Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension.

The present paper provides an update of previous recommendations on Home Blood Pressure Monitoring from the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring and Cardiovascular Variability sequentially published in years 2000, 2008 and 2010. This update has taken into account new evidence in this field, including a recent statement by the American Heart association, as well as technological developments, which have occurred over the past 20 years. The present document has been developed by the same ESH Working Group with inputs from an international team of experts, and has been endorsed by the ESH.

Recommendations for home blood pressure monitoring in Latin American countries: A Latin American Society of Hypertension position paper.

Out-of-office blood pressure (BP) monitoring appears to be a very useful approach to hypertension management insofar it allows to obtain multiple measurements in the usual environment of each individual, allows the detection of hypertension phenotypes, such as white-coat and masked hypertension, and appears to have superior prognostic value than the conventional office BP measurements. Out-of-office BP can be obtained through either home or ambulatory monitoring, which provide complementary and not identical information. Home BP monitoring yields BP values self-measured in subjects' usual living environment; it is an essential method for the evaluation of almost all untreated and treated subjects with suspected or diagnosed hypertension, best if combined with telemonitoring facilities, also allowing long-term monitoring. There is also increasing evidence that home BP monitoring improves long-term hypertension control rates by improving patients' adherence to prescribed treatment. In Latin American Countries, it is widely available, being relatively inexpensive, and well accepted by patients. Current US, Canadian, Japanese, and European guidelines recommend out-of-office BP monitoring to confirm and refine the diagnosis of hypertension.

Ambulatory blood pressure monitoring over 24 h: A Latin American Society of Hypertension position paper-accessibility, clinical use and cost effectiveness of ABPM in Latin America in year 2020.

Accurate office blood pressure measurement remains crucial in the diagnosis and management of hypertension worldwide, including Latin America (LA). Office blood pressure (OBP) measurement is still the leading technique in LA for screening and diagnosis of hypertension, monitoring of treatment, and long-term follow-up. Despite this, due to the increasing awareness of the limitations affecting OBP and to the accumulating evidence on the importance of ambulatory BP monitoring (ABPM), as a complement of OBP in the clinical approach to the hypertensive patient, a progressively greater attention has been paid worldwide to the information on daytime and nighttime BP patterns offered by 24-h ABPM in the diagnostic, prognostic, and therapeutic management of hypertension. In LA countries, most of the Scientific Societies of Hypertension and/or Cardiology have issued guidelines for hypertension care, and most of them include a special section on ABPM. Also, full guidelines on ABPM are available. However, despite the available evidence on the advantages of ABPM for the diagnosis and management of hypertension in LA, availability of ABPM is often restricted to cities with large population, and access to this technology by lower-income patients is sometimes limited by its excessive cost. The authors hope that this document might stimulate health authorities in each LA Country, as well as in other countries in the world, to regulate ABPM access and to widen the range of patients able to access the benefits of this technique.

MASked-unconTrolled hypERtension management based on office BP or on ambulatory blood pressure measurement (MASTER) Study: a randomised controlled trial protocol.

INTRODUCTION: Masked uncontrolled hypertension (MUCH) carries an increased risk of cardiovascular (CV) complications and can be identified through combined use of office (O) and ambulatory (A) blood pressure (BP) monitoring (M) in treated patients. However, it is still debated whether the information carried by ABPM should be considered for MUCH management. Aim of the MASked-unconTrolled hypERtension management based on OBP or on ambulatory blood pressure measurement (MASTER) Study is to assess the impact on outcome of MUCH management based on OBPM or ABPM. METHODS AND ANALYSIS: MASTER is a 4-year prospective, randomised, open-label, blinded-endpoint investigation. A total of 1240 treated hypertensive patients from about 40 secondary care clinical centres worldwide will be included -upon confirming presence of MUCH (repeated on treatment OBP <140/90 mm Hg, and at least one of the following: daytime ABP ≥135/85 mm Hg; night-time ABP ≥120/70 mm Hg; 24 hour ABP ≥130/80 mm Hg), and will be randomised to a management strategy based on OBPM (group 1) or on ABPM (group 2). Patients in group 1 will have OBP measured at 0, 3, 6, 12, 18, 24, 30, 36, 42 and 48 months and taken as a guide for treatment; ABPM will be performed at randomisation and at 12, 24, 36 and 48 months but will not be used to take treatment decisions. Patients randomised to group 2 will have ABPM performed at randomisation and all scheduled visits as a guide to antihypertensive treatment. The effects of MUCH management strategy based on ABPM or on OBPM on CV and renal intermediate outcomes (changing left ventricular mass and microalbuminuria, coprimary outcomes) at 1 year and on CV events at 4 years and on changes in BP-related variables will be assessed. ETHICS AND DISSEMINATION: MASTER study protocol has received approval by the ethical review board of Istituto Auxologico Italiano. The procedures set out in this protocol are in accordance with principles of Declaration of Helsinki and Good Clinical Practice guidelines. Results will be published in accordance with the CONSORT statement in a peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER: NCT02804074; Pre-results.

Deficiencia de hierro y/o anemia en la insuficiencia cardíaca, ¿tratar o no tratar? / Iron deficiency and / or anemia in heart failure, Try or not try?

El déficit de hierro con o sin anemia está siendo reconocido cada vez más como una comorbilidad importante en los pacientes con Insuficiencia Cardíaca (IC). Aunque la deficiencia de hierro es fácilmente diagnosticada por medio de dos marcadores (ferritina sérica y saturación de transferrina), es subdiagnosticada en estos pacientes y pudiera afectar hasta el 50% de los mismos. Aún antes del inicio de la anemia, los pacientes con IC y déficit de hierro muestran disminución en el rendimiento físico y cognitivo con una mala calidad de vida. Más aún, la deficiencia de hierro es un factor de riesgo, independiente de la anemia, de evolución desfavorable (muerte o trasplante cardíaco) en los pacientes con IC crónica. Varios estudios aleatorios controlados han mostrado mejoría en la capacidad de ejercicio, clase funcional de la New York Heart Association y calidad de vida luego de la corrección del déficit de hierro. Diversos factores contribuyen al desarrollo de este déficit, incluyendo edad avanzada, falla renal, hemodilución, inflamación crónica y severidad de la IC. Una variedad de mecanismos se han postulado para explicar la asociación de déficit de hierro e IC y su corrección, como un blanco terapéutico, está ganando una mayor atención(AU)

Iron deficit with or without anemia is being increasingly recognized as an important comorbidity in patients with heart failure. Although iron deficiency is easily diagnosed with two biomarkers (serum ferritin and transferrin saturation), it is underdiagnosed in these patients and could affects up to 50% of them. Even before the onset of anemia, heart failure patients with iron deficiency have decreased physical and cognitive performances and a poorer quality of life. Moreover, iron deficiency is a risk factor, independent of anemia, of unfavorable outcome (death or heart transplantation) in patients with chronic heart failure. Several randomized controlled studies have shown improvement in exercise capacity, New York Heart Association functional class and quality of life after correction of iron deficiency. Different factors contribute to the development of iron deficiency, including increasing age, renal insufficiency, hemodilution, chronic inflammation, and heart failure severity. A variety of mechanisms have been implicated in the association between iron deficiency and heart failure, and its correction as a therapeutic target in these patients is gaining increased attention(AU)

Perfiles circadianos en una población joven y sana / Circadian profile in a young healthy population

Con el objeto de estudiar el perfil de la presión arterial de 24 horas en una población de sujetos jóvenes y sanos, se practicó monitoreo ambulatorio de la presión arterial a 50 estudiantes universitarios de ambos sexos con edades comprendidas entre los 19 y los 28 años. La población mostró un claro perfíl circadiano, con valores de presión arterial inferiores a los encontrados en la literatura extranjera para poblaciones de esta edad. Los valores diurnos y de 24 horas resultaron inferiores también a los valores encontrados en una población universitaria equivalente a la que se le midió la presión arterial por los métodos convencionales, lo cual pone en evidencia un probable componente de reactividad vascular en las tomas casuales. El consumo miocárdico de oxígeno, estimado por el doble producto también mostró un claro perfil circadiano, el cual se relacionó en esta población más con los cambios de frecuencia cardíaca que con los de la presión arterial sistólica. Este hecho tal vez sea debido a la mayor variabilidad de la frecuencia cardíaca que de la presión arterial, que se encontró en esta población joven

Importancia y significación del ritmo circadiano de la presión arterial / Importance and significance of circardian rhythn of the arterial pressure

El advenimiento en las últimas dos décadas, del uso de registradores automáticos de presión arterial (PA), ha permitido conocer el ritmo circardiano de la misma y los factores que lo determinan. Fundamentalmente dicho ritmo está influido por el ciclo sueño-vigilia, y por la actividad. El conocimiento de la variación diaria de este parámetro, ha llevado inevitablemente a la revisión del valor de las tomas de la PA en forma aislada o casual, como parámetro que permite distinguir los sujetos normales y los hipertensos, y más importante aún, a la revisión de la capacidad de predicción de estas tomas de PA, en lo que se refiere a la aparición de daño de los órganos blanco de la enfermedad hipertensiva. La evidencia de la literatura sugiere, por un lado, que individuo catalogados como hipertensos con los métodos tradicionales pueden en realidad padecer lo que se denomina ®hipertensión de bata blanca¼ (cifras anormales de PA que aparecen sólo cuando son determinadas por el médico), cuya significación está por establecerse. Por otro lado la literatura señala que las cifras de 24 horas son mejores predictoras de daño vascular. Los registros de 24 horas de PA ofrecen además la ventaja de ser másreproducibles que las tomas aisladas o casuales, y permiten por otra parte estudiar los valores de PA durante el sueño y durante las fases iniciales del día o la vigilia, períodos estos donde las determinaciones parecen tener importancia fisiopatológica. No existen sin embargo, parámetros aceptados universalmente como normales para los valores de PA de 24 horas, ni tampoco se han realizado estudios de seguimiento de individuos con estos valores, sin tomar en cuenta su PA casual, ya que esto podría acarrear omisión en el tratamiento de sujetos hipertensos. Estos hechos unidos a factores ligados a los costos operativos, restringe hata el momento el uso de estos sitemas a estudios experimentales o a indicaciones clínicas muy precisas. Sin embargo, éstas se han ido ampliando con la experiencia cada vez mayor acumulada en este campo