High Blood Pressure & Cardiovascular Prevention最新文献

Introduction: A strong and well-known association exists between salt consumption, potassium intake, and cardiovascular diseases. MINISAL-SIIA results showed high salt and low potassium consumption in Italian hypertensive patients. In addition, a recent Italian survey showed that the degree of knowledge and behaviour about salt was directly interrelated, suggesting a key role of the educational approach.

Aim: The present multicentre randomised controlled trial study aimed to evaluate the efficacy of a short-time dietary educational intervention by a physician, only during the first visit, on sodium and potassium intake in hypertensive patients.

Methods: Two-hundred-thirty hypertensive subjects participating in the MINISAL-SIIA study were enrolled for this study. After the randomisation, the participants were stratified into the educational intervention (EI) group (n = 109) and control group (C) (n = 121). Anthropometric indexes and blood pressure (BP) measurements were taken in the single-centre, and 24-hour urinary sodium (UrNa) and potassium (UrK) excretion were centrally measured.

Results: After 3 months, there was a reduction in BP, UrNa, and body weight, and an increase in UrK in EI. By contrast, a lower decrease in BP was found in the C group, and a slight rise in UrNa and no substantial change in UrK were revealed. BP changes were positively and significantly associated with changes in UrNa only in EI.

Conclusion: The main results of this trial indicate that a single brief educational intervention by a physician can lead to a reduction in salt intake and BP, and increased potassium consumption in hypertensive patients, without adverse effects.

Trail registration: ClinicalTrial.gov registration number: NCT06651437.

Posterior reversible encephalopathy syndrome (PRES) may present with different clinical symptoms including visual disturbance, headache, seizures and impaired consciousness. Brain MRI shows oedema, usually involving the posterior subcortical regions. Triggering factors include hypertension and obstructive sleep apnea syndrome. The mechanism underlying PRES is under debate, but endothelial dysfunction is implicated. Treatment goals of PRES are gradual blood pressure (BP) lowering to avoid sudden hypoperfusion of vital organs and prevention and management of seizures. PRES usually has a favorable prognosis, but delayed diagnosis and treatment may lead to cardiovascular morbidity, mortality or irreversible neurological deficits.

Introduction: Carotid IMT is a recognized marker for early atherosclerotic changes and a predictor of future CV events. Previous studies showed 11% increased risk of myocardial infarction with each 0.1 mm incremental increase of carotid IMT. In general population, LDL cholesterol levels are positively correlated with carotid IMT in both cross-sectional and longitudinal studies while its role in elite athletes remains understudied.

Aim: This study aimed to investigate the correlation between persistent lipid profile alterations and early markers of atherosclerosis, specifically carotid IMT, in a cohort of elite athletes.

Methods: We included 302 athletes serially evaluated for a prolonged time period. Anthropometric data, blood tests for lipid profiles, and carotid IMT measurements were collected. Dyslipidemia was defined as LDL ≥ 116 mg/dL, and persistent elevation when LDL values remained above the threshold limits in at least three pre-participation screenings. Categorical variables were expressed as frequencies and percentages and were compared using Fisher's exact test or Chi-square test, as appropriate.

Results: 91 athletes (30.1%) had persistently elevated LDL levels. Dyslipidemic athletes were older (30.7 ± 5.7 vs. 29.1 ± 4.1 years, p = 0.008), had higher BMI (p = 0.032), and a higher prevalence of obesity (5.5% vs. 0.5%, p = 0.004) compared to those with normal lipid profiles. Additionally, they had higher total cholesterol (p < 0.0001) and triglycerides (p < 0.0001) but similar HDL levels (p = 0.213). Globally, athletes with altered LDL profiles over long-time period showed higher IMT (0.60 ± 0.10 mm vs. 0.57 ± 0.07 mm, p = 0.014). In particular, longer exposure to elevated LDL was significantly associated with increased IMT (0.61 ± 0.12 mm vs. 0.57 ± 0.06 mm, p = 0.035).

Conclusions: Our study highlights the association between persistently elevated LDL-C and increased carotid IMT in elite athletes, with longer exposure time correlating with more pronounced carotid changes. These findings underscore the importance of regular monitoring of blood lipid profiles and carotid IMT measurements as a non-invasive, cost-effective method to prevent atherosclerotic vascular disease.

Aims: To systematically appraise and summarize the available evidence from published randomized controlled trials considering the effect of nebivolol on blood pressure in patients with hypertension.

Methods: Literature search was performed through Medline (via PubMed), Cochrane Library and Scopus until December 15, 2023. Double-independent study selection, data extraction and quality assessment were performed. Evidence was pooled with three-level mixed-effects meta-analysis.

Results: In total, 7,737 participants with hypertension, who were treated with nebivolol, were analyzed across 91 RCTs. Nebivolol was associated with significantly greater reduction in office systolic and diastolic BP compared to placebo (MD = - 6.01 mmHg; 95% CI = [- 7.46, - 4.55] and MD = - 5.01 mmHg; 95% CI = [- 5.91, - 4.11], respectively). Moreover, resulted a similar reduction in systolic BP (MD = - 0.22 mmHg; 95% CI = [- 0.91, 0.46]) and a significantly greater reduction in diastolic BP compared to the active comparator (MD = - 0.71 mmHg; 95% CI = [- 1.27, - 0.16]). When considering the effect of nebivolol on 24-hour ambulatory BP, notable reductions were observed compared to placebo. In contrast, compared to the active comparators, there was no significant difference in systolic BP reduction, but a significant reduction in diastolic BP favoring nebivolol. Based on moderator analyses, the impact of nebivolol on the pooled estimates remained independent of the dose of nebivolol, age, male sex, trial duration, body mass index (BMI), baseline diabetes, heart failure, and baseline systolic and diastolic BP.

Conclusion: Nebivolol, compared to placebo, showed a significant BP reduction and was non-inferior to other active comparators in terms of BP reduction.

Introduction: Hypertension and dyslipidemia are common contributors to cardiovascular disease (CVD), often occurring together. Effectively Managing both is key to reducing mortality and morbidity, but complex regimens reduce adherence.

Aim: This study investigated the comparative efficacy and safety of a three-drug regimen (TAR) containing telmisartan, amlodipine, and rosuvastatin against two-drug combinations (TA and TR) for managing hypertension and dyslipidemia.

Methods: We searched PubMed, Web of Science, Cochrane, Embase, and Scopus databases for relevant articles matching our inclusion criteria. Following the application of inclusion criteria, four studies were selected for qualitative analysis and four studies for meta-analysis.

Results: Our analysis showed TAR [n = 155] significantly reduced mean systolic blood pressure (MSSBP) at week 4 compared to TR (n = 163) (MD = -15.65 mmHg) and TA (MD = -4.63 mmHg). TAR also showed superiority over all groups (TR [n = 163], TA [n = 162]) in MSSBP reduction. For low-density lipoprotein-cholesterol (LDL-C), TAR only showed a significant difference at week 4 compared to TA (MD = -86.41 mg/dL), with no difference between TAR and TR at either week 4 or 8.

Conclusion: Our findings suggest that TAR may be a safe and effective therapeutic option for the concurrent management of hypertension and dyslipidemia. However, there is no significant difference regarding adverse events between both arms.

Since randomized clinical trials currently do not support continuous positive airway pressure treatment of asymptomatic obstructive sleep apnea (OSA) we proposed the Obesity, Symptoms, and CARdiovascular assessment (OSCAR) algorithm to aid clinicians in the management of asymptomatic low-risk moderate-severe OSA, focusing on weight loss, symptoms and cardiovascular disease (CVD) risk assessment. Exploiting the data of the Sleep Heart Health Study we selected subjects with a body mass index (BMI) < 30 Kg/m², no history of CVD or sleepiness and compared 552 patients with moderate-severe OSA (OSCAR(-)) to 916 individuals without OSA (No-OSA). After adjusting for age, gender, and BMI, there was no significant difference in the risk of major adverse cardiovascular events (MACE) between OSCAR(-) and No-OSA (1.05; 95%CI 0.81-1.37). The study suggests that low-risk moderate-severe OSA patients may not have a greater risk of MACE compared to those without OSA and highlights the need for further research on this topic.

The Sudan conflict has severely impacted hypertension management, exacerbating the condition through chronic stress, disrupted healthcare, and lifestyle changes. Hypertension, a major risk factor for cardiovascular diseases, worsens with war-related stress and limited access to medications due to damaged healthcare infrastructure. Additionally, displacement, economic hardship, and food insecurity contribute to poor diets and reduced physical activity, further complicating blood pressure control. This article highlights the urgent need for adaptive healthcare strategies, such as mobile clinics and international aid, to address these challenges. A concerted effort is required to improve hypertension management and outcomes in conflict-affected populations.

Introduction: Elevated serum total cholesterol levels, very low-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, or a decreased serum high-density lipoprotein cholesterol concentration characterize dyslipidemia. Antisense Oligonucleotide therapy in dyslipidemia targets apolipoprotein B (ApoB), an essential component of low-density lipoprotein (LDL) associated with atherosclerosis development.

Aim: This review aims to critically evaluate the efficacy and safety of this group of medications in mitigating dyslipidemia in at-risk individuals and its potential role in advancing personalized medicine in the management of dyslipidemias.

Methods: A detailed search was conducted from multiple databases adhering to the PRISMA guidelines. Clinical trials and randomized controlled trials on antisense oligonucleotides for management of dyslipidemias were included, excluding non-English studies, case reports and all forms of reviews. Data was screened, with duplicates removed, and key findings were synthesized using a narrative approach.

Results and conclusion: The potential of antisense oligonucleotides (ASOs) to treat dyslipidemia and other disorders has attracted much interest. Several studies and clinical trials have been conducted on the safety and tolerability of ASOs for dyslipidemia. Although statins are the mainstay management of hypercholesterolemia, there is evidence from clinical trials that ASOs can even be more effective with little to no side effects. Novel therapeutic approaches such as antisense oligonucleotides (ASOs) offer tailored therapeutic alternatives. ASOs such as Mipomersen and Volanesorsen provide additional treatment options for patients with inherited lipid abnormalities by lowering certain atherogenic lipoproteins such as apo B and ApoC-III, respectively.

Introduction: Vascular Ehlers-Danlos syndrome (vEDS) is an inherited connective tissue disorder characterized by arterial fragility. Celiprolol is a β1-adrenoceptor antagonist with partial β2 agonist activity that has been shown to reduce rates of vascular events in this setting, though the underlying mechanisms are not yet fully understood. Moreover, very few echocardiographic data are available in patients with vEDS.

Aim: To perform a comprehensive echocardiographic assessment of a cohort of patients with vEDS with or without celiprolol therapy compared with healthy subjects.

Methods: Twenty patients with genetically confirmed diagnosis of vEDS followed at our Institution (University Hospital of Brescia, Italy) were divided into two groups according to whether or not they were on celiprolol therapy at the maximum recommended dose (400 mg daily) for at least 12 months. Both groups were compared to 10 healthy individuals matched for sex, age, body mass index (BMI), and office blood pressure (BP) values. Each participant underwent transthoracic echocardiography with tissue Doppler analysis (TDI) for a comprehensive evaluation of cardiac structure and function.

Results: Mean age was 35 years and mean BMI was 21.6 kg/m². Female sex was prevalent (60%). Left ventricular (LV) internal diameter values tended to be lower in patients with untreated vEDS than in healthy controls (4.33 vs 4.74 cm, respectively), though this difference was not statistically significant. Similar data were observed for LV mass index (56.9 vs 68.6 g/m²), stroke volume (56.6 vs 71.6 mL), and E/A ratio (1.26 vs 1.66), whereas an opposite trend was observed for e' lateral (13.2 vs 12.2 cm/s). No statistically significant difference was found between groups in terms of other parameters of LV mass, systolic and diastolic function. A normal LV geometry was found in all the cases. Indices of mechano-energetic efficiency and ventricular-arterial coupling were also similar between groups. No patient presented with aortic root dilation, mitral valve prolapse, valve insufficiency of more than mild degree, or valve stenosis of any degree.

Conclusion: Our study suggests that patients with vEDS have normal cardiac mass and geometry, as well as normal systolic and diastolic function. Celiprolol therapy does not seem to significantly influence such aspects. Compared with vascular imaging, less stringent follow-up with echocardiography seems reasonable in this setting. Future studies with prospective design should confirm these aspects.

West African (WA) migrants in Europe have higher hypertension rates than the host populations. For African migrants, guidelines recommend diuretics and/or calcium channel blockers (CCB) for primary cardiovascular disease prevention, but data on antihypertensive medication (AHM) prescription patterns or related hypertension control rates are lacking. We assessed AHM prescription patterns and its relation to hypertension control among hypertensive WA migrants in the Netherlands compared to the host population. Cross-sectional data from WA or Dutch origin participants from the HELIUS study were used. Participants with treated hypertension and without diabetes, cardiovascular disease, or microalbuminuria were selected. We used logistic and linear regression analyses to assess the association between AHM categories and hypertension control rates (systolic blood pressure (BP) ≤ 140 mmHg and diastolic BP ≤ 90 mmHg) and the systolic BP levels. We compared 999 WA participants and 314 Dutch participants. Hypertension control rates were lower in the WA origin compared to Dutch origin participants (44.3% versus 58.0%, p < 0.001). For WA participants, prescription rates for any AHM category were: CCB (54.8%), diuretics (18.5%) beta-blocking agents (27.3%) and renin-angiotensin system blockers (52.6%). Prescription rates were higher for CCB and similar for diuretics compared to the Dutch participants. Neither CCB nor diuretics were associated with better control rates. Compared to Dutch participants, West African participants had similar diuretic prescriptions but significantly higher prescriptions for CCB. However, neither medications was associated with better hypertension control. Future research should explore physician and patient factors to improve hypertension control.