2013 ESH/ESC Practice Guidelines for the Management of Arterial HypertensionESH-ESC The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)

Journal of Hypertension (Impact Factor: 4.72). 02/2014; 23(1). DOI: 10.3109/08037051.2014.868629
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    • "The 2013 European guideline increased this threshold to 60 mm Hg without any justification. [25] The IDACO analyses [17] established that below age 60, a 24–h PP level of about 60 mm Hg might be associated with increased risk, but that a safe threshold could not be established. "
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    ABSTRACT: Longitudinal studies demonstrated that the risk of cardiovascular disease increased with pulse pressure (PP). However, PP remains an elusive cardiovascular risk factor with findings being inconsistent between studies. The 2013 ESH/ESC guideline proposed that PP is useful in stratification and suggested 60 mmHg as threshold, moving it up to by 10 mmHg compared with the 2007 guideline without providing any justification. Published thresholds of PP are based on office blood pressure measurement and often on arbitrary categorical analyses. In the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) and in the International Database on Home blood pressure in relation to Cardiovascular Outcome (IDHOCO), we determined outcome-driven thresholds for PP based on ambulatory or home blood pressure measurement, respectively. The main findings are that below age 60 PP does not refine risk stratification, whereas in older people the thresholds were 64 and 76 mmHg for the ambulatory and home PP, respectively. However, PP provided little added predictive value over and beyond classical risk factors.
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    • "Epidemiological studies consistently reported a predictive value of increased C-IMT for myocardial infarction and stroke, independent of traditional CV factors [10,20-25], which has been confirmed in a meta-analysis of 12 relevant general population-based studies [26]. For these reasons, C-IMT is included in the in European Society of Hypertension guidelines as target organ damage (class II, level B) in hypertensive patients [4]. However, based on the results of a single study, the MESA [27], C-IMT is no longer recommended in the 2013 ACC/AHA Guideline on the assessment of Cardiovascular Risk [28]. "
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    ABSTRACT: The identification of vascular alterations at the sub-clinical, asymptomatic stages are potentially useful for screening, prevention and improvement of cardiovascular risk stratification beyond classical risk factors. Increased intima-media thickness of the common carotid artery is a well-known marker of early atherosclerosis, which significantly correlates with the development of cardiovascular diseases. More recently, other vascular parameters evaluating both structural and functional arterial proprieties of peripheral arteries have been introduced, for cardiovascular risk stratification and as surrogate endpoints in clinical trials. Increased arterial stiffness, which can be detected by applanation tonometry as carotid-femoral pulse wave velocity, has been shown to predict future cardiovascular events and to significantly improve risk stratification. Finally, earlier vascular abnormalities such as endothelial dysfunction in the peripheral arteries, detected as reduced flow-mediated dilation of the brachial artery, are useful in the research setting and as surrogate endpoints in clinical trials and have also been suggested for their possible clinical use in the future. This manuscript will briefly review clinical evidence supporting the use of these different vascular markers for cardiovascular risk stratification, focusing on the correct methodology, which is a crucial issue to address in order to promote their use in future for routine clinical practice.
    Cardiovascular Ultrasound 08/2014; 12(1):34. DOI:10.1186/1476-7120-12-34 · 1.34 Impact Factor
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    • "According to the Bland-Altman analysis, the mean difference for intraobserver agreement (95% limits of agreement) was 0.022 (95% CI: -0.053 to 0.098) and intra-observer agreement was 0.012 (95% CI: -0.034 to 0.059). The average IMT will be considered abnormal if it measured > 0.90 mm, or if there will be atherosclerotic plaques with a diameter of 1.5 mm or a focal increase of 0.5 mm or 50% of the adjacent IMT [64]. "
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    ABSTRACT: New technologies could facilitate changes in lifestyle and improve public health. However, no large randomized, controlled studies providing scientific evidence of the benefits of their use have been made. The aims of this study are to develop and validate a smartphone application, and to evaluate the effect of adding this tool to a standardized intervention designed to improve adherence to the Mediterranean diet and to physical activity. An evaluation is also made of the effect of modifying habits upon vascular structure and function, and therefore on arterial aging.Methods/design: A randomized, double-blind, multicenter, parallel group clinical trial will be carried out. A total of 1215 subjects under 70 years of age from the EVIDENT trial will be included. Counseling common to both groups (control and intervention) will be provided on adaptation to the Mediterranean diet and on physical activity. The intervention group moreover will receive training on the use of a smartphone application designed to promote a healthy diet and increased physical activity, and will use the application for three months. The main study endpoints will be the changes in physical activity, assessed by accelerometer and the 7-day Physical Activity Recall (PAR) interview, and adaptation to the Mediterranean diet, as evaluated by an adherence questionnaire and a food frequency questionnaire (FFQ). Evaluation also will be made of vascular structure and function based on central arterial pressure, the radial augmentation index, pulse velocity, the cardio-ankle vascular index, and carotid intima-media thickness. Confirmation that the new technologies are useful for promoting healthier lifestyles and that their effects are beneficial in terms of arterial aging will have important clinical implications, and may contribute to generalize their application in favor of improved population health.Trial registration: Clinical Identifier: NCT02016014.
    BMC Public Health 03/2014; 14(1):254. DOI:10.1186/1471-2458-14-254 · 2.26 Impact Factor
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