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Manage Hypertension Online

Recommended reading

Medical Journals

Articles

Annotated list of 2016 papers

NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. The Lancet. Published online November 15, 2016. Doi: 10.1016/S0140-6736(16)31919-5

This is an interesting overview showing that the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries
in South Asia and Sub-Saharan Africa as well as Central and Eastern Europe

Hughes A, Falaschetti E, Witt N, et al. Association of retinopathy and retinal microvascular abnormalities with stroke and cerebrovascular disease. Stroke 2016;47:2862-4.

Elegant clinical study showing that abnormalities of the retinal microvasculature are independently associated with stroke, cerebral infarcts and white matter lesions

Collins R, Reith C, Emberson J, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. The Lancet. 2016;388(10059):2532-61 Doi: 10.1016/S0140-6736(16)31357-5

Comprehensive review on statin use, including primary prevention for cardiovascular risk in hypertensive patients

Townsend RR, Epstein M. Resistant hypertension: insights on evaluation and management in the post-SPRINT (Systolic Blood Pressure Intervention Trial) era. Hypertension 2016;68:1073-80.

A brief review discussing the definitions and scope of resistant hypertension, including the role of measurement technique, medication nonadherence, the most common causes and the treatment of resistant hypertension, including device management

Elgendy IY, Bavry AA, Gong Y, et al. Long-term mortality in hypertension patients with coronary artery disease: results from the US cohort of the international verapamil (SR)/Trandolapril study. Hypertension 2016;68:1110-4. The online-only data supplement is available at http://hyper-ahajournals.org//lookup/suppl/doi:/10.1/161/hypertensionaha.116.078541.1/DCI

This is the first study to investigate the relationship between long-term all-cause mortality and achieved systolic blood pressure among a cohort of older adult hypertensive patients with documented coronary artery disease

Boal AH, Smith DJ, McCallum L, et al. Monotherapy with major antihypertensive drug classes and risk of hospital admission for mood disorders. Hypertension 2016;68:1132-8. The online-only data supplement is available at http://hyper.ahajournals.org/lookup/suppl/doi:10.1/161/hypertenionaha.116.081881.1/DCI

This study caused a major shock as it revealed that antihypertensive drug classes have a differential effect on hospital admissions for mood disorders. β-blockers and calcium channel blockers seem to be associated with a higher risk for mood disorder hospital admissions. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers may exert a protective effect compared with other antihypertensive drugs at first exposure

Magee LA, von Dadelszen P, Singer J, et al - CHIPS Study Group. The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy study): is severe hypertension just an elevated blood pressure? Hypertension 2016;68:1153-9. The online only data supplement is available at https://hyper.ahajournals.org//lookup/suppl/doi:10.1/161/HYPERTENSIONAHA.116.078621.1DCI

This study discusses the fact that severe hypertension is more than just a problem blood pressure. Rather, severe hypertension is an important clinical outcome worthy of avoidance, which increases the risk of adverse perinatal and maternal outcome beyond the risk of stroke. These issues are independent of the risk of preeclampsia

Mäki-Petäjä KM, Barrett SM, Evans SV, et al. The role of the autonomic nervous system in the regulation of aortic stiffness. Hypertension 2016;68:1290-7. Hypertension is available at http://hyper.ahajournals.org DOI:10/161/HYPERTENSIONAHA.116.08035Hypertension2016,26:1290-1297

The main finding of this series of studies is that in young healthy subjects, the autonomic nervous system regulates aortic stiffness via changes in heart rate and mean blood pressure

Wang C, Ye Z, Li Y, et al. Prognostic value of reverse dipper blood pressure pattern in chronic kidney disease patients not undergoing dialysis: prospective cohort study. Scientific Reports 6:34932 (2016) DOI:10.1038/serp34932. Available from: www.nature.com/scientificreports

This study provides the first evidence that a reverse dipping blood pressure pattern, independent of 24-hour systolic blood pressure, has prognostic value in Chinese chronic kidney disease patients not undergoing dialysis. Further prospective randomized clinical trials are needed to clarify if correction of blood pressure patterns by administration of antihypertensive drugs at night improves the prognosis and attenuates progression of cardiovascular disease and renal disease in chronic kidney patients

The debate on optimum blood pressure targets continues post-SPRINT, with several publications addressing this issue:

Vidal-Petiot E, Ford I, Greenlaw N, et al. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. Lancet 2016;388:2142-52. http://www.sciencedirect.com/science/article/pii/S0140673616313265

A recent analysis of data from 22,672 patients with stable coronary artery disease and hypertension enrolled in the CLARIFY registry was published in the Lancet. The authors found a J-shaped relationship between blood pressure (BP) and the composite of cardiovascular death, myocardial infarction, or stroke with systolic BP >140 mmHg and diastolic BP >80 mmHg and systolic BP <120 mmHg and diastolic BP <70 mmHg being associated with increased risk. The optimal level of blood pressure for these combined cardiovascular endpoints appeared to be about 130/77 mmHg after adjusting for relevant factors. Observational registry data should be interpreted with caution as there is a concern about reverse causality where a low systolic or diastolic BP might only be a marker of poor health rather than the cause of worse clinical outcomes. The authors discuss this in the article and consider that appropriate adjustments were made to overcome this issue.

Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016;387:957-67. http://www.ncbi.nlm.nih.gov/pubmed/26724178

Meta-regression analyses included data from 123 studies (including the SPRINT study) with 613,815 participants and found every 10 mmHg reduction in systolic BP significantly reduced the risk of major cardiovascular disease events (relative risk 0.80, 95% CI 0.77-0.83), coronary heart disease, stroke, heart failure and all-cause mortality, with similar proportional reductions across various population subgroups, irrespective of starting blood pressure. A baseline history for diabetes and chronic kidney disease was associated with smaller, but significant, risk reductions. Calcium channel blockers were superior to other drugs for the prevention of stroke but inferior for the prevention of heart failure, for which diuretics were superior to other drug classes. The authors concluded that their results provide strong support for lowering blood pressure to systolic BP <130 mmHg and providing blood pressure-lowering treatment to individuals with a history of cardiovascular disease, coronary heart disease, stroke, diabetes, heart failure, and chronic kidney disease

Brunstrom M, Carlberg B. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses. Br Med J 2016;352:i717. http://www.ncbi.nlm.nih.gov/pubmed/26920333

A systematic review and meta-analyses of randomised controlled trials of antihypertensive treatment in people with diabetes mellitus from 49 trials including 73,738 participants, found antihypertensive treatment reduced the risks if baseline systolic BP was >150 mmHg or 140-150 mmHg but not if it was <140 mmHg. They concluded if systolic BP is <140 mmHg, further treatment is associated with an increased risk of cardiovascular death, with no observed benefit. The analysis included the ALTITUDE study which found a harmful effect from lower blood pressures achieved by the addition of aliskiren to standard therapy with renin-angiotensin system blockade in patients with type 2 diabetes (Parving HH, et al. N Engl J Med 2012;367:2204-13). Other trials which involved dual blockade of the renin-angiotensin may have contributed to the worse outcome with systolic BP <140 mmHg

Lonn EM, Bosch J, Lopez-Jaramillo P, et al. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 2016;374:2009-20. http://www.ncbi.nlm.nih.gov/pubmed/27041480

In the HOPE-3 study, 12,705 participants at intermediate risk who did not have cardiovascular disease were randomized to receive either candesartan 16 mg/day plus hydrochlorothiazide 12.5 mg/day or placebo. There was no significant benefit of antihypertensive treatment overall, but in a prespecified subgroup analysis, subjects in the upper third of systolic BP (>143.5 mmHg) had significant benefits in cardiovascular outcomes

Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering treatment in hypertension: 8. Outcome reductions vs. discontinuations because of adverse drug events - meta-analyses of randomized trials. J Hypertens 2016;34:1451-63. http://www.ncbi.nlm.nih.gov/pubmed/27228434

Thomopoulos C, Parati G, Zanchetti A. Effects of blood-pressure-lowering treatment in hypertension: 9. Discontinuations for adverse events attributed to different classes of antihypertensive drugs: meta-analyses of randomized trials. J Hypertens 2016;34:1921-32. http://www.ncbi.nlm.nih.gov/pubmed/27454050

These two publications are from a series of meta-analyses looking at adverse effects from antihypertensive drugs. They reported that the absolute treatment discontinuation excess disproportionally increased with larger BP reductions compared with the increase in outcome risk reduction. There was a greater relative excess of treatment discontinuations seen when the achieved systolic BP was below 130 mmHg and angiotensin receptor blockers were the only class of drugs associated with a significantly lower risk of adverse events

Other publications

The following 3 articles are about the relationships between obesity and hypertension

The Working Group on Obesity, Diabetes and the High Risk Patient of the European Society of Hypertension has produced a Consensus Document on the pathogenesis of obesity-induced hypertension discussing a number of protective and promoting factors.

A large population study in middle-aged Chinese men and women showed that the visceral fat index (VFI) and percentage body fat (PBF) assessed by a multifrequency bioelectric impedance device were associated with a higher risk of hypertension and prehypertension, and the strongest association was with the amount of visceral fat (VFI) or the proportion of fat distributed viscerally (VFI/PBF ratio).

  • Association of visceral and total body fat with hypertension and prehypertension in a middle-aged Chinese population. Wang Z et al. J Hypertens. 2015;33:1555-1562. Link to PubMed http://www.ncbi.nlm.nih.gov/pubmed/26103127

A study examined whether adiposity in later midlife is an independent predictor of accelerated stiffening of the aorta in the Whitehall II study participants. General adiposity by body mass index (BMI) and different measures of abdominal adiposity (waist circumference and waist:hip ratio) were both strong predictors of aortic stiffening measured as increase in pulse wave velocity (PWV) between baseline and follow-up after 4 years independent of other background factors. These findings suggest that both general and central adiposity are important and potentially modifiable determinants of arterial aging, and the authors estimated that the increase in PWV linked with high BMI could account for 12% of the projected increase in cardiovascular risk because of high BMI.