1
|
Tokcan M, Lauder L, Götzinger F, Böhm M, Mahfoud F. Arterial hypertension-clinical trials update 2024. Hypertens Res 2024:10.1038/s41440-024-01900-7. [PMID: 39300298 DOI: 10.1038/s41440-024-01900-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/20/2024] [Accepted: 09/02/2024] [Indexed: 09/22/2024]
Abstract
Arterial hypertension remains the most important modifiable cardiovascular risk factor for morbidity and mortality worldwide. This review summarizes and discusses major clinical trials published in 2023 and early 2024 in hypertension research. These trials include new epidemiological data, studies investigating the impact of blood pressure cuff size on blood pressure measurements, benefits of salt substitutes, and novel antihypertensive treatment options, including pharmacotherapy and bariatric surgery in patients with obesity. This summary reviews the major clinical trials published in 2023 and early 2024. AHT arterial hypertension, BP blood pressure, HR hazard ratio, OBP office blood pressure, PRA plasma renin activity, SBP systolic blood pressure.
Collapse
Affiliation(s)
- Mert Tokcan
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Medical Center and Saarland University, Homburg, Germany.
| | - Lucas Lauder
- Department of Cardiology, University Heart Center, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), University Heart Center, University Hospital Basel, Basel, Switzerland
| | - Felix Götzinger
- Department of Cardiology, University Heart Center, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), University Heart Center, University Hospital Basel, Basel, Switzerland
| | - Michael Böhm
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Medical Center and Saarland University, Homburg, Germany
| | - Felix Mahfoud
- Department of Cardiology, University Heart Center, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), University Heart Center, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
2
|
R Muralitharan R, Marques FZ, O'Donnell JA. Recent advancements in targeting the immune system to treat hypertension. Eur J Pharmacol 2024:177008. [PMID: 39304109 DOI: 10.1016/j.ejphar.2024.177008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 09/10/2024] [Accepted: 09/17/2024] [Indexed: 09/22/2024]
Abstract
Hypertension is the key leading risk factor for death globally, affecting ∼1.3 billion adults, particularly in low- and middle-income countries. Most people living with hypertension have uncontrolled high blood pressure, increasing their likelihood of cardiovascular events. Significant issues preventing blood pressure control include lack of diagnosis, treatment, and response to existing therapy. For example, monotherapy and combination therapy are often unable to lower blood pressure to target levels. New therapies are urgently required to tackle this issue, particularly those that target the mechanisms behind hypertension instead of treating its symptoms. Acting via an increase in systemic and tissue-specific inflammation, the immune system is a critical contributor to blood pressure regulation and is considered an early mechanism leading to hypertension development. Here, we review the immune system's role in hypertension, evaluate clinical trials that target inflammation, and discuss knowledge gaps in pre-clinical and clinical data. We examine the effects of anti-inflammatory drugs colchicine and methotrexate on hypertension and evaluate the blockade of pro-inflammatory cytokines IL-1β and TNF-α on blood pressure in clinical trials. Lastly, we highlight how we can move forward to target specific components of the immune system to lower blood pressure. This includes targeting isolevuglandins, which accumulate in dendritic cells to promote T cell activation and cytokine production in salt-induced hypertension. We discuss the potential of the dietary fibre-derived metabolites short-chain fatty acids, which have anti-inflammatory and blood pressure-lowering effects via the gut microbiome. This would limit adverse events, leading to improved medication adherence and better blood pressure control.
Collapse
Affiliation(s)
- Rikeish R Muralitharan
- Hypertension Research Laboratory, School of Biological Sciences, Monash University, Melbourne, VIC, Australia
| | - Francine Z Marques
- Hypertension Research Laboratory, School of Biological Sciences, Monash University, Melbourne, VIC, Australia; Heart Failure Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia; Victorian Heart Institute, Monash University, Clayton, Australia
| | - Joanne A O'Donnell
- Hypertension Research Laboratory, School of Biological Sciences, Monash University, Melbourne, VIC, Australia.
| |
Collapse
|
3
|
Cheng YB, Chan CM, Xu TY, Chen YL, Ding FH, Li Y, Wang JG. Left ventricular structure and function in relation to sodium dietary intake and renal handling in untreated Chinese patients. Hypertens Res 2024:10.1038/s41440-024-01864-8. [PMID: 39251855 DOI: 10.1038/s41440-024-01864-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 08/05/2024] [Accepted: 08/13/2024] [Indexed: 09/11/2024]
Abstract
Whether left ventricular structure and function is associated with sodium dietary intake and renal handling while considering blood pressure (BP) remains unclear. Consecutive untreated patients referred for ambulatory BP monitoring were recruited. Standard echocardiography was performed to measure left ventricular structure and function. Fractional excretion of lithium (FELi) and fractional distal reabsorption rate of sodium (FDRNa) were calculated as markers of proximal and distal tubular sodium handling, respectively. The 952 participants (51.0% women; mean age, 50.8 years) included 614 (64.5%) ambulatory hypertension and 103 (10.8%) left ventricular hypertrophy. There were significant interactions of urinary sodium excretion with FELi (P ≤ 0.045), but not FDRNa (P ≥ 0.36), in relation to left ventricular posterior wall thickness (LVPW), mass (LVM) and mass index (LVMI), but not functional measurements. Only in tertile 1 of FELi, the multivariate-adjusted regression coefficients for urinary sodium excretion reached statistical significance (P ≤ 0.049), being 0.16 ± 0.05 mm, 4.32 ± 1.48 g, and 1.64 ± 0.83 g/m2 for LVPW, LVM and LVMI, respectively. In mutually adjusted analyses, the regression coefficient for LVMI was statistically significant for FELi, FDRNa and 24-h systolic BP, being -2.17 ± 0.49, -1.95 ± 0.54, and 2.99 ± 0.51 g/m2, respectively (P < 0.001). Multivariable analysis of variance showed that sodium renal handling indexes (P ≥ 0.14), but not sodium urinary excretion (P = 0.007), were similarly as 24-h BP associated with LVMI. Heat maps on left ventricular hypertrophy provided a graphical confirmation of the findings. Sodium dietary intake and renal handling interact to be associated with left ventricular structure. Renal handling indexes were similarly in size as, jointly in action with and independently of 24-h BP.
Collapse
Affiliation(s)
- Yi-Bang Cheng
- Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chak-Ming Chan
- Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ting-Yan Xu
- Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yi-Lin Chen
- Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Feng-Hua Ding
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| |
Collapse
|
4
|
McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, Christodorescu RM, Daskalopoulou SS, Ferro CJ, Gerdts E, Hanssen H, Harris J, Lauder L, McManus RJ, Molloy GJ, Rahimi K, Regitz-Zagrosek V, Rossi GP, Sandset EC, Scheenaerts B, Staessen JA, Uchmanowicz I, Volterrani M, Touyz RM. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J 2024:ehae178. [PMID: 39210715 DOI: 10.1093/eurheartj/ehae178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
|
5
|
Kwon Y, Gami AS, Javaheri S, Pressman GS, Scammell TE, Surkin LA, Zee PC. Cardiovascular Risks in People With Narcolepsy: Expert Panel Consensus Recommendations. J Am Heart Assoc 2024; 13:e035168. [PMID: 39119988 DOI: 10.1161/jaha.124.035168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/18/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Observational and retrospective studies suggest that people with narcolepsy may have an increased prevalence of cardiovascular and cardiometabolic comorbidities and may be at greater risk for future cardiovascular events. An expert consensus panel was formed to establish agreement on the risk of hypertension and cardiovascular/cardiometabolic disease in people with narcolepsy and to develop strategies to mitigate these risks. METHODS AND RESULTS Experts in sleep medicine and cardiology were selected to participate in the panel. After reviewing the relevant literature, the experts identified key elements, drafted recommendation statements, and developed discussion points to provide supporting evidence for the recommendations. The draft and final recommendations were rated on a scale from 0 (not at all agree) to 4 (very much agree). All experts had an agreement rating of 4.0 for all 14 revised recommendation statements for patients with narcolepsy. These statements comprised 3 themes: (1) recognize the risk of hypertension and cardiovascular/cardiometabolic disease, (2) reduce the risk of hypertension and cardiovascular/cardiometabolic disease, and (3) reduce sodium intake to lower the risk of hypertension and cardiovascular disease. CONCLUSIONS These consensus recommendations are intended to increase awareness of potential cardiovascular/cardiometabolic risks in patients with narcolepsy for all clinicians. Early monitoring for, and prevention of, cardiovascular risks in this population are of great importance, especially as narcolepsy usually develops in adolescents and young adults, who will be exposed to adverse effects of the disease for decades. Prospective systematic studies are needed to determine association and causation of narcolepsy with cardiovascular/cardiometabolic disorders.
Collapse
Affiliation(s)
| | | | | | - Gregg S Pressman
- Cardiovascular Diseases Fellowship Training Program Jefferson Einstein Hospital Philadelphia PA
| | | | - Lee A Surkin
- Empire Sleep Medicine and VirtuOx, Inc. New York NY
| | - Phyllis C Zee
- Center for Circadian and Sleep Medicine Northwestern University Chicago IL
| |
Collapse
|
6
|
Phillips WT, Schwartz JG. Nasal turbinate lymphatic obstruction: a proposed new paradigm in the etiology of essential hypertension. Front Med (Lausanne) 2024; 11:1380632. [PMID: 39219790 PMCID: PMC11362006 DOI: 10.3389/fmed.2024.1380632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024] Open
Abstract
Hypertension affects an estimated 1.3 billion people worldwide and is considered the number one contributor to mortality via stroke, heart failure, renal failure, and dementia. Although the physiologic mechanisms leading to the development of essential hypertension are poorly understood, the regulation of cerebral perfusion has been proposed as a primary cause. This article proposes a novel etiology for essential hypertension. Our hypothesis developed from a review of nuclear medicine scans, where the authors observed a significantly abnormal increase in nasal turbinate vasodilation in hypertensive patients using quantitative region of interest analysis. The authors propose that nasal turbinate vasodilation and resultant blood pooling obstruct the flow of cerebrospinal fluid passing through nasal turbinate lymphatics, thereby increasing intracranial pressure. The authors discuss the glymphatic/lymphatic clearance system which is impaired with age, and at which time hypertension also develops. The increased intracranial pressure leads to compensatory hypertension via Cushing's mechanism, i.e., the selfish brain hypothesis. The nasal turbinate vasodilation, due to increased parasympathetic activity, occurs simultaneously along with the well-established increased sympathetic activity of the cardiovascular system. The increased parasympathetic activity is likely due to an autonomic imbalance secondary to the increase in worldwide consumption of processed food. This hypothesis explains the rapid worldwide rise in essential hypertension in the last 50 years and offers a novel mechanism and a new paradigm for the etiology of essential hypertension. This new paradigm offers compelling evidence for the modulation of parasympathetic nervous system activity as a novel treatment strategy, specifically targeting nasal turbinate regulation, to treat diseases such as hypertension, idiopathic intracranial hypertension, and degenerative brain diseases. The proposed mechanism of essential hypertension presented in this paper is a working hypothesis and confirmatory studies will be needed.
Collapse
|
7
|
Zhang X, Ye WQ, Xin XK, Gao YJ, Yang F. Global, regional, and national burden of stroke attributable to diet high in sodium from 1990 to 2019: a systematic analysis from the global burden of disease study 2019. Front Neurol 2024; 15:1437633. [PMID: 39206294 PMCID: PMC11349671 DOI: 10.3389/fneur.2024.1437633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Purpose Given the increasing occurrence of stroke and high-sodium diets (DHIS) over the past 30 years, it is crucial to assess the global, national, and regional impact of DHIS on the burden of stroke. Methods and materials The Global Burden of Diseases Study 2019 provided the study's data. We used the Bayesian meta-regression tool DisMod-MR 2.1 to evaluate the burden of stroke attributable to DHIS. Age-standardized disability-adjusted life years (ASDR) and age-standardized mortality rate (ASMR) were used to quantify the burden. We perform correlation analysis utilizing the Spearman rank-order correlation method, and we calculate the estimated annual percentage change (EAPC) to evaluate temporal trends. Results Globally, DHIS accounts for 17,673.33 thousand disability-adjusted life years (DALYs) and 700.98 thousand deaths of stroke in 2019. The burden of stroke attributable to DHIS has declined between 1990 and 2019 globally and in the majority of regions, with the largest declines seen in regions with high sociodemographic indexes (SDI). Both ASMR and ASDR were higher regionally in regions with moderate SDI than those in developed regions. Furthermore, the absolute values of EAPC, reflecting the rate of decrease, were notably lower in these regions compared to developed nations. High-income North America, categorized within the SDI regions, notably witnessed the smallest decline in ASDR over the last three decades. Additionally, from 1990 to 2019, males consistently bore a larger burden of stroke attributable to DHIS. Conclusion The burden of stroke attributable to DHIS remained a major concern despite advancements in public knowledge of stroke and their utilization of emergency medical services. Over the past 30 years, more burden has been placed on males and regions with moderate SDI values; in males, higher EAPC values for both ASMR and ASDR have been found. This underscores the urgent need for effective interventions to alleviate the burden of stroke associated with DHIS.
Collapse
Affiliation(s)
- Xuan Zhang
- The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, China
- Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Wen-qian Ye
- School of Pharmaceutical Science, Medicinal Basic Research Innovation Center of Chronic Kidney Disease, Ministry of Education, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xue-Ke Xin
- School of Management, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ying-jie Gao
- School of Pharmaceutical Science, Medicinal Basic Research Innovation Center of Chronic Kidney Disease, Ministry of Education, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Fan Yang
- School of Pharmaceutical Science, Medicinal Basic Research Innovation Center of Chronic Kidney Disease, Ministry of Education, Shanxi Medical University, Taiyuan, Shanxi, China
| |
Collapse
|
8
|
Wan J, Wang P, Liu S, Wang X, Zhou P, Yang J. Risk factors and a predictive model for left ventricular hypertrophy in young adults with salt-sensitive hypertension. J Clin Hypertens (Greenwich) 2024; 26:933-944. [PMID: 38940286 PMCID: PMC11301447 DOI: 10.1111/jch.14863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/16/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024]
Abstract
Salt-sensitive hypertension is common among individuals with essential hypertension, and the prevalence of left ventricular hypertrophy (LVH) has increased. However, data from early identification of the risk of developing LVH in young adults with salt-sensitive hypertension are lacking. Thus, the present study aimed to design a nomogram for predicting the risk of developing LVH in young adults with salt-sensitive hypertension. A retrospective analysis of 580 patients with salt-sensitive hypertension was conducted. The training set consisted of 70% (n = 406) of the patients, while the validation set consisted of the remaining 30% (n = 174). Based on multivariate analysis of the training set, predictors for LVH were extracted to develop a nomogram. Discrimination curves, calibration curves, and clinical utility were employed to assess the predictive performance of the nomogram. The final simplified nomogram model included age, sex, office systolic blood pressure, duration of hypertension, abdominal obesity, triglyceride-glucose index, and estimated glomerular filtration rate (eGFR). In the training set, the model demonstrated moderate discrimination, as indicated by an area under the receiver operating characteristic (ROC) curve of 0.863 (95% confidence interval: 0.831-0.894). The calibration curve exhibited good agreement between the predicted and actual probabilities of LVH in the training set. Additionally, the validation set further confirmed the reliability of the prediction nomogram. In conclusions, the simplified nomogram, which consists of seven routine clinical variables, has shown good performance and clinical utility in identifying young adults with salt-sensitive hypertension who are at high risk of LVH at an early stage.
Collapse
Affiliation(s)
- Jindong Wan
- Research Center for Metabolic and Cardiovascular DiseasesThe Third Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Department of Clinical NutritionThe Third Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Peijian Wang
- Department of CardiologyThe First Affiliated Hospital of Chengdu Medical CollegeChengduSichuanChina
| | - Sen Liu
- Department of CardiologyThe First Affiliated Hospital of Chengdu Medical CollegeChengduSichuanChina
| | - Xinquan Wang
- Department of CardiologyThe First Affiliated Hospital of Chengdu Medical CollegeChengduSichuanChina
| | - Peng Zhou
- Department of CardiologyThe First Affiliated Hospital of Chengdu Medical CollegeChengduSichuanChina
| | - Jian Yang
- Research Center for Metabolic and Cardiovascular DiseasesThe Third Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Department of Clinical NutritionThe Third Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| |
Collapse
|
9
|
Rakhshani T, Tahmasebi Z, Ghahremani L, Kamyab A, Khani Jeihooni A. The effect of educational intervention based on the PRECEDE-PROCEED model on self-care behaviors and quality of life of hypertensive patients. Front Public Health 2024; 12:1410843. [PMID: 39091531 PMCID: PMC11291360 DOI: 10.3389/fpubh.2024.1410843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/01/2024] [Indexed: 08/04/2024] Open
Abstract
Background To prevent the harmful consequences of hypertension and enhance the quality of life of hypertensive patients, the use of educational models is highly suggested. Therefore, the present study was designed to determine the effect of education based on the PRECEDE-PROCEED on self-care behaviors and the quality of life of hypertensive patients in Kazeroon city, Iran, in 2023. Methods A total of 120 hypertensive individuals who were referred to Kazeroon city health centers participated in the current quasi-experimental study. The participants were divided into two experimental and control groups using a random sampling technique (60 participants in each group). The self-care behaviors questionnaire, the quality of life questionnaire, and a questionnaire based on the PRECEDE-PROCEED model were used as the data acquisition techniques. Both groups completed the questionnaires before and 2 months after the intervention. The educational program included a six-session, 50-60 min training program using three different teaching methods (speaking, Q&A, group discussion, and peer training) in health facilities. The data were examined using paired t, independent t, and chi-square statistical tests after being entered into the SPSS 24 statistical program. Results Following the intervention, the experimental group showed significantly higher values in quality of life, knowledge, attitude, enabling and reinforcing factors, and self-care behaviors compared to the control group (p < 0.001 for all comparisons). The experimental group also exhibited a significant reduction in systolic blood pressure measures compared to the control group (p < 0.001). Conclusion In the present study, education based on the PRECEDE-PROCEED model and focusing on blood pressure self-care behavior in patients with hypertension led to a decrease in their systolic blood pressure measures and improved their quality of life.
Collapse
Affiliation(s)
- Tayebeh Rakhshani
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Tahmasebi
- Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Ghahremani
- Department of Health Education and Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ali Khani Jeihooni
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
10
|
Wang Y, Lee JS, Pollack LM, Kumar A, Honeycutt S, Luo F. Health Care Expenditures and Use Associated with Hypertension Among U.S. Adults. Am J Prev Med 2024:S0749-3797(24)00228-9. [PMID: 39002890 DOI: 10.1016/j.amepre.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/03/2024] [Accepted: 07/07/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION This study seeks to estimate health care expenditures and use associated with hypertension, focusing on differences among racial and ethnic groups. METHODS Data were from the 2019 Medical Expenditure Panel Survey, analyzed in 2023. The study sample included noninstitutionalized U.S. adults aged ≥18 years. Outcome variables were health care expenditures and events. Hypertension was determined by a self-reported diagnosis or diagnosis codes. Race and ethnicity were self-reported. A 2-part model was used to estimate expenditures associated with hypertension. A zero-inflated negative binomial model was used to estimate events associated with hypertension. Sampling designs were applied to generate nationally representative estimates. RESULTS Hypertension was associated with $2,759 (95% confidence interval [CI]: $2,039, $3,479) in health care expenditures and 10.3 (95% CI: 9.3, 11.3) health care events, including prescriptions filled, in 2019 per person. Compared with non-Hispanic White adults, hypertension-associated health care expenditures were significantly lower among Hispanic adults (difference: -$1,877; 95% CI: -$3,389, -$364) and Asian adults (difference: -$2,452; 95% CI: -$4,093, -$811), and hypertension-associated health care events were significantly lower among Hispanic adults (difference: -3.8; 95% CI: -6.1, -1.6) and non-Hispanic Asian adults (difference: -4.1; 95% CI: -6.9, -1.2). Differences between non-Hispanic White adults and non-Hispanic Black adults were not statistically significant in health care expenditures (difference: -$954; 95% CI: -$2,849, $941) and events (difference: 0.3; 95% CI: -2.1, 2.8). CONCLUSIONS This study reveals differences in health care expenditures and use associated with hypertension among racial and ethnic groups. Future studies are needed to examine potential drivers of these differences.
Collapse
Affiliation(s)
- Yu Wang
- Division of Workforce Development, Public Health Infrastructure Center, Centers for Disease Control and Prevention, Atlanta, Georgia; Data Science and Evaluation Team, American Heart Association, Dallas, Texas
| | - Jun S Lee
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa M Pollack
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ashutosh Kumar
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Bizzell US, New Carrollton, Maryland
| | - Sally Honeycutt
- Data Science and Evaluation Team, American Heart Association, Dallas, Texas
| | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
| |
Collapse
|
11
|
Koretz RL. JPEN Journal Club 82. Stepped-wedge cluster randomized trials. JPEN J Parenter Enteral Nutr 2024; 48:633-635. [PMID: 38296935 DOI: 10.1002/jpen.2603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/02/2024]
Affiliation(s)
- Ronald L Koretz
- UCLA Medical Center Olive View, Sylmar, California, USA
- University of California David Geffen School of Medicine, Los Angeles, California, USA
| |
Collapse
|
12
|
Savage P, Cox B, Shahmohammadi M, Kelly B, Menown I. Advances in Clinical Cardiology 2023: A Summary of Key Clinical Trials. Adv Ther 2024; 41:2606-2634. [PMID: 38743242 PMCID: PMC11213809 DOI: 10.1007/s12325-024-02877-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Over the course of 2023, numerous key clinical trials with valuable contributions to clinical cardiology were published or presented at major international conferences. This review seeks to summarise these trials and reflect on their clinical context. METHODS The authors collated and reviewed clinical trials presented at major cardiology conferences during 2023 including the American College of Cardiology (ACC), European Association for Percutaneous Cardiovascular Interventions (EuroPCR), European Society of Cardiology (ESC), Transcatheter Cardiovascular Therapeutics (TCT), American Heart Association (AHA), European Heart Rhythm Association (EHRA), Society for Cardiovascular Angiography and Interventions (SCAI), TVT-The Heart Summit (TVT) and Cardiovascular Research Technologies (CRT). Trials with a broad relevance to the cardiology community and those with potential to change current practice were included. RESULTS A total of 80 key cardiology clinical trials were identified for inclusion. Key trials in acute coronary syndrome (ACS) and antiplatelet management such as HOST-IDEA, T-PASS and STOP-DAPT3 were included in addition to several pivotal interventional trials such as ORBITA 2, MULTISTARS-AMI, ILUMIEN-IV, OCTIVUS and OCTOBER. Additionally, several trials evaluated new stent design and technology such as BIOSTEMI, PARTHENOPE and TRANSFORM. Structural intervention trials included long-term data from PARTNER 3, new data on the durability of transcatheter aortic valve intervention (TAVI), in addition to major new trials regarding transcatheter tricuspid valve intervention from TRISCEND II. Heart failure (HF) and prevention covered several key studies including DAPA-MI, STEP-HF, ADVOR, DICTATE HF and CAMEO-DAPA. In cardiac devices and electrophysiology, several trial exploring novel ablation strategies in atrial fibrillation (AF) such as PULSED AF and ADVENT were presented with further data evaluating the efficacy of anticoagulation in subclinical AF in NOAH-AFNET 6, FRAIL AF and AZALEA-TIMI 71. CONCLUSION This article presents a summary of key clinical cardiology trials published and presented during the past year and should be of interest to both practising clinicians and researchers.
Collapse
Affiliation(s)
- Patrick Savage
- Craigavon Cardiology Department, Southern Health and Social Care Trust, Craigavon, Northern Ireland, UK.
| | - Brian Cox
- Craigavon Cardiology Department, Southern Health and Social Care Trust, Craigavon, Northern Ireland, UK
| | - Michael Shahmohammadi
- Craigavon Cardiology Department, Southern Health and Social Care Trust, Craigavon, Northern Ireland, UK
| | - Bronagh Kelly
- Craigavon Cardiology Department, Southern Health and Social Care Trust, Craigavon, Northern Ireland, UK
| | - Ian Menown
- Craigavon Cardiology Department, Southern Health and Social Care Trust, Craigavon, Northern Ireland, UK
| |
Collapse
|
13
|
Duus CL, Nielsen SF, Hornstrup BG, Mose FH, Bech JN. Self-Performed Dietary Sodium Reduction and Blood Pressure in Patients With Essential Hypertension: A Randomized Clinical Trial. J Am Heart Assoc 2024; 13:e034632. [PMID: 38842286 PMCID: PMC11255768 DOI: 10.1161/jaha.124.034632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/02/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Hypertension is the leading risk factor for cardiovascular disease worldwide. Patients with blood pressure (BP) response to dietary sodium reduction are referred to as "salt sensitive." Salt sensitivity (SS) might be due to differences in sodium storage capacity and the erythrocyte SS examines this capacity of the red blood cells. This study aimed to test the effect of a self-performed sodium reduced diet on BP in patients with essential hypertension and examine whether erythrocyte SS predicts SS. METHODS AND RESULTS Seventy-two patients with hypertension were included and randomized 2:1 to either sodium reduction or a control group for 4 weeks. Blood samples, 24-hour BP measurement, and 24-hour urine collection were performed before and after. The intervention group received advice on how to lower sodium intake. Urinary sodium excretion decreased 66 mmol (95% CI, -96 to -37 mmol) in the intervention group compared with the control group. Systolic 24-hour BP decreased 9 mm Hg after low-sodium diet compared with the control group (95% CI, -13 to -4 mm Hg). Similarly, the difference in reduction in diastolic BP between the groups was 5 mm Hg (95% CI, -8 to -1 mm Hg). We found no correlation between erythrocyte SS at baseline and decrease in 24-hour BP, neither systolic nor diastolic (P=0.66 and P = 0.84). CONCLUSIONS Self-performed sodium reduction was feasible and led to decrease in 24-hour BP of 9/5 mm Hg compared with a control group. The erythrocyte SS did not correlate to the change in BP after lowering sodium intake. REGISTRATION URL: https://clinicaltrials.gov; Unique Identifier: NCT05165823.
Collapse
Affiliation(s)
- Camilla Lundgreen Duus
- University Clinic in Nephrology and Hypertension, Department of MedicineGødstrup HospitalHerningDenmark
| | - Steffen Flindt Nielsen
- University Clinic in Nephrology and Hypertension, Department of MedicineGødstrup HospitalHerningDenmark
| | - Bodil Gade Hornstrup
- University Clinic in Nephrology and Hypertension, Department of MedicineGødstrup HospitalHerningDenmark
| | - Frank Holden Mose
- University Clinic in Nephrology and Hypertension, Department of MedicineGødstrup HospitalHerningDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Jesper Nørgaard Bech
- University Clinic in Nephrology and Hypertension, Department of MedicineGødstrup HospitalHerningDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| |
Collapse
|
14
|
Chrysant SG. The role of gut microbiota in the development of salt-sensitive hypertension and the possible preventive effect of exercise. Expert Rev Cardiovasc Ther 2024; 22:265-271. [PMID: 38823009 DOI: 10.1080/14779072.2024.2364031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/31/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION The aim of the present study is to analyze the data indicating an association between high salt intake and the gastrointestinal microbiota in the development of salt-sensitive hypertension in animals and men. It is also, to discuss the preventive effects of exercise on gut-induced hypertension by favorably modifying the composition of gut microbiota. AREAS COVERED Salt sensitivity is quite common, accounting for 30%-60% in hypertensive subjects. Recently, a novel cause for salt-sensitive hypertension has been discovered through the action of gut microbiota by the secretion of several hormones and the action of short chain fatty acids (SCFAs). In addition, recent studies indicate that exercise might favorably modify the adverse effects of gut microbiota regarding their effects on BP. To identify the role of gut microbiota on the incidence of hypertension and CVD and the beneficial effect of exercise, a Medline search of the English literature was conducted between 2018 and 2023 and 42 pertinent papers were selected. EXPERT OPINION The analysis of data from the selected papers disclosed that the gut microbiota contribute significantly to the development of salt-sensitive hypertension and that exercise modifies their gut composition and ameliorates their adverse effects on BP.
Collapse
Affiliation(s)
- Steven G Chrysant
- Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
15
|
Leitner J, Chiang PH, Agnihotri P, Dey S. The Effect of an AI-Based, Autonomous, Digital Health Intervention Using Precise Lifestyle Guidance on Blood Pressure in Adults With Hypertension: Single-Arm Nonrandomized Trial. JMIR Cardio 2024; 8:e51916. [PMID: 38805253 PMCID: PMC11167324 DOI: 10.2196/51916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/29/2024] [Accepted: 04/09/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Home blood pressure (BP) monitoring with lifestyle coaching is effective in managing hypertension and reducing cardiovascular risk. However, traditional manual lifestyle coaching models significantly limit availability due to high operating costs and personnel requirements. Furthermore, the lack of patient lifestyle monitoring and clinician time constraints can prevent personalized coaching on lifestyle modifications. OBJECTIVE This study assesses the effectiveness of a fully digital, autonomous, and artificial intelligence (AI)-based lifestyle coaching program on achieving BP control among adults with hypertension. METHODS Participants were enrolled in a single-arm nonrandomized trial in which they received a BP monitor and wearable activity tracker. Data were collected from these devices and a questionnaire mobile app, which were used to train personalized machine learning models that enabled precision lifestyle coaching delivered to participants via SMS text messaging and a mobile app. The primary outcomes included (1) the changes in systolic and diastolic BP from baseline to 12 and 24 weeks and (2) the percentage change of participants in the controlled, stage-1, and stage-2 hypertension categories from baseline to 12 and 24 weeks. Secondary outcomes included (1) the participant engagement rate as measured by data collection consistency and (2) the number of manual clinician outreaches. RESULTS In total, 141 participants were monitored over 24 weeks. At 12 weeks, systolic and diastolic BP decreased by 5.6 mm Hg (95% CI -7.1 to -4.2; P<.001) and 3.8 mm Hg (95% CI -4.7 to -2.8; P<.001), respectively. Particularly, for participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 9.6 mm Hg (95% CI -12.2 to -6.9; P<.001) and 5.7 mm Hg (95% CI -7.6 to -3.9; P<.001), respectively. At 24 weeks, systolic and diastolic BP decreased by 8.1 mm Hg (95% CI -10.1 to -6.1; P<.001) and 5.1 mm Hg (95% CI -6.2 to -3.9; P<.001), respectively. For participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 14.2 mm Hg (95% CI -17.7 to -10.7; P<.001) and 8.1 mm Hg (95% CI -10.4 to -5.7; P<.001), respectively, at 24 weeks. The percentage of participants with controlled BP increased by 17.2% (22/128; P<.001) and 26.5% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The percentage of participants with stage-2 hypertension decreased by 25% (32/128; P<.001) and 26.5% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The average weekly participant engagement rate was 92% (SD 3.9%), and only 5.9% (6/102) of the participants required manual outreach over 24 weeks. CONCLUSIONS The study demonstrates the potential of fully digital, autonomous, and AI-based lifestyle coaching to achieve meaningful BP improvements and high engagement for patients with hypertension while substantially reducing clinician workloads. TRIAL REGISTRATION ClinicalTrials.gov NCT06337734; https://clinicaltrials.gov/study/NCT06337734.
Collapse
Affiliation(s)
- Jared Leitner
- Electrical and Computer Engineering Department, University of California, San Diego, La Jolla, CA, United States
| | - Po-Han Chiang
- Electrical and Computer Engineering Department, University of California, San Diego, La Jolla, CA, United States
| | - Parag Agnihotri
- Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Sujit Dey
- Electrical and Computer Engineering Department, University of California, San Diego, La Jolla, CA, United States
| |
Collapse
|
16
|
Narita K. Therapeutic intervention exploring hypertensive patients who respond to health coaching behavior modification therapy. Hypertens Res 2024; 47:1229-1230. [PMID: 38360952 DOI: 10.1038/s41440-024-01601-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/13/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Keisuke Narita
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
| |
Collapse
|
17
|
Minari TP, Manzano CF, Tácito LHB, Yugar LBT, Sedenho-Prado LG, Rubio TDA, Pires AC, Vilela-Martin JF, Cosenso-Martin LN, Moreno H, Yugar-Toledo JC. The Impact of a Nutritional Intervention on Glycemic Control and Cardiovascular Risk Markers in Type 2 Diabetes. Nutrients 2024; 16:1378. [PMID: 38732624 PMCID: PMC11085322 DOI: 10.3390/nu16091378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Nutritional management plays a crucial role in treating patients with type 2 diabetes (T2D), working to prevent and control the progression of chronic non-communicable diseases. OBJECTIVES To evaluate the effects of individualized nutritional interventions on weight, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), fasting blood glucose (FBG), hemoglobin A1c (HbA1c), total cholesterol (TC), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), triglycerides (TGs), systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR)} over 12 months and subsequently at follow-up (15 months). METHODS This longitudinal experimental study (without randomization and blinding) enrolled 84 sedentary participants with T2D (both sexes, aged 18-80 years). They were divided into a control group of 40 participants who received only medical consultations, and an intervention group of 44 participants who received the same medical care along with a nutritional assessment. Consultations occurred quarterly from August 2020 to November 2022 (first-twelfth month), with six to nine patients per session. Subsequently, a follow-up was conducted from December 2022 to November 2023, during which the intervention group had only medical care (during the 12th-15th months). Personalized dietary planning was inspired by the Mediterranean/DASH diets adapted to Brazilian foods and socioeconomic cultures. STATISTICAL ANALYSIS Normal variables were compared between groups for each time point and also within each group across different time points using a two-way ANOVA (repeated measures for intragroup) followed by the Šídák post hoc test. Non-normal variables were compared between groups for each time point using Kruskal-Wallis followed by the Dunn post hoc test, and within each group across different time points using Friedman followed by the Dunn post hoc test. Data with a Gaussian distribution were presented as mean ± standard deviation (SD), and data with a non-Gaussian distribution were presented as median ± interquartile range (IQR). For all cases, α < 0.05 and p < 0.05 were adopted. RESULTS In the intervention group, significant reductions were observed between the first and twelfth month for all parameters (p < 0.05), (except for TC), along with an increase in HDL-C (p = 0.0105). Conversely, in the control group, there was a significant increase in HbA1c, weight, BMI, FBG, and WHR (p < 0.05) between the first and twelfth months. Regarding the comparison between groups, there was a significant difference for all analyzed parameters (p < 0.05) from the first to the twelfth month. In the follow-up, differences were also observed (p < 0.05), except for BMI (p > 0.05). CONCLUSION The individualized nutritional intervention improved eating habits, anthropometric, biochemical, and cardiovascular markers in T2D over 12 months, with sustained results during follow-up. The dietary plan inspired by the Mediterranean and DASH diets demonstrated good adaptation to the Brazilian food culture and the patients' socioeconomic contexts. Consistent monitoring and personalized nutritional management are essential for optimizing long-term outcomes. However, more clinical trials are necessary in order to optimize the level of evidence for longitudinal interventions.
Collapse
Affiliation(s)
- Tatiana Palotta Minari
- Department of Hypertension, State Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
| | - Carolina Freitas Manzano
- Department of Hypertension, State Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
| | - Lúcia Helena Bonalume Tácito
- Department of Endocrinology, State Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
| | | | | | - Tatiane de Azevedo Rubio
- Cardiovascular Pharmacology & Hypertension Laboratory, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| | - Antônio Carlos Pires
- Department of Endocrinology, State Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
| | - José Fernando Vilela-Martin
- Department of Hypertension, State Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
| | - Luciana Neves Cosenso-Martin
- Department of Endocrinology, State Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
| | - Heitor Moreno
- Cardiovascular Pharmacology & Hypertension Laboratory, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| | - Juan Carlos Yugar-Toledo
- Department of Hypertension, State Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
| |
Collapse
|
18
|
Vergallo R, Volpe M. Lowering dietary sodium intake to reduce blood pressure: cum grano salis. Eur Heart J 2024; 45:1301-1302. [PMID: 38320239 DOI: 10.1093/eurheartj/ehae065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Affiliation(s)
- Rocco Vergallo
- Interventional Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), Università di Genova, Genova, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa, 1035-1039, Rome 00189, Italy
- IRCCS San Raffaele Roma, Via della Pisana, 235, 00163 Rome, Italy
| |
Collapse
|
19
|
Tyagi P, Tyagi S, Stewart L, Glickman S. SWOT and Root Cause Analyses of Antimicrobial Resistance to Oral Antimicrobial Treatment of Cystitis. Antibiotics (Basel) 2024; 13:328. [PMID: 38667004 PMCID: PMC11047466 DOI: 10.3390/antibiotics13040328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/29/2024] Open
Abstract
Nearly 150 million cases of urinary tract infections (UTIs) are reported each year, of which uncomplicated cystitis triggers > 25% of outpatient prescriptions of oral antimicrobial treatment (OAT). OAT aids immune cells infiltrating the urothelium in eliminating uropathogens capable of invading the urothelium and surviving hyperosmotic urine. This self-evident adaptability of uropathogens and the short interval between the introduction of Penicillin and the first report of antimicrobial resistance (AMR) implicate AMR as an evolutionary conserved heritable trait of mutant strains selected by the Darwinian principle to survive environmental threats through exponential proliferation. Therefore, AMR can only be countered by antimicrobial stewardship (AMS) following the principle of the five Ds-drug, dose, duration, drug route, and de-escalation. While convenient to administer, the onset of the minimum inhibitory concentration (MIC) for OAT in urine leaves a window of opportunity for uropathogens to survive the first contact with an antimicrobial and arm their descendant colonies with AMR for surviving subsequent higher urine antimicrobial levels. Meanwhile, the initial dose of intravesical antimicrobial treatment (IAT) may be well above the MIC. Therefore, the widespread clinical use of OAT for cystitis warrants an analysis of the strengths, weaknesses, opportunity, and threats (SWOTs) and a root cause analysis of the AMR associated with OAT and IAT.
Collapse
Affiliation(s)
- Pradeep Tyagi
- Department of Urology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Shachi Tyagi
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | | | | |
Collapse
|
20
|
Gupta DK, Lewis CE, Allen NB. Dietary Sodium and Blood Pressure-Reply. JAMA 2024; 331:1155-1156. [PMID: 38563837 DOI: 10.1001/jama.2024.1910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Deepak K Gupta
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
21
|
Keyserling TC, Saraiya VM, Ammerman AS. Dietary Sodium and Blood Pressure. JAMA 2024; 331:1154-1155. [PMID: 38563840 DOI: 10.1001/jama.2024.1907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Thomas C Keyserling
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill
| | - Veeral M Saraiya
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill
| | - Alice S Ammerman
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| |
Collapse
|
22
|
Kohagura K. Effect of Combined DASH Diet with Sodium Restriction on Renal Function. KIDNEY360 2024; 5:487-488. [PMID: 38662535 PMCID: PMC11093539 DOI: 10.34067/kid.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
- Kentaro Kohagura
- Dialysis Unit, University of the Ryukyus Hospital, Nishihara-cho, Okinawa, Japan
| |
Collapse
|
23
|
Srikanth S, Mondal A, Aggarwal S, Alle NR, Odugbemi O, Nayak PR, Vyas A, Desai R. Key hypertension breakthroughs and emerging trends from the AHA's scientific sessions. Curr Probl Cardiol 2024; 49:102434. [PMID: 38309547 DOI: 10.1016/j.cpcardiol.2024.102434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
We aim to summarize selected late-breaking science on hypertension management strategies and disease presented at the 2023 American Heart Association (AHA) conference. The trials discussed below encompass stricter goals of blood pressure management and were expanded into different population groups from different countries with varied socioeconomic backgrounds and settings, collectively advancing our understanding of hypertension treatment and its impact on public health. We summarized the china rural health care project (CRHCP), a four-year study involving over 34,000 participants in rural China, emphasizing the potential of stricter blood pressure goals in lowering the incidence of all-cause dementia and cognitive impairment. Next, we explore the US-based CARDIA-SSBP study, which highlights the impact of dietary sodium on systolic blood pressure in middle-aged individuals. Through a randomized-order cross-over design, the study provides compelling evidence supporting the effectiveness of sodium reduction as a non-pharmacological approach to blood pressure control. The UK-based POP-HT trial offers critical insights into postpartum women with a history of hypertensive pregnancy. The trial emphasizes the benefits of self-monitoring and physician-optimized antihypertensive titration, showcasing significant blood pressure reductions in the intervention group. Furthermore, the KARDIA-1 study introduces us to Zilebesiran, an innovative RNA interference drug. This phase 2 study highlights its potential for achieving sustained blood pressure reductions and its favorable safety profile, marking a significant step forward in hypertension treatment. Lastly, we expand the practical application of the previously conducted landmark SPRINT trial, which showed cardiovascular benefit with intensive SBP control to less than 120 mm Hg in high-risk non-diabetic patients with hypertension compared with routine BP control to <140 mm Hg. The ESPRIT trial and the IMPACTS trial build upon the SPRINT trial, demonstrating the effects of intensive blood pressure lowering in Asian hypertensive patients and in 36 health care clinics in medically underserved states in the US: Louisiana and Mississippi. The IMPACTS trial and the "Hypertension Treatment in Nigeria Program" demonstrate the effectiveness of implementing comprehensive blood pressure control strategies in real-world settings. These studies highlight the feasibility and scalability of such interventions, especially in low-resource environments, and their potential to significantly improve public health outcomes.
Collapse
Affiliation(s)
- Sashwath Srikanth
- Department of Internal Medicine, East Carolina University Greenville, NC, USA
| | - Avilash Mondal
- Department of Internal Medicine, Nazareth Hospital, PA, USA
| | - Sanjana Aggarwal
- Department of Internal Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Naga Ruthvika Alle
- Department of Medicine, Narayana Medical College, Nellore, Andhra Pradesh, India
| | - Olufemi Odugbemi
- Department of Internal Medicine, Lincoln Medical Center, Bronx, NY, USA
| | - Parth R Nayak
- Department of Physiology Ananya College of Medicine & Research, Kalol, India
| | - Ankit Vyas
- Department of Vascular Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA.
| | | |
Collapse
|
24
|
Cohen JB, Juraschek SP. Making Sense of Individual Responses to Sodium Reduction. JAMA 2023; 330:2251-2252. [PMID: 38112823 PMCID: PMC11073508 DOI: 10.1001/jama.2023.23650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Jordana B Cohen
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
25
|
Landolfo M, Spannella F, Poliseno C, Massacesi A, Giulietti F, Festa R, Cavazzin E, Sasso G, Mazza A, Sarzani R. The Effects of ESC/ESH-Based Written Generic Lifestyle Advice and a Nutraceutical on 24-Hour Blood Pressure in Patients with High-Normal Office Blood Pressure and Low-Moderate Cardiovascular Risk. Nutrients 2023; 15:5099. [PMID: 38140359 PMCID: PMC10745575 DOI: 10.3390/nu15245099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Lifestyle changes, eventually coupled with a nutraceutical, are recommended strategies for managing high-normal blood pressure (BP) patients with low-moderate cardiovascular (CV) risk. In a real-life clinical setting, we evaluated the effects of generic written lifestyle advice, extrapolated from the 2018 ESC/ESH guidelines, and a beetroot-based nutraceutical on 24 h BP in a population with a high-normal office BP and low-moderate CV risk. (2) Methods: A longitudinal observational study was conducted in two ESH Hypertension Excellence Centres on 43 consecutive subjects with high-normal BP according to repeated office BP (OBP) measurements and a low-moderate CV risk based on SCORE2/SCORE2-OP. Additionally, 24 h ambulatory BP monitoring (ABPM) was carried out at baseline and three months after lifestyle changes, according to generic written advice from the 2018 ESC/ESH guidelines, coupled with a nutraceutical containing 500 mg of dry beetroot extract. (3) Results: The mean age was 50 ± 11 years, with male prevalence (54%). The prevalence of overweight/obesity was 58%. The mean OBP was 135 ± 3/85 ± 3 mmHg. At baseline, the mean 24 h BP, daytime BP, and night-time BP were 127 ± 7/80 ± 6 mmHg, 131 ± 8/83 ± 6 mmHg, and 118 ± 8/70 ± 5 mmHg, respectively, BP profiles compatible with hypertension status in some subjects. After a median follow-up of 98 (92-121) days, all BPs, except night-time diastolic BP, were significantly decreased: -3 ± 6/-2 ± 4 mmHg for 24 h BP, -3.9 ± 6.0/-3.0 ± 4.0 mmHg for daytime BP, and -3.3 ± 7.4/-1.3 ± 4.7 mmHg for night-time BP, respectively. No significant clinical changes in body weight were detected. BP decreased independently of baseline BP levels, sex, smoking status, and body mass index, while a more substantial BP decrease was observed in older patients. (4) Conclusions: Our exploratory study shows, for the first time, that written generic lifestyle advice taken from the ESC/ESH hypertension guidelines coupled with a beetroot-based nutraceutical may represent a valid initial non-pharmacological approach in subjects with a high-normal office BP and low-moderate CV risk, even without personalized diet interventions.
Collapse
Affiliation(s)
- Matteo Landolfo
- Internal Medicine and Geriatrics, ESH Excellence Hypertension Centre, IRCCS INRCA, 60127 Ancona, Italy; (M.L.); (R.S.)
- Department of Clinical and Molecular Sciences, Centre for Obesity, University “Politecnica delle Marche”, 60126 Ancona, Italy
| | - Francesco Spannella
- Internal Medicine and Geriatrics, ESH Excellence Hypertension Centre, IRCCS INRCA, 60127 Ancona, Italy; (M.L.); (R.S.)
- Department of Clinical and Molecular Sciences, Centre for Obesity, University “Politecnica delle Marche”, 60126 Ancona, Italy
| | - Chiara Poliseno
- Internal Medicine and Geriatrics, ESH Excellence Hypertension Centre, IRCCS INRCA, 60127 Ancona, Italy; (M.L.); (R.S.)
- Department of Clinical and Molecular Sciences, Centre for Obesity, University “Politecnica delle Marche”, 60126 Ancona, Italy
| | - Adriano Massacesi
- Internal Medicine and Geriatrics, ESH Excellence Hypertension Centre, IRCCS INRCA, 60127 Ancona, Italy; (M.L.); (R.S.)
- Department of Clinical and Molecular Sciences, Centre for Obesity, University “Politecnica delle Marche”, 60126 Ancona, Italy
| | - Federico Giulietti
- Internal Medicine and Geriatrics, ESH Excellence Hypertension Centre, IRCCS INRCA, 60127 Ancona, Italy; (M.L.); (R.S.)
| | | | - Enrico Cavazzin
- ESH Excellence Hypertension Unit, Department of Internal Medicine, Rovigo General Hospital, 45100 Rovigo, Italy (A.M.)
| | - Giulio Sasso
- ESH Excellence Hypertension Unit, Department of Internal Medicine, Rovigo General Hospital, 45100 Rovigo, Italy (A.M.)
| | - Alberto Mazza
- ESH Excellence Hypertension Unit, Department of Internal Medicine, Rovigo General Hospital, 45100 Rovigo, Italy (A.M.)
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics, ESH Excellence Hypertension Centre, IRCCS INRCA, 60127 Ancona, Italy; (M.L.); (R.S.)
- Department of Clinical and Molecular Sciences, Centre for Obesity, University “Politecnica delle Marche”, 60126 Ancona, Italy
| |
Collapse
|