[2022 Practice guidelines for the management of arterial hypertension of the Spanish Society of Hypertension]. / Guía práctica sobre el diagnóstico y tratamiento de la hipertensión arterial en España, 2022. Sociedad Española de Hipertensión - Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA).

Hypertension is the most important risk factor for global disease burden. Detection and management of hypertension are considered as key issues for individual and public health, as adequate control of blood pressure levels markedly reduces morbidity and mortality associated with hypertension. Aims of these practice guidelines for the management of arterial hypertension of the Spanish Society of Hypertension include offering simplified schemes for diagnosis and treatment for daily practice, and strategies for public health promotion. The Spanish Society of Hypertension assumes the 2018 European guidelines for management of arterial hypertension developed by the European Society of Cardiology and the European Society of Hypertension, although relevant aspects of the 2017 American College of Cardiology/American Heart Association guidelines and the 2020 International Society of Hypertension guidelines are also commented. Hypertension is defined as a persistent elevation in office systolic blood pressure ≥ 140 and/or diastolic blood pressure ≥ 90 mmHg, and assessment of out-of-office blood pressure and global cardiovascular risk are considered of key importance for evaluation and management of hypertensive patients. The target for treated blood pressure should be < 130/80 for most patients. The treatment of hypertension involves lifestyle interventions and drug therapy. Most people with hypertension need more than one antihypertensive drug for adequate control, so initial therapy with two drugs, and single pill combinations are recommended for a wide majority of hypertensive patients.

Hypertension: The most common chronic health problem in Spain. A call to action.

Hypertension (HYP) is the first cause of death and disability worldwide. In Spain, one in 3 adults was hypertensive in 2010 (62% in those >65 years in 2017). Despite improvement in HYP management over time, only half of treated hypertensive patients are adequately controlled, which translates in 30,000 annual cardiovascular deaths attributable to HYP. Among modifiable determinants of lack of blood pressure (BP) control in Spain are: (a) the white-coat phenomenon (accounting for 20-50% of apparent lack of control) due to not using ambulatory BP monitoring (ABPM, use ≈20%) or self-measurement of home BP (HBPM, use ≈60%) for confirming HYP diagnosis; (b) insufficient patients adherence to BP-lowering lifestyles (e.g., only 40% of hypertensive patients have a sodium intake <2.4g/day, or follow a weight reduction advice), and (c) use of drug monotherapy (≈50% currently), usually insufficient to achieve an optimal control. It is necessary to implement strategies to monitor the evolution of the proportion of subjects with HYP with reasonable national update, to promote population's knowledge of their BP figures and of other cardiovascular risk factors, to improve the degree of HYP control and vascular risk in Spain.

Cardiovascular evaluation using exercise testing performed with face masks during the COVID-19 pandemic.

OBJECTIVE: COVID-19 pandemic is associated with high incidence and fatality, however, non-communicable diseases remain a global public health problem with even greater morbidity and mortality. At present, there is a lag in diagnosis and treatment of patients with heart disease, particularly the performance of exercise testing (ET), due to the fear of aerosol generation and viral dissemination. Although some centers carry out the tests with the use of masks, the information is still superficial and preliminary. The objective of the study was to describe the ergometric performance observed when performing exercise tests during the COVID-19 (PANDEMIC-G) pandemic and to highlight the differences with those results carried out in another time, when there was no COVID-19 (NO PANDEMIC). METHOD: A cross-sectional study was carried out. PANDEMIC-G patients underwent ET between March 2020 and December 2020, once a biological triage was done and all of them wore N95 masks. They were compared to NO PANDEMIC patients that performed an ET between March 2019 and December 2019. Demographic and ergometric variables were presented and analyzed according to their type. All p < 0.05 were considered stochastically significant. RESULTS: A total of 361 ET were studied: 209 (58%) belonged to NO PANDEMIC and 152 (42%) to PANDEMIC-G. The number of ET stopped by dyspnea was greater in PANDEMIC-G (117) than in NO PANDEMIC (8). Exercise tolerance did not show significant changes. Systolic blood pressure, double product, and myocardial oxygen utilization were higher in PANDEMIC-G ET (p < 0.01). CONCLUSIONS: In the COVID-era, fewer stress tests were performed, which were suspended more frequently due to dyspnea. Higher values of systolic blood pressure and myocardial oxygen utilization were observed in PANDEMIC-G as well.

OBJETIVO: La pandemia de COVID-19 se asocia con una alta incidencia y letalidad; sin embargo, las enfermedades no transmisibles siguen siendo un problema de salud pública mundial con una morbilidad y mortalidad aún mayores. Actualmente, existe un retraso en el diagnóstico y tratamiento de los pacientes con enfermedades cardíacas, particularmente en la realización de la prueba de esfuerzo (PE), debido al temor a la generación de aerosoles y la diseminación viral. Aunque algunos centros realizan las pruebas con el uso de tapabocas, la información aún es superficial y preliminar. El objetivo del estudio fue describir el desempeño ergométrico observado al realizar pruebas de ejercicio durante la pandemia COVID-19 (PANDEMIC-G) y remarcar las diferencias con las pruebas realizadas antes de ella (NO PANDEMIC). MÉTODO: Se realizó un estudio transversal. Los pacientes con PANDEMIC-G se sometieron a PE entre marzo y diciembre de 2020, una vez que se realizó un triaje biológico y todos usaron tapabocas N95. Fueron comparados con pacientes NO PANDEMIC, que realizaron una PE entre marzo y diciembre de 2019. Las variables se presentaron y analizaron según su tipo. Todos los valores de p inferiores a 0.05 se consideraron estocásticamente significativos. RESULTADOS: Se estudiaron un total de 361 PE, donde 209 (58%) pertenecían a NO PANDEMIC y 152 (42%) a PANDEMIC-G. El número de PE detenidas por disnea fue mayor en PANDEMIC-G (n = 117) que en NO PANDEMIC (n = 8). La tolerancia al ejercicio no mostró cambios significativos. La presión arterial sistólica, el producto doble y la utilización de oxígeno del miocardio fueron mayores en las PE en el PANDEMIC-G (p < 0.01). CONCLUSIONES: En la era COVID se realizaron menos pruebas de esfuerzo, que se suspendieron con mayor frecuencia por disnea. También se observaron valores más altos de presión arterial sistólica y utilización de oxígeno del miocardio en PANDEMIC-G.