Recent Advances in the Treatment of Hypertension

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425).

Deadline for manuscript submissions: closed (31 January 2023) | Viewed by 58497

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editor


E-Mail
Guest Editor
1. Department of Medicine and Technological Innovation, University of Insubria, 21100 Varese, Italy
2. Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, 21049 Tradate, Italy
Interests: cardiovascular risk assessment in patients with hypertension; diabetes; heart failure and coronary artery disease; evaluation of cardiovascular treatment; diagnosis and treatment of acute myocardial infarction
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Hypertension is one of the most common cardiovascular risk factors and a leading cause of morbidity, disability, and mortality worldwide.

In the last few years, significant developments in the knowledge of basic mechanisms of hypertension and its management have been accrued. However, important differences between Guidelines for the diagnosis and treatment of hypertension exist in the classification of blood pressure levels and definition of treatment goals. Thus, efforts are still mandatory to improve treatment strategies. More specifically, we should learn more about optimal blood pressure targets to be achieved in the general hypertensive population and in specific subgroups at different cardiovascular risk.

The aim of this Special Issue is to collect reviews and original articles investigating pathophysiologic, diagnostic, and therapeutic aspects related to the management of hypertensive patients.

Prof. Dr. Fabio Angeli
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • blood pressure
  • hypertension
  • treatment
  • cardiovascular risk
  • prognosis

Published Papers (12 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Editorial

Jump to: Research, Review, Other

3 pages, 198 KiB  
Editorial
New Perspectives and Strategies for the Management of Hypertension
by Fabio Angeli
J. Cardiovasc. Dev. Dis. 2023, 10(8), 346; https://doi.org/10.3390/jcdd10080346 - 14 Aug 2023
Viewed by 1370
Abstract
Hypertension is the leading preventable risk factor for cardiovascular disease and all-cause mortality worldwide [...] Full article
(This article belongs to the Special Issue Recent Advances in the Treatment of Hypertension)

Research

Jump to: Editorial, Review, Other

13 pages, 2346 KiB  
Article
Effectiveness of the Combination of Enalapril and Nifedipine for the Treatment of Hypertension versus Empirical Treatment in Primary Care Patients
by Humberto Badillo-Alonso, Marisol Martínez-Alanis, Ramiro Sánchez-Huesca, Abel Lerma and Claudia Lerma
J. Cardiovasc. Dev. Dis. 2023, 10(6), 243; https://doi.org/10.3390/jcdd10060243 - 31 May 2023
Cited by 1 | Viewed by 4043
Abstract
Hypertension in Mexico has a prevalence of 32% and is the second most widespread cause of consultation in primary care. Only 40% of patients in treatment have a blood pressure (BP) below 140/90 mmHg. This clinical trial aimed to compare the effectiveness of [...] Read more.
Hypertension in Mexico has a prevalence of 32% and is the second most widespread cause of consultation in primary care. Only 40% of patients in treatment have a blood pressure (BP) below 140/90 mmHg. This clinical trial aimed to compare the effectiveness of the combination of enalapril and nifedipine versus the empirical treatment for hypertension in patients with uncontrolled BP in a primary care center in Mexico City. Participants were randomized to treatment with enalapril and nifedipine (combination group) or to continue with the empirical treatment. Outcome variables were BP control, therapeutic adherence, and adverse effects at 6 months of follow-up. At the end of the follow-up period, BP control (64% versus 77%) and therapeutic adherence (53% versus 93%) showed an improvement from the baseline values in the group that received the combination treatment. BP control (51% versus 47%) and therapeutic adherence (64% versus 59%) in the group who received the empirical treatment did not show improvement from the baseline to follow-up. Combined treatment was 31% more efficacious than conventional empirical treatment (odds ratio = 3.9), which yielded an incremental clinical utility of 18% with high tolerability extent among patients in primary care in Mexico City. These results contribute to the control of arterial hypertension. Full article
(This article belongs to the Special Issue Recent Advances in the Treatment of Hypertension)
Show Figures

Figure 1

16 pages, 501 KiB  
Article
H-Type Hypertension among Black South Africans and the Relationship between Homocysteine, Its Genetic Determinants and Estimates of Vascular Function
by Jacomina P. du Plessis, Leandi Lammertyn, Aletta E. Schutte and Cornelie Nienaber-Rousseau
J. Cardiovasc. Dev. Dis. 2022, 9(12), 447; https://doi.org/10.3390/jcdd9120447 - 9 Dec 2022
Cited by 4 | Viewed by 1827
Abstract
Elevated homocysteine (Hcy) increases cardiovascular disease (CVD) risk. Our objective was to emphasize Hcy’s contribution in hypertension and CVD management by determining H-type hypertension (hypertension with Hcy ≥ 10 µmol/L) and associations between Hcy, blood pressure (BP) and estimates of vascular function among [...] Read more.
Elevated homocysteine (Hcy) increases cardiovascular disease (CVD) risk. Our objective was to emphasize Hcy’s contribution in hypertension and CVD management by determining H-type hypertension (hypertension with Hcy ≥ 10 µmol/L) and associations between Hcy, blood pressure (BP) and estimates of vascular function among Black South Africans. We included 1995 adults (63% female). Plasma Hcy and cardiovascular measures (systolic and diastolic BP (SBP, DBP), pulse pressure, heart rate (HR), carotid-radialis pulse wave velocity (cr-PWV), intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1) were quantified. Five Hcy-related polymorphisms (cystathionine β-synthase (CBS 844ins68, T833C, G9276A); methylenetetrahydrofolate reductase (MTHFR C677T) and methionine synthase (MTR A2756G)) were genotyped. Hcy was >10 µmol/L in 41% (n = 762), and of the 47% (n = 951) hypertensives, 45% (n = 425) presented with H-type. Hcy was higher in hypertensives vs. normotensives (9.86 vs. 8.78 µmol/L, p < 0.0001, effect size 0.56) and correlated positively with SBP, DBP, cr-PWV and ICAM-1 (r > 0.19, p < 0.0001). Over Hcy quartiles, SBP, DBP, HR, cr-PWV and ICAM-1 increased progressively (all p-trends ≤ 0.001). In multiple regression models, Hcy contributed to the variance of SBP, DBP, HR, cr-PWV and ICAM-1. H-type hypertensives also had the lowest MTHFR 677 CC frequency (p = 0.03). Hcy is positively and independently associated with markers of vascular function and raised BP. Full article
(This article belongs to the Special Issue Recent Advances in the Treatment of Hypertension)
Show Figures

Graphical abstract

8 pages, 1585 KiB  
Article
Cardio-Ankle Vascular Index as an Arterial Stiffness Marker Improves the Prediction of Cardiovascular Events in Patients without Cardiovascular Diseases
by Yuko Okamoto, Toru Miyoshi, Keishi Ichikawa, Yoichi Takaya, Kazufumi Nakamura and Hiroshi Ito
J. Cardiovasc. Dev. Dis. 2022, 9(11), 368; https://doi.org/10.3390/jcdd9110368 - 25 Oct 2022
Cited by 6 | Viewed by 1544
Abstract
Several studies have reported that the cardio-ankle vascular index (CAVI), a non-invasive measurement of arterial stiffness, is associated with the incidence of cardiovascular events. We investigated whether adding CAVI to a risk score improves the prediction of cardiovascular events in the setting of [...] Read more.
Several studies have reported that the cardio-ankle vascular index (CAVI), a non-invasive measurement of arterial stiffness, is associated with the incidence of cardiovascular events. We investigated whether adding CAVI to a risk score improves the prediction of cardiovascular events in the setting of primary prevention. This retrospective observational study included consecutive 554 outpatients with cardiovascular disease risk factors but without known cardiovascular disease (68 ± 9 years, 64% men). The CAVI was measured using the VaSera vascular screening system. Major adverse cardiovascular events (MACE) included cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure, and coronary revascularization. During a median follow-up of 4.3 years, cardiovascular events occurred in 65 patients (11.7%). Multivariate Cox analysis showed that abnormal CAVI (>9.0) was significantly associated with the incidence of MACE (hazard ratio 2.31, 95% confidence interval 1.27–4.18). The addition of CAVI to the Suita score, a conventional risk score for coronary heart disease in Japan, significantly improved the C statics from 0.642 to 0.713 (p = 0.04). In addition to a conventional risk score, CAVI improved the prediction of cardiovascular events in patients with cardiovascular disease risk factors but without known cardiovascular diseases. Full article
(This article belongs to the Special Issue Recent Advances in the Treatment of Hypertension)
Show Figures

Figure 1

12 pages, 622 KiB  
Article
Effectiveness of High-Intensity Interval Training and Continuous Moderate-Intensity Training on Blood Pressure in Physically Inactive Pre-Hypertensive Young Adults
by Anil T John, Moniruddin Chowdhury, Md. Rabiul Islam, Imtiyaz Ali Mir, Md Zobaer Hasan, Chao Yi Chong, Syeda Humayra and Yukihito Higashi
J. Cardiovasc. Dev. Dis. 2022, 9(8), 246; https://doi.org/10.3390/jcdd9080246 - 3 Aug 2022
Cited by 3 | Viewed by 3200
Abstract
The likelihood of pre-hypertensive young adults developing hypertension has been steadily increasing in recent years. Despite the fact that aerobic exercise training (AET) has demonstrated positive results in lowering high blood pressure, the efficacy of different types of AET among pre-hypertensive young adults [...] Read more.
The likelihood of pre-hypertensive young adults developing hypertension has been steadily increasing in recent years. Despite the fact that aerobic exercise training (AET) has demonstrated positive results in lowering high blood pressure, the efficacy of different types of AET among pre-hypertensive young adults has not been well-established. The objective of this study was to evaluate the effectiveness of high-intensity interval training (HIIT) and continuous moderate-intensity training (CMT) on the blood pressure (BP) of physically inactive pre-hypertensive young adults. In total, 32 adults (age 20.0 ± 1.1 years and BMI 21.5 ± 1.8) were randomly assigned to three groups: HIIT, CMT and control (CON). The HIIT and CMT groups participated in 5 weeks of AET, while the CON group followed a DASH diet plan only. The HIIT protocol consisted of a 1:4 min work to rest ratio of participants, at an 80–85% heart rate reserve (HR-reserve) and a 40–60% HR-reserve, respectively, for 20 min; the CMT group exercised at 40–60% of their HR-reserve continuously for 20 min. In both the HIIT and CMT groups, systolic blood pressure (SBP) (3.8 ± 2.8 mmHg, p = 0.002 vs. 1.6 ± 1.5 mmHg, p = 0.011) was significantly reduced, while significant reductions in the diastolic blood pressure (DBP) (2.9 ± 2.2 mmHg, p = 0.002) and mean arterial pressure (MAP) (3.1 ± 1.6 mmHg, p < 0.0005) were noted only in the HIIT group. No significant differences in SBP (−0.4 ± 3.7 mmHg, p = 0.718), DBP (0.4 ± 3.4 mmHg, p = 0.714), or MAP (0.1 ± 2.5 mmHg, p = 0.892) were observed in the CON group. Both HIIT and CMT decreased BP in physically inactive pre-hypertensive young adults; however, HIIT yielded more beneficial results in terms of reducing the SPB, DBP and MAP. Full article
(This article belongs to the Special Issue Recent Advances in the Treatment of Hypertension)
Show Figures

Figure 1

12 pages, 1167 KiB  
Article
Renin Angiotensin System Blockers and Risk of Mortality in Hypertensive Patients Hospitalized for COVID-19: An Italian Registry
by Fabio Angeli, Paolo Verdecchia, Antonella Balestrino, Claudio Bruschi, Piero Ceriana, Luca Chiovato, Laura Adelaide Dalla Vecchia, Francesco Fanfulla, Maria Teresa La Rovere, Francesca Perego, Simonetta Scalvini, Antonio Spanevello, Egidio Traversi, Dina Visca, Michele Vitacca and Tiziana Bachetti
J. Cardiovasc. Dev. Dis. 2022, 9(1), 15; https://doi.org/10.3390/jcdd9010015 - 6 Jan 2022
Cited by 17 | Viewed by 2712
Abstract
Background: It is uncertain whether exposure to renin–angiotensin system (RAS) modifiers affects the severity of the new coronavirus disease 2019 (COVID-19) because most of the available studies are retrospective. Methods: We tested the prognostic value of exposure to RAS modifiers (either angiotensin-converting enzyme [...] Read more.
Background: It is uncertain whether exposure to renin–angiotensin system (RAS) modifiers affects the severity of the new coronavirus disease 2019 (COVID-19) because most of the available studies are retrospective. Methods: We tested the prognostic value of exposure to RAS modifiers (either angiotensin-converting enzyme inhibitors [ACE-Is] or angiotensin receptor blockers [ARBs]) in a prospective study of hypertensive patients with COVID-19. We analyzed data from 566 patients (mean age 75 years, 54% males, 162 ACE-Is users, and 147 ARBs users) hospitalized in five Italian hospitals. The study used systematic prospective data collection according to a pre-specified protocol. All-cause mortality during hospitalization was the primary outcome. Results: Sixty-six patients died during hospitalization. Exposure to RAS modifiers was associated with a significant reduction in the risk of in-hospital mortality when compared to other BP-lowering strategies (odds ratio [OR]: 0.54, 95% confidence interval [CI]: 0.32 to 0.90, p = 0.019). Exposure to ACE-Is was not significantly associated with a reduced risk of in-hospital mortality when compared with patients not treated with RAS modifiers (OR: 0.66, 95% CI: 0.36 to 1.20, p = 0.172). Conversely, ARBs users showed a 59% lower risk of death (OR: 0.41, 95% CI: 0.20 to 0.84, p = 0.016) even after allowance for several prognostic markers, including age, oxygen saturation, occurrence of severe hypotension during hospitalization, and lymphocyte count (adjusted OR: 0.37, 95% CI: 0.17 to 0.80, p = 0.012). The discontinuation of RAS modifiers during hospitalization did not exert a significant effect (p = 0.515). Conclusions: This prospective study indicates that exposure to ARBs reduces mortality in hospitalized patients with COVID-19. Full article
(This article belongs to the Special Issue Recent Advances in the Treatment of Hypertension)
Show Figures

Figure 1

Review

Jump to: Editorial, Research, Other

15 pages, 913 KiB  
Review
Artificial Intelligence in Hypertension Management: An Ace up Your Sleeve
by Valeria Visco, Carmine Izzo, Costantino Mancusi, Antonella Rispoli, Michele Tedeschi, Nicola Virtuoso, Angelo Giano, Renato Gioia, Americo Melfi, Bianca Serio, Maria Rosaria Rusciano, Paola Di Pietro, Alessia Bramanti, Gennaro Galasso, Gianni D’Angelo, Albino Carrizzo, Carmine Vecchione and Michele Ciccarelli
J. Cardiovasc. Dev. Dis. 2023, 10(2), 74; https://doi.org/10.3390/jcdd10020074 - 9 Feb 2023
Cited by 12 | Viewed by 3960
Abstract
Arterial hypertension (AH) is a progressive issue that grows in importance with the increased average age of the world population. The potential role of artificial intelligence (AI) in its prevention and treatment is firmly recognized. Indeed, AI application allows personalized medicine and tailored [...] Read more.
Arterial hypertension (AH) is a progressive issue that grows in importance with the increased average age of the world population. The potential role of artificial intelligence (AI) in its prevention and treatment is firmly recognized. Indeed, AI application allows personalized medicine and tailored treatment for each patient. Specifically, this article reviews the benefits of AI in AH management, pointing out diagnostic and therapeutic improvements without ignoring the limitations of this innovative scientific approach. Consequently, we conducted a detailed search on AI applications in AH: the articles (quantitative and qualitative) reviewed in this paper were obtained by searching journal databases such as PubMed and subject-specific professional websites, including Google Scholar. The search terms included artificial intelligence, artificial neural network, deep learning, machine learning, big data, arterial hypertension, blood pressure, blood pressure measurement, cardiovascular disease, and personalized medicine. Specifically, AI-based systems could help continuously monitor BP using wearable technologies; in particular, BP can be estimated from a photoplethysmograph (PPG) signal obtained from a smartphone or a smartwatch using DL. Furthermore, thanks to ML algorithms, it is possible to identify new hypertension genes for the early diagnosis of AH and the prevention of complications. Moreover, integrating AI with omics-based technologies will lead to the definition of the trajectory of the hypertensive patient and the use of the most appropriate drug. However, AI is not free from technical issues and biases, such as over/underfitting, the “black-box” nature of many ML algorithms, and patient data privacy. In conclusion, AI-based systems will change clinical practice for AH by identifying patient trajectories for new, personalized care plans and predicting patients’ risks and necessary therapy adjustments due to changes in disease progression and/or therapy response. Full article
(This article belongs to the Special Issue Recent Advances in the Treatment of Hypertension)
Show Figures

Figure 1

16 pages, 331 KiB  
Review
Tight Blood Pressure Control in Chronic Kidney Disease
by Giorgio Gentile, Kathryn Mckinney and Gianpaolo Reboldi
J. Cardiovasc. Dev. Dis. 2022, 9(5), 139; https://doi.org/10.3390/jcdd9050139 - 30 Apr 2022
Cited by 4 | Viewed by 3391
Abstract
Hypertension affects over a billion people worldwide and is the leading cause of cardiovascular disease and premature death worldwide, as well as one of the key determinants of chronic kidney disease worldwide. People with chronic kidney disease and hypertension are at very high [...] Read more.
Hypertension affects over a billion people worldwide and is the leading cause of cardiovascular disease and premature death worldwide, as well as one of the key determinants of chronic kidney disease worldwide. People with chronic kidney disease and hypertension are at very high risk of renal outcomes, including progression to end-stage renal disease, and, even more importantly, cardiovascular outcomes. Hence, blood pressure control is crucial in reducing the human and socio-economic burden of renal and cardiovascular outcomes in those patients. However, current guidelines from hypertension and renal societies have issued different and sometimes conflicting recommendations, which risk confusing clinicians and potentially contributing to a less effective prevention of renal and cardiovascular outcomes. In this review, we critically appraise existing evidence and key international guidelines, and we finally formulate our own opinion that clinicians should aim for a blood pressure target lower than 130/80 in all patients with chronic kidney disease and hypertension, unless they are frail or with multiple comorbidities. We also advocate for an even more ambitious systolic blood pressure target lower than 120 mmHg in younger patients with a lower burden of comorbidities, to minimise their risk of renal and cardiovascular events during their lifetime. Full article
(This article belongs to the Special Issue Recent Advances in the Treatment of Hypertension)
18 pages, 1022 KiB  
Review
Mechanisms and Clinical Implications of Endothelial Dysfunction in Arterial Hypertension
by Pasquale Ambrosino, Tiziana Bachetti, Silvestro Ennio D’Anna, Brurya Galloway, Andrea Bianco, Vito D’Agnano, Antimo Papa, Andrea Motta, Fabio Perrotta and Mauro Maniscalco
J. Cardiovasc. Dev. Dis. 2022, 9(5), 136; https://doi.org/10.3390/jcdd9050136 - 27 Apr 2022
Cited by 34 | Viewed by 7317
Abstract
The endothelium is composed of a monolayer of endothelial cells, lining the interior surface of blood and lymphatic vessels. Endothelial cells display important homeostatic functions, since they are able to respond to humoral and hemodynamic stimuli. Thus, endothelial dysfunction has been proposed as [...] Read more.
The endothelium is composed of a monolayer of endothelial cells, lining the interior surface of blood and lymphatic vessels. Endothelial cells display important homeostatic functions, since they are able to respond to humoral and hemodynamic stimuli. Thus, endothelial dysfunction has been proposed as a key and early pathogenic mechanism in many clinical conditions. Given the relevant repercussions on cardiovascular risk, the complex interplay between endothelial dysfunction and systemic arterial hypertension has been a matter of study in recent years. Numerous articles have been published on this issue, all of which contribute to providing an interesting insight into the molecular mechanisms of endothelial dysfunction in arterial hypertension and its role as a biomarker of inflammation, oxidative stress, and vascular disease. The prognostic and therapeutic implications of endothelial dysfunction have also been analyzed in this clinical setting, with interesting new findings and potential applications in clinical practice and future research. The aim of this review is to summarize the pathophysiology of the relationship between endothelial dysfunction and systemic arterial hypertension, with a focus on the personalized pharmacological and rehabilitation strategies targeting endothelial dysfunction while treating hypertension and cardiovascular comorbidities. Full article
(This article belongs to the Special Issue Recent Advances in the Treatment of Hypertension)
Show Figures

Figure 1

17 pages, 1462 KiB  
Review
Hypertension and Arrhythmias: A Clinical Overview of the Pathophysiology-Driven Management of Cardiac Arrhythmias in Hypertensive Patients
by Jacopo Marazzato, Federico Blasi, Michele Golino, Paolo Verdecchia, Fabio Angeli and Roberto De Ponti
J. Cardiovasc. Dev. Dis. 2022, 9(4), 110; https://doi.org/10.3390/jcdd9040110 - 6 Apr 2022
Cited by 10 | Viewed by 3857
Abstract
Because of demographic aging, the prevalence of arterial hypertension (HTN) and cardiac arrhythmias, namely atrial fibrillation (AF), is progressively increasing. Not only are these clinical entities strongly connected, but, acting with a synergistic effect, their association may cause a worse clinical outcome in [...] Read more.
Because of demographic aging, the prevalence of arterial hypertension (HTN) and cardiac arrhythmias, namely atrial fibrillation (AF), is progressively increasing. Not only are these clinical entities strongly connected, but, acting with a synergistic effect, their association may cause a worse clinical outcome in patients already at risk of ischemic and/or haemorrhagic stroke and, consequently, disability and death. Despite the well-known association between HTN and AF, several pathogenetic mechanisms underlying the higher risk of AF in hypertensive patients are still incompletely known. Although several trials reported the overall clinical benefit of renin–angiotensin–aldosterone inhibitors in reducing incident AF in HTN, the role of this class of drugs is greatly reduced when AF diagnosis is already established, thus hinting at the urgent need for primary prevention measures to reduce AF occurrence in these patients. Through a thorough review of the available literature in the field, we investigated the basic mechanisms through which HTN is believed to promote AF, summarising the evidence supporting a pathophysiology-driven approach to prevent this arrhythmia in hypertensive patients, including those suffering from primary aldosteronism, a non-negligible and under-recognised cause of secondary HTN. Finally, in the hazy scenario of AF screening in hypertensive patients, we reviewed which patients should be screened, by which modality, and who should be offered oral anticoagulation for stroke prevention. Full article
(This article belongs to the Special Issue Recent Advances in the Treatment of Hypertension)
Show Figures

Figure 1

16 pages, 1315 KiB  
Review
Advances in the Treatment Strategies in Hypertension: Present and Future
by Paolo Verdecchia, Claudio Cavallini and Fabio Angeli
J. Cardiovasc. Dev. Dis. 2022, 9(3), 72; https://doi.org/10.3390/jcdd9030072 - 3 Mar 2022
Cited by 20 | Viewed by 10171
Abstract
Hypertension is the most frequent chronic and non-communicable disease all over the world, with about 1.5 billion affected individuals worldwide. Its impact is currently growing, particularly in low-income countries. Even in high-income countries, hypertension remains largely underdiagnosed and undertreated, with consequent low rates [...] Read more.
Hypertension is the most frequent chronic and non-communicable disease all over the world, with about 1.5 billion affected individuals worldwide. Its impact is currently growing, particularly in low-income countries. Even in high-income countries, hypertension remains largely underdiagnosed and undertreated, with consequent low rates of blood pressure (BP) control. Notwithstanding the large number of clinical observational studies and randomized trials over the past four decades, it is sad to note that in the last few years there has been an impressive paucity of innovative studies. Research focused on BP mechanisms and novel antihypertensive drugs is slowing dramatically. The present review discusses some advances in the management of hypertensive patients, and could play a clinical role in the years to come. First, digital/health technology is expected to be increasingly used, although some crucial points remain (development of non-intrusive and clinically validated devices for ambulatory BP measurement, robust storing systems enabling rapid analysis of accrued data, physician-patient interactions, etc.). Second, several areas should be better outlined with regard to BP diagnosis and treatment targets. Third, from a therapeutic standpoint, existing antihypertensive drugs, which are generally effective and well tolerated, should be better used by exploiting available and novel free and fixed combinations. In particular, spironolactone and other mineral-corticoid receptor antagonists should be used more frequently to improve BP control. In particular, some drugs initially developed for conditions different from hypertension including heart failure and diabetes have demonstrated to lower BP significantly and should therefore be considered. Finally, renal artery denervation is another procedure that has proven effective in the management of hypertension. Full article
(This article belongs to the Special Issue Recent Advances in the Treatment of Hypertension)
Show Figures

Graphical abstract

Other

9 pages, 863 KiB  
Systematic Review
Blood Pressure Increase following COVID-19 Vaccination: A Systematic Overview and Meta-Analysis
by Fabio Angeli, Gianpaolo Reboldi, Monica Trapasso, Gabriella Santilli, Martina Zappa and Paolo Verdecchia
J. Cardiovasc. Dev. Dis. 2022, 9(5), 150; https://doi.org/10.3390/jcdd9050150 - 9 May 2022
Cited by 29 | Viewed by 13352
Abstract
Coronavirus disease 2019 (COVID-19) vaccines proved a strong clinical efficacy against symptomatic or moderate/severe COVID-19 and are considered the most promising approach for curbing the pandemic. However, some questions regarding the safety of COVID-19 vaccines have been recently raised. Among adverse events to [...] Read more.
Coronavirus disease 2019 (COVID-19) vaccines proved a strong clinical efficacy against symptomatic or moderate/severe COVID-19 and are considered the most promising approach for curbing the pandemic. However, some questions regarding the safety of COVID-19 vaccines have been recently raised. Among adverse events to vaccines and despite a lack of signal during phase III clinical trials, an increase in blood pressure (BP) after COVID-19 vaccination has been reported as a potential adverse reaction. We systematically analyze this topic and undertook a meta-analysis of available data to estimate the proportion of patients with abnormal BP or raise in BP after vaccination. Six studies entered the final analysis. Overall, studies accrued 357,387 subjects with 13,444 events of abnormal or increased BP. After exclusion of outlier studies, the pooled estimated proportion of abnormal/increased BP after vaccination was 3.20% (95% CI: 1.62–6.21). Proportions of cases of stage III hypertension or hypertensive urgencies and emergencies was 0.6% (95% CI: 0.1% to 5.1%). In conclusion, abnormal BP is not rare after COVID-19 vaccination, but the basic mechanisms of this phenomenon are still unclear and require further research. Full article
(This article belongs to the Special Issue Recent Advances in the Treatment of Hypertension)
Show Figures

Figure 1

Back to TopTop