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). J Hypertens. 2013;31:1281-1357. [PMID: 23817082 DOI: 10.1097/01.hjh.0000431740.32696.cc]

Implementation of hypertension guidelines by general practitioner societies and the use of single pill combinations in Europe-results of the survey of the general practitioner nucleus of European society of hypertension

PURPOSE

The implementation of hypertension guidelines into the everyday practice of general practitioners (GPs) have an outmost importance to provide optimal care for patients. The aim of our study was, on the one hand to gain insight about the relationship between hypertension societies and GP societies, and on the other hand, to get feedback about the use of single pill combinations (SPC) in each country, as an indicator of guideline implementation.

MATERIALS AND METHODS

The European Society of Hypertension (ESH) GP Nucleus initiated a survey containing 17 questions about the existence and number of national hypertension and GP societies, the relationship between them and with pharmacists and nurse associations, the authors of national guidelines and the availability of SPCs. The survey was sent to the national hypertension society representatives of ESH. Additionally, data about the number of SPCs sold yearly was also checked using IQVIA database.

RESULTS

Responses were collected from 25 European countries. In most of the countries there is only one hypertension society (23/25) and one GP society (18/25), most of which having a relationship with each other (22/25). Of the countries with national hypertension guidelines most of them are written by the national hypertension society (45%) followed by the GP society (27%) or by public administration (27%). Two thirds of the national hypertension societies (16/25) have relationship with nurse societies and half of them (12/25) with pharmacists. In 65% (15/23) of the guidelines dual SPC therapy is recommended for treatment initiation however, marked differences are present in the number of yearly sold SPCs in different countries.

CONCLUSIONS

National hypertension societies have remarkable impact on GPs for the management of hypertensive patients. However, improvement is needed in the collaboration with nurse and pharmacist societies and in some countries in the use of SPCs for hypertension therapy.

The 10 top prescribed medicines in Germany from 1985 to 2022: pharmacological analysis

For many years, pharmaceutical expenditure has been the second largest cost item for statutory health insurance funds (SHI) in Germany after hospital costs. Since prescriptions and expenditure on medicines play such a major role in the German healthcare system, the question arises as to what causes changes in prescriptions. To answer this question, the prescribing trends for the top 10 drugs in 2022 were analyzed over a period of 38 years, from 1985 to 2022. The prescribed defined daily doses (DDD) and the costs per defined daily dose for the 10 medicines were taken from the Arzneiverordnungsreport (AVR) from 1986 to 2023, and the changes in prescribing behavior and their causes were analyzed. The ten most important medicines in 2022, accounting for over 41% of all prescribed daily doses, were ramipril, candesartan, pantoprazole, amlodipine, atorvastatin, levothyroxine, torasemide, simvastatin, bisoprolol, and metoprolol. There are many different reasons for an increase in prescriptions, such as the introduction of generics, a positive study, or a price reduction. Further reasons for an increase in prescriptions are an extension of the indication or the recall of a competing medicine. A change in guidelines or the increasing treatment of laboratory values without clinical symptoms can also lead to an increase in prescriptions. There are also many different reasons for a drop in prescriptions, such as the generic launch of a competitor medicine or a positive study for a competitor medicine. Other reasons for a drop in prescriptions are a negative study or a discussion about the use of a drug. Sometimes, the reasons for prescription changes are also irrational. Overall, this is the most comprehensive long-term analysis of drug prescriptions in Germany. Our data is helpful for predicting drug prescriptions and for preventing future drug shortages not only in Germany but also worldwide.

Antiplatelet potencies of polysaccharides extracted from eight cultivated edible Pleurotus mushroom species

BACKGROUND

Cardiovascular diseases remain a leading global health challenge, necessitating effective antiplatelet therapies to mitigate thrombotic risks. Conventional antiplatelet agents, such as acetylsalicylic acid (ASA) and purinergic receptor type Y, subtype 12 (P2Y12) inhibitors, are effective but present limitations, including bleeding complications and resistance in some patients. This study investigates the antiplatelet potential of polysaccharide fractions extracted from fruiting bodies of eight different edible Pleurotus mushroom species cultivated for the purpose of this research.

METHODS

Mushroom polysaccharide fractions were extracted from eight Pleurotus species (P. citrinopileatus, P. columbinus, P. djamor, P. eryngii, P. florida, P. ostreatus, P. pulmonarius, and P. sajor-caju) with cold water. Using multiple electrode aggregometry, we evaluated their inhibitory effects on platelet aggregation induced by adenosine-5'-diphosphate (ADP) and arachidonic acid (AA).

RESULTS

Polysaccharides from all tested Pleurotus species exhibit significant inhibition of ADP-induced platelet aggregation in the 69-75% range, comparable to or exceeding that of ASA. While their beneficial effect on AA-induced aggregation was lower and limited to selected species with inhibition in the 6-46% range, polysaccharides from P. djamor and P. sajor-caju demonstrated promising dual inhibition.

CONCLUSIONS

This study suggests that Pleurotus-derived polysaccharides may serve as potential natural alternatives or adjuncts to existing antiplatelet therapies. Further in vivo studies and clinical trials are warranted to investigate their therapeutic potential in the prevention and management of cardiovascular disease.

The prognostic value of CXCR4 PET/CT imaging in unilateral primary aldosteronism patients after adrenalectomy

BACKGROUND

CXCR4 PET/CT imaging has emerged as a tool for diagnosis and subtyping of primary aldosteronism (PA). But its prognostic value for postoperative blood pressure recovery has not been fully discussed.

RESULTS

The lesional SUVmax to the contralateral adrenal tissue SUVmean ratio (LCR) was identified as an independent predictor of clinical success at both the 3-month and 6-month assessments. The AUC for LCR was 0.894 at the 3-month and 0.832 at the 6-month. Patients were divided into high and low LCR groups according to the optimal cut-off of 3.240. The high LCR group exhibited elevated CXCR4 and CYP11B2 expression, higher PAC level, a greater probability of achieving complete clinical success compared to the low LCR group. Moreover, LCR was correlated with lateralization index and contralateral suppression index.

CONCLUSIONS

LCR is a reliable independent predictor of postoperative blood pressure recovery in PA. Patients with LCR over 3.240 may benefit more from adrenalectomy. We recommend increased utilization of CXCR4 PET/CT for patients with PA.

REGISTRATION

ChiCTR2200062844. Registered 20 August 2022.

Impact of hypertension on cerebral small vessel disease: A post-mortem study of microvascular pathology from normal-appearing white matter into white matter hyperintensities

Cerebral small vessel disease (SVD) is diagnosed through imaging hallmarks like white matter hyperintensities (WMH). Novel hypotheses imply that endothelial dysfunction, blood-brain barrier (BBB) disruption and neurovascular inflammation contribute to conversion of normal-appearing white matter (NAWM) into WMH in hypertensive individuals. Aiming to unravel the association between chronic hypertension and the earliest WMH pathogenesis, we characterized microvascular pathology in periventricular NAWM into WMH in post-mortem brains of individuals with and without hypertension. Our second aim was to delineate the NAWM-WMH transition from NAWM towards the center of WMH using deep learning, refining WMH segmentation capturing increases in FLAIR signal. Finally, we aimed to demonstrate whether these processes may synergistically contribute to WMH pathogenesis by performing voxel-wise correlations between MRI and microvascular pathology. Larger endothelium disruption, BBB damage and neurovascular inflammation were observed in individuals with hypertension. We did not observe gradual BBB damage nor neurovascular inflammation along the NAWM-WMH transition. We found a strong correlation between BBB damage and neurovascular inflammation in all individuals in both periventricular NAWM and WMH. These novel findings suggest that endothelium disruption, BBB damage and neurovascular inflammation are major contributors to SVD progression, but being already present in NAWM in hypertension.

Bioelectronics hydrogels for implantable cardiac and brain disease medical treatment application

Hydrogel-based bioelectronic systems offer significant benefits for point-of-care diagnosis, treatment of cardiac and cerebral disease, surgical procedures, and other medical applications, ushering in a new era of advancements in medical technology. Progress in hydrogel-based bioelectronics has advanced from basic instrument and sensing capabilities to sophisticated multimodal perceptions and feedback systems. Addressing challenges related to immune responses and inflammation regulation after implantation, physiological dynamic mechanism, biological toxicology as well as device size, power consumption, stability, and signal conversion is crucial for the practical implementation of hydrogel-based bioelectronics in medical implants. Therefore, further exploration of hydrogel-based bioelectronics is imperative, and a comprehensive review is necessary to steer the development of these technologies for use in implantable therapies for cardiac and brain/neural conditions. In this review, a concise overview is provided on the fundamental principles underlying ionic electronic and ionic bioelectronic mechanisms. Additionally, a comprehensive examination is conducted on various bioelectronic materials integrated within hydrogels for applications in implantable medical treatments. The analysis encompasses a detailed discussion on the representative structures and physical attributes of hydrogels. This includes an exploration of their intrinsic properties such as mechanical strength, dynamic capabilities, shape-memory features, stability, stretchability, and water retention characteristics. Moreover, the discussion extends to properties related to interactions with tissues or the environment, such as adhesiveness, responsiveness, and degradability. The intricate relationships between the structure and properties of hydrogels are thoroughly examined, along with an elucidation of how these properties influence their applications in implantable medical treatments. The review also delves into the processing techniques and characterization methods employed for hydrogels. Furthermore, recent breakthroughs in the applications of hydrogels are logically explored, covering aspects such as materials, structure, properties, functions, fabrication procedures, and hybridization with other materials. Finally, the review concludes by outlining the future prospects and challenges associated with hydrogels-based bioelectronics systems.

Mortality risks in different subtypes of masked hypertension in the Spanish ambulatory blood pressure monitoring registry

OBJECTIVE

We aimed to evaluate the risks of death and cardiovascular death of different subtypes of masked hypertension, defined by either isolated daytime or nighttime blood pressure (BP) elevation, or both, compared with patients with normal both office and 24-h BP.

METHODS

We selected 4999 patients with masked hypertension (normal office BP and elevated 24-h BP). They were divided in three different categories: isolated daytime masked hypertension (elevated daytime BP and normal nighttime BP, 800 patients), isolated nighttime masked hypertension (elevated nighttime BP and normal daytime BP, 1069 patients) and daytime and nighttime masked hypertension (elevation of both daytime and nighttime BP, 2989). All-cause and cardiovascular death (median follow-up 9.7 years) were assessed in each of these subtypes in comparison to 10 006 patients with normal both office and 24-h BP. Hazard ratios from Cox models after adjustment for clinical confounders were used for such comparisons.

RESULTS

Compared with patients with normal both office and 24-h BP, isolated daytime masked hypertension was not associated with an increased risk of death in models adjusted for clinical confounders [hazard ratio 1.07; 95% confidence interval (CI): 0.80-1.43]. In contrast, isolated nighttime masked hypertension (hazard ratio: 1.39; 95% CI 1.19-1.63) and daytime and nighttime masked hypertension (hazard ratio: 1.22; 95% CI 1.08-1.37) had an increased risk of death in comparison to patients with BP in the normal range. Similar results were observed for cardiovascular death.

CONCLUSION

The risk of death in masked hypertension is not homogeneous and requires nocturnal BP elevation, either isolated or with daytime elevation. Isolated daytime masked hypertension is not associated with an increased risk of death.

Nighttime Systolic Blood Pressure a Major Factor of Retinal Vascular Caliber Changes in Patients With Newly Diagnosed Type 2 Diabetes Mellitus

BACKGROUND

Changes in retinal vessel caliber are crucial for detecting early retinopathy, a significant cause of blindness in individuals with Diabetes Mellitus type 2 (T2DM). This study aims to evaluate the changes in retinal vessel caliber and identify factors associated with these changes in recently diagnosed T2DM patients.

METHODS

The study included newly diagnosed T2DM patients (within 6 months of diagnosis) who were free of antidiabetic treatment (except metformin) and matched individuals based on age and blood pressure (BP). Data collected included somatometric measurements, BP (office and 24-h), hematological data, albuminuria (via 24-h urine collections), ten-year atherosclerotic cardiovascular disease risk (ASCVD score), endothelial dysfunction (measured by Asymmetric Dimethylarginine, ADMA), retinal microvascular changes, assessed as central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and arteriovenous ratio (AVR) using specialized software on nonmydriatic fundus photographs.

RESULTS

The study involved 87 T2DM patients and 90 controls, aged 57±11 years. Key findings include no significant differences in CRAE, CRVE, and AVR between T2DM patients and controls. Age (P=0.019) and nighttime systolic BP (SBP) (P=0.002) were independent predictors of AVR. CRAE was independently associated with nighttime SBP (P=0.048). CRVE was independently associated with age (P=0.016), dipping (P=0.002), and smoking (P=0.018). In normotensive subjects, AVR was significantly lower in T2DM patients (P=0.035).

CONCLUSIONS

The study concludes that increased nighttime SBP is a more critical factor than hyperglycemia in affecting retinal vascular caliber changes in newly diagnosed T2DM patients. This highlights the importance of managing nocturnal hypertension to prevent retinal damage in this patient population.

Deep learning-based segmentation in MRI-(immuno)histological examination of myelin and axonal damage in normal-appearing white matter and white matter hyperintensities

The major vascular cause of dementia is cerebral small vessel disease (SVD). Its diagnosis relies on imaging hallmarks, such as white matter hyperintensities (WMH). WMH present a heterogenous pathology, including myelin and axonal loss. Yet, these might be only the "tip of the iceberg." Imaging modalities imply that microstructural alterations underlie still normal-appearing white matter (NAWM), preceding the conversion to WMH. Unfortunately, direct pathological characterization of these microstructural alterations affecting myelinated axonal fibers in WMH, and especially NAWM, is still missing. Given that there are no treatments to significantly reduce WMH progression, it is important to extend our knowledge on pathological processes that might already be occurring within NAWM. Staining of myelin with Luxol Fast Blue, while valuable, fails to assess subtle alterations in white matter microstructure. Therefore, we aimed to quantify myelin surrounding axonal fibers and axonal- and microstructural damage in detail by combining (immuno)histochemistry with polarized light imaging (PLI). To study the extent (of early) microstructural damage from periventricular NAWM to the center of WMH, we refined current analysis techniques by using deep learning to define smaller segments of white matter, capturing increasing fluid-attenuated inversion recovery signal. Integration of (immuno)histochemistry and PLI with post-mortem imaging of the brains of individuals with hypertension and normotensive controls enables voxel-wise assessment of the pathology throughout periventricular WMH and NAWM. Myelin loss, axonal integrity, and white matter microstructural damage are not limited to WMH but already occur within NAWM. Notably, we found that axonal damage is higher in individuals with hypertension, particularly in NAWM. These findings highlight the added value of advanced segmentation techniques to visualize subtle changes occurring already in NAWM preceding WMH. By using quantitative MRI and advanced diffusion MRI, future studies may elucidate these very early mechanisms leading to neurodegeneration, which ultimately contribute to the conversion of NAWM to WMH.

Atherosclerosis in patients with cervical artery dissection

INTRODUCTION

Cervical artery dissection (CeAD) is considered a non-atherosclerotic arteriopathy, but atherosclerosis of the cervical arteries may co-exist. We explored the frequency and clinical importance of co-existent atherosclerosis in patients with CeAD.

PATIENTS AND METHODS

Single-center exploratory study from the Stroke Center Basel, Switzerland. We re-reviewed duplex ultrasound images at (i) baseline and (ii) last follow-up visit for the presence versus absence of the following atherosclerotic manifestations in the carotid arteries: (i) abnormal carotid intima-media thickness, (ii) plaques, and (iii) atherosclerotic stenosis. We investigated whether CeAD patients with versus without co-existing atherosclerosis differ regarding (a) recurrence of CeAD and (b) occurrence of vascular events (myocardial infarction, peripheral artery disease, or ischemic stroke) using logistic regression with adjustment for age and follow-up time.

RESULTS

Among 294 CeAD patients (median age 46 [IQR 37-53], 41.8% women), 35 (12%) had any atherosclerotic signs at baseline. Among 196 patients with available follow-up, another 21/196 (11%) patients developed atherosclerosis during a median follow-up of 55.7 months. Patients with atherosclerosis had decreased odds of recurrent CeADs when compared to patients without atherosclerosis (OR 0.03, 95% CI = 0.00-0.30). During follow-up, 6 (15%) vascular events occurred among 40 CeAD patients with atherosclerosis and 13 (8.5%) among 153 patients without atherosclerosis (OR 1.38, 95% CI = 0.39-4.55, data for 3 patients were missing).

DISCUSSION AND CONCLUSION

Signs of atherosclerosis in the carotid artery were detectable in 12% of CeAD patient at baseline. Additionally, 11% of CeAD patients developed new signs of atherosclerosis within the following 5 years. The presence of atherosclerosis may suggest a lower risk for recurrent CeAD. Whether it might indicate an increased risk for late clinical vascular events deserves further studies.

Differences in sex and age response to single pill combination based antihypertensive therapy reflecting in blood pressure and arterial stiffness

OBJECTIVE

There are noticeable sex differences in the treatment response to antihypertensives, with limited data on the response to single pill combinations. The aim of the PRECIOUS trial was to assess the treatment response to perindopril/amlodipine and perindopril/amlodipine/indapamide dual and triple single-pill combination in men and women.

METHODS

Four hundred and forty adults with essential hypertension were assessed in the 16-week interventional, open-label, prospective, international, multicentre trial. Based on the previous antihypertensive therapy, patients were assigned to either perindopril/amlodipine 4/5 mg or perindopril/amlodipine/indapamide 4/5/1.25 mg, with the initial dose up-titrated in 4-week intervals in case of uncontrolled blood pressure. An additional analysis was performed for sex- and age-related differences on the blood pressure response and arterial stiffness in men and women aged 35-74 years.

RESULTS

Women achieved better overall blood pressure control in all age groups, except for the 35-44 age group. Women presented higher average 24 h aortic augmentation indexes than men, but had more pronounced decreasing trends. The pulse wave velocity was only age-dependent, with reductions slightly greater in women. Both the aortic augmentation index and pulse wave velocity were significantly decreased in all groups compared to baseline.

CONCLUSIONS

The results of the PRECIOUS trial contribute significant data to the expanding body of evidence on sex differences in hypertension, including the aspect of age-related changes during the life course of women. The differences between same-aged men and women tend to be smaller with advancing age, but with a greater treatment response in women in all age groups for all observed blood pressure parameters and arterial stiffness.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT03738761.

Comparative effectiveness of exercise interventions on arterial stiffness in individuals at risk for cardiovascular disease: a systematic review and network meta-analysis

Background

Previous studies have shown that exercise can improve arterial stiffness (AS). However, it remains unclear which type of exercise is most effective for managing AS, particularly in individuals at high risk for cardiovascular diseases (CVD). This review aims to evaluate the effects of various exercises on AS and related variables in individuals at high risk for CVD.

Methods

A comprehensive search strategy was employed to systematically explore MEDLINE (PubMed), Embase, Cochrane Library, EBSCOhost, and Web of Science to identify relevant studies. Inclusion criteria were: (1) randomized controlled trials; (2) participants with known CVD risk factors as per the American College of Sports Medicine guidelines; (3) interventions including interval training (INT), aerobic exercise (AE), resistance exercise, and combined exercise (CT); (4) control groups engaging in no intervention, routine care, or health education; (5) outcome measures of pulse wave velocity (PWV), systolic blood pressure (SBP), and diastolic blood pressure; and (6) studies published in English. Studies were assessed using the Cochrane risk of bias tool and analyzed with a random-effects network meta-analysis.

Results

The review included 2,034 participants from 43 studies. Both CT [standardized mean difference (SMD) = -0.98, p < 0.001, I 2 = 84%] and INT (SMD = -0.77, p < 0.001, I 2 = 61%) significantly reduced PWV, but both showed considerable heterogeneity. INT (SMD = -0.382, p < 0.001, I 2 = 45%) and AE (SMD = -0.369, p < 0.001, I 2 = 43%) significantly reduced SBP. Surface under the cumulative ranking curve (SUCRA) showed that CT (SUCRA = 87.2) was the most effective for lowering PWV, while INT (SUCRA = 81.3) was the most effective for lowering SBP.

Conclusion

In high-risk populations for CVD, CT was most effective in improving AS, while INT demonstrated the greatest reduction in SBP. AE showed greater benefits at moderate to low intensities. Due to significant heterogeneity in CT, its results should be interpreted with caution. Further research with larger sample sizes is needed to confirm these findings.

Intervention effectiveness in reducing the clustering of non-communicable disease risk factors in the workplace: A quasi-experimental study

Understanding the clustering patterns of non-communicable disease risk factors is important to address chronic diseases effectively, thus minimizing their onset and enhancing overall health. This study aimed to assess the feasibility and efficacy of a three-year workplace intervention in decreasing clustering of non-communicable disease risk factors in employees. A quasi-experimental study, including six companies, was conducted in the governorate of Sousse between 2010 and 2014. It involved an intervention group (Sousse-Jawhara and Sousse-Erriadh) and a control group (M'saken). The sample of participants in both groups was representative. Actions promoting physical activity, healthy diet, and smoking cessation in the workplace were included in this intervention. The participants' socio-demographic characteristics and data concerning the risk factors were collected through interviews using a pretested questionnaire. The clustering of tobacco use, physical inactivity, unhealthy diet, obesity, and high blood pressure were examined pre- and post-intervention. In the intervention group, the mean risk factors per employee decreased significantly from 1.99 ± 1.00 to 1.81 ± 1.05 (p < 10-3). A minor non-significant increase, from 1.72 ± 0.97 to 1.78 ± 1.11, was noted in the control group. In the intervention group, the prevalence of two risk factor clusters dropped significantly from 40% to 34.4% pre- and post-intervention (p = 0.014). However, a non-significant decline was noted in the control group. Combinations such as obesity/hypertension and unhealthy diet/physical inactivity tended to aggregate in both groups. Overall, the intervention program showed significant protective effects in reducing the co-occurrence of multiple risk factors in the intervention group, with an adjusted OR of 0.81; CI95% [0.68-0.97]. Along with the existing literature, the present study confirmed the feasibility and effectiveness of health promotion programs in reducing non-communicable disease risk factors and their clustering. Integrating this intervention program into a national health policy could potentially generalize its positive impact.

Predictive Value of Cardiopulmonary Exercise Testing Parameters in Patients under Percutaneous Coronary Intervention with High Pulse Pressure

Background

The correlation between cardiopulmonary exercise testing (CPET) parameters and the prognosis of patients undergoing percutaneous coronary intervention (PCI) with high pulse pressure (PP) is unclear. The purpose of present study is to investigate the correlation of CPET parameters in patients under PCI with high PP and assess their reference value for prognosis.

Methods

Individuals aged 18 years and older who were diagnosed with coronary artery disease (CAD) and underwent PCI along with CPET from November 1, 2015 to September 30, 2021 were enrolled. The patients were categorized into two groups based on PP: high PP group (PP of males ≥50 mmHg; PP of females ≥60 mmHg) and normal PP group (PP of males <50 mmHg; PP of females <60 mmHg). The primary endpoint was major adverse cardiovascular events (MACE). The optimal predictors of MACE were identified through Cox regression analysis. The time-dependent receiver operating characteristic (ROC) curves were generated and the area under the ROC curve (AUC) was measured to evaluate the discriminatory ability in patients with high PP.

Results

A total of 2785 patients were included in present study, with a median follow-up period of 1215 (687-1586) days. Through multifactorial analysis, it was determined that peak oxygen uptake (peak VO2, hazard ratio (HR): 0.94, 95% confidence interval (95% CI): 0.88 to 1.00, p = 0.038) and ventilatory equivalent for carbon dioxide (VE/VCO2, HR: 1.08, 95% CI: 1.02 to 1.15, p = 0.007) are important predictive factors in the parameters of CPET. The ROC based on diabetes mellitus (DM), smoking, peak VO2, and VE/VCO2 could effectively evaluate the prognosis of patients [1-year AUC: 0.636 (0.515~0.758), 3-year AUC: 0.675 (0.599~0.752), 5-year AUC: 0.718 (0.607~0.830)].

Conclusions

The prognosis of CAD patients with high PP was worse compared to the patients with normal PP. The peak VO2 and VE/VCO2 were predictors of MACE in CAD patients with high PP.

Low coverage of hepatitis D virus testing in individuals with hepatitis B virus and HIV, the Netherlands, 2000 to 2022

BackgroundSince 2009, European guidelines recommend individuals with hepatitis B virus (HBV) and HIV be tested for hepatitis D virus (HDV).AimTo analyse HDV testing in individuals with HBV/HIV during routine practice in the Netherlands.MethodsWe assessed data from the ATHENA cohort of people with HIV who were ever HBV surface antigen-positive, aged ≥ 18 years and attended one of 24 HIV treatment centres in the Netherlands during 2000-22. Using longitudinal analysis, we estimated the percentage of individuals ever tested for HDV (antibody or RNA test) over time. In cross-sectional analysis, determinants for ever being tested by end of follow-up were assessed using relative risk regression.ResultsWe identified 1,715 individuals with HBV/HIV; 1,460 (85.1%) and 255 (14.9%) were male and female at birth, respectively (median age: 52 years; IQR: 42-59). Only 249 (14.5%) had an HDV test. The percentage tested increased from 5.0% (95% CI: 3.4-7.3) in 2000 to 17.0% (95% CI: 14.9-19.3) in 2022. In 2022, 16.2% (95% CI: 13.7-19.1) of men who have sex with men, 25.0% (95% CI: 9.7-50.9) of persons who inject(ed) drugs and 18.1% (95% CI: 14.6-22.3) of heterosexual/others were tested. In multivariable analysis, ever having an HDV test was associated with detectable HBV DNA viral load (p < 0.001), ever presenting with elevated alanine aminotransferase (ALT) levels (p = 0.023), advanced fibrosis/cirrhosis (p = 0.001) and being overweight/obese (p = 0.043).ConclusionsHDV testing coverage in the Netherlands is low for individuals with HBV/HIV. Although testing was more common in those with advanced liver disease, a considerable proportion at risk of HDV still need testing.

Individual and joint associations of obesity and metabolic health parameters on arterial stiffness: Evidence from the UK Biobank

AIMS

There is conflicting evidence regarding whether excess adiposity without metabolic abnormalities reflects a truly benign phenotype. This study evaluated the independent and joint associations of the presence of excess adiposity and metabolic abnormalities on arterial stiffness.

MATERIALS AND METHODS

Participants in UK Biobank with body mass index (BMI) and arterial stiffness index (ASI) recorded between 2006 and 2010, free from cardiovascular diseases and not underweight (BMI <18.5 kg/m2) were included. The primary outcome was severity of ASI analysed using multivariate-adjusted linear regression.

RESULTS

Of 162 590 participants, 42.5% were overweight and 24.4% were obese. Within the normal BMI strata, 50.7% had ≥1 metabolic abnormality. Compared to individuals with normal BMI and no metabolic abnormality (reference group), increased BMI or metabolic abnormalities were similarly associated with higher ASI: normal BMI with metabolic abnormalities (adjusted β-coefficient and 95% CI, 0.35; 0.30-0.40); overweight without metabolic abnormalities (0.32; 0.26-0.37). Individuals with obesity and no metabolic abnormality had higher ASI (0.65; 0.57-0.74) but was lower than individuals with overweight and metabolic abnormalities (0.80; 0.75-0.84). Individuals with obesity and metabolic abnormalities had the highest ASI (1.07; 1.02-1.12) among all six metabolic combinations, p < 0.001 for each versus reference group. Sensitivity analysis suggested higher ASI with increasing number of metabolic abnormalities within BMI categories and higher ASI in the presence of abdominal obesity within metabolic categories.

CONCLUSIONS

Excess adiposity and metabolic abnormalities are independently associated with increased arterial stiffness to a similar degree, suggesting that metabolically healthy individuals with overweight and obesity are not benign groups. This reinforces the need to prevent excess adiposity and consider primary prevention strategies even before metabolic abnormalities emerge.

Sex-specific differences in the efficacy of renal denervation in patients with resistant hypertension depending on visceral obesity and kidney function

Objective

To investigate the sex differences in the efficacy of renal denervation (RDN) in patients with resistant hypertension (RHT) concerning the size of abdominal fat depots, changes in biomarkers of sympathetic activity, and renal function.

Materials and methods

24 men (56.5 ± 7.8 years) and 33 women (59.5 ± 8.4 years) with RHT were enrolled in the study and underwent RDN. 24-h ambulatory blood pressure (BP) [systolic/diastolic (SBP/DBP)], serum creatinine (with eGFR calculation), serum adipocytokines (leptin, adiponectin, resistin), serum metanephrines and normetanephrines were measured baseline and 12 months after RDN. The size of subcutaneous, visceral, and perirenal adipose tissue (SAT, VAT, and PRAT) was assessed using MRI.

Results

After RDN, BP decreased, leptin increased, and adiponectin, resistin, and metanephrine levels did not change in both sexes. There was a decrease in normetanephrine levels in women and a similar trend in men. In men, the eGFR did not change. In women, the eGFR remained unchanged only in those with chronic kidney disease (CKD) (n = 10) and decreased in the absence of CKD (n = 23) from 79.7 ± 14.1 to 72.1 ± 12.0 ml/min/1.73 m2 (p = 0.011). Men had larger visceral fat depots, and women had larger subcutaneous fat depots. After RDN, the size of adipose tissue in men remained unchanged, and in women, the PRAT thickness decreased from 2.36 ± 1.23 to 2.10 ± 1.17 cm (p = 0.002). Lowering BP in women was associated with increased leptin levels after RDN (r = -0.47 for SBP, r = -0.48 for DBP). Dependence of BP reduction on baseline eGFR was observed in men only [r = 0.44 for SBP, r = 0.48 for pulse pressure (PP)]. Additionally, in men, the decrease in SBP and PP depended on VAT areas (r = -0.44 and r = -0.58, respectively). In women, the SBP reduction showed an inverse correlation between baseline weight (r = -0.35) and waist circumference (r = -0.38).

Conclusions

The magnitude of the antihypertensive effect of RDN depends on signs of visceral obesity and, in men, also on the presence of CKD. Renoprotective effects of RDN in men are obtained regardless of the initial kidney function, while in women, it was observed only in individuals with CKD. Additional beneficial effects of RDN in women include a decrease in normetanephrine levels and a reduction in PRAT size.

Understanding the incidence and recurrence of depression and associated risk factors in 9 years of follow-up: Results from a population-based sample

INTRODUCTION

This paper aims to analyse depression incidence and recurrence rates in a Spanish adult cohort, while also investigating associated risk factors based on depression status at baseline.

METHODS

Longitudinal, prospective study data of the Edad con Salud cohort was used, which comprises a sample representative of the non-institutionalized adult populace at the national level with a final sample size of 2655 Spanish adults. Competing risk regression models were estimated to determine the main risk factors for incident and recurrent depression.

RESULTS

The study found depression incidence at 6.11 per 1,000 person years, with recurrence rates up to 47.8 and 21.3 per 1,000 person years in those with depression at baseline and only history of depression, respectively, with higher rates found among women. Sociodemographic factors were found to primarily predict incident depression, while health and mental health indicators were significant predictors for recurrent depression.

CONCLUSIONS

Our results confirm the augmented risk of experiencing a new episode among individuals with proximal depression, where different risk factors seemed to play a role depending on episode type and depression proximity. These findings provide valuable insights for developing preventive strategies for depression in both the general population and those at risk.

Safety and effectiveness of an herbal decoction (modified Saengmaeksan) in hypertensive patients: Protocol for a real-world prospective observational study

OBJECTIVE

Hypertension, a common chronic disease, often leads to serious complications. While conventional management relies on antihypertensive drugs, which can cause side effects and adherence issues, alternative treatments like herbal medicine are gaining attention. This study examines the efficacy and safety of modified Saengmaeksan, an East Asian herbal remedy, in treating hypertension.

METHODS

This single-arm, prospective, observational study will be conducted at Kyunghee Bichedam Korean Medicine Clinic from October 23, 2023 to August 30, 2024, enrolling 30 hypertensive patients. Over 12 weeks, participants will undergo 4 visits, receiving modified Saengmaeksan twice daily for 8 weeks, with a subsequent 4-week follow-up. Primary outcome is the change in systolic blood pressure from the baseline to week 8. Secondary outcomes include diastolic blood pressure changes, radial artery tonometry, and quality of life evaluations. Safety assessments will include monitoring hematologic parameters and adverse events. Data will be analyzed using an ANCOVA model for adjusting confounders.

DISCUSSION

Modified Saengmaeksan has shown potential for lowering blood pressure in clinical settings, supported by animal and cell studies. However, human studies are scarce. This research will employ radial artery tonometry to analyze blood pressure comprehensively, exploring Saengmaeksan's hemodynamic effects. The study's goal is to support the approval of modified Saengmaeksan as a hypertension treatment by the South Korean Food and Drug Administration and to promote the industrialization of traditional herbal medicine in managing hypertension. The findings will provide essential data for future clinical research, aiding in feasibility assessments and sample size determinations for randomized controlled trials.

Left Atrial Mechanics and Atrioventricular Coupling in Hypertension With Supra-Normal Left Ventricular Ejection Fraction

OBJECTIVES

Supra-normal left ventricular ejection fraction (snLVEF) represents a heterogeneous group with distinct prognoses. Left atrial (LA) strain, measured by speckle tracking echocardiography (STE), is a validated prognostic indicator. This study aimed to evaluate LA and left ventricular (LV) mechanical strains in hypertensive patients with snLVEF.

METHODS

This retrospective study included 101 patients (mean age 59.7 ± 8.4 years; 61.4% men) with primary arterial hypertension and preserved LVEF (≥50%). Patients were categorized into low-normal LVEF (lnLVEF; 50%-59%), mid-normal LVEF (mnLVEF; 60%-69%), and snLVEF (≥70%). LV global longitudinal strain (LVGLS) and LA strains during reservoir (LASr), conduit (LAScd), and contraction (LASct) phases were measured using STE.

RESULTS

Relative wall thickness was significantly higher in snLVEF patients compared to mnLVEF (p < 0.01), with no difference in LVGLS (p = 0.933). Compared to mnLVEF, snLVEF patients had reduced LASr and LAScd (both p < 0.01) but preserved LASct (p = 0.057). In contrast, lnLVEF patients showed greater reductions in all phasic LA strains (all p < 0.01). Loess regression revealed an inverted U-shaped relationship between LASr and LVEF, peaking at LVEF 65%-70%. The mitral E/e'mean ratio and LVGLS correlated moderately to strongly with LASr (r = -0.39 and r = -0.65, respectively; both p < 0.001).

CONCLUSION

Hypertensive patients with snLVEF exhibit impaired LA reservoir and conduit functions while maintaining pump function, suggesting snLVEF may be an intermediate stage between mnLVEF and lnLVEF as hypertension progresses. Further studies are needed to explore the prognostic potential of LA strain in this population.

Association of hypertension and long-term blood pressure changes with new-onset diabetes in the elderly: A 10-year cohort study

AIM

To explore the correlation between new-onset diabetes (NOD), hypertension and blood pressure management among elderly individuals in China.

MATERIALS AND METHODS

A cohort analysis involved 1380 participants aged 60 years or older, initially free of diabetes in 2008, from the Chinese Longitudinal Healthy Longevity Survey. Follow-up assessments occurred every 2-3 years. The relationship between hypertension, blood pressure changes and NOD was analysed using multivariable-adjusted Cox regression.

RESULTS

By 2018, 102 participants developed diabetes, while 1278 remained without diabetes. The cumulative diabetes prevalence increased from 3.1% at 3 years to 7.4% at 10 years. Hypertension prevalence increased from 20.9% at baseline to 41.0% at 10 years, with higher rates in those diagnosed with diabetes during follow-up. Multivariate analysis identified age, gender, baseline hypertension and systolic blood pressure (SBP) as independent predictors of NOD. Hypertension combined with overweight/obesity significantly increased the risk of NOD (hazard ratio [HR] 2.837; 95% confidence interval [CI], 1.680-4.792). We evaluated participants' blood pressure management levels in 2008 and 2011, then tracked the onset of diabetes from 2011 to 2018. Compared with participants with an average SBP below 120 mmHg in 2008 and 2011, those with SBP of 140 mmHg or higher had an 8-fold higher risk of developing NOD (adjusted HR8.492, 95% CI 2.048-35.217, P = .003), the highest risk group. Participants with SBP of 130-139.9 mmHg also had a significantly increased risk (adjusted HR 5.065, 95% CI 1.186-21.633, P = .029), while those with SBP of 120-129.9 mmHg showed no significant difference (HR 2.730, 95% CI 0.597-12.481, P = .195). Consistently high SBP (≥ 130 mmHg) further increased NOD risk (adjusted HR 3.464, 95% CI 1.464-8.196, P = .005).

CONCLUSIONS

Significant predictors of NOD included age, gender, baseline hypertension and blood pressure management. Maintaining SBP consistently below 130 mmHg may be an effective strategy to reduce the incidence of NOD in the general elderly population.

The association of material deprivation with major depressive disorder and the role of loneliness and social support: A cross-sectional study

BACKGROUND

Existing research has highlighted the positive association of material deprivation, loneliness, and poor social support with major depressive disorder (MDD). However, there is limited information on the complex interplay between these risk factors. In this study, we investigated (1) whether loneliness and social support moderate the relationship between material deprivation and MDD and (2) whether social support moderates the association between material deprivation and loneliness.

METHODS

We conducted a cross-sectional study analyzing responses from a representative sample of the Spanish adult population, comprising 2790 individuals who were interviewed between 2019 and 2021. The 12-month prevalence of MDD was assessed using the Composite International Diagnostic Interview (CIDI). Loneliness was measured using the three-item UCLA Loneliness Scale, and social support was evaluated with the Oslo social support scale. Material deprivation was measured using an instrument developed by the Spanish National Institute of Statistics (INE). Regression models were constructed to investigate moderating effects.

RESULTS

About 25 % of participants experienced material deprivation and 2.8 % had MDD. Among those with lower levels of loneliness, the probability of MDD was almost 0.10 and no significant differences were found in relation to material deprivation. Conversely, differences depending on material deprivation ranged from 0.10 (95 % CI 0.03, 0.18) to 0.44 (95 % CI 0.24, 0.65) among those with higher levels of loneliness. Social support effectively moderated the association between material deprivation and loneliness.

LIMITATION

The cross-sectional nature limits causal inferences.

CONCLUSION

Social support has the potential to improve loneliness and mental health in individuals with economic difficulties.

Comparison of Influence of Office and 24-h Central Aortic Blood Pressure on Target Organ Damage in Hypertension

The aim of this study was to explore whether 24-h ambulatory central (aortic) blood pressure (BP) has an advantage over office central aortic BP in screening for hypertension-mediated target organ damage (HMOD). A total of 714 inpatients with primary hypertension and the presence of several cardiovascular risk factors or complications involving clinical HMOD were enrolled. Twenty-four hour central aortic BP was measured by means of a noninvasive automated oscillometric device (Mobil-O-Graph). Office BP was measured with a validated oscillometric Omron device after a 5-min rest in a sitting position. Central aortic pressure waveforms were derived from the radial pressure waveforms with a validated transfer function of the Sphygmocor software, version 8.0 (Atcor Medical, Sydney, Australia). Carotid-femoral pulse wave velocity (cf-PWV) measurement was performed by sequential placement of the transducer on the femoral artery and carotid artery and determining transit time between the two pulses in reference to the R wave of the ECG. cf-PWV was calculated as the measured distance from the suprasternal notch to the femoral artery minus the distance from the suprasternal notch to the carotid artery divided by the pulse transit time. HMOD was defined as the presence of carotid intima-media thickness (IMT) above normal values and/or carotid plaque, left ventricular hypertrophy (LVH), renal abnormalities as assessed by urine albumin/creatinine ratio (ACR) above normal values and/or estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 and/or increased cf-PWV > 10 m/s. In the study cohort of 714 (age 54.52 ± 13.24 years, 74.6% male) patients with primary hypertension, LV mass index (LVMI) was significantly higher in males (p < 0.002) and eGFR was significantly lower in males (p < 0.001). However, there was no statistical significance between males and females in IMT, ACR, and cfPWV. When accounting for confounding factors (age, sex, BMI, triglycerides, total cholesterol, LDL, glucose, smoking, and heart rate), central systolic (cSBP), diastolic (DBP), and pulse (cPP) pressure obtained with 24-h monitoring was more strongly correlated with LVMI than office measurements. Twenty-four hour cSBP and cPP were more strongly correlated with IMT than those of office monitoring. The 24-h augmentation index (AIx) was more strongly correlated with eGFR than office AIX. Twnety-four hour cSBP and cPP were more strongly correlated with lgACR. Office AIx and cPP were more strongly correlated with c-fPWV than 24-h measurements while cSBP, DBP, and cPP obtained by both methods were equally correlated with c-fPWV. Ambulatory central (aortic) pressure may be more strongly related to HMOD than office CAP which may have an advantage in screening for c-fPWV. Trial Registration: Registration number: ChiCTR2000040308.

Sequential exploratory mixed-method research of an eHealth intervention on blood pressure, sleep quality and physical activity in obstructive sleep apnoea: rationale and methodology of the Moore4Medical trial protocol

INTRODUCTION

The management of a chronic and frequent pathology, such as obstructive sleep apnoea (OSA), requires personalised programmes that implement new technology-based tools to improve the comprehensive treatment of the patient to reduce the morbidity associated with this disease. This study will evaluate the effectiveness of an eHealth tool in managing the pathophysiological consequences of OSA and how they impact the quality of life after 3 months of intervention among adults.

METHODS AND ANALYSIS

This is a mixed-method sequential exploratory study protocol. Participants will be≥18 years with a new diagnosis of moderate OSA and diagnosed with hypertension. The qualitative phase will consist of personal semistructured interviews. The quantitative phase will be a triple-blind randomised controlled trial. The experimental group (n=135) will receive an eHealth intervention using an electronic wrist device and a mobile application that will offer specific healthcare recommendations, physical activity indications and hygienic and dietary advice. These recommendations will be based on the information obtained in the qualitative phase. Those in the control group (n=135) will receive the usual educational materials from the sleep unit. The primary outcome will be blood pressure changes at 3 months. Secondary outcomes are subjective sleep quality, sleep apnoea-related parameters, daytime sleepiness, physical activity, empowerment and motivation for change, quality of life, anthropometry, cost-benefit and adherence.

ETHICS AND DISSEMINATION

Ethical approval for the study has been obtained from the Hospital Universitari Arnau de Vilanova (CEIC-2511). Results will be published in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Identifier: NCT05380726.

Evaluation of a Specialist Nurse-Led Post-Coronary Heart Disease Support Program: A Prospective Pre-Post Interventional Study

INTRODUCTION

The impact of multidisciplinary supervised cardiac rehabilitation programs on reducing the risk of having heart problems in the future is well documented. However, little is known about nurse-led post-coronary heart disease (post-CHD).

PURPOSE

Our aim was to evaluate the effectiveness of an educational and counseling-structured nurse-led post-CHD support program by assessing the prediction of psychological, behavioral and dietary variables in relation to adherence to a care plan in a single hospital in Athens (Greece).

METHOD

A prospective follow-up comparative approach in a single group of CHD patients was applied. The structured nurse-led program included eight topics (management of anxiety, physical activity, dietary habits, weight control, smoking cessation, alcohol moderation, family engagement and adherence to a care plan). Participants received tailored nursing interventions focused on psychological and behavioral needs and dietary habits by a CHD-specialized nurse based on patients' medical prescriptions and/or instructions. A modified clinical assessment questionnaire by the European Society of Cardiology was applied to identify pre-post clinical baseline measurements. A nurse-led post-coronary Heart Disease Support Program was evaluated by assessing the predictivity (effect) of specific interventions on adherence to a care plan by employing a logistic regression beta coefficient (Generalized Estimating Equations model).

RESULTS

The sample consisted of 275 patients (66.2% male), with a mean age of 68.5 ± 12.5 years old. CHD patients presented significantly lower anxiety rates (54.27 [1st m] vs. 49.63 [2nd m], p < 0.05). In addition, significant differences were observed between the first and the second measurements of total cholesterol (163.27 [1rst m] vs. 134.44 [2nd m], p < 0.001), BMI (obesity) (33.69 [1rst m] vs. 32.79 [2nd m], p < 0.001), smoking (42.18 [1rst m] vs. 22.55 [2nd m], p < 0.001) and adherence to a care plan (78.90 [1rst m] vs. 89.10 [2nd m], p < 0.001). A Generalized Estimating Equations model revealed that participants with higher levels of anxiety showed significantly lower adherence to a care plan (beta -0.10, p < 0.001) and those with family history of CHD (beta -0.71, p = 0.04) in comparison to those with no CHD history. No significant differences were observed in the predictive variables of smoking (beta 0.08, p = 0.69), alcohol consumption (beta 0.09, p = 0.79) and family engagement (beta -0.11, p = 069) with respect to adherence to a care plan, even after adjusting for age, sex and history of CHD.

CONCLUSION

Our findings indicate that the nurse-led post-CHD support program was found to be partially feasible and effective in our single-group study, emphasizing the need for effective training and retention strategies to enhance the specialization of nurses providing post-CHD care and support.

Effect of Dietary Patterns on Vascular Aging Using the Brachial-Ankle Index

The Mediterranean diet (MD) plays an important role in delaying vascular aging. The main objective of this study was to analyze the association between adherence to the MD and vascular aging estimated with brachial-ankle pulse wave velocity (ba-PWV) in a Spanish population sample and the differences by sex.

METHODS

Cross-sectional descriptive study. A total of 3437 subjects from the EVA, MARK and EVIDENT studies participated. The ba-PWV was assessed with the Vasera VS-1500® device. Vascular aging was classified as healthy vascular aging (HVA), normal vascular aging (NVA) and early vascular aging (EVA) and adherence to the MD was assessed with the Mediterranean Diet Adherence Screener questionnaire.

RESULTS

The mean age was 60.15 ± 9.55 (60.09 ± 9.71 in women; 60.20 ± 9.43 in men). Overall, MD adherence was observed in 48.0% of subjects (40% in women; 54% in men). The mean value of ba-PWV was 14.38 ± 2.71 (women 14.24 ± 2.89; men 14.49 ± 2.56). In multinomial logistic regression a positive association was found overall between HVA and NVA (OR = 1.751, 95% CI: 1.411-2.174, p < 0.001) and between HVA and EVA (OR = 1.501, 95% CI:1.295-1.740, p < 0.001); in women between HVA and NVA (OR = 2. 055, 95% CI:1.456-2.901, p < 0.001) and between HVA and EVA (OR = 1.413, 95% CI:1.124-1.776; p = 0.003); and in men between HVA and NVA (OR = 1.551, 95% CI: 1.175-2.047, p = 0.002) and between HVA and EVA (OR = 1.549, 95% CI: 1.275-1.882; p < 0.001).

CONCLUSIONS

The results of this work indicate that greater adherence to the MD is associated with healthier vascular aging.

Ferroptosis in Cardiovascular Diseases and Ferroptosis-Related Intervention Approaches

OBJECTIVE

Cardiovascular diseases (CVDs) are major public health problems that threaten the lives and health of individuals. The article has reviewed recent progresses about ferroptosis and ferroptosis-related intervention approaches for the treatment of CVDs and provided more references and strategies for targeting ferroptosis to prevent and treat CVDs.

METHODS

A comprehensive review was conducted using the literature researches.

RESULTS AND DISCUSSION

Many ferroptosis-targeted compounds and ferroptosis-related genes may be prospective targets for treating CVDs and our review provides a solid foundation for further studies about the detailed pathological mechanisms of CVDs.

CONCLUSION

There are challenges and limitations about the translation of ferroptosis-targeted potential therapies from experimental research to clinical practice. It warrants further exploration to pursure safer and more effective ferroptosis-targeted thereapeutic approaches for CVDs.

Impact of educational intervention on hypertension management by primary care physician: A randomized control trial

Objective

The current study aimed to observe hypertension educational intervention's effect on general physicians (GPs) to improve blood pressure control and patient outcomes indirectly.

Methods

This randomized control trial includes 42 GPs divided into 2 groups. GPs in group 1 receive face-to-face education with structured educational material on hypertension management strategies by a senior cardiologist. GPs in group 2 receive the print version of education material. The data was collected from six major cities in Pakistan. GPs with at least three years of experience in the broad primary care disciplines, with ages above 18 years, were included in the study.

Results

A total of 42 physicians (21 from each group) completed questionnaires, while out of 420 hypertension patients, 105 newly diagnosed and already diagnosed patients enrolled under physicians of both groups. The educational material did just as well at informing clinicians as the face-to-face group intervention did and both the interventions had a significant effect on knowledge and BP control.

Conclusion

After the 3-month follow-up, both interventions, including face-to-face and educational approaches, demonstrated significant effectiveness in improving knowledge and blood pressure control.

Innovation

The study shows that hypertension educational intervention's effect on general physicians indirectly improves blood pressure control and patient outcomes. And emphasize for developing a hypertension educational program targeted at general physicians.

The correlation between rapid eye movement sleep and nocturnal hypertension in patients with obstructive sleep apnea: A retrospective study

Obstructive sleep apnea (OSA) is a respiratory disease closely associated with hypertension and heart disease. This study aimed to evaluate the diagnostic value of rapid eye movement (REM) sleep during nocturnal hypertension in OSA patients. We selected 194 patients who underwent polysomnography (PSG) at the Respiratory and Critical Care Medicine Department of Jiading District Central Hospital in Shanghai between January 2021 and August 2023. All patients were assigned to the hypertension and normal blood pressure groups, and the differences between the 2 groups were compared. This study included 194 patients (137 with nocturnal hypertension and 57 with normal nocturnal blood pressure). The proportion of male sex, body mass index, apnea-hypopnea index (AHI), REM sleep duration, percentage of REM sleep duration to total sleep duration, REM-AHI, nonrapid eye movement-AHI, oxygen desaturation index (ODI), REM-ODI, nonrapid eye movement-ODI, and average nighttime heart rate during sleep were higher in the hypertension group than in the normal blood pressure group, and the lowest oxygen saturation was lower than that in the normal blood pressure group (P < .05). Logistic regression analysis showed that REM-AHI was an independent risk factor for nocturnal hypertension (adjusted odds ratio, 1.048; 95% confidence interval, 1.011-1.086; P = .01). Receiver operating characteristic curve analysis showed that the REM-AHI had an area under the curve of 0.721 (95% confidence interval, 0.641-0.801; P < .001) for diagnosing nocturnal hypertension in patients with OSA, with a maximum Youden index of 0.379. The optimal critical value of the REM-AHI was 23.6 times/h, with a sensitivity of 64.2% and specificity of 73.7%. REM sleep is closely related to nocturnal hypertension, and patients with OSA are more prone to cardiovascular events.

Antihypertensive Drug Recommendations for Reducing Arterial Stiffness in Patients With Hypertension: Machine Learning-Based Multicohort (RIGIPREV) Study

BACKGROUND

High systolic blood pressure is one of the leading global risk factors for mortality, contributing significantly to cardiovascular diseases. Despite advances in treatment, a large proportion of patients with hypertension do not achieve optimal blood pressure control. Arterial stiffness (AS), measured by pulse wave velocity (PWV), is an independent predictor of cardiovascular events and overall mortality. Various antihypertensive drugs exhibit differential effects on PWV, but the extent to which these effects vary depending on individual patient characteristics is not well understood. Given the complexity of selecting the most appropriate antihypertensive medication for reducing PWV, machine learning (ML) techniques offer an opportunity to improve personalized treatment recommendations.

OBJECTIVE

This study aims to develop an ML model that provides personalized recommendations for antihypertensive medications aimed at reducing PWV. The model considers individual patient characteristics, such as demographic factors, clinical data, and cardiovascular measurements, to identify the most suitable antihypertensive agent for improving AS.

METHODS

This study, known as the RIGIPREV study, used data from the EVA, LOD-DIABETES, and EVIDENT studies involving individuals with hypertension with baseline and follow-up measurements. Antihypertensive drugs were grouped into classes such as angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, diuretics, and combinations of diuretics with ACEIs or ARBs. The primary outcomes were carotid-femoral and brachial-ankle PWV, while the secondary outcomes included various cardiovascular, anthropometric, and biochemical parameters. A multioutput regressor using 6 random forest models was used to predict the impact of each antihypertensive class on PWV reduction. Model performance was evaluated using the coefficient of determination (R2) and mean squared error.

RESULTS

The random forest models exhibited strong predictive capabilities, with internal validation yielding R2 values between 0.61 and 0.74, while external validation showed a range of 0.26 to 0.46. The mean squared values ranged from 0.08 to 0.22 for internal validation and from 0.29 to 0.45 for external validation. Variable importance analysis revealed that glycated hemoglobin and weight were the most critical predictors for ACEIs, while carotid-femoral PWV and total cholesterol were key variables for ARBs. The decision tree model achieved an accuracy of 84.02% in identifying the most suitable antihypertensive drug based on individual patient characteristics. Furthermore, the system's recommendations for ARBs matched 55.3% of patients' original prescriptions.

CONCLUSIONS

This study demonstrates the utility of ML techniques in providing personalized treatment recommendations for antihypertensive therapy. By accounting for individual patient characteristics, the model improves the selection of drugs that control blood pressure and reduce AS. These findings could significantly aid clinicians in optimizing hypertension management and reducing cardiovascular risk. However, further studies with larger and more diverse populations are necessary to validate these results and extend the model's applicability.

Systematic Review and Meta-Analysis of Second-Generation Sham-Controlled Randomized Trials of Renal Denervation Therapy for Patients with Hypertension

INTRODUCTION

Renal denervation has been associated with substantial and sustained blood pressure reduction and is considered to serve as an alternative treatment for patients with resistant hypertension. However, the first published SHAM-controlled trial assessing RDN safety and efficacy showed no difference between groups.

AIM

We aimed to perform a meta-analysis quantifying the magnitude of blood pressure decrease secondary to renal denervation in patients with resistant hypertension.

METHODS

Databases were searched for RCTs that compared RDN therapy to SHAM procedure and reported the outcomes of (1) 24-hour ambulatory blood pressure; (2) Office systolic blood pressure; (3) Daytime systolic blood pressure; and (4) Night-time systolic blood pressure. Mean differences with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was examined with I² statistics. P values of < 0.05 were considered statistically significant. Statistical analyses were performed using RStudio 4.2.3.

RESULTS

Nine studies and 1622 patients were included. The AMBP [MD -3.72 95%CI -5.44, -2.00 p < 0.001; I²=34%] and DSBP [MD -4.10 95%CI -5.84, -2.37 p < 0.001; I²=0%] were significantly reduced in the RDN arm. ODBP [MD -6.04 95%CI -11.31, -0.78 p = 0.024; I²=90%] and NSBP [MD -1.81 95%CI -3.90, 0.27 p = 0.08; I²=0%] did not reach a statistically significant difference between groups.

CONCLUSION

Renal denervation demonstrates greater efficacy in reducing 24-hour ambulatory and daytime systolic blood pressure in patients diagnosed with resistant hypertension.

Does dance therapy benefit the improvement of blood pressure and blood lipid in patients with hypertension? A systematic review and meta-analysis

Objective

Hypertension is a risk factor of cardiovascular disease. Dance, a type of aerobic exercise, is beneficial as a therapy in reducing blood pressure. This study aimed to systematically review the therapeutic effectiveness of dance therapy (DT) on blood pressure and blood lipid of patients with hypertension.

Methods

Searching CNKI, VIP, Wan Fang Databases, CBM, PubMed, EBSCO (MEDLINE), Cochrane Library, and Web of Science to collect randomized controlled trials (RCTs) about dance therapy in the treatment of patients with hypertension according to the inclusion and exclusion criteria, with the search time ranged from the date of database construction to January 2024. The Cochrane risk-of-bias tool and PEDro were used to evaluate the risk of included trials. The meta-analysis was implemented by using RevMan 5.4 and Stata 12.0 software.

Results

A total of 983 patients were included in 11 randomized controlled trials. According to the meta-analysis, compared with the control group, Dance Therapy effectively reduced systolic blood pressure (SBP) [MD = -7.45, 95% CI (-8.50, -6.39), p < 0.0001] and diastolic blood pressure (DBP) [MD = -2.95, 95% CI (-3.78, -2.13), p < 0.0001], and it increased high-density lipoprotein cholesterol (HDL-C) [MD = 0.20, 95% CI (-0.02, 0.42), p < 0.0001]. The subgroup analysis results showed that the treatment efficacy was more excellent with the frequency more than 3 times per week, the cycle less than 12 weeks, and the duration less than 60 min every time.

Conclusion

The results indicates that SBP, DBP, and HDL-C in hypertensive patients have been effectively improved after dance therapy intervention. In addition, it is recommended to implement dance therapy for hypertensive patients with a treatment cycle of 12 weeks, and treat at least 3 times a week, with each treatment duration controlled within 60 min.

Systematic Review Registration

[http://www.crd.york.ac.uk/PROSPERO], identifier [CRD42024500807].

Atypical cervical spondylotic radiculopathy resulting in a hypertensive emergency during cervical extension: A case report and review of literature

BACKGROUND

Extensive research revealed the absence of reports documenting hypertensive emergencies precipitated by changes in the cervical spine posture.

CASE SUMMARY

We here present a 57-year-old woman diagnosed as having cervical spondylotic radiculopathy (CSR) who was scheduled for anterior cervical decompression and fusion. During post-anesthetic positioning, a sudden hypertensive surge was observed when the patient was in a supine position with the neck being slightly extended. This surge was promptly reversed through cervical flexion and head elevation. This event however required an alternate surgical approach for recovery—posterior laminoplasty and endoscopy-assisted nucleus pulposus removal. Following the 6-month outpatient follow-up period, cervical flexion and extension activities substantially improved in the patient without any episodes of increase in acute blood pressure.

CONCLUSION

Maintaining a safe hypotensive posture and performing rapid, thorough decompression surgery may serve as effective interventions for patients presenting symptoms similar to those of CSR accompanied by hypertensive emergencies (HE). This would mitigate the underlying causes of these HEs.

Arterial stiffness measured by pulse wave velocity correlated with cognitive decline in hypertensive individuals: a systematic review

BACKGROUND

Arterial stiffness is a degenerative modification in the arterial wall that significantly affects normal aging. Arterial hypertension is a major risk factor for cerebrovascular impairment. Pulse wave velocity (PWV) is an established gold standard for measuring arterial stiffness. Studies demonstrated that individuals with elevated blood pressure (BP) and PWV are more likely to experience worse cognitive decline compared to those with either condition alone. The aim of this review is to explore the clinical importance of arterial stiffness for cognitive function in older adults with hypertension.

METHODS

The systematic review was reported following the PRISMA 2020 guidelines and Cochrane protocol and was registered in NIHR PROSPERO. PubMed, Embase, Web of Science, CINAHL, and Cochrane databases were searched for relevant publications up to December 2022. Articles were filtered by age and type of study and only those including a sample size of at least 500 individuals were selected. Screening of abstracts and full-text review of selected articles were carried out through Covidence.

RESULTS

The full-text review included a total of 434 articles. Twenty-eight prospective studies have met the inclusion criteria. Selected studies used PWV as the main measurement of stiffness: 24 used carotid-femoral, 2 used brachial-ankle, 1 used aortic PWV, and 11 compared different measures. Studies demonstrated a strong association between increased BP and PWV with brain damage and cognitive deterioration among older adults. One study did not find an interaction with hypertension, while another study found that PWV but not BP was associated with cognitive decline. Few studies showed that the association between stiffness and cognitive outcomes was not significant after adjustment for BP. Several authors suggested that cognitive decline induced by stiff vasculature and hypertension benefited from antihypertensive therapy.

CONCLUSION

The results of this review demonstrated that arterial hypertension is an important factor linking arterial stiffness to cognitive health in older individuals. BP plays a crucial role in brain integrity, whereas PWV was shown to be a strong measure associated with cognitive decline. Together, they can lead to disabling cognitive outcomes. Early screening of stiffness, BP control, and compliance with treatment are essential for cerebrovascular disease prevention.

TRIAL REGISTRATION

NIHR PROSPERO registry ID: CRD42022379887 .

Impact of renal denervation on quality of life (How does renal denervation contribute to improving hypertension treatment affected by poor medication adherence?)

The US Food and Drug Administration has approved renal denervation (RDN) as a new treatment option for hypertension (HT) because it not only has antihypertensive effects but also improves the quality of blood pressure (BP) reduction. RDN is expected to be increasingly used in clinical practice in the future. This review summarizes the impact of RDN on quality of life (QOL). Although the treatment of HT aims to improve life prognosis, the use of antihypertensive agents can impair QOL because of adverse effects and lifestyle changes associated with long-term medication use. Consequently, poor adherence to antihypertensive agents is a common problem and may be the most important issue affecting patient QOL. In RDN trials in patients taking antihypertensive agents, approximately 40% of patients had poor adherence to the drugs. Poor adherence is often the cause of resistant hypertension. Therefore, RDN should be well suited to treating HT and improving QOL. Studies have shown that approximately 30% of HT patients prefer RDN to drug treatment. Patients who prefer RDN are typically male and younger and have high BP, poor adherence, and a history of adverse effects of antihypertensive agents. We hope that RDN will improve not only life prognosis but also QOL in HT patients because of its benefits for adherence. Furthermore, we expect that in the future, RDN will be used in other sympathetic nervous system-related diseases, such as heart failure, atrial fibrillation, and sleep apnea syndrome.

Six weeks of a concurrent training therapy improves endothelial function and arterial stiffness in hypertensive adults with minimum non-responders

BACKGROUND

This study aimed to examine the effects of a six-week of concurrent training using high-intensity interval plus resistance training on flow-mediated dilation and pulse wave velocity in hypertensive, elevated blood pressure, or normotensive. A secondary goal was to analyze the inter-individual variability.

METHODS

A randomized controlled clinical trial was executed with 60 adult participants distributed across six groups: three control groups of hypertensive, elevated blood pressure, or normotensive and other three experimental hypertensive, elevated blood pressure, and normotensive groups, each comprising n=10 individuals. Participants underwent a six-week intervention of concurrent exercise using high-intensity interval plus resistance training three-weekly. Flow mediated dilation and pulse wave velocity and secondary vascular assessments were conducted before and after the intervention.

RESULTS

The hypertensive exercise group exhibited a significant increase in flow mediated dilation (Δ+7.7%; p=0.003) and a reduction in pulse wave velocity (Δ-1.2ms-1; p<0.0001). The normotensive exercise group also showed a significant increase in flow mediated dilation (Δ+8.4%, p=0.002).

CONCLUSION

The six-week concurrent exercise using high-intensity interval plus resistance training protocol, characterized by its clinical time-efficiency, was effective in improving endothelial function, as demonstrated by increased flow mediated dilation, and in reducing arterial stiffness, indicated by decreased pulse wave velocity.

Renalase alleviates salt-induced kidney necroptosis and inflammation

Recent evidence suggests that necroptosis may contribute to the development of kidney injury. Renalase is a novel secretory protein that exerts potent prosurvival and anti-inflammatory effects. We hypothesized that renalase could protect the kidney from salt-induced injury by modulating necroptosis. High salt and renalase treatments were administered to Dahl salt-sensitive (SS) rats, renalase knockout (KO) mice, and HK-2 cells. Furthermore, a cohort of 514 eligible participants was utilized to investigate the association between single nucleotide polymorphisms (SNPs) in the genes RIPK1, RIPK3, and MLKL, and the risk of subclinical renal damage (SRD) over 14 years. A high-salt diet significantly increased the expression of key components of necroptosis, namely RIPK1, RIPK3, and MLKL, as well as the release of inflammatory factors in SS rats. Treatment with recombinant renalase reduced both necroptosis and inflammation. In renalase KO mice, salt-induced kidney injury was more severe than in wild-type mice, but supplementation with renalase attenuated the kidney injury. In vitro experiments with HK-2 cells revealed high salt increased necroptosis and inflammation. Renalase exhibited a dose-dependent decrease in salt-induced necroptosis, and this cytoprotective effect was negated by the knockdown of PMCA4b, which is the receptor of renalase. Furthermore, the cohort study showed that SNP rs3736724 in RIPK1 and rs11640974 in MLKL were significantly associated with the risk of SRD over 14 years. Our analysis shows that necroptosis plays a significant role in the development of salt-induced kidney injury and that renalase confers its cytoprotective effects by inhibiting necroptosis and inflammation.

Blood pressure targets, medication consideration and special concerns in elderly hypertension part I: General principles and special considerations

To achieve a consensus on optimal blood pressure (BP) targets for older adults remains challenging, necessitating a trade-off between cardiovascular benefits and the risk of impaired organ perfusion. Evidence suggests that age and frailty have a minimal influence on the cardiovascular benefits of intensive BP control in community-dwelling elderly. Nonetheless, an increased incidence of acute kidney injury with intensive BP control has been observed in octogenarians. Therefore, it is recommended to maintain systolic BP below 130 mmHg for hypertensive patients aged 65-80 years. If well-tolerated, a systolic BP target below 120 mmHg can be recommended for patients with chronic kidney disease (CKD). However, no conclusive evidence supports a stringent BP target for patients aged 80 years and older. The selection of antihypertensive medications for elderly patients requires consideration of their cardiovascular condition and potential contraindications. Combination therapy may be necessary to achieve the desired BP target. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are the primary choices for patients with CKD. Newer generation mineralocorticoid receptor antagonists may further reduce the risk of cardiovascular or renal events in this population. In conclusion, managing hypertension in elderly patients requires a personalized approach that balances cardiovascular benefits with potential risks, considering individual health profiles and tolerability.

Associating plasma aldosterone concentration with the prevalence of MAFLD in hypertensive patients: insights from a large-scale cross-sectional study

Objective

To explore the link between plasma aldosterone concentration (PAC) and the prevalence of metabolic dysfunction-related fatty liver disease (MAFLD) in hypertensive patients.

Methods

We analyzed data from 41,131 hospitalized patients from January 1, 2014, to December 31, 2023. Multivariate logistic regression models tested associations, with threshold, subgroup, and sensitivity analyses conducted to validate findings.

Results

For each 5-unit increase in PAC, the risk of MAFLD rose by 1.57 times, consistent even in the fully adjusted model. The odds ratios for the Q2, Q3, and Q4 groups compared to Q1 were 1.21, 2.12, and 3.14, respectively. A threshold effect was observed at 14 ng/dL, with subgroup and sensitivity analyses supporting these results.

Conclusions

This study reveals a significant positive association between elevated PAC levels and the prevalence of MAFLD in hypertensive patients. These findings underscore the imperative for further large-scale, prospective studies to validate and expand upon this correlation.

Effect of Therapeutic Drug Monitoring on Adherence and Blood Pressure: A Multicenter Randomized Clinical Trial

BACKGROUND

Drug concentration in blood or urine is an acknowledged method to detect nonadherence. Observational studies suggest that informing patients about low or absent serum drug levels improves blood pressure (BP). We performed a multicenter randomized clinical trial to test the hypothesis that therapeutic drug monitoring (TDM) could improve drug adherence and BP in patients with uncontrolled hypertension (HT).

METHODS

Patients were ≥18 years on stable treatment with at least 2 antihypertensive agents. We planned to randomize 80 nonadherent patients with a systolic daytime ambulatory BP ≥135 mm Hg to TDM intervention or not. The control group and the study personnel who measured BP remained uninformed about serum drug measurements throughout. All patients and physicians were blinded for BPs. Lifestyle advice and detailed information on the disease process and the importance of BP treatment were given to both groups.

RESULTS

From 2017 to 2022, we randomized 46 diagnosed nonadherent from a total of 606 patients with uncontrolled HT. The TDM group had a 6.7 (±14.5) mm Hg reduction from 147.9 (±10.3) to 141.1 (±14.1) mm Hg, and the control group experienced a 7.3 (±13.2) mm Hg reduction from 147.1 (±9.2) to 139.1 (±17.4) mm Hg, P = 0.9 between groups. Adherence improved in both groups, 73% in the TDM group and 59% in the control group became adherent at 3 months, P = 0.51.

CONCLUSIONS

In our prospective multicenter clinical trial of uncontrolled and nonadherent hypertensive patients, we found no additional effect of TDM on BP and drug adherence compared with standard care.

CLINICAL TRIALS REGISTRATION

Trial Number NCT03209154, www.clinicaltrials.gov.

Frequency-Domain Features and Low-Frequency Synchronization of Photoplethysmographic Waveform Variability and Heart Rate Variability with Increasing Severity of Cardiovascular Diseases

Objective-Heart rate variability (HRV) and photoplethysmographic waveform variability (PPGV) are available approaches for assessing the state of cardiovascular autonomic regulation. The goal of our study was to compare the frequency-domain features and low-frequency (LF) synchronization of the PPGV and HRV with increasing severity of cardiovascular diseases. Methods-Our study included 998 electrocardiogram (ECG) and finger photoplethysmogram (PPG) recordings from subjects, classified into five categories: 53 recordings from healthy subjects, aged 28.1 ± 6.2 years, 536 recordings from patients with hypertension (HTN), 49.0 ± 8.8 years old, 185 recordings from individuals with stable coronary artery disease (CAD) (63.9 ± 9.3 years old), 104 recordings from patients with myocardial infarction (MI) that occurred three months prior to the recordings (PMI) (65.1 ± 11.0 years old), and 120 recordings from study subjects with acute myocardial infarction (AMI) (64.7 ± 11.5 years old). Spectral analyses of the HRV and PPGV were carried out, along with an assessment of the synchronization strength between LF oscillations of the HRV and of PPGV (synchronization index). Results-Changes in all frequency-domain indices and the synchronization index were observed along the following gradient: healthy subjects → patients with HTN → patients with CAD → patients with PMI → patients with AMI. Similar frequency-domain indices of the PPGV and HRV show little relationship with each other. Conclusions-The frequency-domain indices of the PPGV are highly sensitive to the development of any cardiovascular disease and, therefore, are superior to the HRV indices in this regard. The S index is an independent parameter from the frequency-domain indices.

Subclinical Atherosclerosis Progression in Low-Risk, Middle-Aged Adults: Carotid Leads Femoral in IMT Increase but Not in Plaque Formation

This study investigated subclinical atherosclerosis progression in low-risk, middle-aged adults (N = 141; a mean age of 49.6 ± 4.7 years) using a 5-year ultrasound follow-up. We compared the involvement of the carotid and femoral arteries.

METHODS

Clinical data, risk factors, carotid/femoral intima-media thickness (IMT), and plaque presence were analyzed.

RESULTS

Cardiovascular risk factors and scores increased significantly at follow-up. Both carotid and femoral mean IMT increased (p < 0.001). While plaque prevalence rose and was similar in both arteries (carotid: 4.8% to 17.9%, femoral: 3.6% to 17.7%, p < 0.001 for both), the progression of plaque burden was greater in femorals. Notably, the carotid mean IMT demonstrated a faster yearly progression rate compared to the mean femoral IMT. The prevalence of pathological nomogram-based mean IMT right or left was higher in the carotids (52.9% to 78.8%, p < 0.001) compared to femorals (23.2% to 44.7%, p < 0.001), with a significant increase at the end of follow-up in both territories.

CONCLUSIONS

This study demonstrates significant subclinical atherosclerosis progression in low-risk, middle-aged adults over 5 years. Carotid arteries showed a faster progression rate of mean IMT and a higher prevalence of pathological nomogram-based mean IMT compared to the femoral arteries. However, plaque burden was similar in both territories, with greater progression in femorals. Identifying carotid and femoral atherosclerosis burden may be a valuable tool for risk stratification in this population.

Prevalence, impact and management of hypertension-mediated organ damage in type 2 diabetes patients

OBJECTIVE

To determine the prevalence, impact and management of hypertension-mediated organ damage (HMOD) according to the presence of type 2 diabetes (T2DM).

METHODS

IBERICAN is an ongoing multicenter, observational and prospective study, including outpatients aged 18-85 years who attended the Primary Care setting in Spain. In this study, the prevalence, impact and management of HMOD according to the presence of T2DM at baseline were analyzed.

RESULTS

At baseline, 8066 patients (20.2% T2DM, 28.6% HMOD) were analyzed. Among patients with T2DM, 31.7% had hypertension, 29.8% dyslipidemia and 29.4% obesity and 49.3% had ≥1 HMOD, mainly high pulse pressure (29.6%), albuminuria (16.2%) and moderate renal impairment (13.6%). The presence of T2DM significantly increased the risk of having CV risk factors and HMOD. Among T2DM population, patients with HMOD had more dyslipidemia (78.2% vs 70.5%; P=0.001), hypertension (75.4% vs 66.4%; P=0.001), any CV disease (39.6% vs 16.1%; P=0.001) and received more drugs. Despite the majority of types of glucose-lowering agents were more frequently taken by those patients with HMOD, compared to the total T2DM population, the use of SGLT2 inhibitors and GLP-1 receptor agonists was marginal.

CONCLUSIONS

In patients daily attended in primary care setting in Spain, one in five patients had T2DM and nearly half of these patients had HMOD. In patients with T2DM, the presence of HMOD was associated with a higher risk of CV risk factors and CV disease. Despite the very high CV risk, the use of glucose-lowering agents with proven CV benefit was markedly low.

Thirty-five years of the European Society of Hypertension: from past to future

The European Society of Hypertension (ESH) was established 35 years ago. Since then, it promoted and coordinated a number of activities which include educational projects, epidemiological surveys and research investigations whose main focus includes different clinical and therapeutic aspects of the hypertensive disease. This article, which is based on data presented during the Presidential lecture held during the 33rd ESH Meeting in Berlin, will provide an overview of the main organization and structure of the ESH. Emphasis will be given to the relevance of the different society bodies, with a particular focus on the educational and research activities, such as the 15 working groups and the more than 120 excellence centers located in European and extra-European countries. Other main activities of the Society refer to the ESH Hypertension Specialist Program, the ESH Summer School, the ESH Young Fellow Program and the Annual Scientific Meeting of the Society. A special emphasis will be given to the central role of the Society in the organization of the various research projects and in the development and dissemination of the ESH Guideline document on hypertension diagnosis and treatment. Finally, the future perspectives of the ESH in the context of the European scientific framework will be highlighted.

Epistaxis and Clinic Blood Pressure Values: Is There a Relationship?

INTRODUCTION

Epistaxis is the most common otorhinolaryngological emergency and historically there have been an important debate whether there is a cause-effect relationship with high blood pressure.

AIM

This retrospective study explored whether hypertension is a significant risk factor for epistaxis in Emergency Department (ED) patients and examined associations between blood pressure levels and epistaxis episodes.

MATERIALS AND METHODS

Two groups were studied: Group A (patients with epistaxis) and Group B (control). Patient characteristics, comorbidities, and medication use were recorded. Blood pressure measurements were taken upon ED arrival and after specialist evaluation. Statistical analyses included descriptive statistics, T-test, χ2 test, and logistic regression.

RESULTS

Group A, enrolled from April 2014 to February 2015, included 102 patients, mean age 67, male-female ratio 2:1. Blood pressure on arrival was over 140/90 mmHg in 73%, decreasing to 26% after 30 minutes. Group B, enrolled from May 2023 to August 2023, included 126 patients, mean age 59, male-female ratio 2:1. Blood pressure on arrival was over 140/90 mmHg in 60%, decreasing to 23% after 30 minutes. Both groups showed reduced blood pressure post-evaluation. Logistic regression identified anticoagulant and/or antiplatelet therapy as the main independent risk factor for epistaxis. Age, sex, blood pressure levels, and hypertension did not significantly influence epistaxis occurrence.

CONCLUSION

No significant correlation between hypertension and epistaxis was found. Anticoagulant and/or antiplatelet therapy was the primary independent risk factor, highlighting the importance of considering medication history in evaluating epistaxis.

The effect of flour-based foods intake in the reduction of cardiometabolic risk: A systematic review

Cardiometabolic risk triggers a state of chronic and subclinical inflammation, conferring a higher risk of morbidity and mortality. Thus, minimal processing of foods with high nutritional value, in the form of flour, becomes an effective dietary strategy in preventing and treating cardiometabolic risk factors. This systematic review aims to evaluate the evidence on the effect of flour-based food intake on reducing the most common cardiometabolic risk factors. We included all randomized controlled trials published up to April 2023 in the main databases PubMed, Scopus and Web of Science. Eleven clinical trials were included. The amount of flour used in the studies ranged from 1.5 g to 36 g/day, and the supplementation period ranged from six weeks to 120 days. Green jackfruit flour, green banana flour, soy flour, flour from rind of the yellow passion fruit, and fenugreek powder demonstrated significant results in improve parameters of glucose homeostasis. Chia flour, green banana flour, soy flour, and fenugreek powder showed improvements in blood pressure measurements. Brazil nut flour and chia flour reduced total cholesterol. Chia flour also increased HDL cholesterol levels. The evidence presented in the current systematic review indicates that flour-derived foods intake is related to improve cardiometabolic risk factors parameters.

Predicting factors of blood pressure normalization in hypertensive patients after short-term follow-up

Introduction

Normalization of blood pressure in hypertensive patients is a major challenge for practitioners. Knowledge of the factors associated with normalization of blood pressure could help optimize management of these hypertensive patients. In this study, we analysed the factors predictive of this in a population of hypertensive patients followed as outpatients in a specialised department.

Patients and methods

Retrospective and analytic study (January 2021-May 2022) of adult hypertensive patients over 40 years old who had been receiving antihypertensive treatment as outpatients in the Cardiology Department of the Bouake Teaching Hospital for at least 6 months. We studied the epidemiological and clinical parameters as well as the factors involved in the normalization of blood pressure in this population. Statistical analysis was performed using SPPS version 26 software (SPSS Inc., Chicago, IL, USA).

Results

We collected 194 patients records (57.7% women). The mean age was 59.13 years [extremes: 40-89 years]. One hundred and nine (56.2%) patients had a low socioeconomic status and 151 (77.83%) had at least 2 cardiovascular risk factors. The mean systolic blood pressure on admission was 171.12 ± 22.38 mmHg [extremes: 140-259 mmHg] and the mean diastolic blood pressure was 97.98 ± 17.83 mmHg [extremes: 60-168 mmHg]. First-line treatment consisted of dual anti-hypertensive therapy (n = 133; 68.55%) and fixed combination (n = 152; 78.35%). Only 25.25% (n = 49) of patients achieved normalization of blood pressure with therapeutic adherence estimated at 37.62% (n = 73). In multivariate analysis adjusted for anti-hypertensive treatment adherence, age (OR = 1.03; 95% CI = 1.002-1.059; p = 0.039), absence of alcoholism (OR = 9.48; 95% CI = 2.13-42.11; p = 0.003), number of cardiovascular risk factors <2 (OR = 1.52; 95% CI = 1.06-2.16; p = 0.021), normalization of uricemia (OR = 1.05; 95% CI = 1.00-1.11; p = 0.039) and natraemia (OR = 1.01; 95% CI = 1.00-1.03; p = 0.021), dual therapy (OR = 0.40; 95% CI = 0.18-0.90; p = 0.027), change in treatment for optimization (OR = 4.22; 95% CI = 1.71-10.37; p = 0.002), intellectual education (OR = 10.40; 95% CI = 4.31-25.10; p < 0.001) and health insurance (OR = 0.09; 95% CI = 0.04-0.21; p < 0.001) were the main factors predicting normalization of blood pressure.

Conclusion

Control of cardiovascular risk factors and compliance with treatment are the main factors in normalizing blood pressure.

Evaluating the role of aldosterone synthesis on adrenal cell fate

Hypertension affects one-third of the adult population worldwide, with primary aldosteronism (PA) accounting for at least 5-10% of these cases. The aldosterone synthase enzyme (CYP11B2) plays a pivotal role in PA manifestation, as increased expression of CYP11B2 leads to excess aldosterone synthesis. Physiological expression of CYP11B2 in humans is normally limited to cells of the adrenal zona glomerulosa under tight homeostatic regulation. In PA, however, there are CYP11B2-positive lesions in the adrenal cortex that autonomously secrete aldosterone, highlighting the dysregulation of adrenal cortex zonation and function as a key aspect of PA pathogenesis. Thus, this review aims to summarize the development of the adrenal glands, the key regulators of adrenal cortex homeostasis, and the dysregulation of this homeostasis. It also discusses the development of CYP11B2 inhibitors for therapeutic use in patients with hypertension, as well as the current knowledge of the effects of CYP11B2 inhibition on adrenal cortex homeostasis and cell fate. Understanding the control of adrenal cell fate may offer valuable insights into both the pathogenesis of PA and the development of alternative treatment approaches for PA.

Visit-to-Visit Systolic Blood Pressure Variability Independently Predicts Cardiovascular Events in a Kidney Transplant Recipients' Cohort

BACKGROUND

The predictive role of blood pressure variability for all-cause mortality and fatal and nonfatal cardiovascular events has been described in the general population and in patients with diabetes, independently of mean BP. Although systolic blood pressure variability has been proposed as an informative measure for predicting clinical outcomes in patients with chronic kidney disease, its role in kidney transplant recipients is still debatable.

METHODS AND RESULTS

We performed a retrospective, observational, monocentric analysis of all kidney transplant recipients in follow-up at the outpatient Nephrology Clinic of San Martino Hospital from January 1, 2016 to December 31, 2016, who underwent kidney transplantation >12 months. The primary outcome was a fatal or nonfatal cardiovascular event (myocardial infarction, unstable angina, stroke, and hospitalization for heart failure). Visit-to-visit systolic blood pressure variability was expressed as the SD of systolic blood pressure values recorded at baseline and 3 months up to 18 months. Among the 272 patients (mean age, 64±13; 63% men) included in the present analyses, for each increase of 2.7 mm Hg in systolic blood pressure SD, the risk for events increased 3-fold (hazard ratio [HR], 3.1 [95% CI, 1.19-7.88]; P=0.02), and patients in the highest tertile of systolic blood pressure SD showed a 4-fold increased risk (HR, 4.1 [95% CI, 1.34-12.43]; P=0.01). This relationship was maintained even after incremental adjustment for time-averaged pulse pressure, age, diabetes, and prior cardiovascular event (HR, 3.2 [95% CI, 1.1-10.0]; P=0.04).

CONCLUSIONS

Long-term blood pressure variability represents a risk factor for cardiovascular events in kidney transplant recipients, even independently by several confounding factors including blood pressure load.