European Society of Hypertension

About: European Society of Hypertension is a other organization based out in Milan, Italy. It is known for research contribution in the topics: Blood pressure & Ambulatory blood pressure. The organization has 146 authors who have published 167 publications receiving 20150 citations.

The changing landscape of thromboprophylaxis for atrial fibrillation: insights from the ISPAF-2 survey.

Abstract: Atrial fibrillation is the most common sustained cardiac dysrhythmia. It represents a major public health problem due to increased mortality risk, reduced quality of life, and increased health costs [1, 2]. The prevalence of nonvalvular atrial fibrillation (AF) continues to increase worldwide, largely affecting the elderly, but also occurring in younger patients as a result of structural heart disease, autonomic imbalance, genetic abnormality, or previous cardiac surgery [3]. The rise in prevalence of AF is largely due to the increasing age of the population. About 1–2% of the total population is affected by AF, but the prevalence of this condition rises to ≈ 10% in individuals aged > 75 years [1–3]. In Europe, the number of adults with AF is rising markedly, with 9 million affected individuals in 2010, and 17 million expected patients in 2050, with an alarming impact on morbidity and mortality [4]. The associated fivefold risk of stroke is one of the most feared complications of AF. It is worth noting that AF accounts for at least 25% of the one million strokes that occur every year in Europe [4]. The true prevalence of AF is probably higher than that indicated by current statistics because prolonged electrocardiographic monitoring may detect clinically silent AF in a variable proportion of subjects who present in sinus rhythm [5]. Despite major advances in the understanding of the diverse pathogenesis, electrophysiological mechanisms, and triggering factors contributing to AF, the management of this dysrhythmia is still palliative in most cases. It consists of pharmacological therapy aimed at either maintenance of sinus rhythm or merely ventricular rate control and lifelong anticoagulation prophylaxis [1, 2]. In particular, oral anticoagulation (OAC) is recommended to reduce the risk of stroke associated with nonvalvular atrial fibrillation (NVAF) in patients at moderate to high risk of thromboembolism [1, 2]. Vitamin K antagonists (VKA), such as warfarin, have been regarded as the standard of care to reduce this increased risk of stroke [1, 2] and subsequent morbidity and mortality. However, prescribing physicians and patients using VKA are well aware of its many limitations, such as delayed onset of action, narrow therapeutic window, need for frequent and regular blood monitoring, frequent dose adjustments, and myriad drug and food interactions, all of which may contribute to underuse of VKA therapy, thereby exposing patients to risk of thromboembolic complications [1, 2, 6, 7]. Even in the monitored setting of randomized trials, anticoagulation with VKA has been unreliable. The ROCKET AF (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) trial reports the VKA arm to be within the therapeutic range of the international normalized ratio only 55% of the time [8]. OAC therapy for NVAF has been revolutionized by the introduction in clinical practice of direct or new oral anticoagulants (DOACs or NOACs), such as dabigatran, rivaroxaban, apixaban and edoxaban, as alternatives to dose-adjusted VKA [9–12]. Meta-analyses of randomized controlled trials [9] as well as observational data [10] document the efficacy and real-life effectiveness of these agents. NOACs, although more expensive than VKA, have the added benefit of favourable pharmacology resulting in convenience for patients, with rapid onset of action, fixed dosing, no laboratory monitoring, and fewer food and drug interactions [1, 2, 11, 12]. It is conceivable that DOAC availability may increase the rate of OAC use for NVAF. A few studies address this issue, reporting almost invariably an increase in the overall numbers of OAC prescriptions, * Giuseppe Mulè’ giuseppe.mule@unipa.it

Obesity and hypertension in cardiac hypertrophy: two sides of the same coin?

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Unexpected severe native aortic subacute endocarditis due to Bartonella quintana in a 40-year-old woman with good socioeconomic condition.

Abstract: We report a case of a severe Bartonella quintana endocarditis in a 40-year-old woman, with a history of moderate aortic regurgitation. She was employed in a private school, and had good socioeconomic condition. She reported of arthralgia and palpitation for a few months, neither symptoms of heart failure nor fever. A systematic transthoracic echocardiography was performed, followed by a transoesophageal echocardiography, which revealed a severe aortic regurgitation and a large aortic vegetation (20 mm, figure 1A, B). There were splenic and renal infarctions seen on CT scan. A parenteral combination of amoxicillin, …