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Objectives: The AHA/ACC-2017 hypertension guideline recommends an age-independent target blood pressure (BP) of less than 130/80 mmHg. In an elderly cohort without established cardiovascular disease (CVD) at baseline, we determined the impact of this guideline on the prevalence of hypertension and associated CVD risk. Methods: Nineteen thousand, one hundred and fourteen participants aged at least 65 years from the ASPirin in Reducing Events in the Elderly (ASPREE) study were grouped by baseline BP: 'pre-2017 hypertensive' (BP <140/90mmHg and/or on antihypertensive drugs); 'reclassified hypertensive' (normotensive by pre-2017 guidelines; hypertensive by AHA/ACC-2017 guideline), and 'normotensive' (BP <130 and <80 mmHg). For each group, we evaluated CVD risk factors, predicted 10-year CVD risk using the Atherosclerotic Cardiovascular Disease (ASCVD) risk equation, and reported observed CVD event rates during a median 4.7-year follow-up. Results: Overall, 74.4% (14 213/19 114) were 'pre-2017 hypertensive'; an additional 12.3% (2354/19 114) were 'reclassified hypertensive' by the AHA/ACC-2017 guideline. Of those 'reclassified hypertensive', the majority (94.5%) met criteria for antihypertensive treatment although 29% had no other traditional CVD risk factors other than age. Further, a relatively lower mean 10-year predicted CVD risk (18% versus 26%, P<0.001) and lower CVD rates (8.9 versus 12.1/1000 person-years, P=0.01) were observed in 'reclassified hypertensive' compared with 'pre-2017 hypertensive'. Compared with 'normotensive', a hazard ratio (95% confidence interval) for CVD events of 1.60 (1.26-2.02) for 'pre-2017 hypertensive' and 1.26 (0.93-1.71) for 'reclassified hypertensive' was observed. Conclusion: Applying current CVD risk calculators in the elderly 'reclassified hypertensive', as a result of shifting the BP threshold lower, increases eligibility for antihypertensive treatment but documented CVD rates remain lower than hypertensive patients defined by pre

Background. Patients with uncontrolled blood pressure (BP) have a fourfold increase in the risk of developing cardiovascular events compared to those with hypertension who have reached the target blood pressure. The purpose of the study was to evaluate the structural characteristics of patients with resistant arterial hypertension (AH) undergoing in-patient treatment at the department of symptomatic hypertensions of the SI “NSC “M.D. Strazhesko Institute of Cardiology” of the National Academy of Medical Sciences of Ukraine” and to determine the achievement of the target blood pressure in patients with resistant AH taking three or more antihypertensive drugs. Materials and methods. The study included 1,146 patients with resistant AH who received 3 or more antihypertensive drugs and were treated at the department of symptomatic hypertensions of the SI “NSC “M.D. Strazhesko Institute of Cardiology” of the National Aca-demy of Medical Sciences of Ukraine”. The level of office BP at admission to the department was ≥ 140/90 mmHg if patients took 3 or more AH drugs. The average level of systolic (SBP)/diastolic blood pressure (DBP) was 174.60 ± 0.64/100.50 ± 0.38 mmHg. Patients underwent the following examinations: body height and weight measurements, office BP, daily blood pressure monitoring, echocardiography, pulse wave velocity and central blood pressure, sleep apnea determination, general blood count, blood biochemical analysis, evaluating the levels of thyroid-stimulating hormone, Т3, Т4, blood renin, blood aldosterone and their correlation, determination of urine metanephrine, cortisol. Results. Among patients with resistant arterial hypertension, there were more women (63 %) than men (37 %). Secondary hypertension was found in 5 %; renoparenchymal arterial hypertension, adrenocortical adenoma with hyperaldesononism and abnormal thyroid function with hypothyroidism predominated in the structure. 16.6 % of patients with resistant arterial hypertension had type 2 diab, Актуальность. Неконтролируемое артериальное давление у лиц (АД) связано с четырехкратным увеличением риска развития сердечно-сосудистых событий по сравнению с пациентами с АГ, достигшими целевого уровня АД. Цель: оценить общую характеристику пациентов с резистентной АГ, которые проходили стационарное лечение в отделении симптоматических гипертензий ГУ «ННЦ «Институт кардиологии имени академика Н.Д. Стражеско» НАМН Украины», и определить достижения целевого уровня артериального давления у пациентов с резистентной АГ, принимающих 3 антигипертензивных препарата и более. Материалы и методы. В исследование были включены 1146 пациентов с резистентной АГ, принимавших 3 антигипертензивных препарата и более, которые лечились в отделении симптоматических гипертензий ГУ «ННЦ «Инсти-тут кардиологии им. акад. Н.Д. Стражеско» НАМН Укра-ины». Уровень офисного АД у больных при поступлении в отделение при приеме 3 антигипертензивных препаратов и более составлял ≥ 140/90 мм рт.ст.: средний уровень систолического (САД)/диастолического АД (ДАД) был 174,60 ± 0,64/100,50 ± 0,38 мм рт.ст. Пациентам проводили следующие обследования: измерение роста и массы тела, офисного АД, суточное мониторирование артериального давления, эхокардиографическое исследование, измерение скорости распространения пульсовой волны и центрального артериального давления, определение ночного апноэ сна, общий анализ крови, биохимический анализ крови, определение уровней тиреотропного гормона, Т3, Т4, ренина крови, альдостерона крови и их соотношения, определение метанефринов мочи, кортизола. Результаты. Среди пациентов с резистентной артериальной гипертензией женщин было больше, чем мужчин, — 62,7 % против 36,7 % соответственно. Среди них у 5 % была обнаружена вторичная АГ, в структуре которой преобладающую долю составляли ренопаренхимная артериальная гипертензия, аденома надпочечников с гиперальдостеронизмом и нарушение функции щитовидной железы с гипотиреозом. У 16,6 % пациентов с резистентной АГ отмечался сахарный, Актуальність. Неконтрольований артеріальний тиск в осіб (АТ) пов’язаний із чотириразовим збільшенням ризику розвитку серцево-судинних подій порівняно з пацієнтами з АГ, які досягли цільового рівня АТ. Мета: оцінити загальну характеристику пацієнтів із резистентною АГ, які проходили стаціонарне лікування у відділенні симптоматичних гіпертензій ДУ «ННЦ «Інститут кардіології імені академіка М.Д. Стражеска» НАМН України», та визначити досягнення цільового рівня артеріального тиску в пацієнтів із резистентною АГ, які приймають 3 антигіпертензивні препарати та більше. Матеріали та методи. У дослідження було включено 1146 пацієнтів із резистентною АГ, які приймали 3 антигіпертензивні препарати та більше і лікувалися у відділенні симптоматичних гіпертензій ДУ «ННЦ «Інститут кардіології ім. акад. М.Д. Стражеска» НАМН України». Рівень офісного АТ при надходженні хворих у відділення при прийомі 3 антигіпертензивних препаратів і більше становив ≥ 140/90 мм рт.ст.: середній рівень систолічного (САТ)/діастолічного АТ (ДАТ) був 174,60 ± 0,64/100,50 ± 0,38 мм рт.ст. Пацієнтам проводили такі обстеження: вимірювання зросту та маси тіла, офісного АТ, добове моніторування артеріального тиску, ехокардіографічне дослідження, вимірювання швидкості поширення пульсової хвилі та центрального артеріального тиску, визначення нічного апное сну, загальний аналіз крові, біохімічний аналіз крові, визначення рівнів тиреотропного гормона, Т3, Т4, реніну крові, альдостерону крові та їх співвідношення, визначення метанефринів сечі, кортизолу. Результати. Серед пацієнтів із резистентною артеріальною гіпертензією жінок було більше, ніж чоловіків, — 62,7 проти 36,7 % відповідно. Серед них у 5 % була виявлена вторинна АГ, де в структурі переважну частку становили ренопаренхімна артеріальна гіпертензія, аденома наднирників із гіперальдостеронізмом та порушення функції щитоподібної залози з гіпотиреозом. У 16,6 % пацієнтів із резистентною АГ відмічався цукровий діабет 2-го типу, 15,8 % пацієнтів перенесли п

A bidirectional relationship between hypertension and kidney disease, with one exacerbating the effect of the other, is well established. Elevated blood pressure (BP) is a well-recognized, modifiable risk factor for cardiovascular (CV) disease as well as for development and progression of chronic kidney disease and, therefore, the identification of optimal BP target is a key issue in the management of renal patients. Recent large trials and real life cohort studies have indicated that below a definite BP value renal protection seems to plateau and too low levels may even be associated with a paradoxical increase in renal morbidity, thus reviving the debate about the so called BP -renal function J-curve relationship. Existing evidence supports a systolic target around 130 mm Hg to combine both renal and CV protection and possibly lower levels in the presence of overt proteinuria.

Purpose of Review: Detection of elevated blood pressure values in elderly patients represents a common clinical condition associated with an increased cardiovascular risk. This has been shown to be the case in both systodiastolic and isolated systolic hypertension as well. However, despite the evidence of the benefits of the blood pressure lowering intervention in terms of reduction of cardiovascular morbidity and mortality, at least two issues related to antihypertensive drug treatment in aged individuals are still undefined: (1) the blood pressure threshold at which antihypertensive drug should be initiated and (2) the blood pressure goals of the therapeutic intervention. Recent Findings: The present paper will critically review the evidence available so far on these two issues as well as the position of current guidelines and consensus statements. Emphasis will be given to the analysis of the new data of the Systolic Blood Pressure Interventional Trial (SPRINT), which have recently demonstrated the benefits, even in individuals aged more than 75 years, of a tight blood pressure reduction to systolic blood pressure to 120 mmHg or less. The potential limitations of the trial will be also critically addressed and the expectations of ongoing clinical studies investigating the issue in elderly patients properly emphasized. Summary: Although of interest, the results of the SPRINT trial encompass a number of limitations which limit their applicability to the general elderly hypertensive population. A prudent approach will be to adopt in clinical practice the less intensive and more conservative targets recommended by current guidelines.

Background and objectives: Previous meta-analyses of our group have investigated the cardiovascular effects of more vs. less intense blood pressure (BP) treatment and the BP levels to be achieved by treatment. A few additional trials have been completed recently, particularly the large SPRINT study. Updating of the previous meta-analyses has been done with the objective of further clarifying the practical question of BP targets of antihypertensive treatment. Methods: Among randomized-controlled trials (RCTs) of BP lowering treatment between 1966 and 2015, 16 (52235 patients) compared more vs. less intense treatment and fulfilled other preset criteria, and in 34 (138127 patients) SBP in the active (vs. placebo) or the more (vs. less) intense treatment was below (vs., respectively, above) three predetermined cutoffs. For their meta-analyses risk ratios (RR) and 95% confidence intervals, standardized to -10/-5mmHg SBP/DBP reduction, and absolute risk reductions of seven fatal and nonfatal outcomes were calculated. Results: More intense BP lowering significantly reduced risk of stroke [RR 0.71 (0.60-0.84)], coronary events [0.80 (0.68-0.95)], major cardiovascular events [0.75 (0.68-0.85)] and cardiovascular mortality [0.79 (0.63-0.97)], but not heart failure and all-cause death. When the 16 RCTs were stratified according to cardiovascular death risk, relative risk reduction did not differ between strata, but absolute risk reduction increased with cardiovascular risk, though the residual risk also increased. Stratification of the 34 RCTs according to the three different SBP cutoffs (150, 140 and 130mmHg) showed that a SBP/DBP difference of -10/-5mmHg across each cutoff significantly reduced risk of all outcomes to the same proportion (relative risk reduction), but absolute risk reduction of most outcomes had a significant trend to decrease at lower cutoffs. Conclusion: Updating of previous meta-analyses indicates that more vs. less intense BP lowering can reduce not only

At the Congress of the European Society on Arterial Hypertension (AH) in June 2007 in Milan were presented Second European Recommendations on AH traditionally attracting huge attention. Novel Recommendations appear to be revision of the 2003 variant and in distinction to recommendations of WHO are oriented to more high economical potential of European Countries. Positions contained in the novel version in recommendations reflect contemporary knowledge about AH in connection with this their educational but not directive or prescribing character is distinctly designated. It is underlined that data of different degree of proof are used. The lack of objective criteria of proof creates problems of comparison with other recommendations. Diagnostic level of AH >= 140/90 mm Hg remained previous however these figures not always appear to be target values. Besides patients with diabetes mellitus diabetes, renal insufficiency and proteinuria to categories of patients to whom achievement of lower target values is required patients with very high risk first of all those who have survived myocardial infarction and stroke are referred. This change will lead to more low parameters of controllable AH. In distinction from 2003 recommendations of American experts in the given recommendations the term "prehypertension" is not used. Big significance is devoted to parameters of BP during ambulatory or home measurement and their norms are given. it is underlined that all parameters of BP are very important for prognosis but long term prognosis more closely tied with ambulatory BP than with single measurements by physician. Novel notions are defined "masked (concealed) AH" and "central BP". Received further development concept of assessment of total cardiovascular risk, according to which BP is a component of multiprofile spectrum of risk factors. Compliance with this concept creates problems of assessment of specific significance of elevated BP as risk factor. It should be underlined that

Efficacy and tolerability of fixed amlodipine/valsartan combination was studied in 86 patients with hypertensive disease hospitalized in departments of general internal medicine or cardiology. All patients had indications for antihypertensive therapy and were randomized either to fixed combination amlodipine/valsartan (n=43) or to therapy which corresponded to the hospital formulary (n=43). Correction of antihypertensive therapy was performed by treating physician at daily rounds. Self-control of blood pressure (BP) was performed by patients with the use of UA767PC apparatus. Results of BP self-control were compared with clinical measurements in order to detect concealed inefficacy of treatment. Results. Rate of achievement of target BP with fixed combination amlodipine/valsartan (93%) was comparable with that on traditional therapy (90%). But the use of fixed combination amlodipine/valsartan compared with traditional therapy was associated with lower clinical and self measured BP, quicker achievement of target BP (5.8±2.3 and 9.2±1.8 days, respectively, p<0.05), lesser number of antihypertensive drugs (2.5±0.6 and 3.0±0.9 days, respectively), lower rate of concealed inefficacy of treatment (12 and 31%, respectively, p<0.05). Conclusions. We have demonstrated appropriateness of inhospital administration of fixed amlodipine/valsartan combination as an approach allowing to achieve target BP in shorter time, with the use of fewer antihypertensive drugs, and diminishing concealed inefficacy of treatment.