Papers chosen by our Scientific Committee Members, Professor Brian Tomlinson, Professor Omar Awwad and Professor Harry Struijker-Boudier

2017 has been a rich and diverse year in terms of hypertension research and publications. We asked our Scientific Committee Members for Manage Hypertension Online, Professor Omar Awwad from Egypt, Professor Harry Struijker-Boudier from The Netherlands, and Professor Brian Tomlinson from Hong Kong to highlight the papers from 2017 which, in their opinion, were the key papers of the year – those that have made the most impact on the scientific community.

These papers are in no particular order

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/

ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension 2017 Nov 13. Available from: Hypertension and Journal of the American College of Cardiology.

These guidelines raised some systemic review questions on high blood pressure in adults including:

• Is there evidence that self-directed monitoring of blood pressure and ambulatory blood pressure monitoring are superior to office-based measurement of blood pressure?
• What is the optimal target for blood pressure lowering during antihypertensive therapy in adults?
• In adults with hypertension, do various antihypertensive drug classes differ in their comparative benefits and harms?
• In adults with hypertension, does initiating treatment with antihypertensive monotherapy versus initiating treatment with 2 drugs offer comparative benefits or harms on specific health outcomes?

Reboussin DM, Allen NB, Griswold ME, et al. Systematic review for the 2017 ACC/AHA/AAPA/

ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension. 2017 Nov 13. pii: HYP.0000000000000067. doi: 10.1161/HYP.

0000000000000067. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29133355

This systematic review provides the evidence on which the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline was based and concludes:

1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers, self-measured BP may be a helpful adjunct to routine office care

2) Systolic BP lowering to a target of <130 mmHg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure and major cardiovascular events

3) No class of medications (i.e. angiotensin converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers or beta-blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome.

Comments:

The new systolic BP target of <130 mmHg is heavily influenced by the SPRINT study.

Beta-blockers were not significantly inferior to thiazides for all-cause mortality and other cardiovascular endpoints, accept for stroke, although beta-blockers were not recommended as a first-line therapy in the 2017 Guideline.

Van Agtmaal MJM, Houben AJHM, Pouwer F, et al. Association of microvascular dysfunction with late-life depression: A systematic review and meta-analysis. JAMA Psychiatry 2017;74: 729-39.

The authors have performed a systematic review on the associations of peripheral and cerebral microvascular dysfunction with late-life depression. The following 5 estimates of microvascular dysfunction were considered: plasma markers of endothelial function, albuminuria, measurement of skin and muscle microcirculation, retinal arteriolar and venular diameter and markers for cerebral small vessel disease. Data from 43,600 participants and 9203 individuals with depression were used in this meta-analysis, which showed that both the peripheral and cerebral forms of microvascular dysfunction are associated with higher odds of late-life depression.

Perrone-Filardi P, Coca A, Galderisi M, et al. Noninvasive cardiovascular imaging for evaluating subclinical target organ damage in hypertensive patients. J Hypertens 2017;35:1727-41.

Consensus paper on the role of noninvasive imaging to detect subclinical target organ damage in hypertensive patients. This review focusses on various novel forms of noninvasive imaging of the heart (echocardiography, MRI), blood vessels (ultrasound, pulse wave velocity, phase-contrast MRI, computed tomography), kidney (GFR, nuclear imaging, MRI), brain (MRI) and eye (microscopy, scanning laser Doppler flowmetry). The authors conclude that evaluation of target organ damage has become a key step in the initial management of patients with hypertension.

Shi Y, Zhou W, Liu X, et al. Resting heart rate and the risk of hypertension and heart failure: A dose-response meta-analysis of prospective studies. J Hypert 2017,35: DOI: 10.1097/

HJH.0000000000001627.

The authors carried out a dose-response meta-analysis of studies that looked at risks associated with resting heart rate and hypertension or heart failure. They identified 13 and 17 cohort studies for hypertension and heart failure, respectively. The relationship between resting heart rate and hypertension or heart failure was consistent in most subgroup analyses except for gender subgroups, with no significant association observed in the subgroup of women. Study conclusion: heart rate shows a linear positive association with the incidence of hypertension and heart failure.

Brunström M, Carlberg B. Association of blood pressure lowering with mortality and cardiovascular disease across blood pressure levels: A systematic review and meta-analysis. JAMA Internal Medicine 2017. Available from:

http://dx.doi.org/10.1001/jamainternmed.2017.6015

This systematic review and meta-analysis recommended that systolic BP of ³140 mmHg should be treated to prevent death and cardiovascular disease, whereas treatment may be considered in patients with coronary heart disease and systolic BP <140 mmHg, but not for primary prevention.

Comment:

The conclusion differs somewhat from the 2017 ACC/AHA/etc. analysis

Faulkner JL, Belin de Chantemle EJ. Sex differences in mechanisms of hypertension associated with obesity. Hypertension 2018:71:15-21. Available from: http://hyperahajournals.org/.

This review summarizes current knowledge of:

• Epidemiological data of sex discrepancies of obesity-associated hypertension
• The sex specificity of the effects of obesity on sympathoactivation and its role in hypertension
• The potential risk of leptin in sex difference in obesity-associated hypertension.

Engeli S, Stinkens R, Heise T, et al. Effect of sacubitril/valsartan on exercise-induced lipid metabolism in patients with obesity and hypertension. Hypertension 2018 Jan;71(1):70-77. Available from: http://hyperahajournals.org/

An imbalance between fatty acid mobilization and utilization may adversely affect cardiovascular and metabolic health. In this study, sacubitril/valsartan treatment did not elicit clinically relevant changes in exercise-induced lipolysis or substrate oxidation in obese patients with hypertension. Natriuretic peptides potently augment human adipose tissue lipolysis, postprandial lipid oxidation, and skeletal muscle oxidative capacity whereas angiotensin II elicits more subtle changes in fatty acid turnover.

Dzeshka MS, Shantsila A, Shantsila E, Lip GYH. Atrial fibrillation and hypertension. Hypertension 2017;70:854-861.

This review attempted to answer important questions such as:

• The optimal blood pressure threshold
• Effectiveness of renal denervation in patients who receive ablation for atrial fibrillation
• Impact of blood pressure lowering on diastolic dysfunction
• Heart failure with preserved ejection fraction in people with atrial fibrillation.
  

Selvarajah V, Mäki-Petäjä KM, Pedro L, et al. Novel mechanism for buffering dietary salt in humans. Effect of salt loading on skin sodium, vascular endothelial growth factor C, and blood pressure. Hypertension 2017 Nov;70(5):930-937. Available from: http://hyperahajournals.org/

This study found that skin sodium increases with dietary salt loading in humans. The skin may buffer dietary sodium, reducing the haemodynamic consequence of increased salt. This effect may be influenced by sex. Skin sodium may influence blood pressure, stroke volume and peripheral vascular resistance.

D’Elia L, La Fata E, Galletti F, et al. Coffee consumption and risk of hypertension: a dose–response meta-analysis of prospective studies. Eur J Nutr 2017 Available from: https://doi.org/10.1007/s00394-017-1591-z

This updated systematic review and meta-analysis included data from four prospective observational studies and found that habitual drinking of one or two cups of coffee per day did not increase the risk of developing hypertension and drinking three or more cups of coffee per day significantly reduced the risk of hypertension with greater consumption having greater benefit

Comment:

Good news for coffee lovers!