The importance of pulse pressure on cardiovascular risk and total mortality in the general population: Is sex relevant?

The aim of the present study is to investigate the predictive value of pulse pressure (PP) on cardiovascular events in the general population and in both sexes, separately. The study involved 2045 participants from the PAMELA study who underwent 24‐hour ambulatory blood pressure (BP) monitoring. The participants were followed from the initial medical visit for a time interval of 137 ± 23 months. It was found that office, home, and 24‐hour blood pressures were significantly higher in the individuals who experienced cardiovascular (CV) events. Office, 24‐hour, and daytime PP were independent predictors of CV events after adjustment for main demographic and clinical parameters in the whole study population. Nighttime PP was an additional independent predictor in men. In conclusion, PP represents an important predictor of cardiovascular events in the general population, particularly among men. Daytime and 24‐hour PP have greater predictive importance than nighttime PP in the general population.     

Threshold and Target for Blood Pressure Lowering in the Elderly

Purpose of Review

Detection of elevated blood pressure values in elderly patients represents a common clinical condition associated with an increased cardiovascular risk. This has been shown to be the case in both systodiastolic and isolated systolic hypertension as well. However, despite the evidence of the benefits of the blood pressure lowering intervention in terms of reduction of cardiovascular morbidity and mortality, at least two issues related to antihypertensive drug treatment in aged individuals are still undefined: (1) the blood pressure threshold at which antihypertensive drug should be initiated and (2) the blood pressure goals of the therapeutic intervention.

Recent Findings

The present paper will critically review the evidence available so far on these two issues as well as the position of current guidelines and consensus statements. Emphasis will be given to the analysis of the new data of the Systolic Blood Pressure Interventional Trial (SPRINT), which have recently demonstrated the benefits, even in individuals aged more than 75 years, of a tight blood pressure reduction to systolic blood pressure to 120 mmHg or less. The potential limitations of the trial will be also critically addressed and the expectations of ongoing clinical studies investigating the issue in elderly patients properly emphasized.

Summary

Although of interest, the results of the SPRINT trial encompass a number of limitations which limit their applicability to the general elderly hypertensive population. A prudent approach will be to adopt in clinical practice the less intensive and more conservative targets recommended by current guidelines.

     

False positive dipstick for urinary blood in childhood

BACKGROUND: In view of the obvious practical advantages, the most common test for hematuria is currently a reagent strip. METHODS: A standardized microscopic examination of the sediment was performed in 20 asymptomatic children referred for evaluation of chronic isolated microhematuria detected by means of a reagent strip. RESULTS: In 6 of the 20 children the microscopic examination failed to confirm the result of the dipstick test. CONCLUSIONS: Confirmation for the presence of hematuria by microscopy is the most important step in children with a positive dipstick for urinary blood.     

The “J Curve” Problem Revisited: Old and New Findings

This paper critically addresses the issue of the “J-curve” paradox—the finding described in studies performed about 30 years ago indicating that treatment-induced systolic blood pressure values below 120 or 125 mm Hg and diastolic blood pressure values below 75 mm Hg are characterized by an increase, rather than a reduction, in the incidence of coronary events. This paper focuses on four major subjects: 1) the benefits of a lower blood pressure target during treatment; 2) the historical background of the “J-curve” phenomenon; 3) the evidence collected in recent clinical trials regarding the existence of a “J-curve” in treated hypertensive patients; and 4) the recent recommendations by the Task Force Committee of the European Society of Hypertension on blood pressure goals to be achieved during treatment.     

Blood pressure control and antihypertensive treatment

Several lines of evidence show that blood pressure (BP) control in treated hypertensive patients is largely unsatisfactory and that this depends on a variety of factors, such as the poor patient's compliance, insufficient use of combination drug treatment as well as true difficulties in achieving well controlled BP. This review article will be focused on the main features of BP control by discussing the data obtained in clinical trials as well as the results available in clinical practice. The paper will also discuss the possible factors responsible for these findings as well as the favourable outcome on cardiovascular risk profile of an effective control of elevated BP. The possible approaches for controlling elevated BP values will be highlighted.