Advances in Understanding of High Blood Pressure Dangers: Acute and Chronic Hypertension-Mediated Organ Damages

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (24 December 2023) | Viewed by 5650

Special Issue Editor

1. Medical Faculty, University of Nis, Nis, Serbia
2. Department for Cardiovascular Disease, Clinical Centre Nis, Nis, Serbia
Interests: cardiology; cardiovascular diseases; hypertension; pulmonary thromboembolism; acute myocardial infarction; aortic dissection; atrial fibrillation

Special Issue Information

Dear Colleagues,

Arterial hypertension (HTN) is one of the world’s largest health problems. It is due to very high HTN-related morbidity and mortality, with consequences that are globally important (medically and socially), as well as at the individual level. The extraordinary prevalence of HTN coupled with the high number and severity of organ damage results in a significant shortening of patients’ lives and a diminishing of their health-related quality. HTN often decreases working ability, and –particularly in the phase of complications– leads to respectable engagements of hospital capacities and treatment costs. Therefore, the economic burden is difficult to overestimate.

The before-mentioned adverse impacts of HTN are realized through either acute or chronic complications. They can occur in every single organ by affecting its artery. Moreover, HTN can damage various organs’ arteries in several ways, e.g., by causing aneurysms/dissections and ruptures, as well as atherosclerosis with/without atherothrombosis. In addition to arteries of any dimension, HTN affects heart function and structure, both acutely and chronically. The same is true for kidneys.

To sum up, complications of HTN are of key medical and social importance, due to their number, severity, and long-term consequences. The pandemic proportions of this non-infectious disease (that currently is believed to affect ≥1.4 billion people worldwide) add to the importance of HTN. Moreover, HTN prevalence constantly increases due to several reasons, and this can be expected to continue. At the same time, the HTN control rate is clearly suboptimal. Having these facts in mind, we –as a medical community- have to constantly improve our knowledge of this medical key problem – HTN and its complications.

This Special Issue aims to improve current knowledge of the complications of arterial hypertension, both acute and chronic. Up-to-date reviews are important, to collect new achievements in understanding the particular organ complication, its modern diagnostic approaches, and/or therapy. Moreover, original work is welcomed since it leads to progress.

Prof. Dr. Goran Koračević
Guest Editor

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Keywords

  • systemic arterial hypertension
  • hypertension-mediated organ damage
  • stroke
  • myocardial infarction
  • aortic dissection
  • aortic aneurism
  • eclampsia
  • heart failure
  • left ventricular hypertrophy
  • chronic kidney disease

Published Papers (4 papers)

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Research

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11 pages, 1467 KiB  
Article
Establishment of an Individual-Specific Nomogram for Predicting the Risk of Left Ventricular Hypertrophy in Chinese Postmenopausal Hypertensive Women
by Ruowen Yuan, Jianshu Chen, Shangyun Zhang, Xiaowei Zhang and Jing Yu
Medicina 2023, 59(3), 598; https://doi.org/10.3390/medicina59030598 - 17 Mar 2023
Cited by 1 | Viewed by 1076
Abstract
Background and Objectives: The physiological phenomenon peculiar to women, namely menopause, makes the occurrence of left ventricular hypertrophy (LVH) in postmenopausal hypertensive women more characteristic. Less is known about the risk of developing LVH in Chinese postmenopausal hypertensive women. Thus, the present study [...] Read more.
Background and Objectives: The physiological phenomenon peculiar to women, namely menopause, makes the occurrence of left ventricular hypertrophy (LVH) in postmenopausal hypertensive women more characteristic. Less is known about the risk of developing LVH in Chinese postmenopausal hypertensive women. Thus, the present study was intended to design a nomogram for predicting the risk of developing LVH in Chinese postmenopausal hypertensive women. Materials and Methods: Postmenopausal hypertensive women aged between 49 and 68 years were divided into either the training set (n = 550) or the validation set (n = 284) in a 2:1 ratio. Patients in the validation set were followed up for one year. A stepwise multivariable logistic regression model was used to assess the predictors of LVH in postmenopausal women with hypertension. The best-fit nomogram was executed using R software. The calibration and decision curve were employed to verify the predictive accuracy of the nomogram. The results were evaluated in the validation set. Results: Menopause age (OR = 0.929, 95% CI 0.866–0.998, p = 0.044), BMI (OR = 1.067, 95% CI 1.019–1.116, p = 0.005), morning systolic blood pressure (SBP: OR = 1.050, 95% CI 1.032–1.069, p = 0.000), morning diastolic BP (DBP OR = 1.055, 95% CI 1.028–1.083, p = 0.003), angiotensin II receptor blocker (ARB) utilization rate (OR = 0.219, 95% CI 0.131–0.365, p = 0.000), LDL-C (OR = 1.460, 95% CI 1.090–1.954, p = 0.011) and cardio-ankle vascular index (CAVI) (OR = 1.415, 95% CI 1.139–1.757, p = 0.028) were associated with LVH in postmenopausal hypertension patients. The nomogram model was then developed using these variables. The internal validation trial showed that the nomogram model described herein had good performance in discriminating a C-index of 0.881 (95% CI: 0.837–0.924) and high quality of calibration plots. External validation of LVH-predictive nomogram results showed that the area under the ROC curve was 0.903 (95%CI 0.900–0.907). Conclusions: Our results indicate that the risk prediction nomogram model based on menopausal age, BMI, morning SBP, morning DBP, ARB utilization rate, LDL-C and CAVI has good accuracy and may provide useful references for the medical staff in the intuitive and individualized risk assessment in clinical practice. Full article
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Review

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17 pages, 727 KiB  
Review
Clinical Review of Hypertensive Acute Heart Failure
by Ratko Lasica, Lazar Djukanovic, Jovanka Vukmirovic, Marija Zdravkovic, Arsen Ristic, Milika Asanin and Dragan Simic
Medicina 2024, 60(1), 133; https://doi.org/10.3390/medicina60010133 - 10 Jan 2024
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Abstract
Although acute heart failure (AHF) is a common disease associated with significant symptoms, morbidity and mortality, the diagnosis, risk stratification and treatment of patients with hypertensive acute heart failure (H-AHF) still remain a challenge in modern medicine. Despite great progress in diagnostic and [...] Read more.
Although acute heart failure (AHF) is a common disease associated with significant symptoms, morbidity and mortality, the diagnosis, risk stratification and treatment of patients with hypertensive acute heart failure (H-AHF) still remain a challenge in modern medicine. Despite great progress in diagnostic and therapeutic modalities, this disease is still accompanied by a high rate of both in-hospital (from 3.8% to 11%) and one-year (from 20% to 36%) mortality. Considering the high rate of rehospitalization (22% to 30% in the first three months), the treatment of this disease represents a major financial blow to the health system of each country. This disease is characterized by heterogeneity in precipitating factors, clinical presentation, therapeutic modalities and prognosis. Since heart decompensation usually occurs quickly (within a few hours) in patients with H-AHF, establishing a rapid diagnosis is of vital importance. In addition to establishing the diagnosis of heart failure itself, it is necessary to see the underlying cause that led to it, especially if it is de novo heart failure. Given that hypertension is a precipitating factor of AHF and in up to 11% of AHF patients, strict control of arterial blood pressure is necessary until target values are reached in order to prevent the occurrence of H-AHF, which is still accompanied by a high rate of both early and long-term mortality. Full article
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19 pages, 3957 KiB  
Review
Coronary Microvascular Dysfunction and Hypertension: A Bond More Important than We Think
by Marija Zdravkovic, Viseslav Popadic, Slobodan Klasnja, Andrea Klasnja, Tatjana Ivankovic, Ratko Lasica, Dragan Lovic, Drasko Gostiljac and Zorana Vasiljevic
Medicina 2023, 59(12), 2149; https://doi.org/10.3390/medicina59122149 - 11 Dec 2023
Cited by 1 | Viewed by 1283
Abstract
Coronary microvascular dysfunction (CMD) is a clinical entity linked with various risk factors that significantly affect cardiac morbidity and mortality. Hypertension, one of the most important, causes both functional and structural alterations in the microvasculature, promoting the occurrence and progression of microvascular angina. [...] Read more.
Coronary microvascular dysfunction (CMD) is a clinical entity linked with various risk factors that significantly affect cardiac morbidity and mortality. Hypertension, one of the most important, causes both functional and structural alterations in the microvasculature, promoting the occurrence and progression of microvascular angina. Endothelial dysfunction and capillary rarefaction play the most significant role in the development of CMD among patients with hypertension. CMD is also related to several hypertension-induced morphological and functional changes in the myocardium in the subclinical and early clinical stages, including left ventricular hypertrophy, interstitial myocardial fibrosis, and diastolic dysfunction. This indicates the fact that CMD, especially if associated with hypertension, is a subclinical marker of end-organ damage and heart failure, particularly that with preserved ejection fraction. This is why it is important to search for microvascular angina in every patient with hypertension and chest pain not associated with obstructive coronary artery disease. Several highly sensitive and specific non-invasive and invasive diagnostic modalities have been developed to evaluate the presence and severity of CMD and also to investigate and guide the treatment of additional complications that can affect further prognosis. This comprehensive review provides insight into the main pathophysiological mechanisms of CMD in hypertensive patients, offering an integrated diagnostic approach as well as an overview of currently available therapeutical modalities. Full article
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11 pages, 476 KiB  
Review
A Need for Improvement in the Definition of Resistant Arterial Hypertension
by Goran Koracevic, Sladjana Micic, Milovan Stojanovic and Marija Zdravkovic
Medicina 2023, 59(4), 803; https://doi.org/10.3390/medicina59040803 - 20 Apr 2023
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Abstract
With the medical and social importance of resistant arterial hypertension (HTN) in mind, we had three goals in this paper: to study the definitions of resistant HTN in the guidelines on the topic, to analyze them, and to suggest some improvements. We found [...] Read more.
With the medical and social importance of resistant arterial hypertension (HTN) in mind, we had three goals in this paper: to study the definitions of resistant HTN in the guidelines on the topic, to analyze them, and to suggest some improvements. We found (at least) eleven insufficiencies in the definition of resistant HTN: (1) different blood pressure (BP) values are used for diagnoses; (2) the number of BP measurements is not specified; (3) the time-frame for the definition is not obtained; (4) it fails to provide normal or target or controlled BP values; (5) secondary HTN is not currently defined as true resistant HTN, but as apparently treatment-resistant HTN; (6) the definition usually directly incorporates BP cut-offs for systolic BP (sBP) and diastolic BP (dBP) making the diagnosis temporary; (7) stress is not included in the exclusion strategy for resistant HTN; (8) there is potentially a need to introduce a category of recovered resistant HTN; (9) to what degree do healthy lifestyle measures have to be fulfilled to consider it as sufficient to change the diagnosis from “apparent treatment-resistant HTN” to the “resistant HTN”; (10) sBP values normal-for-the-age for 61 and 81 year old patients in some guidelines fulfill the criterion for resistant HTN; (11) it probably ought to read “In the absence of contraindications and compelling indications…” in the others. We believe that it is better to use the phrase “above the target BP” for the definition of (treatment) resistant HTN, because the whole story of resistant HTN is related to non-responders to antihypertensive treatment. Therefore, as we treat to target and not to normal values, it is appropriate to define resistant HTN as an insufficiency to reach the target BP values. Moreover, the definition of (treatment) resistant HTN should not be universal for every patient with HTN, but it should be age-related: (treatment) resistant HTN is elevated BP over the target/normal BP values. Using this modification, there will be no need to automatically change the definition of resistant HTN when we change the BP targets in the future. Full article
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