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  • Editors Page

    Overview of the ESH-ISH Joint Meeting 2014

    By Costas Tsioufis (Athens) and Mark Caulfield (London)


                         

    The European Society of Hypertension (ESH) and International Society of Hypertension (ISH) Joint Meeting was successfully held in Athens between 13th and 16th June 2014. Close to 5,000 delegates of different medical specialties (cardiology, internal medicine, general medicine, nephrology, endocrinology, and diabetology) converged to the meeting and interestingly one third of them being from non-European countries. 

    The scientific program covered a wide range of hypertension topics from epidemiology to therapeutics, and specifically reviewed the current evidence on out-of-office blood pressure measurement, blood pressure variability, and resistant hypertension management. Different sessions were focused on updated data regarding the techniques and clinical applicability of the renal sympathetic denervation and critically assessed the impact of the Symplicity HTN-3 results on future clinical practice and research. During the meeting more than 2,200 original abstracts were presented (363 as oral communications and 1,909 as attended posters) from all over the world. The top ten countries contributing to the abstracts' based scientific program were the following: Russia, Greece, Italy, Japan, Spain, China, South Korea, Ukraine, Argentina, and Poland.

    The meeting highlights include Prof. Dominiczak's report on the association of specific genes and their mutations with blood pressure levels and hypertension phenotype as well as the prospective data for the link between low diastolic blood pressure and increased mortality in the elderly by Dr. Muller. Regarding the K-METS study Dr. Park focused on the increased risk of incident microalbuminuria in patients with metabolic syndrome and Dr. Comotti reported the findings of the BEAUTY trial regarding the favorable effects of non-invasive hemodynamics on hypertension control.

    Important studies on renal denervation therapy were presented in the meeting and one of the most interesting ones was the DENER-HTN trial presented by Prof. Azizi in which systolic daytime ambulatory blood pressure was significantly decreased by renal denervation plus standardized medical treatment compared with standardized medical treatment alone in patients with confirmed resistant hypertension. In this context Prof. Bakris proposed different explanations for the Symplicity HTN-3 results concluding that the study's limitations could have led to the negative primary outcome and are hypothesis-generating. In favor of renal denervation therapy were also the 24 months results of the EnligHTN I trial, presented by Prof. Tsioufis, showing sustained and safe office BP reduction.

    Focusing on blood pressure indices, Dr. Ntineri suggested that 24-hour central blood pressure is significantly lower compared to peripheral ambulatory blood pressure in young individuals, while central blood pressure is more closely to cardiac damage than peripheral values. Prof. Kario reported results from the HONEST study showing that increased morning home systolic blood pressure is associated with an augmented risk of cardiovascular events at 2 years and the risk is also high in patients who have masked hypertension. In an important meta-analysis of 9 studies with more than 13,000 individuals Dr. Roush reported that night-time systolic blood pressure has greater dispersion than other types of systolic blood pressure measurements, and that night-time systolic blood pressure better predicts risk for cardiovascular events.

     In the context of antihypertensive drug therapy, Dr. Galyfos presented data from a study evaluating the protective role of beta blockage in cardiac damage in patients with coronary artery disease undergoing carotid endarterectomy, while Prof. Laurent presented data on the greater efficacy and safety of fixed-dose combination of perindopril plus amlodipine compared to monotherapy in hypertensive patients.

    Finally, on behalf of the ESH Scientific Council we would like to cordially thank the Organizing Committee for the efforts and fruitful outcome of this Joint ESH-ISH Meeting. According to the Olympic motto "Citius, Altius, Fortius" we should now work even harder for the next year's ESH meeting on Hypertension and Cardiovascular Protection in Milan (the city of EXPO 2015), and expect all of you to join us there.

    Costas Tsioufis (Athens) and Mark Caulfield (London)

  • From the ESH President

    Welcome to the website of the European Society of Hypertension (ESH), leader in the field of hypertension and cardiovascular prevention. Founded in 1989, the Society is committed to excellence in research, education and clinical practice in hypertension and cardiovascular prevention with the aim of reducing hypertension-induced morbidity and mortality. The activities of the Society are presented here, allowing visitors to consult our most recent guidelines, working documents, meetings, activities and programmes. Using the available online tools, rapid access to these resources can be achieved. Likewise, updated information as well as learning materials are available.  

    Members of the ESH Scientific Council developed the Hypertension Specialist Programme and the Network of Centres of Excellence. Both of these initiatives contribute well to our main aims and objectives as listed above. There are currently 991 Hypertension Specialists and 158 Centres of Excellence.

    More recently we have developed a new programme for National Hypertension Societies to develop a closer affiliation or association with the ESH. We currently have 32 affiliated and 3 associated with the ESH National Societies.

    If you are a member of the ESH, please enjoy all the materials at your disposal across all areas of our Website. If not, please join the ESH to help us develop further excellence in hypertension.

     

    Anna Dominiczak
    ESH President

  • Current News

    Prognostic implications of orthostatic hypotension

    D.L. Clement, University of Gent, Belgium

    Orthostatic hypotension is a disturbing entity that did not much attract interest of hypertension experts. Its causes are largely linked to a malfunctioning of the blood pressure regulation systems; this can be secondary to diabetes, some antihypertensive drugs (mainly the older drugs) but in many cases  the real causes are unknown. In any way, it is seen much more often in elderly people and can lead to syncope and traumata linked to the syncope. However, it is unknown to what extent it influences long term prognosis.

    Dutch investigators (1) have examined a group of 313 patients with orthostatic hypotension and a mean age of 78 years. The authors carefully examined whether orthostatic hypotension, postprandial hypotension and carotid sinus could be clustered but this was not the case. Subsequently they looked at prognostic implications of orthostatic hypotension and for his purpose organised a mean follow up of 23 months.

    Surprisingly there was no significant correlation between the systolic blood pressure drop and prognosis. By contrast, this was clearly the case for diastolic blood pressure with a hazard ratio of 2.5 and 95% CI of 1.20 to 5.22.

    This paper quite clearly has pointed toward the many unknown aspects of orthostatic hypotension. There is no real explanation why there is no prognostic value in the systolic blood pressure drop in such patients, as one would expect that the systolic drop would cause most of the problems in the perfusion of the brain and other organs. Maybe diastolic pressure drop, seen much less frequently is a more advanced stage of the disease and therefore correlates better with long-term prognosis. This nice paper should stimulate blood pressure experts to set up more research on this entity that strongly decreases the quality of life in many elderly patients.

    Reference

    1. Diastolic blood pressure drop after standing. Lagro J. et al. J. Hypertension: 2012: 30: 1195-1202.