SPRINT. Counteracting the risk of prehypertension?

The SPRINT trial1 has raised the possibility that systolic blood pressure (BP) values <120 mm Hg constitute the future goal for high-risk hypertensive patients. At baseline, around 50% of the patients were within the frame of prehypertension, whereas the remaining were hypertensive after an unusual but reliable (for daily clinical practice standard) measurement of office BP. Prehypertension is characterized by an increased cardiovascular risk, particularly in Stage 2 (systolic BP: 130–139 mm Hg) that can attain 40% at 10 years if established cardiovascular disease, diabetes, or both are presented.Sin financiación3.263 JCR (2016) Q2, 24/63 Peripheral Vascular DiseaseUE

Renin–angiotensin system blockade: Finerenone

Finerenone is a novel selective nonsteroidal mineralocorticoid receptor antagonist. Results in preclinical studies showed that lower doses of finerenone were needed to achieve similar cardiorenal protective effects compared to both spironolactone and eplerenone and phase II studies in finerenone in patients with heart failure, type-2 diabetes mellitus and/or chronic kidney disease are encouraging as the drug is effective and safe in patients on renin–angiotensin system inhibitors (significant reduction in albuminuria and a low rate of hyperkalemia), but the primary end points were “soft” end points (serum potassium, estimated glomerular filtration rate, albuminuria, N-terminal prohormone B-type natriuretic peptide levels). Thus, further, large-scale, long-term phase III trials are needed to confirm whether the greater affinity and selectivity is translated into improved clinical outcomes.Sin financiación0.479 JCR (2017) Q4, 72/76 Urology and NephrologyUE

Aldosterone a relevant factor in the beginning and evolution of arterial hypertension

Sin financiación3.046 JCR (2017) Q2, 23/65 Peripheral Vascular DiseaseUE

Mortality study from the Spanish Registry of ABPM. An appeal for the transition of ABPM to clinical practice

Sin financiaciónNo data JCR 20180.129 SJR (2018) Q4, 297/365 Cardiology and Cardiovascular Medicine, 113/141 Internal MedicineNo data IDR 2018UE

New vascular biomarkers related to ABPM phenotypes in untreated patients

Ambulatory blood pressure monitoring (ABPM) constitutes the most complete form to determine the blood pressure (BP) levels of a given patient. It shows the best correlation with cardiovascular (CV) events and death and allows the classification of patients into different phenotypes of great interest to evaluate the real risk accompanying BP.1 Recent guidelines2, 3 coming from United States and Europe have recognized the need of using ABPM mainly with two purposes: (a) classification of patients as real hypertensives, and (b) the analysis of the effect of drugs along the 24 hours. The main phenotypes described by ABPM are white coat hypertension (WCH) and masked hypertension (MH) in untreated patients and white uncontrolled hypertension (WUCH), masked uncontrolled hypertension (MUCH) in treated patients and sustained hypertension (SUCH) in treated or untreated hypertensives.4 These phenotypes are characterized by different levels of risk of mortality with the highest accompanying MH followed by MUCH, SUCH, WCH and WUCH.1 Initially, WCH was considered as a phenotype with little risk for presenting CV and renal events but recent data have indicated that this could not be the case.5 In fact, in our data recently published the hazard ratio for mortality in WCH was 1.79 while in WUCH was only 1.06.1 The frank elevation observed in WCH could be due to the possibility that patients did not receive antihypertensive therapy for years of follow‐up during which it is known that WCH turns into SUCH.6 On the other hand, the classification of a given patient as presenting WCH must include the white coat effect during 24 hours daytime and nighttime.7 Besides allowing an adequate classification, this methodology will diminish significantly the prevalence of WCH.7 As a consequence of what we have described until here clarifying the real degree of arterial involvement in WCH and MH is of great interest to evaluate the prognosis of the patients and the adequacy and promptness of treatment of the elevated BP. In this issue of the journal Sanidas et al8 have described that the adipokines, apelin, and relaxin could be adequate markers for this purpose. Apelin is considered as a cardioprotective parameter opposing the effects of the renin‐angiotensin‐aldosteron system (RAAS) and its low levels are related to the degree of hypertension.9, 10 Relaxin is able to regulate BP levels, fibrosis, inflammation, and angiogenesis through positive effects on endothelial dysfunction in hypertension.11 Sanidas et al8 describe the finding that both adipokines exhibit diminish levels in MH compared to WCH. This finding could indicate that MH is characterized by the presence of the arterial damage accompanying SUCH while WCH, probably in its initial stages, does not present arterial alterations. These data require confirmation due to small sample size presented in this article. However, we cannot deny the possibility that the measurement of these adipokines could help to define the presence or absence of vascular damage in WCH. Nevertheless, it has to be considered that beyond the levels of these adipokines, the balance with other vasoactive substances could modulate the situation in the presence of WCH. In summary, the article to which this editorial is dedicated opens a new line of investigation to characterize two of the most important phenotypes that can be identified when an ABPM is performed.Sin financiación2.719 JCR (2019) Q2, 29/65 Peripheral Vascular Disease0.916 SJR (2019) Q2, 95/362 Cardiology and Cardiovascular Medicine, 82/239 Endocrinology, Diabetes and Metabolism, 39/139 Internal MedicineNo data IDR 2019UE

Impact of the new USA and ESC/ESH HTN guidelines for Spain

Sin financiación22.673 JCR (2019) Q1, 2/138 Cardiac & Cardiovascular Systems5.883 SJR (2019) Q1, 4/362 Cardiology and Cardiovascular MedicineNo data IDR 2019UE

Age and blood pressure goal in women with prior coronary events

The three more important sequalae of sustained hypertension in the heart, include heart failure (HF), conduction to arrhythmia particularly atrial fibrillation (AF) and coronary artery disease (CAD). In this issue of the journal Sava et al. [1] describe analyzing the data from the INternational VErapamil SR-Trandolapril (INVEST) study [2] the optimal systolic blood pressure (BP) to reduce mortality in women with previous coronary events. In a very recent review by Mehilli and Presbitero [3] the characteristics of women with CAD and acute coronary syndrome (ACS) are amply described. Women with CAD differ from men by several aspects as the clinical presentation, the accompanying comorbidities and risk factors, as well as, by the delivery of medical care. Moreover, women use to be older and present frequent and pronounced frailty. They present more frequently ACS without obstructive coronary arteries which makes it difficult the diagnosis and treatment of ACS. Importantly, in young women compared to men early death is more frequent in women, as well as, in older women during the first year after an ACS. The two main Guidelines for the management of arterial hypertension that of European Society of Cardiology (ESC)/European Society of Hypertension (ESH) [4] and that of the American College of Cardiology (ACC)/American Heart Association (AHA) [5] differ in the recommended BP goal for patients with chronic CAD depending on their age. The European Guideline defines the systolic goal BP in patients with CAD as inferior to 130/80 mmHg when the age of the patient is <65 years and between 130 and 139 mmHg whether the age is ≥65 years. The Unite States Guideline defines a goal <130 for every patient with CAD. These goals are the same for men and women albeit these Guidelines contained data from trials enrolling a small number of women that included few patients with CAD [4,5]. The INVEST study [2] included the largest cohort of women with hypertension and chronic CAD. As a consequence, this analysis of Sava et al. [1] is really relevant and has to be applied in daily clinical practice. In synthesis, these authors demonstrate that among women ≥65 years old with arterial hypertension and CAD, in trial systolic BP 130–139 mmHg was associated with lower mortality when compared to values <130 mmHg. Apparently, the recommendation of the European Guideline seems to be more adequate than of the US Guideline for women with both high and low risk accompanying CAD. In patients younger than 65 years both Guidelines recommendation are equal. In summary, this is an interesting paper that demonstrate the need of a higher consideration of women inclusion in cardiovascular trials.Sin financiaciónNo data JCR 20200.194 SJR (2020) Q4, 266/349 Cardiology and Cardiovascular MedicineNo data IDR 2020UE

Monotherapy still useful in a bunch of patients with arterial hypertension

The maintenance of an adequate blood pressure (BP) control during the life-time in the general population still constitutes the most relevant challenge in the prevention of cardiovascular disease and new goals are considered in clinical practice [1,2]. This must be accompanied by the adequate management of the associated risk factors and comorbidities that so frequently accompany the elevation in BP. It is well established that the joint effect of genetic component and inadequate life-style underlie the progressive increase in BP.Sin financiación3.229 JCR (2019) Q2, 55/138 Cardiac & Cardiovascular Systems1.082 SJR (2019) Q1, 82/362 Cardiology and Cardiovascular MedicineNo data IDR 2019UE

Microvascular injury and the kidney in hypertension

La macrocirculación renal participa en el desarrollo de la hipertensión arterial. La elevación de la presión sanguínea sistémica (PS) puede producir daños renales, comenzando por la microcirculación. La hipertensión arterial establecida afecta a las grandes arterias, en las que se desarrolla rigidez. Como consecuencia, la PS central se eleva y aparece pulsatilidad, que contribuye al daño adicional de la microcirculación mediante transmisión directa de la PS elevada.Renal macrocirculation participates in the development of arterial hypertension. The elevation in systemic blood pressure (BP) can damage the kidney starting in the microcirculation. Established arterial hypertension impinge upon the large arteries and stiffness develops. As a consequence central BP raises and BP pulsatility appear and contribute to further damage renal microcirculation by direct transmission of the elevated BP.Sin financiaciónNo data JCR (2018)0.129 SJR (2018) Q4, 306/365 Cardiology and Cardiovascular Medicine, 117/141 Internal MedicineNo data IDR 2018UE

Sacubitril/valsartan in the treatment of arterial hypertension: An unaccomplished promise?

Arterial hypertension continues to be the leading cause of death worldwide and, unfortunately, remains uncontrolled in a significant percentage of hypertensive patients who do not attain the blood pressure (BP) goal that most guidelines recommend (<140/90 mm Hg). A lively debate began after the publication of the Systolic Blood Pressure Intervention Trial (SPRINT), in which a goal of 120 mm Hg was reported to be adequate in a portion of the hypertensive population.Sin financiación3.439 JCR (2017) Q1, 16/65 Peripheral Vascular DiseaseUE