The use of the CNIC-Polypill in real-life clinical practice: opportunities and challenges in patients at very high risk of atherosclerotic cardiovascular disease - expert panel meeting report.

Although the cardiovascular (CV) polypill concept is not new and several guidelines state that a CV polypill should be considered an integral part of a comprehensive CV disease (CVD) prevention strategy, there are still some barriers to its implementation in the real-world setting, mainly in secondary CV prevention. As the CNIC-polypill is the only one approved for secondary CV prevention in patients with atherosclerotic CVD in 27 countries worldwide, a panel of four discussants and 30 participants from 18 countries conveyed in a virtual meeting on April 21, 2022, to discuss key clinical questions regarding the practical use of the CNIC-Polypill and barriers to its implementation.Data presented showed that, although the use of the CV polypill is not explicitly mentioned in the current 2021 European Society of Cardiology guidelines on CVD prevention, it may be used in any patient for secondary CVD prevention tolerating all their components to improve outcomes through different aspects. The favourable results of the Secondary Prevention of Cardiovascular Disease in the Elderly (SECURE) trial now reinforce this recommendation. The panellists presented algorithms on how to switch from any baseline regimen when starting treatment with the CNIC-polypill in different situations, including patients with hypertension, dyslipidaemia, and a previous CV event; at discharge after a cardiovascular event; in chronic ischemic conditions; and in cases of polypharmacy. The panellists and expert discussants did agree that available studies conducted so far with the CNIC-polypill demonstrate that it is as efficacious as the monocomponents, equipotent drugs, or other therapies; reduces the risk of experiencing recurrent major CV events; improves medication adherence; reduces health care costs and resources compared to patients treated with loose drugs; and the patients prefer it over the multipill strategy.In conclusion, the data presented by the participants provided the evidence behind the use of the CNIC-polypill to help fulfil the goal of encouraging its adoption by physicians.

Polypill in cardiovascular disease prevention: recent advances.

Triple therapy with lipid­lowering, antihypertensive, and antiplatelet agents reduces the risk of recurrent cardiovascular fatal and nonfatal events, cardiovascular mortality, and total mortality in secondary prevention. In real life, however, effective implementation of these optimal treatments both in primary and secondary prevention is low, and thus their contribution to cardiovascular prevention is much lower than it could be, based on research data. One of the main barriers to the adequate implementation of these strategies is low adherence to the elevated number of pills, as adherence is adversely affected by the complexity of the prescribed treatment regimen, and can be considerably improved by treatment simplification. This review updates the findings provided by recent epidemiological and clinical studies favoring a polypill­based approach to cardiovascular prevention. The increased prevalence of patients with multiple cardiovascular risk factors and comorbidities provides the rationale for a therapeutic strategy based on a combination of drugs against different risk factors in a single pill. Pharmacologic studies have demonstrated that different cardiovascular drugs can be combined in a single pill with no loss of their individual efficacy, and this favors adherence to and persistence of treatment, as well as multiple risk factor control. Recently, a randomized clinical trial SECURE (Secondary Prevention of Cardiovascular Disease in the Elderly) has shown a significant, 30% reduction in cardiovascular events, and a 33% reduction in cardiovascular death in patients after myocardial infarction treated with a polypill, as compared with usual care, thus supporting the polypill use as an integral part of any cardiovascular prevention strategy.

Velocidade de Onda de Pulso de 8,2m/s como Limiar Associado à Presença de Lesão de Órgão Alvo Cardiovascular / Pulse Wave Velocity of 8.2 m/s as a Threshold Associated with Cardiovascular Target Organ Damage Presence

Resumo Fundamento Estudos prévios estabeleceram valores de normalidade e de referência da Velocidade de Onda de Pulso (VOP). Porém, qual valor de VOP que apresenta a associação mais forte com biomarcadores cardiovasculares ainda é pouco conhecido. Objetivo Identificar o valor de VOP com maior possibilidade de estar associado com hipertrofia ventricular esquerda (HVE), aumento da espessura íntima-média carotídea (EIMC), e presença de placas carotídeas em pacientes hipertensos. Métodos Este é um estudo transversal de 119 pacientes. Análise de curvas características de operação do receptor (ROC) foi realizada para cada biomarcador cardiovascular. A diferença estatística foi estabelecida em p<0,05. Resultados Segundo análises das curvas ROC, valores de VOP de 8,1m/s para HVE, 8,2m/s para EMIC aumentada e 8,7m/s para a presença de placa carotídea foram encontrados, respectivamente. O valor de VOP de 8,2m/s foi definido como melhor o parâmetro para encontrar os três biomarcadores de LOA. A VOP acima de 8,2m/s associou-se ao aumento da EMIC (p = 0,004), à presença de placas carotídeas (p = 0,003) e à HVE (p < 0,001). A VOP acima de 8,2m/s apresentou maior sensibilidade para EMIC aumentada (AUC = 0,678, sensibilidade 62,2), HVE (AUC = 0,717, sensibilidade 87,2), e presença de placas (AUC = 0,649, sensibilidade 74,51) na análise das curvas ROC. Conclusão O valor de 8,2m/s de VOP foi mais sensível em identificar, precocemente, a existência de biomarcadores cardiovasculares de LOA.

Abstract Background Previous studies have established normal and reference values for Pulse Wave Velocity (PWV). However, the PWV value that has the strongest association with cardiovascular biomarkers remains poorly understood. Objective This study aimed to determine the PWV value more likely to be associated with left ventricular hypertrophy (LVH), increased intima-media thickness (IMT), and presence of carotid plaques in patients with hypertension. Methods This cross-sectional study included 119 patients. Analysis of receiver operating characteristic (ROC) curves was performed for each cardiovascular biomarker. Statistical significance was set at p < 0.05. Results According to the ROC curve analysis, the PWV values were 8.1 m/s, 8.2 m/s, and 8.7 for the LVH, IMT, and presence of carotid plaques, respectively. A PWV value of 8.2 m/s was identified as the best parameter to determine the three TOD biomarkers. PWV above 8.2 m/s was associated with increased CIMT (p = 0.004) and the presence of carotid plaques (p = 0.003) and LVH (p<0.001). PWV above 8.2 showed greater sensitivity for increased CIMT (AUC = 0.678, sensitivity = 62.2), LVH (AUC = 0.717, sensitivity = 87.2), and the presence of plaques (AUC = 0.649, sensitivity = 74.51) in the ROC curve analysis. Conclusion The PWV value 8.2 m/s was more sensitive in early identifying the existence of cardiovascular biomarkers of TOD.

Bloqueadores do Receptor de Angiotensina Avaliados por Medida de Consultório e Residencial da Pressão Arterial. Estudo TeleMRPA / Angiotensin Receptor Blockers Evaluated by Office and Home Blood Pressure Measurements. TeleHBPM Study

Resumo Fundamento O tratamento adequado e a obtenção das metas na hipertensão arterial são importantes na redução dos desfechos cardiovasculares. Objetivos Descrever os bloqueadores do receptor de angiotensina (BRA) em monoterapia ou combinação dupla e a taxa de controle da hipertensão arterial. Métodos Estudo transversal que avaliou pacientes em uso de BRA entre 2017 e 2020. Foram excluídos aqueles em uso de três ou mais anti-hipertensivos. As variáveis analisadas foram: sexo, idade, índice de massa corporal, medidas válidas da medida residencial da pressão arterial (MRPA); pressão arterial sistólica (PAS) e diastólica (PAD) obtidas pela MRPA e de forma casual; variabilidade pressórica; classe dos anti-hipertensivos e dos BRAs. Foram utilizados testes de t pareado, qui-quadrado e Fisher, além de sobreposição dos intervalos de confiança de 95% com nível de significância de 5% (p < 0,05). Resultados Foram selecionados 17.013 pacientes; destes, 12.813 preencheram os critérios, dos quais 62,1% eram do sexo feminino. O número médio de medidas válidas foi de 23,3 (±2,0), com médias para a PAS de 126,8±15,8 mmHg e 133,5±20,1 mmHg (p < 0,001) e para a PAD de 79,1±9,7 mmHg e 83,6±11,9 mmHg (p < 0,001) pela MRPA e medida casual, respectivamente. Losartana foi o BRA mais utilizado e o que apresentou comportamentos mais elevados da pressão arterial. As combinações de BRA com diuréticos ou com antagonistas de canal de cálcio tiveram menores valores de pressão arterial. Conclusões Losartana foi utilizada em mais da metade dos pacientes, apesar de ser a menos eficiente na redução e no controle da pressão arterial.

Abstract Background Adequate treatment of arterial hypertension and achieving arterial hypertension goals in are important in reducing cardiovascular outcomes. Objectives To describe angiotensin receptor blockers in monotherapy or double combination therapy and the rate of arterial hypertension control. Methods This cross-sectional study evaluated patients who were using angiotensin receptor blockers between 2017 and 2020. Those using three or more antihypertensive drugs were excluded. The analyzed variables included sex, age, body mass index, valid home blood pressure monitoring (HBPM) measurements, casual and HBPM systolic and diastolic blood pressure measurements, blood pressure variability, and antihypertensive and angiotensin receptor blocker class. Paired t, chi-square, and Fisher's exact tests were used, as well as overlapping 95% confidence intervals and a significance level of 5% (p < 0.05). Results Of 17,013 patients, 12,813 met the inclusion criteria, 62.1% of whom were female. The mean number of valid measurements was 23.3 (SD, 2.0). The mean HBPM and casual measurements for systolic blood pressure were 126.8 (SD, 15.8) mmHg and 133.5 (SD, 20.1) mmHg (p <0.001), respectively, while those for diastolic blood pressure were 79.1 (SD, 9.7 mmHg) and 83.6 (SD, 11.9) mmHg (p <0.001), respectively. Losartan was the most common angiotensin receptor blocker and resulted in the highest blood pressure values. Combinations of angiotensin receptor blockers with diuretics or calcium channel antagonists resulted in lower blood pressure values. Conclusions More than half of the patients used losartan, although it was the least efficient drug for reducing and controlling blood pressure.

A practical approach to switch from a multiple pill therapeutic strategy to a polypill-based strategy for cardiovascular prevention in patients with hypertension.

: Pharmacological treatment recommended by guidelines for very high-risk patients with established cardiovascular disease (CVD) includes lipid-lowering drugs, antihypertensive agents and antiplatelet therapy. Depending on the associated comorbidities, this baseline regimen has to be complemented with other drugs. Therefore, the number of pills to be taken is usually high and adherence to these multiple pill therapeutic regimens and long-term persistence on treatment is low, being the main factor for insufficient control of cardiovascular risk factors. The CNIC (Centro Nacional de Investigaciones Cardiovasculares, Ministerio de Ciencia e Innovación, España) polypill is the only polypill containing low-dose aspirin approved by the EMA and marketed in Europe, and has demonstrated to improve adherence. For this reason, guidelines recommend its use for secondary prevention of CVD, and also for primary prevention of cardiovascular events in patients with multiple cardiovascular risk factors and advanced atherosclerotic process at high risk of thrombosis and low risk of bleeding. This article pretends to simplify the steps that clinicians may follow to switch from any baseline regimen to the polypill with the use of several algorithms and tables showing the equivalent effective daily doses of different angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and statins to facilitate switching, as well as the steps to be followed depending of the initial levels of BP and LDL-cholesterol values to achieve BP and lipid control with the association to the polypill of other BP-lowering or lipid-lowering drugs whenever needed.

Efeito da Redução do Sal de Adição sobre a Pressão Arterial Central e Periférica / Effects of added salt reduction on central and peripheral blood pressure

Resumo Fundamento Os efeitos da redução na ingestão do sal sobre a pressão arterial (PA) casual de hipertensos já foram amplamente estudados, entretanto essa análise ainda é escassa no contexto da redução exclusiva do sal de adição na rigidez arterial e em indivíduos normotensos e pré-hipertensos. Objetivo Avaliar os efeitos da redução progressiva na ingestão do sal de adição (de 6 para 4 g/dia) sobre os valores da pressão periférica e central, a rigidez arterial em normotensos, pré-hipertensos e hipertensos. Métodos Ensaio clínico, simples cego com 13 semanas de seguimento. Foram avaliados normotensos (≤130/85 mmHg), pré-hipertensos (≥130 e <139/≥85 e <90 mmHg) e hipertensos estágio 1 (≥140 e <160/≥90 e <100 mmHg). Utilizou-se medida casual e monitorização residencial da PA com aparelho automático OMRON 705CP, medida central da PA com Sphygmocor®, dosagem do sódio urinário de 24h (colhido no intervalo entre cada visita) e mensuração de sal de adição. Foi adotado nível de significância p<0,05 para todas as análises. Resultados Foram avaliados 55 participantes (18 normotensos; 15 pré-hipertensos; 22 hipertensos) com mediana 48 anos (IQ:39-54). Os grupos foram semelhantes em relação a idade e sexo. Não houve diferença entre medidas de PA e excreção de sódio antes e depois da intervenção. Os parâmetros de rigidez arterial também não sofreram alterações significativas. Conclusão A redução gradativa da ingestão de sal de adição num seguimento de 13 semanas não foi capaz de reduzir de maneira significativa os valores periféricos e centrais da PA. (Arq Bras Cardiol. 2020; 114(3):554-561)

Abstract Background Although the effects of salt intake reduction on casual blood pressure have been extensively studied in hypertensive individuals, data on reductions of added salt on arterial stiffness in both normotensive and prehypertensive subjects are scarce. Objective To evaluate the effects of progressive reduction in added salt intake (from 6 grams to 4 grams per day) on peripheral and central blood pressure and arterial stiffness in normotensive, prehypertensive and hypertensive individuals. Methods This was a single-blinded clinical trial with 13 weeks of follow-up. Normotensive (≤ 130/85 mmHg), prehypertensive (≥ 130 e < 139/≥ 85 e < 90 mmHg) and stage 1 hypertensive individuals (< 139/≥ 85 and < 90 mmHg) were assessed. Casual blood pressure measurements and ambulatory blood pressure monitoring were performed using the automated OMRON 705CP device, and central blood pressure was measured using the Sphygmocor®. Twenty-four-hour urinary sodium excretion and the amounts of added salt consumed were measured. Statistically significance level was set at p < 0.05 for all analysis. Results A total of 55 participants (18 normotensive, 15 prehypertensive and 22 hypertensive), median age 48 years (IQR:39-54) were studied. The groups were not different in age or sex. No difference was observed in blood pressure or sodium excretion levels before and after the intervention. No significant changes in arterial stiffness parameters were observed. Conclusion The progressive reduction in added salt intake during a period of 13 weeks did not cause significant reductions in peripheral and central blood pressure. (Arq Bras Cardiol. 2020; 114(3):554-561)

Latin American Consensus on the management of hypertension in the patient with diabetes and the metabolic syndrome.

: The prevalence of hypertension, type 2 diabetes mellitus (DM2) and the metabolic syndrome continues to increase in Latin America, while the rates of diagnosis, treatment and control of these disorders remain low. The frequency of the risk factors that constitute the metabolic syndrome and are associated with an increased risk of cardiovascular disease has not diminished since the publication of the previous consensus. This document discusses the socioeconomic, demographic, environmental and cultural characteristics of most associated Latin American countries and partially explains the lack of better results in improving clinical and public health actions that allow high morbidity and mortality rates caused by cardiovascular diseases and DM2 to be reduced through programs aligned with the so-called precision medicine, which should be predictive, preventive, personalized and participatory. The Consensus ratifies the diagnostic criteria expressed in the previous consensus to define hypertension and DM2 but, for the metabolic syndrome, and in the absence of evidence, the recommendation is to implement a cohort study that determines the abdominal perimeter value associated with hard outcomes, such as DM2 and CVD. Meanwhile, we recommend modifying the criterion to more than 94 cm in men and more than 84 cm in women according to WHO recommendations. We also recommend the carrying out of a study that identifies the situation of hypertension and DM2 in people of African ancestry who, in Latin America, exceed 75 million and whose epidemiology does not include solid studies. With respect to the proposed therapeutic targets, we recommended maintaining those defined in the previous consensus, but insisting that early pharmacological management of prediabetes with metformin should be introduced, as should the treatment of diabetic hypertensive patients with a combination therapy of two fixed-dose antihypertensive drugs and management with statins. To increase adherence, the use of different drugs combined in a single pill (polypill) is recommended. The simplification of the therapeutic regimen is accompanied by greater control of cardiovascular risk factors, both in primary and secondary prevention, and has been shown to be cost-effective. The consensus recommends the use of the currently available polypill combining an angiotensin-converting enzyme inhibitor, a statin and aspirin for secondary cardiovascular prevention and in patients with a high cardiovascular risk, such as hypertension patients with DM2.

High blood pressure, Alzheimer disease and antihypertensive treatment.

Alzheimer's disease (AD), the most common form of dementia, is a complex disease, the mechanisms of which are poorly understood. AD represents 70% of all dementia cases, affecting up to 50% of elderly persons aged 85 or older, with functional dependence, poor quality of life, institutionalization and mortality. Advanced age is the main risk factor of AD, that is why population ageing, due to life expectancy improvements, increases AD incidence and prevalence, as well as the economic, social, and emotional costs associated with this illness. Existing anti-AD drugs present some limitations, as they target specific downstream neurochemical abnormalities while the upstream underlying pathology continues unchecked. Chronic hypertension has been suggested as one of the largest modifiable risk factors for developing AD. At least 25% of all adults and more than 50% of those over 60 years of age have hypertension. Epidemiological studies have shown that hypertension is a risk factor for dementia and AD, but the association is complex. Some studies have demonstrated that antihypertensive drugs can reduce the risk of AD. This review focuses on current knowledge about the relationship between chronic hypertension and AD as well as antihypertensive treatment effect on AD pathogenesis and its clinical outcomes.

Avaliação da medida central da pressão e rigidez arterial em participantes de caminhada de longa distância / Assessment of central Blood pressure and arterial stiffness in practicing long-distance walking race

Fundamento: A Caminhada Ecológica que ocorre anualmente no Brasil, é um evento único por sua distância (310 Km) e dinâmica de realização (média de 62 km/dia por 5 dias, com ritmo médio de 7,6 km/h). Embora os efeitos benéficos de exercícios de intensidade moderada sejam bem conhecidos, os efeitos do exercício intenso e de longa duração ainda requerem estudo. Objetivo: Avaliar os efeitos da modalidade mista caminhada/corrida em vários parâmetros de pressão arterial (PA) 30 dias antes (A0) do evento, e ao final dos dias 2 (A2), 3 (A3) e 4 (A4) da caminhada. Métodos: Foram medidas PA sistólica e diastólica central (cPAS e cPAD, respectivamente), PA sistólica e diastólica periférica (pPAS e pPAD, respectivamente), pressão de pulso central (cPP), pressão de pulso periférica (pPP), pressão de pulso amplificada (aPP), augmentation index ajustado (AIx75%) e velocidade da onda de pulso (VOP) com Mobil-O-Graph ® (IEM, Stolberg, Alemanha) em 25 atletas do sexo masculino (idade média, 45,3 ± 9,1 anos). Foi considerado significativo valor de p < 0,05. Resultados: Houve redução de cPAS de A0 para A2 (109,5 para 118,1 mmHg) e de A0 para A3 (109,5 para 102,5 mmHg); redução de pPP de A0 para A2 (49,2 para 38,2 mmHg) e de A0 para A4 (49,2 para 41,2 mmHg); redução de aPP de A0 para A1 (15,6 para 9,5 mmHg), de A0 para A2 (15,6 para 8,0 mmHg) e de A0 para A3 (15,6 para 11,2 mmHg). VOP correlacionou-se com idade. Conclusões: A PA caiu nos primeiros dias da caminhada de longa distância, retornando a níveis próximos aos basais no final, e a VOP correlacionou-se fortemente com idade. Esse tipo de exercício promove efeitos na PA e na VOP similares aos vistos em esportes de longa duração e alta intensidade. Tais mudanças em indivíduos saudáveis e treinados não parecem aumentar os riscos cardiovasculares. Este foi o primeiro estudo a avaliar os efeitos desse tipo de exercício no sistema cardiovascular

Background: An ecological hiking occurs yearly in Brazil. It is a unique event because of its distance (310 km) and dynamics (mean of 62 km/day for 5 days with mean pace of 7.6 km/h). Although beneficial effects of moderate-intensity exercises are well-known, the effects of intense and long-duration exercise still require study. Objective: To evaluate the effects of mixed walking/running race on various blood pressure (BP) parameters 30 days before (A0), on the 2 nd (A2), 3 rd (A3), and 4 th (A4) days after completing the day's stage. Methods: Central systolic (cSBP) and diastolic BP (cDBP), peripheral systolic (pSBP) and diastolic BP (pDBP), central pulse pressure (cPP), peripheral pulse pressure (pPP), amplified pulse pressure (aPP), corrected augmentation index (AIx75%) and pulse wave velocity (PWV) were measured using an oscillometric Mobil-O-Graph ® (IEM, Stolberg, Germany) in 25 male athletes (mean age of 45.3 ± 9.1 years). A p value < 0.05 was considered a statistically-significant difference. Results: cSBP decreased from A0 to A2 (109.5 to 118.1 mmHg) and from A0 to A3 (109.5 to 102.5 mmHg); pPP decrease from A0 to A2 (49.2 to 38.2 mmHg) and from A0 to A4 (49.2 to 41.2 mmHg); aPP decrease from A0 to A1 (15.6 to 9.5 mmHg), from A0 to A2 (15.6 to 8.0 mmHg) and from A0 to A3 (15.6 to 11.2 mmHg). PWV correlated with age. Conclusions: Blood pressure dropped on the first days of the race and returned to close to baseline values at the end. PWV correlates strongly with age. This type of exercise promotes effects on BP and PWV similar to those seen in long-duration, high-intensity sports. These changes in trained healthy individuals do not seem to increase cardiovascular risks. This was the first study to assess the effects of this type of exercise on the cardiovascular system

The polypill in cardiovascular prevention: evidence, limitations and perspective - position paper of the European Society of Hypertension.

: Antihypertensive, lipid lowering, antidiabetic and antiplatelet treatments all substantially reduce the risk of cardiovascular morbid and fatal events. In real life, however, effective implementation of these treatments is rare, and thus their contribution to cardiovascular prevention is much less than it could be, based on research data. This article reviews the pros and cons of cardiovascular prevention by the polypill approach. It is argued that the high prevalence of individuals with a multifactorial risk profile provides a strong rationale for a therapeutic strategy based on the combination in a single tablet of drugs against different risk factors. It is further argued that other important favourable arguments exist. First, in real-life adherence to all above treatments is very low, leading to a major increase in the incidence and risk of cardiovascular outcomes. Second, although a large number of factors are involved, adherence is adversely affected by the complexity of the prescribed treatment regimen and can be considerably improved by treatment simplification. Third, recent studies in patients with a history of manifest cardiovascular disease have documented that different cardiovascular drugs can be combined in a single tablet with no loss of their individual efficacy or unexpected inconveniences and this does favour adherence to treatment and multiple risk factor control, supporting use of the polypill in secondary cardiovascular prevention. It is finally also mentioned, however, that the polypill may have some drawbacks and that at present no evidence is available that this approach reduces cardiovascular outcome to a greater degree than standard treatment strategies. Trials are under way to provide an answer to this question and thus allow the therapeutic value of this approach to be known.

The natural history of cardiovascular risk factors in health professionals: 20-year follow-up.

BACKGROUND: The knowledge of the presence and evolution of cardiovascular risk factors in young people may significantly contribute to actions to modify the natural history of these risks and prevent the onset of cardiovascular disease. OBJECTIVES: To assess the presence and evolution of cardiovascular risk factors in health professionals over a 20-year period. METHODS: A group of individuals was evaluated when they first started graduate programs in medicine, nursing, nutrition, dentistry, and pharmacy, and 20 years later. Data obtained in the two phases were compared. Questionnaires about hypertension, diabetes, hypercholesterolemia, family history of early-onset cardiovascular disease, smoking, alcohol consumption, and sedentary lifestyle were administered. Cholesterol, blood glucose, blood pressure, weight, height, and body mass index (BMI) were measured. RESULTS: Of the 281 individuals (62.9 % women; mean age 19.7 years) initially analyzed, 215 (59.07 % women; mean age 39.8 years) were analyzed 20 years later. An increase in mean values of systolic (111.6 vs 118.7 mmHg- p < 0.001) and diastolic blood pressure (71 vs 77.1 mmHg - p < 0.001), cholesterol (150.1 vs 182.4 mg/dL - p < 0.001), blood glucose (74.3 vs 81.4 mg/dL - p < 0.001) and BMI (20.7 vs 23.7 kg/m(2) - p = 0.017) was observed. Despite the decrease of sedentarism (50.2 vs 38.1 % - p = 0.015), the prevalence of hypertension (4.6 vs 18.6 % - p < 0.001), excessive weight (8.2 vs 32.1 % - p < 0.001), hypercholesterolemia (7.8 vs 24.2 % - p < 0.001), and alcohol consumption (32.7 vs 34.9 % - p = 0.037) increased. There was no change in the prevalence of smoking. CONCLUSION: Health professionals presented an increase in systolic and diastolic blood pressure, blood glucose, body mass index, and cholesterol over the 20-year study period. Regarding the prevalence of cardiovascular risk factors, increased blood pressure, overweight, hypercholesterolemia and alcohol consumption, and a decrease in sedentary lifestyle were observed.

Divergencias entre guías de 2013 y 2014 de la hipertensión arterial: Posición de la Sociedad Centroamericana y del Caribe de Hipertensión y Prevención Cardiovascular¹ / Differences between the 2013 and 2014 hypertension guidelines: Position of the Central American and Caribbean Society for Hypertension and Cardiovascular Prevention

Entre finales de 2013 y principios de 2014 se publicaron las guías de hipertensión arterial (HTA) más influyentes a nivel internacional. Aunque no existen grandes diferencias entre ellas, hay discrepancias que pueden repercutir en el tratamiento y el pronóstico de las personas con hipertensión. En este artículo se analizan los principales elementos polémicos de estas guías y se emiten las recomendaciones de la Sociedad Centroamericana y del Caribe de Hipertensión y Prevención Cardiovascular sobre el tema. Las principales divergencias se centran en la categoría de prehipertensión arterial, el uso del riesgo cardiovascular global en la decisión de iniciar el tratamiento antihipertensivo, la vigencia de los betabloqueantes como medicamentos de primera línea en el tratamiento de la HTA no complicada, y el aumento del objetivo terapéutico de mantener las cifras de tensión arterial entre < 140/90 mmHg y < 150/90 mmHg en pacientes mayores de 60 años de edad, sin antecedentes personales de diabetes ni de enfermedad renal crónica. Se analizan críticamente todos los factores a favor y en contra de aceptar cada uno de estos cuatro elementos controvertidos y se incluyen los comentarios que sobre ellos ha realizado la Sociedad. Se concluye que todos los elementos polémicos de las guías de la HTA tienen elementos a favor y en contra. Sin embargo, el peso de la evidencia o el juicio clínico están a favor de subdividir la prehipertensión (Grado I y II), buscar la meta terapéutica de mantener la tensión sistólica de < 140 mmHg en todos los hipertensos de menos de 80 años de edad, mantener a los betabloqueantes como medicamentos de primera línea en la HTA no complicada, y no demorar el inicio del tratamiento farmacológico de la HTA Grado I de bajo riesgo cardiovascular global. Finalmente, se incluyen siete recomendaciones de la Sociedad basadas en los análisis realizados.

Between the end of 2013 and the beginning of 2014 the most internationally influential hypertension guidelines were published. Although there are no major differences between them, there are discrepancies that can have an impact on treatment and prognosis for individuals with hypertension. This article analyzes the main controversial elements in the guides and presents the recommendations of the Sociedad Centroamericana y del Caribe de Hipertensión y Prevención Cardiovascular (Caribbean Society for Hypertension and Cardiovascular Prevention). The main differences are found a) in the categorization of prehypertension, b) in the use of global cardiovascular risk in the decision to begin antihypertensive treatment, c) in the validity of beta-blockers as first-line drugs in treating uncomplicated hypertension, and d) the increase in the therapeutic goal of maintaining values between < 140/90 and < 150/90 mmHg in patients over 60 years of age with no history of diabetes or chronic kidney disease. All the factors in favor of and against accepting each of these four controversial criteria are analyzed critically and the observations made by the Society are included. The conclusion is that there are pros and cons for all controversial elements in the hypertension guides. However, the weight of the evidence and clinical judgment favor subdividing prehypertension into stages I and II, seeking a therapeutic goal of maintaining systolic blood pressure below 140 mmHg in all the hypertensive patients under 80 years of age, retaining beta-blockers as first-line drugs in uncomplicated hypertension, and not delaying the start of drug treatment for hypertension stage I with low global cardiovascular risk. Finally, seven recommendations by the Society based on the analysis are included.

Prevalence of masked hypertension and associated factors in normotensive healthcare workers.

BACKGROUND AND OBJECTIVE: Evidence on the elevated cardiovascular risk associated with masked hypertension (MHT) is becoming stronger. Determining the prevalence of MHT in apparently healthy individuals may enable better risk stratification and management. METHODS: This was a cross-sectional study of normotensive healthcare workers recruited from 52 hypertension units. We included individuals aged at least 18 years with no known history of hypertension and office blood pressure (BP) less than 140/90 mmHg. MHT was defined as mean daytime ambulatory BP of at least 135/85 mmHg. RESULTS: Overall, 485 individuals (mean age 43.1 years, 55% women) were included. The prevalence of MHT was 23.9% [95% confidence interval (CI): 20.1-27.7]. The most prevalent associated cardiovascular risk factors in the total population were smoking (24.9%), dyslipidemia (16.4%), a family history of premature cardiovascular disease (15.9%), and obesity (7.4%). A total of 45.4% of individuals had a family history of hypertension. MHT was associated with male sex [odds ratio (OR) 1.722, 95% CI: 1.091-2.718] and prehypertension (OR 4.561, 95% CI: 2.880-7.222). In univariate analysis, the OR of the diagnosis of MHT increased by 2.3% per year of age. CONCLUSION: The prevalence of MHT in normotensive healthcare workers in Spain is almost 25%. Therefore, 24-h ambulatory BP monitoring should be routine in occupational health checks in health workers, especially men.