TELMISARTAN MONOTHERAPY EFFECTS ON MICROCIRCULATION IN PATIENTS WITH UNCOMPLICATED

ARTERIAL HYPERTENSION

Telmisartan monotherapy (dose – 80 mg), 8weeks course, contributes to restore normal hemodynamic type of microcirculation, normalizes microcirculation response to arterial occlusion and improves capillary blood flow reserve.

BALANCED OPTIMAL MEDICAL THERAPY IS ESSENTIALIN MANAGEMENT OF PATIENTS WITH CORONARY

ARTERY DISEASE: PULSE WAVE VELOCITY LONGTERMFOLLOW UP STUDY

• Combination of optimal medical therapy is essential in management of high-risk hypertensive patients, and it might also reduce cardiovascular risk

WHETHER ACE INHIBITOR/ARB COMBINED WITH CCB ISSUPERIOR TO OTHER COMBINATIONS? A META-ANALYSIS IN

20,669 HYPERTENSIVES

• Clinical evidences favor A+C therapy, which is superior to other combinations

• In current antihypertensive strategy, with greater clinical benefit in cardiovascular outcome and reservation of renal function.

THE SODIUM GLUCOSE COTRANSPORTER 2 INHIBITOR EMPAGLIFLOZIN REDUCES BLOOD PRESSURE AND MARKERS OF ARTERIAL STIFFNESS AND

VASCULAR RESISTANCE IN TYPE 2 DIABETES

• Empagliflozin had favourable effects on BP, arterial stiffness and vascular resistance, which are intermediate markers of cardiovascular risk. The EMPAREG OUTCOMETM trial (NCT01131676) will evaluate whether these benefits will translate into cardiovascular risk reduction.

EFFECTS OF SODIUM AND POTASSIUMSUPPLEMENTATION ON ENDOTHELIAL FUNCTION AND

INFLAMMATION IN UNTREATED (PRE)HYPERTENSIVES: A FULLY CONTROLLED DIETARY

INTERVENTION STUDY

• Sodium and potassium supplementation had little impact on circulating endothelial and inflammatory biomarkers, and only for potassium an effect on flow mediated dilation was observed. This study suggests different actions for sodium and potassium in the pathophysiological processes leading to cardiovascular disease

AMLODIPINE ALONE COMPARED TO AMLODIPINE +ACETYLSALICYLIC ACID ON INFLAMMATION AND

ENDOTHELIAL DAMAGE MARKERS IN HYPERTENSIVE PATIENTS

The addition of ASA to antihypertensive therapy gave a better improvement of inflammatory parameters compared to amlodipine alone, suggesting a role of ASA in reducing inflammation and endothelial damage independently from the blood pressure reduction

MORNING HOME BLOOD PRESSURE IS A STRONG PREDICTOR OF CORONARY ARTERY DISEASE EVENTS AS WELL AS STROKE EVENTS IN HYPERTENSIVE

PATIENTS ON ANTIHYPERTENSIVE TREATMENT. THE HONEST STUDY

• Morning HBP predicted CAD events similarly to stroke events. In contrast, CBP is more likely to underestimate CAD risk than morning HBP. Morning SBP guided approach for managing hypertension may be more effective in predicting future risk of CAD events than CBP based one.

GENETIC MARKERS IN CARDIAC RESYNCHRONIZATIONTHERAPY TREATMENT SUCCESS

Rule induction algorithms can successfully be applied for the classification of heart failure patients in CRT responder and nonresponder status using clinical and genetic parameters.

Our analysis included information on alleles and genotypes of 4 genetic loci, pathophysiologically associated with remodelling of the failing ventricle.

GENETIC BACKGROUND OF FEMORALATHEROSCLEROTIC PLAQUE FORMATION

• Femoral atherosclerotic plaque formation in CFA and SFA is moderately genetically determined. Further studies should elucidate whether offsprings of families at high risk for femoral atherosclerosis may benefit from early ultrasound screening.

24 HOUR MODULATION OF PERIPHERAL AND CENTRALBLOOD PRESSURE, HEART RATE AND ARTERIAL

STIFFNESS IN HEART TRANSPLANT HYPERTENSIVE INDIVIDUALS

• HtHTX there is no nocturnal dipping not only of brachial BP and HR but also of CABPM, and PWV up to 10 years after HTX, probably due to persistent cardiac denervation and/or interference by immunosuppressant drugs. Altered autonomic cardiovascular modulation could play a role in the development of restrictive physiology and possibly also of graft vasculopathy.

CENTRAL VERSUS PERIPHERAL BLOOD PRESSURE IN PREDICTING TARGET ORGAN

DAMAGE

• Central BP is slightly but consistently superior to the peripheral BP in predicting preclinical organ damage except for albuminuria.

WHITE COAT AND MASKED HYPERTENSION AS RISKFACTORS FOR PROGRESSION TO SUSTAINED

HYPERTENSION: THE FINNHOME STUDY

• Neither WCHT, nor MHT can be considered a harmless benign phenomenon.

• Persons in these categories have a several fold risk of developing SHT than those with NT and could benefit from active followup and lifestyle counselling

IN HYPERTENSION THE CHANGE FROM A NONDIPPER TO A DIPPER PATTERN IS ASSOCIATED WITH A BETTER CARDIOVASCULAR PROGNOSIS THAN THE

PERSISTENCE WITHIN THE NONDIPPER PATTERN

• In our study the modification from ND to D vs the persistence of ND is associated with less CV events. These results suggest that SBP nocturnal dipping is not only a static marker of CV risk but can undergo therapeutic intervention to improve prognosis.

ACCURACY OF HOME VERSUS AMBULATORY BLOOD PRESSURE MONITORING IN THE DIAGNOSIS OF

WHITECOAT AND MASKED HYPERTENSION

• Home BP monitoring has high specificity but low sensitivity in the diagnosis of whitecoat and masked hypertension, and may therefore behave as a complementary to, but not a replacement of, ambulatory BP monitoring.

MORNING SURGE AND SLEEPTIMEBLOOD PRESSURE AS PROGNOSTIC MARKERS OF

CARDIOVASCULAR RISK: THE HYGIA PROJECT

• A larger morning BP surge is associated with a significantly lower CVD risk, in line with the markedly greater risk associated with decreasing dipping of the BP pattern, and the most highly significant prognostic value of progressively elevated asleep BP, an independent prognostic marker of CVD risk that has also been prospectively validated as a relevant therapeutic target for CVD risk reduction

DIETARY SALT INTAKE AND ALDOSTERONE RELATEDORGAN DAMAGE IN HYPERTENSION

• Circulating aldosterone contributes to subclinical renal and cardiac damage in primary hypertension, but its contribution is independent of dietary salt intake.

RENAL MICROVASCULATURE AND RENIN SECRETION IN HUMANS WITH MULTIFOCAL RENAL ARTERY FIBROMUSCULAR DYSPLASIA

• Mean renal blood flow is preserved and renin secretion rate is not increased in kidneys with fibromuscular dysplasia contradict with the commonly held hypothesis on renovascular hypertension that states that hypertension is induced by increased renin secretion in response to decreased blood flow.

• Therefore, other pathophysiological mechanisms probably (also) play a role.

THE CONTRIBUTION OF INFLAMMATION AND ATHEROSCLEROSIS TO HYPERTENSION IN KIDNEY TRANSPLANTS

• IL6 and number of carotid plaques are increased in kidney transplants in comparison with CKD patients and are associated with higher sleep SBP and reverse dipper pattern in transplantation

SERUM URIC ACID LEVEL, BUT NOT RENAL FUNCTION ORARTERIAL STIFFNESS, IS ASSOCIATED TO WORSE BLOOD PRESSURE CONTROL IN

GENERAL PRACTICE: DATA FROM THE BRISIGHELLA HEART STUDY

• PWV and AI are similarly increased in newly diagnosed hypertensive patients and patients treated but not controlled, whereas PWV is similar in normotensive and well treated subjects. The main predictors of worse BP control were SERUM URIC ACID, augmentation index and PWV.

URIC ACID LEVELS RELATED TO OBSTRUCTIVE SLEEPAPNEA SYNDROME IN PATIENTS WITH HYPERTENSION

FROM XINJIANG OF CHINA

• UA levels may be involved in OSAS severity and should be considered in sleep apnea management in the future.

PROGNOSTIC VALUE OF SERUM URIC ACID LEVELS TOTHE CARDIOVASCULAR EVENTS IN HYPERTENSIVES

Serum uric acid levels have prognostic value to major cardiovascular events in hypertensive patients.

• Being overweight or obese starting in early adulthood was associated with increased aortic stiffness and decreased performance in a memory test at around age 60, in a new study

• Exposure to obesity since age 36 is associated with later memory dysfunction, and this impact seems to be independent of the acquisition of cardiovascular disease

IRON OVERLOAD EXERTS SYMPATHOEXCITATORYEFFECTS IN MEN WITH ESSENTIAL HYPERTENSION:

MICRONEUROGRAPHIC EVIDENCE

In hypertensive males iron overload exerts marked sympathoexcitatory effects associated with a decrease in insulin sensitivity.

It is likely that the iron overload directly or throughout the concomitant hyperinsulinemia may be responsible for this neuroadrenergic response

FACTORS RELATED TO THE LINK BETWEEN URIC ACID AND SYSTOLIC BLOOD PRESSURE IN YOUTHS

• Uric acid is associated with BP, independently of metabolic factors in boys. The clinical implications require further investigation

DIASTOLIC BLOOD PRESSURE MODIFIES THEASSOCIATION OF URIC ACID WITH ALBUMIN/CREATININE

RATIO IN PREMETABOLIC SYNDROME

• Uric acid is independently associated with albumin/creatinine ratio in individuals with premetabolic syndrome. This association appears to be largely modified by diastolic blood pressure.

CAN WE USE THE CONCEPT OF “ARTERIAL AGING” TOPREDICT BLOOD PRESSURE LEVELS?

• Arterial aging, based on agespecific percentiles, may be a useful screening tool for sustained hypertension, based on office and 24 hour ambulatory BP

HYPERTENSION AND RISK OF EVENTS ASSOCIATED TOREDUCED EGFR. THE ESCARVALRISK STUDY

• eGFR is a prevalent condition in patients with the main CV risk factors. • eGFR below <45 ml/min/1.73 m2 increases mortality risk. • Hypertension by itself had an important role in the risk of mortality in

patients with low eGFR on top of other CV risk factors

24HOUR AMBULATORY CENTRAL BLOOD PRESSURE VARIABILITY AND TARGETORGAN DAMAGE IN

ADOLESCENTS AND YOUNG ADULTS

24hour central ABP variability appears to be associated only with early carotid damage when accounting forABPlevels, whereas LVMI and PWV are mainly determined by average ABP levels.

THE EFFECT OF HEART RATE ON AMBULATORY PULSEPRESSURE IS SENSITIVE TO THE VARIATION OF

ARTERIAL STIFFNESS WITH PRESSURE

• Slower heart rate in hypertensive patients is accompanied by greater ambulatory pulse pressure, largely contributed by the tendency of arteries to stiffen at elevated pressures, and lower diastolic pressure, probably caused by the prolonged pressure decay during the longer diastole accompanied by greater stroke volume

AORTIC STIFFNESS IS AN INDEPENDENT BIOMARKER OF SUBCLINICAL BRAIN DAMAGE

IN ACUTE ISCHEMIC STROKE• Increased aortic stiffness is associated with

brain microvascular disease in patients with acute ischemic stroke, beyond and above classical risk factors.

• PWV provides a useful new tool for identification of subclinical brain damage in AIS.

BLOOD PRESSURE LOWERING EFFICACY OFAMLODIPINE AND NIFEDIPINE GITS IN AMBULATORY

HYPERTENSION

• Both amlodipine and nifedipine GITS are efficacious in reducing clinic and ambulatory blood pressure. However, when a dose of medication is delayed or missed, amlodipine, but not nifedipine GITS, remains efficacious in lowering blood pressure.