May Measurement Month 2019: an analysis of blood pressure screening results from Argentina.

The Argentinean Society of Hypertension, in agreement with the May Measurement Month (MMM) initiative of the International Society of Hypertension, implemented for the third consecutive year a hypertension screening campaign. A volunteer cross-sectional survey was carried out in public spaces and health centres during the month of May 2019 across 33 cities in Argentina. Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg and/or diastolic BP ≥90 mmHg based on the mean of the second and third BP measurements, or in those on treatment for high BP. A total of 94 523 individuals (53.9 ± 17.8 years old, 55 231women and 39 292 men), were evaluated. The age and sex standardized mean BP was 124.7/77.2 mmHg. Among participants, 34.7% were overweight (25-29.9 m/kg2) and 28.7% had obesity (≥30 m/kg2). Individuals identified as being overweight had BP 3/2 mmHg higher and individuals with obesity 6/4 mmHg higher than those with normal weight. The prevalence of hypertension was 52.5%. Although 81.1% were aware and 77.7% were on antihypertensive treatment, only 46.0% of all individuals with hypertension had their BP controlled. Moreover, 19.8% of those not on any antihypertensive medication were found with raised BP. The low level of control of hypertension generates the critical need for the development of community-based prevention strategies reinforcing strategies to increase the awareness and control of hypertension.

May Measurement Month 2018: an analysis of blood pressure screening results from Argentinean cohort.

Hypertension continues to be the leading cause of death and disability in the industrialized world, with a high level of unawareness and unacceptably poor control. Therefore, the Argentinian Society of Hypertension, in agreement with the May Measurement Month (MMM) initiative of the International Society of Hypertension, implemented for the second consecutive year an educational campaign during the month of May 2018. A volunteer cross-sectional survey was carried out in public spaces and health centres during the month of May 2018 across 33 cities in Argentina. Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg or diastolic BP ≥90 mmHg based on the mean of the 2nd and 3rd of three consecutive BP measurements, or in those on treatment for high BP. Statistical analysis including multiple imputation followed the MMM protocol. A total of 70 418 individuals were screened during MMM18, after excluding those under 18 years old. Of the total, 43.8% of participants were classified as hypertensive, 77.7% were aware of their diagnosis, 69.1% were on pharmacological treatment, and 38.7% were controlled. Of those on antihypertensive medication, 56.0% were controlled. It is necessary to reinforce strategies not only to increase the awareness and control of hypertension but also to identify the population groups, in which these strategies would have the greatest impact, helping to reduce the enormous health burden attributed to hypertension.

Do differences in waist circumference modify the relationships among body mass index, insulin resistance, and related cardiometabolic risk factors in apparently healthy women?

OBJECTIVE: The aims of the study were to (1) compare the cardiometabolic risk profile between insulin-resistant and non-insulin-resistant women within similar body mass indexes (BMIs) and waist circumference (WC) groupings and (2) test the hypothesis that measurements of BMI are not inferior to WC in identifying insulin resistance. METHODS: The sample consisted of 899 women without known cardiovascular disease or diabetes. BMI was used to divide participants in normal (<25.0 kg/m(2)), overweight (≥25-29.9 kg/m(2)), and obese (≥30.0 kg/m(2)) subgroups, and waist circumference ≥88 cm was used to identify women with or without abdominal obesity. The 25% of the population with highest fasting insulin concentrations was classified as insulin resistant. BMI, WC, blood pressure, and fasting plasma glucose, insulin, triglyceride, and high-density lipoprotein cholesterol concentrations were compared using analysis of covariance (ANCOVA). The relationships between obesity and insulin resistance were analyzed using univariate, multivariate, and logistic regression. RESULTS: Triglyceride and glucose concentrations were higher and high-density lipoprotein cholesterol concentrations lower in the insulin-resistant group in each BMI category, as was the case when comparing by abdominal obesity. In the univariate analysis, correlations between obesity and the individual cardiometabolic risk factor were significant but weak. In multivariate analysis including both indices, only body mass independently predicted insulin resistance. CONCLUSION: Insulin-resistant women were at greater cardiometabolic risk, irrespective of adiposity category. Obesity contributed to a modest variability in insulin resistance, and abdominal obesity does not add to the ability of BMI to predict insulin resistance.

Circulating angiotensin-(1-7) is decreased in patients with isolated nocturnal hypertension.

Isolated nocturnal hypertension (INHT), defined as nighttime elevated blood pressure (BP) with normal daytime BP assessed by ambulatory BP monitoring, is associated with higher cardiovascular morbidity and mortality. We hypothesized that an alteration in the circulating renin-angiotensin system (RAS) contributes to INHT development. We examined circulating levels of angiotensin (Ang) (1-7) and Ang II and ACE2 activity in 26 patients that met the INHT criteria, out of 50 that were referred for BP evaluation (62% women, 45 ±â€Š16 years old). Those with INHT were older, had a higher BMI, lower circulating Ang-(1-7) (P = 0.002) and Ang II levels (P = 0.02) and no change in ACE2 activity compared to those normotensives. Nighttime DBP was significantly correlated with Ang-(1-7) and Ang II levels. Logistic regression showed significant association in Ang-(1-7) and Ang II levels with INHT. Our study reveals differences in circulating RAS in individuals with INHT.

[Perception and identification of barriers to the use of digital technologies in arterial hypertension]. / Percepción e identificación de barreras para la utilización de tecnologías digitales en hipertensión arterial.

INTRODUCTION: Electronic devices and communication technologies are increasingly used to provide medical care to patients with high blood pressure. The main objective was to evaluate doctors' perception on the usefulness of digital technologies in hypertension. The secondary objectives were to evaluate the prevalence of use of digital technologies in the follow-up of patients with hypertension and to identify the barriers perceived by doctors for their implementation in the Argentine Republic. METHODS: Observational, cross-sectional, multicenter study, based on a self-administered questionnaire, in the Argentine Republic, and coordinated by the Epidemiology group of the Argentine Society of Arterial Hypertension. POPULATION: Doctors who care for patients with high blood pressure. RESULTS: 247 responses were obtained, 35.6% were women and 64.4% men; 92.3% indicated that the use of digital technologies was useful to improve therapeutic adherence; 54.7% received blood pressure results at home through some digital means; 41.3% regularly carry out teleconsultations, only 6.1% through specific digital health platforms, 29.1% through non-specific platforms, by telephone 21.9% and by email (asynchronous) 10.9%. The main perceived barriers were: availability, financial remuneration, regulations, connectivity problems and lack of time. CONCLUSION: The perception of professionals is favorable, as they considered these technologies useful to improve therapeutic adherence, which could have a facilitating effect on their implementation, although the perceived barriers are part of organizational issues to be resolved.

Introducción: Los dispositivos electrónicos y tecnologías de la comunicación se emplean cada vez más frecuentemente para brindar atención médica a los pacientes con hipertensión arterial. El objetivo principal del trabajo fue evaluar la percepción de los médicos sobre la utilidad de las tecnologías digitales en hipertensión arterial. Los objetivos secundarios fueron evaluar la prevalencia de uso de tecnologías digitales en el seguimiento de pacientes con hipertensión arterial e identificar las barreras percibidas por los médicos para la implementación de las mismas en la República Argentina. Métodos: Estudio observacional, de corte transversal, multicéntrico, basado en un cuestionario autoadministrado, en el ámbito de la República Argentina y coordinado por el grupo de Epidemiología de la Sociedad Argentina de Hipertensión Arterial. Población: Médicos que realizan atención de pacientes con hipertensión arterial. Resultados: Se obtuvieron 247 respuestas, 35.6% fueron mujeres y 64.4% hombres; el 92.3 % consideró de utilidad el uso de tecnologías digitales para mejorar la adherencia terapéutica. Reciben resultados de presión arterial en domicilio por algún medio digital 54.7%. Realizan habitualmente teleconsultas 41.3%, solamente el 6.1% por plataformas digitales específicas de salud, el 29.1% por plataformas no específicas, telefónicamente 21.9% y correo electrónico (asincrónicas) 10.9%. Las principales barreras percibidas fueron: disponibilidad, remuneración económica, reglamentación, problemas de conectividad y falta de tiempo. Conclusión: La percepción de los profesionales es favorable, considerándolas útiles para mejorar la adherencia terapéutica, por lo que podría tener un efecto facilitador en la implementación de las mismas, aunque las barreras percibidas forman parte de cuestiones organizacionales a resolver.

Relationship between serum uric acid, nocturnal hypertension and risk for preeclampsia in high-risk pregnancies.

To analyze the possible association between serum uric acid (SUA) and nocturnal hypertension and to evaluate the ability of these variables (alone or in combination) to predict preeclampsia (PE) we conducted a historical cohort study in 532 high-risk pregnancies. Women were divided according to SUA values and nocturnal blood pressure (BP) into four groups: 1- normal SUA and nocturnal normotension; 2- high SUA and nocturnal normotension; 3- normal SUA and nocturnal hypertension and 4- high SUA and nocturnal hypertension. High SUA was defined by the top quartile values and nocturnal hypertension as BP ≥ 120/70 mmHg, using ambulatory blood pressure monitoring (ABPM), during nocturnal rest. Risks for PE were compared using logistic regression. SUA had a weak but significant correlation with daytime systolic ABPM (r = 0.11, p = 0.014), daytime diastolic ABPM (r = 0.13, p = 0.004), nighttime systolic ABPM (r = 0.16, p < 0.001) and nighttime diastolic ABPM (r = 0.18, p < 0.001). Also, all ABPM values were higher in women with high SUA. The absolute risk of PE increased through groups: 6.5%, 13.1%, 31.2%, and 47.9% for groups 1, 2, 3, and 4, respectively, p < 0.001. Compared with Group 1, Group 3 (OR 6.29 95%CI 3.41-11.60), but not Group 2 (OR 2.15 95%CI 0.88-5.24), had statistically significant higher risk for PE. Group 4 (women with both, high SUA and nocturnal hypertension) had the highest risk (OR 13.11 95%CI 6.69-25.70). Risks remained statistically significant after the adjustment for relevant variables. In conclusion, the combination of SUA > 4 mg/dL and nocturnal BP > 120/70 mmHg implies a very high risk to developed PE.

Ambulatory Blood Pressure Monitoring for Diagnosis and Management of Hypertension in Pregnant Women.

Hypertension disorders during pregnancy has a wide range of severities, from a mild clinical condition to a life-threatening one. Currently, office BP is still the main method for the diagnosis of hypertension during pregnancy. Despite of the limitation these measurements, in clinical practice office BP of 140/90 mmHg cut point is used to simplify diagnosis and treatment decisions. The out-of-office BP evaluations are it comes to discarding white-coat hypertension with little utility in practice to rule out masked hypertension and nocturnal hypertension. In this revision, we analyzed the current evidence of the role of ABPM in diagnosing and managing pregnant women. ABPM has a defined role in the evaluation of BP levels in pregnant women, being appropriate performing an ABPM to classification of HDP before 20 weeks of gestation and second ABMP performed between 20-30 weeks of gestation to detected of women with a high risk of development of PE. Furthermore, we propose to, discarding white-coat hypertension and detecting masked chronic hypertension in pregnant women with office BP > 125/75 mmHg. Finally, in women who had PE, a third ABPM in the post-partum period could identify those with higher long-term cardiovascular risk related with masked hypertension.

Uncontrolled and masked uncontrolled blood pressure in treated pregnant women with chronic hypertension and risk for preeclampsia/eclampsia.

To analyze the relationship between the level of BP achieved with treatment and the risk for development of preeclampsia/eclampsia (PE), we conducted a historical cohort study on 149 consecutive pregnant women with treated chronic hypertension, evaluated between January 1, 2016, and November 31, 2022. According to office BP readings and ambulatory blood pressure monitoring (ABPM) performed after 20 weeks of gestation, the cohort was classified in controlled hypertension, white-coat uncontrolled hypertension, masked uncontrolled hypertension and sustained hypertension. Risks for the development of PE were estimated using logistic regression. One hundred and twenty-four pregnant women with a control BP evaluation were included in this analysis. The rates of PE were 19.4%, 27.3%, 44.8% and 47.1% for controlled, white-coat uncontrolled, masked uncontrolled and sustained uncontrolled hypertension, respectively. Compared with women with controlled hypertension, the relative risk for PE increased markedly in women with sustained uncontrolled (OR 3.69, 95% CI, 1.19-11.45) and masked uncontrolled (OR 3.38, 95% CI, 1.30-11.45) hypertension, but not in those with white-coat uncontrolled (OR 1.56 95% CI, 0.36-6.70); adjustment for covariates did not modify the results. Each mmHg higher of systolic and diastolic daytime ABPM increased the relative risk for PE ~4% and ~5%, respectively. Each mmHg higher of systolic and diastolic nocturnal BP increased the risk ~5% and ~6%, respectively. When these risks were adjusted for ABPM values in opposite periods of the day, only nocturnal ABPM remained as a significant predictor. In conclusion, masked uncontrolled hypertension implies a substantial risk for the development of PE, comparable to those of sustained uncontrolled. The presence of nocturnal hypertension seems important.

Masked hypertension and neonatal outcome in high-risk pregnancies.

We previously showed that masked hypertension is a frequent finding in high-risk pregnancies and a strong predictor of preeclampsia/eclampsia. However, neonatal consequences of masked hypertension have not been deeply analyzed. Consequently, the aim of this study was to determine if masked hypertension is a risk factor for poor neonatal outcome. We evaluated a cohort of 588 high-risk pregnant women (29 ± 7 years old with 27 ± 6 weeks of gestation at blood pressure evaluation); 22.1%, 8.5%, 2.9%, and 2.6% had history of hypertension, diabetes, collagen diseases and chronic renal disease, respectively. According to the data of office and ambulatory blood pressures monitoring, women was classified as normotension (61.7%), white-coat hypertension (5.4%), masked hypertension (21.6%) and sustained hypertension (11.2%) respectively. Compared to normotension, all neonatal outcomes were worst in women with masked hypertension; neonates had lower mean birth weight (2577 (842) vs. 3079 (688) g, P < 0.001), higher prevalence of very low (12.1% vs 2.0%, P = .002) and extremely low birth weight (4.3% vs 0%, P < 0.001), and low one-minute APGAR score (7.8% vs 1.8%, P < 0.001). Furthermore, 14.2% needed admission to neonatal intensive care unit (NICE) (P = 0.001). Compared with normotension the risk for poor the combined neonatal outcome (admission to NICE plus still born) was significantly higher in masked hypertension (adjusted OR 2.58 95% CI 1.23-5.40) but not in white-coat hypertension (adjusted OR 0.41 95% CI 0.05-3.12). In conclusion, in high-risk pregnancies, masked hypertension was a strong and independent predictor for poor neonatal outcomes.

Hypertension arising after 20 weeks of gestation: gestational hypertension or masked chronic hypertension?

The objectives of this study were 1-to evaluate the prevalence of masked chronic hypertension in pregnant women classified as gestational hypertension 2-to compare the risks of developing preeclampsia in true gestational hypertension vs those women classified as having gestational hypertension but who had had masked hypertension in the first half of pregnancy. We conducted a cohort study in consecutive high-risk pregnancies who were evaluated before 20 weeks of gestation. Women who developed gestational hypertension (normotension in the office before 20 weeks of gestation and office BP ≥ 140/90 mmHg and/or antihypertensive treatment in the second half of gestation) were divided, according to an ABPM performed before 20 weeks of pregnancy, in two subgroups: subgroup 1-if their ABPM was normal, and subgroup 2-if they had masked chronic hypertension. Risks for preeclampsia (PE) were estimated and compared with normotensive women. Before 20 weeks of gestation, 227 women were evaluated (age 32 ± 6 years, median gestation age 15 weeks); 67 had chronic hypertension (29.5%). Of the remaining 160, 39 developed gestational hypertension (16 in subgroup 1 and 23 insubgroup 2. Compared with normotensive pregnant women, subgroup 1 of women with gestational hypertension did not increase the risk of developing PE (OR = 0.76, 95% CI = 0.16-6.65). Conversely, subgroup 2 of gestational hypertension increased the risk of PE more than 4 times (0R = 4.47 CI = 1.16-12.63). Risk estimation did not change substantially after the adjustment for multiple possible confounders. In conclusion, the59% of women initially diagnosed as gestational hypertensive according to current recommendations had masked chronic hypertension and a very high risk of developing PE.

Position statement on use of pharmacological combinations in a single pill for treatment of hypertension by Argentine Federation of Cardiology (FAC) and Argentine Society of Hypertension (SAHA).

The present document provides scientific evidence reviewed and analysed by a group of specialist clinicians in hypertension that aims to give an insight into a pharmacological strategy to improve blood pressure control. Evidence shows that most hypertensive patients will need at least two drugs to achieve blood pressure goals. There is ample evidence showing that treatment adherence is inversely related to the number of drugs taken. Observational studies show that use of drug combinations to initiate treatment reduces the time to reach the treatment goal and reduces CVD, especially with single pill combinations (SPCs). This work, based on recommendations of the Argentine Federation of Cardiology and Argentine Society of Hypertension as a reference, aims to review the more recent evidence on SPC, and to serve as guidelines for health professionals in their clinical practice and to the wider use of SPCs for the treatment of hypertension. Evidence from clinical trials on the effectiveness and adverse effects of using SPCs are provided. An analysis is also made of the main contributions of SPCs in special populations, e.g., elderly and diabetic patients, and its use in high risk and resistant hypertension. The effects of SPCs on hypertensive-mediated organ damage is also examined. Finally, we provide some aspects to consider when choosing treatments in the economic context of Latin-America for promoting the most efficient use of resources in a scarce environment and to provide quality information to decision makers to formulate safe, cost-effective, and patient-centered health policies. Finally, future perspectives and limitations in clinical practice are also discussed.

[Use of aspirin 100 mg / day to prevent Preeclampsia, in high risk pregnancies, in a cohort from Argentina]. / Utilización de aspirina 100 mg/día para prevenir Preeclampsia, en embarazos de alto riego, en una cohorte de Argentina.

Objectives: The objective of the present study was to analyse the use of 100 g aspirin dose as prevention method for preeclampsia in high risk pregnant patients. Methods: A retrospective cohort study was performed in high risk pregnant patients with a blood pressure protocol, and the use of 100 mg of aspirin vs. its non-use was evaluated in the incidence of PREEC. Estimations between the two groups were performed with and without variable adjustment by means of binary logistic regression models. Results: 633 high risk pregnant patients were evaluated. The average age was 30±7 years old, and 25±8 weeks of pregnancy. 281 women (44.3 %) within this group received aspirin. The total prevalence of PREEC in our sample was 151 pregnant women (23.8 %). Pregnant patients under the aspirin treatment developed less PREEC events (19.2% vs 27.5%, p=0.019); with OR not adjusted 0.62 (IC95% 0.43-0.91 p= 0.017). The risk was similar when it was adjusted by age, preeclampsia history, diabetes mellitus and chronic high blood pressure. (OR adjusted 0.63 IC95% 0.43-0.92 p= 0.017). Conclusions: The use of 100 mg of aspirin a day before the 20th week of pregnancy in high risk pregnant patients decreased the risk of developing PREEC, regardless the age and risk factors.

Objetivos: El objetivo de este estudio fue analizar la utilidad de la dosis de 100 mg de aspirina como medida de prevención para preeclampsia en pacientes embarazadas de alto riesgo. Métodos: Se realizó un estudio de cohorte retrospectivo de embarazadas de alto riesgo en seguimiento con un protocolo de tensión arterial y se evaluó la utilización de aspirina 100 mg vs la no utilización de la misma, en la incidencia de PREEC. Se realizó estimaciones de riesgos entre ambos grupos sin y con ajuste de variables con modelos de regresión logística binaria. Resultados: Fueron evaluadas 633 embarazadas de alto riesgo con promedio de 30±7 años y 25±8 semanas de gestación, de las cuales 281 mujeres (44,3%) recibieron aspirina. La prevalencia total de PREEC en nuestra muestra fue de 151 embarazadas (23,8%). Las embarazadas que estaban ingiriendo aspirina, desarrollaron menos eventos de PREEC (19.2% vs 27.5%, p=0.019); con OR no ajustado 0.62 (IC95% 0.43-0.91 p= 0.017). Siendo este riesgo similar cuando fue ajustado por edad, antecedentes de preeclampsia, diabetes mellitus e hipertensión arterial crónica. (OR ajustado 0.63 IC95% 0.43-0.92 p= 0.017). Conclusiones: La utilización de Aspirina 100 mg por día antes de las 20 semanas de gestación en embarazadas de alto riesgo disminuyó el riesgo de desarrollar PREEC, independientemente de la edad y factores de riesgo.

Plasmatic renin-angiotensin system in normotensive and hypertensive patients hospitalized with COVID-19.

BACKGROUND: Besides its counterbalancing role of the renin-angiotensin system (RAS), angiotensin-converting enzyme (ACE) 2 is the receptor for the type 2 coronavirus that causes severe acute respiratory syndrome, the etiological agent of COVID-19. COVID-19 is associated with increased plasmatic ACE2 levels, although conflicting results have been reported regarding angiotensin (Ang) II and Ang-(1-7) levels. We investigated plasmatic ACE2 protein levels and enzymatic activity and Ang II and Ang-(1-7) levels in normotensive and hypertensive patients hospitalized with COVID-19 compared to healthy subjects. METHODS: Ang II and Ang-(1-7), and ACE2 activity and protein levels were measured in 93 adults (58 % (n = 54) normotensive and 42 % (n = 39) hypertensive) hospitalized with COVID-19. Healthy, normotensive (n = 33) and hypertensive (n = 7) outpatient adults comprised the control group. RESULTS: COVID-19 patients displayed higher ACE2 enzymatic activity and protein levels than healthy subjects. Within the COVID-19 group, ACE2 activity and protein levels were not different between normotensive and hypertensive-treated patients, not even between COVID-19 hypertensive patients under RAS blockade treatment and those treated with other antihypertensive medications. Ang II and Ang-(1-7) levels significantly decreased in COVID-19 patients. When COVID-19 patients under RAS blockade treatment were excluded from the analysis, ACE2 activity and protein levels remained higher and Ang II and Ang-(1-7) levels lower in COVID-19 patients compared to healthy people. CONCLUSIONS: Our results support the involvement of RAS in COVID-19, even when patients under RAS blockade treatment were excluded. The increased circulating ACE2 suggest higher ACE2 expression and shedding.

Neurodevelopmental assessment of infants born to mothers with hypertensive disorder of pregnancy at six months of age.

Infant neurodevelopment is a complex process which may be affected by different events during pregnancy, such as hypertensive disorders of pregnancy (HDP). We conducted a prospective cohort study to compare the prevalence of neurodevelopmental disorders in infants born to mothers with and without HDP at six months of age. Participants attended the Health Observatory of Instituto de Desarrollo e Investigaciones Pediátricas "Prof. Dr. Fernando E. Viteri" during 2018 and 2019. Infant neurodevelopment was assessed with the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III). Data were analyzed using Chi-square, Student's t-test and Mann-Whitney test. Of the 132 participating infants, 68 and 64 were born to mothers with and without HDP, respectively. At six months, the prevalence of risk of neurodevelopmental delay was significantly higher in infants born to mothers with than without HDP (27.9% vs. 9.4%; p = 0.008) (odds ratio, 3.71; 95% confidence interval, 1.30; 12.28). In conclusion, infants born to mothers with HDP had three times increased risk of neurodevelopmental delay at six months of age.

Nocturnal hypertension and risk of developing early-onset preeclampsia in high-risk pregnancies.

To test the hypothesis that nocturnal hypertension identifies risk for early-onset preeclampsia/eclampsia (PE), we conducted an historical cohort study of consecutive high-risk pregnancies between 1st January 2016 and 31st March 2020. Office blood pressure (BP) measurements and ambulatory blood pressure monitoring (ABPM) were performed. The cohort was divided into patients without PE or with early- or late-onset PE (<34 and ≥34 weeks of gestation, respectively). The relative risks of office and ABPM hypertension for the development of late- or early-onset PE were estimated with multinomial logistic regression using no PE as a reference category. Four hundred and seventy-seven women (mean age 30 ± 7 years, with 23 ± 7 weeks of gestation at the time of the BP measurements) were analyzed; 113 (23.7%) developed PE, 69 (14.5%) developed late-onset PE, 44 (9.2%) developed early-onset PE. Office and ambulatory BP increased between the groups, and women who developed early-onset PE had significantly higher office and ambulatory BP values than those with late-onset PE or without PE. Hypertension prevalence increased across groups, with the highest values in early-onset PE. Nocturnal hypertension was the most prevalent finding and was highly prevalent in women who developed early-onset PE (88.6%); only 1.6% of women without nocturnal hypertension developed early-onset PE. Additionally, nocturnal hypertension was a stronger predictor for early-onset PE than for late-onset PE (adjusted OR, 5.26 95%CI 1.67-16.60) vs. 2.06, 95%CI 1.26-4.55, respectively). In conclusion, nocturnal hypertension was the most frequent BP abnormality and a significant predictor of early-onset PE in high-risk pregnancies.

Arterial Stiffness: Its Relation with Prediabetes and Metabolic Syndrome and Possible Pathogenesis.

AIMS: To evaluate arterial stiffness indicators in people with prediabetes (PreD) and its possible pathogenesis. MATERIALS AND METHODS: Pulse wave velocity (PWV) was measured in 208 people with FINDRISC ≥ 13 (57 ± 8 years old, 68.7% women) and thereafter divided into those having either normal glucose tolerance (NGT) or PreD. In each subgroup we also identified those with/out insulin resistance (IR) measured by the triglyceride/HDL-c ratio (normal cut off values previously established in our population). Clinical and metabolic data were collected for all participants. PWV was compared between subgroups using independent t test. RESULTS: Women and men had comparable clinical and metabolic characteristics with obesity (BMI ≥ 30) and antihypertensive-statin treatment, almost half with either NGT or PreD. Whereas 48% of NGT people presented IR (abnormally high TG/HDL-c ratio), 52% had PreD. PWV was significantly higher only in those with a complete picture of metabolic syndrome (MS). CONCLUSIONS: Since PWV was significantly impaired in people with a complete picture of MS, clinicians must carefully search for early diagnosis of this condition and prescribe a healthy life-style to prevent development/progression of CVD. This proactive attitude would provide a cost-effective preventive strategy to avoid CVD's negative impact on patients' quality of life and on health systems due to their higher care costs.

Prevalence of isolated nocturnal hypertension according to 2018 European Society of Cardiology and European Society of Hypertension office blood pressure categories.

OBJECTIVES: To estimate the prevalence of isolated nocturnal hypertension (INH) and its relationships with office blood pressure (BP) categories defined by 2018 ESC/ESH guidelines. METHODS: We conducted a prospective cohort study in consecutive patients referred to perform an ambulatory blood pressure monitoring (ABPM) for diagnosis or therapeutic purposes. Office BP measurements and ABPM were performed in the same visit. The cohort was divided according to office BP in optimal, normal, high-normal and hypertension. The prevalence and adjusted risk for combined daytime and nocturnal hypertension and INH were estimated for each category. RESULTS: We evaluated 1344 individuals, 59.3% women (51 ±â€Š14 years old) and 40.7% men (52 ±â€Š15 years old). 61.5% of the individuals had nocturnal hypertension, 12.9% INH and 48.7% combined daytime and nocturnal hypertension. Prevalence of combined daytime and nocturnal hypertension increased through office BP categories (P < 0.001). Conversely, prevalence of INH was lower in individuals with hypertension than in normotensives (7.4 vs. 17.2%, P < 0.001) and similar between nonhypertensive office BP categories, 16.6, 15 and 19.4% for optimal, normal and high-normal BP, respectively (P < 0.399). In individuals with office BP values less than 140/90 mmHg, the prevalence of masked hypertension phenotypes were 8.6, 17.2 and 30.2% for daytime, INH and combined daytime and nocturnal hypertension, respectively. Adjusted risk for combined daytime and nocturnal hypertension increased significantly through office BP categories; conversely, the risk for INH was similar in all nonhypertensive office BP categories. CONCLUSION: Nocturnal hypertension was the more prevalent phenotype of masked hypertension and more than one-third of the individuals with nocturnal hypertension had INH. The risk for INH was not related to nonhypertensive office BP categories.

Adherence to antihypertensive drug treatment in Argentina: A multicenter study.

Adherence to antihypertensive medication is an important challenge that doctors often face in the treatment of hypertension. Good adherence is crucial to prevent cardiovascular complications. In consequence, the present study aimed at determining the prevalence of adherence to antihypertensive treatment and identifying associated clinical variables. A multicenter cross-sectional study was conducted in 12 cities of Argentina. A systematic sampling was performed in order to select patients with hypertension and under pharmacological treatment for at least 6 months. Physicians took three BP measurements, and the level of adherence was assessed using the self-administered Morisky questionnaire (MMAS-8). Participants were classified into three levels of adherence: high adherence-MMAS score of 8; medium adherence-MMAS scores of 6 to <8; and low adherence-MMAS scores of <6. A total of 1111 individuals (62 ± 12 years old, women 49.4%) were included in the present analysis; 159 (14.3%), 329 (29.6%) and 623 (56.1%) patients had low, medium, and high adherence, respectively. The prevalence of controlled hypertension increased only in high adherent patients: 42.8%, 42.2%, and 64.5% for low, medium, and high adherence groups, respectively. Similarly, systolic BP was lower only in the high adherence group. High educational level (OR 3.47, 95% CI 2.68-4.49) and diuretic treatment (OR 0.64, 95% CI 0.47-0.88) were independent predictors of high adherence. In conclusion, more than a half of treated hypertensive patients had a high level of adherence. These patients had lower BP values and higher control levels. A high educational level predicts high adherence.

May Measurement Month 2019: The Global Blood Pressure Screening Campaign of the International Society of Hypertension.

Elevated blood pressure remains the single biggest risk factor contributing to the global burden of disease and mortality. May Measurement Month is an annual global screening campaign aiming to improve awareness of blood pressure at the individual and population level. Adults (≥18 years) recruited through opportunistic sampling were screened at sites in 92 countries during May 2019. Ideally, 3 blood pressure readings were measured for each participant, and data on lifestyle factors and comorbidities were collected. Hypertension was defined as a systolic blood pressure ≥140 mm Hg, or a diastolic blood pressure ≥90 mm Hg (mean of the second and third readings) or taking antihypertensive medication. When necessary, multiple imputation was used to estimate participants' mean blood pressure. Mixed-effects models were used to evaluate associations between blood pressure and participant characteristics. Of 1 508 130 screenees 482 273 (32.0%) had never had a blood pressure measurement before and 513 337 (34.0%) had hypertension, of whom 58.7% were aware, and 54.7% were on antihypertensive medication. Of those on medication, 57.8% were controlled to <140/90 mm Hg, and 28.9% to <130/80 mm Hg. Of all those with hypertension, 31.7% were controlled to <140/90 mm Hg, and 350 825 (23.3%) participants had untreated or inadequately treated hypertension. Of those taking antihypertensive medication, half were taking only a single drug, and 25% reported using aspirin inappropriately. This survey is the largest ever synchronized and standardized contemporary compilation of global blood pressure data. This campaign is needed as a temporary substitute for systematic blood pressure screening in many countries worldwide.