Innovations in Arterial Hypertension

The anniversary conference was held under the motto «Working together for better blood pressure (BP) control and CVD reduction». Professor Rhian Touyz, the President of ISH, greeted all guests of the forum and noted that the International Society of Hypertension had turned 50 this year. Also she presented a film about history, the main directions and results of ISH work. Despite extensive knowledge, experience and a huge amount of scientific researches, hypertension remains the "number one killer" in the world - every fourth inhabitant of the planet suffers fr om the disease.

Nina Shurkevich highlighted the main ideas from 1746 reports that were presented at the conference and shared new knowledge in treatment of AH. In the first two days there were symposia on "management" of hypertension in East and South-East Asia, Africa, Latin America, Eastern Europe. Researchers note a low level of awareness, treatment and control of hypertension in low- and middle-income countries. If no measures are taken, the number of patients with hypertension up to 2025 will increase by 60%. It is directly related to a high prevalence of such risk factors as obesity and diabetes mellitus.

Besides behavioral risk factors (low physical activity, obesity, smoking, alcohol, salt abuse), it was determined that it is also important to take into account regional differences that affect variability of AH frequency. All these factors tell us about a necessity of creation of world and regional disease prevention programs. Along with foreign colleagues, D. Yakhontov, Professor of the Department of Internal Diseases of the Novosibirsk State Medical University, presented a report from the Russian Federation. He told about the problems of adherence to treatment of AH among the inhabitance of Western Siberia.

One of the main topics of the meeting was global efforts issues aimed to reduce a risk of cardiovascular disease through a management of hypertension. Models for predicting the risk of cardiovascular disease in different regions were also considered. Several reports were presented at the symposium "Genetic and molecular aspects of AH". A breakthrough in modern medicine was an understanding the role of epigenetic regulation and possibility of transmission epigenetic changes mediated by lifestyle and environmental influences from generation to generation. The epigenetic modification is understood as changes in the expression of genes which are not connected with a primary DNA structure. The study of these mechanisms provides for physicians new dimensions for development of the diseases of cardiovascular system and diabetes mellitus.

Over the past three decades, a major breakthrough in a study of chronic hypertension genetics has been achieved. However, a standard approach based on investigation of nucleotide sequence of nuclear DNA can only partially explain an involvement of a human genome in BP regulation. It is obvious today that epigenetic mechanisms have not less, but perhaps, more importance and such mechanisms, despite their inherited nature, can be modified under lifestyle and environment influences.

Several plenary sessions were devoted to the treatment of hypertension in an ageing society. Issues of a hypertension treatment strategy in the elderly and the impact of hypertension on cognitive functions were also considered. There was organized a Symposium entitled "Global efforts to reduce salt intake". According to experts, doubts about an existence of salt effects on heart diseases are usually associated with a low quality of studies. Recommendations for reducing amount of salt in food are not based on robust and credible data, in contrast to the results of multicenter randomized trials of medications. In most experiments, a daily salt intake is estimated using a single sample of urine that is extremely inaccurate. As a result of the discussion, recommendations to decline salt intake for reducing risks of stroke and cardiovascular diseases were made. Reducing salt intake to 2 grams per day leads to a 20% reduction in cardiovascular mortality.

Scientists discussed a study of hypertension in the future, including the study of pediatric hypertension, hypertension among women, resistant hypertension and BP measurement after the end of the mercury of sphygmomanometer (device for BP measuring). Several reports were devoted to the proof that the mechanisms of AH stabilization involved an active participation of the immune system — innate and acquired immunity. Previously, the formation of hypertension was focused on an activation of sympathetic nervous system and kidneys. However, these data were insufficient to understand the AH genesis. At present, the mechanism of development and stabilization of hypertension is considered from a standpoint of the unity operation of three regulatory systems: nervous, immune and endocrine.

For patients with resistant AH (a situation when taking three or more medications is ineffective), interventional approaches to AH treatment are actively developing in the last 10-15 years. This is due not only to achievements of a technical progress, but also to lack of expectations of a new breakthrough in medication in the near future. Several reports of the plenary session included data on treatment of this type of hypertension by radiofrequency ablation of renal sympathetic nerves (renal denervation of the renal arteries).

Renal denervation is the only one of interventional methods for resistant hypertension treatment, which is available in the Russian Federation, wh ere two systems from different producers have already been registered for such procedure. In general, a positive attitude of the speakers allows us to save data on a high efficiency of the procedure. The most important data with the highest evidence level will be received in the near future from two new studies initiated in the USA, wh ere a new generation system (Symplicity Spyral ™), devoid of many shortcomings that could partially explain a failure of the previous study, will be used. This study will allow to get an answer about a true effect of this treatment on BP, completely determine the place of renal denervation in hypertension and, in case of positive results, significantly expand the indications beyond resistant AH.

Widespread in the world vitamin D deficiency is explained by increased interest in finding connections between a level of vitamin D and socially important AH diseases. A doctor from the Netherlands presented this issue at the symposium. It is now recognized that vitamin D deficiency can be considered as nonclassical factor of cardiovascular risk, and further research in this area is extremely promising. There were also reports related to a surgical treatment of hypertension, in particular, the use of iliac arteriovenous bypass.

On the final day, topics about the effect of nutrition on the pathophysiology of AH and atherosclerosis, the mechanism of sodium homeostasis in the pathophysiology of hypertension, and how to implement a large data analysis in the study of hypertension were discussed. Thus, updated information on new directions related to processes, underlying BP regulation and AH development was presented to the conference of the International Society of Hypertension. A deeper understanding of these processes will help to improve treatment and formulate new strategies for prevention of the disease, in order to reduce a global burden and growing epidemic throughout the world.