The year 2011 is now over and we hope that 2012 will be as exciting a year for hypertension as the previous one when our annual meeting was held in Milan. Now we have less than four months to go before the start of the ESH 22^nd Meeting, to be held in London. Research in hypertension is prospering, both in basic and clinical sciences. We would like to highlight some recent achievements.

European research influences new guidelines on hypertension

European data on the improved diagnostic precision of ambulatory blood pressure compared with clinic or office blood pressure has provided the evidence for new National Institute of Health and Clinical Excellence guidelines for hypertension in the UK. ¹ Interestingly in the analysis informing the guideline home blood pressure averaged between over four or seven days is also better than clinic or office blood pressure, but based on the current data not superior to ambulatory blood pressure. These guidelines offer a framework for interpreting ambulatory and home blood pressure in the assessment and care of patients¹. At the European Society of Hypertension Meeting in London in April 2012 a guidelines session will look at existing world guidelines on hypertension as we await the ongoing revision of the current ESH Guidelines on Hypertension to be published in 2013.

New genes discoveries in blood pressure regulation

Multiple new genes with modest effect on blood pressure, pulse pressure and mean arterial pressure that impact on cardiovascular risk have been reported recently in Nature, Nature Genetics and the American Journal of Human Genetics. ^2,3,4  Many of these gene loci come from novel pathways with no known mechanism for influence upon blood pressure regulation. These findings bring the number of loci to 43 and several may present new potential therapeutic targets.

Lifetime risk of elevated blood pressure

The work highlighted by our earlier web editorial on over 1 million Swedish male conscripts described that those with hypertension who were young and may fall below cardiovascular risk thresholds recommended for treatment suffer early CV events ⁵. This finding is reinforced for those in middle-age by a recent publication in the journal Circulation on 61,585 participants in the Cardiovascular Lifetime Risk Pooling Project demonstrating the importance of changes in blood pressure during middle age and their impact upon lifetime risk for cardiovascular disease. ⁶ Those whose blood pressure remained at normal levels or who had reduced their BP by age 55 had the lowest lifetime risk for CVD (between 22 percent to 41 percent risk). Those subjects who developed high blood pressure by age 55 had a higher lifetime risk (between 42 percent to 69 percent risk) of a CVD event ⁶. These finding add to the growing debate about whether lifetime risk calculation would be superior to 10 year risk for those at younger ages.

CPAP treatment of Obstructive Sleep Apnea improves metabolic syndrome

One important risk factor for hypertension and target organ damage is Obstructive Sleep Apnea (OSA) syndrome with its accompanying increased sympathetic nervous activity. OSA is also associated with an increased prevalence of the metabolic syndrome and its components. It is unclear whether treatment of obstructive sleep apnea syndrome with continuous positive airway pressure (CPAP) would modify these outcomes. In a double-blind, placebo-controlled trial, patients with obstructive sleep apnea syndrome were randomized to undergo 3 months of therapeutic CPAP followed by 3 months of sham CPAP, or vice versa, with a washout period of one month in between. ⁷ A total of 86 patients completed the study, 75 (87%) of whom had the metabolic syndrome. CPAP treatment (vs. sham CPAP) was associated with significant mean decreases in systolic blood pressure 3.9/2.5 mmHg. The frequency of the metabolic syndrome was reduced after CPAP therapy (reversal found in 11 of 86 patients [13%] undergoing CPAP therapy vs. 1 of 86 [1%] undergoing sham CPAP). The authors concluded that in patients with moderate-to-severe obstructive sleep apnea syndrome, three months of CPAP therapy lowers blood pressure and partially reverses metabolic abnormalities.

Looking forward to ESH Meeting in London 26^th-29^th April 2012!

With a record 1800 abstracts submitted and Early Bird Registrations (closes 23^rd January 2012) running ahead of usual the European Meeting (usually in June) on Hypertension and Cardiovascular Prevention promises to be an excellent event. The International Conference Centre is located on London's Docklands close to the new 2012 Olympic Park and next to the London City Airport. The Scientific sessions will include keynote and star lectures on the latest advances in hypertension and cardiovascular medicine with a topical focus in this Olympic year on sport and the cardiovascular system (watch this space for a programme update in early January).

Peter M Nilsson (Lund) and Mark Caulfield (London)

References

1.      http://guidance.nice.org.uk/CG127/Guidance/pdf/English.

2.      Ehret et al. Genetic variants from novel pathways influence blood pressure and cardiovascular disease risk. Nature 2011. Sep 11. doi: 10.1038/nature10405.

3.      Wain et al. Genome-wide association study identifies six new loci influencing pulse pressure and mean arterial pressure. Nature Genetics 2011. Sep 11. doi: 10.1038/ng.922.

4.      Johnson et al. Blood Pressure Loci Identified with a Gene-Centric Array. Am J Hum Genet. 2011 Nov 16.

5.      Sundström et al. Association of blood pressure in late adolescence with subsequent mortality: cohort study of Swedish male conscripts. BMJ 2011 Feb. 22;342:d643. doi: 10.1136/bmj.d643.

6.      Allen et al. Impact of Blood Pressure and Blood Pressure Change During Middle Age on the Remaining Lifetime Risk for Cardiovascular Disease: The Cardiovascular Lifetime Risk Pooling Project. Circulation. 2011 Dec 19. [Epub ahead of print].

7.      Sharma SK, et al. CPAP for the metabolic syndrome in patients with obstructive sleep apnea. N Engl J Med. 2011;365:2277-86.