Showing papers by "Sverre E. Kjeldsen published in 2019"

The global burden of hypertension exceeds 1.4 billion people: should a systolic blood pressure target below 130 become the universal standard?

Abstract: In 2010, 1.4 billion people globally had hypertension, with 14% controlled to systolic blood pressure (SBP, mmHg) below 140, which contributes to 18 million cardiovascular deaths annually. Recent hypertension guidelines endorsed SBP targets below 130 or lower for all or some hypertensive patients to

Guía ESC/ESH 2018 sobre el diagnóstico y tratamiento de la hipertensión arterial

Abstract: Autores/Miembros del Grupo de Trabajo: Bryan Williams* (coordinador de la ESC) (Reino Unido), Giuseppe Mancia* (coordinador de la ESH) (Italia), Wilko Spiering (Países Bajos), Enrico Agabiti Rosei (Italia), Michel Azizi (Francia), Michel Burnier (Suiza), Denis L. Clement (Bélgica), Antonio Coca (España), Giovanni de Simone (Italia), Anna Dominiczak (Reino Unido), Thomas Kahan (Suecia), Felix Mahfoud (Alemania), Josep Redon (España), Luis Ruilope (España), Alberto Zanchetti† (Italia), Mary Kerins (Irlanda), Sverre E. Kjeldsen (Noruega), Reinhold Kreutz (Alemania), Stephane Laurent (Francia), Gregory Y.H. Lip (Reino Unido), Richard McManus (Reino Unido), Krzysztof Narkiewicz (Polonia), Frank Ruschitzka (Suiza), Roland E. Schmieder (Alemania), Evgeny Shlyakhto (Rusia), Costas Tsioufis (Grecia), Victor Aboyans (Francia) e Ileana Desormais (Francia)

Change in Cardiorespiratory Fitness and Risk of Stroke and Death.

Abstract: Background and Purpose— Low cardiorespiratory fitness is associated with increased risk of cardiovascular disease. The present study aims to assess whether change of fitness over time has any impac...

Antihypertensive therapy prevents new-onset atrial fibrillation in patients with isolated systolic hypertension: the LIFE study

Abstract: Aims: Atrial fibrillation (AF) is associated with increased cardiovascular risk and the incidence increases with age, hypertension and left ventricular hypertrophy (LVH). Reducing in-treatment syst...

Unattended automated office vs. ambulatory blood pressure in people with high cardiovascular risk: implications for understanding the SPRINT results.

Abstract: B lood pressure (BP) has been measured as office BP, usually taken after 5min of quiet rest, in all clinical outcome trials in hypertension until recently when the Systolic Blood Pressure Intervention Trial (SPRINT) was carried out. In the publication of the main SPRINT results, it was not evident how BP had been measured [1]. Following some literature search [2], it became visible that BP in SPRINT was taken as unattended automated office blood pressure (unattended-AOBP). The more than 100 sites participating in the SPRINT Study in the USA [1,2] used the Omron 907 automated model (Omron Healthcare, Lake Forest, Ilinois, USA). Personnel were additionally trained to use the full capacity of this device by leaving the room prior to the 5min period of rest followed by the preset unattended automated measurements at 5, 6 and 7min. This is properly described in later publications including in the article reporting the subgroup data in the elderly participants [3] though a post hoc investigation in response to the debate [2] suggested that not all investigators had followed the protocol and left the room prior to BP measurement [4], or maybe some of the SPRINT investigators years later did not remember how their personnel had performed the BP measurement [4]. The SPRINT study was designed to compare outcomes in hypertensive people with high cardiovascular risk who were randomized to target office SBP less than 120 mmHg vs. less than 140 mmHg. However, until the method for BP measurement in SPRINT was clarified in detail [2], that is, the unattended approach, there was uncertainty, which BPs had been compared in the SPRINT Study. A 24-h ambulatory BP (AMBP) sub-study in SPRINT participants was particularly useful in this context [5]; it could be calculated that in SPRINT, the investigators compared office SBP of

New data on antihypertensive drugs and risk of cancer: should we worry?

Abstract: Cardiovascular disease (CVD) and cancer are the two leading causes of mortality worldwide. Over the last four decades, there has been a trend towards a decrease in age-standardized deaths due to bo...

Will we ever use angiotensin receptor neprilysin inhibition (ARNi) for the treatment of hypertension

Abstract: The Renin-Angiotensin–Aldosterone System (RAAS) is central to blood pressure (BP) control. Chronic overactivation of the RAAS occurs in a majority of cardiovascular disorders including hypertension...

SBP above 180 mmHg at moderate exercise workload increases coronary heart disease risk in healthy men during 28-year follow-up

Abstract: Objective:We investigated the association between exercise SBP at a moderate workload and long-term risk of coronary heart disease (CHD) in men who were healthy when assessed by two bicycle exercise tests 7 years apart.Methods:During 1972–1975, apparently healthy men (n = 1999) were initially enroll

Are People With Masked Hypertension Adherent to Their Antihypertensive Medication

Abstract: A study published in this issue of the journal aimed to investigate whether masked uncontrolled hypertension (MUCH [masked uncontrolled hypertension]) is attributable to nonadherence of antihypertensive medication. The investigators enrolled 184 hypertensive patients with confirmed controlled office blood pressure (BP). Adequate 24-hour ambulatory BP recordings were successful in 167 participants. MUCH was observed in 86 patients. The remaining 81 patients had adequate controlled BP, both using office and ambulatory daytime BP measurements. Adherence of antihypertensive medication was investigated in these groups of 86 and 81 patients, respectively, by detection of drugs or drug metabolites in 24-hour urine samples using high-performance liquid chromatography– tandem mass spectrometry. Five and 4 patients, respectively, were excluded because of missing urine samples. As many as 69 of the remaining 77 patients in the well-controlled patients were completely adherent to intake of antihypertensive medication, whereas 8 patients were considered partially adherent based on detection of fewer drugs in their urine specimen than what was prescribed by their physicians. Of the 81 patients with MUCH, 69 were completely adherent to the prescribed antihypertensive medications and 12 were partially adherent. None of the patients in either group were fully nonadherent. There was no statistically significant difference in complete or partial adherence between the MUCH patients and the patients with true controlled hypertension. In general, masked hypertension is associated with increased cardiovascular risk and can only be diagnosed using home or ambulatory BP measurements. In otherwise healthy people without treatment for hypertension, masked hypertension may be as frequent as 16%. Diagnosing masked hypertension is challenging as screening programs only use office BP and not ambulatory measurements. Masked hypertension is more prevalent in younger than in older individuals and in people with high normal or prehypertensive range of office BP measurements. Masked hypertension is associated with progression to sustained office hypertension, increased frequency of type-2 diabetes mellitus, and development of hypertension-mediated organ damage. The long-term risk of fatal and nonfatal cardiovascular events in patients with masked hypertension is almost as high as in patients with sustained and verified hypertension. Guidelines recommend that cardiovascular risk factors and hypertension-mediated organ damage should be monitored closely in people with masked hypertension. Lifestyle interventions should be implemented to reduce rise in BP. The impact of antihypertensive drug treatment on cardiovascular outcomes in people with masked hypertension has never been investigated. However, treatment with BP-lowering drugs must be considered, particularly when these patients have hypertension-mediated organ damage and high cardiovascular risk. MUCH is more common than expected: in the Hypertension Optimal Treatment Study, both office and home systolic BP averaged 137 mm Hg in 914 study participants on optimal drug treatment, and MUCH was present in 232 participants. MUCH also occurred in as many as 30% of treated hypertensive patients in the large Spanish Hypertension Registry and was associated with severe comorbidities including diabetes mellitus and chronic kidney disease. Poor adherence to drug treatment is a main mechanism for uncontrolled hypertension and more so in patients with severe hypertension as reviewed elsewhere. Consequently, it is relevant to investigate whether MUCH could be explained by poor adherence to antihypertensive drugs as done by Siddiqui et al. First, it is possible that poor drug adherence is not a problem in MUCH such as found in the present study. It may be that these patients need more drugs or higher doses of the drugs already prescribed to achieve ambulatory target BP <135/85 mm Hg. Second, it may be that these patients with MUCH have an altered balance of their autonomic nervous system with sympathetic overactivity in the ambulatory setting. Only about 5% of the patients referred for apparent treatment-resistant hypertension truly have drug-resistant hypertension, termed refractory hypertension, but mechanisms are not well understood in MUCH. Third, it is also possible that the current study group is not representative for the common hypertensive patients who are treated with antihypertensive medication. It may be that by selection, over long time, patients who are followed in a hypertension specialist or excellence center such as the one in Birmingham, Alabama, have learned the lessons of the danger with high cardiovascular risk and thus are fully compliant to their treatment regiments. It is even likely that such patients, satisfied with their clinic quality including their physicians, more easily volunteer to participate in a study like the present one. The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association. From the Institute for Clinical Medicine, University of Oslo, Norway (S.E.K., I.O.); and Departments of Cardiology (S.E.K.) and Nephrology (I.O.), Oslo University Hospital, Norway. Correspondence to Sverre E. Kjeldsen, Department of Cardiology, Oslo University Hospital Ullevaal, Kirkeveien 166, N-0407 Oslo, Norway. Email s.e.kjeldsen@medisin.uio.no Are People With Masked Hypertension Adherent to Their Antihypertensive Medication?

The PARAGON Heart Failure trial – ongoing investigation of the angiotensin receptor antagonist/neprilysin inhibitor sacubitril/valsartan in heart failure patients with hypertension and preserved ejection fraction

Abstract: Novel angiotensin-receptor antagonist/neprilysin inhibitors (ARNi) seek to exploit the clinical benefits of combining renin-angiotensin-aldosterone-system (RAAS) antagonism and neutral endopeptidas...

Effect of antihypertensive therapy on development of incident conduction system disease in hypertensive patients.

Abstract: BACKGROUND Previous work has demonstrated that treatment of hypertensive patients with the angiotensin-converting enzyme inhibitor lisinopril was associated with a reduced incidence of a composite conduction system disease endpoint and also left bundle branch block (LBBB) compared with chlorthalidone therapy. The relationship of incident conduction system disease to angiotensin receptor blocker therapy has not been examined. METHODS Risk of new right (RBBB) or LBBB in relation to losartan-based vs. atenolol-based treatment was assessed in 8342 hypertensive patients without baseline RBBB or LBBB. Risk of incident intraventricular conduction delay (IVCD), defined as new QRS duration at least 110 ms was assessed in the 7110 patient subset who also had baseline QRS duration less than 110 ms. QRS duration and BBB were determined on in-study ECGs done at 6 months, 1 year and then yearly. RESULTS During 4.8 ± 1.0 years follow-up, 459 patients developed new LBBB (5.5%), 184 (2.2) new RBBB and 1173 (16.5%) a new IVCD. In univariate Cox analyses, losartan-based treatment was not associated with a significantly reduced risk of either new LBBB (hazard ratio 0.95, 95% CI 0.79-1.14, P = 0.583) or RBBB (hazard ratio 1.02, 95% CI 0.76-1.36, P = 0.903), but resulted in a 15% lower risk of new IVCD (hazard ratio 0.85, 95% CI 0.76-0.95, P = 0.005). In a multivariable Cox model that adjusted for other statistically significant predictors of incident IVCD in this population (age, sex, race, history of ischemic heart disease, MI, heart failure, diabetes or atrial fibrillation, prior antihypertensive treatment, baseline total and HDL cholesterol, serum glucose and creatinine and baseline QRS duration as standard covariates and incident MI and on-treatment systolic and diastolic pressure, BMI and Cornell voltage as time-dependent covariates), losartan treatment remained associated with a 13% lower risk of new IVCD (hazard ratio 0.87, 95% CI 0.77-0.98, P = 0.021). CONCLUSION Incident IVCD, but not BBB, is significantly reduced by losartan-based treatment. Further study is warranted to assess the potential differential impact of this therapy on QRS prolongation vs. development of more discrete conduction system block. CLINICAL TRIALS REGISTRATION .

The PARAGON-Heart failure trial - another disappointment for heart failure patients with hypertension and preserved ejection fraction.

Abstract: Novel angiotensin receptor antagonist/neprilysin inhibitors (ARNIs) seek to exploit the clinical benefits of combining renin-angiotensin-aldosterone-system (RAAS) antagonism and neutral endopeptida...

Association of left bundle branch block with new onset abnormal wall motion in treated hypertensive patients with left ventricle hypertrophy: the LIFE Echo Sub-study.

Abstract: Aims: We aimed to investigate whether left bundle branch block (LBBB) is related to new-onset left ventricle (LV) wall motion abnormalities during treatment in hypertensive patients with el...

Need for multiple risk reduction strategies in clinical trials enrolling high risk patients - FOURIER investigating PCSK-9 inhibitor to lower cholesterol revisited.

Abstract: Hypertension is the most prevalent cardiovascular risk factor [1]. Many people with hypertension also have comorbid conditions or risk factors for which novel treatment strategies are being tested ...

Heart failure with preserved ejection fraction

Abstract: Heart failure with preserved ejection fraction (HFpEF) is a complex clinical condition. Initially called diastolic heart failure, it soon became clear that this condition is more than the opposite side of systolic heart failure. It is increasingly prevalent and lethal. Currently, HFpEF represents more than 50% of heart failure cases and shares a 90-day mortality and readmission rate similar to heart failure with reduced ejection fraction. Heart failure with preserved ejection fraction is best considered to be a systemic disease. From a cardiovascular standpoint, it is not just a stiff ventricle. A stiff ventricle combined with a stiff arterial and venous system account for the clinical manifestations of flash pulmonary edema and the marked changes in renal function or systemic blood pressure with minor changes in fluid volume status. No effective pharmacologic treatments are avail able for patients with HFpEF, but an approach to the musculoskeletal system has merit: the functional limitations and exercise intolerance that patients experience are largely due to abnormalities of peripheral vascular function and skeletal muscle dysfunction. Regular exercise training has strong objective evidence to support its use to improve quality of life and functional capacity for patients with HFpEF. This clinical review summarizes the current evidence on the pathophysiologic aspects, diagnosis, and management of HFpEF.

Could adverse events offset the benefit of intensive blood pressure lowering treatment in the Systolic Blood Pressure Intervention Trial

Abstract: I n recent years, there has been as increased focus on more intensive blood pressure (BP)-lowering treatment in routine follow-up of people with hypertension. In this scenario high baseline BP, in particular high SBP, visit-to-visit BP variability and treatment-induced adverse events pose challenges and may impact the benefit of treatment. Although lowering of BP prevents cardiovascular, renal and cerebral complications, the intensity of BPlowering treatment may also be related to adverse events [1], reduced efficacy and possible outweigh the benefits of the intensive BP-lowering treatment. In this issue of Journal of Hypertension Rueda-Ochoa et al. [2] assessed the impact of SBP over time or cumulative BP (defined by a statistical model integrating all SBP values in all patients) and serious adverse events on the intensive hypertension treatment efficacy in the Systolic Blood Pressure Intervention Trial (SPRINT). They used the original SPRINT database available by data request to National Heart, Lung and Blood Institute (BioLINCC repository) under the SPRINT data analysis challenge initiative, organized by The New England Journal of Medicine. Hypotension, bradycardia, falls, syncope, acute renal failure and electrolytes abnormalities were defined as serious adverse events included in the original SPRINT study. SPRINT was a randomized, controlled, open label trial performed at 102 clinical sites in the United States. Rueda-Ochoa et al. [2] included 9068 SPRINT participants with 128 139 repeated SBP measurements in their analyses. Study participants had been randomly assigned to intensive (SBP target <120 mmHg) vs. standard treatment (SBP target between 135 and 139 mmHg). Intensive treatment significantly reduced SBP by an average of 12.73 mmHg during

The Role of Drug Therapy in Lowering Mortality and Morbidity: From Established Heart Failure to High-Risk Hypertension

Abstract: Hypertension, untreated or insufficiently treated, is the most important cause of left ventricular hypertrophy, coronary heart disease, myocardial infarction, arrhythmias, and eventually cardiac failure whether left ventricular ejection fraction is reduced or preserved. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists (aldosterone antagonists) are cornerstones in the treatment of both patients with heart failure with reduced ejection fraction and high-risk hypertension as these drug classes lower morbidity and mortality. These drugs as well as calcium antagonists can safely be used in patients with preserved ejection fraction though no drug class has been shown specifically to lower mortality. Diuretic treatment is generally considered a symptomatic treatment in heart failure patients but is needed in high-risk hypertension to control the high blood pressure and prevent complications. However, for primary prevention of heart failure in hypertensive patients, the various drug classes appear equally effective.