Current Guidelines for Hypertension: Important Highlights for Clinical Practice

In 2007 the European Society of Hypertension, the American Heart Association and the International Society of Hypertension-World Health Organization published new guidelines for the management of hypertension. According to these new guidelines, drug treatment is recommended in all subjects with consistent elevation of blood pressure above 140 mmHg systolic and/or 90 mmHg diastolic. In high-risk subjects, treatment initiation is indicated in lower blood pressure levels (systolic above 130 mmHg and/or diastolic above 85 mmHg). The higher the blood pressure level the sooner the treatment is commenced, with emphasis being placed on the critical role of combination pharmacotherapy in order to achieve optimal blood pressure control.. The implementation of the new guidelines is expected to achieve more effective cardiovascular protection in hypertensive patients

2013 European Guidelines for Hypertension Management

In June 2013 the European Society of Hypertension (ESH) / European Society of Cardiology (ESC) published new guidelines for the management of hypertension. These are the first European Guidelines for hypertension developed by applying a strict “evidence-based” approach using a grading system for the level of evidence and the strength of recommendations. Several recommendations in the new guidelines deserve careful consideration because they change the way that hypertension is managed is routine clinical practice.

Mortality risks in different subtypes of masked hypertension in the Spanish ambulatory blood pressure monitoring registry

Objective: We aimed to evaluate the risks of death and cardiovascular death of different subtypes of masked hypertension, defined by either isolated daytime or nighttime blood pressure (BP) elevation, or both, compared with patients with normal both office and 24-h BP. Methods: We selected 4999 patients with masked hypertension (normal office BP and elevated 24-h BP). They were divided in three different categories: isolated daytime masked hypertension (elevated daytime BP and normal nighttime BP, 800 patients), isolated nighttime masked hypertension (elevated nighttime BP and normal daytime BP, 1069 patients) and daytime and nighttime masked hypertension (elevation of both daytime and nighttime BP, 2989). All-cause and cardiovascular death (median follow-up 9.7 years) were assessed in each of these subtypes in comparison to 10 006 patients with normal both office and 24-h BP. Hazard ratios from Cox models after adjustment for clinical confounders were used for such comparisons. Results: Compared with patients with normal both office and 24-h BP, isolated daytime masked hypertension was not associated with an increased risk of death in models adjusted for clinical confounders [hazard ratio 1.07; 95% confidence interval (CI): 0.80–1.43]. In contrast, isolated nighttime masked hypertension (hazard ratio: 1.39; 95% CI 1.19–1.63) and daytime and nighttime masked hypertension (hazard ratio: 1.22; 95% CI 1.08–1.37) had an increased risk of death in comparison to patients with BP in the normal range. Similar results were observed for cardiovascular death. Conclusion: The risk of death in masked hypertension is not homogeneous and requires nocturnal BP elevation, either isolated or with daytime elevation. Isolated daytime masked hypertension is not associated with an increased risk of death

Blood pressure variability:a review

Blood pressure variability (BPV) predicts cardiovascular events independent of mean blood pressure. BPV is defined as short-term (24-h), medium or long- term (weeks, months or years). Standard deviation, coefficient of variation and variation independent of the mean have been used to quantify BPV. High BPV is associated with increasing age, diabetes, smoking and vascular disease and is a consequence of premature ageing of the vasculature. Long-term BPV has been incorporated into cardiovascular risk models (QRISK) and elevated BPV confers an increased risk of cardiovascular outcomes even in subjects with controlled blood pressure. Long-acting dihydropyridine calcium channel blockers and thiazide diuretics are the only drugs that reduce BPV and for the former explains their beneficial effects on cardiovascular outcomes. We believe that BPV should be incorporated into blood pressure management guidelines and based on current evidence, long-acting dihydropyridines should be preferred drugs in subjects with elevated BPV.</p

Nonvalidated home blood pressure devices dominate the online marketplace in Australia: major implications for cardiovascular risk management

Self-home blood pressure (BP) monitoring is recommended to guide clinical decisions on hypertension and is used worldwide for cardiovascular risk management. People usually make their own decisions when purchasing BP devices, which can be made online. If patients purchase nonvalidated devices (those not proven accurate according to internationally accepted standards), hypertension management may be based on inaccurate readings resulting in under- or over-diagnosis or treatment. This study aimed to evaluate the number, type, percentage validated, and cost of home BP devices available online. A search of online businesses selling devices for home BP monitoring was conducted. Multinational companies make worldwide deliveries, so searches were restricted to BP devices available for one nation (Australia) as an example of device availability through the global online marketplace. Validation status of BP devices was determined according to established protocols. Fifty nine online businesses, selling 972 unique BP devices were identified. These included 278 upper-arm cuff devices (18.3% validated), 162 wrist-cuff devices (8.0% validated), and 532 wrist-band wearables (0% validated). Most BP devices (92.4%) were stocked by international e-commerce businesses (eg, eBay, Amazon), but only 5.5% were validated. Validated cuff BP devices were more expensive than nonvalidated devices: median (interquartile range) of 101.1 (75.0–151.5) versus 67.4 (30.4–112.8) Australian Dollars. Nonvalidated BP devices dominate the online marketplace and are sold at lower cost than validated ones, which is a major barrier to accurate home BP monitoring and cardiovascular risk management. Before purchasing a BP device, people should check it has been validated at https://www.stridebp.org

Global Blood Pressure Screening During the Covid-19 Pandemic: Results From the May Measurement Month 2021 Campaign

BACKGROUND: Raised blood pressure (BP) remains the biggest risk factor contributing to the global burden of disease and mortality, despite the COVID-19 pandemic. May Measurement Month (MMM), an annual global screening campaign aims to highlight the importance of BP measurement by evaluating global awareness, treatment and control rates among adults with hypertension. In 2021, we assessed the global burden of these rates during the COVID-19 pandemic. METHODS: Screening sites were set up in 54 countries between May and November 2021 and screenees were recruited by convenience sampling. Three sitting BPs were measured, and a questionnaire completed including demographic, lifestyle and clinical data. Hypertension was defined as a systolic BP at least 140 mmHg and/or a diastolic BP at least 90 mmHg (using the mean of the second and third readings) or taking antihypertensive medication. Multiple imputation was used to impute the average BP when readings were missing. RESULTS: Of the 642 057 screenees, 225 882 (35.2%) were classified as hypertensive, of whom 56.8% were aware, and 50.3% were on antihypertensive medication. Of those on treatment, 53.9% had controlled BP (\u3c140/90 mmHg). Awareness, treatment and control rates were lower than those reported in MMM campaigns before the COVID-19 pandemic. Minimal changes were apparent among those testing positive for, or being vaccinated against COVID-19. Of those on antihypertensive medication, 94.7% reported no change in their treatment because of the COVID-19 pandemic. CONCLUSION: The high yield of untreated or inadequately treated hypertension in MMM 2021 confirms the need for systematic BP screening where it does not currently exist

Exploring the Design Space of Static and Incremental Graph Connectivity Algorithms on GPUs

Connected components and spanning forest are fundamental graph algorithms due to their use in many important applications, such as graph clustering and image segmentation. GPUs are an ideal platform for graph algorithms due to their high peak performance and memory bandwidth. While there exist several GPU connectivity algorithms in the literature, many design choices have not yet been explored. In this paper, we explore various design choices in GPU connectivity algorithms, including sampling, linking, and tree compression, for both the static as well as the incremental setting. Our various design choices lead to over 300 new GPU implementations of connectivity, many of which outperform state-of-the-art. We present an experimental evaluation, and show that we achieve an average speedup of 2.47x speedup over existing static algorithms. In the incremental setting, we achieve a throughput of up to 48.23 billion edges per second. Compared to state-of-the-art CPU implementations on a 72-core machine, we achieve a speedup of 8.26--14.51x for static connectivity and 1.85--13.36x for incremental connectivity using a Tesla V100 GPU