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Key Clinical Updates in Overview: Systemic Hypertension

The SPYRAL HTN-OFF MED study used a controlled ablation strategy to perform renal sympathetic denervation; clinically meaningful blood pressure reductions occurred in the intervention group compared to the control group.

Although not yet accepted in general clinical practice, renal sympathetic nerve ablation may emerge as an alternative or adjunctive modality in the treatment of hypertension and may become useful in managing resistant hypertension and drug intolerance.

The HYGIA trial compared the effect of nighttime dosing of at least one antihypertensive medication with morning dosing of all antihypertensive medications in 19,000 participants with median follow up 6.3 years and demonstrated improved ambulatory blood pressure and a significant decline in major cardiovascular events in the nighttime dosing group.

Participants in the HYGIA were monitored via ambulatory blood pressure measurement, and the incidence of nocturnal hypotension was very low. However, profound nocturnal hypotension might not be detected in the absence of ambulatory blood pressure monitoring, and ischemic optic neuropathy or other low perfusion complications would be a concern.

Canagliflozin generally lowers blood pressure by 3–4 mm Hg in addition to better glycemic control through inhibition of the SGLT2 glucose transporter in patients with diabetes.

This drug was associated with improved renal outcomes and reduced cardiovascular risk in the CREDENCE trial of patients with diabetic nephropathy and can be considered when additional blood pressure control is needed in patients with type 2 diabetes.

Based on the National Health and Nutrition Survey through 2016, about 45% of adults in the United States have a blood pressure greater than 140/90 mm Hg or are being treated for hypertension. About 80% of people with hypertension are aware of the diagnosis and 75% are receiving treatment, but hypertension is controlled in only 52% of those affected. Cardiovascular morbidity and mortality increase as both systolic and diastolic blood pressures rise, but in individuals over age 50 years, the systolic pressure and pulse pressure are better predictors of complications than diastolic pressure. The prevalence of hypertension increases with age, and it is more common in Blacks than in Whites. Adequate blood pressure control reduces the incidence of acute coronary syndrome by 20–25%, stroke by 30–35%, and heart failure by 50%.

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