Intensive blood pressure lowering: a practical review

Camafort, Miguel; Redón, Josep; Pyun, Wook Bum; Coca, António

doi:10.1186/s40885-020-00153-z

Cited by 14 publications

(8 citation statements)

References 41 publications

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“…Beside these phenotypic characteristics of hypertension in elderly subjects, this population presents some other relevant problems. One of them is that the available evidence on the efficacy and safety of BP lowering treatment in these patients is scarce [36].…”

Section: Other Aspects Related To Abpm In Elderlymentioning

confidence: 99%

Role of ambulatory blood pressure monitoring in elderly hypertensive patients

2022

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Background Arterial hypertension is facing some changes in the last years. Its prevalence is increasing in elderly subjects. This growing prevalence is due to longer survival of the population worldwide, among other factors. On the other hand, recent guidelines have insisted in the relevance of out of office blood pressure measurements, to improve diagnostic and management of hypertension. Therefore, elderly subjects with hypertension could benefit from out of office blood pressure measurements, like ambulatory blood pressure measurements; nevertheless, there are very few or no specific recommendations regarding this. Aim In this review, we will gather the most important information about this subject. Results As hypertension in the elderly has some specific characteristics related to aging of the cardiovascular system, the most important aspect could be that these characteristics make ambulatory blood pressure measurement suitable for its use in elderly. Among those a higher prevalence of white coat hypertension, white coat phenomenon, and a higher nocturnal blood pressure and higher prevalence of nondipper and riser pattern, represent aspects that should be considered for better diagnostic and an improved management. Conclusion As the prevalence of hypertension will grow in the next years, more studies specifically directed to this subject are needed.

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Section: Other Aspects Related To Abpm In Elderlymentioning

confidence: 99%

Role of ambulatory blood pressure monitoring in elderly hypertensive patients

2022

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“…Based on studies conducted by the SPLINT trial ( 2 ) and ACCORD trial ( 3 ), strict BP control shows better cardiovascular (CV) outcomes, forcing physicians to set stricter target BPs in the treatment of HBP ( 4 ). Therefore the importance of obtaining reliable BP readings in patients with hypertension and comorbidities ( 5 ). For this reason, the 2017 ACC/AHA Guidelines recommended lowering the existing threshold BP target from 140/90 mmHg to less than 130/80 mmHg ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Gender-specific differences in central blood pressure and optimal target blood pressure based on the prediction of cardiovascular events

Kim

Kim²

2022

Front. Cardiovasc. Med.

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BackgroundHypertension (HBP) is a common disease among both men and women. Central blood pressure (CBP) is a method of evaluating aorta pressure that can assess the intrinsic BP of an individual patient that more closely correlates with cardiovascular disease (CVD) outcomes than peripheral BP parameters. We evaluated gender-specific differences in CBP and optimal target BP based on a composite outcome of CVD, heart failure (HF), and hypertensive complications in patients with HBP.MethodPatients were enrolled from June 2011 to December 2015 and were followed through December 2019. CBP was measured using radial tonometry. The primary endpoint was a composite outcome.ResultThe median follow-up period for enrolled patients was 6.5 years. Out of a total of 2,115 patients with an average age of 57.9 ± 13.6 years, 266 patients (12.6%) had events of primary end points during the follow-up period. There was no difference in the lowest BP level between men and women in the incidence of CVD. Among the women (49.6%), 78.1% were postmenopausal. In a multivariable Cox proportional hazards model, CBP and systolic BP showed an increase in risk of 10 and 11%, respectively, with every 10 mmHg increase, and there was a similar trend of 12 and 13%, respectively, in postmenopausal women. However, PP showed an increase in risk of about 2% every 10 mmHg increase, but a tendency to increase risk by 19% in postmenopausal women.ConclusionThis study demonstrated that postmenopausal women will continue to show increased risk for CVD at BP higher than the optimal level. Conversely, there was no increase in CV risk due to menopause at BP values below the optimal level. Therefore, well-controlled BP is more important in postmenopausal women.

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“…Hypertension is an important risk factor for cardiovascular and cerebrovascular events [ 1 ], and the number of patients with hypertension has steadily increased to more than 12 million in Korea [ 2 ]. Recently, although clinical trials and meta-analyses have strongly suggested intensive blood pressure (BP) lowering in patients with hypertension [ 3 ], approximately 1%–2% of patients eventually develop a severe acute increase in BP [ 4 ]. Hypertensive crisis or severe hypertension is defined as a BP elevation above 180 mmHg for systolic BP (SBP) and/or above 110–120 mmHg for diastolic blood pressure (DBP) according to the international practice guidelines for hypertension [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and prognosis of patients with very severe acute hypertension visiting the emergency department

Kim

Shin

2022

Clin Hypertens

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Background Data regarding very severe acute hypertension, a serious problem in emergency departments (EDs), are scarce. We investigated the clinical characteristics, practice patterns, and long-term prognoses of patients presenting to the ED with very severe acute hypertension. Methods Cross-sectional study data were obtained from a single regional emergency medical center, including patients aged ≥ 18 years who were admitted to the ED between January 2016 and December 2019 for very severe acute hypertension, which was defined as systolic blood pressure of > 220 mmHg and/or diastolic blood pressure of > 120 mmHg. The patients were classified into two groups based on the presence or absence of hypertension-mediated organ damage (HMOD). Results Among 1,391 patients with very severe acute hypertension in the ED, half of the them (50.2%) had a previous medical history of hypertension, and 547 (39.3%) had acute HMOD. The overall 3-month, 1-year, and 3-year mortality rates were 5.2%, 11.9%, and 17.3%, respectively. In particular, patients with HMOD had a significantly higher mortality rate at each time point than those without HMOD. Among patients with HMOD, acute ischemic stroke was the most common (28.7%). Moreover, intravenous antihypertensive drugs were significantly more prescribed in patients with HMOD than in those without HMOD (79.0% vs. 22.2%, P < 0.001), but there were no differences in oral antihypertensive drugs between the two groups. Conclusions Patients with very severe acute hypertension had poor long-term clinical prognoses. Clinicians should be continuously monitoring and providing appropriate treatment and close follow-up for patients with very severe acute hypertension.

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Intensive blood pressure lowering: a practical review

Cited by 14 publications

References 41 publications

Role of ambulatory blood pressure monitoring in elderly hypertensive patients

Role of ambulatory blood pressure monitoring in elderly hypertensive patients

Gender-specific differences in central blood pressure and optimal target blood pressure based on the prediction of cardiovascular events

Clinical characteristics and prognosis of patients with very severe acute hypertension visiting the emergency department

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