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Congress reports: Highlights ESH 2013

Congress reports: Highlights ESH 2013
  • Cardiometabolic
  • Hypertension

Resource type

Article

The 23rd meeting on hypertension & cardiovascular protection, organized by the European Society of Hypertension (ESH), was held in Milan on 14-17 June, 2013. There were international participants as well as European and many important issues were discussed concerning hypertension and related cardiovascular diseases. The meeting also released to the scientific community the new ESH/ESC guidelines for the management of hypertension, available online. Below  is a summary of the most significant topics presented during the scientific sessions.

A major topic topic of relevance during the meeting was the new technological solutions for the management of resistant hypertension. In particular, results from preliminary studies were presented on the use of two novel interventional approaches, the renal denervation and the baroreflex stimulators. The former acts mainly by reducing the sympathetic overactivity present in such cases with significant reduction of blood pressure (up to 30%) and improved quality of life due to the reduction of antihypertensive agents. Baroflex stimulators are implantable vagal stimulators, to be placed close to the carotid bulb, releasing a periodical impulse able to significantly decrease blood pressure and heart rate. Although for both techniques confirmatory studies have to be performed, they appear quite easy to perform, with few side effects and relatively inexpensive.

Another key issue  regarding hypertension is  that of controlling blood pressure at night. In many cases of uncontrolled hypertension the reason is nocturnal hypertension, an important cardiovascular prognostic factor requiring diagnosis by overnight blood pressure recording using different techniques, some under validation (e.g. pulse transit time). Polysonnography should be also used  to better find subjects at high risk and implement appropriate therapeutic drugs and strategies. Obstructive sleep apneas are a major determinant for nocturnal blood pressure peaks and, together with the associated hypoxia, are responsible for cardiovascular events such as cardiac or cerebral ischemia or arrhythmias. Impairment of cognitive function, metabolic and endocrine disturbances are also present.

Heart rate in hypertension and cardiovascular diseases was another important issue discussed during the meeting’s sessions. Heart rate is a marker of sympathetic activity and predicts cardiovascular risk and events, especially at night , arrhythmias and related mortality (over 80 bpm at rest). Tachycardia can cause mechanical damage to peripheral organs, with reduction of blood flow and of capillary density, due to hypertension, increased arterial stiffness and resistance; it is also correlated to metabolic diseases, e.g. type 2 diabetes and insulin resistance. The new generation of beta-blockers can reduce such overdrive and limit its consequences without metabolic or respiratory side effects and with minimal effects on sexual function.

Another key topic  was that of arrhythmias in hypertension that in turn represent  a major risk for subsequent cardiovascular events, i.e. strokes. Hypertension with left ventricular hypertrophy and dilatation and associated sympathetic overdrive predispose frequently to the onset of atrial fibrillation, the most frequent type. Other factors favouring its occurrence are cardiac ischemic conditions, conduction-repolarization disorders, hypokalemia from antihypertensive drugs and hypoxic obstructive sleep apneas. Beta-blockers and blockers of the renin-angiotensin system together with antiarrhythmic drugs are used to manage  these cases together with the use of aspirin and oral anticoagulants to prevent thromboembolism.

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