Comparison of Risk of Target Organ Damage in Different Phenotypes of Arterial Stiffness and Central Aortic Blood Pressure

The Role of Carotid-Femoral Pulse Wave Velocity in a Metabolic Syndrome Patient with Sudden Cardiac Arrest: A Case Report

INTRODUCTION

Carotid-femoral pulse wave velocity reflecting aortic stiffness could be used as an independent predictor of future cardiovascular events for an individual with metabolic syndrome. However, the routine use of carotid-femoral pulse wave velocity is suboptimized in clinical practice. We report a case of metabolic syndrome with increased carotid-femoral pulse wave velocity and subsequently developed myocardial infarction and sudden cardiac arrest.

CASE PRESENTATION

A Polish man of an age between 40 and 50 years previously diagnosed with metabolic syndrome with essential hypertension, obesity, dyslipidaemia, and impaired glucose level. He developed myocardial infarction, ventricular fibrillation, and was successfully resuscitated with defibrillation. The patient showed high-normal traditional cardiovascular risk factors but an increased carotid-femoral pulse wave velocity. The increased carotid-femoral pulse wave velocity is associated with an increased arterial stiffness, which altered the myocardial perfusion and induced the anterior-lateral ST elevation myocardial infarction. The patient actively participated and completed the phase II cardiac rehabilitation programme. To the best of our knowledge, there have been few studies on carotid-femoral pulse wave velocity screening for patients with metabolic syndrome. Pulse wave velocity screening by a physician appears to be helpful in identifying the potential high-risk population with borderline traditional cardiovascular risk factors.

CONCLUSION

This trajectory highlights the clinical relevance of using carotid-femoral pulse wave velocity as an adjunct marker to assess the risk of cardiovascular event for patients with metabolic syndrome.

Central diastolic blood pressure, plasma aldosterone and uric acid are associated with microalbuminuria in essential hypertension: a case-control study

OBJECTIVE

To study the development of microalbuminuria (MAU) in essential hypertension (EHT), we investigated the association of MAU with central blood pressure (CBP), direct renin concentration (DRC), plasma aldosterone (PA), and uric acid (UA).

METHOD

We determined 24 h-urinary albumin excretion (24 h-UAE) in patients with EHT who were hospitalized at TEDA International Cardiovascular Hospital from June 2020 to May 2022. We defined MAU as 24 h-UAE in the range of 30 mg/24 h to 300 mg/24 h. Univariate and multivariate analyses were conducted to determine the associations of MAU with CBP, DRC, PA, and UA in EHT, considering demographic and clinical information. We also plotted receiver operating characteristic curves (ROCs) for predicting MAU using these results.

RESULTS

More than a quarter of patients (26.5%, 107/404, 95% CI: 22.2-31.1%) were diagnosed with MAU in EHT. A higher body mass index (BMI), longer duration of hypertension, and higher severity were associated with MAU. Also, nearly 10% more creatinine levels were recorded in the MAU group than in the control group (69.5 ± 18.7 µmol/L vs. 64.8 ± 12.5 µmol/L, P = 0.004). The increase was also observed for PA (15.5, 9.7-20.6 ng/dL vs. 12.3, 9.0-17.3 ng/dL, P = 0.024) and UA (419.8 ± 105.6 µmol/L vs. 375.1 ± 89.5 µmol/L, P < 0.001) in the MAU group compared to that in the control group. Several variables were associated with MAU, including central diastolic blood pressure (CDBP) (OR = 1.017, 95% CI: 1.002-1.032, P = 0.027), PA (OR = 1.043, 95% CI: 1.009-1.078, P = 0.012) and UA (OR = 1.005, 95% CI: 1.002-1.008, P < 0.001). For MAU prediction, the area under the curve (AUC) was 0.709 (95% CI: 0.662-0.753; P < 0.001) when CDBP, PA, and UA were used in combination, and the optimal probability of the cut-off value was 0.337.

CONCLUSION

We found that CDBP, PA, and UA, used for MAU prediction, might be associated with its development during EHT.

Therapeutic concordance improves blood pressure control in patients with resistant hypertension

INTRODUCTION

An empathetic approach may be particularly useful in patients with therapy-resistant hypertension (TRH), defined as the failure to achieve target blood pressure (BP) despite a maximal doses of 3 antihypertensive drugs including a diuretic. However, the effects of therapeutic concordance have not been determined in hypertensive patients.

METHODS

We designed a study to explore the impact of therapeutic concordance in patients with TRH, who were included in an intervention arm based on a protocol in which trained personnel periodically verified the pharmacological regimen of these patients.

RESULTS

From a cohort of 5331 hypertensive patients followed-up for 77.64 ± 34.44 months, 886 subjects were found to have TRH; of these, 322 had apparent TRH (aTRH: uncontrolled office BP but optimal home BP) and 285 refused to participate in a second follow-up study, yielding a population of 279 patients with true TRH (tTRH). These tTRH patients were followed according to the therapeutic concordance protocol for 91.91 ± 54.7 months, revealing that 210 patients (75.27%) remained with uncontrolled BP (uncontrolled tTRH, Group I) while 69 patients (24.73%) reached an optimal BP control (average BP <140/90 mmHg in at least 50% of follow-up visits, Group II). Strikingly, at the end of the second follow-up, the percentage of patients displaying a decline in kidney function was significantly smaller in Group II than in Group I (8.5% vs 23.4%, p < 0.012).

CONCLUSIONS

Taken together, our findings indicate for the first time that therapeutic concordance significantly improves the outcome of antihypertensive treatment in a population of patients with TRH.