White-Coat Hypertension: Pathophysiological and Clinical Aspects: Excellence Award for Hypertension Research 2020

Few issues of modern cardiovascular medicine have been as controversial as the relationship between white-coat hypertension (WCH), that is, a common condition in which office blood pressure is elevated while out-of-office blood pressure (ambulatory blood pressure or home blood pressure) is normal. While earlier studies showed no increased risk of cardiovascular events in WCH compared with the normotensive state, more recent studies have changed this conclusion by showing that an increased cardiovascular risk represents a trait of this hypertensive phenotype. The present article will review a number of issues related to WCH, that is, its definition, pathophysiological background, clinical alterations, and prognostic significance. This will be done by considering the available evidence published during the last decades, with special focus on the data collected in PAMELA (Pressioni Arteriose Monitorate e Loro Associazioni)—a research project performed with a cross-sectional and longitudinal design, which has provided a series of novel clinical information on WCH throughout the years. The final part of the article will discuss the therapeutic implications of the abovementioned evidence, as well as some controversial or still undefined issues related to WCH, whose investigation will be an important goal to pursue by future research.

Influence fixed combination therapy on arterial stiffness and erectile function in patients with arterial hypertension

The aim – to evaluate the therapeutic efficacy and dynamics of arterial stiffness using сardio-ankle vascular index (CAVI), as well as the dynamics of erectile function in men of the generic fixed triple combination of valsartan/amlodipine/hydrochlorothiazide and a double fixed combination of valsartan/amlodipine in the treatment of patients with arterial hypertension II–III degree. Materials and methods. The study included patients with moderate and severe arterial hypertension without diabetes. Patients were divided into 2 groups by the method of envelopes of 25 each. The first group (n=25) was assigned a fixed triple combination of tablets valsartan/amlodipine/hydrochlorothiazide. The drug was administered 1 tablet (160 mg of valsartan/5 mg of amlodipine/12.5 mg of hydrochlorothiazide) once a day in the morning for 1 month. Patients in the second group (n=25) received a similar scheme of a double fixed combination of the drug valsartan/amlodipine. The drug was administered 1 tablet (160 mg of valsartan/5 mg of amlodipine) once a day in the morning for 1 month. If necessary, the target level of office blood pressure was less than 140/90 mm Hg, the dose was titrated to a daily dose of 320/10/12.5 mg (valsartan/amlodipine/hydrochlorothiazide) on a fixed triple combination and up to 320/10 mg (valsartan/amlodipine) on a fixed double combination. After 3 months of treatment there was control of therapy.Results and discussion. The study included 50 patients with moderate and severe hypertension. The average age of patients was 54.9±1.8 (25–75) years. The average BMI is 31.2±0.7 kg/m2. The average of the office of SBP and DBP at the beginning of the study were 161.7±1.8 mm Hg and 98.5±1.4 mm Hg in accordance. The office heart rate is 70.7±1.4 bpm. The decrease in the office blood pressure (SBP/DBP) was 35/19 mm Hg (р<0,05) on the double combination and 42/26 mm Hg (р<0,05) on the triple combination. Achieving target BP measurement in the office was 90.9 % – in the double combination and 95.7 % – in triple combination. In the dual combination group, withdrawal was observed in 3 (6 %) patients, in the triple combination group, withdrawal was observed in 4 (8 %) patients. There was a tendency to decrease the stiffness of the arterial wall in terms of cardio-vascular index CAVI, but there was no significant difference. CAVI right on dual therapy up to 8.68±0.57 units and after treatment 8.30±0.55 units. CAVI on the left on double therapy to 8.49±1.49 units and after treatment 8.17±1.49 units. CAVI right on triple therapy up to 8.86±0.39 units and after treatment 8.50±0.40 units from CAVI on the left in a triple combination up to 8.09±0.53 units and after treatment 8.27±0.36 units (p>0.05 for all values). No significant change in erectile function in men was detected during treatment.Conclusion. The dual (valsartan/amlodipine) and triple (valsartan/amlodipine/hydrochlorothiazide) fixed combination showed high antihypertensive efficacy, did not adversely affect metabolic disorders and erectile function in men, and inhibited the progression of stiffness.