scholarly journals Association Between the European Society of Cardiology/European Society of Hypertension Heart Rate Thresholds for Cardiovascular Risk and Neuroadrenergic Markers

Hypertension ◽  
2020 ◽  
Vol 76 (2) ◽  
pp. 577-582 ◽  
Author(s):  
Guido Grassi ◽  
Fosca Quarti-Trevano ◽  
Gino Seravalle ◽  
Raffaella Dell’Oro ◽  
Rita Facchetti ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiovascular Risk ◽  
Ambulatory Blood Pressure ◽  
European Society ◽  
Sympathetic Nerve ◽  
Left Ventricular Mass Index ◽  
Left Ventricular ◽  
Sympathetic Overdrive ◽  
European Society Of Cardiology

The recent European Society of Cardiology/European Society of Hypertension hypertension guidelines identify resting heart rate (HR) values >80 bpm as predictors of cardiovascular risk, with the unproven assumption that this might reflect the presence of a sympathetic overdrive. In the present study, we tested this hypothesis throughout the use of direct and indirect sympathetic markers. In 193 untreated moderate essential hypertensives aged 50.4±0.6 years (mean±SEM), we measured clinic and ambulatory blood pressure and corresponding HR, venous plasma norepinephrine (high performance liquid chromatography), and muscle sympathetic nerve traffic (microneurography). We then subdivided the study population into 2 groups according to HR < or >80 bpm. Eighty-four patients displayed resting HR >80 bpm, which was this cutoff value in the remaining 109 patients, the 2 groups showing superimposable age, and sex distribution. Clinic and ambulatory blood pressure were similar in the 2 groups, whereas left ventricular mass index was significantly greater in the group with HR >80 bpm. Muscle sympathetic nerve traffic values were also significantly greater in this latter group (72.77±0.9 versus vs 36.83±1.3 bursts/min, P <0.0001); this being the case also for norepinephrine (293.0±8.7 versus 254.1±8.9 pg/mL, P <0.002). In the whole population, there was a significant direct relationship between muscle sympathetic nerve traffic, norepinephrine, left ventricular mass index, and HR values. Similar results were obtained when 24-hour HR values were analyzed. Thus patients with hypertension displaying HR >80 bpm are characterized by a marked sympathetic overdrive, particularly when direct adrenergic markers are used. This finding suggests that cardiac and peripheral sympathetic activation are involved in the increased cardiovascular risk detected in this group of patients.

Enhanced brain natriuretic peptide response to peak exercise in heart transplant recipients

1998 ◽  
Vol 85 (6) ◽  
pp. 2270-2276 ◽  
Author(s):  
Bernard Geny ◽  
Anne Charloux ◽  
Eliane Lampert ◽  
Jean Lonsdorfer ◽  
Pascal Haberey ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Transplantation ◽  
Left Ventricular Mass ◽  
Heart Transplant ◽  
Left Ventricular Mass Index ◽  
Left Ventricular ◽  
Peak Exercise ◽  
Transplant Recipients ◽  
Heart Transplant Recipients

We investigated the atrial (ANP) and brain natriuretic peptides (BNP), catecholamines, heart rate, and blood pressure responses to graded upright maximal cycling exercise of eight matched healthy subjects and cardiac-denervated heart transplant recipients (HTR). Baseline heart rate and diastolic blood pressure, together with ANP (15.2 ± 3.7 vs. 4.4 ± 0.8 pmol/l; P < 0.01) and BNP (14.3 ± 2.6 vs. 7.4 ± 0.6 pmol/l; P< 0.01), were elevated in HTR, but catecholamine levels were similar in both groups. Peak exercise O2uptake and heart rate were lower in HTR. Exercise-induced maximal ANP increase was similar in both groups (167 ± 34 vs. 216 ± 47%). Enhanced BNP increase was significant only in HTR (37 ± 8 vs. 16 ± 8%; P < 0.05). Similar norepinephrine but lower peak epinephrine levels were observed in HTR. ANP and heart rate changes from rest to 75% peak exercise were negatively correlated ( r = −0.76, P < 0.05), and BNP increase was correlated with left ventricular mass index ( r = 0.83, P < 0.01) after heart transplantation. Although ANP increase was not exaggerated, these data support the idea that the chronotropic limitation secondary to sinus node denervation might stimulate ANP release during early exercise in HTR. Furthermore, the BNP response to maximal exercise, which is related to the left ventricular mass index of HTR, is enhanced after heart transplantation.

scholarly journals The American Academy of Pediatrics hypertension guidelines identify obese youth at high cardiovascular risk among individuals non-hypertensive by the European Society of Hypertension guidelines

2019 ◽  
Vol 27 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Procolo Di Bonito ◽  
Maria Rosaria Licenziati ◽  
Marco G Baroni ◽  
Claudio Maffeis ◽  
Anita Morandi ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Young People ◽  
American Academy ◽  
Left Ventricular Mass Index ◽  
Left Ventricular ◽  
American Academy Of Pediatrics ◽  
Hypertension Guidelines ◽  
Obese Youth

Background Two different systems for the screening and diagnosis of hypertension (HTN) in children currently coexist, namely, the guidelines of the 2017 American Academy of Pediatrics (AAP) and the 2016 European Society for Hypertension (ESH). The two systems differ in the lowered cut-offs proposed by the AAP versus ESH. Objectives We evaluated whether the reclassification of hypertension by the AAP guidelines in young people who were defined non-hypertensive by the ESH criteria would classify differently overweight/obese youth in relation to their cardiovascular risk profile. Methods A sample of 2929 overweight/obese young people (6–16 years) defined non-hypertensive by ESH (ESH–) was analysed. Echocardiographic data were available in 438 youth. Results Using the AAP criteria, 327/2929 (11%) young people were categorized as hypertensive (ESH–/AAP+). These youth were older, exhibited higher body mass index, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), triglycerides, total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio, blood pressure, left ventricular mass index and lower HDL-C ( p <0.025–0.0001) compared with ESH–/AAP–. The ESH–/AAP+ group showed a higher proportion of insulin resistance (i.e. HOMA-IR ≥3.9 in boys and 4.2 in girls) 35% vs. 25% ( p <0.0001), high TC/HDL-C ratio (≥3.8 mg/dl) 35% vs. 26% ( p = 0.001) and left ventricular hypertrophy (left ventricular mass index ≥45 g/h2.16) 67% vs. 45% ( p = 0.008) as compared with ESH–/AAP–. Conclusions The reclassification of hypertension by the AAP guidelines in young people overweight/obese defined non-hypertensive by the ESH criteria identified a significant number of individuals with high blood pressure and abnormal cardiovascular risk. Our data support the need of a revision of the ESH criteria.

scholarly journals Approaches to the Diagnosis and Treatment of Arterial Hypertension in the Light of European Recommendations

Kardiologiia ◽  
2019 ◽  
Vol 59 (9) ◽  
pp. 64-70
Author(s):  
V. N. Larina ◽  
B. Ya. Bart ◽  
E. A. Vartanian ◽  
E. V. Fedorova ◽  
M. P. Mikhailusova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Drug Treatment ◽  
Arterial Hypertension ◽  
European Society ◽  
Initial Therapy ◽  
Ambulatory Bp Monitoring ◽  
Single Pill ◽  
European Society Of Cardiology

In this review we present analysis the European recommendations on hypertension – what’s new and what has changed in the tactics of managing patients with arterial hypertension (AH). We compared recommendations on hypertension of the European Society of Cardiology (ESC) and the European Society of hypertension (ESH) 2018 with European recommendations of previous years. In the updated version of guidelines, it is still recommended to determine AH as blood pressure (BP) ≥140 and / or ≥90 mm Hg; to subdivide BP levels into optimal, normal, and high normal, to classify severity of AH as 3 degrees, and to distinguish separately its isolated systolic form. Values for out-of-office BP remained unchanged, but recommendations emerged concerning wider use of ambulatory BP monitoring and self-measurement of BP. For initial therapy, it was recommended to use two drugs combinations preferably as single pill combinations. An increase of the role of nurses and pharmacists in teaching, supporting patients and controlling hypertension has been noted. This can improve the achievement of target BP and, as a result, reduce the cardiovascular risk. New European recommendations highlight the modern aspects of classification and diagnosis of AH, main stages of screening, and algorithm of drug treatment of AH.

scholarly journals Primary prevention efforts are poorly developed in people at high cardiovascular risk: A report from the European Society of Cardiology EURObservational Research Programme EUROASPIRE V survey in 16 European countries

2020 ◽  
pp. 204748732090869 ◽  
Author(s):  
Kornelia Kotseva ◽  
Guy De Backer ◽  
Dirk De Bacquer ◽  
Lars Rydén ◽  
Arno Hoes ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Primary Prevention ◽  
European Society ◽  
Research Programme ◽  
European Countries ◽  
High Cardiovascular Risk ◽  
European Society Of Cardiology

Background European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V in primary care was carried out by the European Society of Cardiology EURObservational Research Programme in 2016–2018. The main objective was to determine whether the 2016 Joint European Societies’ guidelines on cardiovascular disease prevention in people at high cardiovascular risk have been implemented in clinical practice. Methods The method used was a cross-sectional survey in 78 centres from 16 European countries. Patients without a history of atherosclerotic cardiovascular disease either started on blood pressure and/or lipid and/or glucose lowering treatments were identified and interviewed ≥ 6 months after the start of medication. Results A total of 3562 medical records were reviewed and 2759 patients (57.6% women; mean age 59.0 ± 11.6 years) interviewed (interview rate 70.0%). The risk factor control was poor with 18.1% of patients being smokers, 43.5% obese (body mass index ≥30 kg/m2) and 63.8% centrally obese (waist circumference ≥88 cm for women, ≥102 cm for men). Of patients on blood pressure lowering medication 47.0% reached the target of <140/90 mm Hg (<140/85 mm Hg in people with diabetes). Among treated dyslipidaemic patients only 46.9% attained low density lipoprotein-cholesterol target of <2.6 mmol/l. Among people treated for type 2 diabetes mellitus, 65.2% achieved the HbA1c target of <7.0%. Conclusion The primary care arm of the EUROASPIRE V survey revealed that large proportions of people at high cardiovascular disease risk have unhealthy lifestyles and inadequate control of blood pressure, lipids and diabetes. Thus, the potential to reduce the risk of future cardiovascular disease throughout Europe by improved preventive cardiology programmes is substantial.

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