Screening and management of hypertensive patients with chronic kidney disease referred to Hypertension Excellence Centres among 27 countries. A pilot survey based on questionnaire.

OBJECTIVE: Real-life management of hypertensive patients with chronic kidney disease (CKD) is unclear. METHODS: A survey was conducted in 2023 by the European Society of Hypertension (ESH) to assess management of CKD patients referred to ESH-Hypertension Excellence Centres (ESH-ECs) at first referral visit. The questionnaire contained 64 questions with which ESH-ECs representatives were asked to estimate preexisting CKD management quality. RESULTS: Overall, 88 ESH-ECs from 27 countries participated (fully completed surveys: 66/88 [75.0%]). ESH-ECs reported that 28% (median, interquartile range: 15-50%) had preexisting CKD, with 10% of them (5-30%) previously referred to a nephrologist, while 30% (15-40%) had resistant hypertension. The reported rate of previous recent (<6 months) estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) testing were 80% (50-95%) and 30% (15-50%), respectively. The reported use of renin-angiotensin system blockers was 80% (70-90%). When a nephrologist was part of the ESH-EC teams the reported rates SGLT2 inhibitors (27.5% [20-40%] vs. 15% [10-25], P  = 0.003), GLP1-RA (10% [10-20%] vs. 5% [5-10%], P  = 0.003) and mineralocorticoid receptor antagonists (20% [10-30%] vs. 15% [10-20%], P  = 0.05) use were greater as compared to ESH-ECs without nephrologist participation. The rate of reported resistant hypertension, recent eGFR and UACR results and management of CKD patients prior to referral varied widely across countries. CONCLUSIONS: Our estimation indicates deficits regarding CKD screening, use of nephroprotective drugs and referral to nephrologists before referral to ESH-ECs but results varied widely across countries. This information can be used to build specific programs to improve care in hypertensives with CKD.

Rationale and design of the CV-PREVITAL study: an Italian multiple cohort randomised controlled trial investigating innovative digital strategies in primary cardiovascular prevention.

INTRODUCTION: Prevention of cardiovascular disease (CVD) is of key importance in reducing morbidity, disability and mortality worldwide. Observational studies suggest that digital health interventions can be an effective strategy to reduce cardiovascular (CV) risk. However, evidence from large randomised clinical trials is lacking. METHODS AND ANALYSIS: The CV-PREVITAL study is a multicentre, prospective, randomised, controlled, open-label interventional trial designed to compare the effectiveness of an educational and motivational mobile health (mHealth) intervention versus usual care in reducing CV risk. The intervention aims at improving diet, physical activity, sleep quality, psycho-behavioural aspects, as well as promoting smoking cessation and adherence to pharmacological treatment for CV risk factors. The trial aims to enrol approximately 80 000 subjects without overt CVDs referring to general practitioners' offices, community pharmacies or clinics of Scientific Institute for Research, Hospitalization and Health Care (Italian acronym IRCCS) affiliated with the Italian Cardiology Network. All participants are evaluated at baseline and after 12 months to assess the effectiveness of the intervention on short-term endpoints, namely improvement in CV risk score and reduction of major CV risk factors. Beyond the funded life of the study, a long-term (7 years) follow-up is also planned to assess the effectiveness of the intervention on the incidence of major adverse CV events. A series of ancillary studies designed to evaluate the effect of the mHealth intervention on additional risk biomarkers are also performed. ETHICS AND DISSEMINATION: This study received ethics approval from the ethics committee of the coordinating centre (Monzino Cardiology Center; R1256/20-CCM 1319) and from all other relevant IRBs and ethics committees. Findings are disseminated through scientific meetings and peer-reviewed journals and via social media. Partners are informed about the study's course and findings through regular meetings. TRIAL REGISTRATION NUMBER: NCT05339841.

Management of hypertension during lenvatinib for advanced thyroid cancer: a suggested diagnostic and therapeutic algorithm.

Background: Hypertension (HTN) is the most frequent adverse event during treatment with lenvatinib (LEN), but data on its best management are limited. Aim: The objective of this study was to assess incidence, features and best management of LEN-related HTN in a consecutive single tertiary-care centre cohort. Methods: Twenty-nine patients were followed up for a mean time of 29.8 months (6-77 months). Results: After a mean follow-up of 6.8 months, HTN was recorded in 76% of cases, as a de novo occurrence in half of them. HTN significantly correlated with LEN dose and was of grade 1, grade 2 and grade 3 in 5%, 50% and 45% of patients, respectively. The majority (77%) of patients with HTN developed proteinuria. There was no correlation between HTN and proteinuria or clinical features or best morphological response or any other adverse event (AE), with the exception of diarrhoea. Patients with or without pre-existing HTN or any other cardiovascular disease had a similar incidence of HTN during LEN, thus excluding the impact of this potential predisposing factor. After evaluation by a dedicated cardiologist, medical treatment was introduced in 21/22 patients (polytherapy in 20 of them). The most frequently used drugs were calcium channel blockers (CCBs) due to their effect on vasodilation. In case of poor control, CCBs were associated with one or more anti-hypertensive drug. Conclusion: HTN is a frequent and early AE in patients on LEN treatment. We suggest a diagnostic and therapeutic algorithm to be applied in clinical practice to allow efficient HTN control and improve patient compliance, reducing LEN discontinuation.

Effects of uric acid-lowering therapy in patients with essential arterial hypertension.

OBJECTIVES: Asymptomatic hyperuricemia (AHU) is elevated serum uric acid (UA) without symptoms. This study aimed to determine the effects of AHU treatment with allopurinol on selected hypertension-mediated organ damage (HMOD) indices in patients with uncomplicated essential arterial hypertension (AH). METHODS: Patients aged 30-70 years with AHU and AH grade 1-2 with adequate blood pressure (BP) control, without previous urate-lowering therapy (ULT), were divided into two groups: (a) ULT (receiving allopurinol) and (b) control (age- and sex-matched patients without ULT). Both received a UA-lowering diet. BP (office, 24 h and central), echocardiographic parameters, carotid intima-media thickness (IMT) and lab tests [high-sensitivity C-reactive protein (hs-CRP)] were measured at baseline and at 6 months follow-up. RESULTS: Of 100 participants, 87 (44 ULT, 43 controls) completed the study. At 6 months follow-up, there was a greater reduction in serum UA concentration in the ULT group than in the control group. Patients receiving allopurinol had significant reductions in office systolic and diastolic BP, central systolic BP, pulse pressure, IMT (0.773 ± 0.121 vs. 0.752 ± 0.13 mm, P = 0.044) and hs-CRP (3.36 ± 2.73 vs. 2.74 ± 1.91 mg/L, P = 0.028) compared to controls. Multivariate regression analysis revealed the independent relationship between reduction in IMT and UA lowering (P < 0.026). CONCLUSION: In patients with AH and AHU, treatment with allopurinol leads to improvement in BP control and reduction in HMOD intensity, in particular IMT. The decrease in hs-CRP concentration associated with ULT may have a beneficial effect on a patient's long-term prognosis.

Lifestyle, psychological, socioeconomic and environmental factors and their impact on hypertension during the coronavirus disease 2019 pandemic.

SUMMARY: The coronavirus disease 2019 (COVID-19) pandemic considerably affects health, wellbeing, social, economic and other aspects of daily life. The impact of COVID-19 on blood pressure (BP) control and hypertension remains insufficiently explored. We therefore provide a comprehensive review of the potential changes in lifestyle factors and behaviours as well as environmental changes likely to influence BP control and cardiovascular risk during the pandemic. This includes the impact on physical activity, dietary patterns, alcohol consumption and the resulting consequences, for example increases in body weight. Other risk factors for increases in BP and cardiovascular risk such as smoking, emotional/psychologic stress, changes in sleep patterns and diurnal rhythms may also exhibit significant changes in addition to novel factors such as air pollution and environmental noise. We also highlight potential preventive measures to improve BP control because hypertension is the leading preventable risk factor for worldwide health during and beyond the COVID-19 pandemic.

Reduction of 24-h blood pressure variability in extreme obese patients 10 days and 6 months after bariatric surgery depending on pre-existing hypertension.

Bariatric surgery is considered as a first line treatment in extreme obese patients to achieve a reduction in health risks. However, after surgical procedure obese patients with normal blood pressure (BP) levels still present residual risk, which may be partly related to lack of correction of BP profile and variability. AIM: To evaluate short (10 days) and mid-term (6 months) changes of mean values, profile and variability of BP after bariatric surgery in extremely obese patients with and without hypertension. MATERIALS & METHODS: A follow-up of cross-sectional study was conducted in 90 obese patients (aged 41.7 ±â€¯11.3, BMI = 46.7 ±â€¯5.7 kg/m2), who met the eligibility criteria and underwent bariatric surgery. Each patient underwent 24-h ambulatory BP monitoring with profile and variability estimation before, 10 days and 6 months after the intervention. RESULTS: Sixty-seven (74.4%) patients had hypertension. Significant decrease from baseline in mean values of systolic and diastolic BP in 10 days (p < .005) and 6 months (p < .005) follow-up were observed only in patients with hypertension. Moreover, only hypertensive subjects revealed significant reduction (p < 0,05) from baseline in 24-h systolic and diastolic BP weighted standard deviation and average real variability after surgical procedure. No changes were found in dipping status. CONCLUSIONS: Bariatric surgery not only decreased BP levels, but also contributed to reduction in BP variability in early period after intervention mainly in patients with pre-existing hypertension.

Modulation of urinary peptidome in humans exposed to high altitude hypoxia.

The exposure of healthy subjects to high altitude represents a model to explore the pathophysiology of diseases related to tissue hypoxia and to evaluate pharmacological approaches potentially useful as a therapy for chronic diseases related to hypoxia. We explored the urinary peptidome to detect alterations induced by the exposure of subjects to different altitudes (sea level, high altitude = 3500 m, very high altitude = 5400 m) and to pharmacological treatment. Urine samples were collected from 47 subjects, randomly and blindly assigned to placebo (n = 24) or Telmisartan (n = 23). Samples were purified by the use of magnetic beads, then analysed by MALDI-TOF MS. Results showed that the urinary peptidome is not affected by the administration of Telmisartan, neither at the sea level nor at high and very high altitudes. In contrast, the urinary protein profiles are modified when subjects are exposed to high and very high altitudes, and we detected six peptides differentially expressed in hypobaric hypoxia at high or very high altitude compared to the sea level. Two of them were identified as fragments of the glycoprotein uromodulin and of the α1-antitrypsin. This is the first proteomic study showing that hypobaric hypoxia conditions affect the urinary peptidome.

[Cracovian program for secondary prevention of ischemic heart disease. Secondary prevention of ischemic heart disease during hospitalization in 1996-97 and 1998-99]. / Krakowski Program Wtórnej Prewencji Choroby Niedokrwiennej Serca. Porównanie realizacji wtórnej prewencji choroby niedokrwiennej serca w okresie hospitalizacji w latach 1996/97 i 1998/99.

INTRODUCTION: Hospitalization for ischaemic heart disease is a convenient moment to initiate pharmacological and non-pharmacological treatment as well as education of patients. The aim of the study was to assess the quality of medical care in the field of secondary prevention in patients hospitalized for ischaemic heart disease in cardiac departments of university and general hospitals in 1998/99 as compared with 1996/97. MATERIAL: Consecutive patients were recruited on the basis of hospital records review of six cardiac departments (three in the university and three in general hospitals) in 1998/99. Inclusion criteria were: age < or = 70 years, inhabitance in the city of Cracow and its province and hospitalization due to: myocardial infarction, unstable angina, coronary angioplasty or coronary-aortic bypass grafting. METHODS: Hospital records of the included patients were reviewed. Data on previous history of ischaemic heart disease, on risk factors (including smoking, hypertension, diabetes, dyslipidemia, obesity) and drugs prescribed at discharge were obtained based on a predefined questionnaire. RESULTS: The frequency of blood pressure measurement in the first 24 hours of hospitalization was 88.8% in 1996/97 vs 95.7% in 1998/99 (p < 0.001). In the first 24 hours after admission total cholesterol concentration was measured in 32.8% and 45.0% of patients (p < 0.001), HDL cholesterol in 30.2% and 41.9% (p < 0.001) and triglycerides in 32.3% and 44.5% (p < 0.001), respectively. Both height and body mass were documented in 54.3% and 61.7% (p < 0.05) of the reviewed charts. Antiplatelet drugs were prescribed at discharge in 86.7% and 90.7% of patients (p < 0.05), beta-blockers in 66.4% and 61.9%, ACE inhibitors in 50.2% and 52.8%, while lipid lowering drugs in 27.1% and 41.6% (p < 0.001), respectively. CONCLUSION: In 1998/99 compared with 1996/97 the quality of care in the field of secondary prevention of ischaemic heart disease was improved in cardiac departments of university and general hospitals in Cracow.

[Cracovian program for secondary prevention of ischemic heart disease. Secondary prevention of ischemic heart disease after discharge in 1997-98 and 1999-2000]. / Krakowski Program Wtórnej Prewencji Choroby Niedokrwiennej Serca. Realizacja wtórnej prewencji choroby niedokrwiennej serca w okresie po hospitalizacji w latach 1997/98 i 1999/2000.

INTRODUCTION: Although most actions undertaken within the scope of the secondary prevention of ischaemic heart disease should be initiated during hospitalization, obtaining maximal effects (quantified by cardiovascular risk reduction) depends largely on continuation and appropriate adjustment of these measures in the post-discharge period. The aim of this paper is to assess the implementation of guidelines on secondary prevention of ischaemic heart disease in the period after discharge from the hospital in the years 1999/2000 as compared with 1997/98. MATERIAL AND METHODS: In the first phase 515 subjects hospitalized in cardiac departments of university and general hospitals in Cracow were included. Out of them, 427 patients attended the control visit 6-18 months after index hospitalization. Based on a standardized questionnaire a structured medical history was obtained including the presence of risk factors and medication. At the same time body height and mass and blood pressure were measured and blood samples were obtained for lipid profile and fasting glucose level. RESULTS: Elevated cholesterol levels (> or = 5.2 mmol/l) were observed in 65.8% of patients in 1998/99 and 66.3% in 1999/2000, high blood pressure (> or = 140/90 mmHg) in 46.2% and 50.4%, obesity (BMI > or = 30 kg/m2) in 24.6% and 27.2%, fasting hyperglycemia (> or = 6.0 mmol/l) in 17.7% and 27.4% (p < 0.05) and smoking in 16.3% and 15.9%, respectively. An increase was observed in the rate of antiplatelet (76.1% in 1998/99 vs 86.7% in 1999/2000, p < 0.001) and lipid lowering drug use (34.0% vs 41.9%, p < 0.05). The rate of beta-blockers and ACE inhibitors use did not change significantly. CONCLUSIONS: In the years 1999/2000 the control of main risk factors of ischaemic heart disease did not improve when compared with 1997/98. There was only an increase in the percentage of patients on antiplatelet and lipid lowering drugs. These results indicate that the dissemination of the guidelines for secondary prevention of ischaemic heart disease among physicians and patients remains one of the top priorities of cardiology in Poland.