Emerging Concepts in the Diagnosis and Treatment of Hypertension in the Sprint Era

With this in mind, our goal is to highlight emerging diagnostic and therapeutic strategies that will enable cardiologists and cardiovascular surgeons to better manage and control blood pressure in their patients. Given the group of experts we assembled as contributors, we are confident that we will achieve this goal. The issue begins with “Current and Future Treatments of Hypertension in the SPRINT era,” 3 a review in which I critically assess the management of hypertension in patients with uncomplicated essential hypertension, diabetes, chronic kidney disease (CKD), coronary artery disease (CAD), and in the elderly and African Americans. Recommendations are provided for first-line and combination antihypertensive therapy. The level to which blood pressure should be lowered in these groups is explored and critiqued, providing the reader with a guide to the current controversy in this area. Based on the results of the Systolic Pressure Intervention Trial (SPRINT), a prediction is made that future guidelines will recommend a treatment goal of < 130/80 mm Hg in patients aged 50 and older who do not have diabetes. 4 The premise of the article entitled “Practical Aspects of Home and Ambulatory Blood Pressure Monitoring” is that these two modalities are superior to office blood pressure measurements for both the diagnosis of hypertension and for assessing risk of future cardiovascular and renal events. Author Aldo Peixoto reviews the indications for these two modalities, including the need to rule out white coat and masked hypertension—blood pressure that is normal in the clinic but elevated outside of the office. Of note, it is recommended that home blood pressure monitoring be obtained in all patients because it is relatively inexpensive and associated with greater patient engagement and better blood pressure control. Cost and technical aspects of both modalities are reviewed, including instructions to give patients on the proper use of and recording of blood pressure measurements with home devices. Although much information is gleaned from measurement of systolic and diastolic blood pressure at the brachial artery, there is emerging evidence that the intrinsic status of the vasculature can be assessed from office-based, noninvasive analysis of radial artery pulse contours. Furthermore, these pulse contours can be more precisely related to future cardiovascular outcomes than standard blood pressure measurements. The physiological basis of this type of analysis is explored in the paper by Raymond Townsend entitled “Novel Uses of Office-Based Measures of Arterial Compliance.” Townsend demonstrates that abnormalities of these contours reflects pathology and stiffening of the vasculature, resulting in elevated central aortic pressure, distorted central aortic pressure profiles, and increased load on the heart. Several longitudinal studies that have incorporated measures of central aortic hemodynamics are reviewed, and the literature shows that these measures predict outcomes such as heart failure better than standard brachial artery blood pressure