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Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To investigate patterns of left ventricular (LV) geometric patterns in patients diagnosed with new-onset hypertension using transthoracic echocardiography. The LV diastolic function was also evaluated in these patients. Materials and Methods: The present study was a cross-sectional study that clinically evaluated patients diagnosed with new-onset hypertension at Burapha University Hospital. To classify LV geometric patterns, electrocardiogram, and transthoracic echocardiography to measure LV mass index and relative wall thickness were performed. Other relevant assessments were also conducted, including the diastolic function. Results: Fifty-five patients diagnosed with new-onset hypertension were enrolled, their mean age was 55.3 years, with a standard deviation of 11.8 years. Of all participants, 70.9% (95% CI 57.1 to 82.4) had concentric remodeling, 16.4% (95% CI 7.8 to 28.8) had concentric hypertrophy, 10.9% (95% CI 4.1 to 22.3) had normal geometry and 1.8% (95% CI 0.1 to 9.7) had eccentric hypertrophy. Of all participants, 81.8% were detected to have abnormal LV diastolic dysfunction. Abnormal relaxation pattern was the most common format. Conclusion: In the present study, approximately 10.9% of patients diagnosed with new-onset hypertension had normal LV geometry, whereas 89.1% had abnormal geometry in different patterns. Concentric remodeling was found to be the predominant abnormal geometrical format. Understanding LV geometric patterns helps clinicians stratify risk, predict prognosis, and make informed decisions about treatment strategies for these patients. [ABSTRACT FROM AUTHOR]

Background: As countries around the globe enforce social distancing and self-isolation to fight the COVID-19 pandemic, telemedicine is emerging as a critical tool to connect physicians and other healthcare professionals with patients dealing with chronic cardiovascular conditions. Technology assisted healthcare delivery is virtually imperative especially in India with a large part belonging to rural and remote regions. The Information and Communication technology (ICT) which is the fundamental part of this technology is the ability to locally connect to a global network. The current pandemic caused by corona has highlighted the importance of this technology even more with patients showing apprehension to go to hospitals for routine check-ups. The emergence of Internet of Things (IoT) has further ensured that a continuum in care can be maintained, with patients having the opportunity to have wearable devices at their homes and using the Telemedicine platform for transmission of medical data from these devices for consultations. Methods: Literary search on the various applications of Telemedicine in healthcare with specific reference to Cardiology. Results: This article highlights our experience in the utilization of this technology for various cardiac conditions, comprehending the challenges of this technology at the practical level and the impact of making healthcare deliver accessible and cost-effective. Conclusions: Information and communication technology (ICT) and the advent of Internet of Things for Medical Devices (IoT-MD) has empowered telemedicine as a powerful model for healthcare delivery in an effective manner. Immense data generated from these devices have further encouraged development of algorithms based on Artificial Intelligence thereby improving clinical effectiveness and ensuring continuity of care. Though possibilities of improving clinical efficacy and healthcare outcomes through AI are enormous, we need to be aware of the associated risks and challenges and try to minimize those through multidisciplinary research, and renewed legal and ethical policies. [ABSTRACT FROM AUTHOR]

Purpose: Recent evidences show that primary hyperparathyroidism (PHPT) patients have a high prevalence of cardiovascular diseases. However, the reported changes in cardiac status are inconsistent in previous studies. The present work evaluated the cardiac structure and function in PHPT patients by echocardiography. Methods: PHPT patients and age- and sex-matched healthy controls were enrolled in this case-control study. Biochemical parameters were retrospectively collected from PHPT patients. Cardiac function and structure were assessed in all subjects using echocardiography. Results: A total of 153 PHPT patients and 51 age- and sex-matched healthy controls were enrolled in this study. The mean serum calcium and parathyroid hormone (PTH) levels in PHPT patients were 2.84 ± 0.28mmol/L and 206.9 (130.0, 447.5) pg/ml, respectively. Left ventricular ejection fraction (LVEF) and early to late mitral annular velocity (E/A) were significantly lower in PHPT patients than in healthy controls (68.2 ± 6.0 vs. 70.7 ± 16.7%, 1.0 ± 0.5 vs. 1.4 ± 0.5, respectively, p both < 0.05). The left ventricular mass index (LVMI) and the relative wall thickness (RWT) were not significantly different between the two groups. However, the difference in LVEF between PHPT patients without hypertension and diabetes and the control groups disappeared. The majority of PHPT patients had normal cardiac geometry; however, a proportion of them exhibited concentric remodeling (normal LVMI, RWT≥0.42). Serum calcium, corrected calcium, ionized calcium and PTH were inversely related to E/A, whereas serum phosphorus and 24-hour urine calcium were positively related to E/A. Furthermore, biochemical parameters were not correlated with LVEF. Conclusions: These findings demonstrate that PHPT patients exhibit diastolic cardiac dysfunction reflected by decreased E/A, as well as possible cardiac structural abnormalities. The serum calcium, phosphorus, and parathyroid hormone levels may influence cardiac structure and function. [ABSTRACT FROM AUTHOR]

Background: Aortic valve neocuspidization (AVNeo) has emerged as a promising aortic valve procedure, and is expected to have a larger effective orifice area (EOA) than commercially available bioprostheses. It is, however, unclear which indices could facilitate left ventricular (LV) reverse remodeling after AVNeo. The aim of this study is to verify the impact of global left ventricular afterload on the LV reverse remodeling following AVNeo.Methods: Data-available consecutive 38 patients (median age, 77; interquartile range, 72.8-82.0) undergoing AVNeo for severe aortic stenosis were enrolled in this study. Preoperative and the last follow-up echocardiographic data were retrospectively analyzed including the valvuloarterial impedance (Zva), a marker of global LV afterload. Reduction in LV geometry index (LVGI) and relative wall thickness (RWT) were used as an indicator for LV reverse remodeling.Results: The Zva reduced in 24 patients (63.2%) during the follow-up period (median, 12 months). Reduction in Zva significantly correlated to improvement of LV geometry (LVGI (r = 0.400, p = 0.013) and RWT (r = 0.627, p < 0.001)), whereas increase in EOA index did not significantly correlate to LVGI (r = 0.009, p = 0.957), or RWT (r = 0.105, p = 0.529)). The reduction in Zva was the multivariate predictor of LV reverse remodeling.Conclusions: Low global LV afterload led to significant LV reverse remodeling even after AVNeo, which could achieve better valve performance than the conventional bioprostheses. [ABSTRACT FROM AUTHOR]

BACKGROUND Whether in volume-dependent primary hypertension, concentric left ventricular (LV) remodeling beyond hypertrophy (LVH) represents the impact of a pressure rather than a volume overload, is unclear. METHODS Using central arterial pressure, and aortic velocity and diameter measurements in the outflow tract (echocardiography), we determined the factors that associate with concentric LVH or remodeling in a community of African ancestry (n = 709) with prevalent volume-dependent primary hypertension. RESULTS Both left ventricular mass index (LVMI) and relative wall thickness (RWT) were positively and independently associated with end diastolic volume (EDV), stroke volume (SV), and peak aortic flow (Q) (P < 0.05 to <0.0001). However, neither LVMI nor RWT were positively and independently associated with systemic vascular resistance (SVR), or aortic characteristic impedance (Zc) or inversely associated with total arterial compliance (TAC). Consequently, both concentric (P < 0.0001) and eccentric (P < 0.0001) LVH were associated with similar increases in EDV, SV, and either office brachial, central arterial, or 24-hour blood pressures (BP), but neither increases in SVR or Zc nor decreases in TAC. LV RWT, but not LVMI was nevertheless independently and inversely associated with myocardial systolic function (midwall shortening and s′) (P < 0.05 to <0.005) and decreases in LV systolic function were noted in concentric (P < 0.05), but not eccentric LVH. CONCLUSIONS In volume-dependent primary hypertension, concentric LVH is determined as much by volume-dependent increases in systemic flow and an enhanced BP as eccentric LVH. Concentric remodeling nevertheless reflects decreases in systolic function beyond LVH. [ABSTRACT FROM AUTHOR]

Objectives: The size of the heart may predict major cardiovascular events (MACE) in patients with stable chest pain. We aimed to evaluate the prognostic value of 3D whole heart volume (WHV) derived from non-contrast cardiac computed tomography (CT). Methods: Among participants randomized to the CT arm of the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE), we used deep learning to extract WHV, defined as the volume of the pericardial sac. We compared the WHV across categories of cardiovascular risk factors and coronary artery disease (CAD) characteristics and determined the association of WHV with MACE (all-cause death, myocardial infarction, unstable angina; median follow-up: 26 months). Results: In the 3798 included patients (60.5 ± 8.2 years; 51.5% women), the WHV was 351.9 ± 57.6 cm3/m2. We found smaller WHV in no- or non-obstructive CAD, women, people with diabetes, sedentary lifestyle, and metabolic syndrome. Larger WHV was found in obstructive CAD, men, and increased atherosclerosis cardiovascular disease (ASCVD) risk score (p < 0.05). In a time-to-event analysis, small WHV was associated with over 4.4-fold risk of MACE (HR (per one standard deviation) = 0.221; 95% CI: 0.068–0.721; p = 0.012) independent of ASCVD risk score and CT-derived CAD characteristics. In patients with non-obstructive CAD, but not in those with no- or obstructive CAD, WHV increased the discriminatory capacity of ASCVD and CT-derived CAD characteristics significantly. Conclusions: Small WHV may represent a novel imaging marker of MACE in stable chest pain. In particular, WHV may improve risk stratification in patients with non-obstructive CAD, a cohort with an unmet need for better risk stratification. Key Points: • Heart volume is easily assessable from non-contrast cardiac computed tomography. • Small heart volume may be an imaging marker of major adverse cardiac events independent and incremental to traditional cardiovascular risk factors and established CT measures of CAD. • Heart volume may improve cardiovascular risk stratification in patients with non-obstructive CAD. [ABSTRACT FROM AUTHOR]

Background: The utility of echocardiographic left ventricular (LV) geometry in the prediction of stroke/coronary heart disease (CHD) and all-cause mortality is not well characterized. This study aimed to evaluate the overall and sex-specific prognostic value of different geometric patterns on the incidence of stroke/CHD and all-cause mortality in a Chinese population-based cohort.Methods: We conducted a prospective study in the general population in Northeast China, and a total of 9940 participants aged ≥ 35 years underwent echocardiography for LV geometry and were successfully followed up for incident stroke/CHD and all-cause death. Cox proportional hazards models were utilized to estimate the association of baseline LV geometry with adverse outcomes.Results: Over a median follow-up of 4.66 years, abnormal LV geometric patterns had increased crude incident rates of stroke/CHD and all-cause mortality compared with normal geometry in overall population and each sex group (all P < 0.05). Multivariable Cox analysis reported that LV concentric and eccentric hypertrophy were associated with incident stroke/CHD (concentric hypertrophy: hazard ratio (HR) = 1.39, 95% confidence interval (CI) = 1.04-1.86; eccentric hypertrophy: HR = 1.42, 95% CI = 1.11-1.82) and all-cause mortality (concentric hypertrophy: HR = 1.50, 95% CI = 1.07-2.12; eccentric hypertrophy: HR = 1.58, 95% CI = 1.19-2.10), and LV concentric remodeling was related to stroke/CHD incidence (HR = 1.42, 95% CI = 1.09-1.84) in total population compared to normal geometry after the adjustment for potential confounders. In men, a significant increase was observed from LV eccentric hypertrophy for incident stroke/CHD, whereas in women, LV concentric hypertrophy was associated with elevated incidence of both stroke/CHD and all-cause death, and eccentric hypertrophy was correlated with increased all-cause mortality (all P < 0.05).Conclusions: Our prospective cohort supports that abnormal LV geometry by echocardiography has a prognostic significance for incident stroke/CHD and all-cause mortality, implying that early detection and intervention of LV structural remodeling in rural China are urgently needed to prevent adverse outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND Risk of atrial fibrillation (AF) in masked and white coat uncontrolled hypertension (MUCH and WUCH, respectively) has not yet been investigated. We assessed the risk of new-onset AF in MUCH and WUCH detected by ambulatory blood pressure (BP) monitoring. METHODS The occurrence of AF was evaluated in 2,135 treated hypertensive patients aged >40 years, with baseline sinus rhythm, by electrocardiogram. Controlled hypertension (CH) was defined as clinic BP <140/90 mm Hg and daytime BP, regardless of nighttime BP, <135/85 mm Hg, MUCH as clinic BP <140/90 mm Hg and daytime BP ≥135 and/or ≥85 mm Hg, WUCH as clinic BP ≥140 and/or ≥90 mm Hg and daytime BP <135/85 mm Hg, and sustained uncontrolled hypertension (SUCH) as clinic BP ≥140 and/or ≥90 mm Hg and daytime BP ≥135 and/or ≥85 mm Hg. RESULTS MUCH was identified in 203 patients (9.5% of all the population, 29% of those with normal clinic BP) and WUCH in 503 patients (23.5% of all the population, 35% of those with high clinic BP). During the follow-up (mean 9.7 years), 116 cases of AF occurred. After adjustment for covariates, patients with MUCH (hazard ratio 2.02, 95% confidence interval, 1.06–3.85) and SUCH (hazard ratio 1.83, 95% confidence interval, 1.04–3.21) had higher risk of new-onset AF than those with CH, whereas those with WUCH (hazard ratio 1.12, 95% confidence interval, 0.59–2.13) did not. CONCLUSIONS When compared with patients with CH, those with MUCH and SUCH are at higher risk (approximately doubled) of new-onset AF, whereas those with WUCH are not. [ABSTRACT FROM AUTHOR]

High blood pressure (BP) is the leading modifiable risk factor of stroke worldwide. Although randomized clinical trials have demonstrated the beneficial effect of BP reduction on stroke risk, there are still insufficiently explored issues concerning the optimal personalized management of BP in stroke patients in terms of thresholds to be achieved and drug classes to be prescribed. Few data are available about BP control in specific clinical contexts such as in older patients, in various stroke subtypes, or in association with co-morbidities such as diabetes. In addition, although drug trials based their conclusions on achieved mean BP values, recent findings indicate that aspects such as circadian variations of BP and BP variability should be taken into account as well. This article aims to highlight current knowledge about BP control in stroke prevention and to provide new perspectives to be addressed in future studies so as to guide clinicians in their day-to-day practice. [ABSTRACT FROM AUTHOR]

Objective: To compare the risk of target organ damage in masked hypertension (MH) and sustained hypertension (SH). Methods: A systematic review and meta-analysis was performed. A search of PubMed, Embase, and the Cochrane Library of relevant case-control studies was performed from inception to December 2019, and articles on MH and SH selected according to the inclusion criteria were analyzed. The primary end point was target organ damage in the heart. The secondary end points were target organ damage in the kidneys and blood vessels. Results: Seventeen studies that met the screening criteria were included in the meta-analysis. Compared with the SH group, in the MH group carotid intima-media thickness (IMT) and E/A ratio were significantly greater and the prevalence of left ventricular remodeling and the pulse wave velocity were significantly lower. Other indicators in the heart, kidneys, and blood vessels were not statistically different between the two groups. IMT: P = 0.01, E/A ratio: P = 0.01, prevalence of left ventricular remodeling: P = 0.02, pulse wave velocity: P = 0.01. Conclusion: Our study has shown that MH may have almost the same degree of target organ damage as SH, so clinicians may need to consider target organ damage. [ABSTRACT FROM AUTHOR]

The article focuses on hypertension is one of the major cardiovascular risk factors, closely related to the major cardiovascular, neurological, and renal adverse events. Topics include the resistant hypertension (RHT) has characterized by uncontrolled blood pressure (BP) despite intensive treatment, the higher risk has not limited only to cardiovascular events, and the documented that effective control of high BP in patients with RHT provides a significant decrease.

BACKGROUND Masked uncontrolled hypertension (MUCH), that is, nonhypertensive clinic but high out-of-office blood pressure (BP) in treated patients is at increased cardiovascular risk than controlled hypertension (CH), that is, nonhypertensive clinic and out-of-office BP. Using ambulatory BP, MUCH can be defined as daytime and/or nighttime and/or 24-hour BP above thresholds. It is unclear whether different definitions of MUCH have similar prognostic information. This study assessed the prognostic value of MUCH defined by different ambulatory BP criteria. METHODS Cardiovascular events were evaluated in 738 treated hypertensive patients with nonhypertensive clinic BP. Among them, participants were classified as having CH or daytime MUCH (BP ≥135/85 mm Hg) regardless of nighttime BP (group 1), nighttime MUCH (BP ≥120/70 mm Hg) regardless of daytime BP (group 2), 24-hour MUCH (BP ≥130/80 mm Hg) regardless of daytime or nighttime BP (group 3), daytime MUCH only (group 4), nighttime MUCH only (group 5), and daytime + nighttime MUCH (group 6). RESULTS We detected 215 (29%), 357 (48.5%), 275 (37%), 42 (5.5%),184 (25%) and 173 (23.5%) patients with MUCH from group 1 to 6, respectively. During the follow-up (10 ± 5 years), 148 events occurred in patients with CH and MUCH. After adjustment for covariates, compared with patients with CH, the adjusted hazard ratio (95% confidence interval) for cardiovascular events was 2.01 (1.45–2.79), 1.53 (1.09–2.15), 1.69 (1.22–2.34), 1.52 (0.80–2.91), 1.15 (0.74–1.80), and 2.29 (1.53–3.42) from group 1 to 6, respectively. CONCLUSIONS The prognostic impact of MUCH defined according to various ambulatory BP definitions may be different. [ABSTRACT FROM AUTHOR]

Treatment-resistant hypertension (TRH) is a well-described condition in adult patients that is associated with poor clinical outcomes. While case reports of hypertension resistant to therapy in children have been published, it is unclear if TRH truly exists in childhood. This educational review will briefly summarize recent evidence and recommendations for TRH in adults, as well as will review the literature regarding medically resistant hypertension in children and adolescents. Finally, we propose a clinical approach for evaluation hypertensive children and adolescents with apparent treatment resistance. [ABSTRACT FROM AUTHOR]

Background: Treatment resistant hypertension(TRH) is detrimental risk of cardiovascular and premature deaths. Globally, the prevalence of resistant hypertension is inclining from time to time and it is yet to be determined in Ethiopia. Objective: To assess the prevalence of apparent TRH and its predictors among ambulatory hypertensive patients on follow up in hypertension clinic of Mekelle Hospital, Northern Ethiopia. Method: A hospital based cross sectional study was conducted from Nov 25, 2018 to July 20, 2019, among 338 adult ambulatory hypertensive patients on follow up in Mekelle Hospital hypertension clinic. Hypertensive patient aged ≥18 years who were on regular follow up and taking antihypertensive medications for at least 6 months were included in the study. A simple random sampling technique was used to recruit the study patients. Results: A total of 338 adult ambulatory hypertensive patients were analysed. More than half, 182 (53.8%) patients were females and the average age of the patients was 58.9 ±11.5. Three hundred thirty-three (98.5%) patients had no family history of hypertension. Majority, 66.8% of the patients were on monotherapy. The prevalence of apparent TRH was calculated to be 8.6% [Confidence Interval = 0.056–0.116]. Patients with Body Mass Index(BMI) greater than 30[Adjusted Odds Ratio(AOR) = 12.1, 95%CI:2.00–73.19, p = 0.007] and longer duration of hypertension were the predictors of resistant hypertension. Conclusion: Even if escalation of antihypertensive medications was not aggressive, apparent TRH was common in the study setting. Obesity (BMI greater than 30) and longer duration of hypertension since diagnosis were the predictors of TRH. Meticulous emphasis should be placed on to detect the prevalence of true hypertension resistance and future studies should discover the impact of aggressive antihypertensive medications scale up on the risks of TRH. [ABSTRACT FROM AUTHOR]

Aims Women with evidence of ischaemia but no obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction (CMD). Although invasively measured coronary flow reserve (CFR) is useful for the diagnosis of CMD, intermediate CFR values are often found of uncertain significance. We investigated myocardial flow reserve and left ventricular (LV) structural and functional remodelling in women with suspected INOCA and intermediate CFR. Methods and results Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study participants who had invasively measured intermediate CFR of 2.0≤ CFR ≤3.0 (n  = 125) were included for this analysis. LV strain, peak filling rate (PFR) and myocardial perfusion reserve index (MPRI) were obtained by cardiac magnetic resonance imaging. Participants were divided: (i) Group 1 (n  = 66) high MPRI ≥ 1.8, and (ii) Group 2 (n  = 59) low MPRI < 1.8. The mean age was 54 ± 12 years and CFR was 2.46 ± 0.27. MPRI was significantly different but CFR did not differ between groups. LV relative wall thickness (RWT) trended higher in Group 2 and circumferential peak systolic strain and early diastolic strain rate were lower (P  = 0.039 and P  = 0.035, respectively), despite a similar LV ejection fraction and LV mass. PFR was higher in Group 1 and LV RWT was negatively related to PFR (r  = −0.296, P  = 0.001). Conclusions In women with suspected INOCA and intermediate CFR, those with lower MPRI had a trend towards more adverse remodelling and impaired diastolic LV function compared with those with higher MPRI. CFR was similar between the two groups. These findings provide evidence that both coronary microvessel vasomotion and structural and functional myocardial remodelling contribute to CMD. [ABSTRACT FROM AUTHOR]

Copyright of Revista da Faculdade de Ciências Médicas de Sorocaba is the property of Revista da Faculdade de Ciencias Medicas de Sorocaba and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND Antihypertensive treatment improves echocardiographic parameters of hypertensive target organ damage in stage II hypertension, but less is known about the effects in stage I hypertension. METHODS In a cohort study nested in the randomized double-blind trial PREVERtreatment, 2-dimensional echocardiograms were performed in 110 individuals, aged 54.8 ± 7.9 years-old, with stage I hypertension at baseline and after 18 months of treatment with chlorthalidone/amiloride or losartan. RESULTS At baseline, 66 (60%) participants had concentric remodeling. After antihypertensive treatment, systolic (SBP) and diastolic blood pressure (BP) were reduced from 141/90 to 130/83 mm Hg (P = 0.009). There was a significant reduction in left ventricular (LV) mass (LVM) index (82.7 ± 17.1 to 79.2 ± 17.5 g/m²; P = 0.005) and relative wall thickness (0.45 ± 0.06 to 0.42 ± 0.05; P < 0.001), increasing the proportion of participants with normal LV geometry (31% to 49%, P = 0.006). Left atrial (LA) volume index reduced (26.8 ± 7.3 to 24.9 ± 6.5 ml/m²; P = 0.001), and mitral E-wave deceleration time increased (230 ± 46 to 247 ± 67 ms; P = 0.005), but there was no change in other parameters of diastolic function. LVM reduction was significantly higher in the 2 higher tertiles of SBP reduction compared to the lower tertile. CONCLUSIONS Treatment of patients with stage I hypertension for 18 months promotes favorable effects in the LA and LV remodeling. This improvement in cardiac end-organ damage might be associated with reduction of long term clinical consequences of hypertensive cardiomyopathy, particularly heart failure with preserved ejection fraction. [ABSTRACT FROM AUTHOR]

BACKGROUND Prognosis of masked and white coat uncontrolled hypertension (MUCH and WCUCH, respectively) detected by ambulatory blood pressure (BP) monitoring is incompletely clear in elderly treated hypertensive patients. We evaluated prognosis of MUCH and WCUCH identified by ambulatory BP monitoring in this setting. METHODS The occurrence of a composite endpoint was evaluated in 1,191 elderly treated hypertensive patients. Controlled hypertension (CH) was defined as clinic BP <140/90 mm Hg and 24-hour BP <130/80 mm Hg, MUCH as clinic BP <140/90 mm Hg and 24-hour BP ≥130 and/or ≥80 mm Hg, WCUCH as clinic BP ≥140 and/or ≥90 mm Hg and 24-hour BP <130/80 mm Hg and sustained uncontrolled hypertension (SUCH) as clinic BP ≥140 and/or ≥90 mm Hg and 24-hour BP ≥130 and/or ≥80 mm Hg. RESULTS MUCH was identified in 142 patients (12% of all the population, 34% of those with normal clinic BP) and WCUCH in 230 patients (19% of all the population, 30% of those with high clinic BP). During the follow-up (9.1 ± 4.9 years, range 0.4-20 years), 392 events occurred. After adjustment for various covariates, patients with MUCH (hazard ratio (HR) 1.60, 95% confidence interval (CI) 1.12-2.29, P = 0.01) and SUCH (HR 1.81, 95% CI, 1.35-2.42, P < 0.001) had significantly higher cardiovascular risk than those with CH, whereas those with WCUCH (HR 1.09, 95% CI, 0.74-1.60, P = 0.66) had not significantly higher risk. CONCLUSIONS In elderly treated hypertensive patients evaluated by ambulatory BP monitoring, compared to individuals with CH, those with MUCH have significantly higher risk and those with WCUCH have slightly and not significantly higher risk. [ABSTRACT FROM AUTHOR]

Background: It is unclear whether obesity and type 2 diabetes (T2D), either alone or in combination, induce left ventricular hypertrophy (LVH) independent of hypertension. In the current study, we provide clarity on this issue by rigorously analysing patient left ventricular (LV) structure via clinical indices and via LV geometric patterns (more commonly used in research settings). Importantly, our sample consisted of hypertensive patients that are routinely screened for LVH via echocardiography and normotensive patients that would normally be deemed low risk with no further action required. Methods: This cross sectional study comprised a total of 353 Caucasian patients, grouped based on diagnosis of obesity, T2D and hypertension, with normotensive obese patients further separated based on metabolic health. Basic metabolic parameters were collected and LV structure and function were assessed via transthoracic echocardiography. Multivariable logistic and linear regression analyses were used to identify predictors of LVH and diastolic dysfunction. Results: Metabolically healthy normotensive obese patients exhibited relatively low risk of LVH. However, normotensive metabolically non-healthy obese, T2D and obese/T2D patients all presented with reduced normal LV geometry that coincided with increased LV concentric remodelling. Furthermore, normotensive patients presenting with both obesity and T2D had a higher incidence of concentric hypertrophy and grade 3 diastolic dysfunction than normotensive patients with either condition alone, indicating an additive effect of obesity and T2D. Alarmingly these alterations were at a comparable prevalence to that observed in hypertensive patients. Interestingly, assessment of LVPWd, a traditional index of LVH, underestimated the presence of LV concentric remodelling. The implications for which were demonstrated by concentric remodelling and concentric hypertrophy strongly associating with grade 1 and 3 diastolic dysfunction respectively, independent of sex, age and BMI. Finally, pulse pressure was identified as a strong predictor of LV remodelling within normotensive patients. Conclusions: These findings show that metabolically non-healthy obese, T2D and obese/T2D patients can develop LVH independent of hypertension. Furthermore, that LVPWd may underestimate LV remodelling in these patient groups and that pulse pressure can be used as convenient predictor of hypertrophy status. [ABSTRACT FROM AUTHOR]

BACKGROUND: The independent prognostic significance of nondipping and morning surge (MS) of blood pressure (BP) in treated hypertensive patients with controlled ambulatory BP is not yet clear. We investigated the association between the aforesaid ambulatory BP parameters and cardiovascular risk in elderly treated hypertensive patients with normal achieved ambulatory BP. METHODS: The occurrence of a composite end-point (stroke, coronary events, heart failure, and peripheral revascularization) was evaluated in 391 elderly treated hypertensive patients (age range 60-90 years) with controlled ambulatory BP (both daytime BP <135/85 mm Hg and nighttime BP <120/70 mm Hg). According to nighttime change and MS of systolic BP, subjects were divided in dippers with normal or high MS (>23 mm Hg) and nondippers. RESULTS: During the follow-up (9.3 ± 4.6 years, range 0.5-20 years), 76 events occurred. The event-rate was 2.09 per 100 patient-years. After adjustment for age, gender, left ventricular (LV) hypertrophy, asymptomatic LV systolic dysfunction at baseline and left atrial enlargement, dippers with high MS (hazard ratio 2.45, 95% confidence interval 1.27-4.73, P = 0.007) and nondippers (hazard ratio 2.04, 95% confidence interval 1.18-3.53, P = 0.01) were at higher cardiovascular risk than dippers with normal MS. CONCLUSIONS: In elderly treated hypertensive patients with normal achieved ambulatory BP, dippers with high MS and nondippers are at increased cardiovascular risk. [ABSTRACT FROM AUTHOR]

Purpose of Review: This article reviews the current knowledge on the prognostic importance of ambulatory blood pressure (BP) monitoring parameters in patients with apparent treatment-resistant hypertension. Recent Findings: Although mean 24-h ambulatory BPs have been consistently established as better cardiovascular risk predictors than clinic (office) BPs in several clinical settings, and ambulatory BP monitoring is generally indicated in patients with resistant hypertension; there were only five previous longitudinal prospective studies that specifically evaluated the prognostic importance of ambulatory BP monitoring parameters in resistant hypertensive patients. These studies are carefully reviewed here. In conjunction, they demonstrated that office BP levels have little, if any, prognostic value in resistant hypertensive patients. Otherwise, several ambulatory BP monitoring parameters are strong cardiovascular risk predictors, particularly nighttime sleep BPs and the non-dipping pattern. Most relevant, the ambulatory BP monitoring diagnosis of true resistant hypertension (i.e., patients with uncontrolled ambulatory BPs, either daytime or nighttime) doubled the risk of future occurrence of major cardiovascular events in contrast to patients with white-coat resistant hypertension (i.e., with controlled ambulatory BPs despite uncontrolled office BPs). Summary: This review reinforces the pivotal role of serial ambulatory BP monitoring examinations in the clinical management of patients with resistant hypertension. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and objective We directly compared sleep apnoea ( SA) rates and risk of cardiovascular and mortality outcomes among SA patients with resistant hypertension ( RH) and non- RH within a large diverse hypertension population. Methods A retrospective cohort study between 1 January 2006 and 31 December 2010 among hypertensive adults (age ≥ 18 years) was performed within an integrated health system. Rates of SA in RH and non- RH were determined. Multivariable logistic regression analyses were used to calculate OR for SA. Cox proportional hazard modelling was used to estimate hazard ratios ( HRs) for cardiovascular and mortality outcomes between SA in RH versus SA in non- RH adjusting for age, gender, race, BMI, chronic kidney disease and other comorbidities. Results SA was identified in 33 682 (7.2%) from 470 386 hypertensive individuals. SA in RH accounted for 5806 (9.6%) compared to SA in non- RH 27 876 individuals (6.8%). Multivariable OR (95% CI) for SA was 1.16 (1.12, 1.19), 3.57 (3.47, 3.66) and 2.20 (2.15, 2.25) for RH versus non- RH, BMI ≥ 30, and males, respectively. Compared to SA in non- RH individuals, SA in RH had a multivariable adjusted HR (95% CI) of 1.24 (1.13, 1.36), 1.43 (1.28, 1.61), 0.98 (0.85, 1.12) and 1.04 (0.95, 1.14) for ischaemic heart event ( IHE), congestive heart failure ( CHF), stroke and mortality, respectively. Conclusion We observed a modest increase in likelihood for SA among RH compared to non- RH patients. Risks for IHE and CHF were higher for SA in RH compared to SA in non- RH patients; however, there were no differences in risk for stroke and mortality. [ABSTRACT FROM AUTHOR]

BACKGROUND The association between ambulatory blood pressure (BP) and future risk of heart failure (HF) is unclear. We investigated the association between ambulatory BP parameters and risk of HF with reduced ejection fraction (HFREF) or preserved ejection fraction (HFPEF) in elderly treated hypertensive patients. METHODS The occurrence of HFREF and HFPEF was evaluated in 1,191 elderly treated hypertensive patients who underwent clinical and instrumental evaluation, including ambulatory BP monitoring to evaluate daytime, nighttime, and 24-hour BP, dipping status, and morning surge (MS) of BP. RESULTS During the follow-up (9.1 ± 4.9 years, range 0.4-20 years), 123 patients developed HF, of whom 56 had HFREF and 67 had HFPEF. After adjustment for other covariates, Cox regression analysis showed that 24-hour systolic BP, but not clinic BP, was independently associated with risk of both HFREF (hazard ratio (HR): 1.36, 95% confidence interval (CI): 1.14-1.63, per 10 mm Hg increment) and HFPEF (HR: 1.35, 95% CI: 1.13-1.61, per 10 mm Hg increment); moreover, high MS of BP (>23 mm Hg) in dippers was independently associated with risk of HFREF (HR: 2.27, 95% CI: 1.00-5.15) and nondipping was independently associated with risk of HFPEF (HR: 2.78, 95% CI: 1.38-5.63). CONCLUSIONS In elderly treated hypertensive patients, 24-hour systolic BP is independently associated with future risk of both HFREF and HFPEF, whereas high MS is independently associated with risk of HFREF and nondipping is independently associated with risk of HFPEF. [ABSTRACT FROM AUTHOR]

Abnormal left ventricular (LV) geometry is associated with extracardiac organ damage in patients with hypertension. The aim of this study was to determine the relationship between LV geometry and white matter lesions (WMLs) in ischemic stroke patients. We retrospectively analyzed data from 155 patients (median age 62; 49.8% male) with mild ischemic stroke (median National Institutes of Health Stroke Scale score 4) who underwent brain magnetic resonance imaging and echocardiography. Patients were categorized into four groups: normal LV geometry, concentric remodeling, eccentric left ventricular hypertrophy (LVH) and concentric LVH. WMLs were graded using the Fazekas scale on fluid-attenuated inversion recovery images. Extensive WMLs were defined as a Fazekas score > 2. Extensive WMLs were more prevalent in patients with concentric LVH, eccentric LVH and concentric remodeling than in those with normal LV geometry. After adjusting for hypertension, age, diabetes mellitus, hypercholesterolemia, glomerular filtration rate and ischemic heart disease, patients with concentric remodeling [odds ratio (OR) 3.94, 95% confidence interval (CI) 1.26–12.31,p = 0.02] and those with concentric LVH (OR 3.69, 95% CI 1.24–10.95,p = 0.02), but not patients with eccentric LVH (OR 2.44, 95% CI 0.72–8.29,p = 0.15), had higher risk of extensive WMLs than patients with normal LV geometry. [ABSTRACT FROM PUBLISHER]

Following the publication of the randomized controlled but open-label trial Symplicity HTN-2, catheter-based renal sympathetic denervation was proposed as a novel treatment for drug-resistant hypertension. Thousands of procedures were routinely performed in Europe, Australia and Asia, and many observational studies were published. A sudden shift from overoptimistic views to radical scepticism occurred later, when the large US randomized sham-controlled trial Symplicity HTN-3 failed to meet its primary blood pressure lowering efficacy endpoint. Experts are divided on the reasons accounting for the large discrepancy between the results of initial studies and those of Symplicity HTN-3. Indeed, the blood pressure lowering effect associated with renal denervation was overestimated in initial trials due to various patient and physician-related biases, whereas it could have been underestimated in Symplicity HTN-3, which was well designed but not rigorously executed. Still, there is a large consensus on the need to further study catheter-based renal denervation in more controlled conditions, with particular emphasis on identification of predictors of blood pressure response. US and European experts have recently issued very similar recommendations on design of upcoming trials, procedural aspects, drug treatment, patient population and inclusion–exclusion criteria. Application of these new standards may represent a second chance for renal denervation to demonstrate—or not—its efficacy and safety in various patient populations. With its highly standardized treatment regimen, the French trial DENERHTN paved the way for this new approach and may inspire upcoming studies testing novel renal denervation systems in different populations. [ABSTRACT FROM AUTHOR]

Resistant hypertension, commonly described as the failure to achieve goal blood pressure (BP) despite an appropriate regimen of three antihypertensive drugs at the maximal tolerated doses, one of which is diuretic, is increasingly recognized as an important problem of public health. Large population studies with office measurements suggest that the prevalence of resistance hypertension is approximately at 6-12 % of the general hypertensive population and 8-28 % of treated hypertensives. However, these estimations do not take into account factors of pseudo-resistance, most importantly, the white-coat effect that can be effectively ruled out with ambulatory blood pressure monitoring (ABPM). Recent studies have clearly shown that when ABPM is used, at least 30-35 % of patients labeled as 'resistant hypertensives' turn out to have well-controlled BP on ambulatory basis, a finding changing entirely the estimates of prevalence of resistance hypertension and actual patient handling. Furthermore, current evidence suggests that ABPM is a much more accurate predictor of cardiovascular events in resistant hypertension compared to office BP and thus can offer a better risk stratification for these high-risk individuals. Finally, ABPM offers the potential of a better evaluation of the effect of pharmacologic and non-pharmacologic therapeutic interventions. This review attempts to summarize recent evidence on the advantages of ABPM in the diagnosis, prognosis, and management of resistant hypertension. [ABSTRACT FROM AUTHOR]

Resistant hypertension (RH) is defined as blood pressure (BP) that remains ⩾140 and/or 90 mm Hg despite therapy with ⩾3 full-dose antihypertensive drugs (classical definition=CD). A definition proposed subsequently (new definition=ND) includes patients requiring ⩾4 drugs irrespective of BP values. We aimed to evaluate whether both definitions characterize the same kind of patients.One hundred and twenty-four consecutively attended patients with RH were classified into two groups according to their BP control: 66 patients had non-controlled BP (all those who met the CD criteria plus a few patients who met the ND criteria); 58 patients had controlled BP (all with RH according to the ND). Clinical, laboratory and office BP data were recorded. RH patients with non-controlled BP were more frequently diabetic (72% vs 49%), and had higher plasmatic glucose (149 vs 130 mg dl−1), cholesterol (179 vs 164 mg dl−1), low-density lipoprotein (LDL)-cholesterol (107 vs 95 mg dl−1) and triglyceride (169 vs 137 mg dl−1) levels; P<0.05 for all comparisons. In multivariate logistic regression analysis, the variables that independently associated with non-controlled BP were diabetes (P=0.001) and higher LDL-cholesterol (P=0.007).We conclude that, although both cohorts of patients are phenotypically quite similar, uncontrolled RH patients have higher prevalence of diabetes mellitus and higher LDL-cholesterol levels than controlled RH patients. [ABSTRACT FROM AUTHOR]

Hypertension is a leading cause of cardiovascular mortality, but only one third of patients achieve blood pressure goals despite antihypertensive therapy. Genetic polymorphisms may partially account for the interindividual variability and abnormal response to antihypertensive drugs. Candidate gene and genome-wide approaches have identified common genetic variants associated with response to antihypertensive drugs. However, there is no currently available pharmacogenetic test to guide hypertension treatment in clinical practice. In this review, we aimed to summarize the recent findings on pharmacogenetics of the most commonly used antihypertensive drugs in clinical practice, including diuretics, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, beta-blockers and calcium channel blockers. Notably, only a small percentage of the genetic variability on response to antihypertensive drugs has been explained, and the vast majority of the genetic variants associated with antihypertensives efficacy and toxicity remains to be identified. Despite some genetic variants with evidence of association with the variable response related to these most commonly used antihypertensive drug classes, further replication is needed to confirm these associations in different populations. Further studies on epigenetics and regulatory pathways involved in the responsiveness to antihypertensive drugs might provide a deeper understanding of the physiology of hypertension, which may favor the identification of new targets for hypertension treatment and genetic predictors of antihypertensive response. [ABSTRACT FROM AUTHOR]

Background There is debate regarding the predictive value of interventricular septum ( IVS) wall thickness for adverse events. Aims The study investigated the association between the severity of thickened IVS and all-cause death in Chinese patients with coronary artery disease ( CAD). Methods A total of 2297 CAD patients verified by angiography was consecutively included. Patients were grouped according to the severity of thickened IVS. Cox regression analysis was conducted to determine the independent prognostic value of thickened IVS for all-cause death. Results During a median follow up of 25 months, 149 patients died. A gradient increase in the risk of death was observed across thickened IVS groups. Compared to patients with normal IVS thickness, the adjusted hazard ratio ( HR) was 1.49 (95% confidence interval ( CI) 1.00-2.23, P = 0.05) and 2.13 (95% CI 1.29-3.54, P = 0.003) for all-cause death in those with mildly and moderately/severely thickened IVS respectively. For one unit increase in IVS thickness, the risk of all-cause death was elevated by 14% (adjusted HR 1.14, 95% CI 1.05-1.24, P = 0.003). In patients with normal indexed left ventricular mass, thickened IVS was also demonstrated as an independent risk factor for all-cause death. Conclusion Thickened IVS can be served as a reliable marker for predicting all-cause death in Chinese patients with CAD, even in those with normal left ventricular mass. [ABSTRACT FROM AUTHOR]

The aim was to assess the control of negative emotions in treated patients with hypertension in comparison with normotensive individuals and to evaluate the association between suppression of negative emotions, control of blood pressure (BP) on ambulatory blood pressure monitoring (ABPM) and blood pressure variability (BPV). We studied 195 patients (women/men: 89/106); mean age 45.4 ± 15.9 years. All patients had ABPM and completed the Courtauld Emotional Control Scale (CECS). The total CECS score and scores for subscales for anger, depression and anxiety were analyzed together with mean BP values from ABPM, and their SD and coefficient of variation as BPV measures. The mean CECS score was 54 ± 12 in all subjects; highest in uncontrolled hypertension 56 ± 11, intermediate 53 ± 12 in controlled hypertension and lowest 48 ± 12 in normotensive subjects. The reference value for the Polish population is 50 ± 11. Significant differences of mean CECS scores among groups were observed ( p = 0.0165) also in multivariate analysis. The difference between uncontrolled hypertension and normotension was significant ( p = 0.0262). Few significant, weak correlations were observed between CECS score or its subscales and ABPM derivates in all subjects. Conclusion. Suppression of negative emotions may adversely affect BP control in treated hypertensive patients and it should be considered a cause of uncontrolled hypertension. [ABSTRACT FROM AUTHOR]

Background: Adverse loading conditions and cardiac injury lead to remodelling of the heart into different patterns of left ventricular (LV) geometry. Geometry can be classified into LV hypertrophy (LVH), concentric remodelling (CR) or normal geometry (NG). The prognostic implications of the different geometric patterns have been extensively studied in middle-aged subjects, but data are scarcer for elderly populations. Methods: From a community-based random sample of 75-year-old men and women, subjects with normal LVEF were selected (n = 303). All-cause and cardiovascular mortality was analysed by LV geometry with Cox regression (unadjusted and adjusted for sex, prevalent hypertension, smoking, diabetes and prevalent ischaemic heart disease). Median follow-up time was 9·9 years. Results: Prevalence of CR and LVH was 19% and 17%, respectively. Hazard ratios (HRs) for CR were 0·93 (95% CI 0·54-1·58) for all-cause and 1·13 (0·48-2·65) for cardiovascular mortality. HRs for LVH were 2·01 (1·30-3·10) for all-cause and 3·55 (1·89-6·67) for cardiovascular mortality. As non-proportionality was present in the form of an increasing hazard for LVH, we partitioned the follow-up time at the median event time (approximately 7 years) and performed Cox regression separately within each time period. HRs for LVH during the first period were 1·23 (0·63-2·42) for all-cause and 1·79 (0·69-4·65) for cardiovascular mortality, while HRs for the second period were 3·06 (1·73-5·41) for all-cause and 6·60 (2·82-15·39) for cardiovascular mortality. Conclusion: In this community-based sample of 75-year-old men and women with normal LVEF, LVH was associated with an adverse prognosis during long-term follow-up, whereas CR was not. [ABSTRACT FROM AUTHOR]