The monthly ESH guide through publications – October/November 2018

Edited by Costas Tsioufis and Alex Kasiakogias

This autumn boasts a large number of intriguing articles covering various fields of hypertension and cardiovascular disease prevention. Let’s see some stimulating picks!


Early cardiovascular protection by initial two-drug fixed-dose combination treatment vs. monotherapy in hypertension

A study on 44534 patients included in the healthcare utilization database of the Lombardy Region (Italy) and had started treatment with one antihypertensive drug or a two-drug fixed-dose combination, compared the risk of hospitalization for CV disease associated with the two treatment strategies. It was shown that compared to initial monotherapy, patients on initial fixed drug combination therapy showed a reduced 1-year risk of hospitalization for any CV event (−21%, P < 0.01).

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Poor oral health and blood pressure control among US hypertensive adults. Results from the National Health and Nutrition Examination Survey 2009 to 2014

In this retrospective analysis of treated hypertensive patients older than 30 years of age, it was shown that mean systolic BP was about 2.3 to 3 mm Hg higher in the presence of periodontitis. In addition, periodontitis was associated with unsuccessful antihypertensive treatment after multiple adjustments, with higher odds by disease severity.

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Relations between dairy product intake and blood pressure. The INTERnational study on MAcro/micronutrients and blood pressure

In 2694 participants of the INTERnational study on MAcro/micronutrients and blood Pressure cross-sectional associations to BP of dairy product intakes were examined. Low-fat dairy consumption was associated with lower BP, especially among participants with low ACR.

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Frequency and associations of prescription nonsteroidal anti-inflammatory drug use among patients with a musculoskeletal disorder and hypertension, heart failure, or chronic kidney disease

In this retrospective cohort study on data from administrative claims databases, an 11% median physician-level prescribing rate among patients with hypertension, heart failure and chronic kidney disease was documented. A total 35552 matched patient pairs each consisting of an exposed and nonexposed patient were examined. No differences in cardiovascular or renal complications or death were identified.

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Nocturia and increase in nocturnal blood pressure. The Nagahama study

In this cross-sectional study on 5959 community participants possible associations of sleep characteristics with sleep BP by simultaneous multiday measurements were examined. The frequency of urination showed strong and independent association with smaller nocturnal BP drop in participants with frequent urination. A 3% oxygen desaturation index and the fragmentation index were also associated with BP change.

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Elevated blood pressure and risk of aortic valve disease: a cohort analysis of 5.4 million UK adults

In this cohort study of 5.4 million patients with no known cardiovascular disease or aortic valve disease at baseline, the relationship between BP and risk of incident aortic stenosis and regurgitation over a median follow-up of 9.2 years was examined. Systolic BP was continuously related to the risk of aortic valve disease with no evidence of a nadir down to 115 mmHg.

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Body silhouette trajectories across the lifespan and vascular aging. The Paris Prospective Study 3

The relationship of lifetime body silhouette trajectories (a marker of weight change across the lifespan) and vascular aging in late adulthood was examined with the use of cross-sectional data from a community-based cohort. Vascular aging was most prominent among individuals who were lean in early life but markedly gained weight during young adulthood and among those who were heavy in early life and maintained weight.

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Central haemodynamics in normal pregnancy. A prospective longitudinal study

In this prospective longitudinal study on 100 healthy women having an uncomplicated pregnancy a longitudinal evaluation of central haemodynamic adaptations was performed. A significant fall in cfPWV was observed mid-pregnancy. Brachial pulse pressure was lowest in the final trimester whereas central pulse pressure remained unchanged, resulting in a significant decrease in aorta-to-brachial pulse pressure amplification.

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Prognostic value of masked uncontrolled hypertension. Systematic review and meta-analysis

This meta-analysis examined the prognostic value of masked uncontrolled hypertension. Six studies using ambulatory blood pressure monitoring and 5 using home blood pressure measurement were identified and the main result was the composite of cardiovascular outcomes and all-cause mortality. Risk was significantly higher in MUCH than in controlled hypertension independently of follow-up length and types of studied events.

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Astronaut Cardiovascular Health and Risk Modification (Astro-CHARM) Coronary Calcium Atherosclerotic Cardiovascular Disease Risk Calculator

This study aimed to develop an atherosclerotic cardiovascular disease risk tool that incorporates coronary artery calcium. Subjects aged 40-65 years from three population-based cohorts were used. The Astro-CHARM tool is the first integrated  risk calculator to incorporate risk factors, including high-sensitivity C-reactive protein and family history, and coronary artery calcium data. In comparison with the risk factor model, the Astro-CHARM model resulted in integrated discrimination improvement (0.0252), and net reclassification improvement (0.121; P<0.0001).

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Long-term mortality after blood pressure-lowering and lipid-lowering treatment in patients with hypertension in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy study: 16-year follow-up results of a randomised factorial trial

This analysis reports all-cause and cardiovascular mortality rates in the median of 15.7 years of follow-up of patients in the ASCOT trial. Among patients in the blood pressure lowering arm, there was no overall difference in cardiovascular mortality between treatments. Patients on amlodipine-based treatment had fewer stroke deaths and patients on atorvastatin had fewer cardiovascular deaths more than 10 years after trial closure.

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Randomized crossover trial of the impact of morning or evening dosing of antihypertensive agents on 24-hour ambulatory blood pressure. The HARMONY Trial

The results of the HARMONY trial have been published. Ninety-five patients were randomized to receive usual therapy either in the morning (6 am–11 am) or evening (6 pm–11 pm) for 12 weeks when participants crossed over to the alternative timing for a further 12 weeks. Mean 24-hour systolic and diastolic blood pressures and mean daytime and nighttime BP did not differ between daytime and evening dosing.

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And some reviews and recommendations:

 

European Society of Hypertension position paper on renal denervation 2018

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Recommendations for participation in competitive sports of athletes with arterial hypertension: a position statement from the sports cardiology section of the European Association of Preventive Cardiology (EAPC)

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Resistant hypertension: Detection, evaluation, and management: A scientific statement from the American Heart Association

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