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2. 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, J, 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, J, 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, J, Muiesan, M, Nasr, E, Nilsson, P, Oliveras, A, Ormezzano, O, Paixão-Dias, V, Papadakis, I, Papadopoulos, D, Perl, S, Polónia, J, Pontremoli, R, Pucci, G, Robles, N, Rubin, S, Ruilope, L, Rump, L, 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, P, Veglio, F, Venzin, R, Viigimaa, M, Weber, T, Widimsky, J, Wuerzner, G, Zelveian, P, Zebekakis, P, Lueders, S, Persu, A, Kreutz, R, Vogt, L, 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, Vogt L., Halimi, J, 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, J, 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, J, Muiesan, M, Nasr, E, Nilsson, P, Oliveras, A, Ormezzano, O, Paixão-Dias, V, Papadakis, I, Papadopoulos, D, Perl, S, Polónia, J, Pontremoli, R, Pucci, G, Robles, N, Rubin, S, Ruilope, L, Rump, L, 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, P, Veglio, F, Venzin, R, Viigimaa, M, Weber, T, Widimsky, J, Wuerzner, G, Zelveian, P, Zebekakis, P, Lueders, S, Persu, A, Kreutz, R, Vogt, L, 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.

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

3. 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, J, 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, J, Fesler, P, Gaciong, Z, Gkaliagkousi, E, Gordin, D, Grassi, G, Grassos, C, Guerrot, D, Huart, J, Izzo, R, 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, J, Muiesan, M, Nasr, E, Nilsson, P, Oliveras, A, Ormezzano, O, Paixão-Dias, V, Papadakis, I, Papadopoulos, D, Perl, S, Polónia, J, Pontremoli, R, Pucci, G, Robles, N, Rubin, S, Ruilope, L, Rump, L, 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, R, Viigimaa, M, Weber, T, Widimsky, J, Wuerzner, G, Zelveian, P, Zebekakis, P, Lueders, S, Persu, A, Kreutz, R, Vogt, L, 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, Vogt L, Halimi, J, 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, J, Fesler, P, Gaciong, Z, Gkaliagkousi, E, Gordin, D, Grassi, G, Grassos, C, Guerrot, D, Huart, J, Izzo, R, 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, J, Muiesan, M, Nasr, E, Nilsson, P, Oliveras, A, Ormezzano, O, Paixão-Dias, V, Papadakis, I, Papadopoulos, D, Perl, S, Polónia, J, Pontremoli, R, Pucci, G, Robles, N, Rubin, S, Ruilope, L, Rump, L, 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, R, Viigimaa, M, Weber, T, Widimsky, J, Wuerzner, G, Zelveian, P, Zebekakis, P, Lueders, S, Persu, A, Kreutz, R, Vogt, L, 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

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.

Published
2024

6. The current best drug treatment for hypertensive heart failure with preserved ejection fraction

Author

Rist, A, Sevre, K, Wachtell, K, Devereux, R, Aurigemma, G, Smiseth, O, Kjeldsen, S, Julius, S, Pitt, B, Burnier, M, Kreutz, R, Oparil, S, Mancia, G, Zannad, F, Rist A., Sevre K., Wachtell K., Devereux R. B., Aurigemma G. P., Smiseth O. A., Kjeldsen S. E., Julius S., Pitt B., Burnier M., Kreutz R., Oparil S., Mancia G., Zannad F., Rist, A, Sevre, K, Wachtell, K, Devereux, R, Aurigemma, G, Smiseth, O, Kjeldsen, S, Julius, S, Pitt, B, Burnier, M, Kreutz, R, Oparil, S, Mancia, G, Zannad, F, Rist A., Sevre K., Wachtell K., Devereux R. B., Aurigemma G. P., Smiseth O. A., Kjeldsen S. E., Julius S., Pitt B., Burnier M., Kreutz R., Oparil S., Mancia G., and Zannad F.

Abstract

More than 90 % of patients developing heart failure (HF) have hypertension. The most frequent concomitant conditions are type-2 diabetes mellitus, obesity, atrial fibrillation, and coronary disease. HF outcome research focuses on decreasing mortality and preventing hospitalization for worsening HF syndrome. All drugs that decrease these HF endpoints lower blood pressure. Current drug treatments for HF are (i) angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor neprilysin inhibitors, (ii) selected beta-blockers, (iii) steroidal and non-steroidal mineralocorticoid receptor antagonists, and (iv) sodium-glucose cotransporter 2 inhibitors. For various reasons, these drug treatments were first studied in HF patients with a reduced ejection fraction (HFrEF). Subsequently, they have been investigated in HF patients with a preserved left ventricular ejection fraction (LVEF, HFpEF) of mostly hypertensive etiology, and with modest benefits largely assessed on top of background treatment with the drugs already proven effective in HFrEF. Additionally, diuretics are given on symptomatic indications. Patients with HFpEF may have diastolic dysfunction but also systolic dysfunction visualized by lack of longitudinal shortening. Considering the totality of evidence and the overall need for antihypertensive treatment and/or treatment of hypertensive complications in almost all HF patients, the principal drug treatment of HF appears to be the same regardless of LVEF. Rather than LVEF-guided treatment of HF, treatment of HF should be directed by symptoms (related to the level of fluid retention), signs (tachycardia), severity (NYHA functional class), and concomitant diseases and conditions. All HF patients should be given all the drug classes mentioned above if well tolerated.

Published
2024

8. 2024 European Society of Hypertension clinical practice guidelines for the management of arterial hypertension

Author

Kreutz, R, Brunström, M, Burnier, M, Grassi, G, Januszewicz, A, Muiesan, M, Tsioufis, K, de Pinho, R, Albini, F, Boivin, J, Doumas, M, Nemcsik, J, Rodilla, E, Agabiti-Rosei, E, Algharably, E, Agnelli, G, Benetos, A, Hitij, J, Cífková, R, Cornelissen, V, Danser, A, Delles, C, Huelgas, R, Járai, Z, Palatini, P, Pathak, A, Persu, A, Polonia, J, Sarafidis, P, Stergiou, G, Thomopoulos, C, Wanner, C, Weber, T, Williams, B, Kjeldsen, S, Mancia, G, Kreutz, Reinhold, Brunström, Mattias, Burnier, Michel, Grassi, Guido, Januszewicz, Andrzej, Muiesan, Maria Lorenza, Tsioufis, Konstantinos, de Pinho, Rosa Maria, Albini, Fabio Lucio, Boivin, Jean-Marc, Doumas, Michalis, Nemcsik, János, Rodilla, Enrique, Agabiti-Rosei, Enrico, Algharably, Engi Abd Elhady, Agnelli, Giancarlo, Benetos, Athanase, Hitij, Jana Brguljan, Cífková, Renata, Cornelissen, Véronique, Danser, A H Jan, Delles, Christian, Huelgas, Ricardo Gómez, Járai, Zoltán, Palatini, Paolo, Pathak, Atul, Persu, Alexandre, Polonia, Jorge, Sarafidis, Pantelis, Stergiou, George, Thomopoulos, Costas, Wanner, Christoph, Weber, Thomas, Williams, Bryan, Kjeldsen, Sverre E, Mancia, Giuseppe, Kreutz, R, Brunström, M, Burnier, M, Grassi, G, Januszewicz, A, Muiesan, M, Tsioufis, K, de Pinho, R, Albini, F, Boivin, J, Doumas, M, Nemcsik, J, Rodilla, E, Agabiti-Rosei, E, Algharably, E, Agnelli, G, Benetos, A, Hitij, J, Cífková, R, Cornelissen, V, Danser, A, Delles, C, Huelgas, R, Járai, Z, Palatini, P, Pathak, A, Persu, A, Polonia, J, Sarafidis, P, Stergiou, G, Thomopoulos, C, Wanner, C, Weber, T, Williams, B, Kjeldsen, S, Mancia, G, Kreutz, Reinhold, Brunström, Mattias, Burnier, Michel, Grassi, Guido, Januszewicz, Andrzej, Muiesan, Maria Lorenza, Tsioufis, Konstantinos, de Pinho, Rosa Maria, Albini, Fabio Lucio, Boivin, Jean-Marc, Doumas, Michalis, Nemcsik, János, Rodilla, Enrique, Agabiti-Rosei, Enrico, Algharably, Engi Abd Elhady, Agnelli, Giancarlo, Benetos, Athanase, Hitij, Jana Brguljan, Cífková, Renata, Cornelissen, Véronique, Danser, A H Jan, Delles, Christian, Huelgas, Ricardo Gómez, Járai, Zoltán, Palatini, Paolo, Pathak, Atul, Persu, Alexandre, Polonia, Jorge, Sarafidis, Pantelis, Stergiou, George, Thomopoulos, Costas, Wanner, Christoph, Weber, Thomas, Williams, Bryan, Kjeldsen, Sverre E, and Mancia, Giuseppe

Published
2024

9. The impact of the COVID-19 Pandemic on hypertension phenotypes (ESH ABPM COVID-19 study)

Author

Ostrowska, A, Wojciechowska, W, Rajzer, M, Weber, T, Bursztyn, M, Persu, A, Stergiou, G, Kiełbasa, G, Chrostowska, M, Doumas, M, Parati, G, Bilo, G, Grassi, G, Mancia, G, Januszewicz, A, Kreutz, R, Narkiewicz, K, Dubiela, A, Imprialos, K, Stavropoulos, K, de Freminville, J, Azizi, M, Cunha, P, Lewandowski, J, Strzelczyk, J, Wuerzner, G, Gosk-Przybyłek, M, Szwęch, E, Prejbisz, A, Van der Niepen, P, Kahan, T, Jekell, A, Spaak, J, Tsioufis, K, Ehret, G, Doroszko, A, Kubalski, P, Polonia, J, Styczkiewicz, K, Styczkiewicz, M, Mazur, S, Veglio, F, Rabbia, F, Eula, E, Águila, F, Sarzani, R, Spannella, F, Jarai, Z, Papadopoulos, D, Sublet, M, Grassos, C, Kahrimanidis, I, Gkaliagkousi, E, Triantafyllou, A, Grodzicki, T, Wizner, B, Seweryn, A, Moczulska, B, Ntineri, A, Robles, N, Widmiski, J, Zbroch, E, Ostrowska, Aleksandra, Wojciechowska, Wiktoria, Rajzer, Marek, Weber, Thomas, Bursztyn, Michael, Persu, Alexandre, Stergiou, George, Kiełbasa, Grzegorz, Chrostowska, Marzena, Doumas, Michaelis, Parati, Gianfranco, Bilo, Grzegorz, Grassi, Guido, Mancia, Giuseppe, Januszewicz, Andrzej, Kreutz, Reinhold, Narkiewicz, Krzysztof, Dubiela, Andżelina, Imprialos, Konstantinos, Stavropoulos, Konstantinos, de Freminville, Jean-Baptiste, Azizi, Michel, Cunha, Pedro Guimarães, Lewandowski, Jacek, Strzelczyk, Jakub, Wuerzner, Gregoire, Gosk-Przybyłek, Maria, Szwęch, Elżbieta, Prejbisz, Aleksander, Van der Niepen, Patricia, Kahan, Thomas, Jekell, Andreas, Spaak, Jonas, Tsioufis, Konstantinos, Ehret, Georg, Doroszko, Adrian, Kubalski, Piotr, Polonia, Jorge, Styczkiewicz, Katarzyna, Styczkiewicz, Marek, Mazur, Stanisław, Veglio, Franco, Rabbia, Franco, Eula, Elisabetta, Águila, Fernando Jaen, Sarzani, Riccardo, Spannella, Francesco, Jarai, Zoltan, Papadopoulos, Dimitrios, Sublet, Marilucy Lopez –, Grassos, Charalampos, Kahrimanidis, Ioannis, Gkaliagkousi, Eugenia, Triantafyllou, Areti, Grodzicki, Tomasz, Wizner, Barbara, Seweryn, Aleksandra, Moczulska, Beata, Ntineri, Angeliki, Robles, Nicolas Roberto, Widmiski, Jiri, Zbroch, Edyta, Ostrowska, A, Wojciechowska, W, Rajzer, M, Weber, T, Bursztyn, M, Persu, A, Stergiou, G, Kiełbasa, G, Chrostowska, M, Doumas, M, Parati, G, Bilo, G, Grassi, G, Mancia, G, Januszewicz, A, Kreutz, R, Narkiewicz, K, Dubiela, A, Imprialos, K, Stavropoulos, K, de Freminville, J, Azizi, M, Cunha, P, Lewandowski, J, Strzelczyk, J, Wuerzner, G, Gosk-Przybyłek, M, Szwęch, E, Prejbisz, A, Van der Niepen, P, Kahan, T, Jekell, A, Spaak, J, Tsioufis, K, Ehret, G, Doroszko, A, Kubalski, P, Polonia, J, Styczkiewicz, K, Styczkiewicz, M, Mazur, S, Veglio, F, Rabbia, F, Eula, E, Águila, F, Sarzani, R, Spannella, F, Jarai, Z, Papadopoulos, D, Sublet, M, Grassos, C, Kahrimanidis, I, Gkaliagkousi, E, Triantafyllou, A, Grodzicki, T, Wizner, B, Seweryn, A, Moczulska, B, Ntineri, A, Robles, N, Widmiski, J, Zbroch, E, Ostrowska, Aleksandra, Wojciechowska, Wiktoria, Rajzer, Marek, Weber, Thomas, Bursztyn, Michael, Persu, Alexandre, Stergiou, George, Kiełbasa, Grzegorz, Chrostowska, Marzena, Doumas, Michaelis, Parati, Gianfranco, Bilo, Grzegorz, Grassi, Guido, Mancia, Giuseppe, Januszewicz, Andrzej, Kreutz, Reinhold, Narkiewicz, Krzysztof, Dubiela, Andżelina, Imprialos, Konstantinos, Stavropoulos, Konstantinos, de Freminville, Jean-Baptiste, Azizi, Michel, Cunha, Pedro Guimarães, Lewandowski, Jacek, Strzelczyk, Jakub, Wuerzner, Gregoire, Gosk-Przybyłek, Maria, Szwęch, Elżbieta, Prejbisz, Aleksander, Van der Niepen, Patricia, Kahan, Thomas, Jekell, Andreas, Spaak, Jonas, Tsioufis, Konstantinos, Ehret, Georg, Doroszko, Adrian, Kubalski, Piotr, Polonia, Jorge, Styczkiewicz, Katarzyna, Styczkiewicz, Marek, Mazur, Stanisław, Veglio, Franco, Rabbia, Franco, Eula, Elisabetta, Águila, Fernando Jaen, Sarzani, Riccardo, Spannella, Francesco, Jarai, Zoltan, Papadopoulos, Dimitrios, Sublet, Marilucy Lopez –, Grassos, Charalampos, Kahrimanidis, Ioannis, Gkaliagkousi, Eugenia, Triantafyllou, Areti, Grodzicki, Tomasz, Wizner, Barbara, Seweryn, Aleksandra, Moczulska, Beata, Ntineri, Angeliki, Robles, Nicolas Roberto, Widmiski, Jiri, and Zbroch, Edyta

Published
2024

10. The impact of the COVID-19 pandemic on blood pressure control in patients with treated hypertension-results of the European Society of Hypertension Study (ESH ABPM COVID-19 Study)

Author

Wojciechowska, W, Rajzer, M, Kreutz, R, Weber, T, Bursztyn, M, Persu, A, Stergiou, G, Parati, G, Bilo, G, Pac, A, Grassi, G, Mancia, G, Januszewicz, A, Wojciechowska, Wiktoria, Rajzer, Marek, Kreutz, Reinhold, Weber, Thomas, Bursztyn, Michael, Persu, Alexandre, Stergiou, George, Parati, Gianfranco, Bilo, Grzegorz, Pac, Agnieszka, Grassi, Guido, Mancia, Giuseppe, Januszewicz, Andrzej, Wojciechowska, W, Rajzer, M, Kreutz, R, Weber, T, Bursztyn, M, Persu, A, Stergiou, G, Parati, G, Bilo, G, Pac, A, Grassi, G, Mancia, G, Januszewicz, A, Wojciechowska, Wiktoria, Rajzer, Marek, Kreutz, Reinhold, Weber, Thomas, Bursztyn, Michael, Persu, Alexandre, Stergiou, George, Parati, Gianfranco, Bilo, Grzegorz, Pac, Agnieszka, Grassi, Guido, Mancia, Giuseppe, and Januszewicz, Andrzej

Abstract

Background: We aimed to determine the influence of coronavirus disease 2019 (COVID-19) pandemic on blood pressure (BP) control assessed by ambulatory blood pressure monitoring (ABPM). Methods: Office BP and ABPM data from two visits conducted within a 9-15 months interval were collected from patients treated for hypertension. In the prepandemic group, both visits took place before, while in the pandemic group, Visit-1 was done before and Visit-2 during the pandemic period. Results: Of 1811 collected patients 191 were excluded because they did not meet the required ABPM time frames. Thus, the study comprised 704 patients from the pandemic and 916 from the prepandemic group. Groups did not differ in sex, age, duration of hypertension, frequency of first line antihypertensive drug use and mean 24 h BP on Visit-1. The prevalence of sustained uncontrolled hypertension was similar in both groups. On Visit-2 mean 24 h BP, daytime and nighttime systolic BP and diastolic BP were higher in the pandemic compared to the prepandemic group (P < 0.034). The prevalence of sustained uncontrolled hypertension on Visit-2 was higher in the pandemic than in the prepandemic group [0.29 (95% confidence interval (95% CI): 0.26-0.33) vs. 0.25 (95% CI: 0.22-0.28), P < 0.037]. In multivariable adjusted analyses a significant difference in BP visit-to-visit change was observed, with a more profound decline in BP between visits in the prepandemic group. Conclusions: This study using ABPM indicates a negative impact of the COVID-19 pandemic on BP control. It emphasizes the need of developing strategies to maintain BP control during a pandemic such as the one induced by COVID-19.

Published
2024

11. Why were the 2023 Guidelines of the European Society of Hypertension not developed as Joint Guidelines together with the European Society of Cardiology?

Author

Kreutz, R, Azizi, M, Grassi, G, Januszewicz, A, Kahan, T, Lurbe, E, Polonia, J, Tsioufis, K, Weber, T, Williams, B, Mancia, G, Kreutz, Reinhold, Azizi, Michel, Grassi, Guido, Januszewicz, Andrzej, Kahan, Thomas, Lurbe, Empar, Polonia, Jorge, Tsioufis, Konstantinos, Weber, Thomas, Williams, Bryan, Mancia, Giuseppe, Kreutz, R, Azizi, M, Grassi, G, Januszewicz, A, Kahan, T, Lurbe, E, Polonia, J, Tsioufis, K, Weber, T, Williams, B, Mancia, G, Kreutz, Reinhold, Azizi, Michel, Grassi, Guido, Januszewicz, Andrzej, Kahan, Thomas, Lurbe, Empar, Polonia, Jorge, Tsioufis, Konstantinos, Weber, Thomas, Williams, Bryan, and Mancia, Giuseppe

Published
2024

12. Rationale of treatment recommendations in the 2023 ESH hypertension guidelines

Author

Mancia, G, Brunström, M, Burnier, M, Grassi, G, Januszewicz, A, Muiesan, M, Tsioufis, K, Kjeldsen, S, Kreutz, R, Mancia, Giuseppe, Brunström, Mattias, Burnier, Michel, Grassi, Guido, Januszewicz, Andrzej, Muiesan, Maria Lorenza, Tsioufis, Konstantinos, Kjeldsen, Sverre E, Kreutz, Reinhold, Mancia, G, Brunström, M, Burnier, M, Grassi, G, Januszewicz, A, Muiesan, M, Tsioufis, K, Kjeldsen, S, Kreutz, R, Mancia, Giuseppe, Brunström, Mattias, Burnier, Michel, Grassi, Guido, Januszewicz, Andrzej, Muiesan, Maria Lorenza, Tsioufis, Konstantinos, Kjeldsen, Sverre E, and Kreutz, Reinhold

Published
2024

13. Assessment and Management of Patients with Obesity and Hypertension in European Society of Hypertension Excellence Centres. A survey from the ESH Working Group on Diabetes and Metabolic Risk Factors

Author

Antza, C, Grassi, G, Weber, T, Persu, A, Jordan, J, Nilsson, P, Redon, J, Stabouli, S, Kreutz, R, Kotsis, V, Antza, Christina, Grassi, Guido, Weber, Thomas, Persu, Alexandre, Jordan, Jens, Nilsson, Peter M, Redon, Josep, Stabouli, Stella, Kreutz, Reinhold, Kotsis, Vasilios, Antza, C, Grassi, G, Weber, T, Persu, A, Jordan, J, Nilsson, P, Redon, J, Stabouli, S, Kreutz, R, Kotsis, V, Antza, Christina, Grassi, Guido, Weber, Thomas, Persu, Alexandre, Jordan, Jens, Nilsson, Peter M, Redon, Josep, Stabouli, Stella, Kreutz, Reinhold, and Kotsis, Vasilios

Abstract

Background: Healthcare providers are faced with an increasing number of patients with obesity and arterial hypertension. Preventing obesity-associated hypertension and appropriately managing patients with established disease are both important. Hence, the aim of our study was to evaluate the clinical care of patients with obesity and hypertension among ESH Excellence Centres (ECs). Methods: We conducted a cross-sectional, international 30-item survey through e-mails. Results: In total, 70 representatives of ECs participated (78% men) with 66% of them practicing medicine for more than 30 years and working in well-equipped clinics. Most were internists (41%) and cardiologists (37%) and 73% reported training on the management of obese patients with hypertension. A majority weigh their patients (77%) and evaluate patients for sleep disorders (93%). However, only 47% spend more than 5min to advise for lifestyle modification in general, 59% for weight loss, 56% for salt intake and 64% for exercise. Finally, a minority of participants ask patients if they like their body (6%) or about previous attempts to lose weight (28%), evaluate 24h urinary sodium excretion rate (22%) and provide written (15%) or personalized (10%) dietary advices. If the patient suffers also from type 2 diabetes mellitus, 66% switch treatment to GLP1 receptor agonists and 60% to SGLT2 inhibitors. Conclusion: Most clinicians in ESH ECs are well educated regarding obesity-associated hypertension, and clinics are sufficiently equipped to manage these patients, as well. However, several deficits were reported regarding efforts to address and implement obesity specific aspects and interventions to improve care in patients with obesity and hypertension.

Published
2024

15. Assessment and management of exaggerated blood pressure response to standing and orthostatic hypertension: consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability

Author

Palatini, P, Kollias, A, Saladini, F, Asmar, R, Bilo, G, Kyriakoulis, K, Parati, G, Stergiou, G, Grassi, G, Kreutz, R, Mancia, G, Jordan, J, Biaggioni, I, de la Sierra, A, Kyriakoulis, KG, Stergiou, GS, Palatini, P, Kollias, A, Saladini, F, Asmar, R, Bilo, G, Kyriakoulis, K, Parati, G, Stergiou, G, Grassi, G, Kreutz, R, Mancia, G, Jordan, J, Biaggioni, I, de la Sierra, A, Kyriakoulis, KG, and Stergiou, GS

Abstract

Recent evidence suggests that an exaggerated blood pressure (BP) response to standing (ERTS) is associated with an increased risk of adverse outcomes, both in young and old individuals. In addition, ERTS has been shown to be an independent predictor of masked hypertension. In the vast majority of studies reporting on the prognostic value of orthostatic hypertension (OHT), the definition was based only on systolic office BP measurements. This consensus statement provides recommendations on the assessment and management of individuals with ERTS and/or OHT. ERTS is defined as an orthostatic increase in SBP at least 20 mmHg and OHT as an ERTS with standing SBP at least 140 mmHg. This statement recommends a standardized methodology to assess ERTS, by considering body and arm position, and the number and timing of BP measurements. ERTS/OHT should be confirmed in a second visit, to account for its limited reproducibility. The second assessment should evaluate BP changes from the supine to the standing posture. Ambulatory BP monitoring is recommended in most individuals with ERTS/OHT, especially if they have high-normal seated office BP. Implementation of lifestyle changes and close follow-up are recommended in individuals with ERTS/OHT and normotensive seated office BP. Whether antihypertensive treatment should be administered in the latter is unknown. Hypertensive patients with ERTS/OHT should be managed as any other hypertensive patient. Standardized standing BP measurement should be implemented in future epidemiological and interventional studies.

Published
2024

16. TIME to face the reality about evening dosing of antihypertensive drugs in hypertension

Author

Kjeldsen, S, Egan, B, Narkiewicz, K, Kreutz, R, Burnier, M, Oparil, S, Mancia, G, Kjeldsen S. E., Egan B. M., Narkiewicz K., Kreutz R., Burnier M., Oparil S., Mancia G., Kjeldsen, S, Egan, B, Narkiewicz, K, Kreutz, R, Burnier, M, Oparil, S, Mancia, G, Kjeldsen S. E., Egan B. M., Narkiewicz K., Kreutz R., Burnier M., Oparil S., and Mancia G.

Published
2023

17. Key questions regarding the SYMPLICITY HTN-3 trial

Author

Kjeldsen, S, Burnier, M, Narkiewicz, K, Kreutz, R, Mancia, G, Kjeldsen S. E., Burnier M., Narkiewicz K., Kreutz R., Mancia G., Kjeldsen, S, Burnier, M, Narkiewicz, K, Kreutz, R, Mancia, G, Kjeldsen S. E., Burnier M., Narkiewicz K., Kreutz R., and Mancia G.

Published
2023

18. Perspectives on improving blood pressure control to reduce the clinical and economic burden of hypertension

Author

Mancia, G, Cappuccio, F, Burnier, M, Coca, A, Persu, A, Borghi, C, Kreutz, R, Sanner, B, Mancia G., Cappuccio F. P., Burnier M., Coca A., Persu A., Borghi C., Kreutz R., Sanner B., Mancia, G, Cappuccio, F, Burnier, M, Coca, A, Persu, A, Borghi, C, Kreutz, R, Sanner, B, Mancia G., Cappuccio F. P., Burnier M., Coca A., Persu A., Borghi C., Kreutz R., and Sanner B.

Abstract

The clinical and economic burden of hypertension is high and continues to increase globally. Uncontrolled hypertension has severe but avoidable long-term consequences, including cardiovascular diseases, which are among the most burdensome and most preventable conditions in Europe. Yet, despite clear guidelines on screening, diagnosis and management of hypertension, a large proportion of patients remain undiagnosed or undertreated. Low adherence and persistence are common, exacerbating the issue of poor blood pressure (BP) control. Although current guidelines provide clear direction, implementation is hampered by barriers at the patient-, physician- and healthcare system levels. Underestimation of the impact of uncontrolled hypertension and limited health literacy lead to low adherence and persistence among patients, treatment inertia among physicians and a lack of decisive healthcare system action. Many options to improve BP control are available or under investigation. Patients would benefit from targeted health education, improved BP measurement, individualized treatment or simplified treatment regimens through single-pill combinations. For physicians, increasing awareness of the burden of hypertension, as well as offering training on monitoring and optimal management and provision of the necessary time to collaboratively engage with patients would be useful. Healthcare systems should establish nationwide strategies for hypertension screening and management. Furthermore, there is an unmet need to implement more comprehensive BP measurements to optimize management. In conclusion, an integrative, patient-focused, multimodal multidisciplinary approach to the management of hypertension by clinicians, payers and policymakers, involving patients, is required to achieve long-term improvements in population health and cost-efficiency for healthcare systems.

Published
2023

19. International Consensus on Standardized Clinic Blood Pressure Measurement – A Call to Action

Author

Cheung, A, Whelton, P, Muntner, P, Schutte, A, Moran, A, Williams, B, Sarafidis, P, Chang, T, Daskalopoulou, S, Flack, J, Jennings, G, Juraschek, S, Kreutz, R, Mancia, G, Nesbitt, S, Ordunez, P, Padwal, R, Persu, A, Rabi, D, Schlaich, M, Stergiou, G, Tobe, S, Tomaszewski, M, Williams, K, Mann, J, Cheung A. K., Whelton P. K., Muntner P., Schutte A. E., Moran A. E., Williams B., Sarafidis P., Chang T. I., Daskalopoulou S. S., Flack J. M., Jennings G., Juraschek S. P., Kreutz R., Mancia G., Nesbitt S., Ordunez P., Padwal R., Persu A., Rabi D., Schlaich M. P., Stergiou G. S., Tobe S. W., Tomaszewski M., Williams K. A., Mann J. F. E., Cheung, A, Whelton, P, Muntner, P, Schutte, A, Moran, A, Williams, B, Sarafidis, P, Chang, T, Daskalopoulou, S, Flack, J, Jennings, G, Juraschek, S, Kreutz, R, Mancia, G, Nesbitt, S, Ordunez, P, Padwal, R, Persu, A, Rabi, D, Schlaich, M, Stergiou, G, Tobe, S, Tomaszewski, M, Williams, K, Mann, J, Cheung A. K., Whelton P. K., Muntner P., Schutte A. E., Moran A. E., Williams B., Sarafidis P., Chang T. I., Daskalopoulou S. S., Flack J. M., Jennings G., Juraschek S. P., Kreutz R., Mancia G., Nesbitt S., Ordunez P., Padwal R., Persu A., Rabi D., Schlaich M. P., Stergiou G. S., Tobe S. W., Tomaszewski M., Williams K. A., and Mann J. F. E.

Published
2023

20. Ambulatory blood pressure monitoring in treated patients with hypertension in the COVID-19 pandemic - The study of European society of hypertension (ESH ABPM COVID-19 study)

Author

Wojciechowska, W, Rajzer, M, Weber, T, Prejbisz, A, Dobrowolski, P, Ostrowska, A, Bilo, G, Mancia, G, Kreutz, R, Januszewicz, A, Wojciechowska W., Rajzer M., Weber T., Prejbisz A., Dobrowolski P., Ostrowska A., Bilo G., Mancia G., Kreutz R., Januszewicz A., Wojciechowska, W, Rajzer, M, Weber, T, Prejbisz, A, Dobrowolski, P, Ostrowska, A, Bilo, G, Mancia, G, Kreutz, R, Januszewicz, A, Wojciechowska W., Rajzer M., Weber T., Prejbisz A., Dobrowolski P., Ostrowska A., Bilo G., Mancia G., Kreutz R., and Januszewicz A.

Abstract

Purpose: The coronavirus disease 2019 (COVID-19) pandemic and the subsequent lockdown profoundly affected almost all aspects of daily life including health services worldwide. The established risk factors for increased blood pressure (BP) and hypertension may also demonstrate significant changes during the pandemic. This study aims to determine the impact of the COVID-19 pandemic on BP control and BP phenotypes as assessed with 24-hour ambulatory BP monitoring (ABPM). Materials and Methods: This is a multi-centre, observational, retrospective and comparative study involving Excellence Centres of the European Society of Hypertension across Europe. Along with clinical data and office BP, ABPM recordings will be collected in adult patients with treated arterial hypertension. There will be two groups in the study: Group 1 will consist of participants who have undergone two ABPM recordings - the second one occurring during the COVID-19 pandemic, i.e. after March 2020, and the first one 9–15 months prior to the second. Participants in Group 2 will have two repeated ABPM recordings - both performed before the pandemic within a similar 9–15 month interval between the recordings. Within each group, we will analyse and compare BP variables and phenotypes (including averaged daytime and night-time BP, BP variability, dipper and non-dipper status, white-coat and masked hypertension) between the two respective ABPM recordings and compare these changes between the two groups. The target sample size will amount to least 590 participants in each of the study groups, which means a total of at least 2360 ABPM recordings overall. Expected outcomes: As a result, we expect to identify the impact of a COVID-19 pandemic on blood pressure control and the quality of medical care in order to develop the strategy to control cardiovascular risk factors during unpredictable global events.

Published
2023

21. Blood pressure variability: methodological aspects, clinical relevance and practical indications for management - a European Society of Hypertension position paper ∗

Author

Parati, G, Bilo, G, Kollias, A, Pengo, M, Ochoa, J, Castiglioni, P, Stergiou, G, Mancia, G, Asayama, K, Asmar, R, Avolio, A, Caiani, E, De La Sierra, A, Dolan, E, Grillo, A, Guzik, P, Hoshide, S, Head, G, Imai, Y, Juhanoja, E, Kahan, T, Kario, K, Kotsis, V, Kreutz, R, Kyriakoulis, K, Li, Y, Manios, E, Mihailidou, A, Modesti, P, Omboni, S, Palatini, P, Persu, A, Protogerou, A, Saladini, F, Salvi, P, Sarafidis, P, Torlasco, C, Veglio, F, Vlachopoulos, C, Zhang, Y, Parati G., Bilo G., Kollias A., Pengo M., Ochoa J. E., Castiglioni P., Stergiou G. S., Mancia G., Asayama K., Asmar R., Avolio A., Caiani E. G., De La Sierra A., Dolan E., Grillo A., Guzik P., Hoshide S., Head G. A., Imai Y., Juhanoja E., Kahan T., Kario K., Kotsis V., Kreutz R., Kyriakoulis K. G., Li Y., Manios E., Mihailidou A. S., Modesti P. A., Omboni S., Palatini P., Persu A., Protogerou A. D., Saladini F., Salvi P., Sarafidis P., Torlasco C., Veglio F., Vlachopoulos C., Zhang Y., Parati, G, Bilo, G, Kollias, A, Pengo, M, Ochoa, J, Castiglioni, P, Stergiou, G, Mancia, G, Asayama, K, Asmar, R, Avolio, A, Caiani, E, De La Sierra, A, Dolan, E, Grillo, A, Guzik, P, Hoshide, S, Head, G, Imai, Y, Juhanoja, E, Kahan, T, Kario, K, Kotsis, V, Kreutz, R, Kyriakoulis, K, Li, Y, Manios, E, Mihailidou, A, Modesti, P, Omboni, S, Palatini, P, Persu, A, Protogerou, A, Saladini, F, Salvi, P, Sarafidis, P, Torlasco, C, Veglio, F, Vlachopoulos, C, Zhang, Y, Parati G., Bilo G., Kollias A., Pengo M., Ochoa J. E., Castiglioni P., Stergiou G. S., Mancia G., Asayama K., Asmar R., Avolio A., Caiani E. G., De La Sierra A., Dolan E., Grillo A., Guzik P., Hoshide S., Head G. A., Imai Y., Juhanoja E., Kahan T., Kario K., Kotsis V., Kreutz R., Kyriakoulis K. G., Li Y., Manios E., Mihailidou A. S., Modesti P. A., Omboni S., Palatini P., Persu A., Protogerou A. D., Saladini F., Salvi P., Sarafidis P., Torlasco C., Veglio F., Vlachopoulos C., and Zhang Y.

Abstract

Blood pressure is not a static parameter, but rather undergoes continuous fluctuations over time, as a result of the interaction between environmental and behavioural factors on one side and intrinsic cardiovascular regulatory mechanisms on the other side. Increased blood pressure variability (BPV) may indicate an impaired cardiovascular regulation and may represent a cardiovascular risk factor itself, having been associated with increased all-cause and cardiovascular mortality, stroke, coronary artery disease, heart failure, end-stage renal disease, and dementia incidence. Nonetheless, BPV was considered only a research issue in previous hypertension management guidelines, because the available evidence on its clinical relevance presents several gaps and is based on heterogeneous studies with limited standardization of methods for BPV assessment.The aim of this position paper, with contributions from members of the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability and from a number of international experts, is to summarize the available evidence in the field of BPV assessment methodology and clinical applications and to provide practical indications on how to measure and interpret BPV in research and clinical settings based on currently available data. Pending issues and clinical and methodological recommendations supported by available evidence are also reported. The information provided by this paper should contribute to a better standardization of future studies on BPV, but should also provide clinicians with some indications on how BPV can be managed based on currently available data.

Published
2023

25. Diverse pharmacological properties, trial results, comorbidity prescribing and neural pathophysiology suggest European hypertension guideline downgrading of beta-blockers is not justified

Author

Esler, M, Kjeldsen, S, Pathak, A, Grassi, G, Kreutz, R, Mancia, G, Esler M, Kjeldsen SE, Pathak A, Grassi G, Kreutz R, Mancia G, Esler, M, Kjeldsen, S, Pathak, A, Grassi, G, Kreutz, R, Mancia, G, Esler M, Kjeldsen SE, Pathak A, Grassi G, Kreutz R, and Mancia G

Abstract

Beta-blockers have solid documentation in preventing cardiovascular complications in the treatment of hypertension; atenolol, metoprolol, oxprenolol and propranolol demonstrate proven cardiovascular prevention in hypertension mega-trials. Hypertension is characterised by activation of the sympathetic nervous system from early to late phases, which makes beta-blockers an appropriate treatment seen from a pathophysiological viewpoint, especially in patients with an elevated heart rate. Beta-blockers represent a heterogenous class of drugs with regard to both pharmacodynamic and pharmacokinetic properties. This position is manifest by reference to another clinical context, beta-blocker treatment of heart failure, where unequivocally there is no class effect (no similar benefit from all beta-blockers); there are good and less good beta-blockers for heart failure. Analogous differences in beta-blocker efficacy is also likely in hypertension. Beta-blockers are widely used for the treatment of diseases comorbid with hypertension, in approximately 50 different concomitant medical conditions that are frequent in patients with hypertension, leading to many de facto beta-blocker first choices in clinical practice. Thus, beta-blockers should be regarded as relevant first choices for hypertension in clinical practice, particularly if characterised by a long half-life, highly selective beta-1 blocking activity and no intrinsic agonist properties.SUMMARYBeta-blockers have solid documentation in preventing cardiovascular complications in the treatment of hypertension; atenolol, metoprolol, oxprenolol and propranolol demonstrate proven cardiovascular prevention in hypertension mega-trialsHypertension is characterised by activation of the sympathetic nervous system from early to late phases, which makes beta-blockers an appropriate treatment seen from a pathophysiological viewpoint, especially in patients with an elevated heart rateBeta-blockers represent a heterogenous class of drug

Published
2022

26. The rationale, protocol and preliminary results of the ESH ABPM COVID-19 study

Author

Wojciechowska, W, Rajzer, M, Weber, T, Prejbis, A, Dobrowolski, P, Ostrowska, A, Bilo, G, Mancia, G, Kreutz, R, Januszewicz, A, Wojciechowska W., Rajzer M., Weber T., Prejbis A., Dobrowolski P., Ostrowska A., Bilo G., Mancia G., Kreutz R., Januszewicz A., Wojciechowska, W, Rajzer, M, Weber, T, Prejbis, A, Dobrowolski, P, Ostrowska, A, Bilo, G, Mancia, G, Kreutz, R, Januszewicz, A, Wojciechowska W., Rajzer M., Weber T., Prejbis A., Dobrowolski P., Ostrowska A., Bilo G., Mancia G., Kreutz R., and Januszewicz A.

Published
2022

27. Do recent meta-analyses truly prove that treatment with blood pressure-lowering drugs is beneficial at any blood pressure value, no matter how low? A critical review

Author

Kreutz, R, Brunstrom, M, Thomopoulos, C, Carlberg, B, Mancia, G, Kreutz R., Brunstrom M., Thomopoulos C., Carlberg B., Mancia G., Kreutz, R, Brunstrom, M, Thomopoulos, C, Carlberg, B, Mancia, G, Kreutz R., Brunstrom M., Thomopoulos C., Carlberg B., and Mancia G.

Abstract

Current European guidelines for the management of hypertension and on cardiovascular disease prevention place the threshold for pharmacological treatment at a SBP level of 140 mmHg or above, with the exception of patients at very high risk (mainly because of coronary heart disease). This is in agreement with the current definition of hypertension, that is, the level of blood pressure at which the benefits of treatment outweigh the risks of treatment, as documented by clinical trials. This rationale and definition was recently challenged by meta-analyses using individual participant-level data from 48 randomized trials by the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC). The authors calculated for a fixed 5 mmHg pharmacological reduction of SBP an overall 10% risk reduction for major cardiovascular events. It was concluded that there was no reliable evidence of heterogeneity of treatment effects by baseline SBP categories; that the effect was independent from the presence of cardiovascular disease; applied also to old and very old individuals up to 84 years or beyond; and that BP-lowering was also beneficial in individuals with normal or high-normal SBP down to a baseline SBP less than 120 mmHg. In this report, we identify and discuss a number of shortcomings of the BPLTTC meta-analyses. In our view, the conclusions by the BPLTTC must be -together with accompanying suggestions to abandon the definition of hypertension - strongly rejected as they are not justified and may be harmful for cardiovascular health in individuals without hypertension.

Published
2022

28. Covid-19 associated reduction in hypertension-related diagnostic and therapeutic procedures in Excellence Centers of the European Society of Hypertension

Author

Weber, T, Amar, J, de Backer, T, Burkard, T, van der Giet, M, Gosse, P, Januszewicz, A, Kahan, T, Mancia, G, Mayer, C, Muiesan, M, Stergiou, G, Tsioufis, K, Vaisse, B, Kreutz, R, Weber T., Amar J., de Backer T., Burkard T., van der Giet M., Gosse P., Januszewicz A., Kahan T., Mancia G., Mayer C. C., Muiesan M. L., Stergiou G. S., Tsioufis K., Vaisse B., Kreutz R., Weber, T, Amar, J, de Backer, T, Burkard, T, van der Giet, M, Gosse, P, Januszewicz, A, Kahan, T, Mancia, G, Mayer, C, Muiesan, M, Stergiou, G, Tsioufis, K, Vaisse, B, Kreutz, R, Weber T., Amar J., de Backer T., Burkard T., van der Giet M., Gosse P., Januszewicz A., Kahan T., Mancia G., Mayer C. C., Muiesan M. L., Stergiou G. S., Tsioufis K., Vaisse B., and Kreutz R.

Abstract

Background: The Covid-19 pandemic necessitated a decrease in non-Covid-19 related diagnostic and therapeutic procedures in many countries. We explored the impact on tertiary hypertension care. Methods: We conducted an electronic survey regarding 6 key procedures in hypertension care within the Excellence Center network of the European Society of Hypertension. Results: Overall, 54 Excellence Centers from 18 European and 3 non-European countries participated. From 2019 to 2020, there were significant decreases in the median number per centre of ambulatory blood pressure monitorings (ABPM: 544/289 for 2019/2020), duplex ultrasound of renal arteries (Duplex RA: 88.5/55), computed tomographic/magnetic resonance imaging angiography of renal arteries (CT/MRI RA: 66/19.5), percutaneous angioplasties of renal arteries (PTA RA: 5/1), laboratory tests for catecholamines (116/67.5) and for renin/aldosterone (146/83.5) (p < 0.001 for all comparisons, respectively). While reductions in all assessed diagnostic and therapeutic procedures were observed in all annual 3-months periods in the comparisons between 2019 and 2020, the most pronounced reduction occurred between April and June 2020, which was the period of the first wave and the first lockdown in most affected countries. In this period, the median reductions in 2020, as compared to 2019, were 50.7% (ABPM), 47.1% (Duplex RA), 50% (CT/MRI RA), 57.1% (PTA RA), 46.9% (catecholamines) and 41.0% (renin/aldosterone), respectively. Overall differences in reduction between 3-month time intervals were statistically highly significant. Conclusion: Diagnostic and therapeutic procedures related to hypertension were dramatically reduced during the first year of the Covid-19 pandemic, with the largest reduction during the first lockdown. The long-term consequences regarding blood pressure control and, ultimately, cardiovascular events remain to be investigated.

Published
2022

30. Harmonization of the American College of Cardiology/American Heart Association and European Society of Cardiology/European Society of Hypertension Blood Pressure/Hypertension Guidelines: Comparisons, Reflections, and Recommendations

Author

Whelton, P, Carey, R, Mancia, G, Kreutz, R, Bundy, J, Williams, B, Whelton P. K., Carey R. M., Mancia G., Kreutz R., Bundy J. D., Williams B., Whelton, P, Carey, R, Mancia, G, Kreutz, R, Bundy, J, Williams, B, Whelton P. K., Carey R. M., Mancia G., Kreutz R., Bundy J. D., and Williams B.

Abstract

The 2017 American College of Cardiology/American Heart Association and 2018 European Society of Cardiology/European Society of Hypertension clinical practice guidelines for management of high blood pressure/hypertension are influential documents. Both guidelines are comprehensive, were developed using rigorous processes, and underwent extensive peer review. The most notable difference between the 2 guidelines is the blood pressure cut points recommended for the diagnosis of hypertension. There are also differences in the timing and intensity of treatment, with the American College of Cardiology/American Heart Association guideline recommending a somewhat more intensive approach. Overall, there is substantial concordance in the recommendations provided by the 2 guideline-writing committees, with greater congruity between them than their predecessors. Additional harmonization of future guidelines would help to underscore the commonality of their core recommendations and could serve to catalyze changes in practice that would lead to improved prevention, awareness, treatment, and control of hypertension, worldwide.

Published
2022

31. Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension

Author

Stergiou, G, Brunstrom, M, Macdonald, T, Kyriakoulis, K, Bursztyn, M, Khan, N, Bakris, G, Kollias, A, Menti, A, Muntner, P, Orias, M, Poulter, N, Shimbo, D, Williams, B, Adeoye, A, Damasceno, A, Korostovtseva, L, Li, Y, Muxfeldt, E, Zhang, Y, Mancia, G, Kreutz, R, Tomaszewski, M, Stergiou G., Brunstrom M., MacDonald T., Kyriakoulis K. G., Bursztyn M., Khan N., Bakris G., Kollias A., Menti A., Muntner P., Orias M., Poulter N., Shimbo D., Williams B., Adeoye A. M., Damasceno A., Korostovtseva L., Li Y., Muxfeldt E., Zhang Y., Mancia G., Kreutz R., Tomaszewski M., Stergiou, G, Brunstrom, M, Macdonald, T, Kyriakoulis, K, Bursztyn, M, Khan, N, Bakris, G, Kollias, A, Menti, A, Muntner, P, Orias, M, Poulter, N, Shimbo, D, Williams, B, Adeoye, A, Damasceno, A, Korostovtseva, L, Li, Y, Muxfeldt, E, Zhang, Y, Mancia, G, Kreutz, R, Tomaszewski, M, Stergiou G., Brunstrom M., MacDonald T., Kyriakoulis K. G., Bursztyn M., Khan N., Bakris G., Kollias A., Menti A., Muntner P., Orias M., Poulter N., Shimbo D., Williams B., Adeoye A. M., Damasceno A., Korostovtseva L., Li Y., Muxfeldt E., Zhang Y., Mancia G., Kreutz R., and Tomaszewski M.

Abstract

Antihypertensive drug therapy is one of the most efficient medical interventions for preventing disability and death globally. Most of the evidence supporting its benefits has been derived from outcome trials with morning dosing of medications. Accumulating evidence suggests an adverse prognosis associated with night-time hypertension, nondipping blood pressure (BP) profile and morning BP surge, with increased incidence of cardiovascular events during the first few morning hours. These observations provide justification for complete 24-h BP control as being the primary goal of antihypertensive treatment. Bedtime administration of antihypertensive drugs has also been proposed as a potentially more effective treatment strategy than morning administration. This Position Paper by the International Society of Hypertension reviewed the published evidence on the clinical relevance of the diurnal variation in BP and the timing of antihypertensive drug treatment, aiming to provide consensus recommendations for clinical practice. Eight published outcome hypertension studies involved bedtime dosing of antihypertensive drugs, and all had major methodological and/or other flaws and a high risk of bias in testing the impact of bedtime compared to morning treatment. Three ongoing, well designed, prospective, randomized controlled outcome trials are expected to provide high-quality data on the efficacy and safety of evening or bedtime versus morning drug dosing. Until that information is available, preferred use of bedtime drug dosing of antihypertensive drugs should not be routinely recommended in clinical practice. Complete 24-h control of BP should be targeted using readily available, long-acting antihypertensive medications as monotherapy or combinations administered in a single morning dose.

Published
2022

32. Methodological Aspects of Meta-Analyses Assessing the Effect of Blood Pressure-Lowering Treatment on Clinical Outcomes

Author

Brunstrom, M, Thomopoulos, C, Carlberg, B, Kreutz, R, Mancia, G, Brunstrom M., Thomopoulos C., Carlberg B., Kreutz R., Mancia G., Brunstrom, M, Thomopoulos, C, Carlberg, B, Kreutz, R, Mancia, G, Brunstrom M., Thomopoulos C., Carlberg B., Kreutz R., and Mancia G.

Abstract

Systematic reviews and meta-analyses are often considered the highest level of evidence, with high impact on clinical practice guidelines. The methodological literature on systematic reviews and meta-analyses is extensive and covers most aspects relevant to the design and interpretation of meta-analysis findings in general. Analyzing the effect of blood pressure-lowering on clinical outcomes poses several challenges over and above what is covered in the general literature, including how to combine placebo-controlled trials, target-trials, and comparative studies depending on the research question, how to handle the potential interaction between baseline blood pressure level, common comorbidities, and the estimated treatment effect, and how to consider different magnitudes of blood pressure reduction across trials. This review aims to address the most important methodological considerations, to guide the general reader of systematic reviews and meta-analyses within our field, and to help inform the design of future studies. Furthermore, we highlight issues where published meta-analyses have applied different analytical strategies and discuss pros and cons with different strategies.

Published
2022

34. Harmonization of the American College of Cardiology/American Heart Association and European Society of Cardiology/European Society of Hypertension Blood Pressure/Hypertension Guidelines

Author

Whelton, P, Carey, R, Mancia, G, Kreutz, R, Bundy, J, Williams, B, Whelton P. K., Carey R. M., Mancia G., Kreutz R., Bundy J. D., Williams B., Whelton, P, Carey, R, Mancia, G, Kreutz, R, Bundy, J, Williams, B, Whelton P. K., Carey R. M., Mancia G., Kreutz R., Bundy J. D., and Williams B.

Abstract

The 2017 American College of Cardiology/American Heart Association and 2018 European Society of Cardiology/European Society of Hypertension clinical practice guidelines for management of high blood pressure/hypertension are influential documents. Both guidelines are comprehensive, were developed using rigorous processes, and underwent extensive peer review. The most notable difference between the 2 guidelines is the blood pressure cut points recommended for the diagnosis of hypertension. There are also differences in the timing and intensity of treatment, with the American College of Cardiology/American Heart Association guideline recommending a somewhat more intensive approach. Overall, there is substantial concordance in the recommendations provided by the 2 guideline-writing committees, with greater congruity between them than their predecessors. Additional harmonization of future guidelines would help to underscore the commonality of their core recommendations and could serve to catalyze changes in practice that would lead to improved prevention, awareness, treatment, and control of hypertension, worldwide.

Published
2022

36. 2022 World Hypertension League, Resolve To Save Lives and International Society of Hypertension dietary sodium (salt) global call to action

Author

Campbell, NRC, Whelton, PK, Orias, M, Wainford, RD, Cappuccio, FP, Ide, N, Neal, B, Cohn, J, Cobb, LK, Webster, J, Trieu, K, He, FJ, McLean, RM, Blanco-Metzler, A, Woodward, M, Khan, N, Kokubo, Y, Nederveen, L, Arcand, J, MacGregor, GA, Owolabi, MO, Lisheng, L, Parati, G, Lackland, DT, Charchar, FJ, Williams, B, Tomaszewski, M, Romero, CA, Champagne, B, L'Abbe, MR, Weber, MA, Schlaich, MP, Fogo, A, Feigin, VL, Akinyemi, R, Inserra, F, Menon, B, Simas, M, Neves, MF, Hristova, K, Pullen, C, Pandeya, S, Ge, J, Jalil, JE, Wang, J-G, Wideimsky, J, Kreutz, R, Wenzel, U, Stowasser, M, Arango, M, Protogerou, A, Gkaliagkousi, E, Fuchs, FD, Patil, M, Chan, AW-K, Nemcsik, J, Tsuyuki, RT, Narasingan, SN, Sarrafzadegan, N, Ramos, ME, Yeo, N, Rakugi, H, Ramirez, AJ, Alvarez, G, Berbari, A, Kim, C-I, Ihm, S-H, Chia, Y-C, Unurjargal, T, Park, HK, Wahab, K, McGuire, H, Dashdorj, NJ, Ishaq, M, Ona, DID, Mercado-Asis, LB, Prejbisz, A, Leenaerts, M, Simao, C, Pinto, F, Almustafa, BA, Spaak, J, Farsky, S, Lovic, D, Zhang, X-H, Campbell, NRC, Whelton, PK, Orias, M, Wainford, RD, Cappuccio, FP, Ide, N, Neal, B, Cohn, J, Cobb, LK, Webster, J, Trieu, K, He, FJ, McLean, RM, Blanco-Metzler, A, Woodward, M, Khan, N, Kokubo, Y, Nederveen, L, Arcand, J, MacGregor, GA, Owolabi, MO, Lisheng, L, Parati, G, Lackland, DT, Charchar, FJ, Williams, B, Tomaszewski, M, Romero, CA, Champagne, B, L'Abbe, MR, Weber, MA, Schlaich, MP, Fogo, A, Feigin, VL, Akinyemi, R, Inserra, F, Menon, B, Simas, M, Neves, MF, Hristova, K, Pullen, C, Pandeya, S, Ge, J, Jalil, JE, Wang, J-G, Wideimsky, J, Kreutz, R, Wenzel, U, Stowasser, M, Arango, M, Protogerou, A, Gkaliagkousi, E, Fuchs, FD, Patil, M, Chan, AW-K, Nemcsik, J, Tsuyuki, RT, Narasingan, SN, Sarrafzadegan, N, Ramos, ME, Yeo, N, Rakugi, H, Ramirez, AJ, Alvarez, G, Berbari, A, Kim, C-I, Ihm, S-H, Chia, Y-C, Unurjargal, T, Park, HK, Wahab, K, McGuire, H, Dashdorj, NJ, Ishaq, M, Ona, DID, Mercado-Asis, LB, Prejbisz, A, Leenaerts, M, Simao, C, Pinto, F, Almustafa, BA, Spaak, J, Farsky, S, Lovic, D, and Zhang, X-H

Published
2023

38. THE IMPACT OF COVID-19 PANDEMIC ON BLOOD PRESSURE CONTROL IN PATIENTS WITH TREATED HYPERTENSION. RESULTS OF EUROPEAN SOCIETY OF HYPERTENSION STUDY (ESH ABPM COVID-19 STUDY)

Author

Wojciechowska, W, Rajzer, M, Weber, T, Chrostowska, M, Doumas, M, De Fréminville, J, Lewandowski, J, Wuerzner, G, Gosk-Przybylek, M, Parati, G, Van Der Niepen, P, Kahan, T, Bursztyn, M, Persu, A, Stergiou, G, Bilo, G, Grassi, G, Mancia, G, Kreutz, R, Januszewicz, A, De Fréminville, JB, Stergiou, GS, Wojciechowska, W, Rajzer, M, Weber, T, Chrostowska, M, Doumas, M, De Fréminville, J, Lewandowski, J, Wuerzner, G, Gosk-Przybylek, M, Parati, G, Van Der Niepen, P, Kahan, T, Bursztyn, M, Persu, A, Stergiou, G, Bilo, G, Grassi, G, Mancia, G, Kreutz, R, Januszewicz, A, De Fréminville, JB, and Stergiou, GS

Published
2023

39. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA)

Author

Mancia, G, Kreutz, R, Brunström, M, Burnier, M, Grassi, G, Januszewicz, A, Muiesan, M, Tsioufis, K, Agabiti-Rosei, E, Algharably, E, Azizi, M, Benetos, A, Borghi, C, Hitij, J, Cifkova, R, Coca, A, Cornelissen, V, Cruickshank, J, Cunha, P, Danser, A, Pinho, R, Delles, C, Dominiczak, A, Dorobantu, M, Doumas, M, Fernández-Alfonso, M, Halimi, J, Járai, Z, Jelaković, B, Jordan, J, Kuznetsova, T, Laurent, S, Lovic, D, Lurbe, E, Mahfoud, F, Manolis, A, Miglinas, M, Narkiewicz, K, Niiranen, T, Palatini, P, Parati, G, Pathak, A, Persu, A, Polonia, J, Redon, J, Sarafidis, P, Schmieder, R, Spronck, B, Stabouli, S, Stergiou, G, Taddei, S, Thomopoulos, C, Tomaszewski, M, Van de Borne, P, Wanner, C, Weber, T, Williams, B, Zhang, Z, Kjeldsen, S, Mancia, Giuseppe, Kreutz, Reinhold, Brunström, Mattias, Burnier, Michel, Grassi, Guido, Januszewicz, Andrzej, Muiesan, Maria Lorenza, Tsioufis, Konstantinos, Agabiti-Rosei, Enrico, Algharably, Engi Abd Elhady, Azizi, Michel, Benetos, Athanase, Borghi, Claudio, Hitij, Jana Brguljan, Cifkova, Renata, Coca, Antonio, Cornelissen, Veronique, Cruickshank, J Kennedy, Cunha, Pedro G, Danser, A H Jan, Pinho, Rosa Maria de, Delles, Christian, Dominiczak, Anna F, Dorobantu, Maria, Doumas, Michalis, Fernández-Alfonso, María S, Halimi, Jean-Michel, Járai, Zoltán, Jelaković, Bojan, Jordan, Jens, Kuznetsova, Tatiana, Laurent, Stephane, Lovic, Dragan, Lurbe, Empar, Mahfoud, Felix, Manolis, Athanasios, Miglinas, Marius, Narkiewicz, Krzystof, Niiranen, Teemu, Palatini, Paolo, Parati, Gianfranco, Pathak, Atul, Persu, Alexandre, Polonia, Jorge, Redon, Josep, Sarafidis, Pantelis, Schmieder, Roland, Spronck, Bart, Stabouli, Stella, Stergiou, George, Taddei, Stefano, Thomopoulos, Costas, Tomaszewski, Maciej, Van de Borne, Philippe, Wanner, Christoph, Weber, Thomas, Williams, Bryan, Zhang, Zhen-Yu, Kjeldsen, Sverre E, Mancia, G, Kreutz, R, Brunström, M, Burnier, M, Grassi, G, Januszewicz, A, Muiesan, M, Tsioufis, K, Agabiti-Rosei, E, Algharably, E, Azizi, M, Benetos, A, Borghi, C, Hitij, J, Cifkova, R, Coca, A, Cornelissen, V, Cruickshank, J, Cunha, P, Danser, A, Pinho, R, Delles, C, Dominiczak, A, Dorobantu, M, Doumas, M, Fernández-Alfonso, M, Halimi, J, Járai, Z, Jelaković, B, Jordan, J, Kuznetsova, T, Laurent, S, Lovic, D, Lurbe, E, Mahfoud, F, Manolis, A, Miglinas, M, Narkiewicz, K, Niiranen, T, Palatini, P, Parati, G, Pathak, A, Persu, A, Polonia, J, Redon, J, Sarafidis, P, Schmieder, R, Spronck, B, Stabouli, S, Stergiou, G, Taddei, S, Thomopoulos, C, Tomaszewski, M, Van de Borne, P, Wanner, C, Weber, T, Williams, B, Zhang, Z, Kjeldsen, S, Mancia, Giuseppe, Kreutz, Reinhold, Brunström, Mattias, Burnier, Michel, Grassi, Guido, Januszewicz, Andrzej, Muiesan, Maria Lorenza, Tsioufis, Konstantinos, Agabiti-Rosei, Enrico, Algharably, Engi Abd Elhady, Azizi, Michel, Benetos, Athanase, Borghi, Claudio, Hitij, Jana Brguljan, Cifkova, Renata, Coca, Antonio, Cornelissen, Veronique, Cruickshank, J Kennedy, Cunha, Pedro G, Danser, A H Jan, Pinho, Rosa Maria de, Delles, Christian, Dominiczak, Anna F, Dorobantu, Maria, Doumas, Michalis, Fernández-Alfonso, María S, Halimi, Jean-Michel, Járai, Zoltán, Jelaković, Bojan, Jordan, Jens, Kuznetsova, Tatiana, Laurent, Stephane, Lovic, Dragan, Lurbe, Empar, Mahfoud, Felix, Manolis, Athanasios, Miglinas, Marius, Narkiewicz, Krzystof, Niiranen, Teemu, Palatini, Paolo, Parati, Gianfranco, Pathak, Atul, Persu, Alexandre, Polonia, Jorge, Redon, Josep, Sarafidis, Pantelis, Schmieder, Roland, Spronck, Bart, Stabouli, Stella, Stergiou, George, Taddei, Stefano, Thomopoulos, Costas, Tomaszewski, Maciej, Van de Borne, Philippe, Wanner, Christoph, Weber, Thomas, Williams, Bryan, Zhang, Zhen-Yu, and Kjeldsen, Sverre E

Abstract

Luis Alcocer (Mexico), Christina Antza (Greece), Mustafa Arici (Turkey), Eduardo Barbosa (Brazil), Adel Berbari (Lebanon), Luís Bronze (Portugal), John Chalmers (Australia), Tine De Backer (Belgium), Alejandro de la Sierra (Spain), Kyriakos Dimitriadis (Greece), Dorota Drozdz (Poland), Béatrice Duly-Bouhanick (France), Brent M. Egan (USA), Serap Erdine (Turkey), Claudio Ferri (Italy), Slavomira Filipova (Slovak Republic), Anthony Heagerty (UK), Michael Hecht Olsen (Denmark), Dagmara Hering (Poland), Sang Hyun Ihm (South Korea), Uday Jadhav (India), Manolis Kallistratos (Greece), Kazuomi Kario (Japan), Vasilios Kotsis (Greece), Adi Leiba (Israel), Patricio López-Jaramillo (Colombia), Hans-Peter Marti (Norway), Terry McCormack (UK), Paolo Mulatero (Italy), Dike B. Ojji (Nigeria), Sungha Park (South Korea), Priit Pauklin (Estonia), Sabine Perl (Austria), Arman Postadzhian (Bulgaria), Aleksander Prejbisz (Poland), Venkata Ram (India), Ramiro Sanchez (Argentina), Markus Schlaich (Australia), Alta Schutte (Australia), Cristina Sierra (Spain), Sekib Sokolovic (Bosnia and Herzegovina), Jonas Spaak (Sweden), Dimitrios Terentes-Printzios (Greece), Bruno Trimarco (Italy), Thomas Unger (The Netherlands), Bert-Jan van den Born (The Netherlands), Anna Vachulova (Slovak Republic), Agostino Virdis (Italy), Jiguang Wang (China), Ulrich Wenzel (Germany), Paul Whelton (USA), Jiri Widimsky (Czech Republic), Jacek Wolf (Poland), Grégoire Wuerzner (Switzerland), Eugene Yang (USA), Yuqing Zhang (China).

Published
2023

40. Late outcomes of renal denervation are more favourable than early ones: facts or fancies?

Author

Persu, A, Stoenoiu, M, Maes, F, Kreutz, R, Mancia, G, Kjeldsen, S, Stoenoiu, MS, Kjeldsen, SE, Persu, A, Stoenoiu, M, Maes, F, Kreutz, R, Mancia, G, Kjeldsen, S, Stoenoiu, MS, and Kjeldsen, SE

Abstract

Following second-generation randomized trials, there is evidence that renal denervation (RDN) decreases blood pressure (BP), although to a lesser extent than suggested in the initial controlled and observational studies. The recent publication of the 36-month follow-up of the Symplicity HTN-3 trial has raised expectations, suggesting increasing, late benefits of the procedure, despite initially negative results. These findings come after those obtained at 36 months in the sham-controlled trial SPYRAL HTN-ON MED and in the Global Symplicity Registry. However, they are susceptible to biases inherent in observational studies (after unblinding for sham-control) and non-random, substantial attrition of treatment groups at 36 months, and used interpolation of missing BPs. More importantly, in SPYRAL HTN-ON MED and Symplicity HTN-3, long-term BP changes in patients from the initial RDN group were compared with those in a heterogeneous control group, including both control patients who did not benefit from RDN and patients who eventually crossed over to RDN. In crossover patients, the last BP before RDN was imputed to subsequent follow-up. In Symplicity HTN-3, this particular approach led to the claim of increasing long-term benefits of RDN. However, comparison of BP changes in patients from the RDN group and control patients who did not undergo RDN, without imputation of BPs from crossover patients, does not support this view. The good news is that despite the suggestion of sympathetic nerve regrowth after RDN in some animal models, there is no strong signal in favour of a decreasing effect of RDN over time, up to 24 or even 36 months. Still, current data do not support a long-term increase in the effect of RDN and the durability of RDN-related BP reduction remains to be formally demonstrated.

Published
2023

41. The Hypertension Excellence Centre programme of the European Society of Hypertension - current status, activities and reshaping for the future

Author

Weber, T, Doumas, M, Delles, C, Jelakovic, B, Viigimaa, M, Narkiewicz, K, Januszewicz, A, Kreutz, R, Grassi, G, Mancia, G, Weber, Thomas, Doumas, Michael, Delles, Christian, Jelakovic, Bojan, Viigimaa, Margus, Narkiewicz, Krzysztof, Januszewicz, Andrzej, Kreutz, Reinhold, Grassi, Guido, Mancia, Giuseppe, Weber, T, Doumas, M, Delles, C, Jelakovic, B, Viigimaa, M, Narkiewicz, K, Januszewicz, A, Kreutz, R, Grassi, G, Mancia, G, Weber, Thomas, Doumas, Michael, Delles, Christian, Jelakovic, Bojan, Viigimaa, Margus, Narkiewicz, Krzysztof, Januszewicz, Andrzej, Kreutz, Reinhold, Grassi, Guido, and Mancia, Giuseppe

Abstract

Purpose: To describe the history of the Excellence Centre (EC) programme of the European Society of Hypertension (ESH) since the beginning in 2006, its achievements, and its future developments. Materials and Methods: We list the number of ECs per country, the research projects performed so far, and the organisational steps needed to reshape the EC programme for the future. Results: In August 2023, the ESH EC programme includes 118 registered ECs in 21 European and 7 non-European countries. Updates about the formal steps for application, re-application, transfer of EC and retirement of EC heads are given. Conclusions: The EC programme of the ESH has been a success from the beginning. Further refinements will make it fit for the next decades.

Published
2023

46. Perspectives on improving blood pressure control to reduce the clinical and economic burden of hypertension.

Author

Mancia, G., Cappuccio, F. P., Burnier, M., Coca, A., Persu, A., Borghi, C., Kreutz, R., and Sanner, B.

Subjects
BLOOD pressure, HYPERTENSION, HEALTH literacy, HEALTH education
Abstract

The clinical and economic burden of hypertension is high and continues to increase globally. Uncontrolled hypertension has severe but avoidable long‐term consequences, including cardiovascular diseases, which are among the most burdensome and most preventable conditions in Europe. Yet, despite clear guidelines on screening, diagnosis and management of hypertension, a large proportion of patients remain undiagnosed or undertreated. Low adherence and persistence are common, exacerbating the issue of poor blood pressure (BP) control. Although current guidelines provide clear direction, implementation is hampered by barriers at the patient‐, physician‐ and healthcare system levels. Underestimation of the impact of uncontrolled hypertension and limited health literacy lead to low adherence and persistence among patients, treatment inertia among physicians and a lack of decisive healthcare system action. Many options to improve BP control are available or under investigation. Patients would benefit from targeted health education, improved BP measurement, individualized treatment or simplified treatment regimens through single‐pill combinations. For physicians, increasing awareness of the burden of hypertension, as well as offering training on monitoring and optimal management and provision of the necessary time to collaboratively engage with patients would be useful. Healthcare systems should establish nationwide strategies for hypertension screening and management. Furthermore, there is an unmet need to implement more comprehensive BP measurements to optimize management. In conclusion, an integrative, patient‐focused, multimodal multidisciplinary approach to the management of hypertension by clinicians, payers and policymakers, involving patients, is required to achieve long‐term improvements in population health and cost‐efficiency for healthcare systems. [ABSTRACT FROM AUTHOR]

Published
2023
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47. The effects of timing of prophylaxis, type of anesthesia, and use of mechanical methods on outcome in major orthopedic surgery - subgroup analyses from 17,701 patients in the XAMOS study

Author

Haas S, Holberg G, Kreutz R, Lassen MR, Mantovani L, Haupt V, Vogtländer K, and Turpie AGG

Subjects
bleeding event, rivaroxaban, thromboprophylaxis, VTE prevention, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Sylvia Haas,1 Gerlind Holberg,2 Reinhold Kreutz,3 Michael Rud Lassen,4 Lorenzo Mantovani,5 Verena Haupt,6 Kai Vogtländer,7 Alexander GG Turpie8 1Formerly Technical University of Munich, 2Bayer HealthCare AG, 3Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin, Berlin, Germany; 4Glostrup Hospital, University of Copenhagen, Glostrup, Denmark; 5CESP-Center for Public Health Research, University of Milan-Bicocca, Monza, Italy; 6Bayer Vital GmbH, Leverkusen, 7Bayer Pharma AG, Wuppertal, Germany; 8Department of Medicine, Hamilton Health Services, Hamilton, ON, Canada Purpose: Real-world data on the use of rivaroxaban in the perioperative period in patients undergoing major orthopedic surgery are limited. Subsets of data from the Phase IV, noninterventional XAMOS study were analyzed to explore the potential influence of timing of the first thromboprophylactic dose, type of anesthesia, and concomitant mechanical prophylaxis on clinical outcomes in patients undergoing major orthopedic surgery in routine clinical practice. Patients and methods: In XAMOS, 8,778 patients received rivaroxaban (10 mg once daily) and 8,635 received standard-of-care (SOC) pharmacological prophylaxis (safety population). Crude incidences of symptomatic thromboembolic and treatment-emergent bleeding events were analyzed according to timing of the first postoperative thromboprophylactic dose, use of general or neuraxial anesthesia, and use of mechanical prophylaxis with pharmacological thromboprophylaxis. Results: In the rivaroxaban group, the incidences of symptomatic thromboembolic events were 0.7%, 1.0%, and 0.7% in patients receiving the first thromboprophylactic dose at ≤6 hours, >6 hours to ≤10 hours, and >10 hours to ≤24 hours after surgery, respectively. In the SOC group, the incidence of symptomatic thromboembolic events was slightly higher when the postoperative dose was given at >10 hours to ≤24 hours (1.8% vs 1.1% at ≤6 hours and 1.3% at >6 hours to ≤10 hours). The antithrombotic effect of rivaroxaban was maintained in comparison to the SOC group. The incidence of major bleeding (RECORD trial definition) was low and similar between the two treatment groups and was not influenced by timing of the first thromboprophylactic dose. Neuraxial anesthesia was used more than any other form of anesthesia for both hip and knee surgery; the effectiveness of rivaroxaban was not influenced by the type of anesthesia used. No spinal hematomas were reported in patients receiving neuraxial anesthesia in either treatment group. Use of mechanical thromboprophylaxis in addition to rivaroxaban or SOC pharmacological prophylaxis did not reduce the risk of thromboembolic events further. Conclusion: The effectiveness and safety of rivaroxaban in patients undergoing major orthopedic surgery in routine clinical practice were maintained irrespective of timing of the first postoperative dose within 24 hours after surgery, the type of anesthesia, and the additional use of mechanical thromboprophylaxis. Keywords: bleeding event, rivaroxaban, thromboprophylaxis, VTE prevention

Published
2016

49. Hypertension and heart failure with preserved ejection fraction: Position paper by the European Society ofHypertension

Author

Kasiakogias, A, Rosei, E, Camafort, M, Ehret, G, Faconti, L, Ferreira, J, Brguljan, J, Januszewicz, A, Kahan, T, Manolis, A, Tsioufis, K, Weber, T, Lueder, T, Smiseth, O, Wachtell, K, Kjeldsen, S, Zannad, F, Mancia, G, Kreutz, R, Kasiakogias A., Rosei E. A., Camafort M., Ehret G., Faconti L., Ferreira J. P., Brguljan J., Januszewicz A., Kahan T., Manolis A., Tsioufis K., Weber T., Lueder T. G. v., Smiseth O. A., Wachtell K., Kjeldsen S. E., Zannad F., Mancia G., Kreutz R., Kasiakogias, A, Rosei, E, Camafort, M, Ehret, G, Faconti, L, Ferreira, J, Brguljan, J, Januszewicz, A, Kahan, T, Manolis, A, Tsioufis, K, Weber, T, Lueder, T, Smiseth, O, Wachtell, K, Kjeldsen, S, Zannad, F, Mancia, G, Kreutz, R, Kasiakogias A., Rosei E. A., Camafort M., Ehret G., Faconti L., Ferreira J. P., Brguljan J., Januszewicz A., Kahan T., Manolis A., Tsioufis K., Weber T., Lueder T. G. v., Smiseth O. A., Wachtell K., Kjeldsen S. E., Zannad F., Mancia G., and Kreutz R.

Abstract

Hypertension constitutes a major risk factor for heart failure with preserved ejection fraction (HFpEF). HFpEF is a prevalent clinical syndrome with increased cardiovascular morbidity and mortality. Specific guideline-directed medical therapy (GDMT) for HFpEF is not established due to lack of positive outcome data from randomized controlled trials (RCTs) and limitations of available studies. Although available evidence is limited, control of blood pressure (BP) is widely regarded as central to the prevention and clinical care in HFpEF. Thus, in current guidelines including the 2018 European Society of Cardiology (ESC) and European Society of Hypertension (ESH) Guidelines, blockade of the renin-angiotensin system (RAS) with either angiotensinconverting enzyme inhibitors or angiotensin receptor blockers provides the backbone of BP-lowering therapy in hypertensive patients. Although superiority of RAS blockers has not been clearly shown in dedicated RCTs designed for HFpEF, we propose that this core drug treatment strategy is also applicable for hypertensive patients with HFpEF with the addition of some modifications. The latter apply to the use of spironolactone apart from the treatment of resistant hypertension and the use of the angiotensin receptor neprilysin inhibitor. In addition, novel agents such as sodium-glucose co-transporter-2 inhibitors, currently already indicated for high-risk patients with diabetes to reduce heart failure hospitalizations, and finerenone represent promising therapies and results from ongoing RCTs are eagerly awaited. The development of an effective and practical classification of HFpEF phenotypes and GDMT through dedicated high-quality RCTs are major unmet needs in hypertension research and calls for action.

Published
2021

50. Sodium-Glucose co-Transporter-2 inhibitors for patients with diabetic and nondiabetic chronic kidney disease: A new era has already begun

Author

Sarafidis, P, Ortiz, A, Ferro, C, Halimi, J, Kreutz, R, Mallamaci, F, Mancia, G, Wanner, C, Sarafidis P., Ortiz A., Ferro C. J., Halimi J. -M., Kreutz R., Mallamaci F., Mancia G., Wanner C., Sarafidis, P, Ortiz, A, Ferro, C, Halimi, J, Kreutz, R, Mallamaci, F, Mancia, G, Wanner, C, Sarafidis P., Ortiz A., Ferro C. J., Halimi J. -M., Kreutz R., Mallamaci F., Mancia G., and Wanner C.

Abstract

Chronic kidney disease (CKD) is a major issue of public health. Hypertension control and use of renin-angiotensin system (RAS) blockers are the cornerstones of treatment for CKD of any cause. However, even under optimal RAS blockade, many individuals will progress towards more advanced CKD. Within the past few years, evidence from cardiovascular outcome trials with sodium-glucose co-Transporter-2 (SGLT-2) inhibitors clearly suggested that these agents substantially delay CKD progression in patients with diabetes mellitus on top of standard-of-care treatment. The Canagliflozin-And-Renal-Events-in-Diabetes-with-Established-Nephropathy-Clinical-Evaluation (CREDENCE) study, showed that canagliflozin substantially reduced the risk of doubling of SCr, end-stage kidney disease (ESKD), or death from renal or cardiovascular causes in 4401 patients with diabetic CKD compared with placebo (hazard ratio 0.70; 95% CI 0.59-0.82). Recently, the Study-To-Evaluate-The-Effect-of-Dapagliflozin-on-Renal-Outcomes-And-Cardiovascular-Mortality-in-Patients-With-Chronic-Kidney-Disease (DAPA-CKD), including 2510 patients with diabetic and 1803 with nondiabetic CKD, also showed an impressive reduction in the risk of ≥50% decline in eGFR, ESKD, or death from renal or cardiovascular causes (HR 0.61; 95% CI 0.51-0.72). The benefit was similar for patients with diabetic and nondiabetic CKD, including patients with glomerulonephritides. Following this conclusive evidence, relevant guidelines should accommodate their recommendations to implement treatment with SGLT-2 inhibitors for patients with diabetic and nondiabetic CKD.

Published
2021

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