The Year in Hypertension

Abstract

It has been a fruitful year in hypertension research, with many important publications since the previous review of the year in hypertension (1). This review distills some of the most important developments in the field of hypertension in the past year that will impact on the diagnosis and treatment of blood pressure (BP), as well as reviews some of the emerging concepts that will shape the approaches to treatment in the years to come. Measurement of BPFundamental to the accurate diagnosis of hypertension is the method used to measure BP. Although office BP measurements have been the reference standard for many years, there is increasing use of self measurement of BP at home and 24-h ambulatory blood pressure measurement (ABPM). Unlike traditional office BP measurements, ABPM provides data on circadian variations of BP and the relative importance of nighttime versus daytime BP. In addition, disparities between office BP and ABPM have led to the concept of white-coat hypertension (i.e., BP elevated in the office but normal by ABPM), and more recently, masked hypertension (i.e., BP that is normal in the office but elevated by home BP measurement or ABPM). Important new information related to all of these issues and their prognostic significance has emerged in the past year. Diagnostic thresholds using 24-h ABPM. These were revisited in a major study of ABPM in 5,682 participants (mean age 59.0 years, 43.3% women) in prospective population studies from Europe and Japan (2). Multivariate analyses were used to establish the ABPM thresholds, which yielded a 10-year cardiovascular risk similar to that associated with optimal (120/80 mm Hg), normal (130/85 mm Hg), and high (140/90 mm Hg) office BP measurements over a median follow-up of 9.7 years. After rounding the data, the approximate optimal 24-h average ABPM systolic/diastolic threshold was 115/75 mm Hg. The optimal daytime average was 120/80 mm Hg, and for nighttime was 100/65 mm Hg. Rounded thresholds for normal BP by ABPM were 125/75, 130/85, and 110/70 mm Hg, respectively, and those for hypertension by ABPM were 130/80, 140/85, and 120/70 mm Hg, respectively (Table 1). These data suggest that population-based outcome-driven thresholds for optimal and normal ABP are lower than those currently proposed by international hypertension guidelines. Home BP measurements-how often? How often should home BP be measured to obtain a standardized average for use in clinical practice? The authors of a recent study from Japan concluded that the average of single measurements twice per day (morning and evening) for 7 days was sufficient (3). However, an excellent accompanying editorial reviewed the dilemmas associated with standardizing the assessment of home BP measurement (4) and concluded that the recommendations of the European Society of Hypertension Working Group on Blood Pressure Monitoring should still be followed (5). Notably, duplicate morning and evening home BP measurements daily for 7 days. The measurements taken on the first day should be discarded, leaving at lea...

The Year in Hypertension

“…The RFA was associated with impressive systolic and diastolic BP reductions of Ͼ20 mm Hg and 10 mm Hg, respectively, which were sustained for as long as 12 months of observation. These BP reductions are similar to those observed in the therapeutic studies of resistant hypertension reviewed last year (3). These initial studies of RFA of the renal nerves seem to justify this novel approach to treatment, but further large-scale studies are required to determine the place of this approach in more routine clinical practice.…”

“…An average total of Ն12 readings is recommended for making clinical decisions. This method is widely used in Europe, and guidelines from Europe for HBPM were discussed in last year's review of the year in hypertension (3). Evidence is accruing to suggest that HBPM may be a better predictor of target organ damage and also helps reduce the "white coat effect" and determine the presence of "masked hypertension."…”

Prehypertension Is Associated With Impaired Nitric Oxide-Mediated Endothelium-Dependent Vasodilation in Sedentary Adults

“…2,[5][6][7] Moreover, ~50% of BP-related deaths occur in individuals with systolic BP between 115 and 140 mm Hg, suggesting that prehypertension accounts for a significant proportion of CVD-related mortality attributed to high BP. 8 Dysfunction of the vascular endothelium, especially impaired endothelium-dependent vasodilation, is etiologically involved in the pathogenesis of atherosclerotic vascular disease and occurs early in atherogenesis, prior to histological or angiographic evidence of disease. 9,10 Impairments in endotheliumdependent vasodilation are largely mediated by a reduction in the bioavailability of endothelium-derived nitric oxide (NO).…”

An overview of fixed-dose combinations of antihypertensive drugs in South Africa

“…BP control in a large population is often only reached with a combination of drugs from different classes. 1,3,6,12 Components in FDCs can be designed to counteract each other's side-effects, resulting in an overall neutral effect. Also, BP goals may be reached earlier than would be the case with monotherapy.…”