Munich, Germany—New insights into blood pressure (BP) measurement, prognostic markers, and renal denervation come from a range of hypertension studies presented at the 2012 Congress of the European Society of Cardiology (ESC). Roland E. Schmieder, MD, Professor of Internal Medicine, Nephrology, and Hypertension, University of Erlangen, and Head of the Clinical Research Unit of Hypertension and Vascular Medicine, University Hospital Erlangen-Nürnberg, Germany, presented a tour of these studies.
BP Measurement: A Call to Action
There is much ongoing discussion about the use of 24-hour ambulatory BP monitoring and the importance of nighttime and daytime BP, and the dipping pattern.
Nocturnal BP is an independent predictor of stroke and new-onset atrial fibrillation (AF), and nighttime systolic BP (SBP) was the most important predictor of cardiovascular (CV) events compared with daytime SBP. In contrast, the dipping pattern (decrease of BP by 10%) and the nighttime-to-daytime ratio of SBP compared with average nocturnal BP were not predictors. “These results further support current evidence that nighttime BP may be more important than daytime BP,” said Dr Schmieder.
This prospective study from researchers in Greece followed 1060 patients with primary hypertension (mean age, 55 years; office BP, 143/91 mm Hg; no history of CV disease) for a mean of 43 months. Nine (0.8%) patients had a stroke and 11 (1%) patients had new-onset AF. The average normal nighttime BP was <120/70 mm Hg.
The benefit of ambulatory BP monitoring during the treatment of hypertension was shown by a cross-sectional analysis from the 3A Registry. Clinical and epidemiology studies have shown the value of 24-hour ambulatory BP monitoring, and recent UK National Institute for Clinical Excellence guidelines for hypertension indicate that it is mandatory for the diagnosis of hypertension; however, data on its use during treatment are limited.
This analysis by German researchers showed that among 4078 patients (average age, 64 years) who were receiving antihypertensive therapy (average, 3 agents), masked hypertension was found in 32.9% of the patients who were categorized as being controlled to <140/90 mm Hg by office BP; white coat hypertension was found in 6.1% of the patients whose BP was deemed controlled by ambulatory BP monitoring. Ambulatory BP monitoring was done at baseline and at 1 year. Only 50.5% of the patients were effectively controlled to target (ie, <140/90 mm Hg) based on office BP, and only 17.6% of the patients were controlled based on ambulatory BP monitoring (<130/80 mm Hg). “This is a call for action,” urged Dr Schmieder.
Renal denervation is a catheter-based interventional therapy for hypertension, especially treatment-resistant hypertension. The 6-month data from the randomized Symplicity HTN-2 trial showed a substantial reduction in BP with renal denervation and no change in the control group.
Data from the 18-month follow-up of the Symplicity HTN-2 trial were presented by researchers from Australia and showed that office BP was reduced, compared with preprocedure BP, by 32/12.5 mm Hg in the original renal denervation group and by 28.4/13.6 mm Hg in the control patients who crossed over to the renal denervation cohort after the first 6 months of the study.
“A sustained blood pressure response” is seen, with no attenuation at 18 months, said Dr Schmieder. “So there is no signal of renal denervation, which is of functional importance.” He also noted a study from AstraZeneca that showed significant improvements in quality of life, anxiety, and depression after renal denervation, “in parallel with a reduction in blood pressure.”
Prognostic Markers Identified in Hypertension
See “New Prognostic Markers in Hypertension Identified” in the print issue of Value-Based Care in Cardiometabolic Health. December 2012;1(3):14.