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Defining intradialytic hypertension: the importance of measuring blood pressure accurately
The blood pressure (BP) profile of patients on maintenance hemodialysis (HD) is characterized by large fluctuations occurring within and between HD sessions. Indeed, during a typical HD session, BP decreases from pre- to postdialysis and generally increases gradually until the next dialysis session owing to salt and fluid retention. In observational studies, both intra- and interdialysis changes in BP have been associated with target-organ damage, cardiovascular events and mortality with a U-shape relationship, the incidence of clinical events increasing in patients with very low as well as very high BP values [1].
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May Measurement Month 2017–2019: results from Switzerland
May Measurement Month (MMM) is an international screening campaign for arterial hypertension initiated by the International Society of Hypertension and endorsed by the World Hypertension League. Its aim is to raise the awareness of elevated blood pressure (BP) in the population worldwide. The goal of the present analyses is to assess the results obtained during three years of this campaign in Switzerland. Swiss data from MMM17 to MMM19 campaigns were used. BP and a questionnaire for basic demographic and clinical information were recorded for each participant. BP measurements and definition of arterial hypertension followed the standard MMM protocol. To assess BP control, European Society of Hypertension 2018 thresholds of <140>
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Assessment of a strategy combining ambulatory blood pressure, adherence monitoring and a standardised triple therapy in resistant hypertension
Hypertension is defined as resistant to therapy when the prescribed drug treatment fails to control blood pressure (BP) and to achieve recommended targets, and the inadequate BP control is confirmed by outof-office BP monitoring in patients whose adherence to therapy has been confirmed [1]. This definition implies that 3 antihypertensive drugs are prescribed at maximally tolerated doses with one of them being a diuretic. In recent years, additional definitions have appeared in the literature [2]. They include the concept of refractory hypertension, when BP remains uncontrolled with the use of 5 antihypertensive agents of different classes, including a long-acting thiazide-like diuretic and spironolactone, or controlled resistant hypertension, when BP falls below targets on 4 antihypertensive medications at maximal or maximally tolerated doses [2]. Frequently, however, uncontrolled hypertension is considered as ‘apparent’ rather than true resistant hypertension because BP has not been measured outside the office, drug adherence has not been assessed and other factors of pseudo-resistance have not been excluded [3].
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Blood pressure from the optical Aktiia Bracelet: a 1-month validation study using an extended ISO81060-2 protocol adapted for a cuffless wrist device
Blood pressure (BP) measurement is essential in the diagnosis and management of hypertension. As such, validation of BP measurement devices is of paramount importance in order to ensure accurate measurements [1]. To date, unvalidated devices dominate the online market, raising questions about adequate hypertension and cardiovascular management worldwide [2]. This lack of validation is specifically true for wrist-band wearables for which no specific recognized validation protocol exists so far. Nevertheless, cuffless measurement solutions have emerged recently with the associate hope of better hypertension management through BP telemonitoring [3]. These devices may increase convenience and patient empowerment in their disease management [4].
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How Do I Manage Hypertension in Patients with Advanced Chronic Kidney Disease Not on Dialysis? Perspectives from Clinical Practice
Abstract: In the general population, the prevalence of moderate and severe chronic kidney disease (CKD) is usually below 5% but this figure is often higher in specific groups of patients such as those with type 2 diabetes. Patients with advanced CKD (CKD stage 3b and 4) are at high or very high cardiovascular risk, and their risk of progressing towards endstage kidney disease (CKD stage 5) and the need of renal replacement therapy are elevated. Hypertension is a major cause of poor cardiovascular and renal outcomes in severe CKD. Therefore, an adequate control of blood pressure (BP) is mandatory. However, normalizing BP is often challenging in these patients because the clinical management of hypertension in advanced CKD is not well defined and rarely supported by large randomized controlled trials. In the present review, we discuss the characteristics of hypertension in advanced CKD, excluding dialysis, and its management integrating data from recent clinical studies and a pragmatic approach enriched by a long-standing clinical experience.
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Hypertension and Drug Adherence in the Elderly
Hypertension is highly prevalent after the age of 65 years affecting more than 60% of individuals in developed countries. Today, there is sufficient evidence from clinical trials that treating elderly subjects with hypertension with antihypertensive medications has a positive benefit/risk ratio even in very elderly patients (>80 years). In recent years, partial or total non-adherence has been recognized as major issues in the long-term management of hypertension in all age categories. However, whether non-adherence is more frequent in hypertensive patients older than 65 years or not is still a matter of debate and the common belief is that adherence is lower in older than in younger patients. Are clinical data supporting this belief? In this brief review, we discuss the topic of drug adherence in elderly in the context of the medical treatment of hypertension. Studies show that drug adherence is actually better in patients aged 65 to 80 years when compared to younger hypertensive patients (<50 years). however, in very old patients (>80 years) the prevalence of non-adherence does increase. In this patients’ group, there are specific risk factors for non-adherence such as cognitive ability, depression, and health believes, in addition to classical risk factors for non-adherence. One important aspect in the elderly is the prescription of potentially inappropriate medications that will interfere with the adherence to necessary treatments. In this context, an interesting new concept was developed few years ago, i.e., the process of deprescribing. Thus, today, in addition to conventional guidelines recommendations (use of single pill combinations, individualization of treatments), the evaluation of cognitive abilities, the regular assessment of potentially inappropriate medications, and the process of deprescribing appear to be three new additional steps to improve drug adherence in the elderly and thereby ameliorate the global management of hypertension.
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Brainstem Correlates of a Cold Pressor Test Measured by Ultra-High Field fMRI
Brainstem Correlates of a Cold Pressor Test Measured by Ultra-High Field fMRI Mariëlle C. Hendriks-Balk, Fatma Megdiche, Laura Pezzi, Olivier Reynaud, Sandra Da Costa, Domenica Bueti, Dimitri Van De Ville and Grégoire Wuerzner
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Comparative effectiveness of different antihypertensive agents in kidney transplantation: a systematic review and meta-analysis
Kidney transplant recipients have a 2-fold risk of cardiovascular (CV) disease compared with the general population [1]. Following transplantation, several factors have the potential to increase CV risk over time, including traditional risk factors [e.g. hypertension (HTN), diabetes], which are highly prevalent [2]. HTN, apart from being a primary CV risk factor, is the most common clinical problem among transplant patients, affecting at least 90% of this population [3]. Inadequate control of post-transplant HTN is associated with an increased risk of CV morbidity and mortality, other than being an independent risk factor for graft loss [4]. Several mechanisms, transplant-specific or not (e.g. elevated renin secretion by the recipients’ native kidneys, poor-quality donor kidneys, renal transplant artery stenosis [5]), are implicated in the pathogenesis of post-transplant HTN. In this context, immunosuppressive medications, essential to prevent acute rejection and graft loss, play a key role in promoting post-transplant HTN [6], as demonstrated in particular for calcineurin inhibitor use [7].
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Is blood pressure measured correctly in dialysis centres? Physicians’ and patients’ views
Blood pressure (BP) is routinely measured as a vital sign before, during and/or after dialysis (peridialysis BP). Even if peridialytic measurements are widely used, the agreement with the interdialytic BP is poor and is often biased by many technical errors [1]. Since accurate BP measurements are critical for making decisions and evaluating a patient’s cardiovascular risk, Working Groups from the ERA-EDTA and the European Society of Hypertension (ESH) issued recommendations on standardized BP measurement in dialysis patients [2]. Previous studies have underlined substantial differences between recommendations for BP measurement in general and effective BP measurements performed by medical staff [3], but whether these recommendations are followed in dialysis centres has not been investigated so far. The objectives of this multi-centric, cross-sectional survey were (i) to assess the adherence to current recommendations [4] on BP measurements in dialysis centres both according to physicians’ and patients’ perspectives and (ii) to evaluate the use of out-of-office BP measurements in dialysis patients.
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Prevalence of Hypertensive Phenotypes After Preeclampsia
Preeclampsia is a hypertensive disorder specific to gestation that affects 5% to 8% of all pregnancies1 and is associated with a greater lifetime risk for cardiovascular and renal complications.2,3 Recently, different international guidelines have underlined that women who had a hypertensive disorder of the pregnancy should benefit from a postpartum screening and management for cardiovascular risk factors, but with no precise recommendations, especially about the timing of the first medical visit.4–7 The existence and the prevalence of specific hypertensive phenotypes after preeclampsia is not known and the place of ambulatory blood pressure monitoring (ABPM) in the early follow-up of preeclampsia needs to be defined.
Recent articles
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- Women’s health, cardiovascular risk and hypertension: the perspective still needs to improve
