In primary care, automated OBP measurements are misleading in approximately 40% of treated hypertensive patients. HBP monitoring is mandatory to avoid overtreatment of subjects with WCH phenomenon and prevent undertreatment and subsequent excess cardiovascular disease in MUCH.

Both arterial blood pressure (BP) average levels and short-term BP variability (BPV) relate to hypertension-mediated organ damage, in particular increased carotid artery intima-media thickness (IMT) and carotid-femoral pulse wave velocity (PWV). Endothelial dysfunction possibly mediates such damage. The authors aimed at further investigating such role in hypertensive patients. In 189 recently diagnosed, untreated hypertensive patients the authors evaluated, in a cross-sectional design, the relationships of BP average levels and short-term systolic (S) BPV (standard deviation of awake SBP or of 24-hour-weighted SBP) with IMT and PWV, and how much these relationships are explained by endothelial function parameters-brachial artery flow-mediated dilation (FMD) and digital reactive hyperemia index (RHI). Multivariable models assessed the strength of these relationships to derive a plausible pathogenetic sequence. Both average SBP values and our measures of SBPV were significantly related to IMT (24-hour mean SBP: r = .156, P = .034; 24-hour-weighted SBPV: r = .157, P = .033) and to PWV (24-hour mean SBP: r = .179, P = .015; 24-hour-weighted SBPV: r = .175; P = .018), but only poorly related to FMD or RHI (P > .05 for all). At univariable regression analysis, FMD and RHI were both related to IMT, (P < .001), but not to PWV. When FMD and RHI were added to average SBP and SBPV parameters in a multivariable model, both significantly (P < .005) contributed to predict IMT, but not PWV. Thus, endothelial dysfunction relates to IMT independently of BP parameters, but appears to play a minor role in the association between BP variability-related variables and arterial stiffening.

Objective: Treatment of obstructive sleep apnoea (OSA) has been shown to reduce blood pressure (BP). However, the effect size is modest and treatment of OSA is not recommended as the only treatment target when treating hypertension. Despite the limited effect of continuous positive airway pressure (CPAP) therapy on BP, it is likely that certain phenotypes of OSA patients respond better to CPAP than others. The aim of the present systematic review and meta-analysis was to identify potential predictors for BP response in patients with OSA undergoing CPAP treatment.Design and method: A systematic search was conducted in three databases (MEDLINE, Embase and Web of Science) using terms exploring three domains (obstructive sleep apnoea, CPAP, clinical trial) based on the following inclusion criteria: i) randomised controlled clinical trials published between January 1st 1960 to December 31st 2017 including a reasonable control group; iii) OSA diagnosis using polysomnography; iv) age >18 years; v) OSA severity of at least 5 AHI/h. The random effect model was fitted to estimate the pooled BP reductions calculated as the difference between the BP change (end-treatment minus baseline) in the CPAP and control group. Moreover, the original estimates have been stratified according to selected patient characteristics. Results: Out of 2445 articles, 59 RCTs were included (n = 7,329 subjects) comparing CPAP with control groups. CPAP was associated with a net reduction in systolic BP of −2.12 (95% CI −2.82 to −1.42) mmHg and in diastolic BP of −1.97 (95% CI −2.46 to −1.48) mmHg, favouring treatment of OSA using CPAP (both p-values < 0.001). The subgroup analysis showed that systolic BP reduction was greater in subjects younger than 60 years (−2.88 fro age 40–50, −2.78 for age 50–60 and −0.61 for age more than 60 years, p = 0.007) and in patients with controlled BP at baseline versus uncontrolled BP (−1.45 vs −4.14, p = 0.002) (Figure 1). Conclusions: Younger patients (< 60 years) with uncontrolled blood pressure at baseline are more likely to experience significant BP reductions with CPAP therapy. Phenotypisation of specific cohorts of patients can guide clinicians to target OSA treatment and help to optimise patients’ cardiovascular risk.

This represents the first attempt to validate in patients the in vitro results of a drug repurposing strategy for cardiovascular disorders. Lumacaftor + Ivacaftor shortened significantly the QTc in the two LQT2 patients with a trafficking defect, largely confirming the findings in their iPSC-CMs but with smaller quantitative changes. The findings are encouraging but immediate translation into clinical practice, without validation in more patients, would be premature.

CMD are associated with increased mortality and suicide risk in IMID. In MS and RA, the effects of depression on mortality risk are greater than associations of these IMID and depression alone.

Heart failure with mid-range ejection fraction represents a heterogeneous and relatively young heart failure category accounting for nearly 20-30% of the overall heart failure population. Due to its complex phenotype, a reliable clinical picture of heart failure with mid-range ejection fraction patients as well as a definite risk stratification are still relevant unsolved issues. In such a context, there is growing interest in a comprehensive functional assessment by means of a cardiopulmonary exercise test, yet considered a cornerstone in the clinical management of patients with heart failure and reduced ejection fraction. Indeed, the cardiopulmonary exercise test has also been found to be particularly useful in the heart failure with mid-range ejection fraction category, several cardiopulmonary exercise test-derived parameters being associated with a poor outcome. In particular, a recent contribution by the metabolic exercise combined with cardiac and kidney indexes research group showed an independent association between the peak oxygen uptake and pure cardiovascular mortality in a large cohort of recovered heart failure with mid-range ejection fraction patients. Contextually, the same study supplied an easy approach to identify a high-risk heart failure with mid-range ejection fraction subset by using a combination of peak oxygen uptake and ventilatory efficiency cut-off values, namely 55% of the maximum predicted and 31, respectively. Thus, looking at the above-mentioned promising results and waiting for specific trials, it is reasonable to consider cardiopulmonary exercise test assessment as part of the heart failure with mid-range ejection fraction work-up in order to identify those patients with an unfavourable functional profile who probably deserve a close clinical follow-up and, probably, more aggressive therapeutic strategies.

To increase mental health literacy and reduce stigma, workplace training should be based on best practice principles of contact-based education, with contextually relevant examples and support from all levels of the organization.

Recent guidelines for the management of hypertension from the 2018 European Society of Cardiology/European Society of Hypertension and the 2017 American College of Cardiology (ACC)/American Heart Association (AHA)1,2 have stressed the importance of out-of-office blood pressure (BP) measurement for hypertension management. There has been a similar emphasis on out-of-office BP monitoring for the management of hypertension in the United Kingdom, Canada, Japan, and other Asian countries.3–6 Ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) are 2 well-validated approaches for measuring out-of-office BP. In the published literature, HBPM is a term that has commonly referred to the self-measurement of BP at home, although in some studies, HBPM has been used to describe a provider or research assistant measuring an individual’s BP in his/her home. ABPM and HBPM can identify white coat hypertension (diagnostic disagreement between office and out-of-office BP in untreated subjects) and white coat uncontrolled hypertension (diagnostic disagreement in treated subjects).1–8 Although ABPM has been the preferred method for out-of-office measurement, the 2017 ACC/AHA BP guideline considered HBPM to be a more practical approach in clinical practice than ABPM, particularly for individuals taking antihypertensive medication. The 2014 Japanese Society of Hypertension Guidelines for the Management of Hypertension proposed HBPM as the most effective and practical for guiding antihypertensive medication initiation and titration in clinical care, while waiting for intervention trials demonstrating better cardiovascular outcomes in patients managed based on out-of-office BP levels

Body acceleration due to heartbeat-induced reaction forces can be measured as mobile phone accelerometer (m-ACC) signals. Our aim was to test the feasibility of using m-ACC to detect changes induced by stress by ultra-short heart rate variability (USV) indices (standard deviation of normal-to-normal interval-SDNN and root mean square of successive differences-RMSSD). Sixteen healthy volunteers were recruited; m-ACC was recorded while in supine position, during spontaneous breathing at rest conditions (REST) and during one minute of mental stress (MS) induced by arithmetic serial subtraction task, simultaneous with conventional electrocardiogram (ECG). Beat occurrences were extracted from both ECG and m-ACC and used to compute USV indices using 60, 30 and 10s durations, both for REST and MS. A feasibility of 93.8% in the beat-to-beat m-ACC heart rate series extraction was reached. In both ECG and m-ACC series, compared to REST, in MS the mean beat duration was reduced by 15% and RMSSD decreased by 38%. These results show that short term recordings (up to 10 s) of cardiac activity using smartphone's accelerometers are able to capture the decrease in parasympathetic tone, in agreement with the induced stimulus.

Objective: Slow controlled breathing has been reported to reduce blood pressure (BP) in hypertensive patients, decreasing sympathetic nerve activity. In hypoxic conditions associated with high altitude, slow deep breathing has also been shown to improve oxygen saturation and to influence BP and heart rate. In the present teaching experiment conducted during the ESH 2018 Summer School, we have evaluated the impact of slow breathing on hemodynamic parameters and O2 saturation when acutely ascending from les Diablerets (altitude 1150 m) to Glacier 3000 (at 3010 m). Design and method: Blood pressure(ABPM, Novacor System, oscillometric validated device), heart rate and O2 saturation were measured at baseline, 30 minutes after arriving at 3010 m, during slow breathing, after 2 hours at altitude and after returning to baseline. Results: Eleven subjects (4 males/7 females) participated in the experiment. Mean age was 34.3 y and mean BMI was 24.3 km/m2. At baseline, systolic (S) BP and diastolic (D) BP were 132 ± 19/86 ± 11 mmHg, heart rate (HR) was 72.5 ± 8 b/min and O2 saturation was 98.2%. Breathing rate was 13.6 per min. Upon arrival at 3000m, O2 saturation decreased to 91.7% (p < 0.01) and breathing rate increased to 16.5 per min. Both SBP and DBP decreased significantly to 123 ± 14 and 78 ± 9 mmHg respectively (P < 0.01) due to the acute vasodilating effects of hypoxemia. Heart rate increased to 94.8 b/min (p < 0.001). Slow breathing to 6 per min, lowered SBP to 118.8 ± 14 and increased DBP 80.9 ± 8.8 mmHg (p = ns). O2 saturation increased slightly to 92.5%. After 2 h, the subjects adapted their oxygenation but heart rate remained elevated (94.5 b/min). When returned to baseline, all values were normalized. Conclusions: Even short terms changes in altitude induce significant changes in BP, heart rate and O2 saturation in healthy subjects. Slow breathing tends to improve BP and O2 saturation

Objective: Background. Heart disease is still Thalassemia Major (TM) patients’ leading cause of death. Growing evidences point out atrial function and global longitudinal strain (GLS) as early hallmarks of iron cardiomyopathy. Purpose. To investigate left atrial size and function and GLS in TM patients with different iron overload status, in order to detect early myocardial iron overload (MIO) induced heart damage. Methods. 1.5T CMR classified 81 white TM patients in “MIO+” (T2* < 20ms, T1 mapping < 918ms), “discrepancy” (T2*>20ms, T1 mapping<918ms) and “MIO-” (T2* > 20ms, T1 mapping>918ms). In addition to normal structure and function, biplane measurement method at 3 time points (maximum, minimum and pre-atrial contraction) were used to calculate atrial functions (reservoir, conduit and emptying function); LV GLS from 2- and 4-chambers cines was also calculated. Results: See Table1. body surface area (1.6 ± 0.2 vs 1.6 ± 0.2, vs 1.6 ± 0.2, p = 0.5) and Hb (9.6 ± 0.6 vs 9.9 ± 0.9 vs 9.7 ± 0.8 g/L, p = 0.9) were balanced; age was smaller in MIO+ (38 ± 8 vs 39 ± 8 vs 35 ± 7y p = 0.04). No differences were observed in LV size, EF. Left atrial (LA) indexed total emptying volume was similar between groups (30 ± 13 vs 29 ± 14, vs 32 ± 14 ml/m2, p0.6), However, the contribution of passive emptying to LA total emptying was reduced in MIO+, intermediate in “discrepancy” and higher in MIO-. Conclusions: 1) In TM patients with preserved LV size and systolic function, the contribution of passive emptying to total LA emptying is reduced proportionally to the amount of iron overload, as observed in restrictive LV filling pattern. We hypothesise that iron deposition in the atria may be contributing to these pathophysiological changes.2) The % of atrial emptying due to atrial contraction observed in TM MIO- patients is higher than the published reference values in general population, suggesting that a different threshold for atrial function should be used, as for LVEF, in TM patients, accounting for hyperdynamic circulation in residual anaemia.

These data suggest that patients with psoriasis can have foot and ankle tendinopathy or enthesopathy without having psoriatic arthritis, presenting a diagnostic challenge to physicians. Further research is needed to elucidate mechanisms contributing to this increased risk.