Towards improving the clinical assessment and management of human hypertension: an overview from this Journal

Hypertension and peripheral arterial disease

“…With age, increased arterial stiffness leads to increased SBP with a decrease in DBP, resulting in a higher pulse pressure. 17 In patients with increased arterial stiffness, increased SBP may disappear in the presence of reduced ventricular ejection fraction, 15 which may partly explain the lower prevalence of ISH in the CAD/CVD cohort. The use of antihypertensives may also partly explain the difference in ISH in the different cohorts of the ATTEST study.…”

“…The antihypertensive of choice may also differ according to the dominant site of vascular disease as different drug classes are more efficient at preventing either cardiovascular or cerebrovascular complications. 15 In this issue of the Journal of Human Hypertension, Safar et al 16 report the associations between different forms of hypertension (isolated systolic hypertension (ISH), systolic-diastolic hypertension) with cardiovascular disease in different vascular territories as part of the ATTEST study. This relationship has been poorly evaluated in the past, and the ATTEST study 16 comprised 37.6% isolated PAD, 37.6% PAD with associated CAD and/or CVD and 24.8% CAD/CVD without PAD, reflecting the participant selection methods of the study (notably, two patients with PAD selected for every patient with CAD/CVD identified from general practice registers).…”

Antihypertensive treatment, adiponectin and cardiovascular risk

“…20,21 The translation of these pathophysiological changes to the benefits seen in clinical outcome trials will give added insight into the value of antihypertensive agents in particular patient subgroups, especially those with diabetes and impaired insulin sensitivity. 22 …”

Hypertension in the elderly: a compelling contraindication for β-blockers?

“…The National Institute for Health and Clinical Excellence (NICE) guidelines for management of hypertension (British Hypertension Society) has recently withdrawn their endorsement for b-blockers as first-line management of hypertension. 13 It remains to be seen if other guideline committees will follow suit. As recently highlighted in this journal, there is wide variation in adherence to management guidelines as well as inter-country differences, which are owing to many factors, including the patient.…”