1. Michael Doumas Internist Aristotle University Thessaloniki, Greece
Meeting of the Balkan Excellent Centers
“Insights in resistant hypertension and Erectile dysfunction and hypertension”
Michael Doumas
Internist
Aristotle University
Thessaloniki, Greece
Για την διαχρονικά σταθερή στηριξή του

2. 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.

3. IRIS project Insights in ResIstant hypertenSion3

4. Evaluation and management of Resistant Hypertension
Measurement
Adherence to treatment
Lifestyle
Drug-induced
Secondary hypertension
Drug therapy adjustments
Doumas, Int J Hypertens 2011

5. Truly resistant hypertension ABPM or HBP
Brown /118 72%
Muxfeldt /497 63%
Douma /289 67%
De Souza /236 75%
De la Sierra ,5%
Douma / %

6. Prevalence of primary aldosteronism
in patients with resistant hypertension
(%) 20 17 22 19 7 11 5 10 15 25 30
Birmingham
USA
Seattle
Oslo
Norway
Prague
Czech Rep.
Shanghai
China
Thessaloniki
Greece
Calhoun DA, Annu Rev Med 2013; 64: 6

7. Douma, Lancet, 2008

8. Doumas M. In Tsioufis, Schmieder, Mancia, eds, book 2016; in press
5/18/2018 7:01 PM
Doumas M. In Tsioufis, Schmieder, Mancia, eds, book 2016; in press
Resistant hypertension
Moderate-severe hypertension
Hypokalemia (spontaneous or induced)
Adrenal incidentaloma
Patients with clinical suspicion for primary aldosteronism (PA)
Screen (ARR)
ARR<30
ARR>30
and aldosterone >15 ng/dl
Exclude PA
Confirmation (Fludrocortisone, IV saline, Captopril, Oral sodium loading)
Suppressed aldosterone
Unsuppressed
aldosterone
Exclude PA
Lateralization (AVS, Imaging, Scintigraphy)
Bilateral
Unilateral
MRAs
Adrenalectomy or
MRAs in patients ineligible for, or unwilling, surgery
L:\CL Presentations MCS\Hpertension\HypertensionAroundtheWorld.ppt

9. EROS project ERectile dysfunctiOn and hypertenSion9

10. Pathophysiology of sexual dysfunction
Atheromatic lesions resulting in vascular insufficiency
and subsequent erectile dysfunction
Doumas, Porto Heli 2016

11. Manolis, J Hypertens 2008

12. Prevalence of erectile dysfunction
Doumas et al, J Androl, 2005

13. Data from everyday clinical practice34 30 26 22 18 14 10
Doumas et al, J Androl, 2005 6
Diuretics
B-blockers
Ca-antag
Ace-inh
ARBs

14. Erectile function score switch from b-blockers to nebivolol
Doumas et al, Asian J Androl 2006
p=0.002
p=0.002

15. add PDE-5 unless contra-indicated Substitute with ARBs or nebivolol *
Patients on
antihypertensive medication
Manolis, Doumas,
Curr Hypertens 2012 ED
No ED
Lifestyle modification
Continue current treatment
add PDE-5
unless contra-indicated
Substitute with
ARBs or
nebivolol *
*unless contraindicated and/or
current treatment absolutely indicated