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Diagnosis and Management of Arterial Hypertension: State of the Art and Current Challenges

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: closed (20 December 2022) | Viewed by 48264

Special Issue Editor

Prof. Dr. Dominique Stephan

E-Mail Website
Guest Editor
Service d’Hypertension et Maladies Vasculaires, University Hospital Strasbourg, Strasbourg, France
Interests: hypertension; vascular diseases; cardiovascular pharmacology

Special Issue Information

Dear Colleagues,

Hypertension (HTN) remains as one of the most common chronic disease worldwide. Nevertheless, there are global disparities of hypertension prevalence, awereness, treatment and control between high-income and low-income or intermediate-income countries where HTN burden is increasing. Several international recommendations have been published from 2017 to the present datae. If the most recent guidelines recommend dual therapy as first step treatment of HTN, blood pressure targets may vary from one side of the Atlantic to the other. Blood pressure measurement in the doctor’s office is the standard method for detecting HTN, although all recommendations agreed to favor ambulatory or home blood pressure measurements. Home blood pressure telemonitoring has been proved to be feasible, cost effective and may allow self-titration of antihypertensive treatment.However, two main barriers limit the effectiveness of antihypertensive treatments: non-adherence by hypertensive patients and clinical inertia by physicians who do not follow good practice guidelines. Resistant hypertension is defined by the failure to achieve blood pressure targets despite appropriate treatment with optimal doses of antihypertensive. White coat hypertension, non-adherence and secondary causes of HTN may be the cause of pseudo resistant hypertension. The management of resistant hypertension includes lifestyle changes, discontinuation of interfering treatment and optimization of antihypertensive treatment following the guidelines.

Since the beginning of the 20th century and the demonstration that arterial hypertension was a risk factor, hypertension has benefited from a century of fundamental and clinical research. In this Special Issue of the Journal of Clinical Medicine, I propose including studies on a topical update of important chapters with respect to the management of hypertension. I would be very honored if you agreed to participate in the publication of this Special Issue.

Prof. Dr. Dominique Stephan
Guest Editor

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Keywords

  • hypertension
  • blood-pressure control
  • arterial stiffness
  • blood pressure self-measurement
  • e-medicine
  • non-adherence
  • clinical inertia
  • endocrine hypertension
  • resistant hypertension
  • SARS-CoV2
  • renin angiotensin inhibitors

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Published Papers (7 papers)

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Research

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8 pages, 871 KiB  
Article
Antihypertensive Therapy and Incidence of Cancer
by Sven H. Loosen, David Schöler, Mark Luedde, Johannes Eschrich, Tom Luedde, Niklas Gremke, Matthias Kalder, Karel Kostev and Christoph Roderburg
J. Clin. Med. 2022, 11(22), 6624; https://doi.org/10.3390/jcm11226624 - 8 Nov 2022
Cited by 3 | Viewed by 1718
Abstract
Background: Antihypertensive pharmacological therapy includes diuretics, beta-blockers, ACE inhibitors, calcium channel blockers and angiotensin II receptor blockers. Besides their use in arterial hypertension, these drugs also play a major role in the therapy of portal hypertension, heart failure and coronary artery disease. Systematic [...] Read more.
Background: Antihypertensive pharmacological therapy includes diuretics, beta-blockers, ACE inhibitors, calcium channel blockers and angiotensin II receptor blockers. Besides their use in arterial hypertension, these drugs also play a major role in the therapy of portal hypertension, heart failure and coronary artery disease. Systematic analyses on the possible influence of these medications on cancer incidence are lacking. Methods: By utilizing the Disease Analyzer database (IQVIA), 349,210 patients with antihypertensive drug prescriptions between 2010 and 2020 without a diagnosis of cancer prior to or at the date of initial drug prescription were included. Propensity score matching was carried out by 1:1:1:1:1 according to the five antihypertensive treatments. Cox regression analyses were performed to investigate an association between antihypertensive drugs and the incidence of cancer. Results: Patients who were diagnosed with cancer were treated with diuretics in 19.9% of cases, calcium channel blockers in 16.9% of cases, and angiotensin II receptor blockers, ACE inhibitors, or beta-blockers in 13.9%, 13.2% and 12.8% of cases, respectively. Cox regression models revealed that diuretic use positively correlated with liver cancer incidence (HR: 1.31, 95%CI: 1.12–2.63) and lymphoid/haematopoietic tissue cancer incidence (HR: 1.27, 95%CI: 1.10–1.46). Use of diuretics negatively correlated with the incidence of prostate (HR: 0.64, 95%CI: 0.53–0.78) and skin cancer (HR: 0.81, 95%CI: 0.72–0.92). Finally, a positive association was found between angiotensin II receptor inhibitors and prostate cancer incidence (HR: 1.50, 95%CI: 1.28–1.65). Conclusions: These data suggest that diuretic use might be associated with liver cancer and lymphoid/haematopoetic tissue cancer development. Full article
(This article belongs to the Special Issue Diagnosis and Management of Arterial Hypertension: State of the Art and Current Challenges)
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14 pages, 511 KiB  
Article
Circadian Blood Pressure Profile in Pediatric Patients with Primary Hypertension
by Michał Szyszka, Piotr Skrzypczyk, Anna Ofiara, Anna Maria Wabik, Radosław Pietrzak, Bożena Werner and Małgorzata Pańczyk-Tomaszewska
J. Clin. Med. 2022, 11(18), 5325; https://doi.org/10.3390/jcm11185325 - 10 Sep 2022
Cited by 1 | Viewed by 1720
Abstract
Our study aimed to evaluate factors affecting circadian BP profile and its association with hypertension-mediated organ damage (HMOD) in pediatric patients with primary hypertension (PH). The study included 112 children (14.7 ± 2.1 age, 79 boys, 33 girls) with untreated PH. Non-dipping was [...] Read more.
Our study aimed to evaluate factors affecting circadian BP profile and its association with hypertension-mediated organ damage (HMOD) in pediatric patients with primary hypertension (PH). The study included 112 children (14.7 ± 2.1 age, 79 boys, 33 girls) with untreated PH. Non-dipping was defined as a nocturnal drop in systolic or diastolic BP (SBP, DBP) < 10%, and a nocturnal drop >20% was defined as extreme dipping. The nocturnal SBP drop was 10.9 ± 5.9 (%), and the DBP drop was 16.2 ± 8.5 (%). Non-dipping was found in 50 (44.6%) children and extreme dipping in 29 (25.9%) patients. The nocturnal SBP decrease correlated with BMI Z-score (r = −0.242, p = 0.010) and left ventricular mass index (LVMI) (r = −0.395, p = 0.006); diastolic DBP decrease correlated with augmentation index (AIx75HR) (r = 0.367, p = 0.003). Patients with a disturbed blood pressure profile had the highest LVMI (p = 0.049), while extreme dippers had the highest augmentation index (AIx75HR) (p = 0.027). Elevated systolic and diastolic BP dipping were risk factors for positive AIx75HR (OR 1.122 95CI (1.009–1.249) and OR 1.095 95CI (1.017–1.177). We concluded that disturbed circadian BP profile was common in children with PH and should not be considered a marker of secondary hypertension. A disturbed circadian BP profile may be associated with higher body weight. In pediatric patients with PH, non-dipping is associated with increased left ventricular mass, and extreme dipping may be a risk factor for increased arterial stiffness. Full article
(This article belongs to the Special Issue Diagnosis and Management of Arterial Hypertension: State of the Art and Current Challenges)
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12 pages, 281 KiB  
Article
High Levels of Thromboxane (TX) Are Associated with the Sex-Dependent Non-Dipping Phenomenon in Ischemic Stroke Patients
by Arleta Drozd, Małgorzata Szczuko, Andrzej Bohatyrewicz, Alina Jurewicz and Dariusz Kotlęga
J. Clin. Med. 2022, 11(9), 2652; https://doi.org/10.3390/jcm11092652 - 9 May 2022
Cited by 2 | Viewed by 2081
Abstract
Background: Inflammation and high blood pressure (nondipping profile) during the rest/sleep period have been associated with an effect on the incidence of cardiovascular disorders and a more severe course in the ischemic cerebrovascular event. There are no available data on the relationship between [...] Read more.
Background: Inflammation and high blood pressure (nondipping profile) during the rest/sleep period have been associated with an effect on the incidence of cardiovascular disorders and a more severe course in the ischemic cerebrovascular event. There are no available data on the relationship between dipping status and the pro-inflammatory metabolites of arachidonic acid (AA); therefore, we undertook a study to investigate the influence of thromboxane on the incidence of nondipping among patients after stroke. Methods: Sixty-two patients with ischemic stroke (including 34 women and 28 men) were tested for the involvement of thromboxane in the nondipping phenomenon. Subjects were analyzed for the presence of the physiological phenomenon of dipping (DIP group) versus its absence—nondipping (NDIP group). Thromboxane (TX) measurements were performed using liquid chromatography, and blood pressure was measured 24 h a day in all subjects. Results: The analysis of the thromboxane level in the plasma of patients after ischemic stroke showed significant differences in terms of sex (p = 0.0004). Among women in both groups, the concentration of TX was high, while similar levels were observed in the group of men from the NDIP group. However, when comparing men in the DIP and NDIP groups, a lower TX level was noticeable in the DIP group. Conclusions: A higher level of TX may be associated with a disturbance of the physiological phenomenon of DIP in men and women. However, in our opinion, TX is not the main determinant of the DIP phenomenon and, at the same time, other pro-inflammatory factors may also be involved in the occurrence of this singularity. Full article
(This article belongs to the Special Issue Diagnosis and Management of Arterial Hypertension: State of the Art and Current Challenges)
11 pages, 1042 KiB  
Article
Arterial Stiffness Determinants for Primary Cardiovascular Prevention among Healthy Participants
by Alexandre Vallée
J. Clin. Med. 2022, 11(9), 2512; https://doi.org/10.3390/jcm11092512 - 29 Apr 2022
Cited by 13 | Viewed by 2635
Abstract
Background: Arterial stiffness (AS), measured by arterial stiffness index (ASI), can be considered as a major denominator in cardiovascular (CV) diseases. Thus, it remains essential to highlight the risk factors influencing its increase among healthy participants. Methods: According to European consensus, AS is [...] Read more.
Background: Arterial stiffness (AS), measured by arterial stiffness index (ASI), can be considered as a major denominator in cardiovascular (CV) diseases. Thus, it remains essential to highlight the risk factors influencing its increase among healthy participants. Methods: According to European consensus, AS is defined as ASI > 10 m/s. The purpose of this study was to investigate the determinants of the arterial stiffness (ASI > 10 m/s) among UK Biobank normotensive and healthy participants without comorbidities and previous CV diseases. Thus, a cross-sectional study was conducted on 22,452 healthy participants. Results: Participants were divided into two groups, i.e., ASI > 10 m/s (n = 5782, 25.8%) and ASI < 10 m/s (n = 16,670, 74.2%). All the significant univariate covariables were included in the multivariate analysis. The remaining independent factors associated with AS were age (OR = 1.063, threshold = 53.0 years, p < 0.001), BMI (OR = 1.0450, threshold = 24.9 kg/m2, p < 0.001), cystatin c (OR = 1.384, threshold = 0.85 mg/L, p = 0.011), phosphate (OR = 2.225, threshold = 1.21 mmol/L, p < 0.001), triglycerides (OR = 1.281, threshold = 1.09 mmol/L, p < 0.001), mean BP (OR = 1.028, threshold = 91.2 mmHg, p < 0.001), HR (OR = 1.007, threshold = 55 bpm, p < 0.001), Alkaline phosphate (OR = 1.002, threshold = 67.9 U/L, p = 0.004), albumin (OR = 0.973, threshold = 46.0 g/L, p < 0.001), gender (male, OR = 1.657, p < 0.001) and tobacco use (current, OR = 1.871, p < 0.001). Conclusion: AS is associated with multiple parameters which should be investigated in future prospective studies. Determining the markers of increased ASI among healthy participants participates in the management of future CV risk for preventive strategies. Full article
(This article belongs to the Special Issue Diagnosis and Management of Arterial Hypertension: State of the Art and Current Challenges)
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Review

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8 pages, 932 KiB  
Review
International Guidelines for Hypertension: Resemblance, Divergence and Inconsistencies
by Junior Justin, Antoine Fayol, Rosa-Maria Bruno, Hakim Khettab and Pierre Boutouyrie
J. Clin. Med. 2022, 11(7), 1975; https://doi.org/10.3390/jcm11071975 - 1 Apr 2022
Cited by 5 | Viewed by 4045
Abstract
High blood pressure is the number one killer in the world. About 1.5 billion people suffered from hypertension in 2010, and these numbers are increasing year by year. The basics of the management of high blood pressure are described in the Canadian, American, [...] Read more.
High blood pressure is the number one killer in the world. About 1.5 billion people suffered from hypertension in 2010, and these numbers are increasing year by year. The basics of the management of high blood pressure are described in the Canadian, American, International and European guidelines for hypertension. However, there are similarities and differences in the definition, measurement and management of blood pressure between these different guidelines. According to the Canadian guidelines, normal blood pressure is less than 140/90 mmHg (systolic blood pressure/diastolic blood pressure). The AHA and ESC estimate normal blood pressure to be less than 120/80 mmHg (systolic blood pressure/diastolic blood pressure). Regarding treatments, the AHA, ISH and ESC are also in agreement about dual therapy as the first-line therapy, while Canadian recommendations retain the idea of monotherapy as the initiation of treatment. When it comes to measuring blood pressure, the four entities agree on the stratification of intervention in absolute cardiovascular risk. Full article
(This article belongs to the Special Issue Diagnosis and Management of Arterial Hypertension: State of the Art and Current Challenges)
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16 pages, 795 KiB  
Review
How to Explore an Endocrine Cause of Hypertension
by Jean-Baptiste de Freminville and Laurence Amar
J. Clin. Med. 2022, 11(2), 420; https://doi.org/10.3390/jcm11020420 - 14 Jan 2022
Cited by 5 | Viewed by 4562
Abstract
Hypertension (HTN) is the most frequent modifiable risk factor in the world, affecting almost 30 to 40% of the adult population in the world. Among hypertensive patients, 10 to 15% have so-called “secondary” HTN, which means HTN due to an identified cause. The [...] Read more.
Hypertension (HTN) is the most frequent modifiable risk factor in the world, affecting almost 30 to 40% of the adult population in the world. Among hypertensive patients, 10 to 15% have so-called “secondary” HTN, which means HTN due to an identified cause. The most frequent secondary causes of HTN are renal arteries abnormalities (renovascular HTN), kidney disease, and endocrine HTN, which are primarily due to adrenal causes. Knowing how to detect and explore endocrine causes of hypertension is particularly interesting because some causes have a cure or a specific treatment available. Moreover, the delayed diagnosis of secondary HTN is a major cause of uncontrolled blood pressure. Therefore, screening and exploration of patients at risk for secondary HTN should be a serious concern for every physician seeing patients with HTN. Regarding endocrine causes of HTN, the most frequent is primary aldosteronism (PA), which also is the most frequent cause of secondary HTN and could represent 10% of all HTN patients. Cushing syndrome and pheochromocytoma and paraganglioma (PPGL) are rarer (less than 0.5% of patients). In this review, among endocrine causes of HTN, we will mainly discuss explorations for PA and PPGL. Full article
(This article belongs to the Special Issue Diagnosis and Management of Arterial Hypertension: State of the Art and Current Challenges)
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Other

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11 pages, 1601 KiB  
Systematic Review
The Effect of Semaglutide on Blood Pressure in Patients without Diabetes: A Systematic Review and Meta-Analysis
by Cormac Kennedy, Peter Hayes, Sulafa Salama, Martina Hennessy and Federica Fogacci
J. Clin. Med. 2023, 12(3), 772; https://doi.org/10.3390/jcm12030772 - 18 Jan 2023
Cited by 19 | Viewed by 30548
Abstract
(1) Background: Recent advances in the pharmacological treatment of obesity with glucagon-like peptide-1 receptor agonists (GLP-1 RA) highlight the potential to target excess body weight to improve blood pressure (BP). This review aimed to determine the BP reduction in trials of semaglutide for [...] Read more.
(1) Background: Recent advances in the pharmacological treatment of obesity with glucagon-like peptide-1 receptor agonists (GLP-1 RA) highlight the potential to target excess body weight to improve blood pressure (BP). This review aimed to determine the BP reduction in trials of semaglutide for weight reduction in patients without diabetes. (2) Methods: Relevant studies were identified via a search of research databases. Studies were screened to include randomized controlled trials (RCTs) of semaglutide versus a placebo in adults. Pooled and sensitivity analyses were performed, and risk of bias was assessed. (3) Results: six RCTs, with 4744 participants, were included in the final analysis. At baseline, the cohorts in these studies had a mean BP in the normotensive range. The mean difference in systolic BP was −4.83 mmHg (95% CI: −5.65 to −4.02), while that for diastolic BP was −2.45 mmHg (95% CI: −3.65 to −1.24). All included studies were of a high methodological quality. (4) Conclusions: A clinically significant reduction in BP was evident following semaglutide treatment in normotensive populations without diabetes. The effect of semaglutide in those with obesity and hypertension is as yet undetermined. Targeting excess body weight may be a novel therapeutic strategy for these patients. Full article
(This article belongs to the Special Issue Diagnosis and Management of Arterial Hypertension: State of the Art and Current Challenges)
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