2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

ABCD
: Appropriate Blood pressure Control in Diabetes
ABI
: ankle–brachial index
ABPM
: ambulatory blood pressure monitoring
ACCESS
: Acute Candesartan Cilexetil Therapy in Stroke Survival
ACCOMPLISH
: Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension
ACCORD
: Action to Control Cardiovascular Risk in Diabetes
ACE
: angiotensin-converting enzyme
ACTIVE I
: Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events
ADVANCE
: Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation
AHEAD
: Action for HEAlth in Diabetes
ALLHAT
: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack
ALTITUDE
: ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints
ANTIPAF
: ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation
APOLLO
: A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People
ARB
: angiotensin receptor blocker
ARIC
: Atherosclerosis Risk In Communities
ARR
: aldosterone renin ratio
ASCOT
: Anglo-Scandinavian Cardiac Outcomes Trial
ASCOT-LLA
: Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm
ASTRAL
: Angioplasty and STenting for Renal Artery Lesions
A-V
: atrioventricular
BB
: beta-blocker
BMI
: body mass index
BP
: blood pressure
BSA
: body surface area
CA
: calcium antagonist
CABG
: coronary artery bypass graft
CAPPP
: CAPtopril Prevention Project
CAPRAF
: CAndesartan in the Prevention of Relapsing Atrial Fibrillation
CHD
: coronary heart disease
CHHIPS
: Controlling Hypertension and Hypertension Immediately Post-Stroke
CKD
: chronic kidney disease
CKD-EPI
: Chronic Kidney Disease—EPIdemiology collaboration
CONVINCE
: Controlled ONset Verapamil INvestigation of CV Endpoints
CT
: computed tomography
CV
: cardiovascular
CVD
: cardiovascular disease
D
: diuretic
DASH
: Dietary Approaches to Stop Hypertension
DBP
: diastolic blood pressure
DCCT
: Diabetes Control and Complications Study
DIRECT
: DIabetic REtinopathy Candesartan Trials
DM
: diabetes mellitus
DPP-4
: dipeptidyl peptidase 4
EAS
: European Atherosclerosis Society
EASD
: European Association for the Study of Diabetes
ECG
: electrocardiogram
EF
: ejection fraction
eGFR
: estimated glomerular filtration rate
ELSA
: European Lacidipine Study on Atherosclerosis
ESC
: European Society of Cardiology
ESH
: European Society of Hypertension
ESRD
: end-stage renal disease
EXPLOR
: Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination
FDA
: U.S. Food and Drug Administration
FEVER
: Felodipine EVent Reduction study
GISSI-AF
: Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation
HbA1c
: glycated haemoglobin
HBPM
: home blood pressure monitoring
HOPE
: Heart Outcomes Prevention Evaluation
HOT
: Hypertension Optimal Treatment
HRT
: hormone replacement therapy
HT
: hypertension
HYVET
: HYpertension in the Very Elderly Trial
IMT
: intima-media thickness
I-PRESERVE
: Irbesartan in Heart Failure with Preserved Systolic Function
INTERHEART
: Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries
INVEST
: INternational VErapamil SR/T Trandolapril
ISH
: Isolated systolic hypertension
JNC
: Joint National Committee
JUPITER
: Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin
LAVi
: left atrial volume index
LIFE
: Losartan Intervention For Endpoint Reduction in Hypertensives
LV
: left ventricle/left ventricular
LVH
: left ventricular hypertrophy
LVM
: left ventricular mass
MDRD
: Modification of Diet in Renal Disease
MRFIT
: Multiple Risk Factor Intervention Trial
MRI
: magnetic resonance imaging
NORDIL
: The Nordic Diltiazem Intervention study
OC
: oral contraceptive
OD
: organ damage
ONTARGET
: ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial
PAD
: peripheral artery disease
PATHS
: Prevention And Treatment of Hypertension Study
PCI
: percutaneous coronary intervention
PPAR
: peroxisome proliferator-activated receptor
PREVEND
: Prevention of REnal and Vascular ENdstage Disease
PROFESS
: Prevention Regimen for Effectively Avoiding Secondary Strokes
PROGRESS
: Perindopril Protection Against Recurrent Stroke Study
PWV
: pulse wave velocity
QALY
: Quality adjusted life years
RAA
: renin-angiotensin-aldosterone
RAS
: renin-angiotensin system
RCT
: randomized controlled trials
RF
: risk factor
ROADMAP
: Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention
SBP
: systolic blood pressure
SCAST
: Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke
SCOPE
: Study on COgnition and Prognosis in the Elderly
SCORE
: Systematic COronary Risk Evaluation
SHEP
: Systolic Hypertension in the Elderly Program
STOP
: Swedish Trials in Old Patients with Hypertension
STOP-2
: The second Swedish Trial in Old Patients with Hypertension
SYSTCHINA
: SYSTolic Hypertension in the Elderly: Chinese trial
SYSTEUR
: SYSTolic Hypertension in Europe
TIA
: transient ischaemic attack
TOHP
: Trials Of Hypertension Prevention
TRANSCEND
: Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease
UKPDS
: United Kingdom Prospective Diabetes Study
VADT
: Veterans' Affairs Diabetes Trial
VALUE
: Valsartan Antihypertensive Long-term Use Evaluation
WHO
: World Health Organization

### 1.1 Principles

The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

/pdf/2013-esh-esc-guidelines-for-the-management-of-arterial-4ydvs5ifsx.pdf

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

https://caltcm.memberclicks.net/assets/documents/acc_aha_chf_2013_guidelines.pdf

2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

Background: Antiplatelet agents are the mainstay for secondary prevention of non-cardioembolic stroke. This systematic review examined the safety and efficacy of

/pdf/aspirin-plus-clopidogrel-as-secondary-prevention-after-1lwk28c5lr.pdf

Aspirin plus Clopidogrel as Secondary Prevention after Stroke or Transient Ischemic Attack: A Systematic Review and Meta-Analysis

2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

International Impact of Stroke

Another success for team efforts in stroke

Thrombolysis We can justifiably emphasize the findings of the third European Cooperative Acute Stroke Study (ECASS-3), which has recently confirmed the use of thrombolytic therapy up to 4.5 hours after onset of ischemic stroke.1 The reality is that alteplase was already a safe and highly effective treatment before the results of ECASS-3 became known. However, a minority allowed their uncertainty over safety and doubts raised by individually neutral trials to restrict implementation of this potent therapy. The latest result broadens the range of patients who may benefit but it has implications beyond these narrow confines. Even after accounting for the expected low rate of symptomatic bleeding—just 2% excess over placebo—alteplase treatment delivered a 10% absolute increase in proportion of patients attaining excellent outcome, indicating 3 valuable lessons. First, any residual doubts over the safety or efficacy of intravenous alteplase early after stroke have been annulled. Second, the challenging time window for treatment can be relaxed, provided this is not at the expense of slower reaction by services. Third, there is evidently scope for further extension of treatment and enhancement of alteplase’s action that begs continued research. We need to test extended patient selection, perhaps via imaging strategies. We must also assess whether we can enhance the extent and rapidity of reperfusion. This may involve incoorporating ancillary measures such as antithrombotic therapy and blood pressure manipulation. One of our challenges is to divorce enhancement of reperfusion from exacerbation of serious bleeding risk. Both better patient selection and careful pharmacological profiling are required. By harnessing our very active clinical services to contribute actively to research, we could make rapid strides. The SITS register’s examination of treatment 3 to 4.5 hours after stroke onset illustrates that over 12 000 patients were treated ‘within label’ in participating centers while ECASS-III was enrolling.2 The EPITHET study3 used perfusion neuroimaging to identify patients expected to benefit from thrombolytic treatment beyond standard treatment windows. In patients with perfusion-/diffusion-weighted imaging mismatch, alteplase increased reperfusion and was associated with enhanced functional outcome. Unfortunately, EPITHET lacked power to confirm whether selection by imaging beyond the licensed time window is ready to be introduced. The ECASS-3 result and EPITHET together should convince us to redouble our efforts to test delayed thrombolysis in carefully selected patients who present too late for standard care. We know that alteplase achieves reperfusion neither immediately nor universally. While the evidence base for alteplase expands, encouraging data for another thrombolytic, tenectaplase, was presented at the International Stroke Conference (ISC). In their pilot study, Molina et al4 demonstrated better rates of recanalization and functional outcome at 3 months, against a trend toward increased hemorrhage. Ultrasound-assisted thrombolysis may improve recanalization rates, though increased bleeding has also been observed. Eggers et al,5 using a transcranial ultrasound delivery device, confirmed increased recanalization at the expense of a trend to increased hemorrhage, leading to premature discontinuation of their study. Ultrasound-assisted lysis merits more robust safety evaluation, in which dose and delivery modality are thoroughly evaluated. We must not let regulatory laxity over evaluation of devices diminish our rigorous appraisal of their potential. We await with interest the results of studies such as TRUST, evaluating the safety and efficacy of 60 minutes’ continuous insonation of the occluded middle cerebral artery in patients with ischemic stroke given intravenous alteplase. We can refer to extensive observational data implying efficacy of intra-arterial thrombolysis, but we lack comparative studies against intravenous (IV) administration. SYNTHESIS EXP is a phase III study being designed to assess whether local intra-arterial tissue plasminogen activator (tPA), as compared to IV tPA, can increase survival free from disability. Recovery after thrombolysis requires successful restoration and maintenance of blood flow. Intuitively, antiplatelet therapy should help prevent reocclusion. Current stroke guidelines reflect concern that the risk of symptomatic bleeding may be unacceptable if antithrombotic therapy is given alongside alteplase. Such caution may be misplaced. Uyttenboogart et al6 have published prospective observational data

Advances in Stroke 2008 Advances in Emerging Therapies

Xanthine Oxidase Inhibition And White Matter Hyperintensity Progression Following Ischaemic Stroke and Transient Ischaemic Attack; The XILO-FIST Randomised Placebo Controlled Trial

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(04)70086-0.pdf

contribute to a cumulative blood pressure load which with time may produce end-organ damage.

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International Impact of Stroke

Another success for team efforts in stroke

Advances in Stroke 2008 Advances in Emerging Therapies

Xanthine Oxidase Inhibition And White Matter Hyperintensity Progression Following Ischaemic Stroke and Transient Ischaemic Attack; The XILO-FIST Randomised Placebo Controlled Trial

contribute to a cumulative blood pressure load which with time may produce end-organ damage.