European Society of Hypertension

ABSTRACTIntroductionSentinel lymph node biopsy (SLNB) after neoadjuvant treatment (NAT) is an increasing option for axillary surgery in patients responding to treatment, whether diagnosed as clinically node‐negative (cN0) or node‐positive (cN + ). This study evaluates SLNB trends in patients with NAT in a large European population.Materials and MethodsData sourced from EUSOMADB, collating prospectively collected data from certified European Breast Units, included 17,321 patients who have undergone NAT between 2010 and 2021. Of those, 9,226 and 8.095 are clinically N0 and cN1, respectively.ResultsDuring the study period, for cN0 patients, there has been a significant increase in the proportion of cases with SLNB, rising from 86% in the 2010–2015 period to 94% in the 2016–2021 period. Consequently, a decline in direct axillary dissection (AD) has been shown in both periods, dropping from 14% to 6% (p < 0.001). Similarly, in cN+ patients, SLNB increased from 25% to 40%, while direct AD decreased from 75% to 60% (p < 0.001). Regarding immunohistochemistry subtypes, higher SLNB rates were reported in triple‐negative and HER2‐enriched tumors. Nevertheless, SLNB rates rose significantly across all immunohistochemical subtypes (p < 0.001) between both periods.Multivariate analysis identified as statistically significant predictors of SLNB: surgery period (second period), molecular subtype (HER2‐positive, triple‐negative), breast‐conserving surgery and type of NAT.ConclusionThis study evidences a substantial shift towards SLNB as the primary axillary surgery following NAT during the study period. This trend emphasizes a preference for less invasive procedures, likely due to the efficacy of neoadjuvant therapy in reducing axillary lymph node involvement.

IntroductionCardiovascular diseases (CVD) represent the leading cause of morbidity and mortality for women worldwide, yet they are often unaware of this heavy burden.AimTo assess cardiovascular risk awareness among Italian women.MethodsFollowing World Heart Day 2023, a cardiovascular prevention campaign was conducted in Italian pharmacies to evaluate the effectiveness of screening activities offered by pharmacies and raise awareness of cardiovascular health status among Italian women. Cardiovascular risk profile and perception of CVD burden relative to other common female-specific diseases were assessed. Blood pressure (BP) measurement and ECG recording were performed.ResultsA total of 1510 women (84.7% < 70 years), enrolled at 91 pharmacies, were included. The most prevalent cardiovascular risk factor was sedentary lifestyle (57.9%), followed by overweight/obesity (44.3%), hypercholesterolemia (37.9%), hypertension (31.3%), family history of early CVD (28.7%), smoking (20.6%), and diabetes (5%). CVD and/or kidney disease were uncommon (3.6%), but 1 in 4 women was classified as being at increased cardiovascular risk, and 47.5% had some type of ECG abnormalities, requiring further assessments in 18% cases. Less than 1 in 3 women was aware of the burden represented by CVD, being the majority mostly concerned with breast cancer and osteoporosis as potential health threats.ConclusionsThe burden of cardiovascular risk factors is high, and the perception of related health threat is low among the examined sample of Italian women, supporting the urgent need to raise awareness of CVD in women as a major health issue and to undertake effective, tailored preventive strategies to reduce such risk in a timely fashion.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40292-025-00701-4.

IntroductionHypertension is the main risk factor for cardiovascular diseases (CVD). Notably, only about half of hypertensive patients manage to achieve the recommended blood pressure (BP) control. Main reasons for the persistence of uncontrolled BP during treatment are lack of compliance on the patients’ side, and therapeutic inertia on physicians’ side.MethodsDuring the global BP screening campaign “May Measure Month” (MMM) (May 1st to July 31st, 2022), a nationwide, cross-sectional, opportunistic study endorsed by the Italian Society of Hypertension was conducted on volunteer adults ≥ 18 years to raise awareness of the health issues surrounding high BP. A questionnaire on demographic/clinical features and questions on the use of fixed-dose single-pills for the treatment of hypertension was administered. BP was measured with standard procedures.ResultsA total of 1612 participants (mean age 60.0±15.41 years; 44.7% women) were enrolled. Their mean BP was 128.5±18.1/77.1±10.4 mmHg. About half of participants were sedentary, or overweight/obese, or hypertensive. 55.5% individuals with complete BP assessment had uncontrolled hypertension. Most were not on a fixed-dose combination of antihypertensive drugs and did not regularly measure BP at home. Self-reported adherence to BP medications was similar between individuals with controlled and uncontrolled BP (95% vs 95.5%).ConclusionsThis survey identified a remarkable degree of therapeutic inertia and poor patients’ involvement in the therapeutic process and its monitoring in the examined population, underlining the importance of prevention campaigns to identify areas of unsatisfactory management of hypertension, to increase risk factors’ awareness in the population with the final purpose of reducing cardiovascular risk.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40292-024-00642-4.

ABSTRACT Palliative care is a holistically oriented philosophy and a model of medical care for patients with life limiting illness. By nature, its care is team-based and quality of life is its objective for patients and families facing life-threatening illness. This care requires timely and accurate assessment and treatment of physical, psychosocial and spiritual symptoms. Responses to these unmet needs can overwhelm patients and loved ones, robbing them of hope for meaningful relief of suffering. Clinical hypnotic approaches can identify and explore the nature of these needs; however, referrals to the spiritual interventions in palliative care are typically made late in the illness trajectory of such illness. Substantial scientific evidence supports early and open access to spiritually directed therapies, including meditative and cognitive techniques, including clinical hypnosis. Spiritual therapies often integrate aspects of effective psychological and meditative approach therapies. These approaches have many shared qualities, including their cognitive orientation, inward focus, inclusion of some rituals, and shared goals of providing emotional support by focusing upon a safe inner space for mental, psychological, and spiritual exploration during days that are full of challenge and threat. This paper reviews The neuroscientific features of inner consciousness, including its role in suffering and in accessing states of mind that relieve suffering; details salient meditative and hypnotic approaches appropriate for palliative settings of care; discusses core principles and orientations shared by effective approaches; and proposes early integration of hypnotic training as a coping skill and a platform for spiritual exploration, as desired.

The risk of cardiovascular disease (CVD) mortality in individuals with an alerting reaction, assessed by hypertension in the first blood pressure (BP) reading but normal BP in further readings, remains unknown in the general population. In a sample of 11 146 adults (51.5% men and 48.5% women) with a mean age of 47.1 years (SD ± 12.3) from a German population-based cohort, we analyzed risk factors and CVD mortality risk associated with an alerting reaction. An alerting reaction was prevalent in 10.2% of the population and associated with sociodemographic, lifestyle, and somatic CVD risk factors. Within a mean follow-up period of 22.7 years (SD ± 7.05 years; max: 32 years; 253 201 person years), 1420 (12.7%) CVD mortality cases were observed. The CVD mortality rate associated with an alerting reaction was significantly higher than in normotension (64 vs. 32 cases/10 000 person-years), but lower than hypertension (118 cases/10 000 person-years). Correspondingly, the alerting reaction was associated with a 23% higher hazard ratio of CVD mortality than normal blood pressure [hazard ratio 1.23 (95% confidence interval 1.02-1.49), P = 0.04]. However, adjustment for antihypertensive medication use attenuated this association [1.19 (0.99-1.44), P = 0.06]. The results may warrant monitoring of an alerting reaction as a preventive measure of CVD mortality in untreated individuals with elevated first BP readings, as well as optimized treatment in treated individuals.

All severe cases of SARS-CoV-2 infections are characterized by a high risk of disease progression towards ARDS, leading to a bad outcome. Respiratory symptoms in COVID-19 patients often do not correspond to disease's worsening. In our sample, median age was 74 years (72-75) and 54% were men. The median period of hospitalization was 9 days. Firstly, we observed a significant asynchronous trend of neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) in 764 selected among 963 patients, who were consecutively recruited in two hospitals (Cannizzaro, S. Marco) in Catania, Italy. NLR values in deceased patients showed an increase from baseline over time. By contrast, CRP tended to fall from baseline to median day of hospitalization in all three subgroups, but steeply increased at the end of hospitalization only in ICU-admitted patients. Then, we evaluated the relationships between NLR and CRP as continuous variables with PaO2/FiO2 ratio (P/F). NLR was an independent predictor of mortality (HR: 1.77, p < 0.0001), while ICU admission was more significantly associated with CRP (HR: 1.70, p < 0.0001). Finally, age, neutrophils, CRP, and lymphocytes are significantly and directly linked to P/F, while the influence of inflammation on P/F, reflected by CRP, was also mediated by neutrophils.

Objective: Hypertension is defined as resistant when the treatment strategy fails to lower office SBP and DBP values to &lt;140 mmHg and/or &lt;90 mmHg, respectively, and the inadequate control of blood pressure is confirmed by ABPM or HBPM in patients whose adherent to therapy. We report a case of resistant hypertension of a 64-year-old woman who referred to our Center in August 2021 for uncontrolled BP (160/94 mmHg) despite anti-hypertensive treatment with ramipril/hydrochlorothiazide 5/25 mg, atenolol 50 mg, ramipril 5 mg and lacidipine 4 mg daily and mild hypokalaemia (3.3 mmol/L). Design and method: Clinical history revealed dyslipidemia in treatment with simvastatin 20 mg/daily, osteoporosis in treatment with calcium and vitamin D supplements, parathyroid nodules in follow-up,family history of CAD. Laboratory tests confirmed hypokalaemia (3.1 mmol/L). Blood glucose, creatinine,lipids thyroid function were normal; no proteinuria was observed. The echocardiogram showed left ventricular hypertrophy with EF 60% and grade-1 diastolic dysfunction. Results: After wash-out of anti-hypertensive drugs, the screening tests revealed high aldosterone plasma levels (1166 pg/mL) and low renin level (1.6 microu/mL) with an ARR of 729. Other adrenal hormone levels were within normal limits. The saline infusion test confirmed the hyper-aldosteronism and an abdominal CT scan revealed a left adrenal neoformation of 17 x 15 mm in seize (Figure 1A). The patient underwent adrenal venous sampling which did not show lateralization and patients refuse to repeat the procedure. Anti-hypertensive therapy with spironolactone, eplerenone, canrenone and amiloride was stopped due to diarrhoea and rectal tenesmus (colonscopy excluded microscopic colitis). A 131I-norcholesterol adrenal scintigraphy with dexamethasone suppression documented early uptake only in the left adrenal gland (Figure 1B). After surgical evaluation, the patient underwent a video-laparoscopic left adrenalectomy and the histological examination revealed an adrenal cortical adenoma. The post-operative course was complicated by a syncopal episode due to hypotension (80/50 mmHg) with head injury for which antihypertensive therapy was revised and at the discharged she takes valsartan 80 mg, verapamil 40 mg twice. Conclusions: Primary aldosteronism intolerant to potassium-sparing diuretics and aldosterone antagonists is a rare condition and the establishment of a multidisciplinary team can improve its management.

Hypertension is the leading modifiable risk factor for cerebral small vessel diseases (SVDs). Yet, it is unknown whether antihypertensive drug classes differentially affect microvascular function in SVDs. To test whether amlodipine has a beneficial effect on microvascular function when compared to either losartan or atenolol, and whether losartan has a beneficial effect when compared to atenolol in patients with symptomatic SVDs. TREAT-SVDs is an investigator-led, prospective, open-label, randomised crossover trial with blinded endpoint assessment (PROBE design) conducted at five study sites across Europe. Patients aged 18 years or older with symptomatic SVD who have an indication for antihypertensive treatment and are suffering from either sporadic SVD and a history of lacunar stroke or vascular cognitive impairment (group A) or CADASIL (group B) are randomly allocated 1:1:1 to one of three sequences of antihypertensive treatment. Patients stop their regular antihypertensive medication for a 2-week run-in period followed by 4-week periods of monotherapy with amlodipine, losartan and atenolol in random order as open-label medication in standard dose. The primary outcome measure is cerebrovascular reactivity (CVR) as determined by blood oxygen level dependent brain MRI signal response to hypercapnic challenge with change in CVR in normal appearing white matter as primary endpoint. Secondary outcome measures are mean systolic blood pressure (BP) and BP variability (BPv). TREAT-SVDs will provide insights into the effects of different antihypertensive drugs on CVR, BP, and BPv in patients with symptomatic sporadic and hereditary SVDs. European Union's Horizon 2020 programme. NCT03082014.

Malignant hypertension has not disappeared and is associated with a poor prognosis. Yet, so far, it has received limited attention from the medical community. Guidelines are mainly based on expert consensus and low quality evidences. We set up a prospective, multicenter, observational cohort of patients with malignant hypertension. We collect at admission medical history, demographic data, ongoing treatment, clinical parameters, symptoms, care pathways, target organ status and at discharge and during follow up treatment administrated, adverse events, blood pressure level, target organ status. We aim to recruit 500 patients with malignant hypertension in 5 years, with a 5-year follow-up. Our primary objective is to assess the 5 years prognosis of these patients. The HAMA (Hypertension Arterielle MAligne, meaning malignant hypertension) registry aims to describe the epidemiology and to assess the prognosis of malignant hypertension in a contemporary multidisciplinary cohort, with emphasis on the diversity of current management and care pathway among the different medical specialties. It may help improving our pathophysiological knowledge, and pave the way to update the definition of this particular form of hypertension. The multidisciplinary network developed in the wake of this project is expected to facilitate the set up therapeutic trials, laying the ground for evidence-based recommendations.

Periodontal diseases are associated with cardiovascular risk factors/diseases, and whether home oral hygiene practices are inversely related to the same conditions could carry relevant practical implications. We investigated the association of home oral hygiene habits with hypertension. During World Hypertension Day 2020, a nationwide cross-sectional survey was conducted on volunteers ≥18 years at 733 Italian pharmacies. Participants underwent standardized blood pressure (BP) measurement and answered a questionnaire on cardiovascular risk factors, oral health status, and home oral hygiene habits (toothbrushing daily frequency and manual/electric toothbrush). The association between home oral care habits and BP was assessed using multivariate logistic regression. Interactions between exposures and outcome were formally tested. Among the 4506 participants (44.8% males, 66.1± 37.8 years), 47.6% reported brushing ≥3 times/day and 23.4% declared using the electric toothbrush. Brushing ≥3 versus &lt;3 times/day and use of electric versus manual toothbrush were associated with 19% (odds ratio [OR]: 0.81, 95% confidence interval [CI] 0.70-0.94) and 28% (OR: 0.72, 95% CI 0.61-0.85) lower odds of hypertension, respectively. No significant additive interaction was observed in the association of exposures with the outcome. Regular daily brushing and electric toothbrushing are associated with a better BP profile in a real-world context. Future interdisciplinary research is warranted to test these findings.