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Hypertension in special populations

ESC Congress 2010


Hypertension in Athletes

Incidence of hypertension is low in athletes, but it can be more frequent with advancing age. It is important to exclude the intake of substances which can increase blood pressure values (and CV risk!!). Diagnostic procedures must include echocardiography and exercise testing. Sport activity can be permitted depending on the presence of well controlled blood pressure values and low CV risk. Although compelling indications do not exist, preferred pharmacological treatment should be based on RAS-blockers and/or calcium antagonists. While endurance sports reduce CV events, power sports increase the risk of coronary artery disease.

Prehypertension in Adolescents

Blood pressure, heart rate and plasma catecholamines correlate positively and there is a profound impact of mental stress. Metabolic variables like lipid fractions and insulin sensitivity are perturbed. Hemodynamic variables like viscosity and MFVR are worsened, and heart rate variability and baroreceptor sensitivity are reduced. Arterial plasma catecholamines predict 18-years changes in body build, BP, glucose and HOMA-index. The overall picture is compatible with sympathetic overactivity and parasympathetic withdrawal.

Hypertension in Pregnancy

Korotkoff Phase V is now recommended for the measurement of DBP in pregnancy with Phase IV being indicated only if Korotkoff sounds persist at cuff pressures approaching 0 mmHg. Non-pharmacological management should be considered for pregnant women with SBP 140-149 mmHg or DBP 90-95 mmHg. In gestational hypertension with or without proteinuria, drug treatment is indicated at BP levels ≥ 140/90 mmHg. In non-severe hypertension, oral methyldopa, labetalol, calcium antagonists, and (less frequently) beta-blockers are drugs of choice. In pre-eclampsia with pulmonary edema, nitroglycerin is the drug of choice, and diuretic therapy is inappropriate because plasma volume is reduced. As emergency treatment, intravenous labetalol, oral methyldopa, and oral nifedipine are indicated. Intravenous hydralazine is no longer the drug of choice because of an excess of perinatal adverse effects. I.v. infusion of sodium nitroprusside is useful in hypertensive crisis, but prolonged administration should be avoided. Calcium supplementation, fish oil, and low-dose aspirin are not recommended. However, low-dose aspirin may be used prophylactically in women with a history of early onset of pre-eclampsia

Octogenarians, presented by T.M.MacDonald (Dundee, UK)

Hypertension is common in whitecoat population. One has to take into account variability. The BP target is 140/70 mm Hg. There was no difference between drugs according to age, tolerance, toxicity and comorbidity. For further results, refer to HYVET Trial and INVEST substudy.




Hypertension in special populations
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.