high blood pressure per day: Summaries of relevant articles on arterial hypertension

early onset hypertension, not the late start, is related to cognitive function Suvila K et al. Hypertension. 2021;77:00-00. DOI: 10.1161

BACKGROUND. High blood pressure is associated with an increased risk of cognitive impairment in a highly age-dependent manner.. However, there are conflicting data on the relationship between the age of onset of AHT and cognitive function..

AIM. To investigate the association between early-onset vs. late-onset AHT with cognitive performance in midlife in 2946 CARDIA study patients (Coronary Artery Risk Development in Young Adults) (middle Ages 55 ± 4 years, 57% women). The participants underwent 9 repeated exams, including blood pressure measurements, in between 1985 y 1986 y 2015 y 2016. Participants underwent brain MRI imaging and completed Digital Symbol Substitution Tests, of Rey Auditory Learning, Rey's Verbal Learning, the Stroop interference test and the Montreal Cognitive Assessment to assess cognitive function in the exam of the year 30. The relationship between the age of onset of hypertension and cognitive function was evaluated using linear regression models adjusted for risk factors for cognitive impairment., including systolic BP.

RESULTS. Individuals with early onset of AHT (before the 35 years) they had 0.24±0.09, 0,22±0,10, 0,27±0.09 and 0.19±0.07 lower standardized Z scores in the digit substitution test, in the stroop test, on the Montreal Cognitive Assessment Test and scored lower on a composite cognitive score than participants without HBP (P0.05 for all). In a subgroup of 559 participants, Neither early-onset nor late-onset AHT was associated with macrostructural brain abnormalities (P>0,05 for all).

CONCLUSIONS. The results indicate that early-onset hypertension is a potent risk factor for cognitive decline in midlife.. Therefore, the assessment of the age of onset of hypertension in clinical practice could improve the stratification of the risk of cognitive impairment in patients with hypertension.

Association between the d|1Systolic Blood Pressure difference between both arms and results of cardiovascular events and mortality. Individual participant data meta-analysis, development and validation of a forecasting algorithm: INTERPRESS-IPD collaboration

Clark CE , et al. Hypertension 2020:77:00-00 DOI : 10.1161/HYPERTENSIONAHA.120.15997.

BACKGROUND: Between-arm systolic differences in blood pressure have been associated with overall and cardiovascular mortality.

AIM Individual data meta-analysis for (1) to quantify independent associations of difference between systolic BP between arms with mortality and cardiovascular events; (2) develop and validate prognostic models that incorporate the difference between both arms, y (3) to determine if the difference in BP between both arms is associated with the risk (adjusted for cardiovascular conditions) common. We searched for studies with BP recording in both arms.. BP measurements measured in one arm and then in the other, Agreements were established with contributing authors and a single data set was created. (INTERPRESS-IPD, with combined data from 24 studies, 53827 participants).

RESULTS The difference in systolic BP between both arms was associated with overall mortality and with cardiovascular mortality.: HR continuously 1,05 (IC del 95%, 1,02-1,08) y 1,06 (IC del 95%, 1,02-1,11), respectively, by 5 each mmHg difference in systolic BP between both arms. The HR for overall mortality increased with the magnitude of the difference in BP between the two arms from a threshold ≥ 5 mmHg (HR 1,07 [IC del 95%, 1,01–1,14]). The differences in systolic BP between arms for each 5 mmHg were associated with cardiovascular events in people without pre-existing disease, after adjusting for atherosclerotic cardiovascular disease (HR, 1,04 [IC del 95%, 1,00-1,08]), Framingham cardiovascular risk score (HR, 1,04 [IC del 95%, 1.01–1.08]), or the cardiovascular risk score calculated with the cardiovascular disease risk algorithm QRISK version 2 (QRISK2) (risk HR, 1.12 [IC 95%, 1.06–1.18]).

CONCLUSIONS. These findings confirm that the difference in systolic BP between arms is associated with an increase in overall mortality., with cardiovascular mortality and with cardiovascular events. BP should be measured in both arms in the cardiovascular examination. The authors propose a difference in systolic BP between both arms of 10 mmHg as upper limit of normality.

Use of tests for primary aldosteronism and mineralocorticoid receptor antagonists in the US Veterans Health System: retrospective cohort study. Cohen JB et al. Ann Intern Med Dic 29. PMID: 33370170 DOI: 10.7326/M20-4873 (Article online before printing)

BACKGROUND. primary aldosteronism (AP) is a common cause of resistant AHT. However, evidence from health systems suggests that rates of use of PC diagnostic tests are low.

AIM. To evaluate the rates of use of tests for PA and the management of high blood pressure based on evidence in patients with resistant high blood pressure..

METHODS. Retrospective cohort study in the United States Veterans Health system. Veterans with resistant AHT (n = 269 010) between 2000 and the 2017 (definition of resistant AHT: 2 BP measurements ≥ 140 o 90 mm Hg with an interval of at least 1 month while using 3 antihypertensive drugs including a diuretic or AHT that requires 4 classes of antihypertensives). AP test use rates were measured (plasma aldosterone-renin) and the association of tests with evidence-based treatment using a mineralocorticoid receptor antagonist. (ARM) and with longitudinal systolic BP.

RESULTS. They were identified 4277 (1,6%) patients who underwent an examination for AP. Initial visit to a nephrologist (HR, 2,05 [IC 95%, 1,66 – 2,52]) or an endocrinologist (HR, 2,48 [IC, 1,69 a 3,63]) was associated with a higher probability of taking the test compared with primary care. Testing for AP was associated with a probability 4 times greater starting treatment with and with better BP control over time. limitations: Predominantly male cohort, retrospective design, susceptibility to office AP misclassification and lack of confirmatory AP testing.

CONCLUSIONS. In a national cohort of veterans with apparent resistant hypertension., PA diagnostic tests were infrequent and were associated with higher rates of MRA treatment and better longitudinal control of blood pressure. The results confirm the low adherence to the practices recommended in the Clinical Guidelines and underscore the urgent need to improve the management of patients with treatment-resistant hypertension..

Screening and national registry in China of primary aldosteronism in hypertensive patients.
Xin Chen et al.. Journal of Human Hypertension (2021) 35:157–161.

BACKGROUND. Within the framework of HTA control initiatives in China, the Prospective Study of Primary Aldosteronism in China was designed as a national multicenter program for screening and registration of primary aldosteronism (AP) in hypertensive patients.

AIM. establish technological platforms, equipment and experience for screening, Diagnosis and treatment of PA in cardiology outpatient clinics.

METHODS. Retrospective cohort study in the United States Veterans Health system. Veterans with resistant AHT (n = 269 010) between 2000 and the 2017 (definition of resistant AHT: 2 BP measurements ≥ 140 o 90 mm Hg with an interval of at least 1 month while using 3 antihypertensive drugs including a diuretic or AHT that requires 4 classes of antihypertensives). AP test use rates were measured (plasma aldosterone-renin) and the association of tests with evidence-based treatment using a mineralocorticoid receptor antagonist. (ARM) and with longitudinal systolic BP.

RESULTS. They were identified 4277 (1,6%) patients who underwent an examination for AP. Initial visit to a nephrologist (HR, 2,05 [IC 95%, 1,66 – 2,52]) or an endocrinologist (HR, 2,48 [IC, 1,69 a 3,63]) was associated with a higher probability of taking the test compared with primary care. Testing for AP was associated with a probability 4 times greater starting treatment with and with better BP control over time. limitations: Predominantly male cohort, retrospective design, susceptibility to office AP misclassification and lack of confirmatory AP testing.

CONCLUSIONS. In a national cohort of veterans with apparent resistant hypertension., PA diagnostic tests were infrequent and were associated with higher rates of MRA treatment and better longitudinal control of blood pressure. The results confirm the low adherence to the practices recommended in the Clinical Guidelines and underscore the urgent need to improve the management of patients with treatment-resistant hypertension..

Aldosterone synthase inhibition with lorundrostat for uncontrolled hypertension

Lucas J. Laffin, MD1,2; David Rodman, MD3; James M. Luther, MD4; et alAnand Vaidya, MD5; Matthew R. Weir, MD6; Natasa Rajicic7; BT Slingsby, Doctor in medicine, doctorado3; Steven E. Nissen, MD1,2; for Target-HTN researchers

author affiliations. Item information

JAMA. 2023;330(12):1140-1150. doi:10.1001/jama.2023.16029

SUMMARY

IMPORTANCE. Excessive aldosterone production contributes to hypertension in both classic hyperaldosteronism and obesity-associated hypertension.. Therapies that reduce aldosterone synthesis may lower blood pressure.

AIM. Compare the safety and efficacy of lorundrostat, an aldosterone synthase inhibitor, con placebo, and characterize dose-dependent safety and efficacy to inform dose selection in future trials.

DESIGN, ENVIRONMENT AND PARTICIPANTS. Randomized trial, placebo-controlled and dose-ranging among adults with uncontrolled hypertension taking 2 or more antihypertensive medications. An initial cohort of 163 participants with suppressed plasma renin (plasma renin activity [PRA] ≤1,0 ng/mL/h) and elevated plasma aldosterone (≥1.0 ng/dL), with the subsequent registration of 37 participants with PRA greater than 1,0. of/mL/h.

INTERVENTIONS. Participants were randomly assigned to placebo or 1 of 5 lorundrostat dosage in the initial cohort (12,5 mg, 50 mg o 100 mg once a day or 12,5 mg o 25 mg twice a day). In the second cohort, The participants were randomly assigned in a proportion of 1:6 a placebo or lorundrostat, 100 mg once a day.

MAIN RESULTS AND MEASURES. The primary endpoint was the change in automated office systolic blood pressure from baseline to 1 week. 8 from the study.

RESULTS. Between July 2021 and June 2022, they were randomized 200 participants and the final follow-up was carried out in September 2022. After 8 weeks of treatment in participants with suppressed PRA, changes in office systolic blood pressure of −14.1 were observed, −13,2, −6.9 and were observed -4,1 mm Hg con 100 mg, 50 mg y 12,5 mg once daily lorundrostat and placebo, respectively. The observed reductions in systolic blood pressure in individuals receiving twice-daily doses of 25 mg y 12,5 mg of lorundrostat fueron de -10,1 y -13,8 mm Hg, respectively. The least squares mean difference between placebo and treatment in systolic blood pressure was −9.6 mm Hg (IC del 90 %, −15,8 a −3,4 mm Hg; P = 0,01 ) for the dose of 50 mg once daily and −7.8 mm Hg (IC del 90 %, −14,1 a −1,5 mm Hg; P = 0,04) by 100 mg per day. Among participants without suppressed ARP, 100 mg once daily lorundrostat decreased systolic blood pressure in 11,4 mm Hg (OF, 2,5 mm Hg), which was similar to the blood pressure reduction among ARP-suppressed participants who received the same dose. Six participants had increases in serum potassium above 6,0 mmol/L that were corrected by dose reduction or drug discontinuation. There were no cases of cortisol insufficiency.

CONCLUSIONS AND RELEVANCE. Among people with uncontrolled hypertension, The use of lorundrostat was effective in reducing blood pressure compared to placebo, which will require more confirmatory studies.

Management of arterial hypertension in stage 1 in adults at low risk of cardiovascular disease 10 years : filling a gap in the guidelines (American Heart Association Scientific Statement).

Jones DW. Whelton PK et al. Hypertension. 2021;77:e58–e67. DOI: 10.1161/HYP.0000000000000195

arterial hypertension (HTA) It is the leading cause of morbidity and mortality from cardiovascular diseases worldwide.. Hypertensive patients and physicians managing AHT have benefited from evidence from event-focused randomized controlled clinical trials.. One of the results of these clinical studies has been the development of evidence-based guidelines.. The commitment to use the evidence from these event-based randomized trials has been a cornerstone in the development of treatment recommendations.. However, In some situations, evidence from event-based trials is not available many clinical situations.

This is the case of the treatment of many patients with AHT in the 1. The objective of this scientific statement is to provide complementary information to the AHT Clinical Practice Guideline for patients with hypertension in stage 1 not treated (systolic BP / diastolic BP, 130-139/80-89 mm Hg) with a risk of atherosclerotic cardiovascular disease 10 years <10% that does not reach a blood pressure <130/80 mm Hg after 6 months of non-pharmacological therapy recommended by the Guidelines. Evidence from sources other than event-based randomized controlled trials is provided here and offers therapy options for clinicians to consider..

In these patients, treatment based on lifestyle changes should be maintained and the possibility of adding drugs within the guidelines should be considered. 4 recommended classes in the american guide of the 2017.

For patients in whom hypertension was identified during adolescence (or in childhood) and who have been prescribed antihypertensive drug treatment, the original indications for starting treatment and the need to continue it should be reconsidered.

In young adults with hypertension in the stage 1 that cannot be controlled with non-pharmacological treatment, special attention should be paid to the use of antihypertensive drugs when there is a family history of premature cardiovascular disease, history of hypertension in pregnancy, or personal history of premature birth.