2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension

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.

Transforming Growth Factor-β-mediated attenuation of cardio-renal oxidative stress, inflammation and fibrosis by L-arginine in fludrocortisone acetate induced-hypertensive rats

Uncontrolled hypertension is a primary contributor to tissue damage in multiple organs, including the heart and kidneys. In this study, we explored the protective roles of L-arginine in a mineralocorticoid-induced rat model of hypertension. To induce hypertension and subsequent organ damage, rats were nephrectomized unilaterally and fed with the mineralocorticoid fludrocortisone acetate and dietary salt (FCA-Salt). These rats were treated with L-arginine for 28 days, and subsequent tests were performed. Biochemical analysis revealed the increased level of inflammation and oxidative stress biomarkers in the plasma, heart, and kidney of the FCA-salt-treated rats. L-arginine treatment decreased the oxidative stress marker malondialdehyde (MDA) by 18 %, 22 %, and 18 % in the heart, kidney, and plasma, respectively. L-arginine also attenuated the advanced oxidative protein products (AOPP). The activity of superoxide dismutase (SOD) increased by 62 %, 45 %, and 16 % in the heart, kidney, and plasma, respectively, in the L-arginine-treated animals compared to the FCA-Salt group. Significant augmentation was also revealed for the nitric oxide (NO), catalase (CAT), and reduced glutathione (GSH). The plasma levels of the kidney function biomarkers uric acid and creatinine were significantly improved after L-arginine treatment. Furthermore, L-arginine remarkably reduced the elevated plasma cytokines IL-1β, IL-17A, TNF-α, and TGF-β1 in FCA-salt-induced hypertensive rats. Histopathological data showed a reduction in fibrosis and tissue damage by L-arginine in the FCA-salt-treated group. We propose that L-arginine could be an effective agent in preventing cardiac and renal dysfunction in hypertensive rats.

Development of the European Society of Hypertension guidelines for the management of arterial hypertension: comparison of the helpfulness of ESH 2013, 2018, and 2023 guidelines

OBJECTIVE

Over the last decade, the European Society of Hypertension (ESH) published several guidelines (GLs) for the Management of Arterial Hypertension (2013, 2018, and 2023). We hypothesized that the GL has been improved because of the publications of new evidence. Thus, we aimed to examine the development of ESH guidelines (ESH GLs) by comparing their helpfulness regarding the diagnosis and treatment of hypertension.

METHODS

A novel mathematical analysis was used to compare ESH GLs. Not only the frequency of Classes of Recommendations (CLASS) and the Levels of Evidence (LEVEL) were examined but a newly developed certainty index (CI) was calculated. This CI allows the CLASS and LEVEL to be assessed together, providing a less biased assessment of GLs, than examining the CLASS and LEVEL independently or related to each other.

RESULTS

The number of recommendations showed continuous and significant increases from 2013 ( N  = 110) to 2018 ( N  = 169), and 2023 ( N  = 269). Examining the frequency of CLASS and/or LEVEL led to biased results, showing both improvements and/or worsening comparing years. However, based on the new analysis, a continuous improvement was shown in the percentage of certainty from 2013 to 2023 (2013: 60.5%, 2018: 72.1%, 2023: 75.3%). Accordingly, the CI was also significantly increased from 2013 (CI: 0.21), to 2018 (CI: 0.44), and to 2023 (CI: 0.51).

CONCLUSION

The analysis shows that compared to previous GLs, the structure of the ESH 2023 GL has been rearranged and simplified. The higher number of Recommendations indicates a continuously accumulating knowledge regarding the mechanisms, clinical findings, and epidemiology of hypertension. Moreover, the ESH 2023 GL shows a higher degree of certainty and CI, corresponding to a higher level of helpfulness of the ESH 2023 GL for healthcare professionals to diagnose, prevent, and treat hypertension.

"Gut Microbiota as a Therapeutic Target for Hypertension: Challenges and Insights for Future Clinical Applications" "Gut Microbiota and Hypertension Therapy"

PURPOSE OF REVIEW

Systemic hypertension is a major risk factor for cardiovascular disease and remains challenging to manage despite the widespread use of antihypertensive medications and lifestyle modifications. This review explores the role of gut microbiota in hypertension development and regulation, highlighting key mechanisms such as inflammation, gut-brain axis modulation, and bioactive metabolite production. We also assess the potential of microbiota-targeted therapies for hypertension management.

RECENT FINDINGS

Emerging evidence indicates that microbial dysbiosis, high-salt diets, and gut-derived metabolites such as short-chain fatty acids (SCFAs) and bile acids significantly influence blood pressure regulation. Preclinical and early clinical studies suggest that interventions targeting gut microbiota, including probiotics, prebiotics, synbiotics, fecal microbiota transplantation (FMT), and dietary modifications, may help modulate hypertension. However, variability in gut microbiota composition among individuals and limited human trial data pose challenges to translating these findings into clinical practice. While microbiota-based therapies show promise for hypertension management, further research is needed to establish their efficacy and long-term effects. Large-scale, standardized clinical trials are crucial for understanding the therapeutic potential and limitations of gut microbiota interventions. A deeper understanding of the gut-hypertension axis could lead to novel, personalized treatment strategies for hypertension.

Post-isometric exercise hypotension occurs irrespective of muscle mass in adults with hypertension: A randomized clinical trial

OBJECTIVE

Isometric exercise can be an alternative approach to lowering blood pressure in individuals with hypertension. However, it is uncertain whether the muscle mass involved can influence Post-Exercise Hypotension (PEH). Thus, the authors evaluate the acute effect of an isometric exercise session with a Small Muscle Mass (SMM) and a Large Muscle Mass (LMM) on Systolic (SBP) and Diastolic (DBP) blood pressure in individuals with hypertension.

METHOD

Randomized clinical trial with 36 volunteers aged 40‒70y with hypertension allocated into (n = 12/group): control group (no exercise), SMM group (bilateral isometric handgrip contractions using a hydraulic handheld dynamometer), and LMM group (bilateral isometric full knee extension on a leg extension machine). Both exercise interventions consisted of 4 × 2 min of bilateral contraction at 30 % of the individual's maximum capacity. The authors used 24-hour Ambulatory Blood Pressure Monitoring (ABPM) after the interventions. One-way ANOVA or Generalized Estimation Equations (GEE) were used to test for potential differences (p < 0.05).

RESULTS

The authors found no increase in SBP/DBP immediately after the interventions. However, 24 h ABPM revealed lower SBP post-intervention in the SMM group (Δ-4.1 mmHg; p = 0.044) and the LMM group (Δ-5.6 mmHg; p = 0.040) compared to the control group, with no difference between these groups. DBP did not change over a period of 24 h ABPM.

CONCLUSIONS

In conclusion, isometric exercise-induced PEH assessed by 24 h ABPM regardless of the muscle mass involved. This study shows that both interventions may contribute to lowering blood pressure in individuals with hypertension.

TRIAL REGISTRATION

www.

CLINICALTRIALS

gov; ID NCT03982758.

Diagnostic and prognostic yields of ambulatory blood pressure measurements in haemodialysis patients: a 6-year longitudinal study

BACKGROUND

Blood pressure (BP) control in haemodialysis (HD) patients is essential. Peri-dialytic BP levels do not accurately diagnose hypertension or predict the cardiovascular (CV) mortality.

METHODS

In this study, we recruited 43 adult patients who had been on chronic HD for ≥3 months. Seven-day home BP monitoring (HBPM) (values of Day1 discarded) and 44-h interdialytic ambulatory BP monitoring (iABPM) were performed. Pre- and post-dialysis BP levels were measured during the 6 dialysis sessions prior to iABPM. A 6-year follow-up was carried out to assess all-cause and CV mortality.

RESULTS

In patients considered as normotensive in pre-dialysis (n = 17), masked hypertension was found in 24% and 29% on the basis of iABPM and HBPM, respectively. Conversely, among hypertensive patients in pre-dialysis (n = 26), 'white-coat' hypertension was noted in 23% either by iABPM or HBPM. After a 6-year follow-up, 25 patients were deceased including 6 patients from CV causes. Day-time systolic BP measured by iABPM was associated with all-cause mortality in an adjusted model for age and gender (p = 0.045).

CONCLUSION

In chronic HD patients, 44-h iABPM and 6-day HBPM show a reliable concordance and help to re-classify ∼25% of cases miscategorised based on pre-dialysis measurements. Day-time systolic BP levels using iABPM were significantly associated with 6-year all-cause mortality.

Evaluation of Aktiia cuffless blood pressure monitor across 24-h, daytime, and night-time measurements versus ambulatory monitoring: a prospective, single-centre observational study

OBJECTIVES

Cuffless blood pressure (BP) monitors represent an innovative approach to BP assessment, overcoming the traditional episodic nature of readings obtained from cuff-based, oscillometric modalities. Nonetheless, the comparison of these cuffless devices against their cuff-based counterparts remain debated.

METHODS

This study evaluated BP readings from a cuffless, continual BP monitor (Aktiia monitor, Neuchâtel, Switzerland) and a standard 24-h ambulatory BP monitor (ABPM; Dyasis 3, Novacor, Paris, France) in 54 patients undergoing a 12-week cardiac rehabilitation program in Neuchâtel, Switzerland. Comparisons encompassed 24-h, daytime (9 a.m.-9 p.m.), and night-time (11 p.m.-7 a.m.) systolic and diastolic BP (SBP, DBP) using a 7-day average from Aktiia overlapping a 1-day average from ABPM. Nocturnal dip analysis was performed with 1-day average from Aktiia coinciding with ABPM measurements.

RESULTS

No significant differences emerged between the Aktiia and ABPM monitors for 24-h and daytime SBP (24-h: 2.6 ± 12.3 [-0.2, 5.4] mmHg, r  = 0.57, P  = 0.06; daytime: 1.2 ± 12.4 [-1.6, 4.0] mmHg, r  = 0.60, P  = 0.38). Night-time SBP showed more evident differences (12.5 ± 14.4 [9.3, 15.8] mmHg, r  = 0.39, P  < 0.001). DBP were within clinical range across 24-h and daytime (24-h: -2.9 ± 7.9 [-4.7, -1.1] mmHg, r  = 0.63, P  = 0.002; daytime: -3.1 ± 8.2 [-5.0, -1.3] mmHg, r  = 0.64, P  = 0.001), and showed significant differences for night-time (4.1 ± 8.5 [2.2, 6.0] mmHg, r  = 0.57, P  < 0.001). The concordance rate with ABPM's nocturnal dip was 79% for 1-day average from Aktiia.

CONCLUSIONS

These results demonstrate that the Aktiia monitor yields BP measurements consistent with an ABPM monitor despite some systematic differences during night-time readings. The Aktiia monitor holds potential for future use in continual BP monitoring.

CLINICAL TRIAL REGISTRATION

NCT04548986. URL: https://clinicaltrials.gov/study/NCT04548986?tab=results.

Prevalence and Predictive Features of CT-Derived Nonalcoholic Fatty Liver Disease in Metabolically Healthy MACS

OBJECTIVE

Patients with mild autonomous cortisol secretion (MACS) are at increased risk of cardiometabolic outcomes, such as hyperglycemia, metabolic syndrome, and cardiovascular diseases. Nonalcoholic fatty liver disease (NAFLD) is also associated with increased cardiometabolic risk. We aimed to investigate the prevalence and predictors of NAFLD in metabolically healthy subjects with MACS.

METHODS

Forty patients with MACS and 60 patients with nonfunctioning adrenal incidentaloma (NFAI) matched for age, gender, and body mass index were included. We excluded various diseases that may lead to NAFLD, such as diabetes, cardiovascular diseases, and liver disorders. Non-alcoholic fatty liver disease was evaluated with unenhanced abdominal computed tomography and noninvasive fatty liver indices.

RESULTS

Patients with MACS had lower mean liver attenuation values (Hounsfield units, HU) than those with NFAI (p = 0.001). Visceral adiposity index, hepatic steatosis index, and fatty liver index were higher in the MACS group than in the NFAI group (p = 0.009, p = 0.002, p = 0.023, respectively). However, there was no significant association between the mean liver HU value and these indices. There was a significant association between serum cortisol level after the 1 mg dexamethasone suppression test (DST) and mean liver HU value independent of other traditional risk factors in various models performed in multivariable linear regression analysis.

CONCLUSIONS

Our findings suggest that MACS is associated with an increased risk of NAFLD, and serum cortisol level after 1 mg DST is an independent predictor of NAFLD in patients with MACS.

Endothelin-converting Enzyme-1b Genetic Variants Increase the Risk of Coronary Artery Ectasia

Coronary artery ectasia (CAE), defined as a 1.5-fold or greater enlargement of a coronary artery segment compared to the adjacent normal coronary artery, is frequently associated with atherosclerotic coronary artery disease (CAD). Membrane-bound endothelin converting enzyme-1 (ECE-1) is involved in the maturation process of the most potent vasoconstrictor ET-1. Polymorphisms in the endothelin (ET) gene family have been shown associated with the development of atherosclerosis. This study aims to investigate the effects of rs213045 and rs2038089 polymorphisms in the ECE-1 gene which have been previously shown to be associated with atherosclerosis and hypertension (HT), in CAE patients. Ninety-six CAE and 175 patients with normal coronary arteries were included in the study. ECE-1b gene variations rs213045 and rs2038089 were determined by real-time PCR. The frequencies of rs213045 C > A (C338A) CC genotype (60.4% vs. 35.4%, p < 0.001) and rs2038089 T > C T allele (64.58% vs. 35.42%, p = 0.017) were higher in the CAE group compared to the control group. The multivariate regression analysis showed that the ECE-1b rs213045 CC genotype (p = 0.001), rs2038089 T allele (p = 0.017), and hypercholesterolemia (HC) (p = 0.001) are risk factors for CAE. Moreover, in nondiabetic individuals of the CAE and control groups, it was observed that the rs213045 CC genotype (p < 0.001), and rs2038089 T allele (p = 0.003) were a risk factor for CAE, but this relationship was not found in the diabetic subgroups of the study groups (p > 0.05). These results show that ECE-1b polymorphisms may be associated with the risk of CAE and this relationship may change according to the presence of type II diabetes.

Increased cardiovascular risk despite unchanged body composition in non functional adrenal incidentaloma

BACKGROUND

Non-functional adrenal incidentaloma (NFAI) is associated with an increased risk of adverse cardiometabolic outcome. Identifying predictors of atherosclerotic cardiovascular disease (ASCVD) may enable more appropriate management strategies in patients with NFAI. We aimed to investigate the body composition parameters and ASCVD risk in patients with NFAI.

METHODS

Eighty patients with NFAI and 80 controls matched for age, gender and body mass index (BMI) were included. ASCVD risk was assessed on Framingham Risk Score (FRS) and American Heart Association/American College of Cardiology (AHA/ACC) score. Body composition was evaluated using a segmental body composition analyzer.

RESULTS

There were no significant differences in age, gender, blood pressure or body composition parameters between the two groups. Patients with NFAI had higher FRS and AHA/ACC scores than controls (P=0.017, P=0.024, respectively). In patients with NFAI, independent predictors for FRS were serum cortisol level after 1mg dexamethasone suppression test (DST) and waist/hip ratio (WHR), while independent predictors for AHA/ACC score were serum cortisol level after 1mg DST, WHR and fasting plasma glucose (FPG), in various multivariate linear regression models.

CONCLUSIONS

FRS and AHA/ACC scores may be useful in determining ASCVD risk in patients with NFAI, and serum cortisol level after 1mg DST is an independent predictor of ASCVD in these patients, even in the absence of hypercortisolism.

Heart failure with preserved ejection fraction: from echocardiographic characteristics to a cardiovascular damage score in a high-risk hypertensive population

BACKGROUND

Heart failure with preserved ejection fraction (HFpEF) is a high prevalence condition, with high rates of hospitalization and mortality. Arterial hypertension is the main risk factor for HFpEF. Among hypertensive patients, alterations in cardiac and vascular morphology identify hypertension-mediated organ damage (HMOD). Cardiac HMOD in terms of ventricular hypertrophy and diastolic dysfunction is a continuum between the preclinical condition (arterial hypertension) and HFpEF. In hypertensive patients, it is currently unknown what is the prevalence of individuals classifiable as being at high risk of developing HFpEF and whether aortic morphofunctional vascular changes are present.

AIM

This study seeks to retrospectively assess the prevalence of echocardiographic alterations consistent with the diagnosis of HFpEF in a cohort of patients with essential arterial hypertension, and the prevalence of vascular HMOD (V-HMOD) in different risk categories of patients.

METHODS

Hypertensive outpatients referred at the Hypertension Center of Turin from 2003 to 2021 were retrospectively evaluated. Patients with a previous diagnosis of heart failure and known cardiovascular events were excluded. A predictive model associated with the risk of HFpEF development was calculated using echocardiographic variables. V-HMOD morphological and functional parameters were assessed by ascending aorta diameter and arterial stiffness (carotid-femoral pulse wave velocity, cfPWV).

RESULTS

Eight hundred and four patients (34.8% women) were analyzed, age 53.1 ± 14 years; left ventricular mass index (LVMi) and E / e' ratio were impaired in 15.9 and 29.1% of cases, respectively. Dividing them into tertiles according to score: score 1 or less (30.2%); score 2-3 (47.4%); score at least 3 (22.7%). Patients identified at high risk of HFpEF (score ≥3) had higher age, BMI and blood pressure than the other two groups ( P  < 0.05); they showed a significantly higher prevalence of female patients (42.3%), treatment with at least two antihypertensive drugs (40.1%), diabetes (7.1%), and dyslipidemia (28%; P  < 0.05), with a larger ascending aorta diameter (35.5 ± 5.5 mm, P  < 0.05) and higher cfPWV (8.8 ± 2.4 m/s, P  < 0.05).

CONCLUSION

At least one in five hypertensive patients, referred to an outpatient echocardiographic examination, has C-HMOD compatible with a high-risk category of HFpEF and have a significant increase in V-HMOD. This reinforces the notion that arterial hypertension and HFpEF are not two distinctly separate conditions but a continuum of pathophysiologic alterations.

Quality of life, neurocognitive functioning, psychological issues, sexuality and comorbidity more than 2 years after commencing immune checkpoint inhibitor treatment

BACKGROUND

Increasing numbers of patients diagnosed with advanced cancer survive long-term after treatment with immune checkpoint inhibitors (ICIs). To design adequate interventions for these survivors, knowledge regarding quality of life (QOL) and its association with long-term and late effects of ICI treatment is required. Therefore, this study aimed to evaluate QOL, neurocognitive function, psychological issues, sexuality, and comorbidities in patients surviving at least 2 years after commencing ICI treatment.

METHODS

We performed a cross-sectional study in patients with stage III-IV melanoma, non-small cell lung cancer (NSCLC), urothelial cell carcinoma (UCC), or renal cell carcinoma (RCC) who survived at least 2 years after the start of ICIs. We assessed QOL, neurocognitive function, psychological issues, sexual function and comorbidity in survivors. Additionally, we evaluated QOL of informal caregivers.

RESULTS

132 survivors (70 melanoma, 50 NSCLC, 12 UCC or RCC) and 80 caregivers were included. Median age was 65 years (range 30-85) and 50 survivors were women (38%). Median time since start and cessation of ICI treatment was 33 (range 21-91) and 18 (range 0-68) months, respectively. Average survivor QOL was comparable to the reference population, but 37 (28%) survivors had poor QOL. Depression and anxiety were negatively correlated with all QOL domains. Although immune-related adverse events were common, there was no association with lower QOL. Caregiver and survivor QOL were only weakly related. Neurocognitive concerns and formally tested neurocognitive impairment were present in 22 (17%) and 13 (15%) survivors, respectively, and were not associated with a diagnosis of brain metastases. Men had a high prevalence of erectile dysfunction and low sexual satisfaction. Half of the survivors met the criteria for the metabolic syndrome.

CONCLUSIONS

At least 2 years after the start of ICI treatment, one-quarter of cancer survivors had a clinically relevant lower QOL. This was associated with symptoms of depression and anxiety, but not with immune-related adverse events. Sexual issues and metabolic syndrome are prevalent. Survivorship care should address these issues in this population.

Burden of Coronary Artery Disease as a Predictor of New Vascular Events and Mortality in Patients With Ischemic Stroke: Insights From the Norwegian Stroke in the Young Study

BACKGROUND

Studies in young patients with stroke identified coronary artery disease (CAD) as a main contributor to mortality. In the present NOR-SYS (Norwegian Stroke in the Young Study), we aimed to investigate the prevalence of CAD, and the impact on new vascular events and mortality.

METHODS

A total of 385 patients with ischemic stroke, aged ≤60 years, were included. CAD was defined as a history of CAD or positive coronary imaging (computed tomography or coronary angiography).

RESULTS

Mean age was 49.6 years, and 68.1% were men. The prevalence of CAD was 25.2% (n=97) (nonobstructive, 9.6% [n=37]; and obstructive, 15.6% [n=60]). In the subsample of patients without clinical CAD but with femoral plaque on ultrasound (n=58) who underwent cardiac computed tomography, 46% (n=27) had nonobstructive CAD and 28% (n=16) had obstructive CAD. During a median follow-up of 10.1 years, 36 patients (9.4%) died, 84 (21.8%) reached a composite end point of new stroke, myocardial infarction, or death, whereas 64 (16.6%) had a composite end point of new stroke or death. Event-free survival was significantly lower in patients with obstructive CAD versus no CAD or nonobstructive CAD (log-rank P<0.001). In the multivariable Cox regression models, CAD was a strong and independent predictor of all-cause mortality (hazard ratio [HR], 2.20 [95% CI, 1.05-4.60]; P=0.037) and the composite end point of death or recurrent ischemic stroke (HR, 3.24 [95% CI, 1.46-7.20]; P=0.004).

CONCLUSIONS

In young and middle-aged ischemic stroke survivors, a quarter of patients had CAD. CAD was an independent predictor of recurrent stroke and mortality. In patients without previous CAD, but femoral plaque on ultrasound, nearly a half had nonobstructive and one-fourth had obstructive CAD. Systematic screening with cardiac computed tomography may identify high-risk patients after ischemic stroke.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT01597453.

Hypertension and Cushing's syndrome: hunt for the red flag

INTRODUCTION

The prevalence of secondary hypertension is reported to be 5-15% of people with hypertension. Causes of secondary hypertension include Cushing's syndrome (CS), a rare but serious clinical condition characterized by chronic endogenous hypercortisolism associated with increased morbidity and mortality, especially for cardiovascular complications. The challenge for the clinician is thus to identify the phenotype of hypertensive patients who should be screened for endogenous hypercortisolism.

METHODS

This study was performed according to the PRISMA statement. The search was last updated in June 2023, and only English language studies were considered. Titles and abstracts have been screened for articles selection, identifying only those that dealt with prevalence of Cushing's syndrome in hypertensive patients. Finally, eight papers were included in the review. Data regarding year of publication, populations' characteristics, inclusion criteria, screening test and cut-off used, and CS prevalence have been extracted.

RESULTS

The study search identified eight studies, from 1977 to 2020, including a total number of 11,504 patients, ranging from 80 to 4429 patients for each study. The prevalence of CS reported was variable among the studies, ranging from 0 to 7.7%, having Cushing's disease (CD) a prevalence range of 0-1.2%. The highest prevalence has been found in selected populations of hypertensive patients younger than 40 years (6.2%) or harbouring an adrenal lesion (7.7%). The most used screening test was 1 mg overnight dexamethasone suppression test (1 mg DST), with different cut-off.

CONCLUSION

The most fitting CS profile encompasses younger age (i.e., < 40 years old), rapidly evolving hypertension and the presence of adrenal adenomas, along with subjects with pituitary lesions, who should still be prioritized in the diagnostic pathway. Overall, in the case of hypertensive patients presenting a clinical picture highly suggestive of CS, it is advisable to perform one of the available screening tests (UFC, 1 mg DST, LNSC). LNSC is likely the most discriminatory test and may be preferred, depending on its availability. Conversely, for hypertensive patients with an adrenal incidentaloma, the 1 mg DST is recommended as the screening test to exclude CS.

The acute impact of resistance exercise training on cardiovascular parameters in trained and untrained adults with high blood pressure

Individuals with elevated blood pressure or stage 1 hypertension (ES1H) are recommended to engage in lifestyle modifications, including resistance exercise training (RT), to reduce blood pressure. Twenty-five adults (age = 51.4 ± 5.2 y; 15F/10 M) with ES1H who had either recently completed 9 weeks of 3 days/week RT intervention (TR; n = 12) or a non-exercise control period (UT; n = 13) completed the study. All participants had their peripheral and central systolic (SBP and cSBP) and diastolic blood pressure (DBP and cDBP), flow-mediated dilation (FMD), carotid-femoral pulse wave velocity, c-reactive protein (CRP), cardiovagal baroreflex sensitivity (BRS), resting cardiac output, resting total peripheral resistance, and heart rate variability measures including low-frequency power, high-frequency power, and root mean square of the successive differences (lnRMSSD) collected before (T1), 20-24 h after (T2), and 72-h (T3) after a single RT session. Compared to UT, TR experienced reductions in FMD from T1 to T2 (mean change: - 2.51 ± 0.55%; p = 0.012) but were protected against reductions in BRS, which was significantly lower in UT at T2 (- 1.76 ± 1.47 ms/mmHg; p = 0.019). CRP was significantly elevated in both groups at T2 compared to T1 (+ 0.61 ± 0.29 mg/L; p = 0.037), whereas DBP (+ 3.19 ± 1.6 mmHg; p = 0.003) and lnRMSSD (- 0.29 ± 0.07 ms; p = 0.015) were significantly different at T3 compared to T1. There were no other significant effects observed. Trained individuals may experience impairments in endothelial function but be protected from impairments in cardiovagal BRS during the 24 h following a resistance exercise session performed in accordance with exercise guidelines for individuals with ES1H.

Pharmacists delivering hypertension care services: a systematic review and meta-analysis of randomized controlled trials

Background

Community-based models of care with the involvement of pharmacists and other nonphysician healthcare professionals can help improve blood pressure (BP) control. We aimed to synthesize the evidence of effectiveness of pharmacist interventions on BP among patients with hypertension.

Methods

We performed systematic searches to identify randomized controlled trials (RCTs) assessing the effect of pharmacist interventions on BP among outpatients (latest search, March 2024). The effect on systolic and diastolic BP change or BP control were pooled using random effects model. Subgroup analysis for the types of pharmacist interventions and healthcare settings were performed. The risk of bias was assessed using the Cochrane Risk of Bias Tool 2. The protocol was registered in PROSPERO (CRD42021279751) and published in an open-access peer-reviewed journal.

Results

Out of 2,330 study records identified in 7 electronic databases, a total of 95 RCTs, with 31,168 participants (control 16,157, intervention 15,011), were included. The intervention was led by the pharmacist in 75% of the studies and in collaboration with other healthcare providers in 25%. Pharmacist interventions included patient education in 88%, feedback to healthcare providers in 49%, and patient reminders in 24% of the studies. Systolic and diastolic BP were reduced after pharmacist intervention by -5.3 mmHg (95% CI: -6.3 to -4.4; I 2 = 86%) and -2.3 mmHg (95% CI: -2.9 to -1.8; I 2 = 75%), respectively. The reduction of systolic BP tended to be larger if the intervention was collaborative, conducted in outpatient clinics, based on healthcare provider education, or through healthcare provider feedback. Analyses restricted to relatively large or high-quality studies yielded similar estimates, with lower between-studies heterogeneity.

Conclusion

Pharmacist care for patients with hypertension consistently improves BP across various settings and interventions. Pharmacist care is one key element of the solution to the global burden of hypertension and cardiovascular diseases.

PROSPERO registration number

CRD42021279751.

Clinical and genetic aspects of Bardet-Biedl syndrome in adults in Norway

BACKGROUND

Bardet-Biedl syndrome (BBS) is a rare nonmotile ciliopathy characterized by retinal dystrophy, polydactyly, obesity, genital anomalies, renal dysfunction, and learning difficulties. The objectives were to describe the retinal, oral, and metabolic characteristics relevant to adults with BBS as well as the prevalence of genetic variants.

METHODS

A cross-sectional study of 30 adults with BBS (15 males, 15 females, mean age 39.8 ± 13.6 years) was recruited from a single centre for rare disorders in Norway. Participants attended a one day hospital visit including medical (blood pressure, body mass index), ophthalmological and oral examinations. Blood samples were collected and genetic analyses were performed.

RESULTS

Age at diagnosis varied from one year to 30 years. The incidence of overweight/obesity, hypertension, kidney disease, and diabetes mellitus was 82%, 67%, 27%, and 23%, respectively. All had retinitis pigmentosa. Prior to the study, 14 participants (47%) had confirmed extinguished electroretinography. Eleven participants were examined with electroretinography during the study period, and all had extinguished electroretinography. 50% perceived light, 23% saw hand motion, and one participant did not perceive light. Oral anomalies were identified in 77% of the participants, including abnormal palates (58%), crowded teeth (50%), and small teeth (60%). A genetic cause was identified in all participants, most commonly in BBS1 (n = 11) and BBS10 (n = 9). Other variants were found in BBS5, BBS7, BBS9, and MKKS. In addition to exon-located variants, a novel deep intronic variant causing mis-splicing was identified in BBS7.

CONCLUSIONS

A multidisciplinary examination is important for proper management of BBS. The genotype and phenotype of this sample were heterogeneous, including kidney failure, genital anomalies and obesity. Genome sequencing increased the likelihood of identifying the genetic cause. In BBS populations, the patients will benefit from testing or reanalysis, preferably with genome sequencing, including searching for deep intronic variants.

Continuous measurement of carotid-femoral pulse wave velocity (PWVcf.) during general anaesthesia using Doppler: a preliminary study

This study explores the feasibility of continuous pulse wave velocity (PWV) monitoring during general anaesthesia (GA), particularly in response to blood pressure fluctuations. Our aim is to evaluate whether dynamic PWV can provide new insight to detect cardiovascular risks. From December 2022 to February 2023, continuous carotid and femoral Doppler monitoring was performed on patients scheduled for surgery with GA, to collect PWV data at awakening (PWVAW) and during GA (PWVGA). The study investigated PWV's response to MAP fluctuations using the α-angle, a dynamic stiffness parameter. We evaluated PWV and α-angle efficacy in discriminating between low (CVR-) and high (CVR+) cardiovascular risk patients. Among 43 patients, 41 (95%) had successful PWV measurements. PWVAW was significantly higher than PWVGA (8.1 vs. 7.4 m.s-1, p < 0.0001). This difference vanished after matching MAP levels. A strong correlation was found between PWVAW and PWVGA (r = 0.88, and r = 0.97 at the same MAP levels). PWVGA, α-angle and their product (α x PWVGA) were significantly higher in CVR + patients (8.1 vs. 6.9 m.s-1, p < 0.01; 2.6 vs. 1.3 degrees, p < 0.001; 21.8 vs. 8.1 degrees.m.s-1, p < 0.001, respectively), with AUC values indicating good predictive capabilities for cardiovascular risk (PWVGA: AUC [95%CI] = 0.80 [0.65-0.95]; α-angle: 0.83 [0.69-0.96]; product: 0.86 [0.74-0.97]). Measurement of PWV under GA using carotid and femoral Doppler is a feasible method to continuously assess arterial stiffness under general anaesthesia. Further studies are required to validate the α-angle parameter in different physiological conditions.

The link between adherence to antihypertensive medications and mortality rates in patients with hypertension: a systematic review and meta-analysis of cohort studies

BACKGROUND

Hypertension (HTN) significantly contributes to cardiovascular disease (CVD) and mortality. This systematic review and meta-analysis specifically investigates how different levels of adherence to antihypertensive therapy (AHT) affect mortality rates in HTN patients. By synthesizing cohort studies, it aims to enhance understanding and inform clinical practices to improve outcomes in hypertensive populations.

METHODS

Our meta-analysis employed a comprehensive search strategy using keywords related to hypertension, medical adherence, and mortality across PubMed, Scopus, and Web of Science, up to July 2024. The eligibility criteria focused on cohort studies linking AHT adherence to mortality. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias (ROB). Quantitative analyses involved hazard ratios (HR) and confidence intervals (CI), with an 80% adherence threshold. Subgroup and meta-regression analyses were also conducted using STATA-17 to explore various outcome factors.

RESULTS

From initial 1,999 studies 12 cohort studies included in our analysis. All included studies had low ROB score. A meta-analysis of 12 studies involving 2,198,311 patient with HTN revealed that poor adherence to treatment significantly increased all-cause mortality (HR: 1.32 [1.14, 1.51], p < 0.001) with high heterogeneity (I²: 98.73%). Additionally, an analysis of four studies with 1,695,872 patients indicated that low adherence was linked to elevated cardiovascular mortality (HR: 1.61 [1.43, 1.78], p < 0.001), showing moderate heterogeneity (I²: 49.51%).

CONCLUSIONS

The study found that poor adherence to AHT significantly increases overall and cardiovascular mortality risk, underscoring the need for improved compliance strategies. Limitations like inconsistent definitions, observational biases, and varying follow-up durations necessitate further research to validate these findings.

CLINICAL TRIAL NUMBER

Not applicable.

Evolution of cardiovascular risk factors and the risk for cardiovascular events in a Caucasian population with polycystic ovary syndrome

OBJECTIVE

To estimate the risk of cardiovascular (CV) events (primary aim) and to evaluate the long-term variation in CV risk factors in a Caucasian population of women with polycystic ovary syndrome (PCOS).

DESIGN

Matched cohort prospective study based on 10 years of follow-up.

METHODS

One hundred twenty Caucasian women with PCOS diagnosed by the National Institutes of Health criteria in reproductive age were assessed at baseline (2009) and at the end of follow-up (2020) for major and minor CV events and CV risk factors. Five controls were exactly matched by age and the presence/absence of type 2 diabetes with each participant at baseline (total number = 600) and followed up to evaluate the relative risk of PCOS for CV events. Change in epicardial fat thickness (EFT) was also analysed.

RESULTS

The mean age of patients with PCOS at follow-up was 51.9 ± 7.7 years. No major CV events were detected in PCOS patients (0% vs. 2% among controls), and the incidence of any minor CV events was 4.2% vs. 2.3% among controls (P = .340). The percentage of most CV risk factors (obesity, type 2 diabetes, hypertension, dyslipidaemia, and carotid intima media thickness ≥1 mm with or without plaques with non-critical stenosis) increased. By contrast, both short- and long-axis EFTs and smoking decreased markedly.

CONCLUSIONS

Caucasian patients with PCOS do not have an increased risk for CV events during the late reproductive or early post-menopausal period, despite the increase in most CV risk factors, except for EFT that markedly decreases. Further studies are needed to determine the role of EFT on CV risk in PCOS.

What Is New and Different in the 2024 European Society of Cardiology Guidelines for the Management of Elevated Blood Pressure and Hypertension?

In 2024, the European Society of Cardiology released a new guideline for the management of elevated blood pressure (BP) and hypertension. The guideline introduced a new BP categorization: (1) nonelevated (office BP <120/70 mm Hg) for which drug treatment is not recommended, (2) elevated (120-139/70-89 mm Hg) for which drug treatment is recommended based on cardiovascular disease risk and follow-up BP level, and (3) hypertension (≥140/90 mm Hg) for which prompt confirmation and drug treatment are recommended in most individuals. The initial default systolic BP treatment target is 120 to 129 mm Hg; however, relaxed targets (BP as low as reasonably achievable) are recommended in case of treatment intolerance, adults ≥85 years, symptomatic orthostasis, moderate-to-severe frailty, or limited life expectancy. Here, we summarize what is new and different in the 2024 European Society of Cardiology guidelines, relative to other major international hypertension guidelines in Europe and America. Our aim is to reconcile any uncertainty clinicians may have about implementing these various guidelines in patient care.

Nurse-Managed Hypertension Care in Primary Health Care Centers in Region Stockholm and Its Association With Blood Pressure Control and Key Indicators for Contractual Follow-Up

The study aimed to investigate if primary health care centers (PHCCs) offering nurse-managed hypertensive care differ from PHCCs with other types of hypertension care regarding blood pressure levels and other key indicators. In this cross-sectional study of the hypertension care given in PHCCs in Stockholm County (now called Region Stockholm), we included all 227 PHCCs in the region. To assess the extent of nurses' involvement in the PHCCs hypertension care, a questionnaire was distributed to all PHCCs in Region Stockholm. Data on blood pressure levels was collected from a primary health care quality system (Primary Care Quality). Data on key indicators regarding follow-up was obtained from the Region Stockholm database on follow-up (LUD). Blood pressure levels and LUD-data were then analyzed with regards to whether the PHCC had nurse-managed hypertension care or not. Our analysis comprised 119 267 patients diagnosed with hypertension registered in any of the regions 227 PHCCs. Of the 81 PHCCs that responded to the questionnaire, 55 reported having nurse-managed hypertension care, and 26 were classified as having non-nurse managed hypertension care, while 146 were classified as unknown type of hypertension care. There were no differences in patients reaching desired blood pressure levels between nurse-managed and non-nurse-managed hypertension care. Nurse-led hypertension care units were on par with the other types of PHCCs. Thus, nurse-led hypertension care seems to be as safe and effective as other types of hypertension care in PHCCs.

Effects of New Zealand Black Currant Extract on Exercising Substrate Utilization and Postexercise Blood Pressure in Men and Women

New Zealand black currant extract (NZBC) has been shown to increase fat oxidation during exercise and decrease the postexercise blood pressure in men and women. The change in fat oxidation by NZBC has also been shown to be correlated to body composition in men and women. There has never been a comparison of sex responses within the same study. Twenty-two participants (11 men and 11 women, age: 29 ± 8 years, maximal oxygen uptake: 44 ± 9 ml·kg-1·min-1, body fat: 18% ± 6%) had resting blood pressure measured for 2 hr (no exercise). In a double-blind, placebo-controlled (PLA), randomized crossover design, participants completed 1 hr of treadmill exercise at 50% maximal oxygen uptake with expired gas measurement, followed by 2-hr resting blood pressure measurement with 7 days of NZBC or PLA. Average fat oxidation was different between the conditions (NZBC: 0.27 ± 0.11 g/min, PLA: 0.21 ± 0.12 g/min, p < .001), but the response between men and women was not different. When combined, there was no relationship (p > .05) between body fat percentage and change in fat oxidation (r = -.079), with men also demonstrating no relationship (r = -.069), although women did demonstrate a relationship (r = .691, p < .05). In the 2-hr rest, systolic pressure delta change was larger with NZBC than PLA (no exercise vs. NZBC: -5.5 ± 5.4 mmHg vs. no exercise vs. PLA: -2.9 ± 5.1 mmHg, p < .001) but was not different between men and women. A 7-day intake of NZBC extract increases fat oxidation during moderate-intensity exercise and decreases postexercise blood pressure in men and women. The magnitude of change in fat oxidation in women is correlated to body fat percentage.

Effect of single-pill versus free equivalent combinations on persistence and major adverse cardiovascular events in hypertension: a real-world analysis

OBJECTIVES

Hypertension guidelines recommend the use of single-pill combinations (SPCs) of antihypertensive drugs to improve treatment persistence and blood pressure control. This study aimed to investigate the long-term effects of ramipril/amlodipine (R/A) SPC versus free equivalent dose combinations (FEC) on cardiovascular outcomes and treatment persistence.

METHODS

This retrospective, observational study analysed the database of the Hungarian National Health Insurance Fund. The study included patients with hypertension aged at least 18 years who were initiated on R/A SPC or FEC of different dose combinations (R/A 5/5, 5/10, 10/5 and 10/10 mg) between 2012 and 2018, with follow-up for up to 60 months. Imbalances in baseline characteristics were reduced with propensity score-based sub-classification. All analyses were performed with Cox proportional hazard model and propensity score sub-classification to adjust the imbalances in baseline characteristics. Drug persistence and MACEs were the primary and secondary endpoints, respectively.

RESULTS

Overall, 104 882 patients with SPC and 68 324 patients with FEC-treated hypertension were included. The R/A 5/5 mg combination represented the largest proportion (62%). The nonpersistence rate was significantly lower with SPC than with FEC from month 1 to month 24 in the R/A 5/5 mg combination ( P  < 0.001) and during the entire observation period in the remaining combinations. The MACE rate was significantly reduced with all R/A SPCs versus FECs. No effects on age and sex on both endpoints were noted.

CONCLUSION

This study further supports the beneficial effects of the use of SPC on 60-month persistence and MACEs in hypertension.

Blood Pressure Goals and Outcomes in Kidney Transplant Recipients in an Analysis of the Collaborative Transplant Study

Introduction

Hypertension is an independent risk factor for cardiovascular disease, the leading cause of death in kidney transplant recipients. However, optimal blood pressure targets posttransplant remain uncertain. We investigated the impact of different American College of Cardiology and the American Heart Association (ACC/AHA) blood pressure categories on graft survival and patient mortality, and analyzed subgroup-specific effects.

Methods

This large-scale retrospective study included 1-year blood pressure data from 62,556 kidney transplant recipients across 209 centers in 39 countries, using the collaborative transplant study (CTS) database. Primary outcomes were death-censored graft failure and patient mortality during first 6 years posttransplantation. Multivariable Cox regression analysis controlled for multiple immunological and nonimmunological confounders.

Results

At 1 year posttransplant, 77% of kidney transplant recipients had hypertension. We did not find a significant difference in death-censored graft failure and patient mortality between patients with normal blood pressure (< 120/< 80 mm Hg) and those with elevated blood pressure (120-129/< 80 mm Hg). Hypertension stages 1 (130-139/80-89 mm Hg) and 2 (≥ 140/≥ 90 mm Hg) were associated with an 11% and 55% increased risk of death-censored graft failure, respectively. Patient mortality was only significantly increased in those with hypertension stage 2. Kidney transplant recipients with hypertension stage 2 continued to have an increased risk of graft failure, even when they achieved normal blood pressure in the second year posttransplant. Certain subgroups of patients were at particularly high risk of detrimental effects of high blood pressure.

Conclusion

This study highlights the negative impact of hypertension early after kidney transplantation and emphasizes the importance of effective treatment to improve long-term graft and patient survival.

Individuation of a cut-off value of triglyceride-glucose index for incident diabetes mellitus in patients with essential hypertension

The prevalence of obesity and diabetes, risk factors for atherosclerotic vascular diseases, is increasing worldwide; therefore, it is desirable to early identify them to reduce cardiovascular events. Thus, we investigated whether the triglyceride-glucose index (TyG index), a new marker of insulin resistance, is associated with incident diabetes in patients with newly diagnosed arterial hypertension. We selected 585 patients with newly diagnosed arterial hypertension referred to our tertiary Clinic of Catanzaro University Hospital for the evaluation of their cardiometabolic risk profile. None of the patients had diabetes mellitus at enrollment and took any drug known to affect glucose metabolism. Patients underwent medical history collection, clinical examination and laboratory tests. The TyG index was calculated as the ln [fasting TG (mg/dl) × FPG (mg/dl)/2], as previously suggested. During the follow-up [mean 8.5 years (range 3.1-10.7)], there were 78 new cases of incident diabetes (1.57% patient-year). Patients who developed diabetes mellitus were older and had a higher body mass index (BMI), baseline blood pressure, fasting glucose, insulin, homeostatis model sssessment (HOMA) index, triglyceride, creatinine and hs-CRP mean values, while estimated glomerular filtration rate values were lower. At the Cox regression analysis, covariates significantly associated with incident diabetes were: BMI (HR = 2.842, 95%CI = 2.299-3.514), TyG index (HR = 2.392, 95%CI = 1.745-3.192), age (HR = 1.944, 95%CI = 1.527-2.474), hs-CRP (HR = 1.409, 95%CI = 1.153-1.722), and HOMA (HR = 1.325, 95%CI = 1,079-1.756). The best estimated cut-off value of TyG index in predicting diabetes was 4.71. In addition, we documented a significant relationship between TyG index and HOMA (r = 0.575; p < 0.0001). Present data demonstrate that TyG index, a simple and cost-effective marker of insulin resistance, is useful in predicting incident diabetes in patients with arterial hypertension.

Health determinants among participants in targeted health dialogues offered to all 40-year-old individuals in a metropolitan region of 1.4 million people

OBJECTIVE

To examine cardiovascular risk factors in 40-year-old participants in the health screening program targeted health dialogues (THDs).

DESIGN

Cross-sectional study.

SETTING

99 Swedish healthcare centers.

INTERVENTION

Metabolic risk factors and health behaviors were assessed. THDs were provided.

SUBJECTS

1831 (62.3%) THD participants that consented to take part in the research project.

MAIN OUTCOME MEASURES

(1) Prevalence of metabolic risk factors (blood pressure, LDL cholesterol, fasting plasma glucose, BMI, waist-hip ratio) and unhealthy behaviors (tobacco, alcohol, diet, physical activity) by sex, education, and place of birth. (2) Associations between different health behaviors and between the number of unhealthy behaviors and prevalence of metabolic risk factors. (3) THD participation by sociodemographics compared to age-matched controls.

RESULTS

Men had a higher prevalence of all metabolic risk factors, excessive alcohol use and tobacco use than women. Lower educated individuals had a higher prevalence of metabolic risk factors (except for LDL cholesterol) and tobacco use than highly educated. Participants born outside Sweden had a higher prevalence of obesity, high waist-hip ratio, and tobacco use. Participants with 3-4 unhealthy behaviors had significantly higher prevalence of each of the metabolic risk factors except BMI. Women, highly educated and Swedish-born participants were slightly over-represented in the THDs.

CONCLUSION

Considering the associations between unhealthy behaviors and metabolic risk factors, the THD method, covering lifestyle as well as objective health measures, may be an appropriate method for early identification of individuals at risk for future non-communicable diseases in the whole population with a specific focus on certain groups.

CLINICALTRIALS.GOV

NCT04912739.

Prevalence, awareness, treatment and control of hypertension in the Brazilian population and sociodemographic associated factors: data from National Health Survey

BACKGROUND

Hypertension is the main risk factor for cardiovascular diseases and more recent studies that estimated the prevalence of this condition considering aspects such as awareness of diagnosis, treatment, and control, revealing alarming results in the global scenario.

OBJECTIVE

To estimate the prevalence and assess the factors associated with hypertension prevalence, awareness, treatment, and control.

METHODS

This is a cross-sectional study based on data from the 2013 National Health Survey in Brazil. A total of 59,226 individuals of both sexes took part in this study. Exposure were defined based on blood pressure measurements, self-reported diagnosis of hypertension and use of antihypertensive medication. We estimated the prevalence of the dependent variables and the associations were subsequently tested by calculating prevalence ratios using Poisson regression.

RESULTS

The study population was composed mostly of women (52.3%), aged 36 to 59 years (42.6%), of white race/color (47.5%), with low schooling between 0 and 8 years (49.1%), having a partner (55.7%), in the urban area of the country (86.2%), mainly in the Southeast region (43.9%) and without health insurance (69.7%). The prevalence of hypertension in the Brazilian population was 32.3%. 60.8% were aware of the diagnosis, 90.6% were taking medication treatment and, of these, 54.4% had controlled blood pressure. Female gender and older age were associated with greater awareness (PR 1,34; 95% CI 1,28 - 1,40 / PR 2,40; 95% CI 2,15 - 2,69; respectively), treatment (PR 1,10; 95% CI 1,07 - 1,12 / PR 1,25; 95% CI 1,17 - 1,35; respectively) and control (PR 1,10; 95% CI 1,02 - 1,17 / PR 0,83; 95% CI 0,73 - 0,96; respectively). Other factors such as having a partner, health insurance, living in the urban area, race/color and schooling were also associated with dependent variables.

CONCLUSION

This study reveals that although a high percentage of hypertensive patients are taking medication, there are still substantial gaps in awareness and control, particularly among certain sociodemographic groups. Men, those with less schooling, black and brown people, those living in rural areas and those without health insurance have lower levels of awareness and control of hypertension.

Inter-individual differences in the blood pressure lowering effects of dietary nitrate: a randomised double-blind placebo-controlled replicate crossover trial

PURPOSE

Dietary nitrate supplementation increases nitric oxide (NO) bioavailability and reduces blood pressure (BP). Inter-individual differences in these responses are suspected but have not been investigated using robust designs, e.g., replicate crossover, and appropriate statistical models. We examined the within-individual consistency of the effects of dietary nitrate supplementation on NO biomarkers and BP, and quantified inter-individual response differences.

METHODS

Fifteen healthy males visited the laboratory four times. On two visits, participants consumed 140 ml nitrate-rich beetroot juice (~ 14.0mmol nitrate) and, on the other two visits, they consumed 140 ml nitrate-depleted beetroot juice (~ 0.03mmol nitrate). Plasma nitrate and nitrite concentrations were measured 2.5 h post-supplementation. BP was measured pre- and 2.5 h post-supplementation. Between-replicate correlations were quantified for the placebo-adjusted post-supplementation plasma nitrate and nitrite concentrations and pre-to-post changes in BP. Within-participant linear mixed models and a meta-analytic approach estimated participant-by-condition treatment response variability.

RESULTS

Nitrate-rich beetroot juice supplementation elevated plasma nitrate and nitrite concentrations and reduced systolic (mean:-7mmHg, 95%CI: -3 to -11mmHg) and diastolic (mean:-6mmHg, 95%CI: -2 to -9mmHg) BP versus placebo. The participant-by-condition interaction response variability from the mixed model was ± 7mmHg (95%CI: 3 to 9mmHg) for systolic BP and consistent with the treatment effect heterogeneity t = ± 7mmHg (95%CI: 5 to 12mmHg) derived from the meta-analytic approach. The between-replicate correlations were moderate-to-large for plasma nitrate, nitrite and systolic BP (r = 0.55 to 0.91).

CONCLUSIONS

The effects of dietary nitrate supplementation on NO biomarkers and systolic BP varied significantly from participant to participant. The causes of this inter-individual variation deserve further investigation.

TRIAL REGISTRATION

https://clinicaltrials.gov/study/NCT05514821 .

Digital Transformation in Cardiology - Mobile Health

The World Health Organization recognizes digital health as a key driver for sustainable health systems. Digital health is broad concept that refers to the use of digital technologies to improve health and healthcare. Mobile health is part of digital health and refers to the use of mobile devices such as smartphones, tablets, and wearable gadgets to deliver health-related services. By proactively utilizing personal health records from mHealth, in conjunction with electronic health records, advanced medical practices can be achieved. This integration facilitates app-based patient education and encouragement, lifestyle modification, and efficient sharing of medical information between hospitals. Beyond emergency care, information sharing enables patients to visit multiple healthcare facilities without redundant tests or unnecessary referrals, reducing the burden on both patients and healthcare providers.

Association between Life's essential 8 and mortality among individuals with hypertension

The "Life's Essential 8" (LE8) score is an assessment of cardiovascular health recently introduced by the American Heart Association. This study aimed to explore the correlation of the total LE8 score and its individual metrics with all-cause and cardiovascular disease (CVD) mortality in patients with hypertension. Data from 10,556 hypertension adults were retrieved from National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. After a median follow-up of 6.75 years, patients with high LE8 scores (≥ 75 points) showed significantly lower mortality rates from all causes and CVD (P < 0.001). Cox regression analysis indicated that high LE8 scores were associated with a 40% lower risk of all-cause [0.60(0.50-0.73)] and CVD mortality [0.60(0.43-0.83)] compared to low scores. As the total LE8 score increased linearly, the likelihood of all-cause and CVD mortality decreased, with a potential threshold at 60 points. Subgroup analyses revealed that diet, sleep, nicotine exposure, physical activity, and blood glucose control affected both types of mortality. The LE8 score was negatively correlated with the risks of all-cause and CVD mortality in hypertensive patients. Life interventions and management of physical indicators based on the LE8 score may be an effective way to improve mortality in hypertensive patients.

Serum uric acid, renal function and prognosis in patients with chronic heart failure and reduced ejection fraction. Insights from the Italian Network on Heart Failure

BACKGROUND

The role of hyperuricemia on short-term clinical prognosis in outpatients with heart failure and reduced ejection fraction (HFrEF) has few investigations and inconclusive results. We evaluated the prognostic impact of serum uric acid (SUA) on short-term clinical outcome among ambulatory patients with chronic HFrEF enrolled in a nationwide cardiology registry, stratified by the presence of chronic renal dysfunction (CKD).

METHODS

2246 outpatients with LVEF ≤40 %, vital status at 1-year follow-up known, and with SUA and creatinine available were stratified accordingly to SUA tertiles (≤5.6 5.7-7.3, >7.3 mg/dl) and by CKD as defined by an estimated glomerular filtration rate < 60 ml/min/1.73m2.

RESULTS

Patients in the 2nd and 3rd SUA tertile were older, more symptomatic (NYHA class III-IV), with a lower EF, higher creatinine and heart rate. They had more commonly atrial fibrillation and CKD. At 1-year follow-up, patients in the 2nd and 3rd SUA levels tertile had an increased risk of cardiovascular death and/or HF hospitalization than those in the first tertile (HR 1.72 95 % CI 1.26-2.35, and HR 2.20 95 % CI 1.63-2.97, respectively). After multivariable adjustment, SUA was no longer associated with adverse outcome in the overall cohort. When the multivariable analysis was separately performed in patients with or without CKD, SUA was independently associated with cardiovascular death/HF hospitalization (p = 0.02) only in the latter group.

CONCLUSIONS

Mildly to moderately elevated SUA levels are associated to one-year survival in outpatients with HFrEF, but hyperuricemia resulted an independent marker of outcome only in patients without CKD.

Association of Mediterranean Diet with Cardiovascular Risk Factors and with Metabolic Syndrome in Subjects with Long COVID: BioICOPER Study

BACKGROUND

Long COVID has been associated with increased cardiovascular risk and chronic low-grade inflammation, raising concerns about its long-term metabolic consequences. Given that the Mediterranean diet (MD) has shown beneficial effects on cardiovascular risk factors and inflammation in various populations, it is important to explore its potential impact on individuals with Long COVID. Therefore, the aim is to determine the association of the MD with cardiovascular risk factors (CVRF) and metabolic syndrome (MetS) in Caucasian subjects diagnosed with Long COVID.

METHODS

Cross-sectional study, 305 subjects diagnosed with Long COVID were included following the WHO criteria. Adherence to MD was evaluated with the MEDAS (Mediterranean Diet Adherence Screener) with 14 items used in Prevention with Mediterranean Diet study (PREDIMED study). The criteria considered to diagnose MetS were blood pressure, glycemia, triglycerides, HDL cholesterol, and waist circumference. Other CVRFs considered were tobacco consumption, total cholesterol, LDL cholesterol, body mass index, and baseline uric acid levels. The association between MD with CVRF and the number and components of MetS was analyzed using multiple regression models and multinomial regression.

RESULTS

The mean age was 52.75 ± 11.94 years (men 55.74 ± 12.22 and women 51.33 ± 11.57; p = 0.002), (68% women). The mean of the MEDAS questionnaire was 7.76 ± 2.37. The presented MetS were 23.6% (39.8% men and 15.9% women p < 0.001). In the multiple regression analysis, after adjusting for age and average time from acute COVID-19 infection to the date of inclusion in this study, the mean MD score showed a negative association with uric acid (β = -0.295; 95% CI: -0.496 to -0.093), BMI (β = -0.049; 95% CI: -0.096 to -0.002), the number of MetS components (β = -0.210; 95% CI: -0.410 to -0.010), and waist circumference (WC) (β = -0.021; 95% CI: -0.037 to -0.003) and a positive association with HDL cholesterol (β = -0.018; 95% CI: 0.001 to -0.037).

CONCLUSIONS

The findings of this study suggest that higher Mediterranean diet scores are associated with lower levels of uric acid, fewer MetS components, smaller waist circumference, and higher HDL cholesterol levels in individuals with Long COVID.

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.

Smoking Cessation and the Odds of Developing Hypertension in a Working-Age Male Population: The Impact of Body Weight Changes

BACKGROUND

Smoking elevates blood pressure (BP) whereas smoking cessation increases body weight (BW), which predisposes new quitters to the development of hypertension. This study aimed to investigate the effect of smoking cessation and subsequent BW change on the odds of developing hypertension.

METHODS

A total of 10,354 Japanese male workers (mean age, 38.4 ± 8.8 years) without hypertension who underwent a baseline annual medical checkup were followed up for three years to detect the development of hypertension. They were divided into six groups according to their smoking status (nonsmokers, new quitters, or continuous smokers) and BW change (≥3 kg or <3 kg) during the follow-up period. Logistic regression analysis was used to calculate odds ratio (OR) for developing hypertension.

RESULTS

During the follow-up period, 1,032 participants developed hypertension. After adjusting for multiple potential confounders, the odds of developing hypertension were significantly higher in new quitters with BW gains ≥ 3 kg (OR, 2.95, 95% confidence interval [CI], 1.37-6.35) compared to nonsmokers with BW gains < 3 kg. However, increased odds of developing hypertension were not observed in those with BW gains < 3 kg (OR, 0.90, 95% CI, 0.52-1.58). Continuous smokers were at increased odds of developing hypertension regardless of their BW changes (BW gain < 3 kg, OR, 1.35, 95% CI, 1.13-1.61 vs. BW gain ≥ 3 kg, OR, 1.90, 95% CI, 1.43-2.52).

CONCLUSIONS

The odds of developing hypertension were increased in new quitters only when their BW gain was not controlled after smoking cessation.

Second Derivative of the Finger Photoplethysmogram Predicts the Risk of Developing Hypertension in Middle-Aged Men

AIM

Increased arterial stiffness impairs the functional and structural properties of arteries, which in turn elevates blood pressure (BP). The aim of this study was to test whether indices obtained from the second derivative of the finger photoplethysmogram (SDPTG), a marker of arterial stiffness, predict future development of hypertension in middle-aged men.

METHODS

The SDPTG was measured in 902 men without hypertension (mean age 44±6 years) at an annual medical checkup. The development of hypertension was monitored for a maximum of 4 years. Two indices of arterial stiffness were calculated from the SDPTG waveforms: b/a, an index of large elastic arterial stiffness, and d/a, an index of systemic arterial stiffness, including the structural and functional properties of small and muscular arteries and peripheral circulation. A Cox proportional hazards model was used to examine whether the b/a and d/a ratios were independent predictors of future development of hypertension.

RESULTS

During the follow-up period, 124 individuals developed hypertension, defined as a systolic/diastolic BP ≥ 140/90 mm Hg or the use of antihypertensive medications. The hazard ratio for the development of hypertension significantly increased in the lowest quartile of the d/a ratio (2.84, 95% confidence interval: 1.58-5.13, p＜0.001) compared with the highest quartile, after adjusting for multiple potential confounders. In contrast, the b/a ratio did not show significant hazard ratios for the development of hypertension.

CONCLUSIONS

The d/a ratio, calculated from the SDPTG waveforms, predicted the risk of future development of hypertension in this study population.

Assessment of cardiovascular risk and physical activity: the role of cardiac-specific biomarkers in the general population and athletes

The first part of this Inter-Society Document describes the mechanisms involved in the development of cardiovascular diseases, particularly arterial hypertension, in adults and the elderly. It will also examine how consistent physical exercise during adolescence and adulthood can help maintain blood pressure levels and prevent progression to symptomatic heart failure. The discussion will include experimental and clinical evidence on the use of specific exercise programs for preventing and controlling cardiovascular diseases in adults and the elderly. In the second part, the clinical relevance of cardiac-specific biomarkers in assessing cardiovascular risk in the general adult population will be examined, with a focus on individuals engaged in sports activities. This section will review recent studies that suggest a significant role of biomarkers in assessing cardiovascular risk, particularly the presence of cardiac damage, in athletes who participate in high-intensity sports. Finally, the document will discuss the potential of using cardiac-specific biomarkers to monitor the effectiveness of personalized physical activity programs (Adapted Physical Activity, APA). These programs are prescribed for specific situations, such as chronic diseases or physical disabilities, including cardiovascular diseases. The purposes of this Inter-Society Document are the following: 1) to discuss the close pathophysiological relationship between physical activity levels (ranging from sedentary behavior to competitive sports), age categories (from adolescence to elderly age), and the development of cardiovascular diseases; 2) to review in detail the experimental and clinical evidences supporting the role of cardiac biomarkers in identifying athletes and individuals of general population at higher cardiovascular risk; 3) to stimulate scientific societies and organizations to develop specific multicenter studies that may take into account the role of cardiac biomarkers in subjects who follow specific exercise programs in order to monitor their cardiovascular risk.

Impact of Initial Heart Rate, Diastolic Pressure, and Pulse Pressure on Prognostic Outcomes in Heart Failure Patients with Mildly Reduced Ejection Fraction

Background

Heart rate, diastolic pressure, and pulse pressure are key modifiable factors influencing heart failure prognosis. While heart failure with mildly reduced ejection fraction (HFmrEF) is a distinct subgroup of heart failure, the prognostic impact of these hemodynamic parameters in this population remains unclear, necessitating focused investigation. This study aims to elucidate their effects on HFmrEF patient outcomes.

Methods

We retrospectively analyzed 1,653 hFmrEF patients treated at Xiangtan Central Hospital (2015-2020). Using decision tree classification, patients were categorized based on initial heart rate (≤77 bpm and >77 bpm). The ≤77 bpm group was further divided by pulse pressure (≤37 mmHg and >37 mmHg), and the >77 bpm group by diastolic pressure (≤63 mmHg, 63-100 mmHg, and >100 mmHg). Multivariate COX regression assessed mortality associations.

Results

With a median follow-up of 33 months, overall mortality was 21.7% for heart rates ≤77 bpm and 30.4% for >77 bpm. Multivariate COX regression showed that among patients with heart rates ≤77 bpm, those with pulse pressure >37 mmHg had a higher mortality risk than those with pulse pressure ≤37 mmHg (HR 3.184; 95% CI 1.008-10.058; p=0.048). For patients with heart rates >77 bpm, those with diastolic pressure 63-100 mmHg had a lower mortality risk compared to ≤63 mmHg (HR=0.652, 95% CI: 0.450-0.943, p=0.023), with the lowest risk in patients with diastolic pressure >100 mmHg (HR=0.370, 95% CI: 0.205-0.666, p=0.001).

Conclusion

This study highlights that HFmrEF patients with heart rates ≤77 bpm and pulse pressure ≤37 mmHg had the lowest mortality risk, while those with heart rates >77 bpm and diastolic pressure ≤63 mmHg faced the highest risk. These findings provide valuable insights for risk stratification and may guide personalized management of HFmrEF patients.

The Effects of a Food Supplement, Based on Co-Micronized Palmitoylethanolamide (PEA)-Rutin and Hydroxytyrosol, in Metabolic Syndrome Patients: Preliminary Results

BACKGROUND

Metabolic syndrome (MetS) patients have impaired hypothalamic regulatory functions involved in food intake and energy expenditure and suffer from a state of meta-inflammation. Pre-clinical studies demonstrated that ultramicronized palmitoylethanolamide (PEA) acts both on the adipose tissue and the central nervous system, while hydroxytyrosol (HTyr) counteracts several types of dysmetabolism.

OBJECTIVES

The aim of our randomized crossover double-blind placebo-controlled pilot study was to evaluate the potential effects of a food supplement (FS) containing a co-micronized formulation of PEA and rutin along with HTyr, combined with a tailored calorie-controlled Mediterranean diet, in patients with MetS.

METHODS

Nineteen patients were enrolled and block-randomized to an eight-week MD together with the FS or placebo. After a two-week washout period, the treatments were reversed. Data on laboratory parameters and those detected by capillary sampling, anthropometry, body composition analysis, ultrasound examination, blood pressure monitoring, the 36-Item Short-Form Health Survey questionnaire, handgrip strength test, and physical performance tests were collected at each time point (protocol code R.S. 262.22, registered on 20 December 2022).

RESULTS

At the end of the study, patients supplemented with the FS showed a significant reduction in body weight, body mass index, fat mass, and inflammation biomarkers (CRP and ESR), compared to placebo-supplemented patients. In contrast, the fat-free mass, phase angle, and body cell mass were increased in FS compared to placebo patients.

CONCLUSIONS

Although preliminary, the results of our clinical study suggest that co-micronized PEA-rutin and HTyr may be of help against adiposopathy in patients with MetS.

High prevalence of unrecognized chronic kidney disease in the Lolland-Falster Health Study: a population-based study in a rural provincial area of Denmark

Chronic kidney disease (CKD) affects 10-15% globally and is a marked independent risk factor for cardiovascular disease. Prevalence estimations are essential for public health planning and implementation of CKD treatment strategies. This study aimed to estimate the prevalence and stages of CKD in the population-based Lolland-Falster Health Study, set in a rural provincial area with the lowest socioeconomic status in Denmark. Additionally, the study characterized participants with CKD, evaluated the overall disease recognition, including the awareness of CKD and compared it with other common conditions. Cross-sectional data were obtained from clinical examinations, biochemical analyses, and questionnaires. CKD was defined as albuminuria (urine albumin-creatinine ratio ≥30 mg/g), estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m², or by a diagnosis in the National Patient Register. Patient awareness was assessed by self-reported CKD, and overall disease recognition by either a registered hospital diagnosis or self-reported CKD. Among 16 097 adults (median age 58.6 years), CKD prevalence was 18.0% (n = 2903), with 70.1% identified by albuminuria, 28.4% by reduced eGFR, and 1.5% by a registered diagnosis alone. Of those with CKD, 98.8% had stages 1-3 (eGFR ≥30 ml/min/1.73 m²), and 1.2% had stages 4-5 (eGFR <30 ml/min/1.73 m²). Female sex, comorbidities, smoking, and low socioeconomic parameters were independently associated with CKD. Patient awareness of CKD was 4.4%, compared to >50% for hypertension and >80% for diabetes, and the overall CKD recognition (self-reported or registered diagnosis) was 7.1%. Thus, in this population-based study, CKD was highly prevalent but poorly recognized, indicating great potential for preventing CKD progression and related complications.

Enhancing indoor air quality and cardiopulmonary health in patients with asthma by photocatalytic oxidation and filters air cleaner

BACKGROUND

Air purifiers can enhance indoor air quality and health outcomes, and studies have primarily focused on filters and particulate matter (PM) in households. Photocatalytic oxidation (PCO) is a promising technique for eliminating gaseous pollutants and bioaerosols. However, no field study was conducted in household. Therefore, this study evaluated the effects of the PCO and PCO + filters intervention on indoor air pollutants and cardiopulmonary endpoints in households.

METHODS

A randomized, double-blind crossover clinical trial was conducted. Indoor air pollutants, including PM, bioaerosols, and gaseous pollutants and cardiopulmonary endpoints including lung function, fractional exhaled nitric oxide (FeNO), respiratory symptoms, and blood pressure were assessed before and after intervention.

FINDINGS

This was the first study to evaluate the effects of PCO and PCO + filters interventions on indoor air pollutants and cardiopulmonary health in households. Indoor total volatile organic compounds (TVOC) and sulfur dioxides (SO2) significantly reduced after PCO intervention, however, we also observed the significant reduction in percentage of predicted values of forced vital capacity (FVC%) and forced expiratory volume in 3 s (FEV3%) and increased in FeNO after 13 days of PCO intervention. The PCO + filters intervention significantly reduced the levels of indoor PM1, PM2.5, PM4, PM10, total suspended particulate matter, ultrafine particles, airborne bacteria, fungi, endotoxin, mites, TVOC, nitrogen dioxide, and SO2, and marginal reduction in carbon monoxide. However, indoor carbon dioxide significantly increased after PCO/PCO + filters intervention. As for cardiopulmonary health, FVC%, and FEV1 % marginally increased 7 days after the PCO + filters intervention.

Correlation analysis of estimated pulse wave velocity and severe abdominal aortic calcification: based on the National Health and Nutrition Examination Survey database

Objective.To investigate how severe abdominal aortic calcification (SAAC) and estimated pulse wave velocity (ePWV) relate to each other and to all-cause and cardiovascular disease (CVD) mortalities.Approach.National Health and Nutrition Examination Survey 2013-2014 data were analyzed. ePWV, computed using age and mean blood pressure, served as an independent variable. Dependent variable SAAC (AAC score >6) was quantified using dual-energy x-ray absorptiometry and Kauppila grading. A weighted logistic regression model, interaction terms, and restricted cubic spline analysis examined relationship between ePWV and SAAC. Kaplan-Meier curves were drawn among SAAC people. A weighted Cox regression model was built to examine associations of ePWV with all-cause and CVD mortalities.Main results.2849 individuals were included. A strong positive connection (odds ratio (OR) > 1,P< 0.05) was seen between ePWV and SAAC risk. Interaction termP-value indicated that only ethnicity (P< 0.05) had an impact on this link but smoking, alcohol use, age, sex, body mass index, or hypertension did not. SAAC patients showed greater ePWV, all-cause and CVD mortalities (P< 0.05) than non-SAAC subjects. Greater ePWV (>12.00 m s-1) was associated with higher risks of all-cause and CVD mortalities in SAAC participants (hazard ratio (HR) > 1,P< 0.05). Significance.This study, for the first time based on the NHANES database, reveals a positive correlation between ePWV and SAAC, and identifies ePWV as an independent predictor of all-cause and cardiovascular mortality risk in patients with SAAC, providing a new biomarker for the prevention and early intervention of cardiovascular diseases.

Association Between Serum Essential Metal Elements and Blood Pressure in Children: A Cohort Study

A limited number of cohort studies have explored the impact of serum essential metal elements on blood pressure (BP) or glycolipids and their regulatory mechanism in children. This study aimed to investigate the relationship between serum metal concentrations of iron (Fe), zinc (Zn), calcium (Ca), copper (Cu), and magnesium (Mg) and BP in children, and explore the potential mediating effects of glycolipid profiles. This cohort study included 1993 children (3566 BP measurements) aged 6-14 years in Chongqing, China. Serum essential metals, BP, lipid profiles, and glucose and insulin levels were measured. The relationship between serum metal levels and BP was analyzed using generalized linear and regression models, and a mediation analysis was performed to examine the potential mediating role of glycolipids. After adjusting for confounders, positive associations were found between serum Fe and Zn levels and BP parameters (all P < 0.05). A "U" style relationship between Cu and BP was found. Stronger associations were found in children aged ≤ 10 years, with sex-specific differences for Fe, Zn, and Cu. The relationship between elevated BP and serum Mg and Ca was not found. Our study found that triglycerides showed a significant relationship with Fe and Zn levels (P < 0.005). Moreover, triglycerides, partially mediate the effects of Zn on elevated BP. Serum Fe, Zn, and Cu concentrations were associated with BP in children, and age and sex differences were observed. Triglycerides may play a mediating role. These findings highlight the importance of maintaining an optimal serum essential metal status for cardiovascular health in children and suggest potential early prevention strategies.

Connection between oral health and chronic diseases

Chronic diseases have emerged as a paramount global health burden, accounting for 74% of global mortality and causing substantial economic losses. The oral cavity serves as a critical indicator of overall health and is inextricably linked to chronic disorders. Neglecting oral health can exacerbate localized pathologies and accelerate the progression of chronic conditions, whereas effective management has the potential to reduce their incidence and mortality. Nevertheless, limited resources and lack of awareness often impede timely dental intervention, delaying optimal therapeutic measures. This review provides a comprehensive analysis of the impact of prevalent chronic diseases-such as diabetes mellitus, rheumatoid arthritis, cardiovascular disorders, and chronic respiratory diseases-on oral health, along with an exploration of how changes in oral health affect these chronic conditions through both deterioration and intervention mechanisms. Additionally, novel insights into the underlying pathophysiological mechanisms governing these relationships are presented. By synthesizing these advancements, this review aims to illuminate the complex interrelationship between oral health and chronic diseases while emphasizing the urgent need for greater collaboration between dental practitioners and general healthcare providers to improve overall health outcomes.

Impact of Mediterranean Diet Adherence on the Incidence of New-Onset Hypertension in Adults With Obesity in Korea: A Nationwide Cohort Study

This study investigated the association between adherence to the Mediterranean diet (MD) and new-onset hypertension (HTN) in a cohort of community-dwelling, middle-aged, older Korean individuals with obesity. We used data from the Korean Genome and Epidemiology Study, a population-based prospective cohort study. The Korean version of the MD Adherence Screener was used to evaluate compliance with the MD. The primary endpoint was the incidence of new-onset HTN. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval for HTN incidence with increasing MD adherence. Data from 1995 participants with obesity without HTN at baseline were analyzed. After adjusting for confounders, participants with moderate (Group 2) and high adherence (Group 3) to the MD had HRs for new-onset HTN of 0.72 (0.57-0.90) and 0.73 (0.56-0.95), respectively, compared with those with low adherence (Group 1). Sex and age differences were associated with MD adherence and HTN incidence. The association between MD adherence and HTN incidence was only significant in males and in participants aged 40-64 years. There was no significant association between MD adherence and new-onset HTN in females or those aged ≥ 65 years. In conclusion, this study found a significant association between adherence to the MD and a reduction in new-onset HTN in Korean adults with obesity. Considering its value and sustainability, the adoption of the MD may contribute to the prevention of new-onset HTN in populations with obesity.

As-Needed Blood Pressure Medication and Adverse Outcomes in VA Hospitals

Importance

Asymptomatic blood pressure (BP) elevations in the hospital are commonly treated with as-needed BP medications, including recurring as-needed and 1-time administration. Veterans represent a population at risk of ischemic events from rapid lowering of BP, but the impact of as-needed BP medication use in this population is unknown.

Objective

To assess the risks of acute kidney injury (AKI) and other outcomes from as-needed BP medication administration in a hospitalized veteran cohort.

Design, Setting, and Participants

This retrospective cohort study using target trial emulation and propensity score matching included adult veterans, who were hospitalized 3 or more days in Veterans Administration hospitals between October 1, 2015, and September 30, 2020. Participants must have been hospitalized on a non-intensive care unit medical or surgical floor, must not have undergone surgery, and must have received at least 1 scheduled BP medication in the first 24 hours of admission. Participants also must have had at least 1 systolic BP more than 140 mm Hg during hospitalization. Data in this study were analyzed from April 2023 to August 2024.

Main Outcomes and Measures

The primary outcome was time to first AKI occurrence during hospitalization. Secondary outcomes included greater than 25% reduction in systolic BP within 3 hours of as-needed BP medication administration and the composite outcome of myocardial infarction, stroke, or death during hospitalization.

Results

Of the 133 760 veterans eligible for analysis (mean [SD] age, 71.2 [11.6] years), 96% were male. The mean (SD) baseline estimated glomerular filtration rate was 75.7 (22.7) mL/min/1.73m2. A total of 28 526 patients (21%) received as-needed BP medication. As-needed BP medication use was associated with an increased AKI risk (adjusted hazard ratio, 1.23 [95% CI, 1.18-1.29]) compared to nonusers. Subgroup analyses showed higher AKI risk with intravenous as-needed BP medication use (compared to oral or combined oral and intravenous routes). Secondary analyses indicated as-needed BP medication users had a 1.5-fold greater risk of rapid BP reduction (95% CI, 1.39-1.62) and 1.69-fold higher rate of the composite outcome (95% CI, 1.49-1.92) compared to nonusers.

Conclusions and Relevance

The results of this retrospective cohort study showed that as-needed BP medication use among veterans is associated with increased AKI risk. The risks and benefits of this type of BP medication use would best be determined through a prospective trial, and these data suggest that there is the necessary equipoise to conduct such a trial.

Subsequent high blood pressure and hypertension by hypertensive disorders of pregnancy: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

Hypertensive disorders of pregnancy can cause hypertension in the future. Understanding how the blood pressure values of women with and without hypertensive disorders of pregnancy differ will facilitate follow-up blood pressure monitoring in clinical settings. This study investigated the association between hypertensive disorders of pregnancy and subsequent high blood pressure and hypertension. This study used Japanese data from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Follow-up systolic and diastolic blood pressures in normotensive women during pregnancy and those with hypertensive disorders of pregnancy were estimated using analysis of covariance adjusted for women with low birthweight, history of gestational diabetes mellitus, age, body mass index, pulse rate, smoking and drinking at the follow-up assessment, paternal hypertension history, and maternal hypertension or hypertensive disorders of pregnancy history. Finally, we performed a multiple logistic regression analysis. In total, 7343 women were included in the analysis. Women with a history of hypertensive disorders of pregnancy had higher blood pressure approximately three years postpartum compared with normotensive women. Hypertensive disorders of pregnancy in the most recent pregnancy in different subgroups, such as nulliparous women, multiparous women without a history of hypertensive disorders of pregnancy, and multiparous women with a history of hypertensive disorders of pregnancy, were associated with an increased risk of subsequent hypertension. Women's birthweight was also weakly associated with hypertension. Even one experience of hypertensive disorders of pregnancy may contribute to elevated blood pressure and hypertension approximately three years postpartum. In addition, women's birthweights may have a weak relationship with increasing blood pressure.

Course of brain damage following malignant hypertension

Malignant hypertension (MHT) crisis triggers widespread microvascular damage, particularly in the brain. Despite recent MRI evidence highlighting acute cerebral injuries during MHT crises, follow-up data remain scarce. This study seeks to fill this gap by exploring how brain MRI markers evolve following acute MHT crisis management. We conducted a retrospective analysis of brain MRI data from MHT patients admitted to Bordeaux University Hospital between 2008 and 2022. Eligible patients had at least one follow-up MRI. Analysis blinded to clinical data was performed to identify markers of posterior reversible encephalopathy syndrome (PRES), acute stroke, cerebral hemorrhage, and microangiopathy. Out of 149 patients, 47 had follow-up MRIs. Most were male (72.3%) with a mean age of 48.2 ± 10.8 years. The median interval between initial and follow-up MRI was 228 days. Follow-up MRIs revealed new strokes in 10.6% of patients, cerebral hemorrhages in 4.3%, and no cases of PRES. Additionally, more patients exhibited chronic lacunar infarcts and/or microbleeds, with overall Fazekas scores remaining stable in 66.0%, improving in 31.9%, and worsening in 2.1%. Subgroup analyses based on blood pressure control or follow-up duration showed no significant differences in MRI markers. This study sheds light on the risk of new cerebrovascular events and the dynamic changes in brain MRI markers following acute MHT crisis management. Understanding these changes could lead to improved diagnosis, personalized treatment strategies, and proactive patient care for individuals with MHT.