Estudios recientes han mostrado dos aspectos relevantes en el manejo de la hipertensión arterial

Estudios recientes han mostrado dos aspectos relevantes en el manejo de la hipertensión arterial
1/ La relevancia de la adherencia al tratamiento antihipertensivo entre adultos jóvenes al inicio del tratamiento antihipertensivo y el incremento del riesgo cardiovascular en los sujetos con pobre adherencia.
2/ La importancia de lograd un buen control de la PA en la edad media de la vida, y mantenerlo posteriormente para prevenir la aparición de lesiones cerebrovasculares silentes, que se traducirían posteriormente en aumento en la incidencia y recurrencia de ictus o en alteración cognitiva
Ambos conceptos apoyan la idea de que el control de la PA debe ser adecuado, precoz y mantenido en el tiempo.
Hokyou Lee , Yuichiro Yano , So Mi Jemma Cho , Ji Eun Heo, Dong-Wook Kim, Sungha Park , Donald M. Lloyd-Jones , Hyeon Chang Kim. Adherence to Antihypertensive Medication and Incident Cardiovascular Events in Young Adults With Hypertension.
Hypertension. 2021;77:1341-1349. DOI: 10.1161/ HYPERTENSIONAHA.120.16784.)
ABSTRACT: Treatment and control rates for high blood pressure are unsatisfactory in young adults. Adherence to pharmacological treatment is alarmingly low, with absence of data on its consequences in young adults with hypertension. We investigated the association of antihypertensive medication nonadherence with incident cardiovascular events among young adults initiating pharmacological treatment for hypertension. From a nationwide health insurance database, we included 123 390 participants (75.1% male) of age 20 to 44 years, free of prior cardiovascular disease (CVD), who initiated pharmacological treatment for hypertension from 2004 through 2007. Participants were categorized as either adherent (proportion of days covered ≥0.8; n=45 350) or nonadherent (proportion of days covered <0.8; n=78 040) to antihypertensive medication during the first year of treatment. The primary outcome was composite CVD events, including myocardial infarction, stroke, heart failure, and cardiovascular death. Over a median follow-up of 10 years, 3002 new CVD events occurred. CVD incidence rates per 100 000 person-years were 191.0 in the adherent group and 282.1 in the nonadherent group. Multivariable adjusted hazard ratio for CVD events associated with nonadherence versus adherence was 1.57 (95% CI, 1.45–1.71). There was a dose-response association between medication adherence (in quartiles or continuous proportion of days covered) and CVD risk. In conclusion, among young adults who initiated pharmacological treatment for high blood pressure, poor medication adherence was associated with higher risk for future CVD events. (Hypertension. 2021;77:1341-1349. DOI: 10.1161/Karolina AgnieszkaWartolowska * and Alastair John Stewart Webb. Midlife blood pressure is associated with the severity of whitematter hyperintensities: analysis of the UK Biobank cohort study.  European Heart Journal (2021) 42, 750–757 CLINICAL RESEARCH doi:10.1093/eurheartj/ehaa756 Imaging
Aims White matter hyperintensities (WMH) progress with age and hypertension, but the key period of exposure to elevated blood pressure (BP), and the relative role of systolic BP (SBP) vs. diastolic BP (DBP), remains unclear. This study aims to determine the relationship between WMH and concurrent vs. past BP.
Methods and results
UK Biobank is a prospective community-based cohort of 40–69-year olds from 22 centres, with magnetic resonance imaging in a subgroup of over 40 000 people at 4–12 years after baseline assessment. Standardized associations between WMH load (WMH volume normalized by total white matter volume and logit-transformed) and concurrent vs. past BP were determined using linear models, adjusted for age, sex, cardiovascular risk factors, BP source, assessment centre, and time since baseline. Associations adjusted for regression dilution bias were determined between median WMH and usual SBP or DBP, stratified by age and baseline BP. In 37 041 eligible participants with WMH data and BP measures, WMH were more strongly associated with concurrent SBP [DBP: b = 0.064, 95% confidence interval (CI) 0.050–0.078; SBP: b = 0.076, 95% CI 0.062–0.090], but the strongest association was for past DBP (DBP: b = 0.087, 95% CI 0.064–0.109; SBP: b = 0.045, 95% CI  0.022–0.069), particularly under the age of 50 (DBP: b = 0.103, 95% CI 0.055–0.152; SBP: b = 0.012, 95% CI -0.044 to 0.069). Due to the higher prevalence of elevated SBP, median WMH increased 1.126 (95% CI 1.107–1.146) per  10mmHg usual SBP and 1.106 (95% CI 1.090–1.122) per 5mmHg usual DBP, whilst the population attributable fraction of WMH in the top decile was greater for elevated SBP (19.1% for concurrent SBP; 24.4% for past SBP).
Any increase in BP, even below 140 for SBP and below 90mmHg for DBP, and especially if requiring antihypertensive medication, was associated with increased WMH.
Conclusions WMH were strongly associated with concurrent and past elevated BP with the population burden of severe WMH greatest for SBP. However, before the age of 50, DBP was more strongly associated with WMH. Long-term prevention of WMH may require control of even mildly elevated midlife DBP.
Keywords Small vessel disease • Diastolic blood pressure • Hypertension • White matter hyperintensities • Magnetic resonance imaging*