American Society of Hypertension

 Renal Denervation with the SPYRAL HTN Global Clinical Trial Program 

• Understand the impact of variable adherence to complex drug therapy regimens on clinical trial outcomes

• Appreciate the relationship between absolute pressure drop and cardiovascular risk reduction across the spectrum of co-morbidities within the uncontrolled hypertensive population

• Uncover new histological insights into the anatomical distribution of the renal nerves

 

Improving Cardiovascular Clinical Outcomes: The Role of Beta Blockers 

in Dual RAAS Blockade• Explain the mechanisms of action of the RAAS, its

interaction with the SNS, specifically with respect to cardiovascular diseases like hypertension and heart failure

• Contrast the mechanisms of action and pharmacologic effects of beta-blockers in treating hypertension and heart failure, including receptor targets and vasodilatory properties

• Identify the benefits of beta blockers in the management of hypertension and heart failure

• Formulate management plans for patients that incorporate

Applying Technological Innovations in Blood Pressure Measurement for Improved

Outcomes in Treatment and Management• Explain the role of central blood pressure in

individual hypertensive patient assessment• Apply technological evaluations of the

cardiovascular system to improve risk assessment• Characterize differential effects of anti-

hypertension medications on brachial and central blood pressure

• Utilize the central blood pressure waveform and arterial stiffness measurements for improved outcomes in patients with elevated blood pressures

Hypertension 2015: Important Concepts In BP Control

• Evaluate the benefits of initial combination versus single agent antihypertensive therapy to control elevated blood pressure

• Delineate pharmacologic and clinical differences within the thiazide diuretic class

• Define resistant hypertension and its appropriate workup

• Recognize the importance of lifestyle modification, and the evidence for the use of chlorthalidone vs. HCTZ, and mineralocorticoid receptor antagonism (spironolactone) in those with resistant hypertension

Target organ complications and cardiovascular events associated with masked hypertension and white coat

hypertension: analysis from the dallas heart study

• Our study demonstrated a first direct evidence of increased target organ damage and CV complications associated with white coat hypertension and Masked hypertension in a multiethnic population.

• Study provided support for routine use of home BP monitoring in detecting presence of MH and WCH

Increased risk of stroke among hypertensive patients with abnormally short sleep duration: analysis of the national health

interview survey

• Hypertensive patients with either very short sleep or long sleep duration had an almost two fold greater likelihood of having a stroke.

• Healthcare providers caring for hypertensive patients should incorporate a sleep history in their routine examination in order to optimize efforts to prevent or manage stroke

White coat hypertension as predictor of long-lasting blood pressure decline in

stage 1 hypertension

• In a substantial portion of young-to-middle-age stage 1 hypertensives antihypertensive treatment can be deferred because of a spontaneous long-lasting BP decline.

• WCH at baseline is an important predictor of this favourable outcome even when the initial clinic BP drop is taken into account.

Wave intensity patterns in the aorta are associated with diastolic function in older adults

• A prominent late systolic suction wave traveling forward in the arterial tree is associated with abnormal diastolic relaxation.

• This novel adverse pattern of abnormal ventricular-arterial interactions may be due to a premature onset of LV relaxation or excessive blood inertia as a result of abnormal arterial load.

• Wave intensity analysis is a useful technique to gain insights into systolic-diastolic coupling

Effects of aging and blood pressure on timing and amplitude of central pulse contour landmarks

• Timing of central pressure landmarks is relatively fixed, while the amplitude of the late-systolic central BP peak is associated with aging, hypertension, proximal large artery stiffness and distal arteriolar resistance

Targeted delivery of endothelial cells by overexpression of interleukin-8 receptors promotes functional recovery of the

kidney after ischemia-reperfusion injury

• Ischemia-reperfusion acute kidney injury (AKI) damages the renal microvascular endothelium compromising renal function.

• We tested the hypothesis that targeted systemic delivery of rat aortic endothelial cells (ECs) transduced with IL8 receptors attenuates the inflammatory response and promotes structural and functional recovery of the kidney in rats following AKI.

Prescribing patterns of renin-angiotensin-aldosterone-system inhibitors are inconsistent with guidelines for treatment of cardio renal comorbiditie

• Despite clear-cut clinical guidelines, relatively few patients in the U.S. are prescribed maximum recommended doses of RAASi, even those patients with serious comorbidities.

• Future studies should investigate whether the availability of new therapies to treat hyperkalemia may facilitate maintaining patients on recommended therapeutic doses of RAAS inhibitors and mineralocorticoid receptor antagonists

Efficacy and tolerability of nebivolol added to RAAS inhibitors

• In patients treated, but not controlled, with a RAAS inhibitor (ACEI or ARB), nebivolol 10 and 20 mg/day lowered DBP significantly more than placebo at 12 weeks.

• Nebivolol 20 mg/day also lowered SBP significantly more than placebo .

• Additionally, nebivolol did not increase the rate of adverse events when added to either an ACEI or ARB.

• Overall, these data suggest that nebivolol, added to an ongoing therapy with an ACEI or ARB, has significant, additional antihypertensive efficacy with good tolerability.

Predictors of changes in cardiac structure and diastolic function at dipper and non-dipper treated hypertensive patients

• Worsening of LV diastolic dysfunction was found at dippers and non-dippers groups of hypertensive patients after 10 years.

• Abnormalities in LV diastolic function in hypertensive patients were associated with baseline diastolic night-time BP, concentric cardiac remodeling, postprandial hyperinsulinemia and hsCRP

Effects of dipeptidyl peptidase 4 inhbition on urinary albumin excretion in type 2 diabetic patients

• The UAE tends to progress over time in type 2 diabetic patients with micro- or macroalbuminuria regardless of blood pressure.

• Vildagliptin added as an antidiabetic treatment may help to slow this progression.

Prognostic impact of sleep-time relative blood pressure decline for predicting the risk of developing chronic kidney disease

• New-onset CKD was significantly greater in non-dippers and, to a larger extent in risers.

• Results indicate a blunted sleep-time relative BP decline predicts the development of CKD, rather than being a consequence of this condition

Sleep-time blood pressure as a therapeutic target for reducing the risk of

developing chronic kidney disease

• Sleeptime SBP mean derived from ambulatory BP monitoring (ABPM) is the most significant independent prognostic marker of new-onset CKD

Influence of class and treatment-time regimen of hypertension medications on the risk of developing chronic kidney disease

• Renin-angiotensin blockade, however, is significantly superior to any other BP-lowering strategy for reducing the risk of CKD, apart from the documented decrease of cardiovascular risk, when the medications are dosed at bedtime.

Clinical and hemodynamic effectiveness of telmisartan at hypertensives with hyperinsulinemia and heart failure

• HI in hypertensives with HF-PEF leads to a more severe course of disease with increasing of SBP and DBP, formation ofprognostically unfavorable circadian BP profiles ‘‘non-dipper’’ and severe HF clinical signs accompanied by decreasing of 6MWT parameters.

• Complex antihypertensive treatment with inclusion of telmisartan, torasemid and atorvastatin reduces HF-PEF clinical signs

• Improves tolerance to physical activity, allowing BP stabilization, provides formation of favorable circadian BP profiles as with normal plasma EI level and as with reactive and spontaneous HI in hypertensives with HF-PEF

Does body mass index (BMI) modulate effect of dietary sodium reduction on blood pressure: a cross-

over randomized trial

• Low sodium diet decreases blood pressure in both BMI groups but the effect was more significant in patients with normal BMI.

• Obesity may confound or attenuate the effect of dietary sodium reduction

Systolic blood pressure reductions with sotagliflozin (LX4211), a dual SGLT1 and SGLT2 inhibitor, are associated with reductions

in urinary sodium excretion

• Sotagliflozin 400 mg qd effectively lowered SBP at Week 12 in patients with SBP 130 mm Hg.

Patiromer increased time to RAAS inhibitor discontinuation compared with placebo in advanced CKD patients with hyperkalemia

• Patiromer discontinuations due to AEs occurred in 6% and 5% of patients in each phase.

• After controlling s-K+ , patiromer reduced HK recurrence and increased time to RAAS inhibitor discontinuation compared to placebo in CKD Stage 4-5 patients, with good tolerabilit

Salt-sensitive? It May Not Be Sodium Intake; It May be in your Genes

• In this study, 334 subjects from 124 families were put on a low-salt diet for seven days, followed by a high-salt diet for seven days and then a high-salt, high-potassium diet for seven days.

• The results of this family-based study indicate that genetic variants in the Renalese gene are significantly associated with blood pressure responses to dietary salt intake, showing that genetics plays a role in determining how sensitive a person's blood pressure is to sodium intake.