Actualizaciones en HTA JUNIO 2022

The ESH meeting will be held in the Megaron Athens International Conference Center, located in the city centre of Athens.

Prof. Kontantinos Tsioufis
Chair, ESH 2022 Meeting

Prof. Reinhold Kreutz
President of ESH

Respecto a las ultimas publicaciones más relevantes en el campo de la HTA, habría que resaltar dos trabajos que se acaban de publicar en la revista Hypertension y que son relevantes para la práctica clínica:

1/ Mancia G, Facchetti R, Vanoli J, Dell’Oro R, Seravalle G, Grassi G. White-Coat Hypertension Without Organ Damage: Impact on Long-Term Mortality, New Hypertension, and New Organ Damage. Hypertension. 2022;79:00–00. DOI: 10.1161/HYPERTENSIONAHA.121.18792.

BACKGROUND: According to some guidelines, white-coat hypertension (WCH) carries little or no increase of cardiovascular risk in the absence of organ damage (OD), but no data are available on this issue.

METHODS: Using the population data from PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni), we evaluated cardiovascular and total mortality over a median follow-up of 29 years in WCH (elevated office and normal 24-hour or home blood pressure [BP]) and normotensive controls (normal in- and out-of-office blood pressure) with no echocardiographic left ventricular hypertrophy and no reduction of estimated glomerular filtration rate. Patients with sustained hypertension (SH, in  and out-of-office blood pressure elevation) and normotensive, WCH, and SH with cardiac and renal OD served as controls.

RESULTS: In the 1423 subjects analyzed, there were 165 cardiovascular and 526 all-cause deaths. After adjustment for confounders, no-OD WCH exhibited a risk of fatal cardiovascular events lower than that of no-OD SH but greater than that of no-ODN (hazard ratio, 2.0 [95% CI, 1.1–3.6], P=0.02), this being the case also for all-cause mortality. Compared with no-OD normotensive, no-OD WCH also exhibited a greater 10-year adjusted risk to develop new SH or OD. Similar findings

were obtained in normotensive, WCH, and SH with OD.

CONCLUSIONS: The present study provides the first evidence that WCH with no OD is accompanied by a noticeable increase in long-term risk of mortality, new hypertension, and new OD, thereby differing from normotensive.

Comentario: El término de HTA de bata blanca se usa habitualmente en sujetos no tratados para describir la situación que se produce cuando la PA en la consulta está por encima de 140/90 mmHg y la PA ambulatoria obtenida mediante MAPA está por debajo de los límites de normalidad.  Este manuscrito, basado en el seguimiento a largo plazo (29 años) de 1.423 sujetos  del estudio PAMELA, señala la importancia de revalorar el diagnóstico de HTA de bata blanca periódicamente, incluso en aquellos sujetos sin lesión inicial de órganos diana.

2/ Verdecchia P, Angeli F , Reboldi G.  Chronic Kidney Disease and Left Ventricular

Hypertrophy. Potent Modifiers of the Prognostic Impact of Circadian Blood Pressure Changes.

Hypertension. 2022;79:1028–1036. DOI: 10.1161/HYPERTENSIONAHA.122.18969.

BACKGROUND: It is unclear whether the prognostic value of blood pressure (BP) changes from day to night is modified by concomitant risk factors and organ damage.

METHODS: We studied 3247 clinically hypertensive patients who underwent off-therapy 24-hour ambulatory BP monitoring during their initial diagnostic work-up. Over a mean 9.9-year follow-up, 292 patients developed a first primary outcome event (composite of nonfatal myocardial infarction, nonfatal stroke, cardiovascular death, hospitalization for heart failure) and 281 died. The day-night BP changes were analyzed as night-to-day systolic BP ratio and included in semiparametric Cox models.

RESULTS: After allowance for age, sex, diabetes, cigarette smoking, low-density lipoprotein cholesterol, serum uric acid and average 24-hour systolic BP, the night-to-day systolic BP ratio maintained an independent association with outcome (hazard ratio, 1.17 [1.01–1.35]; P=0.041). When 2 markers of organ damage, chronic kidney disease and left ventricular hypertrophy, were added to the model, the night-to-day systolic BP ratio failed to maintain an independent association with outcome (hazard ratio, 1.19 [0.97–1.31]). The Akaike Information Criterion and the Schwarz-Bayes Information Criterion showed that, after allowance for other covariables, the night-to-day systolic BP ratio: (1) provided less information when compared with chronic kidney disease and left ventricular hypertrophy and (2) did not improve information provided by chronic kidney disease and left ventricular hypertrophy. Results were comparable on all-cause death as well as using categories of the

night-day systolic BP ratio (extreme dippers, dippers, nondippers, reverse dippers).

CONCLUSIONS: Chronic kidney disease and left ventricular hypertrophy are potent modifiers of the prognostic value of the circadian BP changes.

Comentario: Existe una amplia evidencia sobre el valor pronóstico negativo de la P nocturna elevada. La relevancia de este estudio prospectivo, llevado a cabo en 3.247 hipertensos, seguidos durante una media de  9,9 años, es que la presencia de afectación renal ( enfermedad renal crónica) o de hipertrofia ventricular izquierda podría explicar una buen parte de este peor pronóstico.