Despite great number of drugs and device-based approaches, resistant hypertension remains the stumbling block in cardiology. Several sessions discussed issues related to the refractory hypertension. In particular, the diagnostics of fibromuscular dysplasia and its variants drew a lot of attention. Professor A. Pesu (Belgium) presented the first results of the European Registry of fibromuscular dysplasia. Device-based methods were actively discussed, i.e. baroreflex activation, sympathetic renal denervation, carotid stimulation, aortic arch stimulation, arteriovenous fistula etc. At one session, the long-term outcomes of the neurovascular decompression of the brainstem were reported in a small sample. The authors believe that in some cases this method can be highly effective when the blood pressure variability is due to the anatomical features of the cerebral circulation. In a session on resistant hypertension two reports by Russian scientists were included: Dr. T. Ripp (Tomsk) presented the results of the efficacy of distant versus conventional renal denervation, and Dr. L. Korostovtseva (St Petersburg) reported the changes in asymmetric dymethylarginine after renal denervation 

Dr. M. Tomaszewski (United Kingdom) gave a lecture on the pseudo-resistance, presenting several striking examples of low compliant patients. In these cases a doctor should act as a detective catching the patient as a non-adherent liar. Despite high costs, laboratory methods of drug detection in urine and blood are widely implemented in the research and routine clinical practice. Novel technology, so called “Digital spy”, is a device which can read information on the time of drug intake from a chip built in a pill. The developers believe that this technology can increase the compliance, however, the idea of the patient shadowing seems non-compliant with the deontology.

A rapidly developing field in healthcare i.e. use of information and communication technologies is a promising field. These technologies can help to establish doctor-patient "partnership", reduce therapeutic inertia, provide multiple opportunities to communicate with the patient and may potentially reduce treatment costs. During a separate session mHealth (mobile Health) related issues were discussed, in particular, its potential for the low resource settings.

Several reports were devoted to different methods of blood pressure measurement (office and out-of-office, cuff-based and non-cuff-based etc.), their role for population screening programs, diagnosing masked hypertension, prognostic role of different thresholds. Professor G. Parati (Italy), the pupil of Professor A. Zanchetti, remains the leading expert in the field of blood pressure monitoring. In his talk, he emphasized the difficulties of blood pressure monitoring in hypertensive obese patients.

A lot of attention was drawn to other issues of risk factor modification, screening programs for early vascular aging (EVA) detection. Professor S. Laurent (France) and professor P. Nilsson (Sweden) are the leaders and movers of the field. Metabolic disorders, including diabetes mellitus, dyslipidemias, hyperuricemia were also hot topics for discussion. During the session on diabetes, Russian specialists presented their data: Dr. I Pchelin (St Petersburg) talked about the relation between proinflammatory markers and cardiovascular and renal function in diabetes. Professor L. Minushkina (Moscow) presented original data on the impact of SGLT2 inhibitors on the blood pressure variability.

A “novel” risk factors included in the new guidelines is the anxiety and psychological stress. The stress-related issues were discussed during the breakfast session.

At the meet-the-expert sessions, the participants learnt how to use the genetic studies in cardiovascular pathology (chairperson – professor А. Dominiczak, United Kingdom), what is the role of microRNAs  in hypertension and target-organ damage (chairman  – professor T. Unger, the Netherlands), and had the opportunity to discuss the weak points of the SPRINT study (chairman – professor L. Lindholm, Sweden).

At traditional debate session, the definition and classification of hypertension were discussed. However, after the presentation of the novel European guidelines the hot dispute did not take place, despite the efforts of the chairman to increase the temperature and provoke the speakers. American position was presented by professor P. Whelton (USA) was not supported by the audience (2 votes against the rest of the public). However, he accepted that the American guidelines 2017 caused a real epidemiological revolution and called for collaboration to unite the efforts.  

 

Frequent complications of hypertension, including heart rhythm disorders and heart failure as the final stage of cardiovascular continuum, were also discussed. The well-structured report by professor E. Baranova (St Petersburg) on the original paper of the association between fibrosis markers of the epicardial fat and paramteres of electroanatomical mapping in atrial fibrillation caused a vivid discussion.  Dr. M. Markov (Moscow) presented a concept of the pathogenic link between unilateral carotid occlusion and pulmonary hypertension.

Before the Congress, the third meeting of the International Hypertension Club was held in Barcelona. The Russian delegate Dr. N. Zvartau (Almazov National Medical Research Centre, St Petersburg) briefly reported the need for developing guidelines on hypertension treatment in patients with liver disease which excited high interest and dispute. After the guidelines 2018 were presented, it appeared that hepatocardiovascular association remains one of the gaps in the knowledge. However, a tight collaboration with gastroenterologists will help to fill in this gap by the future update of the guidelines.

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