Main issues in the treatment of hypertension are the low level of blood pressure (BP) control and the economic burden for health care systems. Mobile application with telemonitoring of BP could contribute to better control and lower costs by reducing office visits. This could be useful nowadays with difficult access to health system due to covid-19. The purpose of this study was to investigate if an innovative management strategy of hypertension, such as the use of ESH care application for smartphones combined with a dedicated platform, could improve hypertension control and replace frequent office visits.30 uncontrolled hypertensive patients, treated or untreated [mean age 53 ± 9 years, mean office BP (OBP) 146.3 ± 6.2 / 92.5 ± 9 mmHg, 53% men, 33% smokers, 23% with hypercholesterolemia] were randomized to the application assisted strategy (AAS) (17 patients), where a mobile phone application was offered to communicate home BP measurements (HBPm), or to regular office visits (13 patients). Patients' BP measurements (HBPm for AAS and OBP for standard care group) were evaluated in 1 and 3 months with treatment titration if uncontrolled. In all patients OBP and ambulatory BP measurement (ABPM) were evaluated in 6 months.In both groups the reduction in OBP and ABPM was significant in 6 months. In the AAS group the reduction in systolic/diastolic OBP and 24 h systolic/diastolic BP in 6 months was -26.5 ± 5.6 / -19.4 ± 8.2 mmHg (p < 0,001) and -19.6 ± 7.7 / -13.8 ± 4.8 mmHg (p < 0.001), respectively. In the standard care group, the reduction in systolic/diastolic OBP and 24 h systolic/diastolic BP in 6 months was -22.6 ± 9.7 / -9.6 ± 11 mmHg (p < 0.005) and-18.4 ± 6.0 / - 8.8 ± 4.4 mmHg (p < 0.001). In AAS group compared to standard care group there was a greater reduction in 24 h diastolic BP (-13.8 ± 4.8 mmHg vs -8.8 ± 4.4 mmHg, p = 0.016) and in diastolic OBP (-19.4 ± 8.2 mmHg vs -9.6 ± 11.0 mmHg, p = 0.04).The present results indicate that the monitoring of patients through a mobile health tool could be useful in hypertension management as it is correlated with better BP control compared to office visits. The trial is still enrolling patients.
Objective: Currently, evidence on the prognosis of patients with hypertensive crises (HC) and resistant hypertension (RH) is limited. The purpose of our study was to register the prevalence, and clinical phenotype of patients with HC admitted to the emergency department (ED) and a 12-month follow-up to record cardiovascular outcomes in a Greek tertiary hospital. Design and method: The study population included patients visiting the ED with acute an increase in blood pressure (BP) (systolic BP > or = 180mmHg and/or diastolic BP > or = 120mmHg). HC patients were classified as hypertensive emergencies or urgencies depending on the presence or absence of acute hypertension-mediated organ damage, respectively. In all patients, the baseline characteristics were registered for 12 consecutive months. After stratification of the HC population by RH (excluding non-adherence to medication as a cause for HC), we created two subgroups, those with and without RH. Finally, we compared outcomes (composite endpoint of deaths or hospitalizations from cardiovascular causes) by RH during a 12-month follow-up. Results: Out of 38,589 patients assessed in the ED, 353(0.91%) had HC, of whom 256 had hypertensive urgencies, and 97 had emergencies. The clinical status of 81 patients was not available during follow-up. The mean age of the remaining HC patients was 68±13 years, 49.6% were males, and 80.3% had a history of hypertension (58 patients had RH). More patients with RH had composite events (27.6% vs. 12.8%, p<0.001), deaths (10.3% vs. 0.6%, p = 0.002), and hospitalizations (27.6% vs. 12.1%, p<0.001) from a cardiovascular cause. RH vs. non-RH phenotype was associated with OR 1.437 (95% CI 1.006-2.012) after adjustment for confounders. Conclusions: RH is an independent risk factor of increased cardiovascular risk in patients with HC.
Objective: The purpose of our registry was to record the prevalence, clinical characteristics and management of patients with hypertensive urgencies (HU) and emergencies (HE) assessed in the emergency department and during hospitalization in a Greek General Hospital for a period of 12 months. Design and method: The study population consisted of patients presenting at the emergency department with acute increase in blood pressure (BP)systolic BP > or =180 mmHg and/or diastolic BP > or =120 mmHg and depending on the presence or absence of acute hypertension-mediated target organ damage, participants were divided into the HE and the HU group, respectively. In all patients the demographic, clinical and therapeutic parameters were recorded for 12 months. Results: Out of 38589 patients assessed in the ED during a period of 12 months, 353 (0.91%) had HU and HE, out of which 254 (72%) had HU and 99 (28%) had HE. The mean age of the patients was 67.4 ± 12.9 years, 49% were males and 80% had history of hypertension. Patients with HE compared to those with HU had higher systolic BP levels in the emergency department(200 ± 21 vs 194 ± 18 mmHg, p = 0.024) as well as heart rate(94 ± 20 vs 81 ± 16bpm, p < 0.0001), while there were no differences in diastolic BP (p = NS). Moreover, patients with HE compared to HU were older (72.7 ± 12.1 vs 61.4 ± 12.7 years, p < 0.0001), had lower hematocrit (39.2 ± 5.5 vs 42.5 ± 4.5%, p < 0.0001)and more increased creatinine values (1.5 ± 1.3 vs 0.9 ± 0.3 mg/dl, p < 0.0001). From the total population91 patients with HE and 25with HU were admitted in the hospital and remained for 6.4 ± 5.6 days. During hospitalization there was an increase of serum creatinine by 0.11 ± 0.45 mg/dl, and a decrease of high sensitivity troponin by 99.65 ± 840.15pg/ml. Finally, a reduction in both systolic BP by 12 ± 23 mmHg and diastolic BP by 6 ± 13 mmHg were observed from admission until hospital discharge. Conclusions: Our 12 months registry presents the current clinical phenotype of HU and HE as well as the alterations in biochemical and hemodynamic data during hospitalization. These findings emphasize the need for further research in this setting.
Objective: A hypertensive response during exercise has been associated with adverse cardiovascular outcomes in general population and hypertensive patients. On the other hand, microcirculation is the major site of control of vascular resistance and thus has a key role in the etiopathogenesis of hypertension. The aim of our study was to investigate the presence of a possible correlation between blood pressure and heart rate response during exercise with a microcirculation index (capillary rarefaction) in a cohort of hypertensive patients. Design and method: We studied 105 untreated patients with stage I-II essential hypertension (70% men, mean age: 59.5 years, mean office blood pressure: 150/92mmHg). Patients with diabetes mellitus, secondary hypertension, atherosclerotic cardiovascular disease, heart failure, significant chronic renal or pulmonary disease and any other systemic illness or orthopedic problems that would not allow maximal effort on a treadmill were excluded. All participants underwent maximal exercise testing, using the Bruce protocol, as well as nail-fold videocapillaroscopy assessment by using VideoCap 3.0 videomicroscope. Results: A significant negative correlation between diastolic BP at minute-1 of the recovery phase and capillary density expressed in capillaries/mm was revealed (Pearson's r = -0.365, p = 0.043). A significant negative correlation was also observed between capillary density and peak heart rate (Pearson's r = -0.364, p = 0.024) as well as between heart rate increase from stage 1 to 2 and capillary density Pearson's r = -0.746, p = 0.013). Our study shows that in a small cohort of hypertensive patients, capillary rarefaction was associated with a steeper increase in heart rate during exercise, as well as with a higher peak heart rate and higher diastolic blood pressure values during the recovery phase. Conclusions: These findings suggest that new indices such as capillary rarefaction may provide insights into possible autonomic dysfunction and could also be taken into account in the assessment of hypertensive patients.
Currently there are scarce epidemiological data regarding prevalence, clinical phenotype, and therapy of hypertensive urgencies (HU) and emergencies (HE). The aim of this article was to record the prevalence, clinical characteristics, and management of patients with HU and HE assessed in an emergency department (ED) of a tertiary hospital.The population consisted of patients presenting with HE and HU in the ED (acute increase in systolic blood pressure (BP) ≥ 180 mmHg and/or diastolic BP ≥120 mmHg with and without acute target organ damage, respectively). Of the 38 589 patients assessed in the ED during a 12-month period, 353 (0.91%) had HU and HE. There were 256 (72.5%) cases presented as HU and 97 (27.5%) as HE. Primary causes for both HU and HE were stress/anxiety (44.9%), increased salt intake (33.9%), and non-adherence to medication (16.2%). Patients with HU reported mainly dizziness/headache (46.8%) and chest pain (27.4%), whereas those with HE presented dyspnoea (67%), chest pain (30.2%), dizziness/headache (10.3%), and neurological disorders (8.2%). In HE, the underlying associated conditions were pulmonary oedema (58%), acute coronary syndrome (22.6%), and neurological disorders/stroke (7.2%). All HE cases were hospitalized and received intensive healthcare, including dialysis.This 1-year single-centre registry demonstrates a reasonable prevalence of HU and HE contributing to the high volume of visits to the ED. Stress, increased salt intake and non-adherence were main triggers of HE and HU. Dizziness and headache were the prevalent symptoms of HU patients while heart failure was the most common underlying disease in patients with HE.
Objective: Background: at present, few data are available on the prognosis of hypertensive emergencies and urgencies admitted to Emergency Departments (ED). The aim of our study was to evaluate the incidence of total and cardiovascular events during follow-up in hypertensive patients admitted in 2 ED in Italy and Greece with hypertensive emergencies or urgencies. Design and method: Methods: medical records of patients aged > 18 yrs, admitted to the ED with blood pressure values > = 180 mmHg (SBP) and/or > = 120 mmHg (DBP) were collected and analysed (24% of patients were classified as “hypertensive emergency” and 76 % as “hypertensive urgency”). Data in 1218 patients (556 men and 662 women, mean age 70 + 13 years) were analysed; the mean duration of follow-up after admission to the ED was 19.5 + 7 months years. Results: Results: During the follow-up cardiovascular events occurred in 148 patients (69 cardiac events, 43 cerebrovascular events). In 272 pts (22 %) a new episode of acute BP rise was recorded. A total of 87 deaths was recorded during follow-up (in 28 patients for cardiovascular causes). All cause and CV mortality were greater in patients with a previous hypertensive emergency (14.7 vs 4.7 %, chisquare p = 0.0001 and 5.8 vs 1.2% chisquare p < 0.0001 for all-cause and for CV mortality, respectively). The incidence of non fatal cardiovascular events was 10,11 and 2,11 per 100 patient-years in patients with hypertensive emergency and urgency, respectively and similar results were obtained when we considered separately the occurrence of cerebrovascular events. Conclusions: Conclusions: admission to the ED for hypertensive emergencies identifies hypertensive patients at increased risk for fatal and non fatal cardiovascular events. Our results underline the need for an accurate follow-up in patients with hypertensive emergencies and urgencies.
Objective: While there are several studies that have focused on the role of face masks in preventing airborne transmission of SARS-CoV-2, few data are available on their effects on physiological measures, and no study has examined their effects on blood pressure (BP). The purpose of our study was to investigate the effect of surgical masks on BP in drug-treated hypertensive patients who had a routine follow-up visit to a university hospital outpatient hypertension clinic. Design and method: The study included already treated hypertensive patients aged > 18 years, while the exclusion criteria were atrial fibrillation or any other arrhythmia affecting the BP measurement, an arm circumference > 42 cm, mental disorders, Parkinson disease, pregnancy, intolerance to the BP measurement method, or unwillingness to participate. A new surgical mask was provided to all participants to replace the face mask that was already in use. After the routine mask-on office BP measurement, patients were left alone and randomized to automated office BP measurement, with measurements taken after first wearing a mask for 10 min, then without wearing the mask for 10 min, and vice versa. Results: A total number of 265 patients were included in the study. Among the participants, 115 were women (43.4%), the mean age was 62 ± 12 years, and the mean office BP was 134 ± 15 / 81 ± 12 mmHg. There was no significant difference between mask-on unattended systolic BP (133 ± 15 mmHg) and mask-off unattended systolic BP (132 ± 15 mmHg) (P = 0.13) or between mask-on unattended diastolic BP (77 ± 13 mmHg) and mask-off unattended diastolic BP (76 ± 13 mmHg) (P = 0.32). Moreover, there was no difference in the heart rate (mask-on first, 69 ± 11 bpm; mask-off first, 69 ± 11 bpm, P = 0.7). Conclusions: Common surgical masks do not affect systolic/diastolic BP levels during unattended BP measurements in treated hypertensive patients.
Objective: Smokers often hesitate quitting in fear of gaining weight. Smoking is a strong risk factor for coronary artery disease (CAD), while the respective risk of body weight is less clear. We studied the prognostic ability for CAD of different combinations of smoking habits and obesity status. Design and method: We followed 1700 normal weight to moderately obese treated hypertensive patients, without a history of cardiovascular disease for a mean period of 3.6 ± 1.8 years. Current smoking at the baseline examination was recorded as smoking at least one cigarette daily. Body weight and height were measured with standardized methods and body mass index (BMI) served as the measure of obesity. Obesity was defined as a BMI> or = 30 kg/m2. Based on the smoking and obesity status, four groups were identified: non-obese/non-smokers (n = 888, 52.2% of the total population), obese/non-smokers (n = 404, 23.8%), non-obese/smokers (n = 282, 16.6%) and obese/smokers (n = 126, 7.4%). The follow-up plan involved regular visits for blood pressure and risk factor management. Endpoint of interest was coronary heart disease set as the composite of myocardial infarction or significant coronary artery stenosis revealed by angiography, or coronary revascularization procedure, and non-obese/non-smokers served as the reference group. Results: Incidence of CAD was 4.7 events per 1,000 patient-years in non-obese/non-smokers, 4.8 events per 1,000 patient-years in obese/non-smokers, 12.2 events per 1,000 patient-years in non-obese/smokers and 13.5 events per 1,000 patient-years in obese/smokers. Multivariate cox regression showed that after introducing both smoking and obesity into a model controlling for traditional risk factors, only smoking was associated with a significantly higher risk of 3.06 (CI:1.60–5.85, p = 0.001) for CAD. Unadjusted as well as adjusted for risk factors cox regression analysis revealed a similar risk for obese/nonsmokers compared to the reference group and a greater risk for non-obese/smokers and obese/smokers (HR:3.01, CI:1.36–6.63, and HR:3.81, CI:1.39–10.44 respectively for the adjusted models). Conclusions: In normal weight to moderately obese treated hypertensive patients, smoking, but not obesity, is a strong predictor of CAD. Combination of smoking with a BMI over 30Kg/m2 has the worse prognosis.
Few data have been published regarding the holistic approach of post-Covid patients, examining physical health. The purpose of our study was to examine the impact of arterial hypertension in the cardiopulmonary status of post-covid patients 3 months after the first day of infection.All participants who recovered Covid-19 infection underwent cardiorespiratory exercise using either Bruce or modified Bruce protocol where all parameters were evaluated and transthoracic echocardiogram. The population was separated into two groups based on history of hypertension. Group I (n = 29) included hypertensive subjects and Group II (n = 75) included normotensive subjects.A total of 104 patients were assessed 3 months after the onset of COVID-19 symptoms. We recorded a mean age of 49 ± 15 years, 50.5% of them were males, 8.7% had a history of coronary heart disease. Hypertensives had higher BMI (29.24 ± 24 vs 26.64 kg/m2, p < 0.01) and BSA (2.09 ± 0.25 vs. 1.95 ± 0.58, p = 0.001). They were hospitalized in higher percentage comparing to normotensives (72.4% vs. 41.3%, p < 0.01). Left atrial diameter (41 ± 6 vs. 35 ± 5.5 mm, p < 0.001) was significantly larger in hypertensives. Furthermore, A wave (79 ± 21 vs. 58 ± 18 cm/s, p < 0.001) and ratios of E/A (1.01 ± 0.42 vs. 1.28 ± 0.44, p < 0.01) and E/E' (7.3 ± 3.7 vs. 5.9 ± 4.3, p < 0.01) differed between two groups. Finally, LVEF (%) was significantly impaired in hypertensive comparing to normotesive subjects (53 ± 13% vs. 59 ± 7%). This finding was depicted in lower maximum oxygen consumption (VO2 22 ± 4.5 vs.28 ± 8 ml/kg/min, p < 0.001), metabolic equivalents (METS) at peak, 9.1 ± 3 vs. 14 ± 20, p < 0.001), maximum heart rate (maxHR 147 ± 17 vs. 165 ± 21 bpm, p < 0.001) and HR1st minute recovery (123 ± 28 vs. 138 ± 21 bpm, p: 0.02) comparing to normotensive. Systolic blood pressure (SBP, 180 ± 29 vs. 165 ± 25mmHg, p: 0.02) during the 1st minute of recovery was higher in hypertensives. Finally, the duration of exercise was significantly lower in patients with hypertension (7.3 ± 2.7 vs. 9 ± 4 min, p:0.02).the current study highlighted the negative impact of hypertension in the ability to exercise. Regardless of the disease severity, post-covid patients need a comprehensive approach for rehabilitation including the modification of risk factors like hypertension and obesity.
