The term RH describes a subgroup of hypertensive patients whose BP is uncontrolled despite the use of at least three antihypertensive drugs in an appropriate combination at optimal or best tolerated doses. True RH is considered when appropriate lifestyle measures and treatment with optimal or best tolerated doses of three or more drugs (a thiazide/thiazide-like diuretic, plus renin-angiotensin system -RAS- blocker and a calcium channel blocker -CCB-) fail to lower office BP to <140/90 mmHg; besides the inadequate BP control should be confirmed by home blood pressure monitoring (HBPM) or 24-hour ambulatory; and evidence of adherence to therapy and exclusion of secondary causes of hypertension are required. RH patients are at a high risk of cardiovascular events and death. RH is associated with a higher prevalence of end-organ damage. When stricter criteria are applied, a reasonable estimate of the prevalence of true RH is 5 % of the total hypertensive population. The predominant hemodynamic pattern appears to be increased systemic vascular resistance and plasma volume with normal or even low cardiac output. We must rule out pseudo-resistance before diagnosing true drug resistance. RH is a therapeutic challenge, and its management includes lifestyle interventions, avoiding nonadherence to treatment, avoiding inertia, appropriate use of antihypertensive drugs based on current evidence, especially long-acting diuretics, and the addition of mineralocorticoid receptor antagonists. RCTs to identify the most protective medical therapy in RH are needed. A series of drugs in different stages of investigation could significantly impact RH treatment in the future.

2021-04-08·Current Pharmaceutical Design4区 · 医学

Mechanisms for Cardiorenal Protection of SGLT-2 Inhibitors

4区 · 医学

Article

作者: Vaios, Vasilios ; Salmas, Marios ; Liakopoulos, Vassilios ; Eleftheriadis, Theodoros ; Dounousi, Evangelia ; Georgianos, Panagiotis I.

Despite optimal treatment of diabetic kidney disease (DKD) with adequate blood pressure control and agents blocking the renin-angiotensin-system (RAS), the residual cardiorenal risk of these patients remains substantially high. There is, therefore, an unmet need for additional therapies effective to retard the progression of DKD and improve cardiovascular outcomes in this high-risk population. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors represent a novel drug class that received regulatory approval for improving glycemic control in patients with type 2 diabetes and preserved kidney function. Large outcome trials designed to test their cardiovascular safety profile showed an unexpected improvement in cardiovascular outcomes and also suggested a slower progression of DKD with SGLT-2 inhibition. The Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy (CREDENCE), a trial that was designed to specifically investigate the renoprotective properties of SGLT-2 inhibitors in patients with overt DKD already receiving guideline-based therapy with a RAS-blocker, was prematurely terminated due to an impressive benefit of canagliflozin on kidney and cardiovascular outcomes. These impressive results refine the role and the indication of SGLT-2 inhibitors as a cardioand renoprotective strategy in patients with DKD. In this article, we provide an overview of the available clinical- trial evidence and explore the mechanisms mediating the cardiorenal protection afforded by SGLT-2 inhibitors. We conclude with perspectives for a potential beneficial effect of this novel drug class in patients with non-diabetic kidney disease.

2021-01-01·Journal of Hypertension2区 · 医学

The corona-virus disease 2019 pandemic compromised routine care for hypertension: a survey conducted among excellence centers of the European Society of Hypertension

2区 · 医学

Article

作者: R Kreutz ; M Okorie ; J Redon ; J Brguljan ; Z Jarai ; Fj Aguila ; D Raev ; J Vaclavik ; E Lurbe ; A Gottsater ; K Tsioufis ; E Nasr ; Ml Muiesan ; I Barna ; Z Gaciong ; Ea Rosei ; R Zweiker ; Tk Makris ; Lc Rump ; T Kahan ; D Lovic ; R Sarzani ; Nr Robles ; Stojanov ; S Eckert ; Weber, Thomas ; A Mazza ; Gs Stergiou ; M Lopez-Sublet ; I Tikkanen ; C Rajkumar ; G Abraham ; Aj Manolis ; C Sierra ; F Veglio ; Es Muxfeldt ; M Volpe ; T De Backer ; Wks Barroso ; D Webb ; S Obregon ; A Januszewicz ; N Chapman ; A Oliveras ; C Giannattasio ; Jd Mediavilla ; R Pontremoli ; M Marketou ; F Mallamaci ; Z Parounak ; I Papadakis ; M Glover ; P Zebekakis ; C Grassos ; M Azizi ; T Weber ; M Viigimaa ; Y Sirenko ; M Dorobantu

Background:The Covid-19 pandemic caused a shutdown of healthcare systems in many countries. We explored the impact on hypertension care in the Excellence Center (EC) network of the European Society of Hypertension.Methods:We conducted a 17-question electronic survey among ECs.Results:Overall, 52 ECs from 20 European and three non-European countries participated, providing hypertension service for a median of 1500 hypertensive patients per center per year. Eighty-five percent of the ECs reported a shutdown lasting for 9 weeks (range 0–16). The number of patients treated per week decreased by 90%: from a median of 50 (range 10–400) before the pandemic to a median of 5.0 (range 0–150) during the pandemic (P < 0.0001). 60% of patients (range 0–100%) declared limited access to medical consultations. The majority of ECs (57%) could not provide 24-h ambulatory BP monitoring, whereas a median of 63% (range 0–100%) of the patients were regularly performing home BP monitoring. In the majority (75%) of the ECs, hypertension service returned to normal after the first wave of the pandemic. In 66% of the ECs, the physicians received many questions regarding the use of renin–angiotensin system (RAS) blockers. Stopping RAS-blocker therapy (in a few patients) either by patients or physicians was reported in 27 and 36.5% of the ECs.Conclusion:Patient care in hypertension ECs was compromised during the Covid-19-related shutdown. These data highlight the necessity to develop new strategies for hypertension care including virtual clinics to maintain services during challenging times.

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