((Title)) Masked hypertension is more likely in men, smokers and the
overweight
Masked hypertension is more likely in male patients, in current smokers and in
patients with higher body mass index (BMI)(Sheppard JP, Fletcher B, Gill P,
et al. Am J Hypertens 2015; Sep 22. pii: hpv157). A meta-analysis of 70
studies involving 86,167 patients was conducted to identify factors that may
predict the difference seen between home- and clinic-based blood pressure
measurements. Factors that may predict a lower (i.e. white coat hypertension)
or higher (i.e. masked hypertension) ambulatory blood pressure measurement
(ABPM) compared with the clinic measurement were analysed. White coat
hypertension was defined as a negative home-clinic blood pressure difference
(i.e. ABPM <135/85 mm Hg, but clinic BP ≥140/90 mm Hg), and masked
hypertension was defined as a positive home-clinic blood pressure difference
(i.e. ABPM ≥135/85, but clinic BP <140/90 mm Hg). Masked hypertension was
associated with male gender, increasing BMI, current smoking status, and
systolic blood pressure measured in the clinic. White coat hypertension was
associated with female gender. These findings demonstrate that while ABPM
is an important tool for the diagnosis of high blood pressure, other factors
including increased systolic blood pressure readings in the clinic and common
patient characteristics such as increased BMI and male gender can assist in
the diagnosis.
((Title)) Eating high levels of dietary sodium increases the risk of
developing high blood pressure
People with normal blood pressure who consume high levels of dietary
sodium are at increased risk of developing high blood pressure compared with
those who consume relatively low levels of sodium (Takase H, Sugiura T,
Kimura G, et al. J Am Heart Assoc 2015; July 29:4(8). pii: e001959). A
Japanese study investigated the effect of dietary sodium intake on the future
development of hypertension in individuals with normal blood pressure.
Sodium intake was estimated based on urinary sodium excretion. Two groups
of participants were compared, those consuming higher levels of dietary
sodium (<9.0 g/day for men, and <7.5 g/day for women), and those with lower
levels of consumption (<3.5 g/day for men, and <3.0 g/day for women). A total
of 4523 individuals with normal blood pressure were follow-up for a median of
3 years. During the follow-up period, 1027 participants (22.7%) developed
hypertension. The risk of developing hypertension was 25% higher in the
group with the higher sodium intake, compared with the group with the lower
sodium intake. Yearly increases in sodium intake were also associated with
an increase in systolic blood pressure over time. These findings demonstrate
the importance of dietary sodium restriction in reducing the age-dependent
increase in blood pressure, and in reducing the risk of developing
hypertension in the general population.
((Title)) Reducing heart failure hospitalisations depends on adherence to
antihypertensive therapy
People with high blood pressure who have high adherence to antihypertensive
therapy have a significantly lower risk of hospitalisation for heart failure than
those with low adherence (Corrao G, Rea F, Ghirardi A, et al. Hypertension
2015; Oct; 66(4): 742-9). An Italian study involving 76,107 patients
investigated the impact of different levels of adherence to antihypertensive
therapy and hospitalisation for heart failure in real-life practice during 2005.
The patients were aged 40-80 years of age and were newly treated for high
blood pressure. Adherence to antihypertensive therapy was measured by the
proportion of days covered by treatment. High adherence was defined as
>75% of days, intermediate adherence as 51-75% of days, low adherence as
26-50% of days and very low adherence as ≤25% of days on treatment.
Greater adherence was associated with progressively lower risk, and patients
with high adherence had a 34% less risk of hospitalisation for heart failure
compared with patients with very low adherence. This benefit was seen
across age groups and drug classes, including angiotensin converting enzyme
inhibitors, angiotensin receptor blockers and diuretics, but not calcium channel
blockers. These findings demonstrate that adherence to antihypertensive
therapy is critical in reducing the risk of hospitalisation for heart failure, and
this benefit can be achieved using a variety of commonly prescribed
antihypertensive medications.