Blood Pressure最新文献

{"title":"Adherence and blood pressure control in patients with primary aldosteronism","authors":"Thi Minh Phuong Nikrýnová Nguyen, B. Štrauch, O. Petrák, Z. Krátká, R. Holaj, I. Kurcová, V. Marešová, A. Pilková, J. Hartinger, P. Waldauf, T. Zelinka, J. Widimský","doi":"10.1080/08037051.2022.2061416","DOIUrl":"https://doi.org/10.1080/08037051.2022.2061416","url":null,"abstract":"Abstract Purpose The aim of our study was to evaluate the adherence to mineralocorticoid receptor (MR) antagonists and other antihypertensive therapy and blood pressure control in conservatively treated patients with primary aldosteronism (PA). Materials and methods Conservatively treated subjects with previously confirmed PA (n-50, 64.5 ± 9 years of age, 24% women) were investigated via our outpatient hypertension clinic. All subjects underwent regular examinations in our clinic. In addition to basic laboratory and clinical parameters, 24 h ambulatory blood pressure monitoring (ABPM) (Spacelabs) was evaluated. Unplanned blood sampling for assessment of serum antihypertensive drug concentrations by the means of liquid chromatography–mass spectrometry was performed in all patients. In case of spironolactone, its active metabolite canrenone was also evaluated. Total non-compliance was then defined as the absence of all measured antihypertensive drugs. Partial non-compliance was calculated as the absence of serum levels of at least one, but not all antihypertensive drugs prescribed. Results Good blood pressure control was detected (mean 24 h systolic/diastolic BP 130 ± 12/77 ± 9 mmHg). The average number of antihypertensive drugs was 3.9 ± 1.5. All subjects were treated by MR antagonists. 44% of patients received spironolactone (average daily dose 45 ± 20 mg) and in the remaining 56% of subjects eplerenone was administered (average daily dose 80 ± 30 mg) due to spironolactone side effects. Assessment of antihypertensive drug concentrations revealed full adherence in 80% of all subjects, partial nonadherence was noted in the remaining 20% of subjects. MR antagonist levels were detected in almost all subjects (49 out of 50). Conclusions Good blood pressure control and adherence to therapy were detected in conservatively treated patients with PA. Eplerenone had to be used quite often as male subjects did not tolerate dose escalation due to spironolactone side effects.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41974212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of ambulatory blood pressure monitoring in detection of masked hypertension and risk of hypertension mediated organ damage in normotensive patients with type 2 diabetes mellitus","authors":"H. Gupta, T. Vidhale, Manas Pustake, C. Gandhi, Tanmoy Roy","doi":"10.1080/08037051.2022.2061415","DOIUrl":"https://doi.org/10.1080/08037051.2022.2061415","url":null,"abstract":"Abstract Purpose In patients with diabetes, unrecognised hypertension is a serious problem risk factor for the development and progression of chronic complications. The study aimed to determine the prevalence of masked hypertension in normotensive diabetic patients, the factors affecting it, and its association with diabetes complications using ambulatory blood pressure monitoring (ABPM). Materials and methods A cross-sectional observational study was conducted on 150 normotensive diabetic patients. Patients were subjected to an interview and clinical examination to record demographic data, epidemiological data, and significant past history. ABPM was performed for each patient. Urine samples, echocardiogram, and ophthalmologic fundoscopy were done to check for diabetes-related complications. Results The mean age of all participants was 56.7 ± 7.8 years. A total of 93 patients (62%) were males. 99 (66%) patients had masked hypertension. A total of 85 (56.7%) were non-dippers, 49 (32.7%) were dippers, 1 (0.7%) was extreme dipper and 15 (10%) were reverse dippers. Non-dipping and reverse dipping were associated with concentric left ventricular hypertrophy LVH (p < .001). Masked hypertension was associated with concentric LVH (p = .001) and nephropathy (p =.008) whereas, nocturnal hypertension was associated with concentric LVH (p = .001) and nephropathy (p =.003). Conclusions A single office blood pressure (BP) reading cannot rule out hypertension in patients with diabetes. Regardless of hypertension, clinicians should have all patients, especially patients with diabetes, undergo ABPM at least once. Masked hypertension, changes in nocturnal dipping and other phenomena that raise the risk of diabetes complications but cannot be measured by office BP can be measured by ABPM, and thus ABPM can provide a good prognostic benefit.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47179983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central and brachial pulse pressure predicts cardiovascular and renal events in treated hypertensive patients","authors":"Tsuneo Takenaka, Y. Ohno, K. Eguchi, Hiroshi Miyashita, Hiromichi Suzuki, Kazuyuki Shimada","doi":"10.1080/08037051.2022.2062295","DOIUrl":"https://doi.org/10.1080/08037051.2022.2062295","url":null,"abstract":"Abstract Purposes Central blood pressure is a stronger predictor of cardiovascular prognosis rather than brachial blood pressure. The reflection wave reaches the abdominal aorta sooner than ascending aorta. Thus, the contribution of central pulse pressure (cPP) to renal events may differ from that of cardiovascular events. Methods The subanalysis of the ABC-J II study was performed. Subjects were 3434 treated hypertensive patients with a mean follow-up of 4.7 years. Left ventricular hypertrophy, an index of cardiovascular risk, correlated with cPP better than central systolic blood pressure in this cohort. The contribution of brachial pulse pressure (bPP) and cPP to cardiovascular and renal events was analysed. Results Cox proportional-hazard analysis revealed that sex (p < 0.001), height (p < 0.05), history of cardiovascular diseases (p < 0.001), number of antihypertensive drugs (p < 0.05), and cPP (p < 0.05) contributed to cardiovascular events. However, Cox proportional-hazard analysis disclosed that baseline serum creatinine (p < 0.001) and bPP (p < 0.05) predicted renal events. After adjusting for the history of cardiovascular diseases, Cox regression demonstrated only sex as a significant predictor of cardiovascular events. After adjusting for baseline serum creatinine, no parameters were shown to predict renal events. Conclusions The present findings support our previous data that the absence of cardiovascular or renal diseases is an important determinant for event-free survival, and suggest that cPP and bPP contribute to cardiovascular and renal events in treated hypertensive patients.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44153799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertension management during the COVID-19 pandemic: what can we learn for the future?","authors":"M. Burnier, S. Kjeldsen, K. Narkiewicz, B. Egan, R. Kreutz","doi":"10.1080/08037051.2022.2058909","DOIUrl":"https://doi.org/10.1080/08037051.2022.2058909","url":null,"abstract":"","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45155740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased blood pressure variability is associated with probable rapid eye movement sleep behaviour disorder in elderly hypertensive patients","authors":"A. Toba, J. Ishikawa, K. Harada","doi":"10.1080/08037051.2022.2055531","DOIUrl":"https://doi.org/10.1080/08037051.2022.2055531","url":null,"abstract":"Abstract Purpose An increased blood pressure variability (BPV) has been reported to be associated with older age and cognitive dysfunction; however, associations between increased BPV and rapid eye movement sleep behaviour disorder (RBD) has not been thoroughly investigated in patients without clinical Lewy body diseases. Materials and methods In frailty outpatient clinic, we evaluated ambulatory BP, RBD screening questionnaire (RBDSQ), and beat-to-beat heart rate variability during positional change from sitting to standing in 112 elderly hypertensive patients. Results The mean age was 81.2 ± 6.3 years (68% male). There were 15 patients who had probable RBD (RBDSQ scores ≥ 5). Patients with RBD had a greater body mass index, coefficient of variation (CV) in 24-h diastolic BP (23.5 ± 6.1 versus 18.7 ± 5.8, p = 0.005), awake diastolic BP (23.0 ± 7.7 versus 18.6 ± 6.2, p = 0.017), and nocturnal systolic BP (14.9 ± 5.5 versus 12.0 ± 4.4, p = 0.025) compared with those without RBD, while systolic BP, diastolic BP, and cognitive function did not differ significantly between patients with and without RBD. Patients with RBD exhibited larger orthostatic BP fall compared with patients without RBD (−4.9 ± 11.0 versus 7.5 ± 11.8, p = 0.009) and lower CV of R–R intervals while standing (1.3 ± 0.6 versus 2.4 ± 1.5, p = 0.039). Multiple regression analysis revealed that patients with RBD had significantly greater CV of nocturnal systolic BP independent of age, sex, BMI, history of diabetes and dyslipidaemia, and use of antihypertensive drugs (p = 0.008). Conclusion An increased BPV in ambulatory BP, associated with autonomic dysfunction, can be observed in patients with probable RBD even in elderly patients without clinical presentation of Lewy body diseases.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43346782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal sympathetic denervation lowers systemic vascular resistance in true treatment-resistant hypertension.","authors":"Kaja K Bergo,&nbsp;Anne C Larstorp,&nbsp;Pavel Hoffmann,&nbsp;Ulla Hjørnholm,&nbsp;Alessandro Cataliotti,&nbsp;Aud Høieggen,&nbsp;Morten Rostrup,&nbsp;Fadl Elmula M Fadl Elmula","doi":"10.1080/08037051.2020.1789446","DOIUrl":"https://doi.org/10.1080/08037051.2020.1789446","url":null,"abstract":"<p><strong>Purpose: </strong>Renal sympathetic denervation (RDN) is again gaining interest as recent well-designed trials have demonstrated reduced ambulatory blood pressure (BP) after RDN. However, the hemodynamic mechanisms have not been elucidated. We aimed for the first time to investigate the effect of RDN on the \"Hallmark of Hypertension\" namely increased systemic vascular resistance index (SVRI).</p><p><strong>Materials and methods: </strong>We investigated SVRI change in patients with true treatment-resistant hypertension randomised to RDN (<i>n</i> = 9) or drug adjusted control (<i>n</i> = 9). Treatment-resistant hypertension was defined as office systolic BP ≥ 140 mmHg despite ≥ 3 antihypertensive drugs including a diuretic. True treatment-resistant hypertension was confirmed prior to inclusion with ambulatory daytime systolic BP ≥ 135 mmHg immediately after witnessed intake of antihypertensive drugs. Hemodynamic variables were recorded with thoracic impedance cardiography at baseline and at three and six months follow-up after RDN. This non-invasive method also guided further tailoring of drug treatment in the control group aiming to normalise hemodynamic variables and BP.</p><p><strong>Results: </strong>From three to six months follow-up after RDN, SVRI decreased with a median of -611 dyn*s*m²/cm⁵ [IQR -949 to -267] (<i>p</i> < 0.01), while supine mean BP decreased with a median of -11 mmHg [IQR -21 to -3] (<i>p</i> = 0.02). In the same period, SVRI in the control group was reduced with -674 dyn*s*m²/cm⁵ [IQR -1,309 to -340] (<i>p</i> < 0.01), while supine mean BP decreased with -15 mmHg [IQR -29 to -6] (<i>p</i> = 0.01). Thus, hemodynamic variables and BP in the two groups normalised in parallel.</p><p><strong>Conclusion: </strong>Our data suggest that in patients with true treatment-resistant hypertension, renal sympathetic denervation lowers BP by reducing systemic vascular resistance of similar size as in the control group with careful individual selection of antihypertensive drugs and dose titration.</p>","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08037051.2020.1789446","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38132345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smoking and overweight associated with masked uncontrolled hypertension: a Hypertension Optimal Treatment (HOT) Sub-Study.","authors":"Magnus Holanger,&nbsp;Sverre E Kjeldsen,&nbsp;Kenneth Jamerson,&nbsp;Stevo Julius","doi":"10.1080/08037051.2020.1787815","DOIUrl":"https://doi.org/10.1080/08037051.2020.1787815","url":null,"abstract":"<p><strong>Purpose: </strong>The Hypertension Optimal Treatment (HOT) Study investigated the relationship between target office diastolic blood pressure (BP) ≤80, ≤85 or ≤90 mmHg and cardiovascular morbidity and mortality in 18,790 patients aged 50-80 years. The home BP sub-study enrolled 926 patients and the aim was to clarify whether the separation into the BP target groups in the office prevailed in the out-of-office setting. The present study aimed to identify variables that characterised masked uncontrolled hypertension (MUCH) and white coat uncontrolled hypertension (WUCH).</p><p><strong>Material and methods: </strong>The sub-study participants took their home BP when office BP had been up titrated. The cut-off for normal or high BP was set to ≥135/85 mmHg at home and ≥140/90 mmHg in the office. We analysed data by using multivariate and stepwise multivariate logistic regression with home and office BP combinations as the dependent variables.</p><p><strong>Results: </strong>WUCH was associated with lower body mass index (BMI) (odds ratio (OR) 0.92, 95% confident intervals (CIs) 0.88-0.96, <i>p</i> < 0.001). MUCH was associated with smoking (OR 1.89, 95% CIs 1.25-2.86, <i>p</i> = 0.0025) and with lower baseline heart rate (OR 0.98, 95% CIs 0.97-0.99, <i>p</i> = 0.03) and higher BMI (OR 1.03, CIs 1.00-1.06, <i>p</i> = 0.04). MUCH remained associated with smoking (OR 2.76, 95% CIs 1.76-4.35, <i>p</i> < 0.0001) also when using ≥140/90 mmHg as the cut-off for both home and office BP. MUCH was also associated with higher BMI (OR 1.05, 95% CIs 1.01-1.09, <i>p</i> = 0.009) while WUCH was associated with lower BMI (OR 0.93, 95% CIs 0.90-0.97, <i>p</i> = 0.0005) when using ≥140/90 mmHg as a cut-off.</p><p><strong>Conclusion: </strong>Our data support that 'reversed or masked' treated but uncontrolled hypertension (MUCH) is common and constitutes about 25% of treated hypertensive patients. This entity (MUCH) is rather strongly associated with current smoking and overweight while uncontrolled white coat (office) hypertension (WUCH) is associated with lower BMI.</p>","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08037051.2020.1787815","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38132348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambulatory blood pressure monitoring by a novel cuffless device: a pilot study.","authors":"Filippo Scalise,&nbsp;Davide Margonato,&nbsp;Andrea Sole,&nbsp;Antonio Sorropago,&nbsp;Giovanni Sorropago,&nbsp;Giuseppe Mancia","doi":"10.1080/08037051.2020.1785273","DOIUrl":"https://doi.org/10.1080/08037051.2020.1785273","url":null,"abstract":"<p><strong>Purpose: </strong>Cuffless blood pressure (CL-BP) measurements are believed to be a potentially alternative to cuff-occlusion-based (C-BP) measurement. A new cuffless device was developed for ambulatory BP monitoring. We assessed the accuracy of a new CL-BP device compared to a standard oscillatory C-BP device over the 24 h.</p><p><strong>Materials and methods: </strong>Eighty-four consecutive patients were included in the study. BP was measured simultaneously by the CL-BP device and by a C-BP device over the 24 h. Calculations included 24 h mean systolic (S) BP, the mean diastolic (D) BP and the heart rate (HR). Correlations between the CL-BP and C-BP measurements were sought using Pearson's correlation coefficients and Bland-Altman plots.</p><p><strong>Results: </strong>Using the C-BP device, the 24 h SBP value for the cohort was 125.4 ± 10.9 mmHg (mean ± SD); the corresponding DBP value being 75 ± 8.3 mmHg. Mean SBP/DBP were higher with the CL-BP device, i.e. 131.1 ± 15.9/80.2 ± 9.7 mmHg . The correlation coefficients between the two sets of values were significant (SBP: <i>r</i> = 0.58, DBP: <i>r</i> = 0.65). Better correlations for SBP and DBP were found 1) in patients with BMI > 25 (SBP: <i>r</i> = 0.65, DBP: <i>r</i> = 0.70) compared to those with BMI <25 and 2) in males compared to females (SBP: <i>r</i> = 0.71, DBP: <i>r</i> = 0.77).</p><p><strong>Conclusions: </strong>In our patients a CL-BP device estimated 24 h mean SBP and DBP differently from the classical oscillometric device, with a moderate correlation. CL-BP measurements were most accurate on male and overweight subjects.</p>","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08037051.2020.1785273","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38104469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antihypertensive prescription patterns and cardiovascular risk in patients with newly diagnosed hypertension- an analysis of statutory health insurance data in Germany.","authors":"Christian Beger,&nbsp;Thomas Unger,&nbsp;Hermann Haller,&nbsp;Florian P Limbourg","doi":"10.1080/08037051.2020.1779582","DOIUrl":"https://doi.org/10.1080/08037051.2020.1779582","url":null,"abstract":"<p><strong>Purpose: </strong>Hypertension is the most important risk factor for disease and premature death. Treatment strategies adjusted for cardiovascular risk have been proposed in guidelines, but real-life treatment strategies for patients with newly diagnosed hypertension in Germany are largely unknown. The aim of the study was to analyse initial drug treatment strategies and associated risk status in patients with newly diagnosed hypertension.</p><p><strong>Material and methods: </strong>In the representative research database of the public health insurance system in Germany (2077899 individuals) we identified patients with newly diagnosed hypertension in 2012 and analysed co-existing cardiovascular co-morbidities and hypertension-mediated organ damage by ICD-codes as qualifiers for high risk. Health insurance billing datasets for redeemed prescriptions were analysed at several time points using ATC-codes.</p><p><strong>Results: </strong>The incidence of hypertension was 2.6%, 33.6% of the patients were at high risk at diagnosis, mainly due to cardiovascular co-morbidities. Most patients initially received monotherapy (55.4%), of which ACE inhibitors (43.8%) or beta-blockers (32.4%) were the leading drug classes, while 21.7% of patients received no drug therapy during the first year. The treatment strategies of low and high-risk patients resembled each other - high-risk patients also received mostly monotherapy during the first year after diagnosis (53.4%), while 13.7% remained without drug therapy. Combination therapy was the most frequent treatment strategy one year after hypertension diagnosis (40.6%) and in the long term (68.4%).</p><p><strong>Conclusion: </strong>Initial treatment strategies may not always be stratified according to cardiovascular risk. The majority of patients with hypertension receives initial monotherapy independent of their individual risk. However, combination therapy represents the major form of therapy in the long-term.</p>","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08037051.2020.1779582","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38048915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subclinical macroangiopathic target organ damage in type 1 diabetes mellitus patients.","authors":"Magdalena Błaszkowska,&nbsp;Anna Shalimova,&nbsp;Bogumił Wolnik,&nbsp;Elżbieta Orłowska-Kunikowska,&nbsp;Beata Graff,&nbsp;Michał Hoffmann,&nbsp;Peter Nilsson,&nbsp;Jacek Wolf,&nbsp;Krzysztof Narkiewicz","doi":"10.1080/08037051.2020.1770054","DOIUrl":"https://doi.org/10.1080/08037051.2020.1770054","url":null,"abstract":"Abstract Purpose We have summarized key studies regarding the assessment of subclinical macroangiopathic target organ damage (TOD) in type 1 diabetes mellitus (T1DM). Results Although chronic complications resulting from hyperglycemia, in particular macroangiopathies, are still the first cause of death in T1DM, there has been growing recognition of the role of hypoglycemia in cardiovascular morbidity and mortality. Subclinical TOD diagnosis ensures early implementation of the complex management aiming at either partial reversal of these complications or at least its downturn. To better identify patients with early TODs, several non-invasive diagnostic techniques are employed, including the ultrasonographic assessment of the intima-media thickness (IMT), computed tomography (CT) for coronary artery calcium (CAC) scores, and pulse wave velocity (PWV) measurement for arterial stiffness evaluation. Various studies reported that T1DM patients present an increased IMT. An increasing IMT fairly correlates with the cardiovascular (CV) events risk even after the adjustment to age, diabetes duration, quality of glucose control as well as the presence of hypertension, and chronic complications. Another, well established marker of the organ damage – CAC score is recommended by ACC/AHA guidelines to assess the overall CV risk in T1DM. Also, the arterial stiffness evaluation with PWV may further improve CV risk prediction, which has been reported in multiple studies including the Framingham Heart Study. Conclusions There is shortage of data from prospective studies which could confirm the benefits of early treatment initiation based on the presence of the subclinical organ damage in T1DM. Most evidence comes from T2DM trials, where effective preventive measures were identified i.e.: smoking cessation, reasonable blood glucose control, efficacious hypertension treatment, and dyslipidemia management, as well as renoprotection. There is still a field for further research to see if routine assessment of asymptomatic vascular damage and early implementation of aggressive treatment would reduce mortality excess from CVD in T1DM.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08037051.2020.1770054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37981776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}