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The article offers the guidelines for hypertension management and its diagnosis focusing on blood pressure thresholds and targets.

Renal denervation has emerged as a novel approach for the treatment of patients with drug-resistant hypertension. To date, only limited data have been published using multielectrode radiofrequency ablation systems. In this article, we present the 12-month data of EnligHTN I, a first-in-human study using a multielectrode ablation catheter. EnligHTN I enrolled 46 patients (average age, 60±10 years; on average 4.7±1.0 medications) with drug-resistant hypertension. Eligible patients were on ≥3 antihypertensive medications and had a systolic blood pressure (BP) ≥160 mm Hg (≥150 mm Hg for diabetics). Bilateral renal artery ablation was performed using a percutaneous femoral approach and standardized techniques. The average baseline office BP was 176/96 mm Hg, average 24-hour ambulatory BP was 150/83 mm Hg, and average home BP was 158/90 mm Hg. The average reductions (mm Hg) at 1, 3, 6, and 12 months were as follows: office: -28/-10, -27/-10, -26/-10, and -27/-11 mm Hg (P<0.001 for all); 24-hour ambulatory: -10/-5, -10/-5, -10/-6 (P<0.001 for all), and -7/-4 for 12 months (P<0.0094). Reductions in home measurements (based on 2-week average) were -9/-4, -8/-5,-10/-7, and -11/-6 mm Hg (P<0.001 at 12 months). At 12 months, there were no signals of worsening renal function and no new serious or life-threatening adverse events. One patient with baseline nonocclusive renal artery stenosis progressed to 75% diameter stenosis, requiring renal artery stenting. The 12-month data continue to demonstrate safety and efficacy of the EnligHTN ablation system in patients with drug-resistant hypertension. Home BP measurements parallel measurements obtained with 24-hour ambulatory monitoring. [ABSTRACT FROM AUTHOR]

: Justified Exclusion? Renal denervation (RDN) is a minimally invasive, interventional procedure, introduced about a decade ago to better manage patients with drug-resistant hypertension. Likewise, very old patients (>75 years) were not included in the study, although these patients are expected to have primarily ISH, and information about the efficacy of RDN in this ever increasing age group is urgently needed. [Extracted from the article]

Vascular ageing is characterized by increased pulse wave velocity (PWV) and unfavorable modulation of arterial compliance.[7] There is a strong correlation of increased arterial stiffness with adverse renal, brain, and cardiovascular outcomes. Interestingly, after accounting for gender, the blood pressure (BP) and heart rate did not alter the association of MSNA with carotid-femoral PWV and carotid compliance.[1] Although previous reports suggest that the link between BP and MSNA was more pronounced in aged females than in males,[2] there were no gender differences in the association of resting MSNA with carotid-femoral PWV nor carotid properties.[1] From a therapeutic point of view, the results of the current study suggest that sympathetic nervous system activity modulation could impact arterial stiffness and consequently cardiovascular outcome. [Extracted from the article]

Abstract: GReek-AntiPlatElet Atrial Fibrillation registry is a multicenter, observational, noninterventional study of atrial fibrillation patients undergoing percutaneous coronary intervention. Primary endpoint included clinically significant bleeding rate at 12 months between different antithrombotic regimens prescribed at discharge; secondary endpoints included major adverse cardiovascular events and net adverse clinical events. A total of 647 patients were analyzed. Most (92.9%) were discharged on novel oral anticoagulants with only 7.1% receiving the vitamin K antagonist. A little over half of patients (50.4%) received triple antithrombotic therapy (TAT)-mostly (62.9%) for ≤1 month-whereas the rest (49.6%) received dual antithrombotic therapy (DAT). Clinically significant bleeding risk was similar between TAT and DAT [Hazard ratio (HR) = 1.08; 95% confidence interval (CI), 0.66-1.78], although among TAT-receiving patients, the risk was lower in those receiving TAT for ≤1 month (HR = 0.50; 95% CI, 0.25-0.99). Anticoagulant choice (novel oral anticoagulant vs. vitamin K antagonist) did not significantly affect bleeding rates ( P = 0.258). Age, heart failure, leukemia/myelodysplasia, and acute coronary syndrome were associated with increased bleeding rates. Risk of major adverse cardiovascular events and net adverse clinical events was similar between ΤAT and DAT (HR = 1.73; 95% CI, 0.95-3.18, P = 0.075 and HR = 1.39; 95% CI, 0.93-2.08, P = 0.106, respectively). In conclusion, clinically significant bleeding and ischemic rates were similar between DAT and TAT, although TAT >1 month was associated with higher bleeding risk., Competing Interests: D. Alexopoulos has received lecturing honoraria/advisory board fees from Astrazeneca, Bayer, Boehringer Ingelheim, Pfizer, Medtronic, Biotronik, and Chiesi Hellas. I. Zarifis has received lecturing honoraria from Boehringer Ingelheim. L. Poulimenos has received research grants and honoraria from Astra Zeneca, Bayer, Boehringer-Ingelheim, ELPEN, Menarini, MSD, Novartis, Pfizer, Servier outside the submitted work. E. Skalidis has received lecturing honoraria/advisory board fees from Astrazeneca, Bayer, Boehringer Ingelheim, Medtronic. V. Voudris has received lecturing honoraria/advisory board fees from Bayer and Medtronic. Other authors report no relationships that could be construed as a conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The clinical significance of masked hypertension (MHT) and white-coat hypertension (WCHT) remains controversial, whereas subclinical inflammation and arterial stiffness are associated with an adverse prognosis. We examined the interrelationships of MHT, WCHT, and sustained hypertension (SHT) with high-sensitivity C-reactive protein (hs-CRP) and arterial stiffness., Methods: Our population consisted of 291 untreated nondiabetic patients with MHT [office blood pressure (BP) < 140/90 mmHg and daytime BP ≥ 135/85 mmHg; n = 32], WCHT (office BP ≥ 140/90 mmHg and daytime BP < 135/85 mmHg; n = 81), SHT (office BP ≥ 140/90 mmHg and daytime BP ≥ 135/85 mmHg; n = 178), and 44 age-matched and sex-matched control normotensives., Results: SHT compared with WCHT, MHT, and normotension exhibited higher pulse wave velocity (PWV; 8.2 ± 1.4 vs. 7.5 ± 1.2 vs. 7.3 ± 0.9 vs. 6.8 ± 0.5 m/s, respectively; P < 0.05) and hs-CRP (2.8 ± 0.7 vs. 2.2 ± 0.6 vs. 1.9 ± 0.4 vs. 1.2 ± 0.3 mg/l, respectively; P < 0.05), independently of confounders. Of note, there was no difference between the MHT and WCHT groups with regard to hs-CRP and PWV levels (P = not significant). In hypertensives, hs-CRP was associated with 24-h systolic BP (r = 0.350, P < 0.0001) and PWV (r = 0.228, P < 0.0001), whereas PWV was associated with 24-h systolic BP (r = 0.330, P < 0.0001)., Conclusion: MHT and WCHT represent two states of equivalent subclinical vascular dysfunction reflected by hs-CRP and PWV. Moreover, MHT and WCHT are characterized by a higher degree of inflammatory activation and arterial stiffening compared with normotension and by a lesser degree compared with SHT. The association of 24-h BP with both hs-CRP and PWV underscores the dominant role of hemodynamic load on hypertensive damage progression.

Objectives: We sought to investigate the plausible interrelationship of exaggerated blood pressure response during exercise (EBPR) with ambulatory arterial stiffness index (AASI) in never-treated patients with uncomplicated essential hypertension., Methods: Ninety-nine never-treated hypertensive patients (aged 50.7 years, 61 male) underwent 24 h ambulatory blood pressure (BP) recording, complete echocardiographic study and treadmill exercise testing and were classified as patients with (n=36) and without EBPR (n=63) based on the systolic BP elevation at peak exercise (>or=210 mmHg for men and >or=190 mmHg for women). Arterial stiffness was evaluated by means of both AASI and pulse wave velocity (PWV)., Results: Hypertensives with EBPR, compared with those without EBPR, exhibited significantly higher 24 h systolic BP and pulse pressure (by 3.8 mmHg, P=0.041 and by 7.2 mmHg, P<0.001, respectively), and decreased peak early diastolic velocity and peak early diastolic velocity/peak atrial systolic velocity ratio (by 1.1 cm/s and by 0.11, both P<0.05, respectively). PWV and AASI values were higher in the EBPR group compared with the normal response group independently of confounders (by 0.9 m/s, P<0.001 and by 0.06, P=0.043, respectively). PWV (beta=0.308, P=0.008) and 24-h pulse pressure (beta=0.297, P=0.010), but not AASI, were independently associated with peak exercise systolic BP., Conclusion: EBPR constitutes a sign of premature cardiovascular stiffening in the setting of uncomplicated hypertension. The close relationship between EBPR and PWV but not AASI enhances the concept of PWV as a superior measure of arterial stiffness and constitutes an important factor in the interpretation of EBPR-linked cardiovascular risk.