The ESH guide through publications- December 2018

Edited by Costas Tsioufis and Alex Kasiakogias

Another year full of good science has been left behind and it is time to review the nice publications of the last month of 2018. Happy New Year to all!


Benefits and harms of antihypertensive treatment in low-risk patients with mild hypertension

This is a longitudinal study on data from the Clinical Practice Research Datalink for 19143 adult patients who had mild hypertension (untreated blood pressure of 140/90-159/99 mm Hg) and no previous treatment. During a median follow-up period of 5.8 years, no evidence of an association was found between antihypertensive treatment and mortality or between antihypertensive treatment and cardiovascular disease but there was evidence of an increased risk of adverse events.

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Sustainability of blood pressure reduction in black barbershops

New, 12-month data on the efficacy of health promotion by Black barbershops that liaised with certified pharmacists in the US have been published. In the intervention group, patrons were prescribed BP medication by pharmacists; the control group was assigned lifestyle modifications. At 12 months a 20.8mmHg greater BP reduction was recorded in the intervention group. Similarly, BP<130/80mmHg was documented in 68% of the intervention group and 11% of the control group.

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Effects of blood pressure lowering on cardiovascular events, in the context of regression to the mean: a systematic review of randomized trials

In this meta-analysis of 86 trials with a mean follow-up of 3.7 years the clinical relevance of the regression to the mean effect for clinical trials was examined. Most mean BP change was because of regression to the mean rather than treatment. At high baseline BP levels, even after rigorous hypertension diagnosis, downwards regression to the mean caused much of the fall in BP. At low baseline BP levels, upwards regression to the mean increased BP levels, even in treatment groups. It is concluded that clinical practice should focus less on pretreatment BP levels, which rarely predict future untreated BP levels or rule out capacity to benefit from BP lowering in high cardiovascular risk patients.

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Alirocumab and cardiovascular outcomes after acute coronary syndrome

In this multicentre, randomized, double-blind, placebo-controlled trial involving 18,924 patients who had an acute coronary syndrome 1 to 12 months earlier and had cholesterol levels above target under statin therapy at a high-intensity dose or at the maximum tolerated dose, the effects of alirocumab targeting to LDL cholesterol levels 25-50mg/dl was examined. After a median of 2.8 years, the risk of recurrent ischemic cardiovascular events was lower among those who received alirocumab, and the absolute benefit was greatest in those with a baseline LDL greater than 100mg/dl.

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Associations of variability in blood pressure, glucose and cholesterol concentrations, and body mass index with mortality and cardiovascular outcomes in the general population

In an analysis of more than 6.5million members of the Korean National Insurance System free of diabetes, hypertension and dyslipidemia, the variability of blood glucose, total cholesterol and systolic blood pressure out of at least three examinations was calculated. Multivariate cox regression analysis showed a significant association of high variability of all parameters with all-cause mortality, myocardial infarction and stroke.

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Out-of-clinic sympathetic activity is increased in patients with masked uncontrolled hypertension

This study examined 72 true controlled hypertensive patients and 80 masked uncontrolled hypertensive patients (MUCH) based on clinic automated and ambulatory BP. MUCH patients had significantly higher out-of-clinic BP variability and lower heart rate variability compared with true controlled hypertensives, as well as higher levels of out-of-clinic urinary catecholamines and metanephrines levels consistent with higher out-of-clinic sympathetic activity. In contrast, there was no difference in in-clinic plasma catecholamines and spot-urine/plasma levels of metanephrines between the 2 groups, consistent with similar levels of sympathetic activity while in clinic.

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Thirty-day readmissions after hospitalization for hypertensive emergency

This study used data from the Nationwide Readmissions Database to identify index hospitalizations for hypertensive emergency. In 166531 index hospitalizations for hypertensive emergency, the overall incidence of unplanned 30-day readmissions was 17.8%. One out of 6 patients hospitalized for hypertensive emergency had an unplanned 30-day readmission. Heart failure, uncontrolled hypertension, and stroke were among the most frequent causes of readmission; however, over half of all readmissions were because of non-cardiovascular causes.

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Improving hypertension control in primary care with the Measure Accurately, Act Rapidly, and Partner With Patients Protocol

The recently proposed protocol of Measure Accurately, Act Rapidly, Partner with patients (MAP) has been studied on 16787 hypertensive patients of 16 family medicine clinics. Measure accurately included staff training in attended BP measurement and unattended automated office BP when intake BP was ≥140/≥90 mm Hg. Act rapidly (therapeutic inertia) included protocol-guided escalation of antihypertensive medications when office BP was ≥140/≥90 mm Hg. Partner with patients included shared decision making, BP self-monitoring, and affordable medications. Study data were obtained from electronic records. The protocol was associated with significantly increased BP control rates and reduced therapeutic inertia.

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Early sexual experience and hypertension in US adults results from the National Health and Nutrition Examination Survey 2001–2016

Using data from 2001 to 2016 National Health and Nutrition Examination Survey, the authors examined the association of age at the first sexual intercourse and hypertension (SBP ≥ 130 mmHg or DBP ≥ 80 mmHg). It was shown that a first sexual intercourse before 19 years of age is associated with hypertension during adulthood in US non-Hispanic white and Hispanic women, but not in non-Hispanic black.

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 And of course, the Practice guidelines document of the latest ESC/ESH guidelines:

 2018 Practice Guidelines for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. ESC/ESH Task Force for the Management of Arterial Hypertension

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