OBJECTIVE:Pulse pressure (PP), is a simple measure of arterial stiffness. Several studies have shown that PP increases the risk of cardiovascular (CV) events but they were limited to clinic measure, ...mostly performed on individuals with high CV risk. Furthermore few studies reported PP-related risk of morbidity and mortality separately for genders.
DESIGN AND METHOD:3200 subjects, stratified for sex and decades of ages, were randomly selected to be representative of the general population of Monza (Northern Italy). In each subject we performed the following mesurements1) Clinic (C) Systolic (S) Blood Pressure (BP) and Diastolic (D) BP (sphygmomanometer), 2) Home SBP and DBP (Philips HP 5331), 3) Ambulatory (24 h) SBP and DBP (Spacelabs 90207), 4) Body Mass Index (BMI), 5) Blood Glucose and Serum Cholesterol. Each subject was followed for 12 years, during which all deaths were collected and classified by ICD-X codes as being a CV (ICD-X I-0 to I-99) or non CV death. Non-fatal CV events were identified by hospital diagnosis also using ICD-X codes and validated on the hospital clinical records.
RESULTS:The complete data set was obtained in 2045 subjects. PP was calculated as difference between SBP and DBP. Office, home and 24 h blood pressures were significantly higher in individuals who experienced a CV event or died during follow-up. Clinic, 24 h and Daytime PP were independent predictors of CV events after adjustment for main demographic and clinical parameters in the whole study population (HR 1.24, CI 1.03–1.49; HR 1.17, CI 1.01–1.36; HR 1.2, CI 1.03–1.39, respectively; p < 0.05 for all). Nighttime PP was an additional independent predictor in men (HR 1.23, CI 1.03–1.47, p < 0.05). None of measured PP (Clinic, Home, 24 h, Day- and Nighttime) was predictor of CV events in women. None of calculated PP was predictor of all-cause mortality in general population and in both genders.
CONCLUSIONS:Clinic and 24 h, but not home, PP represent a predictor of CV events in general population and in its male fraction. In females PP does not increase risk of CV events. All-cause death is not predicted by any of the PP measured.
This review analyses methods and devices used worldwide to evaluate the arterial stiffness. Three main methodologies are based upon analysis of pulse transit time, of wave contour of the arterial ...pulse, and of direct measurement of arterial geometry and pressure, corresponding to regional, systemic and local determination of stiffness. They are used in clinical laboratory and/or in clinical departments. Particular attention is given to the reproducibility data in literature for each device. This article summarizes the discussion of the dedicated Task Force during the first Conference of Consensus on Arterial Stiffness held in June 2000 (Paris, France).
•Whether blood pressure elevation is temporary and in need of treatment, or reflects a chronic hypertensive state is not always easy to unravel.•Many patients presented in the ED with acute pain or ...stress, may have an acute BP increased due to pain, stress or “white coat” effect.•Hypertensive emergency is often a life-threatening clinical condition and is defined as the presence of abnormal BP values associated with acute hypertension-related organ damage.•It's important to distinguish hypertensive emergency from hypertensive urgency, usually considered a more benign condition that requires more likely an outpatient visit and treatment.
Hypertension urgency and emergency represents a challenging condition in which clinicians should determine the assessment and/or treatment of these patients. Whether the elevation of blood pressure (BP) levels is temporary, in need of treatment, or reflects a chronic hypertensive state is not always easy to unravel. Unfortunately, current guidelines provide few recommendations concerning the diagnostic approach and treatment of emergency department patients presenting with severe hypertension. Target organ damage determines: the timeframe in which BP should be lowered, target BP levels as well as the drug of choice to use. It's important to distinguish hypertensive emergency from hypertensive urgency, usually a benign condition that requires more likely an outpatient visit and treatment.
OBJECTIVE:The aim of the Global SYMPLICITY Registry (GSR) is to collect real-world data on the safety and efficacy of renal denervation (RDN) using either the original Symplicity Flex (TM) renal ...denervation catheter or the newer-generation Symplicity Spyral (TM) catheter, which applies radiofrequency energy circumferentially to each renal artery quadrant simultaneously.Furthermore, following newer understanding of the renal anatomy, a sub-cohort of patients are receiving treatment of renal artery branch vessels in addition to the main renal artery.
DESIGN AND METHOD:The GSR is a prospective, multi-centre, non-randomized international registry of RDN enrolling up to 3000 patients with uncontrolled hypertension. Patients are followed at 3, 6, 12, 24, and 36 months. Follow up data collected per routine care includesclinical assessment, office blood pressure measurement, 24-hour ambulatory blood pressure measurement, blood tests, ECGs, renal artery imaging, and EQ-5D quality of life questionnaire. At the time of ESH 2017 six month safety and efficacy data will be available for ∼2500 patients and 3-year data will be available on ∼1750 patients. Moreover, data from post-hoc analysis of ∼270 patients treated with the Symplicity Spyral catheter as well as data on ∼90 patients who had RDN treatment in both the main renal artery and branches will be available for presentation.
RESULTS:The Global SYMPLICITY Registry is the largest real world database of renal denervation therapy and has enrolled over 2500 patients to date. The registry also includes the largest dataset of renal artery branch treatment reported so far. All available follow-up data informing on short and long-term safety and efficacy of the Symplicity renal denervation system will be presented.
CONCLUSIONS:These data supplement the randomized and sham-controlled SPYRAL HTN-ON MED and OFF MED trials evaluating safety and efficacy of renal denervation performed in the main renal artery and branch vessels in patients with uncontrolled hypertension.
Abstract
Background
Body composition predicts cardiovascular outcomes, but it is uncertain whether anthropometric measures can replace the more expensive serum total cholesterol for cardiovascular ...risk stratification in low resource settings.
Purpose
The purpose of the study was to compare the additive prognostic ability of serum total cholesterol with that of body mass index (BMI), waist/hip ratio (WHR), and estimated fat mass (EFM, calculated using a validated prediction equation), individually and combined.
Methods
We used data from the MORGAM (MONICA, Risk, Genetics, Archiving, and Monograph) Prospective Cohort Project, an international pooling of cardiovascular cohorts, to determine the relationship between anthropometric measures, serum cholesterol, and cardiovascular events, using multivariable Cox proportional-hazards regression analysis. We further investigated the ability of these measures to enhance prognostication beyond a simpler prediction model, consisting of age, sex, smoking status, systolic blood pressures, and country, using comparison of area under the receiver operating characteristics curve (AUCROC) derived from binary logistic regression models. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of death from coronary heart disease, myocardial infarction, or stroke.
Results
The study population consisted of 52,188 apparently healthy subjects (56.3% men) aged 47±12 years ranging from 20 to 84, derived from 37 European cohorts, with baseline between 1982–2002 all followed for 10 years during which MACE occurred in 2465 (4.7%) subjects. All anthropometric measures (BMI: hazard ratio (HR) 1.04 95% confidence interval (CI): 1.03–1.05 per kg/m2; WHR: HR 7.5 4.0–14.0 per unit; EFM: HR 1.02 1.01–1.02 per kg) as well as serum total cholesterol (HR 1.20 1.16–1.24 per mmol/l) were significantly associated with MACE (P<0.001 for all), independently of age, sex, smoking status, systolic blood pressures, and country. The addition of serum cholesterol significantly improved the predictive ability of the simple model (AUCROC 0.818 vs. 0.814, P<0.001), as did the combination of WHR, BMI, and EFM (AUCROC 0.817 vs. 0.814, P=0.004). When assessed individually, BMI (AUCROC 0.816 vs. 0.814, P=0.004) and WHR (AUCROC 0.815 vs. 0.814, P=0.02) improved model performance, while EFM narrowly missed significance (AUCROC 0.815 vs. 0.814, P=0.06). There was no significant difference in the predictive ability of a model including serum cholesterol versus that including all three anthropometric measures (AUCROC 0.818 vs. 0.817, P=0.13). The figure shows the pertinent areas under the ROC curve in predicting MACE.
Conclusion
In this large population-based cohort study, the addition of a combination of anthropometric measures, i.e. BMI, WHR, and EFM, raised the predictive ability of a simple prognostic model comparable to that obtained by the addition of serum total cholesterol.
Figure 1
Funding Acknowledgement
Type of funding source: None
OBJECTIVE:Masked (MUCH) and white coat uncontrolled hypertension (WUCH) are more and more frequently investigated for their long-term prognostic significance Classification is usually made by a ...single set of office and out-of-office blood pressure (BP) measurements during the treatment period. To evaluate the long-term reproducibility of MUCH and WUCH, an information crucial for determining the long-term prognostic impact of these conditions.
DESIGN AND METHOD:Reproducibility of MUCH and WUCH was assessed in 1664 hypertensive patients recruited for the ELSA study treated with atenolol or lacidipine (+/– additional drugs) during a 4-year period. Office and 24-hour BP was measured at baseline and every year during treatment, allowing repeated classification of either condition.
RESULTS:After 1 year of treatment 21.1% and 17.8% of the patients were classified as MUCH and WUCH, respectively. For both conditions the prevalence was similar in the following years, although with a large change in patients composition because only about 1/3 of patients classified as MUCH or WUCH at one set of office and ambulatory BP measurements maintained the same classification at a subsequent set of measurements. In only 4.5% and 6.2% MUCH and WUCH persisted throughout the treatment period. MUCH and WUCH reproducibility was worse than that of patients showing control or lack of control of both office and ambulatory BP.
CONCLUSIONS:Both MUCH and WUCH display a poor reproducibility over time. This should be taken into account in studies assessing the long-term prognostic value of these conditions based on only one set of BP measurements.
OBJECTIVE:24-hour blood pressure variability (BPV) is independently related to cardiovascular outcomes, but conflicting evidence is available on the relative prognostic importance of systolic and ...diastolic BPV. Aim of this study was to verify the hypothesis that the association of systolic and diastolic blood pressure variability over 24 hours with cardiovascular mortality in untreated subjects is affected by age.
DESIGN AND METHOD:24-hour ambulatory blood pressure monitoring was obtained in 10,500 untreated individuals assessed for hypertension in the frame of the Dublin Outcome Study (age 54.4 ± 14.5 years, 47% males) followed up over a median time of 5.4 years. The association of short-term systolic and diastolic blood pressure variability with cardiovascular deaths (N = 498) was assessed in the entire sample and separately in younger and older age subgroups.
RESULTS:Diastolic BPV was directly and independently related to cardiovascular mortality (adjusted hazard ratio (adjHR) for 24-hour weighted standard deviation 1.15 95% confidence interval 1.07–1.24) and the strength of this association did not differ significantly among age groups. Conversely, systolic BPV was independently associated with cardiovascular mortality only in younger (<50 years) subjects (adjHR for 24-hour weighted standard deviation 1.68 95% confidence interval 1.30–2.17), superseding the predictive value of diastolic BPV in this group (Figure).(Figure is included in full-text article.)
CONCLUSIONS:Diastolic short-term BPV independently predicts cardiovascular mortality in hypertensive subjects at all ages, while systolic BPV seems a particularly strong predictor in young adults. If confirmed, these findings might improve the understanding of the prognostic value of BPV, with new perspectives for its possible clinical application.
OBJECTIVE:The ESC/ESH Guidelines for hypertension issued in 2018 identify resting heart rate (HR) values greater than 80 beats/minute as predictors of cardiovascular risk, with the undocumented ...evidence that this detection might represent the occurrence of a sympathetic cardiovascular overdrive. In the present study we tested this hypothesis throughout the use of direct and indirect markers of sympathetic neural function.
DESIGN AND METHOD:In 167 untreated and uncomplicated mild-to moderate essential hypertensives recruited for different investigations and aged 51.8 ± 3.2 years (mean ± SEM) without other cardiovascular or non-cardiovascular disease, we measured clinic and ambulatory blood pressure (BP), HR (EKG), venous plasma norepinephrine (NE, HPLC assay) and efferent postganglionic muscle sympathetic nerve traffic (MSNA, microneurography). We then subdivided the study population in 2 groups according to HR values <= or >80 beats/minute.
RESULTS:Sixty eight patients displayed resting HR > 80 beats/minute while the remaining 99 below this threshold value, the 2 groups showing superimposable age values and gender distribution. Body mass index, clinic and ambulatory BP were similar in the 2 groups this being the case also for LVMI and metabolic variables. In contrast MSNA values were significantly greater (P < 0.02) in the former than in the latter group both when expressed as bursts incidence over time (49.2 ± 1.8 vs 39.5 ± 1.4 bs/min) and when corrected for HR (60.7 ± 3.0 vs 51.4 ± 2.5 bs/100 hb). NE showed a tendency to be greater in the former group without achieving, however, statistical significance. In the whole population there was a significant direct relationship between MSNA and HR values (r = 0.61, P < 0.01)
CONCLUSIONS:Thus hypertensive patients displaying HR > 80 beats/minute are characterized by a marked sympathetic overdrive, particularly when direct adrenergic markers are employed. This finding suggests that cardiac and peripheral sympathetic activation may participate at the increased cardiovascular risk detected in this group of patients.
OBJECTIVE:Nerve traffic recordings (MSNA) have shown that sympathetic activation may occur in obese individuals (O). However, the small sample size of the available studies, presence of ...comorbidities, including sleep apnea, heterogeneity of the patients examined as well as presence of confounders represented major weaknesses not allowing to draw definite conclusions. This is particularly the case for overweight condition.
DESIGN AND METHOD:The present metanalysis evaluated 1167 O recruited in 45 microneurographic studies. The analysis was primarily based on MSNA quantification in O of different clinical severity, excluding as concomitant conditions hypertension, sleep apnea and other comorbidities.Assessment was extended to the relationships of MSNA with other neuroadrenergic markers, such as venous plasma norepinephrine and heart rate (NE and HR, respectively), anthropometric variables, such as body mass index (BMI), waist-hip ratio (WHR) and metabolic variables.
RESULTS:Compared to normoweight MSNA was significantly greater after adjustments for confounders in overweight and more so in O (37.0 ± 4.1 vs 43.2 ± 3.5 and 50.4 ± 5 bs/100 hb, P < 0.01). MSNA was directly and significantly related to BMI and WHR (r = 0.41 and r = 0.64, P < 0.04 and <0.01 respectively), clinic blood pressure (r = 0.68, P < 0.01), total cholesterol, LDL cholesterol, triglycerides and glucose (r = 0.91, 0.94, 0.80 and 0.59, respectively, P < 0.01). No significant correlation was found between anthropometric indices and plasma insulin, HOMA index and plasma leptin. No correlation was found between MSNA and HR and NE.
CONCLUSIONS:Both O and overweight patients are characterized by sympathetic overactivity which mirrors the increase in BMI and WHR and the severity of the obese state and reflects metabolic alterations, with the exclusion of insulin. Neither HR nor NE appear to represent in O and in overweight faithful mirrors of the occurring sympathetic activation.
OBJECTIVE:In the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study, clinical, metabolic variables as well as office, home, and ambulatory blood pressure (BP) values were measured ...contemporaneously at baseline and after a ten-year period of follow-up, which allowed us to assess the value of selective and combined elevation of these BPs in predicting new onset metabolic syndrome (MetS).
DESIGN AND METHOD:The present analysis included 1,182 participants without MetS at baseline, as defined by the APT III criteria. Based on office, 24-hour ambulatory BP and home values, subjects were divided into 4 groupsnormal, with coat hypertension (WCH), masked hypertension (MH); and sustained hypertension (SH).
RESULTS:As compared to subjects with in-office and out-of-office BP normality a greater age- and gender-adjusted incidence of new onset Mets was observed in WCH (OR = 2.03, CI:1,21-3.41, p = 0.007), MH (OR = 2.55, CI:1.26–5.17; p = 0.009) and SH (OR = 2.28, CI:1.43–3.99, p = 0.0009) when out-of-office BP was defined by ambulatory criteria. This was not the same when out-of-office BP was based on home criteria, as only the WCH group showed a significant greater OR risk (2.16, CI1.28–3.63, p = 0.003).
CONCLUSIONS:Our study provides evidence that isolated or combined BP elevations when identified by office/ambulatory measurements, carry an increase in risk of new onset MetS, while classifying the population by combining office/home BPs only WCH is associated with a greater risk of incident MetS. In a clinical perspective, a comprehensive evaluation of BP status based on office/ambulatory measurements may substantially improve the risk stratification of new onset MetS and to activate measures for its prevention
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