The global prevalence of hypertension continues to rise, but the awareness, treatment, and control rates of hypertension have improved, but there is still room for improvement. The economic burden of hypertension on residents and society is increasing day by day, and it has become a major public health problem. Therefore, how to better monitor and manage blood pressure is very important. During the ESC 2022 conference, this publication specially invited Professor Jose Ramon from the University Hospital of Santiago de Compostela, Spain, to conduct an exclusive interview based on the latest research progress in the field of hypertension.
International Circulation: How does blood pressure monitoring time affect results? Is it better to start sooner?
Professor Jose Ramon: High blood pressure is a number one killer all over the world. It increases cardiovascular risk. It increases, particularly, the risk of a stroke. It is the number one risk factor for chronic kidney dysfunction with diabetes. So we have to screen all the population, and particularly the population older than 30 years of age, for high blood pressure. We have to screen this population because in patients where the blood pressure is higher, it is mandatory to control blood pressure from the beginning. Very important information was published recently, if you are hypertensive before 40 years of age, your cardiovascular risk is much higher than if you develop high blood pressure in your 50s or 60s. So it is necessary to screen the population for high blood pressure so the focus can be on blood pressure control immediately to avoid cardiovascular and kidney dysfunction.
International Circulation: How do different blood pressure measurement methods differ?
Professor Jose Ramon: Nowadays, we have a lot of blood pressure measurement devices, and particularly home devices that are well-validated. Systolic blood pressure increases risk more than diastolic blood pressure. That is method number one. Method number two - night blood pressure increases risk significantly higher than daytime blood pressure, so we have to control nighttime blood pressures as well. Method number three is that blood pressure at home is associated with a cardiovascular risk much high than blood pressures obtained in the physicians office or outside of the home. So it is important that people measure blood pressure at home with validated devices. Currently, there are a lot of validated devices. So I recommend that, not only hypertensive individuals, but the general population, at least before 50 years of age, have a device for measuring blood pressure at home.
International Circulation: How to control the frequency of blood pressure measurement in hypertensive patients?
Professor Jose Ramon: This is very important because the hypertensive patient needs to know that blood pressure control means having a systolic blood pressure of less than 130 mmHg and a diastolic blood pressure of 80 mmHg. This is the optimal blood pressure control. Patients with well-controlled blood pressure can measure their blood pressure every 4-6 months, but for patients with poorer blood pressure control, it is recommended that monitoring is done monthly at home and adjusting their lifestyle (reduce salt intake, reduce body weight, quit smoking) and then adjust medication to achieve an optimal blood pressure control of < 130/80 mmHg.
International Circulation: In the relevant guidelines, what are the new developments in the diagnosis and treatment of hypertension?
Professor Jose Ramon: The most important hypertensive guidelines are the North American Guidelines, which were published five years ago in 2017. The European Hypertension Guidelines were published four years ago in 2018. Since then, there has not been much new information. We have seen good information regarding blood pressure goals. We have seen good information regarding the available anti-hypertensive medications, but no new anti-hypertensive medications in the last 3-4 years. Nor are we expecting any new anti-hypertensive medications in the near future. But new information that was published and presented here at this ESC Congress in Barcelona was asking the question whether it is better to take anti-hypertensive medication in the morning or in the evening, because it was suggested that taking medication in the evening was better. But this important clinical trial, the TIME trial, reported here, and they randomized patients to receive their anti-hypertensive treatment in the early morning and in the evening. The results in terms of cardiovascular protection were essentially the same. This is very relevant information. You can take your anti-hypertensive medication in the morning or the evening, because the protection is the same. I think this is very relevant information for hypertensive patients.
International Circulation: What are the highlights of this year's conference ?
Professor Jose Ramon: The biggest highlights of this year’s conference beyond the information regarding when to best take anti-hypertensive medication were the DELIVER trial with dapagliflozin in heart failure patients with preserved and mildly reduced ejection fraction. The trial was positive, offering protection for these patients. For me this is very important. There was a huge trial with a Spanish polypill including aspirin, atorvastatin and ramipril. The protection in patients with myocardial infarction was significantly higher than when taking the drugs individually - important information for patients. Also important information was a very cheap diuretic, acetazolamide, being used in patients with acute heart failure, which improved the prognosis by improving the decongestion very rapidly in this group of patients. Also, in lipids, for the near future, a new LDL-reducing drug, inclisiran, has been shown to reduce LDL by > 50%, and only needs to be injected every six months with a sustained effect. So there is a lot of new information with relevant clinical implications.
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