The monthly ESH guide through publications – May 2018

Edited by Costas Tsioufis and Alex Kasiakogias

With June approaching fast -and with it the 28th European Meeting in Hypertension, in Barcelona- let us have a look at some of the latest research to be up to date!

 

Relationship between clinic and ambulatory blood-pressure measurements and mortality.

This study examined the associations of blood pressure measured in the clinic (clinic blood pressure) and 24-hour ambulatory blood pressure with all-cause and cardiovascular mortality in a large cohort of patients in primary care. Ambulatory blood-pressure measurements were a stronger predictor of all-cause and cardiovascular mortality than clinic blood-pressure measurements. White-coat hypertension was not benign, and masked hypertension was associated with a greater risk of death than sustained hypertension.

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Impact of cardiovascular risk on the relative benefit and harm of intensive treatment of hypertension

The lower rate of primary outcome events in the intensive treatment group in SPRINT (Systolic Pressure Intervention Trial) was associated with increased clinically significant serious adverse events (SAEs). This study investigated the effect of baseline 10-year CVD risk on primary outcome events and all-cause SAEs in SPRINT. Those with lower baseline CVD risk had more harm than benefit from intensive treatment, whereas those with higher risk had more benefit.

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Night-time heart rate nondipping: clinical and prognostic significance in the general population

Studies addressing the association between a reduced drop of heart rate (HR) at night with subclinical organ damage and cardiovascular events in the general population are scanty. Among 2021 individuals enrolled in the Pressioni Monitorate E Loro Associazioni study a blunted dipping of nocturnal HR was associated with preclinical cardiac damage in terms of left atrial enlargement and was predictive of cardiovascular morbidity and mortality in the general population.

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Age- and sex-specific reference values for media/lumen ratio in small arteries and relationship with risk factors

Small-artery remodeling is an early feature of target organ damage in hypertension and retains a negative prognostic value. The aim of the study is to establish age- and sex-specific reference values for media/lumen in small arteries obtained in humans by biopsy. In a predominantly hypertensive population, media/lumen Z scores were associated with major cardiovascular risk factors, including body mass index, cholesterol, smoking, glucose, and systolic blood pressure. Significant sex differences were observed.

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Effect of mineralocorticoid antagonists on blood pressure lowering: overview and meta-analysis of randomized controlled trials in hypertension

Although mineralocorticoid antagonists (MRAs) have been proposed as effective fourth-line blood pressure (BP)-lowering agents in resistant hypertension, this effect in hypertension at-large is unclear. This meta-analysis showed that the extent of BP lowering following treatment with MRAs in patients with and without resistant hypertension was similar and not accompanied by increased rate of treatment-related discontinuations compared with other active comparators.

Effect of mineralocorticoid antagonists on blood pressure lowering: overview and meta-analysis of randomized controlled trials in hypertension.

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MicroRNAs in peripheral mononuclear cells as potential biomarkers in hypertensive patients with heart failure with preserved ejection fraction

MicroRNAs (miRs) regulate gene expression and play an important role in ventricular and vascular remodelling. However, there are limited data regarding their role in heart failure with preserved ejection fraction (HFpEF). miR-26b, miR-208b, and miR-499 showed a distinct profile in hypertensive patients with HFpEF that is related with functional capacity. Further studies are needed to assess the role of miRs as prognostic tools or as therapeutic targets in these patients.

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Accuracy of self-reported hypertension: a systematic review and meta-analysis

The objective of this meta-analysis was to estimate the sensitivity and specificity of self-reported hypertension (HTN) as compared with the clinical diagnosis in epidemiological studies. Less than half of patients with HTN would not be identified by self-reporting in epidemiological studies. Self-reported HTN has important limitations and may represent an important source of bias in research depending on regional, socioeconomic, and cultural differences.

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Preconception blood pressure levels and reproductive outcomes in a prospective cohort of women attempting pregnancy

Elevated blood pressure in young adulthood is an early risk marker for cardiovascular disease. Despite a strong biological rationale, little research has evaluated whether incremental increases in preconception blood pressure have early consequences for reproductive health. Findings from this analysis of the EAGeR trial (Effects of Aspirin on Gestational and Reproduction; 2007-2011) suggest that preconception blood pressure among healthy women is associated with pregnancy loss, and lifestyle interventions targeting blood pressure among young women may favourably impact reproductive health.

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Impact of obstructive sleep apnea on cardiac organ damage in patients with acute ischemic stroke

Both obstructive sleep apnea (OSA) and cardiac organ damage have a crucial role in acute ischemic stroke. This study confirms the high prevalence of OSA in stroke patients, suggesting also an association between OSA and cardiac target organ damage. Acute stroke patients with OSA had higher left ventricular mass and showed greater left atrial enlargement than patients without OSA. Our finding of structural LV abnormalities in acute stroke patients with OSA suggests a potential role of OSA as contributing factor in determining both cerebrovascular and cardiac damage, even in absence of clear link with a history of blood pressure elevation.

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Association between baseline LDL-C level and total and cardiovascular mortality after LDL-C lowering: A systematic review and meta-analysis

Effects on specific fatal and nonfatal end points appear to vary for low-density lipoprotein cholesterol (LDL-C)-lowering drug trials. In these meta-analyses and meta-regressions, more intensive compared with less intensive LDL-C lowering was associated with a greater reduction in risk of total and cardiovascular mortality in trials of patients with higher baseline LDL-C levels. This association was not present when baseline LDL-C level was less than 100 mg/dL, suggesting that the greatest benefit from LDL-C-lowering therapy may occur for patients with higher baseline LDL-C levels.

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Echocardiographic assessment of left ventricular morphology and function in patients with fibromuscular dysplasia: the ARCADIA-POL study

This study sought to provide a comprehensive assessment of left ventricle (LV) structure, and function and to detect alterations in cardiac properties in relationship to presence, subtypes and extent of fibromuscular dysplasia (FMD). In contrast to those with atherosclerotic RAS, it did not show differences in LV morphology and function between FMD patients and matched controls. Although FMD can result in hypertension and serious vascular complications, there is no proof that it can alter LV regardless of FMD type and its extent.

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Isolated systolic hypertension in the young: a position paper endorsed by the European Society of Hypertension

Whether isolated systolic hypertension in the young (ISHY) implies a worse outcome and needs antihypertensive treatment is still a matter for dispute. ISHY is thought to have different mechanisms than systolic hypertension in the elderly. Only future clinical trials will elucidate if a benefit can be achieved with pharmacological treatment in some subgroups of ISHY patients with associated risk factors and/or high central blood pressure. Isolated systolic hypertension in the young: a position paper endorsed by the European Society of Hypertension.

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