2013 ESH/ESC Guidelines for the management of arterial hypertension

Mancia, Giuseppe; Fagard, Robert; Narkiewicz, Krzysztof; Redón, Josep; Zanchetti, Alberto; Böhm, Michael; Christiaens, Thierry; Cífková, Renata; Backer, Guy De; Dominiczak, Anna F.; Galderisi, Maurizio; Grobbee, Diederick E.; Jaarsma, Tiny; Kirchhof, Paulus; Kjeldsen, Sverre E.; Laurent, Stéphane; Manolis, Athanasios; Nilsson, Peter M.; Ruilope, Luís M.; Schmieder, Roland E.; Sirnes, Per Anton; Sleight, Peter; Viigimaa, Margus; Waeber, Bernard; Zannad, Faı̈ez

doi:10.1097/01.hjh.0000431740.32696.cc

Cited by 4,425 publications

(1,817 citation statements)

References 726 publications

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“…Supine resting blood pressure (BP) was measured twice and averaged in each patient after at least 10 min of rest in a quiet room. Uncontrolled hypertension was defined by averaged systolic BP ≥140 mmHg or a diastolic BP ≥ 90 mmHg 10. The International Federation of Clinical Chemistry standardized haemoglobin A1c (HbA1c) (cut‐off 64 mmol/mol) level, estimated glomerular filtration rate (eGFR), and creatinine were obtained from local pathology records.…”

Section: Methodsmentioning

confidence: 99%

Variations in subclinical left ventricular dysfunction, functional capacity, and clinical outcomes in different heart failure aetiologies

Wang¹,

Yang²,

Nolan³

et al. 2018

ESC Heart Failure

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AimsPatients with heart failure (HF) risk factors are described as being in Stage A of this condition (SAHF). Management is directed towards prevention of HF progression, but to date, no evidence has been described to align the intensity of this intervention to HF risk. We sought to what extent SAHF of Type 2 diabetes mellitus (T2DM) and other HF risks showed differences in subclinical left ventricular function, exercise capacity, and prognosis.Methods and resultsWe recruited 551 elder asymptomatic SAHF patients (age 71 ± 5 years, 49% men, 290 T2DM) with at least one risk factor from a community‐based population with preserved ejection fraction. All underwent a comprehensive echocardiogram including global longitudinal strain (GLS) and a 6 min walk test and were followed for 2 years. The primary endpoints were new‐onset HF and all‐cause mortality. The T2DM group was associated with reduced 6 min walk test distance (451 ± 111 vs. 493 ± 87 m, P < 0.001), worse diastolic function (E/e′ 9.2 ± 2.7 vs. 8.7 ± 2.4, P = 0.028), and impaired GLS (−17.7 ± 2.6% vs. −19.0 ± 2.6%, P < 0.001). Over a median follow‐up of 1.6 years, 49 T2DM‐SAHF and 27 other‐SAHF met the primary endpoint. T2DM‐SAHF had significantly worse outcome than other‐SAHF (P = 0.021). In Cox models, obesity [hazard ratio (HR) = 2.46; P = 0.007], atrial fibrillation (HR = 2.39; P = 0.028), 6 min walk distance (HR = 0.99; P = 0.034), and GLS (HR = 1.14; P = 0.033) were independently associated with the primary endpoint in T2DM‐SAHF, independent of age and glycaemic control.ConclusionsThe T2DM‐SAHF has worse subclinical left ventricular function, exercise capacity, and prognosis than other‐SAHF. Impaired GLS, atrial fibrillation, exercise capacity, and obesity are associated with a worse prognosis in T2DM‐SAHF but not in other‐SAHF.

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Section: Methodsmentioning

confidence: 99%

Variations in subclinical left ventricular dysfunction, functional capacity, and clinical outcomes in different heart failure aetiologies

Wang¹,

Yang²,

Nolan³

et al. 2018

ESC Heart Failure

View full text Add to dashboard Cite

show abstract

“…In fact, some guidelines for clinical management, including those from the National Institute for Health and Care Excellence, stipulate that all patients undergoing assessment or treatment for hypertension should receive initial and periodic lifestyle advice, which includes ascertaining their level of alcohol consumption and encouraging a reduced intake if they drink hazardously or heavily 6, 7. The American Heart Association guidelines for the prevention and treatment of high BP recommend limiting daily alcohol intake to 2 or less drinks for men and 1 or less drinks for women 8…”

Section: Introductionmentioning

confidence: 99%

Sex‐Specific Associations Between Alcohol Consumption and Incidence of Hypertension: A Systematic Review and Meta‐Analysis of Cohort Studies

Roerecke

Tobe

Kaczorowski

et al. 2018

JAHA

131

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BackgroundAlthough it is well established that heavy alcohol consumption increases the risk of hypertension, the risk associated with low levels of alcohol intake in men and women is unclear.Methods and ResultsWe searched Medline and Embase for original cohort studies on the association between average alcohol consumption and incidence of hypertension in people without hypertension. Random‐effects meta‐analyses and metaregressions were conducted. Data from 20 articles with 361 254 participants (125 907 men and 235 347 women) and 90 160 incident cases of hypertension (32 426 men and 57 734 women) were included. In people drinking 1 to 2 drinks/day (12 g of pure ethanol per drink), incidence of hypertension differed between men and women (relative riskwomen vs men=0.79; 95% confidence interval, 0.67–0.93). In men, the risk for hypertension in comparison with abstainers was relative risk=1.19 (1.07–1.31; I2=59%), 1.51 (1.30–1.76), and 1.74 (1.35–2.24) for consumption of 1 to 2, 3 to 4, and 5 or more standard drinks per day, respectively. In women, there was no increased risk for 1 to 2 drinks/day (relative risk=0.94; 0.88–1.01; I2=73%), and an increased risk for consumption beyond this level (relative risk=1.42; 1.22–1.66).ConclusionsAny alcohol consumption was associated with an increase in the risk for hypertension in men. In women, there was no risk increase for consumption of 1 to 2 drinks/day and an increased risk for higher consumption levels. We did not find evidence for a protective effect of alcohol consumption in women, contrary to earlier meta‐analyses.

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“…In defining goal blood pressure, the Seventh and Eighth Joint National Committees4, 12 and the European Society of Hypertension and the European Society of Cardiology guidelines13 have recommended a systolic/diastolic blood pressure (SBP/DBP) target of less than 140/90 mm Hg for the general adult population including those with chronic kidney disease or diabetes mellitus, although the SBP/DBP target for the elderly is less consistent. A recent systematic review and meta‐analysis of 19 trials suggested that intensive blood pressure lowering, including targeting SBP/DBP lower than current recommendations, has further protective effects against major cardiovascular events 14.…”

Section: Introductionmentioning

confidence: 99%

Treatment Intensification for Hypertension in US Ambulatory Medical Care

Lin

Mukamal

2016

JAHA

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BackgroundHypertension is widely prevalent yet remains uncontrolled in nearly half of US hypertensive adults. Treatment intensification for hypertension reduces rates of major cardiovascular events and all‐cause mortality, but clinical inertia remains a notable impediment to further improving hypertension control. This study examines the likelihood and determinants of treatment intensification with new medication in US ambulatory medical care.Methods and ResultsUsing the nationally representative National Ambulatory Medical Care Survey (2005–2012) and National Hospital Ambulatory Medical Care Survey (2005–2011), we identified adult primary care visits with diagnosed hypertension and documented blood pressure exceeding goal targets and assessed the weighted prevalence and odds ratios of treatment intensification by initiation or addition of new medication. Approximately 41.7 million yearly primary care visits (crude N: 14 064, 2005–2012) occurred among US hypertensive adults with documented blood pressure ≥140/90 mm Hg, where treatment intensification may be beneficial. However, only 7.0 million of these visits (95% confidence interval 6.2–7.8 million) received treatment intensification with new medication, a weighted prevalence of 16.8% (15.8% to 17.9%). This proportion was consistently low and decreased over time. This decline was largely driven by decreasing medication initiation levels among patients on no previous hypertension medications from 31.8% (26.0% to 38.4%) in 2007 to 17.4% (14.0% to 21.4%) in 2012, while medication addition levels remained more stable over time.ConclusionsUS hypertensive adults received treatment intensification with new medication in only 1 out of 6 primary care visits, a fraction that is declining over time. A profound increase in intensification remains a vast opportunity to maximally reduce hypertension‐related morbidity and mortality nationwide.

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2013 ESH/ESC Guidelines for the management of arterial hypertension

Cited by 4,425 publications

References 726 publications

Variations in subclinical left ventricular dysfunction, functional capacity, and clinical outcomes in different heart failure aetiologies

Variations in subclinical left ventricular dysfunction, functional capacity, and clinical outcomes in different heart failure aetiologies

Sex‐Specific Associations Between Alcohol Consumption and Incidence of Hypertension: A Systematic Review and Meta‐Analysis of Cohort Studies

Treatment Intensification for Hypertension in US Ambulatory Medical Care

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