[Unattended automatic office blood pressure measurement: the new standard?].

Unattended automatic office blood pressure measurement (uAOBP) is starting to become recognised as the preferred method of blood pressure measurement in practice. The body of evidence to support this position is growing. uAOBP decreases intra- and interobserver variability by reducing measurement error.

Stepwise treatment of uncontrolled HyperTensioN (Stepwise-HTN): Study design of a cluster randomised controlled trial in primary care.

Background: Uncontrolled hypertension is a major health problem, and a key risk factor for cardiovascular disease. Most patients are detected and managed in primary care, but approximately 50% remains uncontrolled. Our aim is to assess whether a guided stepwise work-up management strategy for patients with uncontrolled hypertension in primary care would result in better blood pressure control in these patients compared to usual care.

[Critical doctors and cognitive bias].

A doctor with good critical thinking skills will intervene when required, but abstain from intervening wherever possible. He or she has the ability to apply resource stewardship, acknowledges the limitations of guidelines and is able to deviate from protocols when appropriate, with sound arguments for why this is in the patient's best interest. We believe that critical thinking is an important skill for any doctor, and that it will contribute to better patient-centred outcomes at lower societal costs and with greater job satisfaction among healthcare professionals.

[New guideline on hypertension sickens society].

The introduction in the USA of the new AHA Guideline on management of Hypertension has fuelled controversy on the optimal definition and treatment of hypertension. A more strict definition (130/80 mmHg) and the advice to treat the major part of the hypertensive population well below 140/90 mmHg is a recipe for medicalisation of society. Advocates of the guideline emphasise the growing body of evidence to support more aggressive treatment.

Patient characteristics do not predict the individual response to antihypertensive medication: a cross-over trial.

Background: International guidelines on hypertension management do not agree on whether patient characteristics can be used for the first choice of treatment of uncomplicated essential hypertension.

Objective: We wanted to identify predictive patient characteristics to the response of two different classes of antihypertensive drugs in patients with newly diagnosed hypertension in primary care.

Methods: We conducted a prospective, open label, blinded endpoint cross-over trial in 120 patients with a new diagnosis of hypertension from 10 family practices.

Hydrochlorothiazide treatment increases the abundance of the NaCl cotransporter in urinary extracellular vesicles of essential hypertensive patients.

The thiazide-sensitive NaCl cotransporter (NCC), located apically in distal convoluted tubule epithelia, regulates the fine-tuning of renal sodium excretion. Three isoforms of NCC are generated through alternative splicing of the transcript, of which the third isoform has been the most extensively investigated in pathophysiological conditions. The aim of this study was to investigate the effect of different anti-hypertensive treatments on the abundance and phosphorylation of all three NCC isoforms in urinary extracellular vesicles (uEVs) of essential hypertensive patients.

A novel approach to office blood pressure measurement: 30-minute office blood pressure vs daytime ambulatory blood pressure.

Purpose: Current office blood pressure measurement (OBPM) is often not executed according to guidelines and cannot prevent the white-coat effect. Serial, automated, oscillometric OBPM has the potential to overcome both these problems. We therefore developed a 30-minute OBPM method that we compared with daytime ambulatory blood pressure.

Non-cardiovascular co-morbidity in elderly patients with heart failure outnumbers cardiovascular co-morbidity.

Background: Patients with heart failure often suffer from multiple co-morbid conditions. However, until now only cardiovascular co-morbidity has been well described.

Aims: To understand heart failure in the context of multi-morbidity, by describing the age and sex specific patterns of non-cardiovascular co-morbidity in elderly patients with heart failure in general practice.