Abstract The May Measurement Month (MMM) 2023 global blood pressure (BP) screening campaign was conducted in Greece aiming to raise hypertension awareness and control in the general population. Volunteers aged ≥18 years were recruited through opportunistic screening in 11 cities. Each participant was assessed with triplicate seated BP measurements using validated automated upper-arm cuff devices and a standardized questionnaire on medical history. These data were submitted online through a custom-designed app of the global MMM campaign. Hypertension was defined as BP ≥140/90mmHg (average of second-third measurement) and/or use of antihypertensive drugs. A total of 5,437 individuals were analysed (mean age 53±17.1 years, 46.2% men, 27.8% current smokers, 10.9% with diabetes, 6.7% with cardiovascular disease) and 41.7% were hypertensive. The prevalence of hypertension was higher in men compared to women and in older compared to youngers individuals. Among hypertensives, 73.9% were unaware of their diagnosis, 69.9% were on antihypertensive drugs, and 47.6% were treated and controlled (BP <140/90mmHg). These data suggest that in Greece a high prevalence of hypertension persists, and often is undiagnosed, untreated, and uncontrolled. Global BP screening campaigns such as MMM are important and need to be complemented by public health initiatives at a national level for improving hypertension diagnosis and control.

Objectives Cardiovascular (CV) diseases are associated with adverse outcomes. However, attention has typically focused on outcomes considered relevant by doctors, whereas the potential gap in perception and relative importance of outcomes that may exist between patients and doctors has been scarcely explored. Evidence available reports the views of either patients or doctors alone, and data are analysed in aggregate. We investigated this issue by surveying for the first time patients’ and doctors’ opinions simultaneously, on a one-to-one basis.Design Survey involving patients with different CV diseases. Each patient and their attending doctor were asked to simultaneously but independently gauge the importance each attached to a predetermined set of outcomes, filling out disease-specific questionnaires. Results were analysed by compositional analysis.Setting Inpatients and outpatients being seen by cardiologists and internal medicine specialists at hospitals affiliated with the National Health System in Umbria, Italy.Participants All-comer patients, presenting with one of the following conditions: atrial fibrillation (AF), myocardial infarction (MI), heart failure (HF) or considered at high CV risk.Main outcome measures Importance attached to outcomes relative to life path, quality of life, future clinical events.Results From 337 paired questionnaires returned, significant differences between patients’ and doctors’ perspectives emerged. Specifically: (1) patients with AF were significantly less concerned about the risk of stroke than doctors; (2) worsening of HF was a greater concern for doctors than patients, whereas patients weighed the risk of disability more; (3) patients with a previous MI, or at high CV risk, weighed the risk of hospitalisation less relevant than doctors, but were significantly more concerned about the risk of disability.Conclusions Simultaneous, one-to-one assessment of patients’ and doctors’ opinion shows remarkable differences between patients’ perception and physicians’ judgement concerning the relevance of major CV outcomes. Appreciation and sharing of these issues may inform better tailoring of cardiac care.

OBJECTIVE The COVID-19 pandemic had an adverse impact on several cardiovascular risk factors. This study investigated the prevalence, awareness and treatment of hypertension in Greece before and after the pandemic. Data were collected in the context of the May Measurement Month (MMM) global survey initiated by the International Society of Hypertension. METHODS Adult volunteers (age >= 18 years) were recruited through opportunistic screening in public areas across cities in Greece in 2019 and 2022. Medical history and triplicate sitting blood pressure (BP) measurements were taken using validated automated upper-arm cuff devices. The data were uploaded to the international MMM cloud platform. Hypertension was defined as systolic BP >= 140 mm Hg and/or diastolic >= 90 mm Hg and/or self-reported use of drugs for hypertension. The same threshold was used to define uncontrolled BP in treated individuals. RESULTS Data from 12,080 adults were collected (5,727/6,353 in MMM 2019/2022; men 46/49%, p < 0.01; mean age 52.7 f 16.6/54.8 f 16.2, p <0.001; smokers, 24.7/30.5, p <0.001; diabetics 12/11.5%, p = NS; cardiovascular disease 5/ 5.8%, p = NS). The prevalence of hypertension was 41.6/42.6% (MMM 2019/2022, p = NS), with 21.3/27.5% of individuals with hypertension being unaware of their condition (p < 0.001), 5.6/2.4% aware untreated (p < 0.001), 24.8/ 22.1% treated uncontrolled (p < 0.05), and 48.3/47.8% treated controlled (p = NS). CONCLUSION In Greece, the COVID-19 pandemic did not appear to affect the prevalence and control of hypertension; however, the rate of undiagnosed hypertension was higher after the pandemic. National strategies need to be implemented for the early detection and optimal management of hypertension in the general population in Greece. (Hellenic Journal of Cardiology 2025;86:73-79) (c) 2024 Hellenic Society of Cardiology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Objective: The risk of atrial fibrillation (AF) is strongly associated with age, increasing the risk of both cardiovascular events and mortality. Evidence suggests an inverse, independent and graded association between cardiorespiratory fitness (CRF) and AF incidence in younger individuals. However, information on the association between CRF and AF incidence on hypertensive individuals >75 years of age is limited. Design and method: We identified of 57,137 hypertensive individuals ages >75.0 years (mean age 79.4±4.0), with no diagnosis of AF or ischemic cardiac disease prior to or upon completion of a standardized exercise treadmill test (ETT) as a part of clinical evaluation. We established four fitness categories based on age-stratified quartiles of peak METs achieved: Least-fit (3.7±0.8 METs; n=14,518); Low-Fit (5.9±0.9 METs; n=14,518); Moderately-Fit (7.0±0.72 METs; n=11,390); and Highly-Fit (9.8±1.4 METs; n=11,463). Multivariable Cox proportional hazard models were applied after adjusting for age, resting blood pressure, smoking, race, sleep apnea, chronic kidney disease, dyslipidemia, and medications. P-values <0.05 using two sided tests were considered statistically significant. Results: During 482,967.0 person-years of follow-up (median 7.8 years), there were 6,645 new AF cases occurred (11.6%) or 13.8 events per 1000 person-years of follow-up. In multivariable-adjusted analyses, CRF was inversely with the risk of developing AF, independent of all traditional comorbidities. For every 1-MET increase in exercise capacity the AF-risk was 9% lower (HR=0.91; CI: 0.90-0.93; p<0.001). The association across CRF categories was graded. Compared to the Least-Fit category (referent), the risk was 22% lower (HR=0.78; CI: 0.74-0.83; p<0.001) for the Low-Fit; 32% lower (HR=0.68; CI: 0.63-0.73; p<0.001) for the Moderately-Fit, and 40% lower (HR=0.60; CI: 0.56-0.65; p<0.001) for Highly-Fit individuals. Conclusions: Increased CRF reduces the risk of AF in individuals ages >75 years. The association is inverse, independent, and graded. For every 1-MET increase in exercise capacity the AF-risk was 9% lower.

Objective Real-life management of patients with hypertension and chronic kidney disease (CKD) among European Society of Hypertension Excellence Centres (ESH-ECs) is unclear : we aimed to investigate it. Methods A survey was conducted in 2023. The questionnaire contained 64 questions asking ESH-ECs representatives to estimate how patients with CKD are managed. Results Overall, 88 ESH-ECS representatives from 27 countries participated. According to the responders, renin-angiotensin system (RAS) blockers, calcium-channel blockers and thiazides were often added when these medications were lacking in CKD patients, but physicians were more prone to initiate RAS blockers (90% [interquartile range: 70-95%]) than MRA (20% [10-30%]), SGLT2i (30% [20-50%]) or (GLP1-RA (10% [5-15%]). Despite treatment optimisation, 30% of responders indicated that hypertension remained uncontrolled (30% (15-40%) vs 18% [10%-25%]) in CKD and CKD patients, respectively). Hyperkalemia was the most frequent barrier to initiate RAS blockers, and dosage reduction was considered in 45% of responders when kalaemia was 5.5-5.9 mmol/L. Conclusions RAS blockers are initiated in most ESH-ECS in CKD patients, but MRA and SGLT2i initiations are less frequent. Hyperkalemia was the main barrier for initiation or adequate dosing of RAS blockade, and RAS blockers' dosage reduction was the usual management.

Brain function is directly and indirectly associated with lipoprotein levels and function. Thus, overproduction or deficiency of lipids and/or lipoproteins can significantly affect brain homeostasis. Although the development and progression of atheroma plaques represents probably the most recognized mechanism of stroke, dyslipidaemia can induce or aggravate stroke also through other mechanisms. In this chapter, we discuss how dyslipidaemia can affect the brain through several different pathways leading to brain deterioration and damage and how treatment with statins and cholesterol reduction may improve stroke outcomes.

Objective: Real-life management of hypertensive patients with chronic kidney disease (CKD) is unclear. Methods: A survey was conducted in 2023 by the European Society of Hypertension (ESH) to assess management of CKD patients referred to ESH-Hypertension Excellence Centres (ESH-ECs) at first referral visit. The questionnaire contained 64 questions with which ESH-ECs representatives were asked to estimate preexisting CKD management quality. Results: Overall, 88 ESH-ECs from 27 countries participated (fully completed surveys: 66/88 [75.0%]). ESH-ECs reported that 28% (median, interquartile range: 1550%) had preexisting CKD, with 10% of them (5- 30%) previously referred to a nephrologist, while 30% (15-40%) had resistant hypertension. The reported rate of previous recent (<6 months) estimated glomerular filtration rate (eGFR) and urine albumin- creatinine ratio (UACR) testing were 80% (50- 95%) and 30% (15- 50%), respectively. The reported use of renin-angiotensin system blockers was 80% (70-90%). When a nephrologist was part of the ESH-EC teams the reported rates SGLT2 inhibitors (27.5% [20- 40%] vs. 15% [10-25], P = 0.003), GLP1-RA (10% [10- 20%] vs. 5% [5- 10%], P = 0.003) and mineralocorticoid receptor antagonists (20% [1030%] vs. 15% [10- 20%], P = 0.05) use were greater as compared to ESH-ECs without nephrologist participation. The rate of reported resistant hypertension, recent eGFR and UACR results and management of CKD patients prior to referral varied widely across countries. Conclusions: Our estimation indicates deficits regarding CKD screening, use of nephroprotective drugs and referral to nephrologists before referral to ESH-ECs but results varied widely across countries. This information can be used to build specific programs to improve care in hypertensives with CKD.

The vast majority of antianginal drugs decrease heart rate and or blood pressure levels or the inotropic status of the left ventricle to decrease myocardial oxygen consumption (MVO2) and thus anginal symptoms. Ranolazine presents a completely different mechanism of action, which reduces the sodium-dependent calcium overload inhibiting the late sodium current. Current European Society of Cardiology (ESC) guidelines for the management of angina in patients with chronic coronary symptoms recommend the use of several drugs such as ranolazine, b-blockers, calcium channel blockers, long-acting nitrates, ivabradine, nicorandil and trimetazidine for angina relief. However, ranolazine, in addition to symptom relief properties, is an antianginal drug showing favorable effects in decreasing the arrhythmic burden and in ameliorating the glycemic profile of these patients. In this review, we summarize the available data regarding the antianginal and pleiotropic effects of this drug.

Objective: The recent ESH Guidelines include elevated resting heart rate (RHR) as an independent risk factor among the established and suggested novel risk factors that influence cardiovascular risk in patients with hypertension, indicating sympathetic overdrive. Increased fitness affects both mortality and RHR. However, the association between RHR and mortality risk, adjusted for cardiorespiratory fitness, age, comorbidities and medication has not been fully explored. Design and method: We evaluated the association between RHR and mortality in 422,702 hypertensive patients (mean age 62.5 ± 8.6 years) with no evidence of atrial fibrillation during the entire follow-up. All completed a standardized exercise treadmill test (ETT), with no evidence of overt heart disease prior to and at the time of the ETT. To assess the risk in a wide and clinically relevant spectrum, we established 6 RHR categories per 10 heartbeat intervals ranging from <=60 to >100 beats. We used multivariable Cox regression to assess the RHR-mortality association. We adjusted the models for age, body mass index, cardiac risk factors, exercise capacity, and medications (including b-blockers). Results: During the median follow-up of 10.6 years, providing 4,551,327 person-years, there were 107,863 deaths with an average annual rate of 23.7 events per 1,000 person-years. We noted approximately 7% increase in risk for each 10 heart beats. Mortality risk was significantly elevated at a RHR of >80 beats/min (HR; 1.15, CI; 1.12 - 1.17; p <0.006) and increased progressively to 41% (HR; 1.41, CI; 1.36 - 1.45; p <0.001) for those with a RHR of >100 beats/min. Similar trends were noted for subjects aged <60; 60-69; and >=70 years and those treated with b blockers. In all assessments, mortality risk was consistently overestimated when fitness was not considered. Conclusions: We noted a progressive increase in mortality risk with increased RHR at >80 bpm in hypertensive patients with no AF. The association was independent of comorbidities, and medications.

Objective: The present study aimed to systematically appraise and quantitatively summarize the available evidence from published randomized controlled trials (RCTs) considering the effect of nebivolol on blood pressure (BP) levels in patients with hypertension. Design and method: The literature search was performed through Medline (via PubMed), Cochrane Library and Scopus until December 15, 2023. Double-independent study selection, data extraction and quality assessment were performed. Evidence was pooled with three-level mixed-effects meta-analysis. Results: In total, 7,737 participants with hypertension, who were treated with nebivolol, were analyzed across 91 RCTs. Most trials had a high risk of bias according to the Cochrane Collaboration tool (RoB2). Nebivolol was associated with significantly greater reduction in office systolic and diastolic BP compared to placebo (MD = -6.01 mmHg; 95% CI= [-7.46, - 4.55] and MD = -5.01 mmHg; 95% CI= [-5.91, -4.11], respectively). Moreover, nebivolol resulted in a similar reduction in systolic BP (MD = -0.22 mmHg; 95% CI= [-0.91, 0.46]) and a significantly greater reduction in diastolic BP compared to active comparator (MD = -0.71 mmHg; 95% CI= [-1.27, -0.16]). When considering the effect of nebivolol on 24-hour ambulatory BP, notable reductions were observed compared to placebo. In contrast, compared to the active comparator, there was no significant difference in ambulatory systolic BP reduction, but a significant reduction in ambulatory diastolic BP favoring nebivolol was noted. Based on moderator analyses, the impact of nebivolol on the pooled estimates remained independent of the duration of RCTs, gender, age, body mass index, history of diabetes or heart failure. Conclusions: Our findings suggest that nebivolol resulted in a significant reduction in BP compared to placebo and seemed to be non-inferior to active comparator in terms of BP reduction. When considering the effect of nebivolol on 24-hour ambulatory BP, nebivolol was superior to placebo, while compared to the active comparator, there was no significant difference in ambulatory systolic BP reduction, but a significant reduction in ambulatory diastolic BP. Future, large-scale, and meticulously designed trials are necessary to further establish the place of nebivolol in the treatment algorithm of hypertension.

To systematically appraise and summarize the available evidence from published randomized controlled trials considering the effect of nebivolol on blood pressure in patients with hypertension. Literature search was performed through Medline (via PubMed), Cochrane Library and Scopus until December 15, 2023. Double-independent study selection, data extraction and quality assessment were performed. Evidence was pooled with three-level mixed-effects meta-analysis. In total, 7,737 participants with hypertension, who were treated with nebivolol, were analyzed across 91 RCTs. Nebivolol was associated with significantly greater reduction in office systolic and diastolic BP compared to placebo (MD = − 6.01 mmHg; 95

Objective: The COVID-19 pandemic appeared to have an adverse impact on the management of cardiovascular risk factors. This study investigated the prevalence, awareness, treatment, and control of hypertension in the adult population in Greece before and after the COVID-19 pandemic (2019 and 2022) in the context of the May Measurement Month (MMM) global survey initiated by the International Society of Hypertension (ISH). Design and method: Adult volunteers were recruited through opportunistic screening in public areas in several cities of Greece in 2019 and 2022. Information on medical history and triplicate sitting blood pressure (BP) measurements were obtained using validated automated upper-arm cuff devices with appropriate cuff size. Data were uploaded to an international online platform. Hypertension was defined as systolic BP >=140 mmHg and/or diastolic >=90 mmHg, and/or self-reported use of drugs for hypertension. The same threshold was used for the definition of uncontrolled hypertension in treated individuals. Results: The MMM survey collected data from 5,727 adults in 2019 and 6,353 in 2022. The characteristics of the participants in 2019/2022 were: men 46/49%, p<0.01; mean age 52.7±16.6/54.8±16.2, p<0.001; smokers, 24.7/30.5, p<0.001; diabetic 12/11.5%, p=NS; history of cardiovascular disease 5/5.8%, p=NS). The prevalence of hypertension was 41.6/42.6% (2019/2022, p=NS). Among patients with hypertension, 21.3/27.5% (2019/2022, p<0.001) were unaware of their condition, 5.6/2.4% were aware but untreated (p<0.001), 24.8/22.1% were treated but uncontrolled (p<0.05), and 48.3/47.8% were treated controlled (p=NS). Conclusions: The COVID-19 pandemic did not significantly affect the prevalence and the control of hypertension in the general population in Greece. However, the rate of undiagnosed hypertension was increased after the pandemic.

Hypertension remains a major problem worldwide, especially across the Asia-Pacific region, which reports high prevalence rates and slow improvements in treatment rate and blood pressure (BP) control rate. Asian patients with hypertension may also vary with regard to phenotype and the epidemiology of the complications of hypertension, especially when compared with Western patients. Given these differences, Western guidelines may not necessarily be applicable to countries in the Asia Pacific. This narrative review aims to provide a critical comparison between the recently published European Society of Hypertension (ESH) 2023 guidelines and existing local guidelines in select Asian countries, offer expert opinion on how to fill gaps in the ESH 2023 guidelines for hypertension in the Asian context, and examine the need for harmonisation of hypertension guidelines worldwide. This review focuses on the definition and diagnosis of hypertension, the treatment thresholds and targets, and recommendations on the use of pharmacotherapy.