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1. Renal sympathetic denervation 2024 in Austria: recommendations from the Austrian Society of Hypertension : Endorsed by the Austrian Society of Nephrology and the Working Group of Interventional Cardiology of the Austrian Society of Cardiology.

Author

Zweiker D, Koppelstätter C, Hohenstein K, Lang I, Perl S, Bugger H, Brandt MC, Horn S, Binder RK, Watschinger B, Frick M, Niessner A, and Weber T

Subjects
Humans, Antihypertensive Agents therapeutic use, Austria, Kidney innervation, Nephrology standards, Practice Guidelines as Topic, Treatment Outcome, Cardiology standards, Hypertension surgery, Hypertension therapy, Sympathectomy methods, Sympathectomy standards
Abstract

Renal sympathetic denervation (RDN) is an interventional supplement to medical treatment in patients with arterial hypertension. While the first sham-controlled trial, SYMPLICITY HTN‑3 was neutral, with improved procedural details, patient selection and follow-up, recent randomized sham-controlled trials of second-generation devices show a consistent blood pressure lowering effect of RDN, as compared to sham controls. These new data and the recent U.S. Food and Drug Administration (FDA) premarket approval of two RDN devices are the basis for the present recommendations update.This joint position paper from the Austrian Society of Hypertension, together with the Austrian Society of Nephrology and the Working Group of Interventional Cardiology from the Austrian Society of Cardiology includes an overview about the available evidence on RDN and gives specific recommendations for the work-up, patient selection, pretreatment, procedural management and follow-up in patients undergoing RDN in Austria. Specifically, RDN may be used in clinical routine care, together with lifestyle measures and antihypertensive drugs, in patients with resistant hypertension (i.e. uncontrolled blood pressure on 3 antihypertensive drugs) and in those with uncontrolled hypertension, after adequate work-up, if institutional, patient-related and procedural conditions are fulfilled., (© 2024. The Author(s).)

Published
2024
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2. Screening and management of hypertensive patients with chronic kidney disease referred to Hypertension Excellence Centres among 27 countries. A pilot survey based on questionnaire.

Author

Halimi JM, Sarafidis P, Azizi M, Bilo G, Burkard T, Bursztyn M, Camafort M, Chapman N, Cottone S, de Backer T, Deinum J, Delmotte P, Dorobantu M, Doumas M, Dusing R, Duly-Bouhanick B, Fauvel JP, Fesler P, Gaciong Z, Gkaliagkousi E, Gordin D, Grassi G, Grassos C, Guerrot D, Huart J, Izzo R, Águila FJ, Járai Z, Kahan T, Kantola I, Kociánová E, Limbourg FP, Lopez-Sublet M, Mallamaci F, Manolis A, Marketou M, Mayer G, Mazza A, MacIntyre IM, Mourad JJ, Muiesan ML, Nasr E, Nilsson P, Oliveras A, Ormezzano O, Paixão-Dias V, Papadakis I, Papadopoulos D, Perl S, Polónia J, Pontremoli R, Pucci G, Robles NR, Rubin S, Ruilope LM, Rump LC, Saeed S, Sanidas E, Sarzani R, Schmieder R, Silhol F, Sokolovic S, Solbu M, Soucek M, Stergiou G, Sudano I, Tabbalat R, Tengiz I, Triantafyllidi H, Tsioufis K, Václavík J, van der Giet M, Van der Niepen P, Veglio F, Venzin RM, Viigimaa M, Weber T, Widimsky J, Wuerzner G, Zelveian P, Zebekakis P, Lueders S, Persu A, Kreutz R, and Vogt L

Subjects
Humans, Surveys and Questionnaires, Male, Female, Pilot Projects, Referral and Consultation, Antihypertensive Agents therapeutic use, Middle Aged, Mass Screening methods, Europe, Aged, Glomerular Filtration Rate, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic physiopathology, Hypertension drug therapy, Hypertension complications
Abstract

Objective: Real-life management of hypertensive patients with chronic kidney disease (CKD) is unclear., Methods: A survey was conducted in 2023 by the European Society of Hypertension (ESH) to assess management of CKD patients referred to ESH-Hypertension Excellence Centres (ESH-ECs) at first referral visit. The questionnaire contained 64 questions with which ESH-ECs representatives were asked to estimate preexisting CKD management quality., Results: Overall, 88 ESH-ECs from 27 countries participated (fully completed surveys: 66/88 [75.0%]). ESH-ECs reported that 28% (median, interquartile range: 15-50%) had preexisting CKD, with 10% of them (5-30%) previously referred to a nephrologist, while 30% (15-40%) had resistant hypertension. The reported rate of previous recent (<6 months) estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) testing were 80% (50-95%) and 30% (15-50%), respectively. The reported use of renin-angiotensin system blockers was 80% (70-90%). When a nephrologist was part of the ESH-EC teams the reported rates SGLT2 inhibitors (27.5% [20-40%] vs. 15% [10-25], P  = 0.003), GLP1-RA (10% [10-20%] vs. 5% [5-10%], P  = 0.003) and mineralocorticoid receptor antagonists (20% [10-30%] vs. 15% [10-20%], P  = 0.05) use were greater as compared to ESH-ECs without nephrologist participation. The rate of reported resistant hypertension, recent eGFR and UACR results and management of CKD patients prior to referral varied widely across countries., Conclusions: Our estimation indicates deficits regarding CKD screening, use of nephroprotective drugs and referral to nephrologists before referral to ESH-ECs but results varied widely across countries. This information can be used to build specific programs to improve care in hypertensives with CKD., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2024
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3. Management of patients with hypertension and chronic kidney disease referred to Hypertension Excellence Centres among 27 countries. On behalf of the European Society of Hypertension Working Group on Hypertension and the Kidney.

Author

Halimi JM, Sarafidis P, Azizi M, Bilo G, Burkard T, Bursztyn M, Camafort M, Chapman N, Cottone S, de Backer T, Deinum J, Delmotte P, Dorobantu M, Doumas M, Dusing R, Duly-Bouhanick B, Fauvel JP, Fesler P, Gaciong Z, Gkaliagkousi E, Gordin D, Grassi G, Grassos C, Guerrot D, Huart J, Izzo R, Jaén Águila F, Járai Z, Kahan T, Kantola I, Kociánová E, Limbourg F, Lopez-Sublet M, Mallamaci F, Manolis A, Marketou M, Mayer G, Mazza A, MacIntyre I, Mourad JJ, Muiesan ML, Nasr E, Nilsson P, Oliveras A, Ormezzano O, Paixão-Dias V, Papadakis I, Papadopoulos D, Perl S, Polónia J, Pontremoli R, Pucci G, Robles NR, Rubin S, Ruilope LM, Rump LC, Saeed S, Sanidas E, Sarzani R, Schmieder R, Silhol F, Sokolovic S, Solbu M, Soucek M, Stergiou G, Sudano I, Tabbalat R, Tengiz I, Triantafyllidi H, Tsioufis K, Václavík J, van der Giet M, der Niepen PV, Veglio F, Venzin R, Viigimaa M, Weber T, Widimsky J, Wuerzner G, Zelveian P, Zebekakis P, Lueders S, Persu A, Kreutz R, and Vogt L

Subjects
Humans, Europe, Antihypertensive Agents therapeutic use, Male, Surveys and Questionnaires, Female, Middle Aged, Calcium Channel Blockers therapeutic use, Societies, Medical, Angiotensin Receptor Antagonists therapeutic use, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic drug therapy, Hypertension drug therapy
Abstract

Objective Real-life management of patients with hypertension and chronic kidney disease (CKD) among European Society of Hypertension Excellence Centres (ESH-ECs) is unclear : we aimed to investigate it. Methods A survey was conducted in 2023. The questionnaire contained 64 questions asking ESH-ECs representatives to estimate how patients with CKD are managed. Results Overall, 88 ESH-ECS representatives from 27 countries participated. According to the responders, renin-angiotensin system (RAS) blockers, calcium-channel blockers and thiazides were often added when these medications were lacking in CKD patients, but physicians were more prone to initiate RAS blockers (90% [interquartile range: 70-95%]) than MRA (20% [10-30%]), SGLT2i (30% [20-50%]) or (GLP1-RA (10% [5-15%]). Despite treatment optimisation, 30% of responders indicated that hypertension remained uncontrolled (30% (15-40%) vs 18% [10%-25%]) in CKD and CKD patients, respectively). Hyperkalemia was the most frequent barrier to initiate RAS blockers, and dosage reduction was considered in 45% of responders when kalaemia was 5.5-5.9 mmol/L. Conclusions RAS blockers are initiated in most ESH-ECS in CKD patients, but MRA and SGLT2i initiations are less frequent. Hyperkalemia was the main barrier for initiation or adequate dosing of RAS blockade, and RAS blockers' dosage reduction was the usual management.

Published
2024
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4. Low-grade systemic inflammation and left ventricular dysfunction in hypertensive compared to non-hypertensive hypertrophic cardiomyopathy.

Author

Zach DK, Schwegel N, Santner V, Winkelbauer L, Hoeller V, Kolesnik E, Gollmer J, Seggewiss H, Batzner A, Perl S, Wallner M, Reiter U, Rainer PP, Zirlik A, Ablasser K, and Verheyen N

Subjects
Adult, Humans, Female, Middle Aged, Aged, Male, Case-Control Studies, Cross-Sectional Studies, Inflammation diagnostic imaging, Inflammation complications, Hypertrophy, Left Ventricular, Cardiomyopathy, Hypertrophic complications, Cardiomyopathy, Hypertrophic diagnostic imaging, Ventricular Dysfunction, Left, Hypertension
Abstract

Background: Arterial hypertension (HTN) is associated with excess mortality in hypertrophic cardiomyopathy (HCM), but underlying mechanisms are largely elusive. The objective of this study was to investigate the association between HTN and markers of left ventricular (LV) dysfunction and low-grade systemic inflammation in a HCM cohort., Methods: This was a single-center cross-sectional case-control study comparing echocardiographic and plasma-derived indices of LV dysfunction and low-grade systemic inflammation between 30 adult patients with HCM and HTN (HTN+) and 30 sex- and age-matched HCM patients without HTN (HTN-). Echocardiographic measures were assessed using post-processing analyses by blinded investigators., Results: Mean age of the study population was 55.1 ± 10.4 years, 30% were women. Echocardiographic measures of systolic and diastolic dysfunction, including speckle-tracking derived parameters, did not differ between HTN+ and HTN-. Moreover, levels of N-terminal pro B-type natriuretic peptide were balanced between cases and controls. Compared with HTN-, HTN+ patients exhibited a higher white blood cell count [8.1 ± 1.8 10 9 /l vs. 6.4 ± 1.6 10 9 /l; p < 0.001] as well as higher plasma levels of interleukin-6 [2.8 pg/ml (2.0, 5.4) vs. 2.1 pg/ml (1.5, 3.4); p = 0.008] and high-sensitivity C-reactive protein [2.6 mg/l (1.4, 6.5) vs. 1.1 mg/l (0.9, 2.4); p = 0.004]., Conclusion: This study demonstrates that HTN is associated with indices of low-grade systemic inflammation among HCM patients. Moreover, this analysis indicates that the adverse impact of HTN in HCM patients is a consequence of systemic effects rather than alterations of cardiac function, as measures of LV systolic and diastolic dysfunction did not differ between HTN+ and HTN-., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Published
2024
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5. [Austrian Consensus on High Blood Pressure 2019].

Author

Weber T, Arbeiter K, Ardelt F, Auer J, Aufricht C, Brandt MC, Dichtl W, Ferrari J, Föger B, Henkel M, Hohenstein-Scheibenecker K, Horn S, Kautzky-Willer A, Kepplinger E, Knoflach M, Koppelstätter C, Mache C, Marschang P, Mayer G, Metzler B, Oberbauer R, Obermair F, Obermayer-Pietsch B, Perl S, Pilz S, Prischl FC, Podczeck-Schweighofer A, Rebhandl E, Rohla M, Roller-Wirnsberger R, Saely CH, Siostrzonek P, Slany J, Stoschitzky K, Waldegger S, Wenzel RR, Weiss T, Wirnsberger G, Winhofer-Stöckl Y, Zweiker D, Zweiker R, and Watschinger B

Subjects
Austria, Blood Pressure, Consensus, Humans, Antihypertensive Agents therapeutic use, Cardiovascular Diseases prevention & control, Hypertension complications, Hypertension drug therapy
Abstract

Elevated blood pressure remains a major cause of cardiovascular disease, disability, and premature death in Austria, with suboptimal rates of detection, treatment and control also in recent years. Management of hypertension is a common challenge for physicians with different spezializations. In an attempt to standardize diagnostic and therapeutic strategies and, ultimately, to increase the rate of patients with controlled blood pressure and to decrease the burden of cardiovascular disease, 13 Austrian medical societies reviewed the evidence regarding prevention, detection, workup, treatment and consequences of high blood pressure in general and in various clinical scenarios. The result is presented as the first national consensus on blood pressure. The authors and societies involved are convinced that a joint national effort is needed to decrease hypertension-related morbidity and mortality in our country.

Published
2019
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6. Plasma parathyroid hormone and cardiovascular disease in treatment-naive patients with primary hyperparathyroidism: The EPATH trial.

Author

Wetzel J, Pilz S, Grübler MR, Fahrleitner-Pammer A, Dimai HP, von Lewinski D, Kolesnik E, Perl S, Trummer C, Schwetz V, Meinitzer A, Belyavskiy E, Völkl J, Catena C, Brandenburg V, März W, Pieske B, Brussee H, Tomaschitz A, and Verheyen ND

Subjects
Aged, Blood Pressure physiology, Blood Pressure Monitoring, Ambulatory methods, Cardiotonic Agents pharmacology, Echocardiography methods, Female, Humans, Male, Middle Aged, Organ Size, Antihypertensive Agents pharmacology, Cardiovascular Diseases blood, Cardiovascular Diseases epidemiology, Cardiovascular Diseases etiology, Cardiovascular Diseases prevention & control, Heart Ventricles pathology, Hyperparathyroidism, Primary blood, Hyperparathyroidism, Primary complications, Hyperparathyroidism, Primary diagnosis, Hyperparathyroidism, Primary physiopathology, Hypertension blood, Hypertension diagnosis, Hypertension drug therapy, Hypertension physiopathology, Parathyroid Hormone blood, Pulse Wave Analysis methods
Abstract

Patients with primary hyperparathyroidism are at increased risk for high blood pressure, vascular stiffening, and left ventricular hypertrophy, but previous studies have failed to demonstrate the direct associations with circulating parathyroid hormone (PTH) levels. The authors investigated cross-sectional relationships between PTH and 24-hour pulse wave velocity, nocturnal systolic blood pressure, and left ventricular mass index in patients with primary hyperparathyroidism who were treatment-naive with cinacalcet, renin-angiotensin-aldosterone-system inhibitors, and thiazide or loop diuretics. In 76 patients, mean±SD of pulse wave velocity, nocturnal systolic blood pressure, and left ventricular mass index values were 9.3±1.8 m/s, 116.6±17.0 mm Hg, and 92.8±23.0 g/m². In multivariate linear regression analyses with adjustment for potentially confounding parameters, PTH was independently associated with nocturnal systolic blood pressure (adjusted ß coefficient=.284, P=.040), mean 24-hour pulse wave velocity (ß=.199, P=.001), and left ventricular mass index (ß=.252, P=.025). PTH may promote vascular and cardiac remodeling in primary hyperparathyroidism. Interventional trials are needed to test the antihypertensive and cardioprotective effects of PTH-inhibitory treatment strategies., (©2017 Wiley Periodicals, Inc.)

Published
2017
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7. Effects of a multifaceted educational program on blood pressure and cardiovascular risk in hypertensive patients: the Austrian herz.leben project.

Author

Perl S, Riegelnik V, Mrak P, Ederer H, Rakovac I, Beck P, Kraler E, Stoff I, Winklehner S, Klima G, Pieske BM, Pieber TR, and Zweiker R

Subjects
Aged, Antihypertensive Agents therapeutic use, Austria, Female, Humans, Hypertension drug therapy, Male, Middle Aged, Risk Factors, Blood Pressure drug effects, Cardiovascular Diseases prevention & control, Hypertension complications, Hypertension physiopathology, Patient Education as Topic methods
Abstract

Objective: Although hypertension is the most prevalent risk factor for cardiovascular and cerebrovascular morbidity and mortality, the level of blood pressure control remains poor. To amplify quality of care in hypertensive patients, a multifaceted program consisting of structured educational programs for both patients and staff, structured documentation and feedback reports with peer comparison, was implemented on a multicentre basis. Main targets were improvement of blood pressure control and reduction of cardiovascular risk. A provisional reimbursement was provided., Methods: Patients were eligible for inclusion in the program if office blood pressure was uncontrolled (>160/95 or >140/90 mmHg) in addition to elevated cardiovascular risk [>15% according to the New Zealand Risk Score (NZRS)]. Blood pressure and lipid panels were measured at entry in the program and after 12 months. Patients attended four educational units held by hypertension nurses and physicians. All data were collected in structured documentation sheets and benchmarking reports were provided every 6 months., Results: Two thousand and forty-one patients were enrolled in the program within 5 years and 3 months; 54% female, age 62.8 ± 11.1years, BMI 29.50 ± 7.88 kg/m (mean ± SD). To date, 744 patients have been seen at 1-year follow-up. Entry blood pressure was 156.1 ± 20.8/88.9 ± 11.1 mmHg. Total cholesterol showed mean levels of 207.0 ± 46.0 mg/dl, low-density lipoprotein 122.3 ± 41.6 mg/dl, high-density lipoprotein 57.2 ± 22.4 mg/dl and calculated cardiovascular risk level (NZRS) was 17.28 ± 8.29%. One year following the educational program, blood pressure was reduced to 139.2 ± 15.6 (P < 0.001)/82.1 ± 9.5 mmHg (P < 0.001). NZRS (14.1 ± 7.2%; P < 0.001) and BMI (29.26 ± 4.92 versus 29.06 ± 4.99) also improved significantly., Conclusion: This structured educational program showed its ability to improve intermediate outcomes in hypertensive patients. Better blood pressure control and significant reduction of the individual cardiovascular risk profile were achieved. A broad implementation of the program in the management of hypertension seems justified.

Published
2011
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8. Telmisartan improves vascular function independently of metabolic and antihypertensive effects in hypertensive subjects with impaired glucose tolerance.

Author

Perl S, Schmölzer I, Sourij H, Pressl H, Eder M, Zweiker R, and Wascher TC

Subjects
Adult, Aged, Antihypertensive Agents pharmacology, Cross-Over Studies, Double-Blind Method, Female, Glucose Intolerance blood, Glucose Intolerance physiopathology, Humans, Hypertension metabolism, Hypertension physiopathology, Male, Middle Aged, Prospective Studies, Telmisartan, Vascular Diseases metabolism, Antihypertensive Agents therapeutic use, Benzimidazoles therapeutic use, Benzoates therapeutic use, Glucose Intolerance drug therapy, Hypertension drug therapy, Hypoglycemic Agents therapeutic use, Vascular Diseases drug therapy, Vascular Diseases physiopathology
Abstract

Background: Hypertensive patients with IGT have increased risk for cardiovascular disease and progression to diabetes mellitus. Clinical trials suggest that the ARB telmisartan uniquely possesses PPARγ agonistic properties and improves insulin resistance as well as vascular endothelial dysfunction. The aim of the present study was to compare vascular effects of telmisartan and losartan in relation to their metabolic and antihypertensive effects in hypertensive patients with IGT., Materials and Methods: 24 patients were randomised in a double-blind, prospective, cross-over trial. At baseline and after 12 weeks of either treatment an oGTT, and endothelial function testing was performed., Results: Endothelial function improved significantly by telmisartan treatment but not by losartan treatment (FMD; T: 7.9 ± 0.7%, vs B: 6.4 ± 0.8, p<0.01; vs L: 6.4 ± 0.6, p<0.001) at almost identical antihypertensive effect of both agents. Insulin resistance assessed by HOMA (T: 2.20 ± 0.47 vs B: 3.04 ± 0.60, p<0.01; vs L: 3.38 ± 0.84, T vs L p<0.05) and ISI120 (T: 0.114 ± 0.003 vs B: 0.092 ± 0.002, p<0.001; vs L: 0.090 ± 0.006, T vs L p<0.01) improved significantly after telmisartan only, as did glucose tolerance (p<0.01). The improvement of the endothelial function observed, significantly depended on pretreatment insulin resistance but was independent of improvements of insulin resistance, blood pressure or glucose tolerance., Conclusion: In hypertensive patients with IGT telmisartan compared to losartan improved endothelial function and insulin resistance independently, supporting the hypothesis that glucometabolic and vascular insulin resistance are differentially regulated., (Copyright © 2008 Elsevier Ireland Ltd. All rights reserved.)

Published
2010
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9. May Measurement Month 2019: The Global Blood Pressure Screening Campaign of the International Society of Hypertension

Author

Beaney, Thomas, Schutte, Aletta E, Stergiou, George S, Borghi, Claudio, Burger, Dylan, Charchar, Fadi, Cro, Suzie, Diaz, Alejandro, Damasceno, Albertino, Espeche, Walter, Jose, Arun Pulikkottil, Khan, Nadia, Kokubo, Yoshihiro, Maheshwari, Anuj, Marin, Marcos J, More, Arun, Neupane, Dinesh, Nilsson, Peter, Patil, Mansi, Prabhakaran, Dorairaj, Ramirez, Agustin, Rodriguez, Pablo, Schlaich, Markus, Steckelings, Ulrike M, Tomaszewski, Maciej, Unger, Thomas, Wainford, Richard, Wang, Jiguang, Williams, Bryan, Poulter, Neil R, Michael H Olsen, Kristin T West-Gustave, Phillip D Levy, Vivian W. Y. Lee, Kenneth L Connell, Naima N. H. Hammoudi, Pascal Bovet, Bharathi Viswanathan, Sabine Perl, Bernard K Kramer, Adrian J. B. Brady, Olulola O Oladapo, Jephat Chifamba, Dejuma Y Goshu, Desalew M Kassie, Sintayehu A Gebru, Toure A Ibrahim, Soumana Kabirou, Elham Tavassoli, Mahsa Zolfaghari, Vahideh Yavari, Larysa Mishchenko, Olena Matova, Tetiana Kolenyk, Liliiya Zelenenka, Sergiy Fedorov, Maria Dorobantu, Alexandra Paval, Jesse Bittman, Biri Mangat, Sarah Melville, Alexander Leung, Neusa Jessen, Eamon Dolan, Hiroshi N. A. Itoh, Atul Pathak, Tine L. M. De Backer, Arman S Postadzhiyan, Osiris V Valoy-Tiburcio, Angel R Gonzalez-Medina, Laura G Valdez-Valoy, Fernando S Wyss, Erkin Mirrakhimov, Sunil K Nadar, Ana I Barrientos, Chukwuemeka R Nwokocha, Magdalene I Nwokocha, Dean Picone, Jun Yang, Yook C Chia, Siew M Ching, Bertrand F Ellenga Mbolla, Christian M Kouala Landa, Corine Y Houehanou, Kolawole W Wahab, Ayodele B Omotoso, Jose Ortellado, Graciela Gonzales, Luis M Ruilope, Enrique Rodilla, Ana Molinero, Angela J Woodiwiss, Ane Orchard, Ruan Kruger, Jana Brguljan, Nina Bozic, Aleksandra O Konradi, Oxana P Rotar, Irian Chazova, Tiny K Masupe, John T Tlhakanelo, Keneilwe Motlhatlhedi, George Stergiou, Michalis Doumas, Pantelis Zebekakis, Francesco P Cappuccio, Carolina Barciela, Tricia Tay, Naranjargal Dashdorj, Khulan Tuvdendarjaa, Khatantuul Boldbaatar, Fernando T Lanas, Melanie Paccot, Mohammed Ishaq, Saulat Sidique, Feroz Memon, Robert N Najem, Ali K Abu Alfa, Samir M. J. Mallat, Jacek J Jozwiak, Maciej Banach, Piotr Janowski, Betty Twumasi-Ankrah, Gustavus A Myers-Hansen, Elliot K Tannor, Marisa F Neto, Sudhirsen Kowlessur, Bhooshun Ori, Jaysing Heecharan, Hatem A Fageh, Hawa A Derbi, Omara M Msalam, Fastone M Goma, Charity Syatalimi, Penias Jr Tembo, Musawa Mukupa, Henry L Ndhlovu, Maureen L Chirwa, Mary M Mbeba, Parounak H Zelveian, Zoya N Hakobyan, Svetlana Gourgenyan, Myeong-Chan Cho, Hae-Young Lee, Jinho Shin, Gianfranco Parati, Guido Grassi, Claudio Ferri, Bezhan Tsinamdzgvrishvili, Amiran Gamkrelidze, Dali Trapaidze, Eduardo C. D. Barbosa, Weimar S Barroso, Audes M Feitosa, Vanda M Azevedo, Luis A Dias, Glenda N Garcia, Isaulina Delgado, Genc Burazeri, Gentiana Qirjako, Alban Ylli, Rudina Cumashi, Antonieta P Costantini-Olmos, Igor Morr, Elias Chuki, Tzung-Dau Wang, Wen-Jone Chen, Hung-Ju Lin, Fazila-Tun-Nesa Malik, Sohel R Choudhury, Mohammad Abdullah Al Mamun, Mir Ishraquzzaman, Ghadeer S Aljuraiban, Fatima Y Al Slail, Shatha K Aldhwailea, Ann A Badawi, Nguyen L Viet, Hoang A Tien, Nguyen T. A. Dong, Cao T Sinh, Huynh V Minh, Tran K Son, Fortunat K Katamba, Nathan B Buila, Anastase Dzudie, Samuel Kingue, Njume Epie, Armel Njomou, Marie S Ndom, Afzalhussein M Yusufali, Nooshin M Bazargani, Buthaina A. Bin Belaila, Amrish Agrawal, Aisha M Suhail, Elijah N Ogola, Bernard M Gitura, Lilian Mbau, Hellen K Nguchu, Felix A Barasa, Enrique Gomez, Luis A Alcocer, Martin Rosas, Silvia Palomo, Alfredo J Estrada, Patricio Lopez-Jaramillo, Gregorio Sanchez-Vallejo, Maria E Casanova, Edgar Arcos, Gustavo Aroca, Bhagawan Koirala, Harikrishna Bhattarai, Ghanashyam Pandey, Surya Devkota, Sweta Koirala, Kamal Ranabhat, Pratik Khanal, Tara B Adhikari, Dolores D Bonzon, Deborah Ignacia D Ona, Leilani M Asis, Benjamin A Balmores Jr, Rafael C Castillo, Diego J Stisman, Walter G Espeche, Marcos J Marin, Irene L Ennis, Xin Chen, Hongyu Wang, Min Liu, Xinhua Yin, Xiaolong Wang, Sandeep Bhalla, Priyanka Gupta, Narsingh Verma, Bal K Gupta, Shehla Sheikh, Gregoire Wuerzner, Laura Garré, José Boggia, Dédonougbo M Houenassi, José A OctavioSeijas, Jean-René M'buyamba-Kabangu, Trésor M Tshiswaka, Dénes Páll, Zoltán Járai, Rafael Hernández, Fortunato Garcia Vásquez, Jesús A Lopez-Rivera, Monica L Gúzman-Franolic, Savarino Victoria Pereira, Mário J Fernandes, Maria S Garcia, Teresa Gijon, Vitoria V. B. Meira Da Cunha, Beaney T, Schutte AE, Stergiou GS, Borghi C, Burger D, Charchar F, Cro S, Diaz A, Damasceno A, Espeche W, Jose AP, Khan N, Kokubo Y, Maheshwari A, Marin MJ, More A, Neupane D, Nilsson P, Patil M, Prabhakaran D, Ramirez A, Rodriguez P, Schlaich M, Steckelings UM, Tomaszewski M, Unger T, Wainford R, Wang J, Williams B, Poulter NR, Thomas, B, Aletta E, S, George S, S, Claudio, B, Dylan, B, Fadi, C, Suzie, C, Alejandro, D, Albertino, D, Walter, E, Arun Pulikkottil, J, Nadia, K, Yoshihiro, K, Anuj, M, Marcos J, M, Arun, M, Dinesh, N, Peter, N, Mansi, P, Dorairaj, P, Agustin, R, Pablo, R, Markus, S, Ulrike M, S, Maciej, T, Thomas, U, Richard, W, Jiguang, W, Bryan, W, Neil R, P, H Olsen, M, T West-Gustave, K, D Levy, P, Lee, V, L Connell, K, Hammoudi, N, Bovet, P, Viswanathan, B, Perl, S, K Kramer, B, Brady, A, O Oladapo, O, Chifamba, J, Y Goshu, D, M Kassie, D, A Gebru, S, A Ibrahim, T, Kabirou, S, Tavassoli, E, Zolfaghari, M, Yavari, V, Mishchenko, L, Matova, O, Kolenyk, T, Zelenenka, L, Fedorov, S, Dorobantu, M, Paval, A, Bittman, J, Mangat, B, Melville, S, Leung, A, Jessen, N, Dolan, E, Itoh, H, Pathak, A, De Backer, T, S Postadzhiyan, A, V Valoy-Tiburcio, O, R Gonzalez-Medina, A, G Valdez-Valoy, L, S Wyss, F, Mirrakhimov, E, K Nadar, S, I Barrientos, A, R Nwokocha, C, I Nwokocha, M, Picone, D, Yang, J, C Chia, Y, M Ching, S, F Ellenga Mbolla, B, M Kouala Landa, C, Y Houehanou, C, W Wahab, K, B Omotoso, A, Ortellado, J, Gonzales, G, M Ruilope, L, Rodilla, E, Molinero, A, J Woodiwiss, A, Orchard, A, Kruger, R, Brguljan, J, Bozic, N, O Konradi, A, P Rotar, O, Chazova, I, K Masupe, T, T Tlhakanelo, J, Motlhatlhedi, K, Stergiou, G, Doumas, M, Zebekakis, P, P Cappuccio, F, Barciela, C, Tay, T, Dashdorj, N, Tuvdendarjaa, K, Boldbaatar, K, T Lanas, F, Paccot, M, Ishaq, M, Sidique, S, Memon, F, N Najem, R, K Abu Alfa, A, Mallat, S, J Jozwiak, J, Banach, M, Janowski, P, Twumasi-Ankrah, B, A Myers-Hansen, G, K Tannor, E, F Neto, M, Kowlessur, S, Ori, B, Heecharan, J, A Fageh, H, A Derbi, H, M Msalam, O, M Goma, F, Syatalimi, C, Jr Tembo, P, Mukupa, M, L Ndhlovu, H, L Chirwa, M, M Mbeba, M, H Zelveian, P, N Hakobyan, Z, Gourgenyan, S, Cho, M, Lee, H, Shin, J, Parati, G, Grassi, G, Ferri, C, Tsinamdzgvrishvili, B, Gamkrelidze, A, Trapaidze, D, Barbosa, E, S Barroso, W, M Feitosa, A, M Azevedo, V, A Dias, L, N Garcia, G, Delgado, I, Burazeri, G, Qirjako, G, Ylli, A, Cumashi, R, P Costantini-Olmos, A, Morr, I, Chuki, E, Wang, T, Chen, W, Lin, H, Malik, F, R Choudhury, S, Abdullah Al Mamun, M, Ishraquzzaman, M, S Aljuraiban, G, Y Al Slail, F, K Aldhwailea, S, A Badawi, A, L Viet, N, A Tien, H, Dong, N, T Sinh, C, V Minh, H, K Son, T, K Katamba, F, B Buila, N, Dzudie, A, Kingue, S, Epie, N, Njomou, A, S Ndom, M, M Yusufali, A, M Bazargani, N, Bin Belaila, B, Agrawal, A, M Suhail, A, N Ogola, E, M Gitura, B, Mbau, L, K Nguchu, H, A Barasa, F, Gomez, E, A Alcocer, L, Rosas, M, Palomo, S, J Estrada, A, Lopez-Jaramillo, P, Sanchez-Vallejo, G, E Casanova, M, Arcos, E, Aroca, G, Koirala, B, Bhattarai, H, Pandey, G, Devkota, S, Koirala, S, Ranabhat, K, Khanal, P, B Adhikari, T, D Bonzon, D, D Ona, D, M Asis, L, A Balmores Jr, B, C Castillo, R, J Stisman, D, G Espeche, W, J Marin, M, L Ennis, I, Chen, X, Wang, H, Liu, M, Yin, X, Wang, X, Bhalla, S, Gupta, P, Verma, N, K Gupta, B, Sheikh, S, Wuerzner, G, Garré, L, Boggia, J, M Houenassi, D, A OctavioSeijas, J, M'buyamba-Kabangu, J, M Tshiswaka, T, Páll, D, Járai, Z, Hernández, R, Garcia Vásquez, F, A Lopez-Rivera, J, L Gúzman-Franolic, M, Victoria Pereira, S, J Fernandes, M, S Garcia, M, Gijon, T, Meira Da Cunha, V, and RS: CARIM other

Subjects
Male, Population level, Comorbidity, 030204 cardiovascular system & hematology, 0302 clinical medicine, Prevalence, adults, Medicine, Mass Screening, awareness, 030212 general & internal medicine, 1102 Cardiorespiratory Medicine and Haematology, Aged, 80 and over, Aspirin, treatment, adults, awareness, blood pressure, hypertension, risk factor, screening, treatment, blood pressure, Middle Aged, Lifestyle factors, risk factor, Female, Life Sciences & Biomedicine, medicine.drug, Adult, medicine.medical_specialty, hypertension, Adolescent, awarene, Opportunistic Sampling, Elevated blood, 1117 Public Health and Health Services, 03 medical and health sciences, Young Adult, Internal Medicine, Humans, Risk factor, Antihypertensive Agents, Aged, Science & Technology, business.industry, screening, Blood Pressure Determination, 1103 Clinical Sciences, Mean blood pressure, Blood pressure, Peripheral Vascular Disease, Cardiovascular System & Hematology, Emergency medicine, Cardiovascular System & Cardiology, business, MMM Investigators
Abstract

Elevated blood pressure remains the single biggest risk factor contributing to the global burden of disease and mortality. May Measurement Month is an annual global screening campaign aiming to improve awareness of blood pressure at the individual and population level. Adults ({greater than or equal to}18 years) recruited through opportunistic sampling were screened at sites in 92 countries during May 2019. Ideally three blood pressure readings were measured for each participant, and data on lifestyle factors and co-morbidities were collected. Hypertension was defined as a systolic BP {greater than or equal to} 140 mmHg, and/or a diastolic BP {greater than or equal to} 90 mmHg (mean of the second and third readings) or taking antihypertensive medication. When necessary, multiple imputation was used to estimate participants' mean blood pressure. Mixed-effects models were used to evaluate associations between blood pressure and participant characteristics. Of 1,508,130 screenees 482,273 (32.0%) had never had a blood pressure measurement before and 513,337 (34.0%) had hypertension, of whom 58.7% were aware and 54.7% were on antihypertensive medication. Of those on medication, 57.8% were controlled to

Published
2020

10. May Measurement Month 2017: an analysis of blood pressure screening results worldwide

Author

Thomas Beaney, Aletta E Schutte, Maciej Tomaszewski, Cono Ariti, Louise M Burrell, Rafael R Castillo, Fadi J Charchar, Albertino Damasceno, Ruan Kruger, Daniel T Lackland, Peter M Nilsson, Dorairaj Prabhakaran, Agustin J Ramirez, Markus P Schlaich, Jiguang Wang, Michael A Weber, Neil R Poulter, C Napiza-Granada, Ma. RC Sevilla, AA Atilano, DID Ona, A More, AP Jose, A Maheshwari, D Kondal, W Yu, W Li, S Xu, J Yu, H Zhang, B Widyantoro, Y Turana, TD Situmorang, Y Sofiatin, R Barack, H-J Lin, T-D Wang, W-J Chen, Y Sirenko, O Evstigneeva, E Negresku, ME Yousif, SA Medani, HM Beheiry, IA Ali, JM Zilberman, MJ Marin, PD Rodriguez, F Garcia-Vasquez, KE Kramoh, D Ekoua, P Lopez-Jaramillo, J Otero, G Sanchez, C Narvaez, JL Accini, R Hernandez-Hernandez, JA Octavio, I Morr, J Lopez-Rivera, D Ojji, A Arije, A Babatunte, KW Wahab, M Fernandes, SV Pereira, M Valentim, A Dzudie, S Kingue, DA Djomou Ngongang, EN Ogola, FA Barasa, B Gitura, F-T-N Malik, SR Choudhury, MA Al Mamun, VH Minh, NL Viet, S Cao Truong, C Ferri, G Parati, C Torlasco, C Borghi, FM Goma, C Syatalimi, PH Zelveian, E Barbosa, W Sebba Barroso, E Penaherrera, E Jarrin, A Yusufali, N Bazargani, B Tsinamdzgvrishvili, D Trapaidze, D Neupane, SR Mishra, J Jozwiak, J Malyszko, A Konradi, I Chazova, M Ishaq, F Memon, AM Heagerty, J Keitley, AJB Brady, JR Cockcroft, BJ McDonnell, F Lanas, Y-C Chia, H Ndhlovu, I Kiss, LM Ruilope, BF Ellenga Mbolla, AS Milhailidou, AJ Woodiwiss, S Perl, E Dolan, V Azevedo, L Garre, JG Boggia, VWY Lee, S Kowlessur, M Miglinas, D Sukackiene, RD Wainford, D Habonimana, T Masupe, J Ortellado, G Wuerzner, L Alcocer, G Burazeri, E Sanchez Delgado, D Lovic, CK Mondo, A Mostafa, SK Nadar, O Valdez Tiburcio, A Leiba, M Dorobantu, T De Backer, J Chifamba, G Stergiou, CR Nwokocha, S Sokolovic, AI Toure, KL Connell, NA Khan, D Burger, M De Carvalho Rodrigues, BK Kramer, RE Schmieder, T Unger, FS Wyss, NV Yameogo, H Beistline, JG Kenerson, B Alfonso, MH Olsen, M Soares, Beaney, T, Schutte, A, Tomaszewski, M, Ariti, C, Burrell, L, Castillo, R, Charchar, F, Damasceno, A, Kruger, R, Lackland, D, Nilsson, P, Prabhakaran, D, Ramirez, A, Schlaich, M, Wang, J, Weber, M, Poulter, N, Napiza-Granada, C, Sevilla, M, Atilano, A, Ona, D, More, A, Jose, A, Maheshwari, A, Kondal, D, Yu, W, Li, W, Xu, S, Yu, J, Zhang, H, Widyantoro, B, Turana, Y, Situmorang, T, Sofiatin, Y, Barack, R, Lin, H, Wang, T, Chen, W, Sirenko, Y, Evstigneeva, O, Negresku, E, Yousif, M, Medani, S, Beheiry, H, Ali, I, Zilberman, J, Marin, M, Rodriguez, P, Garcia-Vasquez, F, Kramoh, K, Ekoua, D, Lopez-Jaramillo, P, Otero, J, Sanchez, G, Narvaez, C, Accini, J, Hernandez-Hernandez, R, Octavio, J, Morr, I, Lopez-Rivera, J, Ojji, D, Arije, A, Babatunte, A, Wahab, K, REIS FERNANDES, M, Pereira, S, Valentim, M, Dzudie, A, Kingue, S, Djomou Ngongang, D, Ogola, E, Barasa, F, Gitura, B, Malik, F, Choudhury, S, Al Mamun, M, Minh, V, Viet, N, Cao Truong, S, Ferri, C, Parati, G, Torlasco, C, Borghi, C, Goma, F, Syatalimi, C, Zelveian, P, Barbosa, E, Sebba Barroso, W, Penaherrera, E, Jarrin, E, Yusufali, A, Bazargani, N, Tsinamdzgvrishvili, B, Trapaidze, D, Neupane, D, Mishra, S, Jozwiak, J, Malyszko, J, Konradi, A, Chazova, I, Ishaq, M, Memon, F, Heagerty, A, Keitley, J, Brady, A, Cockcroft, J, Mcdonnell, B, Lanas, F, Chia, Y, Ndhlovu, H, Kiss, I, Ruilope, L, Ellenga Mbolla, B, Milhailidou, A, Woodiwiss, A, Perl, S, Dolan, E, Azevedo, V, Garre, L, Boggia, J, Lee, V, Kowlessur, S, Miglinas, M, Sukackiene, D, Wainford, R, Habonimana, D, Masupe, T, Ortellado, J, Wuerzner, G, Alcocer, L, Burazeri, G, Sanchez Delgado, E, Lovic, D, Mondo, C, Mostafa, A, Nadar, S, Valdez Tiburcio, O, Leiba, A, Dorobantu, M, De Backer, T, Chifamba, J, Stergiou, G, Nwokocha, C, Sokolovic, S, Toure, A, Connell, K, Khan, N, Burger, D, De Carvalho Rodrigues, M, Kramer, B, Schmieder, R, Unger, T, Wyss, F, Yameogo, N, Beistline, H, Kenerson, J, Alfonso, B, Olsen, M, Soares, M, and Thomas Beaney, Aletta E Schutte, Maciej Tomaszewski, Cono Ariti, Louise M Burrell, Rafael R Castillo, Fadi J Charchar, Albertino Damasceno, Ruan Kruger, Daniel T Lackland, Peter M Nilsson, Dorairaj Prabhakaran, Agustin J Ramirez, Markus P Schlaich, Jiguang Wang, Michael A Weber, Neil R Poulter, MMM Investigators, Claudio Borghi

Subjects
Adult, Male, AWARENESS, medicine.medical_specialty, Lydia Becker Institute, Adolescent, Cross-sectional study, Population, Blood Pressure, 030204 cardiovascular system & hematology, Global Health, Young Adult, 03 medical and health sciences, 0302 clinical medicine, ResearchInstitutes_Networks_Beacons/lydia_becker_institute_of_immunology_and_inflammation, Diabetes mellitus, MANAGEMENT, MMM Investigators, Humans, Mass Screening, Medicine, 030212 general & internal medicine, Imputation (statistics), Young adult, education, Volunteer, Mass screening, Public, Environmental & Occupational Health, Aged, Aged, 80 and over, prescription, education.field_of_study, Science & Technology, HYPERTENSION, business.industry, lcsh:Public aspects of medicine, Medicine (all), lcsh:RA1-1270, General Medicine, Middle Aged, medicine.disease, PREVALENCE, Anniversaries and Special Events, Cross-Sectional Studies, Blood pressure, Emergency medicine, Female, business, Life Sciences & Biomedicine
Abstract

Summary Background Increased blood pressure is the biggest contributor to the global burden of disease and mortality. Data suggest that less than half of the population with hypertension is aware of it. May Measurement Month was initiated to raise awareness of the importance of blood pressure and as a pragmatic interim solution to the shortfall in screening programmes. Methods This cross-sectional survey included volunteer adults (≥18 years) who ideally had not had their blood pressures measured in the past year. Each participant had their blood pressure measured three times and received a a questionnaire about demographic, lifestyle, and environmental factors. The primary objective was to raise awareness of blood pressure, measured by number of countries involved, number of people screened, and number of people who have untreated or inadequately treated hypertension (defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, or both, or on the basis of receiving antihypertensive medication). Multiple imputation was used to estimate the mean of the second and third blood pressure readings if these were not recorded. Measures of association were analysed using linear mixed models. Findings Data were collected from 1 201 570 individuals in 80 countries. After imputation, of the 1 128 635 individuals for whom a mean of the second and third readings was available, 393 924 (34·9%) individuals had hypertension. 153 905 (17·3%) of 888 616 individuals who were not receiving antihypertensive treatment were hypertensive, and 105 456 (46·3%) of the 227 721 individuals receiving treatment did not have controlled blood pressure. Significant differences in adjusted blood pressures and hypertension prevalence were apparent between regions. Adjusted blood pressure was higher in association with antihypertensive medication, diabetes, cerebrovascular disease, smoking, and alcohol consumption. Blood pressure was higher when measured on the right arm than on the left arm, and blood pressure was highest on Saturdays. Interpretation Inexpensive global screening of blood pressure is achievable using volunteers and convenience sampling. Pending the set-up of systematic surveillance systems worldwide, MMM will be repeated annually to raise awareness of blood pressure. Funding International Society of Hypertension, Centers for Disease Control and Prevention, Servier Pharmaceutical Co.

Published
2018

11. MASked-unconTrolled hypERtension management based on office BP or on ambulatory blood pressure measurement (MASTER) Study: a randomised controlled trial protocol

Author

George L. Bakris, Moo Yong Rhee, Richard J McManus, Konstantinos Tsioufis, Kushal Madan, Juan Eugenio Ochoa, Franco Cecchi, Paolo Palatini, Enrico Agabiti-Rosei, Davide Soranna, Paulina Wijnmaalen, Josep Redon, Alberto Zanchetti, Antonella Zambon, Roland E. Schmieder, Pietro Amedeo Modesti, Thomas Kahan, Sabine Perl, Alejandro de la Sierra, Maria Dorobantu, Thays Faria, Mónica Doménech, Bojan Jelaković, Giuseppe Mancia, Jeong Bae Park, Franco Veglio, Ramiro A. Sanchez, Gabriel Waisman, Enrique Rodilla Sala, Giovanna Branzi, Stefano Omboni, Dario Pellegrini, Alexandra Konradi, Yuqing Zhang, Maria Grazia Valsecchi, Nanfang Li, Yong Huo, Ji-Guang Wang, Marzena Chrostowska, Cristian Podoleanu, Nicolas Federico Renna, Stéphane Laurent, Gianfranco Parati, Giacomo Pucci, Milos Stojanovic, José A. Octavio, George S. Stergiou, Grzegorz Bilo, UCH. Departamento de Medicina (Extinguido), Producción Científica UCH 2018, UCH. Departamento de Medicina y Cirugía, Parati, G, Agabiti-Rosei, E, Bakris, G, Bilo, G, Branzi, G, Cecchi, F, Chrostowska, M, De la Sierra, A, Domenech, M, Dorobantu, M, Faria, T, Huo, Y, Jelaković, B, Kahan, T, Konradi, A, Laurent, S, Li, N, Madan, K, Mancia, G, Mcmanus, R, Modesti, P, Ochoa, J, Octavio, J, Omboni, S, Palatini, P, Park, J, Pellegrini, D, Perl, S, Podoleanu, C, Pucci, G, Redon, J, Renna, N, Rhee, M, Rodilla Sala, E, Sanchez, R, Schmieder, R, Soranna, D, Stergiou, G, Stojanovic, M, Tsioufis, K, Valsecchi, M, Veglio, F, Waisman, G, Wang, J, Wijnmaalen, P, Zambon, A, Zanchetti, A, and Zhang, Y

Subjects
HYPERTENSION MANAGEMENT, Hipertensión, masked uncontrolled hypertension, Enfermedades cardiovasculares - Pacientes - Factores de riesgo, office blood pressure, MASKED UNCONTROLLED HYPERTENSION, Medicina Clínica, Cardiovascular Medicine, 030204 cardiovascular system & hematology, AMBULATORY BLOOD PRESSURE MONITORING, law.invention, 0302 clinical medicine, Clinical trials, Randomized controlled trial, law, Blood Pressure Monitoring, Masked Hypertension, purl.org/becyt/ford/3.2 [https], Protocol, Multicenter Studies as Topic, 030212 general & internal medicine, Cardiovascular system - Diseases - Patients - Risk factors, Blood pressure, OFFICE BLOOD PRESSURE, Randomized Controlled Trials as Topic, Sistemas Cardíaco y Cardiovascular, General Medicine, Blood Pressure Monitoring, Ambulatory, 3. Good health, Cor Malalties, Echocardiography, Ambulatory, Hypertension, purl.org/becyt/ford/3 [https], Hipertensió, ambulatory blood pressure monitoring, hypertension, hypertension management, treated hypertensive patients, TREATED HYPERTENSIVE PATIENTS, medicine.medical_specialty, Ambulatory blood pressure, CIENCIAS MÉDICAS Y DE LA SALUD, Heart Ventricles, treated hypertensive patient, Pressió sanguínia, 03 medical and health sciences, medicine, Albuminuria, Humans, Antihypertensive Agents, Protocol (science), business.industry, Consolidated Standards of Reporting Trials, Presión sanguínea, Good clinical practice, Emergency medicine, business, Declaration of Helsinki, Assaigs clínics
Abstract

Introduction Masked uncontrolled hypertension (MUCH) carries an increased risk of cardiovascular (CV) complications and can be identified through combined use of office (O) and ambulatory (A) blood pressure (BP) monitoring (M) in treated patients. However, it is still debated whether the information carried by ABPM should be considered for MUCH management. Aim of the MASked-unconTrolled hypERtension management based on OBP or on ambulatory blood pressure measurement (MASTER) Study is to assess the impact on outcome of MUCH management based on OBPM or ABPM. Methods and analysis MASTER is a 4-year prospective, randomised, open-label, blinded-endpoint investigation. A total of 1240 treated hypertensive patients from about 40 secondary care clinical centres worldwide will be included -upon confirming presence of MUCH (repeated on treatment OBP

Published
2018

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