Background: Heart failure with preserved ejection fraction (HFpEF) is a complex disease which accounts for more than half of all HF hospital admissions with high prevalence and lack of effective evidence-based management. Sodium-glucose cotransporter 2 (SGLT2) inhibitor is a new antidiabetic drug that recently gained a new role in the management of heart failure with reduced ejection fraction but its role in HFpEF had yet to be studied.Study and results: EMPEROR-Preserved trial set out to evaluate the effects of SGLT2 inhibition with empagliflozin on major heart failure outcomes in patients with HFpEF. The patients were randomized in a 1:1 fashion into two groups; to receive either empagliflozin 10 mg per day (n = 2,997) or placebo (n = 2,991) in addition to usual therapy. Empagliflozin led to a 21% risk reduction of the composite of cardiovascular death or hospitalization for heart failure, which was mainly related to a 29% lower risk of hospitalization for heart failure rather than effect on cardiovascular death empagliflozin. The effects SGLT2 inhibitors were consistent in all patients.

BackgroundThere are limited data on ‘masked uncontrolled hypertension’ (MUCH) in patients with treated and apparently well-controlled BP is unknown.ObjectivesTo define the prevalence and predictors of MUCH among hypertensive patients with controlled office blood pressure.MethodsOne hundred ninety-nine hypertensive patients presented to the specialized hypertension clinics at two University Hospitals. All patients had controlled office blood pressure (less than 140/90 mmHg). Patients were assessed regarding history, clinical examination, and laboratory data. All patients underwent ambulatory blood pressure monitoring (ABPM) for 24 h, within a week after the index office visit. MUCH was diagnosed if average 24-h ABPM was elevated (systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg) despite controlled clinic BP.ResultsSixty-six patients (33.2%) had MUCH according to 24-h ABPM criteria (mean age 53.5 ± 9.3 years, 60.6% men). MUCH was mostly caused by the poor control of nocturnal BP; with the percentage of patients in whom MUCH was solely attributable to an elevated nocturnal BP almost double that due to daytime BP elevation (57.3% vs. 27.1%, P < 0.001). The most common predictors of MUCH were smoking, DM and positive family history of DM.ConclusionThe prevalence of masked suboptimal BP control is high. Office BP monitoring alone is thus inadequate to ascertain optimal BP control because many patients have an elevated nocturnal BP. ABPM is needed to confirm proper BP control, especially in patients with high cardiovascular risk profile. Smoking, DM and positive family history of DM were the most common predictors of MUCH.

ObjectiveThe DASSL Model, conceived by the Health Research Board, aims to overcome challenges to linking data in Ireland including lack of unique patient identifiers, inconsistent application of legislation and siloed data. The objective of the Proof-of-Concept is to develop and test a demonstrator technical infrastructure to support this model. ApproachA stakeholder committee of representatives from government, health services, data controllers, patients/public and researchers was established. National and international data sharing and linkage landscapes were reviewed via interviews, scientific papers and grey literature. Five case studies were developed to demonstrate different linkages, data and research purposes, with synthetic data mimicking real health/social datasets generated using data dictionaries, data controller input, national statistics and Synthpop, Synthetic Data Vault and General Adversarial Networks. The technical infrastructure remains under development with linkage software being evaluated. Stakeholders will test this infrastructure and a final report will outline considerations for a national solution. ResultsSynthetic versions of administrative data, patient registries, electronic patient records, longitudinal cohorts, imaging and genomics are being generated. Matching variables and content data will be split and securely shared respectively with the Trusted Third Party (TTP) and Health Data Hub (HDH) on a project-by-project basis and at regular intervals. The selected linkage software will be used to match both unique identifiers and personally-identifiable data using probabilistic and deterministic techniques between datasets and with a population spine. The encrypted linkage key will be shared with the HDH, where the data view for each case study will be created by the Research Support Unit using the content data. A locked down virtual Safe Haven will support researcher access with disclosure control check on any outputs. ConclusionA DASSL infrastructure could support sharing, linking and analysis of health and social data in Ireland. However, high quality data including matching variables need to be collected to produce beneficial findings. A national rollout requires a governance and legislative model, improvements in data collection, further public engagement and significant resourcing.

Background: Blood pressure (BP) shows short-term variability within the 24 h, which can only be assessed with 24h ambulatory blood pressure monitoring (ABPM). It is of utmost importance to control BP throughout the night to reduce incidence of hypertension complications. The purpose of this study is to evaluate the effect of timing and frequency of antihypertensive medications on the average nighttime and 24-h blood pressure control. Results: The study enrolled 199 hypertensive patients with controlled office blood pressure; 135 (67.8%) patients were on once daily antihypertensive medication (group 1) while 64 (32.2%) patients were on twice daily doses (group 2). The mean office SBP was 128.7 ± 7.8 mmHg in group 1 vs 129.6 ± 6.6 mmHg in group 2, (p = 0.421). ABPM readings for both groups were as follows: mean daytime SBP was 125.4 ± 11.6 mmHg vs 130.1 ± 12.9, p = 0.011; mean nighttime SBP was 117.0 ± 12.4 mmHg vs 123.1 ± 13.9 mmHg, p = 0.002, and mean 24-h SBP was 122.7 ± 10.6 mmHg vs 127.5 ± 12.0, p = 0.005. The prevalence of non-dipping was 68.9% in group 1 vs 70.3% in group 2 patients, p = 0.8 (the mean dipping ratio was 0.93 ± 0.08 in group 1 vs 0.95 ± 0.07 in group 2, p = 0.198). The prevalence of masked hypertension was higher in group 2 (28.1% vs 43.8%, p = 0.029). Conclusion: Taking an extra antihypertensive pill at night did not show a decrease in the nighttime or the average 24H blood pressure in hypertensive patients with controlled office BP. On the contrary, patients who used twice daily antihypertensive medications seem to have higher nighttime and 24-h SBP, although the dipping ratio was comparable in both groups.

Even though the American Heart Association Scientific Sessions 2021 was a fully virtual meeting, it caught the attention of cardiologists with its prestigious program and practice-changing sessions and late breaking clinical trials. We report on some of the top trials presented during this meeting.