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Meeting of the Balkan Excellent Centers “Insights in resistant hypertension and Erectile dysfunction and hypertension” Michael Doumas Internist Aristotle University Thessaloniki, Greece Abstract Two large projects are currently underway in our department: a) IRIS project (Insights in ResIstant hypertenSion), and b) EROS project (ERectile dysfunctiOn and hypertenSion). The IRIS project aims to evaluate several aspects of the current management of resistant hypertension and additionally to identify ideal candidates for interventional therapy. We focus on use of out-of-office blood pressure measurements, lifestyle modification, drug adjustment, and the effort to simplify a diagnostic algorithm for the exclusion of primary aldosteronism, the most common cause of secondary hypertension in patients with resistant hypertension. Finally, we evaluate several tests as potential predictors of response to interventional therapy. The EROS project aims to evaluate the prevalence of sexual dysfunction in patients with hypertension, cardiovascular risk factors, and overt cardiovascular disease. In addition, we aim to identify contributing pathophysiological factors and to evaluate the effect of antihypertensive drugs on sexual function, especially when used in combination. Finally, we try to evaluate the role of sexual dysfunction in cardiovascular disease prediction and the best way to identify asymptomatic coronary artery disease in hypertensive patients with recent onset sexual dysfunction. IRIS project Insights in ResIstant hypertenSion Evaluation and management of Resistant Hypertension • Measurement • Adherence to treatment • Lifestyle • Drug-induced • Secondary hypertension • Drug therapy adjustments Doumas, Int J Hypertens 2011 Truly resistant hypertension ABPM or HBP • Brown 2001 85/118 72% • Muxfeldt 2005 313/497 63% • Douma 2008 192/289 67% • De Souza 2010 175/236 75% • De la Sierra 2011 8295 62,5% • Douma 2008 1.286/1.913 66% Prevalence of primary aldosteronism in patients with resistant hypertension 30 (%) 25 22 20 20 19 17 15 11 10 7 5 0 Birmingham USA Seattle USA Oslo Prague Norway Czech Rep. Shanghai China Thessaloniki Greece Calhoun DA, Annu Rev Med 2013; 64: 233-247 Douma, Lancet, 2008 Doumas M. In Tsioufis, Schmieder, Mancia, eds, book 2016; in press Patients with clinical suspicion for primary aldosteronism (PA) •Resistant hypertension •Moderate-severe hypertension •Hypokalemia (spontaneous or induced) •Adrenal incidentaloma Screen (ARR) ARR>30 and aldosterone >15 ng/dl ARR<30 Exclude PA Confirmation (Fludrocortisone, IV saline, Captopril, Oral sodium loading) Unsuppressed aldosterone Suppressed aldosterone Exclude PA Lateralization (AVS, Imaging, Scintigraphy) Bilateral MRAs Unilateral Adrenalectomy or MRAs in patients ineligible for, or unwilling, surgery EROS project ERectile dysfunctiOn and hypertenSion Pathophysiology of sexual dysfunction Atheromatic lesions resulting in vascular insufficiency and subsequent erectile dysfunction Doumas, Porto Heli 2016 Manolis, J Hypertens 2008 Prevalence of erectile dysfunction Hypertensives 9% 14% Severe Moderate Mild None 12% 65% 2% x2=35.92 5% p<0.001 7% Severe Moderate Mild None 86% Normotensives Doumas et al, J Androl, 2005 Data from everyday clinical practice 34 30 26 22 18 14 10 6 Diuretics B-blockers Ca-antag Doumas et al, J Androl, 2005 Ace-inh ARBs Erectile function score switch from b-blockers to nebivolol 30 Doumas et al, Asian J Androl 2006 p=0.002 p=0.002 20 22,09 17,22 10 0 Before After Patients on antihypertensive medication Lifestyle modification add PDE-5 unless contraindicated *unless contraindicated and/or current treatment absolutely indicated Curr Hypertens 2012 ED No ED Continue current treatment Manolis, Doumas, Substitute with ARBs or nebivolol *