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ESC Congress 2022 – Highlights on Hypertension

By Rosa Maria Bruno, on behalf of the Council on Hypertension

Discover some selected highlights on hypertension from the ESC Congress 2022 which took place on 26-29 August 2022 in Barcelona and onsite. 

Hotline Session: Treatment In the Morning versus Evening: the TIME Study Results (26 August)

Does it matter if you take your blood pressure (BP) pills in the morning or in the evening? After few observational studies showing some benefit with bedtime administration, a large randomized trial of 21,104 subjects gave a clear answer: no difference between the two treatment arms, but no more side effects neither. The main results of the TIME study were presented by Thomas MacDonald (UK).

The study design was particularly interesting: TIME was a decentralised trial, with screening, consent, randomisation, and follow-up performed through an online study portal and by email.

Access the session on-demand on ESC 365

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Renal denervation: back on track. The 2022 ESC position paper on renal denervation: what you need to know (27 August)

In this session, chaired by Emanuele Barbato (Italy) and Felix Mahfoud (Germany), the new clinical consensus document on renal denervation (RDN), prepared jointly by the ESC Council of Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) has been presented. After an update of the recent literature that demonstrated the BP-lowering efficacy and safety of the 2nd-generation RDN devices by Andrew Sharp (UK), patient selection (Michel Azizi, France), procedural aspects (Rosa Maria Bruno, France), and recommendations for future clinical trials (Sofie Brouwers, Belgium) were presented.

Who should undergo RDN? The experts suggest that RDN may be used in patients with uncontrolled BP under 3 or more drugs, but may also be an option in patients intolerant to multiple medications according to patient preferences.

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A joint session with the European Space Agency (ESA): Space for Cardiology, Cardiology for Space! (27 August)

In this stimulating session, several important issues were addressed including a description of ESA’s plans for the future, fascinating data on cardiac adaptation to microgravity obtained through space echocardiography, and a report on the effects of pollution on cardiovascular health. Gianfranco Parati (Italy) described what the cardiovascular changes are in extreme environments, focussing on the effects of gravity and hypobaric hypoxia at altitude. Clear evidence was provided that blood pressure increases over 24 hours under hypobaric hypoxia exposure. Such an increase is proportional to the altitude reached, more evident during the night, and more pronounced with advancing age. Recommendations published in a position paper of the ESC Council on Hypertension for safe exposure to altitude of patients affected by cardiovascular conditions were also summarised.

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Great Debate: hypertension during exercise should be treated (27 August)

Around 1/3 of normotensives / controlled hypertensive patients have an exaggerated blood pressure response to exercise: how to manage this common condition? Claudio Borghi (Italy) defended the pro side in this debate and presented the epidemiological and prognostic value of the problem. André La Gerche (Australia), on the con side, argue against the possibility to correctly assess this phenomenon in terms of accuracy and precision. Brian Williams' (UK) final word was clearly on the con side!

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Blood pressure measurements: the longer the better? (27 August)

In this session chaired by Gianfranco Parati (Italy) and Thomas Kahan (Sweden), some innovative aspects in hypertension were discussed.

Rhian Touyz (Canada) reviewed the importance of BP load and variability over time, and old and new way to measure them. Rocardo De Armas (USA) presented the results of a study implementing a remote care program in the management of patients with multiple medication intolerances.

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Official joint session with the European Society of Hypertension (ESH): Gender does matter in hypertension! (27 August)

Anastasia Mihailidou (Australia) and Isabella Sudano (Switzerland) warn about increased hypertension burden of hypertension in women and present recent evidence and gaps in knowledge. A symposium preparing the floor for the new scientific statement on Sex differences in arterial hypertension, which will be soon published in the European Heart Journal. Targeting hypertension is predicted to be the more effective strategy to reduce cardiovascular burden in women. However, a crucial gap remains under-representation of women in cardiovascular clinical trials (less than 39% between 2010-2017), a phenomenon which is not unavoidable and limits the potential of developing sex-specific recommendations in cardiovascular disease, including hypertension.

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