ABCD
: Appropriate Blood pressure Control in Diabetes
ABI
: ankle–brachial index
ABPM
: ambulatory blood pressure monitoring
ACCESS
: Acute Candesartan Cilexetil Therapy in Stroke Survival
ACCOMPLISH
: Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension
ACCORD
: Action to Control Cardiovascular Risk in Diabetes
ACE
: angiotensin-converting enzyme
ACTIVE I
: Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events
ADVANCE
: Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation
AHEAD
: Action for HEAlth in Diabetes
ALLHAT
: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack
ALTITUDE
: ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints
ANTIPAF
: ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation
APOLLO
: A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People
ARB
: angiotensin receptor blocker
ARIC
: Atherosclerosis Risk In Communities
ARR
: aldosterone renin ratio
ASCOT
: Anglo-Scandinavian Cardiac Outcomes Trial
ASCOT-LLA
: Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm
ASTRAL
: Angioplasty and STenting for Renal Artery Lesions
A-V
: atrioventricular
BB
: beta-blocker
BMI
: body mass index
BP
: blood pressure
BSA
: body surface area
CA
: calcium antagonist
CABG
: coronary artery bypass graft
CAPPP
: CAPtopril Prevention Project
CAPRAF
: CAndesartan in the Prevention of Relapsing Atrial Fibrillation
CHD
: coronary heart disease
CHHIPS
: Controlling Hypertension and Hypertension Immediately Post-Stroke
CKD
: chronic kidney disease
CKD-EPI
: Chronic Kidney Disease—EPIdemiology collaboration
CONVINCE
: Controlled ONset Verapamil INvestigation of CV Endpoints
CT
: computed tomography
CV
: cardiovascular
CVD
: cardiovascular disease
D
: diuretic
DASH
: Dietary Approaches to Stop Hypertension
DBP
: diastolic blood pressure
DCCT
: Diabetes Control and Complications Study
DIRECT
: DIabetic REtinopathy Candesartan Trials
DM
: diabetes mellitus
DPP-4
: dipeptidyl peptidase 4
EAS
: European Atherosclerosis Society
EASD
: European Association for the Study of Diabetes
ECG
: electrocardiogram
EF
: ejection fraction
eGFR
: estimated glomerular filtration rate
ELSA
: European Lacidipine Study on Atherosclerosis
ESC
: European Society of Cardiology
ESH
: European Society of Hypertension
ESRD
: end-stage renal disease
EXPLOR
: Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination
FDA
: U.S. Food and Drug Administration
FEVER
: Felodipine EVent Reduction study
GISSI-AF
: Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation
HbA1c
: glycated haemoglobin
HBPM
: home blood pressure monitoring
HOPE
: Heart Outcomes Prevention Evaluation
HOT
: Hypertension Optimal Treatment
HRT
: hormone replacement therapy
HT
: hypertension
HYVET
: HYpertension in the Very Elderly Trial
IMT
: intima-media thickness
I-PRESERVE
: Irbesartan in Heart Failure with Preserved Systolic Function
INTERHEART
: Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries
INVEST
: INternational VErapamil SR/T Trandolapril
ISH
: Isolated systolic hypertension
JNC
: Joint National Committee
JUPITER
: Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin
LAVi
: left atrial volume index
LIFE
: Losartan Intervention For Endpoint Reduction in Hypertensives
LV
: left ventricle/left ventricular
LVH
: left ventricular hypertrophy
LVM
: left ventricular mass
MDRD
: Modification of Diet in Renal Disease
MRFIT
: Multiple Risk Factor Intervention Trial
MRI
: magnetic resonance imaging
NORDIL
: The Nordic Diltiazem Intervention study
OC
: oral contraceptive
OD
: organ damage
ONTARGET
: ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial
PAD
: peripheral artery disease
PATHS
: Prevention And Treatment of Hypertension Study
PCI
: percutaneous coronary intervention
PPAR
: peroxisome proliferator-activated receptor
PREVEND
: Prevention of REnal and Vascular ENdstage Disease
PROFESS
: Prevention Regimen for Effectively Avoiding Secondary Strokes
PROGRESS
: Perindopril Protection Against Recurrent Stroke Study
PWV
: pulse wave velocity
QALY
: Quality adjusted life years
RAA
: renin-angiotensin-aldosterone
RAS
: renin-angiotensin system
RCT
: randomized controlled trials
RF
: risk factor
ROADMAP
: Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention
SBP
: systolic blood pressure
SCAST
: Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke
SCOPE
: Study on COgnition and Prognosis in the Elderly
SCORE
: Systematic COronary Risk Evaluation
SHEP
: Systolic Hypertension in the Elderly Program
STOP
: Swedish Trials in Old Patients with Hypertension
STOP-2
: The second Swedish Trial in Old Patients with Hypertension
SYSTCHINA
: SYSTolic Hypertension in the Elderly: Chinese trial
SYSTEUR
: SYSTolic Hypertension in Europe
TIA
: transient ischaemic attack
TOHP
: Trials Of Hypertension Prevention
TRANSCEND
: Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease
UKPDS
: United Kingdom Prospective Diabetes Study
VADT
: Veterans' Affairs Diabetes Trial
VALUE
: Valsartan Antihypertensive Long-term Use Evaluation
WHO
: World Health Organization

### 1.1 Principles

The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

/pdf/2013-esh-esc-guidelines-for-the-management-of-arterial-4ydvs5ifsx.pdf

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

https://caltcm.memberclicks.net/assets/documents/acc_aha_chf_2013_guidelines.pdf

2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

Because of new evidence on several diagnostic and therapeutic aspects of hypertension, the present guidelines differ in many respects from the previous ones. Some of the most important differences are listed below: 
1. Epidemiological data on hypertension and BP control in Europe. 
2. Strengthening of the prognostic value of home blood pressure monitoring (HBPM) and of its role for diagnosis and management of hypertension, next to ambulatory blood pressure monitoring (ABPM). 
3. Update of the prognostic significance of night-time BP, white-coat hypertension and masked hypertension. 
4. Re-emphasis on integration of BP, cardiovascular (CV) risk factors, asymptomatic organ damage (OD) and clinical complications for total CV risk assessment. 
5. Update of the prognostic significance of asymptomatic OD, including heart, blood vessels, kidney, eye and brain. 
6. Reconsideration of the risk of overweight and target body mass index (BMI) in hypertension. 
7. Hypertension in young people. 
8. Initiation of antihypertensive treatment. More evidence-based criteria and no drug treatment of high normal BP. 
9. Target BP for treatment. More evidence-based criteria and unified target systolic blood pressure (SBP) (<140 mmHg) in both higher and lower CV risk patients. 
10. Liberal approach to initial monotherapy, without any all-ranking purpose. 
11. Revised schema for priorital two-drug combinations. 
12. New therapeutic algorithms for achieving target BP. 
13. Extended section on therapeutic strategies in special conditions. 
14. Revised recommendations on treatment of hypertension in the elderly. 
15. Drug treatment of octogenarians. 
16. Special attention to resistant hypertension and new treatment approaches. 
17. Increased attention to OD-guided therapy. 
18. New approaches to chronic management of hypertensive disease

/pdf/2013-esh-esc-guidelines-for-the-management-of-arterial-4eubk4p0u3.pdf

2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)

2018 ESC/ESH Guidelines for the management of arterial hypertension.

IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040.

by two researchers and 28 eligible studies identified. Ecologic estimates of mean total cholesterol, LDL, HDL, and triglycerides were computed by linear regression, adjusting for participants’ mean age, year of data collection and geographical coverage. results: In 2005, the mean total cholesterol at 50 years of age was 215 mg/dL [95% confidence interval (95%CI): 210 to 219] among women and 219 mg/dL (95%CI: 206 to 232) among men. Between 1985 and 2005, the mean adjusted variation in total cholesterol per calendar year was 0.4 mg/dL (95%CI: -0.3 to 1.2) among women and -0.1 mg/dL (95%CI: -0.6 to 0.4) among men. Data on LDL, HDL and triglycerides covered a much narrower period, precluding analysis of time trends. In 2001 the adjusted mean levels of LDL, HDL and triglycerides were 132 mg/dL, 59 mg/dL and 111 mg/dL, respectively, among women, and 132 mg/dL, 49 mg/ dL and 150 mg/dL, respectively, among men. conclusions: Estimated mean cholesterol, respective fractions, and prevalence of dyslipidaemia suggest a high proportion of high-risk subjects in the Portuguese population. Between 1985 and 2005, mean total cholesterol did not vary significantly.

Dyslipidaemia, and Mean Blood Cholesterol and Triglycerides Levels in the Portuguese Population: a Systematic Review

Background 
Most migrant studies have compared health characteristics between migrants and nationals of the host country. We aimed at comparing health characteristics of migrants with nationals from their home country.


Methods 
Portuguese national health survey (2005-6; 30,173 participants aged 18-75 years) and four national health surveys conducted in Switzerland (2002, 2004, 2007 and 2011, totalling 1,170 Portuguese migrants of the same age range). Self-reported data on length of stay, cardiovascular risk factors, healthcare use and health status were collected.


Results 
Resident Portuguese were significantly older and more educated than migrants. Resident Portuguese had a higher mean BMI and prevalence of obesity than migrants. Resident Portuguese also reported more frequently being hypertensive and having their blood pressure screened within the last year. On the contrary, migrant Portuguese were more frequently smokers, had a medical visit in the previous year more frequently and self-rated their health higher than resident Portuguese. After adjustment for age, gender, marital status and education, migrants had a higher likelihood of smoking, of having a medical visit the previous year, and of self-rating their current health as good or very good than resident Portuguese. Compared to Portuguese residents, cholesterol screening in the previous year was more common only among migrants living in Switzerland for more than 17 years.


Conclusion 
Portuguese migrants in Switzerland do not differ substantially from resident Portuguese regarding most cardiovascular risk factors. Migrants consider themselves healthier than Portuguese residents and more often had a recent medical visit.

/pdf/portuguese-migrants-in-switzerland-healthcare-and-health-53pmfcrx49.pdf

Portuguese Migrants in Switzerland: Healthcare and Health Status Compared to Portuguese Residents

Objectives To estimate cardiac rehabilitation (CR) referral and participation rates among patients with acute coronary syndrome (ACS) and to identify their determinants, in two Portuguese regions. Design Prospective cohort study. Setting Patients consecutively admitted to the cardiology department of two hospitals, one in the district of Porto and one in the north-east region (NER) of Portugal, were enrolled in the EPIHeart cohort and then followed up for 6 months. Participants Between August 2013 and December 2014, 939 patients were included in the cohort, and 853 were re-evaluated at 6-month follow-up. Outcome measures Referral rate was defined as the proportion of eligible patients who were referred to a CR programme, whereas participation rate was defined as the proportion of eligible patients who completed a CR programme, as was recommended by their physicians. Results Patients referred were 32.3% and 10.7% of those eligible in Porto and NER, respectively. In both regions, referral to CR decreased with age and with longer travel times to CR centres and increased with education or social class. At follow-up, 128 patients from Porto (26.2% of those eligible and 81.0% of those referred) and 26 from NER (7.1% of those eligible and 66.7% of those referred) reported actually participating in a CR programme. In Porto, the main barriers to participation were the long time until a programme was available and lack of perceived benefit. Patients in NER identified distance to CR and costs as the main barriers. Conclusions CR remains clearly underused in Portugal, with major inequalities in access between regions. Achieving equitable and greater use of CR requires a multilevel approach addressing barriers related to healthcare system, providers and patients in order to improve provision, referral and participation.

https://bmjopen.bmj.com/content/bmjopen/8/1/e018934.full.pdf

Inequalities in access to cardiac rehabilitation after an acute coronary syndrome: the EPiHeart cohort.

INTRODUCTION The aim of this study was to identify determinants of plasma B-type natriuretic peptide (BNP) levels at the population level. METHODS In a cross-sectional study, the authors evaluated 559 community subjects aged > or = 45 years. The association between plasma BNP concentration and the hypothesized determinants was assessed by linear regression using the natural logarithm of BNP plasma concentration as the dependent variable and separate models for each gender. RESULTS Plasma BNP was significantly higher in women. BNP increased with age, more steeply in men than women (p < 0.05 for the interaction). In univariate analysis, BNP was associated with left ventricular systolic dysfunction (LVSD), moderate to severe valvular abnormalities, left atrial diameter/body surface area, left ventricular mass index, systolic blood pressure, lower creatinine clearance and jugular venous distension. In women it was also associated with left ventricular end-diastolic diameter/body surface area and atrial fibrillation, and in men with changes in the segmental wall motion index. The final multivariate models included age, LVSD and left atrial size as significant independent determinants of BNP level, explaining 16.8% and 32.3% of BNP variability in women and men respectively. CONCLUSION The association between BNP and left atrial size independently of systolic dysfunction suggests that BNP might reflect subclinical diastolic abnormaltes. False positive BNP levels for the diagnosis of left ventricular systolic dysfunction and heart failure are probably due to high BNP levels in people with cardiac abnormalities not detected by echocardiography.

Demographic, clinical and echocardiographic determinants of B-type natriuretic peptide plasma concentration. A population-based study.

OBJECTIVE To retrospectively investigate the association between short stature and increased sitting height ratio (SHR) - indicators of stunting - and obesity markers in adults. DESIGN Cross-sectional evaluation of the EPIPorto cohort. Weight, height, sitting height and waist circumference were measured. Obesity was assessed for men and women through BMI and waist-to-height ratio (WHtR). Short stature (women, <152 cm; men, <164 cm) and high SHR (women, ≥54·05 %; men, ≥53·25 %) were taken as stunting measures. OR with 95 % CI were computed using logistic regression models. SETTING Representative sample of adults from EPIPorto, an adult cohort study from Porto, Portugal. SUBJECTS A sample of 1682 adults, aged 18-86 years, was analysed. RESULTS Higher obesity prevalence was found among women (BMI≥30·0 kg/m2: 25·5 v. 13·3 %, P<0·001) and a higher proportion of men presented abdominal obesity (WHtR≥0·5: 80·1 v. 71·1 %, P<0·001). A positive association was found between short stature and obesity measures for women (multivariate-adjusted OR; 95 % CI: 1·75; 1·17, 2·62 for BMI≥30·0 kg/m2; 1·89; 1·24, 2·87 for WHtR≥0·5). Increased SHR was associated with higher likelihood of having BMI≥30·0 kg/m2 in both sexes (multivariate-adjusted OR; 95 % CI: 2·10; 1·40, 3·16 for women; 1·92; 1·07, 3·43 for men) but not with WHtR≥0·5. CONCLUSIONS Different growth markers are associated with obesity in adults. However, this association depends on the population and anthropometric measures used: short stature is associated with a higher risk of presenting excessive weight in women but not in men; SHR is more sensitive to detect this effect in both sexes.

/pdf/the-influence-of-stunting-on-obesity-in-adulthood-results-w3ehp54x4h.pdf

Ana Azevedo

Papers

Dyslipidaemia, and Mean Blood Cholesterol and Triglycerides Levels in the Portuguese Population: a Systematic Review

Portuguese Migrants in Switzerland: Healthcare and Health Status Compared to Portuguese Residents

Inequalities in access to cardiac rehabilitation after an acute coronary syndrome: the EPiHeart cohort.

Demographic, clinical and echocardiographic determinants of B-type natriuretic peptide plasma concentration. A population-based study.

The influence of stunting on obesity in adulthood: results from the EPIPorto cohort.