germany), Paul Whelton (USA), Jiri Widimsky (Czech Republic), Jacek Wolf (Poland), Grégoire Wuerzner (Switzerland), Eugene Yang (USA), Yuqing Zhang (China).
Collapse
Affiliation(s)
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Guido Grassi
- Clinica Medica, University Milano-Bicocca, Milan, Italy
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Maria Lorenza Muiesan
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
| | | | - Engi Abd Elhady Algharably
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Michel Azizi
- Université Paris Cité, Paris, France; AP-HP Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE
- INSERM, Paris
| | - Athanase Benetos
- Université de Lorraine, CHRU-Nancy, Department of Geriatric Medicine and INSERM DCAC, Nancy, France
| | - Claudio Borghi
- Department of Medical and Surgical Sciences-IRCCS AOU S. Orsola di Bologna, Bologna, Italy
| | - Jana Brguljan Hitij
- University Medical Centre Ljubljana, Department of Hypertension, Medical University Ljubljana, Ljubljana, Slovenia
| | - Renata Cifkova
- Center for Cardiovascular Prevention, Thomayer University Hospital
- Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Spain
| | | | | | - Pedro G Cunha
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital Senhora da Oliveira, Guimarães/Minho University
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - A H Jan Danser
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Christian Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | | | - Maria Dorobantu
- University of Medicine and Pharmacy 'Carol Davila', The Romanian Academy
| | - Michalis Doumas
- 2nd Prop Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - María S Fernández-Alfonso
- Instituto Pluridisciplinar and Facultad de Farmacia, Universidad Complutense de Madrid
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Jean-Michel Halimi
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, CHRU Tours
- Equipe d'Accueil EA4245, Université de Tours
- INI-CRCT, Tours, France
| | - Zoltán Járai
- South-Buda Center Hospital St. Imre University Hospital, Budapest & Semmelweis University, Budapest, Hungary
| | - Bojan Jelaković
- UHC Zagreb, Dept for Nephrology, Hypertension, Dialysis and Transplantation, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center
- Medical Faculty, University of Cologne, Cologne, Germany
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | | | - Dragan Lovic
- Singidunum University, Clinic for internal Disease Intermedica Cardiology Department, Hypertension Centre, Nis, Serbia
| | - Empar Lurbe
- Consorcio Hospital General Universitario de Valencia, Valencia
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid
- University of Valencia, Valencia, Spain
| | - Felix Mahfoud
- Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital and Saarland University, Homburg, Germany
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | - Marius Miglinas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Krzystof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | - Teemu Niiranen
- Department of Internal Medicine, Turku University Hospital and University of Turku, Turku
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Paolo Palatini
- Studium Patavinum, Department of Medicine, University of Padova, Padova, Italy
| | - Gianfranco Parati
- IRCCS, Istituto Auxologico Italiano, Ospedale San Luca
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Atul Pathak
- Princess Grace Hospital Monaco (Centre Hospitalier Princesse Grace, CHPG)
| | - Alexandre Persu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | | | - Josep Redon
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid
- Incliva Research Institute, University of Valencia
- CIBEROBN, Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Pantelis Sarafidis
- 1st Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Roland Schmieder
- University Hospital Erlangen, Friedrich Alexander University Erlangen/Nürnberg, Germany
| | - Bart Spronck
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Stella Stabouli
- First Department of Pediatrics, Aristotle University Thessaloniki, Hippokratio Hospital, Thessaloniki
| | - George Stergiou
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester
- Manchester Royal Infirmary, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Christoph Wanner
- Division of Nephrology, Wuerzburg University Clinic, Wuerzburg, Germany
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London (UCL); National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, UK
| | - Zhen-Yu Zhang
- Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, Institute for Clinical Medicine, and Ullevål Hospital, University of Oslo, Oslo, Norway
| |
Collapse
|
9
|
Yaneva-Sirakova T, Petrov I, Traykov L, Coca A, Cunha PG, Gasecki D, Farukh B, Kotsis V, Vicario A, Manios E, Sierra C, Hering D. Twenty-four-hour ambulatory blood pressure monitoring-from silent to whispering brain damage. Blood Press 2023; 32:2208228. [PMID: 37209040 DOI: 10.1080/08037051.2023.2208228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/22/2023]
Affiliation(s)
| | - Ivo Petrov
- Acibadem City Clinic UMHAT Cardiovascular Center, Sofia, Bulgaria
| | - Latchezar Traykov
- Department of Neurology, UMHAT "Alexandrovska", Neurology clinic, Medical University Sofia, Bulgaria
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Pedro G Cunha
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk; Hospital Senhora da Oilveira, Life and Health Research Institute, Minho University, Guimarães, Portugal
| | - Dariusz Gasecki
- Department of Adult Neurology, Medical University of Gdansk, Gdansk, Poland
| | - Bushra Farukh
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, United Kingdom
| | - Vasilios Kotsis
- Third Dept. of Int. Medicine, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece
| | - Augusto Vicario
- Heart-Brain Unit, Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - Efstathis Manios
- Dept. of Clinical Therapeutics National, and Kapodistrian University of Athens, Alexandra Hospital, Greece
| | - Cristina Sierra
- Department of Internal Medicine, University of Barcelona, Hospital Clinic, Barcelona, Spain
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
10
|
Grigorian-Shamagian L, Coca A, Morais J, Perez-Martinez P. Correction: The use of the CNIC-Polypill in real-life clinical practice: opportunities and challenges in patients at very high risk of atherosclerotic cardiovascular disease - expert panel meeting report. BMC Proc 2023; 17:27. [PMID: 37828604 PMCID: PMC10568817 DOI: 10.1186/s12919-023-00279-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Affiliation(s)
- Lilian Grigorian-Shamagian
- Department of Cardiology, Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio Marañón and Facultad de MedicinaUniversidad Complutense de Madrid, Madrid, Spain.
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Joao Morais
- Leiria Hospital Centre, Leiria, Portugal
- ciTechCare - Center for Innovative Care and Health Technology, Polytechnique of Leiria, Leiria, Portugal
| | - Pablo Perez-Martinez
- Lipids and Atherosclerosis Unit, IMIBIC/Reina Sofa University Hospital/University of Córdoba, Córdoba, Spain
- CIBER Fisiopatologia Obesidad Y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
11
|
Inuzuka S, Vitorino PVDO, Barroso AS, Magalhães FG, Sousa AC, Alves Filho RPP, Melo VA, Oliveira LFD, Sousa ALL, Jardim PCBV, Coca A, Barroso WKS. Pulse Wave Velocity of 8.2 m/s as a Threshold Associated with Cardiovascular Target Organ Damage Presence. Arq Bras Cardiol 2023; 120:e20220934. [PMID: 37909579 DOI: 10.36660/abc.20220934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 08/24/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Previous studies have established normal and reference values for Pulse Wave Velocity (PWV). However, the PWV value that has the strongest association with cardiovascular biomarkers remains poorly understood. OBJECTIVE This study aimed to determine the PWV value more likely to be associated with left ventricular hypertrophy (LVH), increased intima-media thickness (IMT), and presence of carotid plaques in patients with hypertension. METHODS This cross-sectional study included 119 patients. Analysis of receiver operating characteristic (ROC) curves was performed for each cardiovascular biomarker. Statistical significance was set at p < 0.05. RESULTS According to the ROC curve analysis, the PWV values were 8.1 m/s, 8.2 m/s, and 8.7 for the LVH, IMT, and presence of carotid plaques, respectively. A PWV value of 8.2 m/s was identified as the best parameter to determine the three TOD biomarkers. PWV above 8.2 m/s was associated with increased CIMT (p = 0.004) and the presence of carotid plaques (p = 0.003) and LVH (p<0.001). PWV above 8.2 showed greater sensitivity for increased CIMT (AUC = 0.678, sensitivity = 62.2), LVH (AUC = 0.717, sensitivity = 87.2), and the presence of plaques (AUC = 0.649, sensitivity = 74.51) in the ROC curve analysis. CONCLUSION The PWV value 8.2 m/s was more sensitive in early identifying the existence of cardiovascular biomarkers of TOD.
Collapse
Affiliation(s)
- Sayuri Inuzuka
- Universidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO - Brasil
| | | | | | | | | | | | - Victoria Alves Melo
- Universidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO - Brasil
| | | | - Ana Luiza Lima Sousa
- Universidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO - Brasil
| | | | - Antonio Coca
- Hypertension and Vascular Risk Unit. Hospital Clinic. University of Barcelona, Barcelona - Espanha
| | | |
Collapse
|
12
|
Amorim KCFO, Vitorino PVO, Feitosa ADM, Santos MC, Bezerra R, Lopes LR, Camafort M, Coca A, Sousa ALL, Barroso WKS. Hypertension evaluated in the public and private Brazilian health system hypertension in public and private service. Front Cardiovasc Med 2023; 10:1254933. [PMID: 37795487 PMCID: PMC10545870 DOI: 10.3389/fcvm.2023.1254933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction Hypertension (HT) remains the leading cause of death worldwide. In Brazil it is estimated that 35% of the adult population has HT and that about 20% of these have blood pressure values within the targets recommended for the reduction of cardiovascular risk. There are some data that point to different control rates in patients treated by cardiologists in public and private referral center and this is an important point to be investigated and discussed. Objective To compare sociodemographic characteristics, body mass index (BMI), antihypertensive (AH) drugs, blood pressure (BP) and control rate in public (PURC) and private (PRRC) referral centers. Methodology A cross-sectional multicenter study that analyzed data from hypertensive patients assisted by the PURC (one in Midwest Region and other in Northeast region) and PRRC (same distribution). Variables analyzed: sex, age, BMI, classes, number of AH used and mean values of systolic and diastolic BP by office measurement and home blood pressure measurement (HBPM). Uncontrolled hypertension (HT) phenotypes and BP control rates were assessed. Descriptive statistics and χ2 tests or unpaired t-tests were performed. A significance level of p < 0.05 was considered. Results A predominantly female (58.9%) sample of 2.956 patients and a higher prevalence of obesity in PURC (p < 0.001) and overweight in PRRC (p < 0.001). The mean AH used was 2.9 ± 1.5 for PURC and 1.4 ± 0.7 for PRRC (p < 0.001). Mean systolic and diastolic BP values were higher in PURC as were rates of uncontrolled HT of 67.8% and 47.6% (p < 0.001) by office measurement and 60.4% and 35.3% (p < 0.001) by HBPM in PURC and PRRC, respectively. Conclusion Patients with HT had a higher prevalence of obesity in the PURC and used almost twice as many AH drugs. BP control rates are worse in the PURC, on average 15.3 mmHg and 12.1 mmHg higher than in the PRRC by office measurement.
Collapse
Affiliation(s)
- Kecia C. F. O. Amorim
- Pós Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, Brasil
| | - Priscila Valverde O. Vitorino
- Programa de Pós-graduação Stricto Sensu em Atenção à Saúde, Escola de Ciências Sociais e da Saúde, Pontifícia Universidade Católica de Goiás, Goiânia, Brasil
| | - Audes D. M. Feitosa
- Serviço de Hipertensão de Pernambuco, Procape/UPE, Universidade de Pernambuco, Recife, Brasil
| | - Mayara Cedrim Santos
- Serviço de Hipertensão de Pernambuco, Procape/UPE, Universidade de Pernambuco, Recife, Brasil
| | - Rodrigo Bezerra
- Serviço de Hipertensão de Pernambuco, Procape/UPE, Universidade de Pernambuco, Recife, Brasil
| | - Lais Rocha Lopes
- Departamento de Clínica Médica, Hospital das Clínicas, EBESERH, Goiânia, Brasil
| | - Miguel Camafort
- Hypertension Unit, Hospital Clínic, Barcelona University, Barcelona, Spain
| | - Antonio Coca
- Hypertension Unit, Hospital Clínic, Barcelona University, Barcelona, Spain
| | - Ana Luíza Lima Sousa
- Pós Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, Brasil
- Liga de Hipertensão Arterial, Universidade Federal de Goiás, Goiânia, Brasil
| | - Weimar K. S. Barroso
- Pós Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, Brasil
- Departamento de Clínica Médica, Hospital das Clínicas, EBESERH, Goiânia, Brasil
- Liga de Hipertensão Arterial, Universidade Federal de Goiás, Goiânia, Brasil
| |
Collapse
|
13
|
Guimarães Filho GC, de Oliveira Vitorino PV, Inuzuka S, Barroso AS, Pacífico Alves Filho RP, Melo VA, de Oliveira Urzeda LF, Lima Sousa AL, Coca A, Veiga Jardim PCB, Barroso WKS. Pharmacological treatment of hypertension guided by peripheral or central blood pressure: a comparison between the two strategies. Front Cardiovasc Med 2023; 10:1247146. [PMID: 37771662 PMCID: PMC10525392 DOI: 10.3389/fcvm.2023.1247146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Background Arterial hypertension treatment guided by central blood pressures (CPB) rather than peripheral blood pressures (PBP) measurement has the potential to show greater effectiveness in preventing or even regressing stiffness and target organ damage (TOD). Objective This study aimed to compare the parameters of CBP and PBP measurements, arterial stiffness, TOD and renal profile in patients with anti-hypertensive treatment guided by CBP or PBP targets. Methods A randomized clinical trial was conducted in central group (CG) and peripheral group (PG). Patients were randomized, evaluated every 3 months for BP and antihypertensive adjustments during a one-year follow up. The procedures in V1 and V5: anthropometric assessment; CBP/PBP measurements, carotid ultrasound; echocardiography; laboratory tests. Paired and unpaired t-tests and the χ2 were used (significance level: 5%). Results The study evaluated 59 participants (30CG/29PG). The augmentation index (AIx) was higher in the CG (27.3% vs. 20.3%, p = 0.041). Intergroup analysis has found central diastolic BP lower in the CG (78.9 vs. 84.3 mmHg, p = 0.024) and the Alx difference between groups ceased to exist after a one-year follow-up. Intragroup comparisons, after intervention, showed a lower frequency of changed PWV (p < 0.001) and LVMI (p = 0.018) in the CG. The PG showed a higher frequency of changed PWV (p < 0.001) and LVMI (p = 0.003). Conclusion The intervention guided by central BP reduced the central diastolic BP and AIx compared to the PG. There was a reduction in the frequency of changed PWV and LVMI in the CG.
Collapse
Affiliation(s)
- Gilberto Campos Guimarães Filho
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | | | - Sayuri Inuzuka
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | - Adriana Sebba Barroso
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | | | - Victoria Alves Melo
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | - Luiz Fernando de Oliveira Urzeda
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | - Ana Luiza Lima Sousa
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Paulo César Brandão Veiga Jardim
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | - Weimar Kunz Sebba Barroso
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| |
Collapse
|
14
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
15
|
Grigorian-Shamagian L, Coca A, Morais J, Perez-Martinez P. The use of the CNIC-Polypill in real-life clinical practice: opportunities and challenges in patients at very high risk of atherosclerotic cardiovascular disease - expert panel meeting report. BMC Proc 2023; 17:20. [PMID: 37587509 PMCID: PMC10433542 DOI: 10.1186/s12919-023-00268-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/18/2023] Open
Abstract
Although the cardiovascular (CV) polypill concept is not new and several guidelines state that a CV polypill should be considered an integral part of a comprehensive CV disease (CVD) prevention strategy, there are still some barriers to its implementation in the real-world setting, mainly in secondary CV prevention. As the CNIC-polypill is the only one approved for secondary CV prevention in patients with atherosclerotic CVD in 27 countries worldwide, a panel of four discussants and 30 participants from 18 countries conveyed in a virtual meeting on April 21, 2022, to discuss key clinical questions regarding the practical use of the CNIC-Polypill and barriers to its implementation.Data presented showed that, although the use of the CV polypill is not explicitly mentioned in the current 2021 European Society of Cardiology guidelines on CVD prevention, it may be used in any patient for secondary CVD prevention tolerating all their components to improve outcomes through different aspects. The favourable results of the Secondary Prevention of Cardiovascular Disease in the Elderly (SECURE) trial now reinforce this recommendation. The panellists presented algorithms on how to switch from any baseline regimen when starting treatment with the CNIC-polypill in different situations, including patients with hypertension, dyslipidaemia, and a previous CV event; at discharge after a cardiovascular event; in chronic ischemic conditions; and in cases of polypharmacy. The panellists and expert discussants did agree that available studies conducted so far with the CNIC-polypill demonstrate that it is as efficacious as the monocomponents, equipotent drugs, or other therapies; reduces the risk of experiencing recurrent major CV events; improves medication adherence; reduces health care costs and resources compared to patients treated with loose drugs; and the patients prefer it over the multipill strategy.In conclusion, the data presented by the participants provided the evidence behind the use of the CNIC-polypill to help fulfil the goal of encouraging its adoption by physicians.
Collapse
Affiliation(s)
- Lilian Grigorian-Shamagian
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón and Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Joao Morais
- Leiria Hospital Centre, Leiria, Portugal
- ciTechCare - Center for Innovative Care and Health Technology, Polytechnique of Leiria, Leiria, Portugal
| | - Pablo Perez-Martinez
- Lipids and Atherosclerosis Unit, IMIBIC/Reina Sofia University Hospital/University of Córdoba, Córdoba, Spain
- CIBER Fisiopatologia Obesidad Y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
16
|
Barbosa ECD, Farina GS, Basso CS, Camafort M, Coca A, Nadruz W. Seasonal variation in blood pressure: what is still missing? Front Cardiovasc Med 2023; 10:1233325. [PMID: 37663410 PMCID: PMC10469506 DOI: 10.3389/fcvm.2023.1233325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Seasonal variation of blood pressure (BP) is a topic in cardiology that has gained more attention throughout the years. Although it is extensively documented that BP increases in seasons coupled with lower temperatures, there are still many gaps in this knowledge field that need to be explored. Notably, seasonal variation of BP phenotypes, such as masked and white coat hypertension, and the impact of air pollution, latitude, and altitude on seasonal variation of BP are still poorly described in the literature, and the levels of the existing evidence are low. Therefore, further investigations on these topics are needed to provide robust evidence that can be used in clinical practice.
Collapse
Affiliation(s)
- Eduardo Costa Duarte Barbosa
- Hypertension Leagueof Porto Alegre, Porto Alegre, Brazil
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, Brazil
- Department of Hypertension and Cardiometabolism, São Francisco Hospital, Santa Casa de Misericórdia de Porto Alegre, Feevale University, Porto Alegre, Brazil
| | - Giovani Schulte Farina
- Hypertension Leagueof Porto Alegre, Porto Alegre, Brazil
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden, Germany
| | - Carolina Souza Basso
- Hypertension Leagueof Porto Alegre, Porto Alegre, Brazil
- School of Medicine, Lutheran University of Brazil, Canoas, Brazil
| | - Miguel Camafort
- Hypertension and Vascular Risk Unit, Hospital Clínic (IDIBAPS), Department of Internal Medicine, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Hospital Clínic (IDIBAPS), Department of Internal Medicine, University of Barcelona, Barcelona, Spain
| | - Wilson Nadruz
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, Brazil
| |
Collapse
|
17
|
Coca A, Castellano JM, Camafort M, Fuster V. Polypill in cardiovascular disease prevention: recent advances. Pol Arch Intern Med 2023; 133. [PMID: 36916535 DOI: 10.20452/pamw.16460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Triple therapy with lipid lowering, antihypertensive, and antiplatelet agents reduce the risk of recurrent cardiovascular (CV) fatal and non-fatal events, CV mortality and total mortality in secondary prevention. In real life, however, effective implementation of these optimal treatments both in primary and secondary prevention is low and thus their contribution to CV prevention is much less than it could be, based on research data. One of the main barriers to the adequate implementation of this strategies is low adherence to such elevated number of pills, because adherence is adversely affected by the complexity of the prescribed treatment regimen and can be considerably improved by treatment simplification. This review will update the findings provided by recent epidemiological and clinical studies favouring a polypill-based approach to CV prevention. The elevated prevalence of subjects with multiple CV risk factors and comorbidities provides the rationale for a therapeutic strategy based on the combination in a single tablet of drugs against different risk factors. Pharmacological studies have demonstrated that different CV drugs can be combined in a single tablet with no loss of their individual efficacy and this favours both adherence and persistence in treatment and multiple risk factor control. Recently, the randomized clinical trial Secondary Prevention of Cardiovascular Disease in the Elderly (SECURE), has shown a significant 30% reduction in CV events and 33% reduction in CV death in patients after myocardial infarction treated with a polypill in comparison with usual care, supporting its use as an integral part of any CV prevention strategy.
Collapse
|
18
|
Alves MAM, Feitosa ADM, Mota-Gomes MA, Paiva AMG, Barroso WS, Miranda RD, Barbosa ECD, Brandão AA, Diniz PGS, Berwanger O, Lima-Filho JL, Sposito AC, Coca A, Nadruz W. Accuracy of screening strategies for masked hypertension: a large-scale nationwide study based on home blood pressure monitoring. Hypertens Res 2023; 46:742-750. [PMID: 36380200 DOI: 10.1038/s41440-022-01103-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/26/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022]
Abstract
This study compared the ability of guideline-proposed office blood pressure (OBP) screening thresholds [European Society of Hypertension (ESH) guidelines: 130/85 mmHg for individuals with an OBP < 140/90 mmHg; American College of Cardiology/American Heart Association (ACC/AHA) guidelines: 120/75 mmHg for individuals with an OBP < 130/80 mmHg] and novel screening scores to identify normotensive individuals at high risk of having masked hypertension (MH) in an office setting. We cross-sectionally evaluated untreated participants with an OBP < 140/90 mmHg (n = 22,266) and an OBP < 130/80 mmHg (n = 10,005) who underwent home blood pressure monitoring (HBPM) (derivation cohort) from 686 Brazilian sites. MH was defined according to criteria suggested by the ESH (OBP < 140/90 mmHg; HBPM ≥ 135/85 mmHg), Brazilian Society of Cardiology (BSC) (OBP < 140/90 mmHg; HBPM ≥ 130/80 mmHg) and ACC/AHA (OBP < 130/80 mmHg; HBPM ≥ 130/80 mmHg). Scores were generated from multivariable logistic regression coefficients between MH and clinical variables (OBP, age, sex, and BMI). Considering the ESH, BSC, and ACC/AHA criteria, 17.2%, 38.5%, and 21.2% of the participants had MH, respectively. Guideline-proposed OBP screening thresholds yielded area under curve (AUC) values of 0.640 (for ESH criteria), 0.641 (for BSC criteria), and 0.619 (for ACC/AHA criteria) for predicting MH, while scores presented as continuous variables or quartiles yielded AUC values of 0.700 and 0.688 (for ESH criteria), 0.720 and 0.709 (for BSC criteria), and 0.671 and 0.661 (for ACC/AHA criteria), respectively. Further analyses performed with alternative untreated participants (validation cohort; n = 2807 with an OBP < 140/90 mmHg; n = 1269 with an OBP < 130/80 mmHg) yielded similar AUC values. In conclusion, the accuracy of guideline-proposed OBP screening thresholds in identifying individuals at high risk of having MH in an office setting is limited and is inferior to that yielded by scores derived from simple clinical variables.
Collapse
Affiliation(s)
- Marco A M Alves
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil
| | - Audes D M Feitosa
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil.,Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Recife, PE, Brazil.,UNICAP Clinical Research Institute, Recife, PE, Brazil
| | | | | | - Weimar S Barroso
- Hypertension League, Cardiovascular Section, Federal University of Goiás, Goiânia, GO, Brazil
| | - Roberto D Miranda
- Cardiovascular Section, Geriatrics Division, Paulista School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil.,Hospital Israelita Albert Eistein, São Paulo, SP, Brazil
| | - Eduardo C D Barbosa
- Department of Hypertension and Cardiometabolism, São Francisco Hospital - Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Andréa A Brandão
- School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Paulo G S Diniz
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil
| | - Otavio Berwanger
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - José L Lima-Filho
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil
| | - Andrei C Sposito
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, SP Paulo, Brazil
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Wilson Nadruz
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil. .,Department of Internal Medicine, School of Medical Sciences, State University of Campinas, SP Paulo, Brazil.
| |
Collapse
|
19
|
Manolis AJ, Kallistratos MS, Camafort M, Coca A. How low should blood pressure be in patients with chronic coronary and cerebrovascular diseases. Eur J Intern Med 2023; 109:22-29. [PMID: 36631307 DOI: 10.1016/j.ejim.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
Over the last three decades, there are an increasing number of investigators and meta-analyses focusing on the fact that lowering blood pressure levels below a critical point is no longer beneficial and possibly even deleterious. In recent years, several trials and meta-analyses assessing intensive blood pressure (BP) lowering found that intensive treatment and lower blood pressure levels are associated with a reduction in CV events and mortality. However, a careful examination of the results shows that current data are not easily applicable to the general hypertensive population. In addition, recommendations of different guidelines since 2017 so far suggest different BP levels regarding the systolic and diastolic thresholds to be achieved and maintained, particularly in specific clinical situations such as patients with coronary artery disease and stroke. The challenge is to better define the limits of intervention and to define phenotypes of patients who are particularly vulnerable to over-aggressive lowering of blood pressure. This article reviews the evidence, controversies and current state of knowledge regarding intensive BP lowering and the lower thresholds of BP to be achieved in patients with chronic coronary or cerebrovascular diseases.
Collapse
Affiliation(s)
- A J Manolis
- Cardiology Department, Metropolitan Hospital, Piraeus, Greece
| | | | - M Camafort
- Hypertension and Vascular Risk Unit, Department of Internal Medicine. Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - A Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine. Hospital Clínic, University of Barcelona, Barcelona, Spain
| |
Collapse
|
20
|
Wyss F, Valdez O, Camafort M, Coca A. [Comprehensive Therapeutic Approach to Hypertension. Recommendations for Central America and the Caribbean]. Hipertens Riesgo Vasc 2023; 40:40-47. [PMID: 35697633 DOI: 10.1016/j.hipert.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/04/2022] [Accepted: 05/08/2022] [Indexed: 11/30/2022]
Abstract
Latin American hypertension guidelines, tailored to the needs of countries of Central and South America, should be applied and known by most Latin American physicians. The knowledge and implementation of the Guidelines is one of the greatest challenges of hypertension societies in Latin America such as the Central American and Caribbean Society of Arterial Hypertension (SCCH), the Latin American Society of Hypertension (LASH) and the Inter-American Society of Cardiology (SIAC). In 2020, the Inter-American Society of Cardiology (SIAC) published its position on the current Guidelines for Arterial Hypertension due to the need to standardize the evaluation, diagnosis, treatment and control of hypertension, establishing recommendations that should be adopted in all Latin American countries, aimed at optimizing the management of cardiovascular risk and achieving a substantial improvement in the reduction of cardiovascular events and mortality. This document intends to reinforce all proposals by the LASH guidelines and the position of the SIAC in relation to the therapeutic approach and pharmacological recommendations for patients with hypertension (HT), in order to achieve better HT control in the Central American and Caribbean area, and the consequently prognosis improvement of cardiovascular disease in the area.
Collapse
Affiliation(s)
- F Wyss
- Servicios y Tecnología Cardiovascular de Guatemala, Sociedad Centroamericana y del Caribe de Hipertensión Arterial y Prevención Cardiovascular, Ciudad de Guatemala, Guatemala.
| | - O Valdez
- Unidad de Cardiología, Hospital Central Romana, y Centro Especialidades Médicas Romana (CEMER), Sociedad Centroamericana y del Caribe de Hipertensión Arterial y Prevención Cardiovascular, Santo Domingo, República Dominicana
| | - M Camafort
- Unidad de Hipertensión, Unidad de Insuficiencia Cardiaca, Servicio de Medicina Interna, ICMID, Hospital Clínic IDIBAPS, Universidad de Barcelona, Barcelona, España; CIBER-OBN, Instituto de Salud Carlos III, Madrid, España
| | - A Coca
- Unidad de Hipertensión, Unidad de Insuficiencia Cardiaca, Servicio de Medicina Interna, ICMID, Hospital Clínic IDIBAPS, Universidad de Barcelona, Barcelona, España; Sociedad Europea de Hipertensión, Zug, Suiza
| |
Collapse
|
21
|
Coca A, Camafort M. A Further Step to Classical Semiology: The Subtle Expression of Structural and Functional Cerebral Changes in Hypertension. Am J Hypertens 2022; 35:593-595. [PMID: 35413093 DOI: 10.1093/ajh/hpac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Institute of Medicine and Dermatology, Hospital Clínic (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Miguel Camafort
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Institute of Medicine and Dermatology, Hospital Clínic (IDIBAPS), University of Barcelona, Barcelona, Spain
| |
Collapse
|
22
|
Barroso WKS, Brandão AA, Vitorino PVDO, Feitosa ADDM, Barbosa ECD, Miranda RD, Redon J, Camafort-Babkowski M, Coca A, Gomes MAM. Angiotensin Receptor Blockers Evaluated by Office and Home Blood Pressure Measurements. TeleHBPM Study. Arq Bras Cardiol 2022; 118:S0066-782X2022005005204. [PMID: 35544853 PMCID: PMC9345159 DOI: 10.36660/abc.20210504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/08/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adequate treatment of arterial hypertension and achieving arterial hypertension goals in are important in reducing cardiovascular outcomes. OBJECTIVES To describe angiotensin receptor blockers in monotherapy or double combination therapy and the rate of arterial hypertension control. METHODS This cross-sectional study evaluated patients who were using angiotensin receptor blockers between 2017 and 2020. Those using three or more antihypertensive drugs were excluded. The analyzed variables included sex, age, body mass index, valid home blood pressure monitoring (HBPM) measurements, casual and HBPM systolic and diastolic blood pressure measurements, blood pressure variability, and antihypertensive and angiotensin receptor blocker class. Paired t, chi-square, and Fisher's exact tests were used, as well as overlapping 95% confidence intervals and a significance level of 5% (p < 0.05). RESULTS Of 17,013 patients, 12,813 met the inclusion criteria, 62.1% of whom were female. The mean number of valid measurements was 23.3 (SD, 2.0). The mean HBPM and casual measurements for systolic blood pressure were 126.8 (SD, 15.8) mmHg and 133.5 (SD, 20.1) mmHg (p <0.001), respectively, while those for diastolic blood pressure were 79.1 (SD, 9.7 mmHg) and 83.6 (SD, 11.9) mmHg (p <0.001), respectively. Losartan was the most common angiotensin receptor blocker and resulted in the highest blood pressure values. Combinations of angiotensin receptor blockers with diuretics or calcium channel antagonists resulted in lower blood pressure values. CONCLUSIONS More than half of the patients used losartan, although it was the least efficient drug for reducing and controlling blood pressure.
Collapse
Affiliation(s)
- Weimar Kunz Sebba Barroso
- Universidade Federal de GoiásLiga de Hipertensão ArterialGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil
| | - Andréa Araujo Brandão
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro – Cardiologia, Rio de Janeiro, RJ – Brasil
| | - Priscila Valverde de Oliveira Vitorino
- Pontifícia Universidade Católica de GoiásEscola de Ciências Sociais e da SaúdeGoiâniaGOBrasilPontifícia Universidade Católica de Goiás - Escola de Ciências Sociais e da Saúde,Goiânia, GO – Brasil
| | - Audes Diógenes de Magalhães Feitosa
- Universidade de PernambucoRecifePEBrasilUniversidade de Pernambuco, Recife, PE – Brasil
- Universidade Católica de PernambucoRecifePEBrasilUniversidade Católica de Pernambuco, Recife, PE – Brasil
| | - Eduardo Costa Duarte Barbosa
- Complexo Hospitalar Santa Casa de Misericórdia de Porto AlegrePorto AlegreRSBrasilComplexo Hospitalar Santa Casa de Misericórdia de Porto Alegre – Cardiologia, Porto Alegre, RS - Brasil
| | - Roberto Dischinger Miranda
- Universidade Federal de São PauloEscola Paulista de MedicinaSão PauloSPBrasilUniversidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP – Brasil
| | - Josep Redon
- University of ValenciaValenciaEspanhaUniversity of Valencia – Hypertension, Valencia, Comunitat Valenciana – Espanha
| | - Miguel Camafort-Babkowski
- University of BarcelonaHospital ClínicHypertension UnitBarcelonaCatalunyaEspanhaUniversity of Barcelona - Hospital Clínic. Hypertension Unit, Barcelona, Catalunya – Espanha
| | - Antonio Coca
- Hypertension and Vascular Risk UnitHospital ClinicUniversity of BarcelonaBarcelonaEspanhaHypertension and Vascular Risk Unit. Hospital Clinic. University of Barcelona,Barcelona – Espanha
| | - Marco Antônio Mota Gomes
- Centro Universitário CESMACHospital do CoraçãoMaceióALBrasilCentro Universitário CESMAC - Hospital do Coração, Maceió, AL – Brasil
| |
Collapse
|
23
|
Rodrigues B, Barboza CA, Moura EG, Ministro G, Ferreira-Melo SE, Castaño JB, Nunes WMS, Mostarda C, Coca A, Vianna LC, Moreno-Junior H. Acute and Short-Term Autonomic and Hemodynamic Responses to Transcranial Direct Current Stimulation in Patients With Resistant Hypertension. Front Cardiovasc Med 2022; 9:853427. [PMID: 35360028 PMCID: PMC8962672 DOI: 10.3389/fcvm.2022.853427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/18/2022] [Indexed: 12/03/2022] Open
Abstract
Previously, we demonstrated that acute transcranial direct current stimulation (tDCS) reduced blood pressure (BP) and improved autonomic modulation in hypertensives. We hypothesized that acute and short-term tDCS intervention can promote similar benefits in resistant hypertensive patients (RHT). We assessed the impact of one (acute intervention) and ten (short-term intervention) tDCS or SHAM (20 min, each) sessions on BP, pulse interval (PI) and systolic blood pressure variabilities, humoral mechanisms associated with BP regulation, and cytokines levels. True RHT subjects (n = 13) were randomly submitted to one and ten SHAM and tDCS crossing sessions (1 week of “washout”). Hemodynamic (Finometer®, Beatscope), office BP, and autonomic variables (accessed through spectral analysis of the pulse-to-pulse BP signal, in the time and frequency domain – Fast Fourrier Transform) were measured at baseline and after the short-term intervention. 24 h-ambulatory BP monitoring was measured after acute and short-term protocols. Acute intervention: tDCS reduced BP, cardiac output, and increase high-frequency band of PI (vagal modulation to the heart). Short-term protocol: tDCS did not change BP and cardiac output parameters. In contrast, central systolic BP (−12%), augmentation index (−31%), and pulse wave velocity (34%) were decreased by the short-term tDCS when compared to SHAM. These positive results were accompanied by a reduction in the low-frequency band (−37%) and an increase of the high-frequency band of PI (+62%) compared to SHAM. These findings collectively indicate that short-term tDCS concomitantly improves resting cardiac autonomic control and pulse wave behavior and reduces central BP in RHT patients, https://ensaiosclinicos.gov.br/rg/RBR-8n7c9p.
Collapse
Affiliation(s)
- Bruno Rodrigues
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, Brazil
- Laboratory of Cardiovascular Pharmacology & Hypertension, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
- *Correspondence: Bruno Rodrigues
| | - Catarina A. Barboza
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, Brazil
| | - Eliezer G. Moura
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, Brazil
| | - Gabriela Ministro
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, Brazil
| | - Silvia E. Ferreira-Melo
- Laboratory of Cardiovascular Pharmacology & Hypertension, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Javier B. Castaño
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, Brazil
| | - Wilton M. S. Nunes
- Laboratory of Cardiovascular Investigation & Exercise, School of Physical Education, University of Campinas (UNICAMP), Campinas, Brazil
| | - Cristiano Mostarda
- Physical Education Department, Federal University of Maranhão (UFMA), São Luís, Brazil
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Lauro C. Vianna
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Brazil
| | - Heitor Moreno-Junior
- Laboratory of Cardiovascular Pharmacology & Hypertension, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| |
Collapse
|
24
|
Feitosa FGAM, Feitosa ADM, Paiva AMG, Mota-Gomes MA, Barroso WS, Miranda RD, Barbosa ECD, Brandão AA, Lima-Filho JL, Sposito AC, Coca A, Nadruz W. Impact of the COVID-19 pandemic on blood pressure control: a nationwide home blood pressure monitoring study. Hypertens Res 2021; 45:364-368. [PMID: 34857897 PMCID: PMC8636576 DOI: 10.1038/s41440-021-00784-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/15/2021] [Accepted: 09/30/2021] [Indexed: 01/08/2023]
Abstract
There are concerns that hypertension control may decrease during the COVID-19 pandemic. This study evaluated the impact of the COVID-19 pandemic on office blood pressure (OBP) and home blood pressure monitoring (HBPM) control in a large Brazilian nationwide sample. The results of an adjusted spline analysis evaluating the trajectory of OBP and HBPM control from 01/Jan/2019 to 31/Dec/2020 among independent participants who were untreated (n = 24,227) or treated (n = 27,699) with antihypertensive medications showed a modest and transient improvement in OBP control among treated individuals, which was restricted to the early months following the COVID-19 pandemic outbreak. Furthermore, slight reductions in OBP and HBPM values were detected in the early months following the COVID-19 pandemic outbreak among treated (n = 987) participants for whom blood pressure measurements before and during the pandemic were available, but not among untreated (n = 495) participants. In conclusion, we found no major adverse influence of the COVID-19 pandemic on OBP and HBPM control in a large nationwide sample.
Collapse
Affiliation(s)
- Fabiana G A M Feitosa
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil.,Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Recife, PE, Brazil.,University Hospital Oswaldo Cruz, University of Pernambuco, Recife, PE, Brazil
| | - Audes D M Feitosa
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil.,Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Recife, PE, Brazil.,UNICAP Clinical Research Institute, Recife, PE, Brazil
| | | | | | - Weimar S Barroso
- Hypertension League, Federal University of Goiás, Goiânia, GO, Brazil
| | - Roberto D Miranda
- Cardiovascular Section, Geriatrics Division, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Eduardo C D Barbosa
- Department of Hypertension and Cardiometabolism, São Francisco Hospital - Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Andréa A Brandão
- School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - José L Lima-Filho
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil
| | - Andrei C Sposito
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, SP Paulo, Brazil
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Wilson Nadruz
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil. .,Department of Internal Medicine, School of Medical Sciences, State University of Campinas, SP Paulo, Brazil.
| |
Collapse
|
25
|
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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
26
|
Batista SR, Vitorino PVO, Silva RR, Sousa ALL, Barroso WKS, Coca A. Cardiovascular multimorbidity and associated factors: the first Brazilian Registry of patients with hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiometabolic multimorbidity (CM-MM) defined by the occurrence of at least two of morbidities (diabetes mellitus, stroke, acute myocardial infarction) is a important issue for health systems and it was associated with several health negative outcomes, especially decreasing of the life expectancy.
Purpose
To analyze the occurrence of CM-MM and associated factors among Brazilian patients with hypertension.
Methods
Cross-sectional study with participants of The First Brazilian Registry of Patients with Hypertension (BRH) from 45 sites in all regions of Brazil (n=2,646). For this study we select the individuals with ≥65 years (n=1,033) and CM-MM was defined with the presence of ≥2 of the following: diabetes mellitus, stroke, acute myocardial infarction evaluated by self related. CM-MM was analyzed according to sex, age, race, presence of others morbidities (dyslipidemia, myocardial revascularization, heart failure and chronic kidney disease), control of blood pressure, obesity, physical activity, actual smoking and alcohol consumption. The numerical variables were presented by median and interquartile range, the categorical variables by absolute and relative frequency. To verify the variables associated with the outcome, simple logistic regression was performed.
Results
CM-MM was present in 8.9% of participants. The median age was 71.6 (IQ: 67.9–76.8), female (59.7%), 65–70 years of age (39.6%), and 59.8% were white. Obesity was present in 55.8% and 48.4% of individuals have no blood pressure controlled. The occurrence of diabetes mellitus, stroke, and acute myocardial infarction was, respectively, 32.7%, 14.7% and 6.7%. A higher occurrence of CM-MM was observed in males, aged between 70 and 75 years old and with 75 years old or more, the presence of dyslipidemia; myocardial revascularization (MR); heart failure (HF) and kidney disease. The intersection size among diseases is represented in Figure 1. After multiple analysis, the following variables were associated with the presence of cardiovascular multimorbidity: male gender; age equal to or greater than 75 years and report of dyslipidemia, MR and HF.
Conclusions
The prevalence of CM-MM was high and an approach based on the clusters of cardiometabolic diseases can be a potent care strategy.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Intersection size among diseases CM-MM
Collapse
Affiliation(s)
- S R Batista
- Federal University of Goias, Department of Internal Medicine, Goiania, Brazil
| | | | - R R Silva
- Federal University of Goias, Goiania, Brazil
| | - A L L Sousa
- Federal University of Goias, Goiania, Brazil
| | - W K S Barroso
- Federal University of Goias, Department of Internal Medicine, Goiania, Brazil
| | - A Coca
- University of Barcelona, Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS), Barcelona, Spain
| |
Collapse
|
27
|
Coca A. Marcadores pronósticos fiables de la evolución de la insuficiencia cardíaca del anciano: ¿es la monitorización ambulatoria de la presión arterial uno de ellos? Rev Clin Esp 2021. [DOI: 10.1016/j.rce.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
28
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
29
|
Lhermitte B, Blandin AF, Coca A, Guerin E, Durand A, Entz-Werlé N. Signaling pathway deregulation and molecular alterations across pediatric medulloblastomas. Neurochirurgie 2021; 67:39-45. [PMID: 29776650 DOI: 10.1016/j.neuchi.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/06/2018] [Accepted: 01/13/2018] [Indexed: 12/21/2022]
Abstract
Medulloblastomas (MBs) account for 15% of brain tumors in children under the age of 15. To date, the overall 5-year survival rate for all children is only around 60%. Recent advances in cancer genomics have led to a fundamental change in medulloblastoma classification and is evolving along with the genomic discoveries, allowing to regularly reclassify this disease. The previous molecular classification defined 4 groups (WNT-activated MB, SHH-activated MB and the groups 3 and 4 characterized partially by NMYC and MYC driven MBs). This stratification moved forward recently to better define these groups and their correlation to outcome. This new stratification into 7 novel subgroups was helpful to lay foundations and complementary data on the understanding regarding molecular pathways and gene mutations underlying medulloblastoma biology. This review was aimed at answering the recent key questions on MB genomics and go further in the relevance of those genes in MB development as well as in their targeted therapies.
Collapse
Affiliation(s)
- B Lhermitte
- Laboratoire de Pathologie, CHU Hautepierre, 1, avenue Molière, 67098 Strasbourg, France
| | - A F Blandin
- EA3430, Progression tumorale et microenvironnement, approches translationnelles et épidémiologie, université de Strasbourg, 3, avenue Molière, 67000 Strasbourg, France
| | - A Coca
- Service de Neurochirurgie, CHU Hautepierre, 1, avenue Molière, 67098 Strasbourg, France
| | - E Guerin
- Laboratoire de biologie moléculaire et plateforme régionale d'oncobiologie d'Alsace, CHU Hautepierre, 1, avenue Molière, 67098 Strasbourg, France
| | - A Durand
- EA3430, Progression tumorale et microenvironnement, approches translationnelles et épidémiologie, université de Strasbourg, 3, avenue Molière, 67000 Strasbourg, France
| | - N Entz-Werlé
- EA3430, Progression tumorale et microenvironnement, approches translationnelles et épidémiologie, université de Strasbourg, 3, avenue Molière, 67000 Strasbourg, France; Service de pédiatrie onco-hématologie, CHU Hautepierre, 1, avenue Molière, 67098 Strasbourg, France.
| |
Collapse
|
30
|
Affiliation(s)
- Antonio Coca
- Department of Medicine, University of Barcelona, Hospital Clínic, Barcelona, Spain
| |
Collapse
|
31
|
Coca A. Reliable prognostic markers for the progression of heart failure in older adults: Is ambulatory blood pressure monitoring one of them? Rev Clin Esp 2021; 221:470-472. [PMID: 34154975 PMCID: PMC8464162 DOI: 10.1016/j.rceng.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
- A Coca
- Unidad de Hipertensión y Riesgo Vascular, Servicio de Medicina Interna, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain.
| |
Collapse
|
32
|
Morales-Salinas A, Olsen MH, Kones R, Kario K, Wang JG, Beilin L, Weber MA, Yano Y, Burrell LM, Orias M, Dzudie A, Lavie C, Ventura H, Sundström J, de Simone G, Coca A, Rumana U, Marrugat J. Erratum to "Second Consensus on Treatment of Patients Recently Diagnosed with Mild Hypertension and Low Cardiovascular Risk". [YMCD 45/10 (October 2020) 100653]. Curr Probl Cardiol 2021; 46:100877. [PMID: 34148707 DOI: 10.1016/j.cpcardiol.2021.100877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A Morales-Salinas
- Associate Professsor, Universidad de Ciencias Médicas de Villa Clara, Villa Clara, Cuba.
| | - M H Olsen
- Professor, Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - R Kones
- Director, Cardiometabolic Research Institute, Houston, TX, USA. Chief Medical Officer, Community Diabetes Prevention Program, Houston, TX, USA. Editor-in-Chief, Research Reports in Clinical Cardiology.
| | - K Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
| | - J G Wang
- The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Tel: +86-21-64662193 ext 610911).
| | - L Beilin
- Professor of Medicine in the School of Medicine & Pharmacology at the Royal Perth Hospital Campus, University of Western Australia.
| | - M A Weber
- Professor of Medicine, Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center.
| | - Y Yano
- Assistant Professor in Family Medicine and Community Health, Duke University, Durham, NC.
| | - L M Burrell
- Departments of Medicine and Cardiology, The University of Melbourne, Austin Health, Victoria, 3084, Australia.
| | - M Orias
- Department of Nephrology, Sanatorio Allende, Independencia 768, 5000 Córdoba, Argentina.
| | - A Dzudie
- Hôpital Général de Douala Douala, Cameroon.
| | - C Lavie
- Medical Director Cardiac Rehabilitation and Prevention, Director Exercise Laboratories, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, Editor in Chief, Progress in Cardiovascular Diseases, New Orleans, Louisiana.
| | - H Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana.
| | - J Sundström
- Professor of Epidemiology, Uppsala University, +4670422522.
| | - G de Simone
- Professor of Medicine, Chair, Council on Hypertension, European Society of Cardiology, Hypertension Research Cente & Dprt of Translational Biomedical Sciences, Federico II University Hospital, via S. Pansini 5, bld # 1, 80131 Napoli, Italy.
| | - A Coca
- Honorary Professor of Medicine. Department of Internal Medicine, Hospital Clínic, University of Barcelona, Spain, Phone: +34 618 769 035.
| | - U Rumana
- New York Institute of Technology, Old Westbury, NY.
| | - J Marrugat
- Institut Hospital del Mar d'investigacions Mèdiques (IMIM) - CIBERCV, Barcelona, Catalonia, Spain.
| |
Collapse
|
33
|
Hanssen H, Boardman H, Deiseroth A, Moholdt T, Simonenko M, Kränkel N, Niebauer J, Tiberi M, Abreu A, Solberg EE, Pescatello L, Brguljan J, Coca A, Leeson P. Personalized exercise prescription in the prevention and treatment of arterial hypertension: a Consensus Document from the European Association of Preventive Cardiology (EAPC) and the ESC Council on Hypertension. Eur J Prev Cardiol 2021; 29:205-215. [PMID: 33758927 DOI: 10.1093/eurjpc/zwaa141] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/09/2020] [Accepted: 11/30/2020] [Indexed: 12/20/2022]
Abstract
Treatment of hypertension and its complications remains a major ongoing health care challenge. Around 25% of heart attacks in Europe are already attributed to hypertension and by 2025 up to 60% of the population will have hypertension. Physical inactivity has contributed to the rising prevalence of hypertension, but patients who exercise or engage in physical activity reduce their risk of stroke, myocardial infarction, and cardiovascular mortality. Hence, current international guidelines on cardiovascular disease prevention provide generic advice to increase aerobic activity, but physiological responses differ with blood pressure (BP) level, and greater reductions in BP across a population may be achievable with more personalized advice. We performed a systematic review of meta-analyses to determine whether there was sufficient evidence for a scientific Consensus Document reporting how exercise prescription could be personalized for BP control. The document discusses the findings of 34 meta-analyses on BP-lowering effects of aerobic endurance training, dynamic resistance training as well as isometric resistance training in patients with hypertension, high-normal, and individuals with normal BP. As a main finding, there was sufficient evidence from the meta-review, based on the estimated range of exercise-induced BP reduction, the number of randomized controlled trials, and the quality score, to propose that type of exercise can be prescribed according to initial BP level, although considerable research gaps remain. Therefore, this evidence-based Consensus Document proposes further work to encourage and develop more frequent use of personalized exercise prescription to optimize lifestyle interventions for the prevention and treatment of hypertension.
Collapse
Affiliation(s)
- Henner Hanssen
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland
| | - Henry Boardman
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Arne Deiseroth
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway and Women's Clinic, St. Olavs Hospital, Trondheim, Norway
| | - Maria Simonenko
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Nicolle Kränkel
- Charité, University Medicine Berlin, Department of Cardiology, Campus Benjamin-Franklin (CBF), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Germany
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Austria.,Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Monica Tiberi
- Department of Public Health, Azienda Sanitaria Unica Regionale Marche AV 1 Pesaro, Italy
| | - Ana Abreu
- Cardiology Department, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte, Portugal.,Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa, Portugal
| | | | - Linda Pescatello
- Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, USA
| | - Jana Brguljan
- Universitiy Medical Centre Ljubljana, Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Hospital Clínic, University of Barcelona, Spain
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| |
Collapse
|
34
|
Affiliation(s)
- Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Michel Burnier
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Hypertension Research Foundation, St-Légier, Switzerland
| |
Collapse
|
35
|
Cífková R, Johnson MR, Kahan T, Brguljan J, Williams B, Coca A, Manolis A, Thomopoulos C, Borghi C, Tsioufis C, Parati G, Sudano I, McManus RJ, van den Born BJH, Regitz-Zagrosek V, de Simone G. Peripartum management of hypertension: a position paper of the ESC Council on Hypertension and the European Society of Hypertension. Eur Heart J Cardiovasc Pharmacother 2021; 6:384-393. [PMID: 31841131 DOI: 10.1093/ehjcvp/pvz082] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 12/10/2019] [Indexed: 12/26/2022]
Abstract
Hypertensive disorders are the most common medical complications in the peripartum period associated with a substantial increase in morbidity and mortality. Hypertension in the peripartum period may be due to the continuation of pre-existing or gestational hypertension, de novo development of pre-eclampsia or it may be also induced by some drugs used for analgesia or suppression of postpartum haemorrhage. Women with severe hypertension and hypertensive emergencies are at high risk of life-threatening complications, therefore, despite the lack of evidence-based data, based on expert opinion, antihypertensive treatment is recommended. Labetalol intravenously and methyldopa orally are then the two most frequently used drugs. Short-acting oral nifedipine is suggested to be used only if other drugs or iv access are not available. Induction of labour is associated with improved maternal outcome and should be advised for women with gestational hypertension or mild pre-eclampsia at 37 weeks' gestation. This position paper provides the first interdisciplinary approach to the management of hypertension in the peripartum period based on the best available evidence and expert consensus.
Collapse
Affiliation(s)
- Renata Cífková
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Vídeňská 800, 140 59 Prague 4, Czech Republic.,Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Mark R Johnson
- Institute of Reproductive and Developmental Biology, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, UK
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Jana Brguljan
- Division of Internal Medicine, Department of Hypertension, Medical Faculty, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Bryan Williams
- UCL Institute of Cardiovascular Sciences, University College London, London, UK
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Costas Thomopoulos
- Department of Cardiology, Helena Venizelou General & Maternal Hospital, Athens, Greece
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology Unit, Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S.Luca Hospital, Milan, Italy
| | - Isabella Sudano
- Department of Cardiology, University Heart Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Bert-Jan H van den Born
- Departments of Internal and Vascular Medicine, Department of Public Health, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Vera Regitz-Zagrosek
- Berlin Institute for Gender in Medicine and CCR, Charité University Medicine Berlin, and DZHK, Partner Site Berlin, Germany
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences, Hypertension Research Center, Federico II University, Naples, Italy
| |
Collapse
|
36
|
Parati G, Kjeldsen S, Coca A, Cushman WC, Wang J. Adherence to Single-Pill Versus Free-Equivalent Combination Therapy in Hypertension: A Systematic Review and Meta-Analysis. Hypertension 2021; 77:692-705. [PMID: 33390044 DOI: 10.1161/hypertensionaha.120.15781] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Poor adherence to antihypertensive therapy is a major cause of poor blood pressure (BP) control in patients with hypertension. Regimen simplification may improve adherence and BP control. This systematic review assessed whether single-pill combination (SPC) therapy led to improved adherence, persistence, and better BP control compared with free-equivalent combination (FEC) therapy in patients with hypertension. PubMed, Medline, Embase, and the Cochrane Library were searched until July 2020, in addition to manual searching of relevant congress abstracts from 2014 to 2020 for studies including adults with hypertension aged ≥18 years receiving SPC or FEC antihypertensive therapy measuring any of the following: adherence, persistence, and reductions in systolic BP and/or diastolic BP. Adherence and persistence were summarized in a narrative analysis; direct pair-wise meta-analysis was conducted to compare BP reductions with SPC therapy versus FEC therapy using fixed-effect and random-effects models. Following screening, 44 studies were included. The majority (18 of 23) of studies measuring adherence showed adherence was significantly improved in patients receiving SPCs versus FECs. Overall, 16 studies measured persistence, of which 14 showed that patients receiving SPCs had significantly improved persistence or were significantly less likely to discontinue therapy than patients receiving FECs. Systolic BP (mean difference, -3.99 [95% CI, -7.92 to -0.07]; P=0.05) and diastolic BP (-1.54 [95% CI, -2.67 to -0.41]; P=0.0076) were both significantly reduced with SPC therapy compared with FEC therapy at week 12. SPC therapy leads to improved adherence and persistence compared with FEC therapy and may lead to better BP control in patients with hypertension.
Collapse
Affiliation(s)
- Gianfranco Parati
- From the Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto di Ricovero e Cura a Carattere scientifico (IRCCS), Istituto Auxologico Italiano, Milan, Italy (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P.)
| | - Sverre Kjeldsen
- Department of Cardiology, University of Oslo, Ullevaal Hospital, Norway (S.K.)
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Spain (A.C.)
| | - William C Cushman
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, USA (W.C.C.)
| | - Jiguang Wang
- Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (J.W.)
| |
Collapse
|
37
|
Abstract
According to the last Hypertension guideline recommendations, it may be concluded that intensive BP lowering is only advisable in a subgroup of patients where there is a clear net benefit of targeting to lower BP goals. However, taking into account the relevance of correct BP measurement, estimates of the benefits versus the harm should be based on reliable office BP measurements and home BP measurements. There is still debate about which BP goals are optimal in reducing morbidity and mortality in uncomplicated hypertensives and in those with associated comorbidities. In recent years, trials and meta-analyses have assessed intensive BP lowering, with some success. However, a careful examination of the results shows that current data are not easily applicable to the general hypertensive population. This article reviews the evidence on and controversies about intensive BP lowering in general and in specific clinical situations, and the importance of obtaining reliable BP readings in patients with hypertension and comorbidities.
Collapse
Affiliation(s)
- Miguel Camafort
- Department of Internal Medicine-ICMiD. Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain. .,Cardiovascular Risk, Nutrition and Aging Research Group. IDIBAPS, Barcelona, Spain. .,Ciber-OBN, Instituto de Salud Carlos III, Madrid, Spain.
| | - Josep Redón
- Ciber-OBN, Instituto de Salud Carlos III, Madrid, Spain.,Hypertension Clinic. Hospital Clinico, University of Valencia, Valencia, Spain
| | - Wook Bum Pyun
- Department of Cardiology, Ewha Womans University. Seoul Hospital, Seoul, South Korea
| | - Antonio Coca
- Department of Internal Medicine-ICMiD. Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.,Cardiovascular Risk, Nutrition and Aging Research Group. IDIBAPS, Barcelona, Spain
| |
Collapse
|
38
|
Coca A, Kreutz R, Manolis AJ, Mancia G. A practical approach to switch from a multiple pill therapeutic strategy to a polypill-based strategy for cardiovascular prevention in patients with hypertension. J Hypertens 2020; 38:1890-1898. [PMID: 32890261 DOI: 10.1097/hjh.0000000000002464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
: Pharmacological treatment recommended by guidelines for very high-risk patients with established cardiovascular disease (CVD) includes lipid-lowering drugs, antihypertensive agents and antiplatelet therapy. Depending on the associated comorbidities, this baseline regimen has to be complemented with other drugs. Therefore, the number of pills to be taken is usually high and adherence to these multiple pill therapeutic regimens and long-term persistence on treatment is low, being the main factor for insufficient control of cardiovascular risk factors. The CNIC (Centro Nacional de Investigaciones Cardiovasculares, Ministerio de Ciencia e Innovación, España) polypill is the only polypill containing low-dose aspirin approved by the EMA and marketed in Europe, and has demonstrated to improve adherence. For this reason, guidelines recommend its use for secondary prevention of CVD, and also for primary prevention of cardiovascular events in patients with multiple cardiovascular risk factors and advanced atherosclerotic process at high risk of thrombosis and low risk of bleeding. This article pretends to simplify the steps that clinicians may follow to switch from any baseline regimen to the polypill with the use of several algorithms and tables showing the equivalent effective daily doses of different angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and statins to facilitate switching, as well as the steps to be followed depending of the initial levels of BP and LDL-cholesterol values to achieve BP and lipid control with the association to the polypill of other BP-lowering or lipid-lowering drugs whenever needed.
Collapse
Affiliation(s)
- Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
- Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | | | - Giuseppe Mancia
- Policlinico di Monza, Monza
- University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
39
|
Wyss F, Coca A, Lopez-Jaramillo P, Ponte-Negretti C. Position statement of the Interamerican Society of Cardiology (IASC) on the current guidelines for the prevention, diagnosis and treatment of arterial hypertension 2017-2020. Int J Cardiol Hypertens 2020; 6:100041. [PMID: 33447767 PMCID: PMC7803017 DOI: 10.1016/j.ijchy.2020.100041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES As an Inter-American Society we are convinced of the need to standardize the steps in which we diagnose, evaluate, treat and control hypertension, establishing guidelines and rules that should be adopted in all countries of Latin America, aimed at standardizing management and control of CV risk in order to achieve a substantial decrease in CV events. METHODS In the last four years important international guidelines for the diagnosis, management, treatment and control of arterial hypertension have been published. In America, mostly in mid- and low-income countries, hypertension is a major problem of public health, being the most important cardiovascular risk factor due to its great population impact. Therefore, it is crucial to dedicate all the possible efforts to increase substantially the number of hypertensive patients diagnosed in a given area, and to improve the percentage of controlled patients. This is a major necessity in order to reduce the morbidity and mortality for CVD in the Latin American region, although no guidelines takes the Latin American populations into account, and much less standardizes their diagnosis and management. CONCLUSIONS The Inter-American Society of Cardiology suggest the use of the blood pressure classification of the Latin American Society of Hypertension (LASH) and recommends the use of the SCORE System to stratify the global CV risk because this system has the capability to adapt the global risk by means of a correcting factor based on the ethnicity of the different native populations in America.
Collapse
Affiliation(s)
| | - Antonio Coca
- Internal Medicine, Universidad de Barcelona, Espana
| | | | | |
Collapse
|
40
|
Morales-Salinas A, Olsen MH, Kones R, Kario K, Wang J, Beilin L, Weber MA, Yano Y, Burrell L, Orias M, Cameroon DA, Lavie CJ, Ventura H, Sundström J, de Simone G, Coca A, Rumana U, Marrugat J. Second Consensus on Treatment of Patients Recently Diagnosed With Mild Hypertension and Low Cardiovascular Risk. Curr Probl Cardiol 2020; 45:100653. [PMID: 32828558 DOI: 10.1016/j.cpcardiol.2020.100653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
|
41
|
Virbel G, Cebula H, Coca A, Lhermitte B, Bauchet L, Noël G. [Choice optimisation of radiation therapy technique for central neurocytomas from literature data]. Cancer Radiother 2020; 24:882-891. [PMID: 32753237 DOI: 10.1016/j.canrad.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/28/2020] [Accepted: 03/11/2020] [Indexed: 12/31/2022]
Abstract
Neurocytomas represent 0,25 to 0,5 of brain tumours. These tumours have neuronal differentiation. It's a young adult disease. The main treatment is neurosurgery. The place of other therapies is still unclear, noticeably with regards to radiotherapy. This review aim is to determine the place and the modalities of radiotherapy in the management of neurocytomas. A literature search using PubMed allowed to select the most relevant studies. Finally, 22 studies were selected according to pre-established criteria to answer the problem. All studies were retrospective studies except one. The analysis conclusion defined radiotherapy as a treatment of choice in selected patients, when surgical resection was incomplete or when tumour was atypical.
Collapse
Affiliation(s)
- G Virbel
- Département de radiothérapie, ICANS, 17, rue Albert-Calmette, 67200 Strasbourg, France
| | - H Cebula
- Département de neurochirurgie, hôpital de Hautepierre, 1, rue Molière, 67200 Strasbourg, France
| | - A Coca
- Département de neurochirurgie, hôpital de Hautepierre, 1, rue Molière, 67200 Strasbourg, France
| | - B Lhermitte
- Service d'anatomopathologie, hôpital de Hautepierre, 1, rue Molière, 67200 Strasbourg, France
| | - L Bauchet
- Service de neurochirurgie, hôpital Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France; Inserm, U1051, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - G Noël
- Département de radiothérapie, ICANS, 17, rue Albert-Calmette, 67200 Strasbourg, France.
| |
Collapse
|
42
|
Di Rocco F, Scavarda D, Vinchon M, Szathmari A, Riffaud L, Bohra A, Blauwblomme T, Boetto S, Gimbert E, Ferrand S, Coca A, Chivoret N, Coll G, Delion M, Roujeau T, Mottolese C, Zerah M. Impact de la pandémie COVID-19 sur la neurochirurgie pédiatrique en France. Neurochirurgie 2020; 66:192-194. [PMID: 32504645 PMCID: PMC7833797 DOI: 10.1016/j.neuchi.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/24/2020] [Indexed: 12/24/2022]
Affiliation(s)
- F Di Rocco
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France.
| | - D Scavarda
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - M Vinchon
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - A Szathmari
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - L Riffaud
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - A Bohra
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - T Blauwblomme
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - S Boetto
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - E Gimbert
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - S Ferrand
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - A Coca
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - N Chivoret
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - G Coll
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - M Delion
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - T Roujeau
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - C Mottolese
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - M Zerah
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | -
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| |
Collapse
|
43
|
López-Jaramillo P, Barbosa E, Molina DI, Sanchez R, Diaz M, Camacho PA, Lanas F, Pasquel M, Accini JL, Ponte-Negretti CI, Alcocer L, Cobos L, Wyss F, Sebba-Barroso W, Coca A, Zanchetti A. Latin American Consensus on the management of hypertension in the patient with diabetes and the metabolic syndrome. J Hypertens 2020; 37:1126-1147. [PMID: 30882601 DOI: 10.1097/hjh.0000000000002072] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
: The prevalence of hypertension, type 2 diabetes mellitus (DM2) and the metabolic syndrome continues to increase in Latin America, while the rates of diagnosis, treatment and control of these disorders remain low. The frequency of the risk factors that constitute the metabolic syndrome and are associated with an increased risk of cardiovascular disease has not diminished since the publication of the previous consensus. This document discusses the socioeconomic, demographic, environmental and cultural characteristics of most associated Latin American countries and partially explains the lack of better results in improving clinical and public health actions that allow high morbidity and mortality rates caused by cardiovascular diseases and DM2 to be reduced through programs aligned with the so-called precision medicine, which should be predictive, preventive, personalized and participatory. The Consensus ratifies the diagnostic criteria expressed in the previous consensus to define hypertension and DM2 but, for the metabolic syndrome, and in the absence of evidence, the recommendation is to implement a cohort study that determines the abdominal perimeter value associated with hard outcomes, such as DM2 and CVD. Meanwhile, we recommend modifying the criterion to more than 94 cm in men and more than 84 cm in women according to WHO recommendations. We also recommend the carrying out of a study that identifies the situation of hypertension and DM2 in people of African ancestry who, in Latin America, exceed 75 million and whose epidemiology does not include solid studies. With respect to the proposed therapeutic targets, we recommended maintaining those defined in the previous consensus, but insisting that early pharmacological management of prediabetes with metformin should be introduced, as should the treatment of diabetic hypertensive patients with a combination therapy of two fixed-dose antihypertensive drugs and management with statins. To increase adherence, the use of different drugs combined in a single pill (polypill) is recommended. The simplification of the therapeutic regimen is accompanied by greater control of cardiovascular risk factors, both in primary and secondary prevention, and has been shown to be cost-effective. The consensus recommends the use of the currently available polypill combining an angiotensin-converting enzyme inhibitor, a statin and aspirin for secondary cardiovascular prevention and in patients with a high cardiovascular risk, such as hypertension patients with DM2.
Collapse
Affiliation(s)
- Patricio López-Jaramillo
- Clinica de Síndrome Metabolico, Prediabetes y Diabetes, Direccion de Investigaciones FOSCAL y Facultad de Salud, Universidad de Santander (UDES), Bucaramanga, Colombia
| | | | - Dora I Molina
- Universidad de Caldas e IPS Médicos Internistas de Caldas, Manizales, Colombia
| | - Ramiro Sanchez
- Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina
| | | | - Paul A Camacho
- Direccion de Investigaciones FOSCAL y Facultad de Salud, Universidad Autonoma de Bucaramanga (UNAB), Bucaramanga, Colombia
| | | | | | - José L Accini
- Fundacion Hospital Universidad del Norte y Universidad Libre, Barranquilla, Colombia
| | | | - Luis Alcocer
- Instituto Mexicano de Salud Cardiovascular, Ciudad de Mexico, Mexico
| | - Leonardo Cobos
- Unidad de Cardiologia, Hospital El Pino, Santiago, Chile
| | - Fernando Wyss
- Servicios y Tecnologica Cardiovascular de Gautemala, S.A., Guatemala
| | | | - Antonio Coca
- Hospital Clínico, Universidad de Barcelona, Spain
| | - Alberto Zanchetti
- Istituto Auxologico Italiano, IRCCS, and Università degli Studi of Milan, Italy
| | | |
Collapse
|
44
|
Coca A, Doménech M. How to implement the recommendations of the 2018 ESC/ESH Hypertension Guidelines in a given patient: a step by step approach. Eur Heart J Cardiovasc Pharmacother 2020; 5:164-170. [PMID: 30851109 DOI: 10.1093/ehjcvp/pvz011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/25/2019] [Accepted: 03/07/2019] [Indexed: 11/13/2022]
Abstract
All clinical guidelines release general recommendations based on the best available evidence on the issue, usually obtained from epidemiological studies, randomized clinical trials, or meta-analyses. However, the final data of these studies are averages of a given parameter from groups of patients whose clinical characteristics are not necessarily similar to those of a specific patient seen in daily practice. As the guidelines recommendations have to be implemented in patients, not in group of patients, the final decisions concerning an individual patient must be made by the attending physician, in consultation with the patient and caregiver, as appropriate. In this article, a clinical case of a patient with hypertension and other associated cardiovascular risk factors is discussed and managed following the recommendations of the 2018 ESC/ESH Hypertension Guidelines implemented in this specific patient.
Collapse
Affiliation(s)
- Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIPBAPS), University of Barcelona, c/ Villarroel 170, 08036-Barcelona, Spain
| | - Monica Doménech
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIPBAPS), University of Barcelona, c/ Villarroel 170, 08036-Barcelona, Spain
| |
Collapse
|
45
|
Arantes AC, Sousa ALL, Vitorino PVDO, Jardim PCBV, Jardim TDSV, Rezende JM, Lelis EDS, Rodrigues RB, Coca A, Barroso WKS. Effects of added salt reduction on central and peripheral blood pressure. Arq Bras Cardiol 2020; 114:554-561. [PMID: 32267330 PMCID: PMC7792722 DOI: 10.36660/abc.20180426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 04/15/2019] [Accepted: 05/15/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Although the effects of salt intake reduction on casual blood pressure have been extensively studied in hypertensive individuals, data on reductions of added salt on arterial stiffness in both normotensive and prehypertensive subjects are scarce. OBJECTIVE To evaluate the effects of progressive reduction in added salt intake (from 6 grams to 4 grams per day) on peripheral and central blood pressure and arterial stiffness in normotensive, prehypertensive and hypertensive individuals. METHODS This was a single-blinded clinical trial with 13 weeks of follow-up. Normotensive (≤ 130/85 mmHg), prehypertensive (≥ 130 e < 139/≥ 85 e < 90 mmHg) and stage 1 hypertensive individuals (< 139/≥ 85 and < 90 mmHg) were assessed. Casual blood pressure measurements and ambulatory blood pressure monitoring were performed using the automated OMRON 705CP device, and central blood pressure was measured using the Sphygmocor®. Twenty-four-hour urinary sodium excretion and the amounts of added salt consumed were measured. Statistically significance level was set at p < 0.05 for all analysis. RESULTS A total of 55 participants (18 normotensive, 15 prehypertensive and 22 hypertensive), median age 48 years (IQR:39-54) were studied. The groups were not different in age or sex. No difference was observed in blood pressure or sodium excretion levels before and after the intervention. No significant changes in arterial stiffness parameters were observed. CONCLUSION The progressive reduction in added salt intake during a period of 13 weeks did not cause significant reductions in peripheral and central blood pressure. (Arq Bras Cardiol. 2020; 114(3):554-561).
Collapse
Affiliation(s)
- Ana Carolina Arantes
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil
| | - Ana Luiza Lima Sousa
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil
| | - Priscila Valverde de O. Vitorino
- Pontificia Universidade Católica de GoiásEscola de Ciências Sociais e da SaúdeGoiâniaGoiásBrasilPontificia Universidade Católica de Goiás - Escola de Ciências Sociais e da Saúde - Mestrado em Atenção à Saúde, Goiânia, Goiás – Brasil
| | - Paulo Cesar B. Veiga Jardim
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil
| | - Thiago de Souza Veiga Jardim
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil
| | - Jeeziane Marcelino Rezende
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
| | - Ellen de Souza Lelis
- Pontificia Universidade Católica de GoiásEscola de Ciências Sociais e da SaúdeGoiâniaGoiásBrasilPontificia Universidade Católica de Goiás - Escola de Ciências Sociais e da Saúde - Mestrado em Atenção à Saúde, Goiânia, Goiás – Brasil
| | - Rafaela Bernardes Rodrigues
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
| | - Antonio Coca
- Universitat de BarcelonaBarcelonaEspanhaUniversitat de Barcelona, Barcelona – Espanha
| | - Weimar Kunz Sebba Barroso
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil
| |
Collapse
|
46
|
Sabio R, Parodi R, Coca A. [Impact of cognitive biases in therapeutic inertia in arterial hypertension: Not everything is as it seems]. Hipertens Riesgo Vasc 2020; 37:78-81. [PMID: 31542309 DOI: 10.1016/j.hipert.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 12/13/2022]
Abstract
Therapeutic inertia is defined as the failure to take therapeutic decisions, such as initiating, adding or increasing the dose of a drug during patient follow-up, despite there being an indication to do so. It is currently considered that therapeutic inertia is a considerable impediment to achieving adequate control of hypertension, and this has implications for the prognosis of the disease. Therapeutic inertia might be due to various factors involving physicians, patients and the health system. Many studies have attempted to find determinants for therapeutic inertia in hypertension and to explain the reasons why health professionals in charge of treatment are failing to make the appropriate modifications to therapy. The many reasons for therapeutic inertia on the part of physicians include the various cognitive and affective biases that influence clinical reasoning and decision-making during healthcare activity in doctors' surgeries. Identifying and recognising these cognitive and affective biases could be important for planning educational strategies for health professionals. This requires a multi-dimensional approach, including knowledge beyond that observed in terms of insufficient information and updating on the disease, and starting to analyse and consider other reasons. Preventing therapeutic inertia should be made a priority along with other important measures to control hypertension and minimise its consequences.
Collapse
Affiliation(s)
- R Sabio
- Servicio de Medicina Interna, Hospital SAMIC de Alta Complejidad, El Calafate, Argentina.
| | - R Parodi
- Servicio de Medicina Interna, Hospital Provincial Centenario, Rosario, Argentina
| | - A Coca
- Unidad de Hipertensión y Riesgo Vascular, Servicio de Medicina Interna, Hospital Clínico, Universidad de Barcelona, Barcelona, España
| |
Collapse
|
47
|
Barroso WKS, Inuzuka S, Guimarães GC, Pacífico RP, Melo VA, Oliveira LF, Silva E, Mesquita GR, Valle DSC, Vitorino PV, Sousa ALL, Jardim PCBV, Coca A. Pharmacological Management of Hypertension Guided by Central or Peripheral Blood Pressure Measurement: Comparison of Two Strategies on the Incidence of Intermediate Outcome. Artery Res 2020. [DOI: 10.2991/artres.k.200104.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
48
|
Parati G, Agostoni P, Basnyat B, Bilo G, Brugger H, Coca A, Festi L, Giardini G, Lironcurti A, Luks AM, Maggiorini M, Modesti PA, Swenson ER, Williams B, Bärtsch P, Torlasco C. Clinical recommendations for high altitude exposure of individuals with pre-existing cardiovascular conditions: A joint statement by the European Society of Cardiology, the Council on Hypertension of the European Society of Cardiology, the European Society of Hypertension, the International Society of Mountain Medicine, the Italian Society of Hypertension and the Italian Society of Mountain Medicine. Eur Heart J 2019; 39:1546-1554. [PMID: 29340578 PMCID: PMC5930248 DOI: 10.1093/eurheartj/ehx720] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 12/15/2017] [Indexed: 01/22/2023] Open
Abstract
Adapted from Bärtsch and Gibbs2 Physiological response to hypoxia. Life-sustaining oxygen delivery, in spite of a reduction in the partial pressure of inhaled oxygen between 25% and 60% (respectively at 2500 m and 8000 m), is ensured by an increase in pulmonary ventilation, an increase in cardiac output by increasing heart rate, changes in vascular tone, as well as an increase in haemoglobin concentration. BP, blood pressure; HR, heart rate; PaCO2, partial pressure of arterial carbon dioxide. ![]()
Collapse
Affiliation(s)
- Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, S. Luca Hospital, Piazzale Brescia, 20, 20149 Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milan, Italy
| | - Piergiuseppe Agostoni
- Department of Cardiology, Heart Failure Unit, Centro Cardiologico Monzino, via Parea 4, 20138 Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, via Festa del Perdono 7, 20122 Milan, Italy
| | - Buddha Basnyat
- Nuffield Department of Clinical Medicine, Oxford University Clinical Research Unit-Nepal and Centre for Tropical Medicine and Global Health, University of Oxford, Old Road campus, Roosevelt Drive, Headington, Oxford OX3 7FZ, UK
| | - Grzegorz Bilo
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, S. Luca Hospital, Piazzale Brescia, 20, 20149 Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milan, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine at the EURAC Research, viale Druso 1, 39100 Bolzano, Italy.,Medical University, Christoph-Probst-Platz 1, Innrain 52 A - 6020 Innsbruck, Austria
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Luigi Festi
- Surgery Department, Ospedale di Circolo Fondazione Macchi, viale Luigi Borri, 57, 21100 Varese, Italy.,University of Insubria, via Ravasi 2, 21100 Varese, Italy
| | - Guido Giardini
- Department of Neurology, Neurophysiopathology Unit, Valle d'Aosta Regional Hospital, via Ginevra, 3, 11100 Aosta, Italy
| | - Alessandra Lironcurti
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, S. Luca Hospital, Piazzale Brescia, 20, 20149 Milan, Italy
| | - Andrew M Luks
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, 98195 WA, USA
| | - Marco Maggiorini
- Medical Intensive Care Unit, University Hospital, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Pietro A Modesti
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134 Florence, Florence, Italy
| | - Erik R Swenson
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, 98195 WA, USA.,Pulmonary, Critical Care and Sleep Medicine, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, 98108 WA, USA
| | - Bryan Williams
- University College London (UCL) and NIHR UCL Hospitals Biomedical Research Centre, NHS Foundation Trust, University College, Gower St, Bloomsbury, London WC1E 6BT, UK
| | - Peter Bärtsch
- Department of Internal Medicine, University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Camilla Torlasco
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, S. Luca Hospital, Piazzale Brescia, 20, 20149 Milan, Italy
| |
Collapse
|
49
|
Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. [2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH)]. G Ital Cardiol (Rome) 2019; 19:3S-73S. [PMID: 30520455 DOI: 10.1714/3026.30245] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
50
|
Coca A, Mazón P, Marín F. ¿Existen lagunas en la evidencia vinculada al tratamiento de la hipertensión leve de bajo riesgo cardiovascular? Respuesta. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2019.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|