High prevalence of masked uncontrolled morning hypertension in elderly non‐valvular atrial fibrillation patients: Home blood pressure substudy of the ANAFIE Registry

In the ANAFIE Registry home blood pressure subcohort, we evaluated 5204 patients aged ≥75 years with non‐valvular atrial fibrillation (NVAF) to assess blood pressure (BP) control, prevalence of masked hypertension, and anticoagulant use. Mean clinic (C) and home (H) systolic/diastolic BP(SBP/DBP) was 128.5/71.3 and 127.7/72.6 mm Hg, respectively. Overall, 77.5% of patients had hypertension; of these, 27.7%, 13.4%, 23.4%, and 35.6% had well‐controlled, white coat, masked, and sustained hypertension, respectively. Masked hypertension prevalence increased with diabetes, decreased renal function, age ≥80 years, current smoker status, and chronic obstructive pulmonary disease. By morning/evening average, 59.0% of patients had mean H‐SBP ≥ 125 mm Hg; 48.9% had mean C‐SBP ≥ 130 mm Hg. Early morning hypertension (morning H‐SBP ≥ 125 mm Hg) was found in 65.9% of patients. Although 51.1% of patients had well‐controlled C‐SBP, 52.5% of these had uncontrolled morning H‐SBP. In elderly NVAF patients, morning H‐BP was poorly controlled, and masked uncontrolled morning hypertension remains significant.     

Sleep Blood Pressure Self‐Measured at Home as a Novel Determinant of Organ Damage: Japan Morning Surge Home Blood Pressure (J‐HOP) Study

To study whether sleep blood pressure (BP) self‐measured at home is associated with organ damage, the authors analyzed the data of 2562 participants in the J‐HOP study who self‐measured sleep BP using a home BP monitoring (HBPM) device, three times during sleep (2 am , 3 am , 4 am ), as well as the home morning and evening BPs. The mean sleep home systolic BPs (SBPs) were all correlated with urinary albumin/creatinine ratio (UACR), left ventricular mass index (LVMI), brachial‐ankle pulse wave velocity (baPWV), maximum carotid intima‐media thickness, and plasma N‐terminal pro‐hormone pro–brain‐type natriuretic peptide (NTproBNP) (all P<.001). After controlling for clinic SBP and home morning and evening SBPs, associations of home sleep SBP with UACR, LVMI, and baPWV remained significant (all P<.008). Even in patients with home morning BP <135/85 mm Hg, 27% exhibited masked nocturnal hypertension with home sleep SBP ≥120 mm Hg and had higher UACR and NTproBNP. Masked nocturnal hypertension, which is associated with advanced organ damage, remains unrecognized by conventional HBPM.     

Home blood pressure control status in 2017‐2018 for hypertension specialist centers in Asia: Results of the Asia BP@Home study

A self‐measured home blood pressure (BP)‐guided strategy is an effective practical approach to hypertension management. The Asia BP@Home study is the first designed to investigate current home BP control status in different Asian countries/regions using standardized home BP measurements taken with the same validated home BP monitoring device with data memory. We enrolled 1443 medicated hypertensive patients from 15 Asian specialist centers in 11 countries/regions between April 2017 and March 2018. BP was relatively well controlled in 68.2% of patients using a morning home systolic BP (SBP) cutoff of <135 mm Hg, and in 55.1% of patients using a clinic SBP cutoff of <140 mm Hg. When cutoff values were changed to the 2017 AHA/ACC threshold (SBP <130 mm Hg), 53.6% of patients were well controlled for morning home SBP. Using clinic 140 mm Hg and morning home 135 mm Hg SBP thresholds, the proportion of patients with well‐controlled hypertension (46%) was higher than for uncontrolled sustained (22%), white‐coat (23%), and masked uncontrolled (9%) hypertension, with significant country/regional differences. Home BP variability in Asian countries was high, and varied by country/region. In conclusion, the Asia BP@Home study demonstrated that home BP is relatively well controlled at hypertension specialist centers in Asia. However, almost half of patients remain uncontrolled for morning BP according to new guidelines, with significant country/regional differences. Strict home BP control should be beneficial in Asian populations. The findings of this study are important to facilitate development of health policies focused on reducing cardiovascular complications in Asia.     

Enhanced Blood Pressure–Lowering Effect of Olmesartan in Hypertensive Patients With Chronic Kidney Disease–Associated Sympathetic Hyperactivity: HONEST Study

To investigate the blood pressure (BP)–lowering effect of olmesartan in relation to chronic kidney disease (CKD)–associated sympathetic nerve activity, a subanalysis was performed using data from the first 16 weeks of the Home BP Measurement With Olmesartan‐Naive Patients to Establish Standard Target Blood Pressure (HONEST) study, a prospective observational study of hypertensive patients. Essential hypertensive patients who took no antihypertensive agent at baseline were classified based on baseline morning home systolic BP (MHSBP) in quartiles. In each class, patients were further classified based on baseline morning home pulse rate (MHPR). A subgroup analysis in patients with/without chronic kidney disease (CKD) was performed. A total of 5458 patients (mean age, 63.0 years; 51.6% women) were included. In the 4th quartile of baseline MHSBP (≥165 mm Hg), patients with MHPR ≥70 beats per minute had a greater BP reduction (by 3.2 mm Hg) than those with MHPR <70 beats per minute after 16 weeks of olmesartan‐based treatment (P=.0005). An even greater BP reduction (by 6.6 mm Hg) was observed in patients with CKD than in patients without CKD in this group (P=.0084). Olmesartan was more effective in hypertensive patients with high MHSBP and MHPR ≥70 beats per minute, especially in patients with CKD. Olmesartan may have enhanced BP‐lowering effects by improving renal ischemia in hypertensive CKD patients with potential increased sympathetic nerve activity.     

Threshold value of home pulse pressure predicting arterial stiffness in patients with type 2 diabetes: KAMOGAWA‐HBP study

This cross‐sectional multicenter study was designed to evaluate the threshold value of home pulse pressure (PP) and home systolic blood pressure (SBP) predicting the arterial stiffness in 876 patients with type 2 diabetes. We measured the area under the receiver‐operating characteristic curve (AUC) and estimated the ability of home PP to identify arterial stiffness using Youden‐Index defined cut‐off point. The arterial stiffness was measured using the brachial‐ankle pulse wave velocity (baPWV). AUC for arterial stiffness in morning PP was significantly greater than that in morning SBP (P < .001). AUC for arterial stiffness in evening PP was also significantly greater than that in evening SBP (P < .001). The optimal cut‐off points for morning PP and evening PP, which predicted arterial stiffness, were 54.6 and 56.9 mm Hg, respectively. Our findings indicate that we should pay more attention to increased home PP in patients with type 2 diabetes.     

Reliability of morning,before‐dinner,and at‐bedtime home blood pressure measurements in patients with hypertension

The authors evaluated differences in the reliability of home blood pressure measurements taken in the morning, before dinner, and at bedtime. Forty‐eight patients with hypertension (age range, 50–89 years; mean age, 76.4 years) measured their home blood pressure using a validated automatic information/communication technology‐based device for 14 consecutive days. Those days were divided into the first seven days (1–7) and the following 8 to 14 days (days 8–14) and compared systolic blood pressure (SBP) reliability in the two periods for each measurement time point. In Bland‐Altman analyses, morning SBP showed the least standard error of measurement (3.0 mm Hg). There were fixed biases in morning and before‐dinner SBP with average limits of agreement of 3.9 and 6.4 mm Hg, respectively. For at‐bedtime SBP, a random error was detected and the minimal detectable change was 13.8 mm Hg. The percentage of near‐maximal variation of morning SBP was the smallest at 18.1%. Morning SBP therefore provided the most reliable home blood pressure value in the day.     

Nocturnal blood pressure patterns and cardiovascular outcomes in patients with masked hypertension

Masked hypertension (MHT) is characterized by normal clinic and above normal 24‐hour ambulatory blood pressure (BP) levels. We evaluated clinical characteristics and CV outcomes of different nocturnal patterns of MHT. We analyzed data derived from a large cohort of adult individuals, who consecutively underwent home, clinic, and ambulatory BP monitoring at our Hypertension Unit between January 2007 and December 2016. MHT was defined as clinic BP <140/90 mm Hg and 24‐hour BP ≥ 130/80 mm Hg, and stratified into three groups according to dipping status: (a) dippers, (b) nondippers, and (c) reverse dippers. From an overall sample of 6695 individuals, we selected 2628 (46.2%) adult untreated individuals, among whom 153 (5.0%) had MHT. In this group, 67 (43.8%) were nondippers, 65 (42.5%) dippers, and 21 (13.7%) reverse dippers. No significant differences were found among groups regarding demographics, clinical characteristics, and prevalence of risk factors, excluding older age in reverse dippers compared to other groups (P < 0.001). Systolic BP levels were significantly higher in reverse dippers than in other groups at both 24‐hour (135.6 ± 8.5 vs 130.4 ± 6.0 vs 128.2 ± 6.8 mm Hg, respectively; P < 0.001) and nighttime periods (138.2 ± 9.1 vs 125.0 ± 6.3 vs 114.5 ± 7.7 mm Hg; P < 0.001). Reverse dipping was associated with a significantly higher risk of stroke, even after correction for age, gender, BMI, dyslipidemia, and diabetes (OR 18.660; 95% IC [1.056‐33.813]; P = 0.046). MHT with reverse dipping status was associated with higher burden of BP and relatively high risk of stroke compared to both dipping and nondipping profiles, although a limited number of CV outcomes have been recorded during the follow‐up.     

Self‐measured worksite blood pressure and its association with organ damage in working adults: Japan Morning Surge Home Blood Pressure (J‐HOP) worksite study

The effects of elevations in blood pressure (BP) on worksite stress as an out‐of‐office BP setting have been evaluated using ambulatory BP monitoring but not by self‐measurement. Herein, we determined the profile of self‐measured worksite BP in working adults and its association with organ damage in comparison with office BP and home BP measured by the same home BP monitoring device. A total of 103 prefectural government employees (age 45.3 ± 9.0 years, 77.7% male) self‐measured their worksite BP at four timepoints (before starting work, before and after a lunch break, and before leaving the workplace) and home BP in the morning, evening, and nighttime (at 2, 3, and 4 a.m.) each day for 14 consecutive days. In the total group, the average worksite systolic BP (SBP) was significantly higher than the morning home SBP (129.1 ± 14.3 vs. 124.4 ± 16.4 mmHg, p = .026). No significant difference was observed among the four worksite SBP values. Although the average worksite BP was higher than the morning home BP in the study participants with office BP < 140/90 mmHg (SBP: 121.4 ± 9.4 vs. 115.1 ± 10.4 mmHg, p < .001, DBP: 76.0 ± 7.7 vs. 72.4 ± 8.4 mmHg, p = .013), this association was not observed in those with office BP ≥ 140/90 mmHg or those using antihypertensive medication. Worksite SBP was significantly correlated with the left ventricular mass index evaluated by echocardiography (r = 0.516, p < .0001). The self‐measurement of worksite BP would be useful to unveil the risk of hypertension in working adults who show normal office and home BP.     

Incidence,prevalence, and predictors of treatment‐resistant hypertension with intensive blood pressure lowering

Recent guidelines call for more intensive blood pressure (BP)‐lowering and a less‐stringent treatment‐resistant hypertension (TRH) definition, both of which may increase the occurrence of this high‐risk phenotype. We performed a post hoc analysis of 11 784 SPRINT and ACCORD‐BP participants without baseline TRH, who were randomized to an intensive (<120 mm Hg) or standard (<140 mm Hg) systolic BP target. Incidence, prevalence, and predictors of TRH were compared using the updated definition (requiring ≥4 drugs to achieve BP < 130/80 mm Hg) during intensive treatment, vs the former definition (requiring ≥4 drugs to achieve BP < 140/90 mm Hg) during standard treatment. Incidence/prevalence of apparent refractory hypertension (RFH; uncontrolled BP despite ≥5 drugs) was similarly compared. Overall, 5702 and 6082 patients were included in the intensive and standard treatment cohorts, respectively. Crude TRH incidence using the updated definition under intensive treatment was 30.3 (95% CI, 29.3‐31.4) per 100 patient‐years, compared with 9.7 (95% CI, 9.2‐10.2) using the prior definition under standard treatment. Point prevalence using the prior TRH definition at 1‐year was 7.5% in SPRINT and 14% in ACCORD vs 22% and 36%, respectively, with the updated TRH definition. Significant predictors of incident TRH included number of baseline antihypertensive drugs, having diabetes, baseline systolic BP, and Black race. Incidence of apparent RFH was also significantly greater using the updated vs prior definition (4.5 vs 1.0 per 100 person‐years). Implementation of the 2017 hypertension guideline, including lower BP goals for most individuals, is expected to substantially increase treatment burden and incident TRH among the hypertensive population.     

Association of normal systolic blood pressure in the emergency department with higher in‐hospital mortality among hypertensive patients

Blood pressure is commonly elevated at the hospital emergency department (ED), especially among hypertensive patients. The aim of the study was to determine the association between ED systolic blood pressure (SBP) and in‐hospital mortality among hypertensive patients. The authors retrospectively retrieved records of hypertensive patients who were hospitalized during a seven‐year period. The authors examined the association between SBP and in‐hospital mortality rate, adjusted for demographics, heart rate, comorbidities, laboratory results, and hospital ward. Overall, 96 423 patients were included. Compared to patients with SBP 110‐139 mm Hg, the adjusted odds ratios were 4.1 (95% CI, 3.7‐4.6) with SBP <90, 1.6 (95% CI, 1.4‐1.7) with SBP 90‐109, 0.7 (95% CI, 0.6‐0.7) with SBP 140‐159, 0.7 (95% CI, 0.6‐0.7) with SBP 160‐179, 0.7 (95% CI, 0.6‐0.8) with SBP 180‐199, 0.9 (95% CI, 0.7‐1.1) with SBP 200‐219, and 1.1 (95% CI, 0.7‐1.7) with SBP ≥220 mm Hg. Thus, SBP levels of 110‐139 mm Hg were associated with higher in‐hospital mortality in comparison with elevated SBP up to 200 mm Hg.     

Physician‐Pharmacist Co‐Management and 24‐Hour Blood Pressure Control

The objectives of this study were to compare indices of 24‐hour blood pressure (BP) following a physician‐pharmacist collaborative intervention and to describe the associated changes in antihypertensive medications. This was a secondary analysis of a prospective, cluster‐randomized clinical trial conducted in 6 family medicine clinics randomized to co‐managed (n=3 clinics, 176 patients) or control (n=3 clinics, 198 patients) groups. Mean ambulatory systolic BP (SBP) was significantly lower in the co‐managed vs the control group: daytime BP 122.8 mm Hg vs 134.4 mm Hg (P<.001); nighttime SBP 114.8 mm Hg vs 123.7 mm Hg (P<.001); and 24‐hour SBP 120.4 mm Hg vs 131.8 mm Hg (P<.001), respectively. Significantly more drug changes were made in the co‐managed than in the control group (2.7 vs 1.1 changes per patient, P<.001), and there was greater diuretic use in co‐managed patients (79.6% vs 62.6%, P<.001). Ambulatory BPs were significantly lower for the patients who had a diuretic added during the first month compared with those who never had a diuretic added (P<.01). Physician‐pharmacist co‐management significantly improved ambulatory BP compared with the control group. Antihypertensive drug therapy was intensified much more for patients in the co‐managed group.     

Trajectory of systolic blood pressure in a low‐income,racial‐ethnic minority cohort with diabetes and baseline uncontrolled hypertension

In two primary care clinics in Texas serving low‐income patients, systolic blood pressure (SBP) trajectory was examined during 2 years in patients with diabetes mellitus (mean SBP ≥140 mm Hg: 152 mm Hg±11.2 in the baseline year). Among 860 eligible patients, 62.0% were women, 78.8% were Hispanic, and 41.2% were uninsured. Overall, SBP dropped 0.56 mm Hg per month or 13.4 mm Hg by 24 months. For patients with mean glycated hemoglobin ≥9% in year 1, SBP declined 4.8 mm Hg less by 24 months vs those with glycated hemoglobin <7% (P=.03). Compared with white women, SPB declined 7.2 mm Hg less by 24 months in Hispanic women (P=.03) and 9.6 mm Hg less by 24 months in black men (P=.04). SBP also declined 9.1 mm Hg less by 24 months for patients taking four or more blood pressure drug classes at baseline vs one drug class. In this low‐income cohort, clinically complex patients and racial‐ethnic minorities had clinically significantly smaller declines in SBP.     

Short‐term effects of perindopril‐amlodipine vs perindopril‐indapamide on blood pressure control in sub‐Saharan type 2 diabetic individuals newly diagnosed for hypertension: A double‐blinded randomized controlled trial

Poor blood pressure (BP) control contributes to complications in sub‐Saharan African (SSA) type 2 diabetic individuals. Experts have advocated the use of combination therapies for effective BP control in these patients. The suggested combinations should include a RAAS antagonist and either a CCB or a thiazide diuretic; however, their efficacy is yet to be established in SSA. We investigated the short‐term effects of two combination therapies on BP control in SSA type 2 diabetic individuals. This was a double‐blinded randomized controlled trial conducted at the Yaoundé Central Hospital (Cameroon) from October 2016 to May 2017. We included type 2 diabetic patients, newly diagnosed for hypertension. After baseline assessment and 24‐hour ABPM, participants were allocated to receive either a fixed combination of perindopril + amlodipine or perindopril + indapamide for 42 days. Data analyses followed the intention‐to‐treat principle. We included fifteen participants (8 being females) in each group. Both combinations provided good circadian BP control after 6 weeks with similar efficacy. Twenty‐four‐hour SBP dropped from 144 to 145 mm Hg vs 128 to 126 mm Hg with perindopril‐amlodipine and perindopril‐indapamide, respectively (P = 0.003 for both groups). Twenty‐four‐hour DBP dropped from 85 to 78 mm Hg (P = 0.013) vs 89 to 79 mm Hg (P = 0.006) in the same respective groups. No significant adverse effect was reported. A fixed initial combination of perindopril‐amlodipine or perindopril‐indapamide achieved similar effective BP control after 6 weeks in SSA type 2 diabetic individuals with newly diagnosed hypertension. Therefore, these combinations can be used interchangeably in this indication.     

A randomized controlled trial on the blood pressure–lowering effect of amlodipine and nifedipine‐GITS in sustained hypertension

In a multicenter, randomized trial, we investigated whether the long half‐time dihydropyridine calcium channel blocker amlodipine was more efficacious than the gastrointestinal therapeutic system (GITS) formulation of nifedipine in lowering ambulatory blood pressure (BP) in sustained hypertension (clinic systolic/diastolic BP 140‐179/90‐109 mm Hg and 24‐hour systolic/diastolic BP ≥ 130/80 mm Hg). Eligible patients were randomly assigned to amlodipine 5‐10 mg/day or nifedipine‐GITS 30‐60 mg/day. Ambulatory BP monitoring was performed for 24 hours at baseline and 4‐week treatment and for 48 hours at 8‐week treatment with a dose of medication missed on the second day. After 8‐week treatment, BP was similarly reduced in the amlodipine (n = 257) and nifedipine‐GITS groups (n = 248) for both clinic and ambulatory (24‐hour systolic/diastolic BP 10.3/6.5 vs 10.9/6.3 mm Hg, P ≥ 0.24) measurements. However, after missing a dose of medication, ambulatory BP reductions were greater in the amlodipine than nifedipine‐GITS group, with a significant (P ≤ 0.04) between‐group difference in 24‐hour (–1.2 mm Hg) and daytime diastolic BP (–1.5 mm Hg). In conclusion, amlodipine and nifedipine‐GITS were efficacious in reducing 24‐hour BP. When a dose of medication was missed, amlodipine became more efficacious than nifedipine‐GITS.     

Prognostic value of morning surge of blood pressure in middle‐aged treated hypertensive patients

We investigated the prognostic value of morning surge (MS) of blood pressure (BP) in middle‐aged treated hypertensive patients. The occurrence of a composite end point (coronary events, stroke, and heart failure requiring hospitalization) was evaluated in 1073 middle‐aged treated hypertensive patients (mean age 49 years). Patients with preawakening MS of BP above the 90th percentile (27/20.5 mm Hg for systolic/diastolic BP) were defined as having high MS of BP. During the follow‐up (mean 10.9 years), 131 cardiovascular events occurred. After adjustment for various covariates, including known risk markers and ambulatory BP parameters, patients with high MS of systolic BP (hazard ratio 1.81, 95% confidence interval 1.10‐2.96) and those with high MS of diastolic BP (hazard ratio 1.98, 95% confidence interval 1.19‐3.28) were at higher cardiovascular risk than those with normal MS. In middle‐aged treated hypertensive patients, high MS of systolic and diastolic BP is independently associated with increased cardiovascular risk.     

Ambulatory blood pressure and risk of new‐onset atrial fibrillation in treated hypertensive patients

The aim of this study was to evaluate the influence of clinic and ambulatory blood pressure (BP) on the occurrence of new‐onset atrial fibrillation (AF) in treated hypertensive patients. We studied 2135 sequential treated hypertensive patients aged >40 years. During the follow‐up (mean 9.7 years, range 0.4–20 years), 116 events (new‐onset AF) occurred. In univariate analysis, clinic, daytime, nighttime, and 24‐h systolic BP were all significantly associated with increased risk of new‐onset AF, that is, hazard ratio (95% confidence interval) per 10 mm Hg increment 1.22 (1.11–1.35), 1.36 (1.21–1.53), 1.42 (1.29–1.57), and 1.42 (1.26–1.60), respectively. After adjustment for various covariates in multivariate analysis, clinic systolic BP was no longer associated with increased risk of new‐onset AF, whereas daytime, nighttime, and 24‐h systolic BP remained significantly associated with outcome, that is, hazard ratio (95% confidence interval) per 10 mm Hg increment 1.09 (0.97–1.23), 1.23 (1.10–1.39), 1.16 (1.03–1.31), and 1.22 (1.06–1.40), respectively. Daytime, nighttime, and 24‐h systolic BP are superior to clinic systolic BP in predicting new‐onset AF in treated hypertensive patients. Future studies are needed to evaluate whether a better control of ambulatory BP might be helpful in reducing the occurrence of new‐onset AF.     

Early morning home blood pressure control among treated patients with controlled office blood pressure

Elevated morning blood pressure (BP) has a significantly increased risk of cardiovascular events, so morning BP is of substantial clinical importance for the management of hypertension. This study aimed to evaluate early morning BP control and its determines among treated patients with controlled office BP. From May to October 2018, 600 treated patients with office BP < 140/90 mm Hg were recruited from hypertension clinics. Morning BP was measured at home for 7 days. Morning home systolic blood pressure (SBP) increased by an average of 11.5 mm Hg and that morning home diastolic blood pressure (DBP) increased by an average of 5.6 mm Hg compared with office BP. Morning home SBP, DBP, and their moving average were more likely to be lower among patients with a office SBP < 120 mm Hg than among patients with a office SBP ranging from 120 to 129 mm Hg and from 130 to 139 mm Hg (P < .001). A total of 45% of patients had early morning BP < 135/85 mm Hg. The following factors were significantly correlated with morning BP control: male sex, age of <65 years, absence of habitual snoring, no drinking, adequate physical activity, no habit of high salt intake, office BP < 120/80 mm Hg, and combination of a calcium channel blocker (CCB) and angiotensin receptor blocker or angiotensin‐converting enzyme inhibitor (ARB/ACEI). Less than half of patients with controlled office BP had controlled morning BP and that positive changes may be related to an office BP < 120/80 mm Hg, combination of a CCB and ACEI/ARB and a series of lifestyle adjustments.     

Self‐blood pressure monitoring is associated with improved awareness,adherence, and attainment of target blood pressure goals: Prospective observational study of 7751 patients

We investigated whether self‐blood pressure monitoring (SBPM) can improve the control rate of blood pressure (BP), adherence of antihypertensive medications, and the awareness of the importance of BP control in hypertensive patients. A total of 7751 patients who visited the outpatient clinics of private and university hospitals in Korea were given automatic electronic BP monitors and were recommended to measure their BP daily at home for 3 months. Changes in office BP, attainment of target BP, adherence to taking antihypertensive drugs, and awareness of BP were compared before and after SBPM. Patients and physicians were surveyed on their perception of BP and SBPM. Mean BP significantly decreased from 142/88 to 129/80 mm Hg (P < .001), and attainment of the target BP increased from 32% to 59% (P < .001) after SBPM. Drug non‐adherence, which was defined as patient's not taking medication days per week, decreased significantly from 0.86 days to 0.53 days (P < .001). The rate of awareness of the BP goal increased from 57% to 81% (P < .001). Patients estimated that their mean BP was 125/81 mm Hg, but their actual mean BP was 142/88 mm Hg. Awareness about the importance of SBPM increased from 90% to 98%. The rate of SBPM ≥ once per week further increased, from 34% to 96%. In conclusion, SBPM is associated with reduced BP, better BP control rate, greater drug adherence, and improved perception of BP by the patients.     

12-Month Results From the Unblinded Phase of the RADIANCE-HTN SOLO Trial of Ultrasound Renal Denervation

ObjectivesThis study reports the 12-month results of the RADIANCE-HTN (A Study of the ReCor Medical Paradise System in Clinical Hypertension) SOLO trial following unblinding of patients at 6 months.BackgroundThe blood pressure (BP)–lowering efficacy and safety of endovascular ultrasound renal denervation (RDN) in the absence (2 months) and presence (6 months) of antihypertensive medications were previously reported.MethodsPatients with daytime ambulatory BP ≥135/85 mm Hg after 4 weeks off medication were randomized to RDN (n = 74) or sham (n = 72) and maintained off medication for 2 months. A standardized medication escalation protocol was instituted between 2 and 5 months (blinded phase). Between 6 and 12 months (unblinded phase), patients received antihypertensive medications at physicians’ discretion. Outcomes at 12 months included medication burden, change in daytime ambulatory systolic BP (dASBP) and office or home systolic BP (SBP), visit-to-visit variability in SBP, and safety.ResultsSixty-five of 74 RDN patients and 67 of 72 sham patients had 12-month dASBP measurements. The proportion of patients on ≥2 medications (27.7% vs. 44.8%; p = 0.041), the number of medications (1.0 vs. 1.4; p = 0.015), and defined daily dose (1.4 vs. 2.2; p = 0.007) were less with RDN versus sham. The decrease in dASBP from baseline in the RDN group (−16.5 ± 12.9 mm Hg) remained stable at 12 months. The RDN versus sham adjusted difference at 12 months was −2.3 mm Hg (95% confidence interval [CI]: −5.9 to 1.3 mm Hg; p = 0.201) for dASBP, −6.3 mm Hg (95% CI: −11.1 to −1.5 mm Hg; p = 0.010) for office SBP, and −3.4 mm Hg (95% CI: −6.9 to 0.1 mm Hg; p = 0.062) for home SBP. Visit-to-visit variability in SBP was smaller in the RDN group. No renal artery injury was detected on computed tomographic or magnetic resonance angiography.ConclusionsDespite unblinding, the BP-lowering effect of RDN was maintained at 12 months with fewer prescribed medications compared with sham.     

Patterns of hypertension management in France in 2015: The ESTEBAN survey

The purposes of this study were to describe the hypertensive population and therapeutic management of hypertension in adults between 18 and 74 years of age in France in 2015.
Esteban survey is a cross‐sectional survey with a clinical examination conducted in a representative sample of French adults aged 18‐74 years between 2014 and 2016. Esteban was entirely public‐funded. Blood pressure (BP) was measured during clinical examination with a standardized protocol, and pharmacological treatment was collected through the exhaustive Système National des Données de Santé (SNDS) database. Hypertension was defined by systolic BP (SBP)> 140 mm Hg, diastolic BP (DBP)> 90 mm Hg or treatment with BP‐lowering drugs. The therapeutic control of treated hypertensive patients was defined by SBP < 140 mm Hg and DBP < 90 mm Hg.
Adherence to drug treatment was defined as more than 80% of days covered by BP‐lowering drug per year. The prevalence of hypertension was 31.3%. 74.7% of aware hypertensive participants taking an antihypertensive drug, and 57.7% of them were treated with a single antihypertensive pharmacological class. Overall, among hypertensives, 24.3% had a satisfactory BP control. Only 49.7% of treated hypertensives participants were controlled, and 33.6% of them were adherent to their drug treatment. The prevalence of hypertension in France remains high, with only 74.7% of the aware hypertensive participants receiving pharmacological therapy and only 48.9% of aware hypertensives with a BP at goal. More effective measures are needed to improve clinical management of hypertension in France.