Hypertensive states of pregnancy.

Hypertensive disorders in pregnancy (HDP) remain a leading cause of pregnancy-related maternal and foetal morbidity and mortality worldwide, including chronic hypertension, gestational hypertension, and pre-eclampsia. Affected women and newborns also have an increased risk of cardiovascular disease later in life, independent of traditional cardiovascular disease risks. Despite these risks, recommendations for optimal diagnosis and treatment have changed little in recent decades, probably due to fear of the foetal repercussions of decreased blood pressure and possible drug toxicity. In this document we review the diagnostic criteria and classification of (HDP), as well as important aspects regarding pathophysiology and early detection that allows early identification of women at risk, with the aim of preventing both immediate and long-term consequences. Prophylactic treatment with aspirin is also reviewed early and a therapeutic approach is carried out that involves close maternal and foetal monitoring, and if necessary, the use of safe drugs in each situation. This review aims to provide an updated vision for the prevention, diagnosis, and treatment of HDP that is useful in our usual clinical practice.

[2022 Practice guidelines for the management of arterial hypertension of the Spanish Society of Hypertension]. / Guía práctica sobre el diagnóstico y tratamiento de la hipertensión arterial en España, 2022. Sociedad Española de Hipertensión - Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA).

Hypertension is the most important risk factor for global disease burden. Detection and management of hypertension are considered as key issues for individual and public health, as adequate control of blood pressure levels markedly reduces morbidity and mortality associated with hypertension. Aims of these practice guidelines for the management of arterial hypertension of the Spanish Society of Hypertension include offering simplified schemes for diagnosis and treatment for daily practice, and strategies for public health promotion. The Spanish Society of Hypertension assumes the 2018 European guidelines for management of arterial hypertension developed by the European Society of Cardiology and the European Society of Hypertension, although relevant aspects of the 2017 American College of Cardiology/American Heart Association guidelines and the 2020 International Society of Hypertension guidelines are also commented. Hypertension is defined as a persistent elevation in office systolic blood pressure ≥ 140 and/or diastolic blood pressure ≥ 90 mmHg, and assessment of out-of-office blood pressure and global cardiovascular risk are considered of key importance for evaluation and management of hypertensive patients. The target for treated blood pressure should be < 130/80 for most patients. The treatment of hypertension involves lifestyle interventions and drug therapy. Most people with hypertension need more than one antihypertensive drug for adequate control, so initial therapy with two drugs, and single pill combinations are recommended for a wide majority of hypertensive patients.

Hypertension: The most common chronic health problem in Spain. A call to action.

Hypertension (HYP) is the first cause of death and disability worldwide. In Spain, one in 3 adults was hypertensive in 2010 (62% in those >65 years in 2017). Despite improvement in HYP management over time, only half of treated hypertensive patients are adequately controlled, which translates in 30,000 annual cardiovascular deaths attributable to HYP. Among modifiable determinants of lack of blood pressure (BP) control in Spain are: (a) the white-coat phenomenon (accounting for 20-50% of apparent lack of control) due to not using ambulatory BP monitoring (ABPM, use ≈20%) or self-measurement of home BP (HBPM, use ≈60%) for confirming HYP diagnosis; (b) insufficient patients adherence to BP-lowering lifestyles (e.g., only 40% of hypertensive patients have a sodium intake <2.4g/day, or follow a weight reduction advice), and (c) use of drug monotherapy (≈50% currently), usually insufficient to achieve an optimal control. It is necessary to implement strategies to monitor the evolution of the proportion of subjects with HYP with reasonable national update, to promote population's knowledge of their BP figures and of other cardiovascular risk factors, to improve the degree of HYP control and vascular risk in Spain.

[Blood pressure measurement campaign (May Measurement Month) from community pharmacies in 2018: analysis of screening in Spain]. / Campaña de medida de la presión arterial (May Measurement Month) desde las farmacias comunitarias en el 2018: análisis del cribado en España.

INTRODUCTION: Within the international project May Measurement Month, in Spain, the community pharmacy is where the greatest number of measurements are carried out and where the population can be made aware of the importance of regular blood pressure measurement. OBJECTIV: To ascertain the situation of the Spanish population's blood pressure and dissemination of the importance of its regular measurement through the community pharmacies. METHODS: Cross-sectional descriptive study carried out in Spanish community pharmacies during the month of May 2018, among pharmacy users of legal age. Systolic blood pressure, diastolic blood pressure and heart rate were measured as main variables. RESULTS: Five thousand, seven hundred and eighty-five readings were made by 891 pharmacists. One thousand, seven hundred and fifty-five (34.8%) people had not had their blood pressure measured in the last year. Of the participants, 31.2% had high blood pressure readings. Mean systolic blood pressure was 127.1±20.1 and mean diastolic blood pressure 77.5±12.5, higher in men (p<.001). There were normal blood pressure values in 3,981 (68.8%) patients; one high reading in 1,226 (21.2%); and two in 578 (10%). There were 912 (15.76%) patients with SBP≥140 and 314 (5.4%) with DBP≥90. Four (0.07%) hypertensive emergencies were detected. CONCLUSIONS: Three out of ten participants had a high blood pressure reading. Therefore, protocolized blood pressure readings carried out in a health care facility such as the community pharmacy, allowed the identification of a significant number of subjects with high and untreated blood pressure.

2021 Spanish Society of Hypertension position statement about telemedicine.

The pandemic caused by coronavirus SARS-CoV-2 (COVID-19) has forced, in many cases, to replace face-to-face consultation with the telematic consultation, in order to reduce the risk of contagion associated with the presence of patients in health centres. This change may represent an opportunity for a different and more effective communication between professionals and patients, allowing better accessibility to medical care and more systematic and comprehensive approach to patients with hypertension and cardiovascular risk. However, organisational tools are needed to facilitate communication between patients and professionals, specifically with the exchange of clinical data by remote monitoring of variables associated with hypertension and cardiovascular risk (blood pressure, weight, height, blood tests…), and allow monitoring of adherence to treatments, lifestyles and risk factors. It would be desirable for this to be carried out by multidisciplinary teams, both from primary care, hospital and community pharmacy, with an adequate coordination of care. This document of the Spanish Society of Hypertension (SEH-LELHA) tries to give the keys to improve the quality of care of telematic consultations of patients with hypertension and cardiovascular risk, provide basic criteria of telematic or face to face attention and systematise their content. Likewise, the follow-up criteria are proposed by the different professionals.

[Awareness, treatment and control of blood pressure according to place of recruitment and sex in the May Measure Month 2018 survey in Spain]. / Conocimiento, tratamiento y control de la presión arterial según lugar de reclutamiento y sexo en la encuesta May Measure Month 2018 en España.

OBJECTIVE: To analyse the data, according to recruiting place and sex, of the survey May Measure Month in 2018 (MMM18) in Spain, promoted by the International Society of Hypertension. METHODS: Subjects more than 18 years old were studied. MMM18 protocol was performed. Volunteers were recruited through the Spanish Society of Community Pharmacy (SEFAC) and the Spanish Society of Hypertension (SEH-LELHA). General linear models of blood pressure (BP) were carried out in subjects with and without treatment, and adjusted by age, sex, tobacco use, obesity and recruitment site. RESULTS: 7 511 individuals (mean age 51.7 ± 19.6 years, 36.8% males) were screened. Systolic and diastolic BP was higher in males (129.0-16.7/119.6-18.2 mmHg) (78.3-11.1/74.8-10.7 mmHg) (p < 0.001). There was a linear relationship between systolic BP, age and sex, with higher values in males (11.2 mmHg in untreated and 4.5 mmHg in treated) (p < 0.001). Diastolic BP was inverted U-shaped, with highest level in males and between 50-55 years. The proportion of individuals with hypertension (pharmacies; public and clinical area) was 47.2% (54.2; 34.1 and 34.8%). Seventy-five percent were aware of their diagnosis (77.5; 61.5 and 69.2%), with 22% of them without pharmacological treatment (20.7; 26.0 and 27.9%). Sixty-four point five percent of those under antihypertensive treatment met targets (62.9; 65.6 and 69.1%) (p < 0.001). CONCLUSIONS: There is big room for improvement in MMM indicators in Spain. Nearly half of subjects are hypertensive. Of those aware of their condition, 1 in 5 did not follow pharmacological treatment and of those treated, 1 in 3 did not meet targets. BP levels were significantly higher in males. Our study suggests that gender differences described should be considered in the BP thresholds established.

[Position statement on ambulatory blood pressure monitoring (ABPM) by the Spanish Society of Hypertension (2019)]. / Documento de la Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA) sobre monitorización ambulatoria de la presión arterial (MAPA) 2019.

Conventional blood pressure (BP) measurement in clinical practice is the most used procedure for the diagnosis and treatment of hypertension (HT), but is subject to considerable inaccuracies due to, on the one hand, the inherent variability of the BP itself and, on the other hand biases arising from the measurement technique and conditions, Some studies have demonstrated the prognosis superiority in the development of cardiovascular disease using ambulatory blood pressure monitoring (ABPM). It can also detect "white coat" hypertension, avoiding over-diagnosis and over-treatment in many cases, as well detecting of masked hypertension, avoiding under-detection and under-treatment. ABPM is recognised in the diagnosis and management of HT in most of international guidelines on hypertension. The present document, taking the recommendations of the European Society of Hypertension as a reference, aims to review the more recent evidence on ABPM, and to serve as guidelines for health professionals in their clinical practice and to encourage ABPM use in the diagnosis and follow-up of hypertensive subjects. Requirements, procedure, and clinical indications for using ABPM are provided. An analysis is also made of the main contributions of ABPM in the diagnosis of "white coat" and masked HT phenotypes, short term BP variability patterns, its use in high risk and resistant hypertension, as well as its the role in special population groups like children, pregnancy and elderly. Finally, some aspects about the current situation of the Spanish ABPM Registry and future perspectives in research and potential ABPM generalisation in clinical practice are also discussed.

[Spanish Society of Hypertension position statement on the 2017 ACC/AHA hypertension guidelines]. / Documento de la Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA) sobre las guías ACC/AHA 2017 de hipertensión arterial.

The American College of Cardiology (ACC) and the American Heart Association (AHA) have recently published their guidelines for the prevention, detection, evaluation, and management of hypertension in adults. The most controversial issue is the classification threshold at 130/80mmHg, which will allow a large number of patients to be diagnosed as hypertensive who were previously considered normotensive. Blood pressure (BP) is considered normal (<120mmHg systolic and <80mmHg diastolic), elevated (120-129 and <80mmHg), stage 1 (130-139 or 80-89mmHg), and stage 2 (≥140 or ≥90mmHg). Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication. In management, cardiovascular risk would be determinant since those with grade 1 hypertension and an estimated 10-year risk of atherosclerotic cardiovascular disease ≥10%, and those with cardiovascular disease, chronic kidney disease and/or diabetes will require pharmacological treatment, the rest being susceptible to non-pharmacological treatment up to the 140/90mmHg threshold. These recommendations would allow patients with level 1 hypertension and high atherosclerotic cardiovascular disease to benefit from pharmacological therapies and all patients could also benefit from improved non-pharmacological therapies. However, this approach should be cautious because inadequate BP measurement and/or lack of systematic atherosclerotic cardiovascular disease calculation could lead to overestimation in diagnosing hypertension and to overtreatment. Guidelines are recommendations, not impositions, and the management of hypertension should be individualized, based on clinical decisions, preferences of the patients, and an adequate balance between benefits and risks.

[Use of ambulatory blood pressure monitoring]. / Utilización de la monitorización ambulatoria de la presión arterial.

Hypertension (HT) is the most important risk factor in the development of cardiovascular disease. Classically diagnosis and management have been based on conventional office blood pressure (BP) but it has as main limitation that only offers information of a particular time and presents multiple biases dependent on inherent variability of blood pressure and measurement technique itself. Ambulatory blood pressure monitoring (ABPM) consists of performing multiple measurement of blood pressure, performed automatically, outside the medical setting, during the normal activities of the individual and in a 24-hour period. Multiple studies have demonstrated the prognosis superiority in the development of cardiovascular disease of ABPM, it allows detection of white coat HT as well, avoiding overdiagnosis and overtreatment and the detection of patients with masked H T, who contrarily are at risk of underdetection and undertreatment. Also it provides nighttime BP and circadian variability that provides additional prognostic value. © 2017 SEHLELHA. Published by Elsevier España, S.L.U. All rights reserved.

[Epidemiology of hypertension]. / Epidemiología de la hipertensión arterial.

Hypertension (HT) is the first cause of death and disability worldwide. One in 3 adults in Spain is hypertensive (66% in those > 60 years). Despite improvement in hypertension management over time, only half of treated hypertensive patients are adequately controlled. This translates in 40,000 annual cardiovascular deaths attributable to H T. Among modifable determinants of lack of blood pressure (BP) control in Spain are: a) the white coat phenomenon (accounting for 20-50% of false lack of control) due to not using ambulatory BP monitoring (current use, 20%) or self-BP measurement (use, 60%) for confirming HT diagnosis; b) insufficient patients adherence to BP reducing lifestyles (e.g., only 40% of hypertensive patients have a sodium intake < 2.4 g/day, or follow a weight reduction advice), and c) use of drug monotherapy (≈50%), usually insufficient to achieve adequate control. © 2017 SEHLELHA. Published by Elsevier España, S.L.U. All rights reserved.

[Ambulatory blood pressure monitoring for hypertension diagnosis?] / ¿Monitorización ambulatoria de la presión arterial en el diagnóstico de la hipertensión arterial?

The early and accurate diagnosis of hypertension is essential given its importance in the development of cardiovascular disease. The boundaries between normal blood pressure (BP) and hypertension are arbitrary and based on the benefits of treating exceeding those of not treating. Conventional BP measurement at the clinic only offers information of a particular time and presents multiple biases dependent on inherent variability of BP and measurement technique itself. Multiple studies have demonstrated the prognosis superiority in the development of cardiovascular disease of ambulatory blood pressure monitoring (ABPM), allows detection of white coat hypertension, avoiding overdiagnosis and overtreatment, and the detection of patients with masked hypertension who are at risk of underdetection and undertreatment. ABPM also assess nightime BP and circadian variability, providing additional prognostic value. ABPM is recognized in the diagnosis of hypertension in 2011 British NICE Guidelines, very argued at the 2013 European Society of Hypertension guidelines, and recommended in the US Preventive Services Task Force in 2015, 2016 Canadian Guidelines and the 2016 Spanish Program of Preventive Activities and Health Promotion (PAPPS). Its generalization is likely to be only a matter of time.

[Cardiovascular disease in hypertension: gender differences in 100,000 clinical records]. / Enfermedad cardiovascular en pacientes con hipertensión arterial: diferencias por género a partir de 100.000 historias clínicas.

OBJECTIVES: To examine the type of cardiovascular disease (CVD) and treatment and achievement of treatment goals in blood pressure and lipids in hypertensive patients in primary care. PATIENTS AND METHODS: A cross-sectional study of all medical records of hypertensive patients, from which patients with antihypertensive treatment who visited the 25 Primary Health Care Centers of the 6(th) sanitary district of Madrid during 2008 were selected. RESULTS: From a total of 92,079 patients, 19,501 (21 2%) with an arterial hypertension had a previous diagnosis of CVD (23.9% in males and 19.1% in females). In hypertensive with CVD, the most frequent diagnosis and their proportion in males and females were: ischemic heart disease 35.6% (43.7%/27.6%), atrial fibrillation 29.5% (25%/33.9%), stroke 24% (22%/26.7%), chronic renal disease 15.7% (18.2%/13.2%), heart failure 15.3% (10.4%/20.2%) and peripheral artery disease 7.5% (8.7%/6.4%) (P<.05). Antihypertensive drugs, lipid-lowering drugs and antiplatelet therapy were used more often by males, with women predominating in the prescription of diuretics and angiotensin receptor blockers and anticoagulants, (P<.05).The proportion of patients with blood pressure<140/90 mmHg was 60.5% and 59.1%, and that of LDL-cholesterol <100mg/ dl was 40.4% y 31% (P<.005), in males and females, respectively. CONCLUSIONS: In almost all the 20,000 patients with CVD studied, substantial gender differences in the prevalence, therapy and achievements of goals in the different types of CVD were observed. These results suggest the convenience of homogenization of the computerized registries at the present, for monitoring results over time, with no need of continuous sampling-based studies.