High Blood Pressure & Cardiovascular Prevention最新文献

Introduction: Hypertension is leading non communicable disease associated with high morbidity and mortality. There is uncertainty about the superiority of angiotensin receptor blocker (ARB)-diuretic versus ARB-calcium channel blocker (CCB) combination for the treatment of hypertension.

Aim: This meta-analysis compares the effectiveness of angiotensin receptor blocker (ARB)-diuretic versus ARB-calcium channel blocker (CCB) combination therapies in adults with hypertension.

Methods: RCTs were identified through PubMed, Embase, Scopus, and Cochrane Central; data were analyzed using RevMan 5.4.1 with a random-effects model. Primary outcomes were mortality, systolic blood pressure (SBP), and diastolic blood pressure (DBP); secondary outcomes included serum electrolytes and renal function.

Results: 3549 studies were identified based on database searches. 19 studies were included for analyses. Meta-analysis revealed no significant difference between both the combination therapies for primary outcomes: all-cause mortality [RR: 1.19 (95% CI: 0.85 to 1.65; p = 0.31)], SBP [MD: 1.24 mmHg (95% CI: - 0.48 to 2.96; p = 0.16; I² = 59%)], and DBP [MD: 0.62 mmHg (95% CI: - 0.15 to 1.38; p = 0.11; I² = 0%)]. The diuretic group showed significant changes in serum sodium, chloride, creatinine, e-GFR, and increased uric acid. Risk of bias was mostly low, with moderate to high evidence certainty.

Conclusion: Both ARB + CCB and ARB + diuretic combinations showed comparable effectiveness in lowering blood pressure and all-cause mortality in hypertensive adults. ARB + CCB seems to be having good safety profile, with better renal functions based on biomarkers.

Introduction: The age-related dynamics of blood pressure (BP) arise from complex, often concurrent interactions among multiple factors (e.g., sex, type-2 diabetes mellitus [T2DM], body mass index [BMI]), making it challenging to isolate individual variable effects. Disentangling factor's contribution to BP trajectories across the lifespan remains a challenge.

Aim: Machine learning (ML) algorithms were applied to data from 219 individuals from a publicly available dataset to model age-related trends in systolic and diastolic BP, using age, sex, BMI, heart rate, and T2DM as predictors.

Methods: Five regression models (linear regression, random forests, support vector machines, gaussian process regression [GPR], and neural networks) were tested. The best-fitting models capturing complex predictor-target relationships were used to simulate systolic and diastolic BP trajectories under customized scenarios, independently varying sex, BMI, and T2DM to assess isolated effects.

Results: The squared exponential GPR yielded the best predictions for systolic BP, while the Matern 5/2 kernel performed best for diastolic BP. Systolic BP increased with age, with steeper trends at higher BMI. Women had lower systolic BP in early and mid-adulthood, but values surpassed men's in older age, especially with T2DM. Diastolic BP rose until midlife, then declined in both sexes. Women showed a similar crossover pattern, attenuated by T2DM, particularly at higher BMI.

Conclusion: ML simulations from a static dataset assessed individual factors' contributions to BP trajectories, producing results consistent with empirical evidence (e.g., greater T2DM impact on BP dynamics and faster age-related BP rise in women than men) and highlighting the potential for counterfactual analyses.

Introduction: A concerning increase in coronary artery disease (CAD) among younger Indians calls attention to genetic biomarkers that indicate early vascular stress. The tumor suppressor gene p53, known primarily for its oncogenic role, also modulates vascular apoptosis and inflammation. However, its link with metabolic and nitrosative stress in CAD remains underexplored.

Aim: To determine the potential of p53 as an integrated biomarker and to analyze the connection between p53 gene expression, lipid abnormalities, inflammatory (IL-6) and nitrosative (3-nitrotyrosine) markers in CAD.

Methods: In this case-control study, 90 CAD patients and 90 age-matched healthy controls (18-50 years old) participated. Enzymatic techniques were used to evaluate lipid profile parameters, RT-PCR was used to detect p53 gene expression (2^^-ΔΔCt method), and ELISA was used to quantify the levels of interleukin-6 (IL-6) and 3-nitrotyrosine (3-NT). Data were analyzed with t-test, Mann-Whitney U, chi-square, and Pearson correlation (p < 0.05).

Results: CAD subjects showed higher total cholesterol, triglycerides, LDL-C, IL-6,and 3-NT, and lower HDL-C compared with controls (all p < 0.01). p53 was up-regulated 1.6-fold in CAD and correlated positively with 3-NT (r = 0.709, p < 0.001) and IL-6 (r = 0.513, p < 0.01).

Conclusion: This is the first Indian case-control study to integrate p53 gene expression with lipid, inflammatory, and nitrosative markers in relatively young CAD patients, offering a novel molecular perspective on early atherogenesis.

Introduction: Obesity represents a significant public health problem, particularly due to its strong association with additional cardiovascular risk factors, such as hypertension, insulin resistance (IR), type 2 diabetes mellitus, metabolic syndrome (MS) and cardiovascular disease. IR is the underlying factor of the relationship between obesity and metabolic dysregulation. The identification of IR is crucial for early diagnosis, clinical management and specific treatment.

Aim: This study aims to evaluate the diagnostic efficacy of the Triglycerides/Glucose (TyG) Index in identifying IR and target-organ damage in a cohort of patients with essential hypertension.

Methods: we have evaluated 235 consecutive patients with essential hypertension (50.1% men and 49.9% women; mean age 51.9 ± 17.3 years), stratified for body mass index (BMI). Biochemical analysis and instrumental evaluation were assessed to identify target-organ damage.

Results: Increased BMI was associated with higher values of blood pressure, glycaemia and triglycerides. In patients with higher BMI, we observed more prevalent target-organ damage, particularly cardiac remodeling (78.3%) and higher 24-h urinary albumin excretion (83.7±48 mg/L). The TyG index proved to be a stronger biomarker for identifying the development of MS (AUC 0.78) and cardiac remodeling (AUC 0.66).

Conclusions: This study confirms that obesity is correlated with a impaired hemodynamic and metabolic profile. The TyG index could represent an efficient and easy-to-use indicator for identifying both individuals developing MS and early cardiac remodeling, especially in normal-weight subjects.

Introduction: The use of epidemiological surveys might contribute to identify ineffective clinical behaviors and to improve them with educational interventions.

Aim: In the present survey, we evaluated the clinical attitudes for the management of patients with hypertension, in a sample of physicians in Italy who were included in an educational program in 2023.

Methods: Data from a total of 995 hypertensives (mean age 64.8 ± 13.3 years; 58.4% men) were reported in the survey. Complete data on antihypertensive treatment use and achievement of blood pressure (BP) goals at follow-up were available for only 494 individuals, whose data were therefore analyzed and compared with baseline.

Results: At baseline, 381 patients received BP-lowering treatment, 146 (31.6%) were treated with monotherapy, 129 (26.1%) with free dose combinations and 106 (21.4%) with single-pill FDCs. BP values < 140/80 mmHg and < 130/80 mmHg were detected in 70 (14.2%) and 23 (4.6%) subjects, respectively. At follow-up evaluation, the number of treated patients rise to 462, 44 receiving monotherapy, 35 free dose combinations and 383 single-pill FDCs (p < 0.05 compared to baseline). A significant improvement of BP control was achieved, and BP values < 140/80 mmHg and < 130/80 mmHg were recorded in 470 (95.1%) and 383 (77.5%) individuals, respectively (p < 0.05 compared to baseline).

Conclusions: The survey identified a high prevalence of uncontrolled hypertension in the examined sample with a low use of FDCs also by specialist physicians qualified to treat high BP. After the attendance to an educational program, the prescription of FDCs significantly raised in parallel with the increase in the proportion of patients who reached recommended BP targets.

Introduction: Hypertension, a major cardiovascular risk, is affected by body composition and metabolism.

Aim: We assessed the associations of body composition with hypertension and the mediating role of insulin resistance (IR).

Methods: In Hefei Hongsifang Company, 743 employees aged 40-60 were recruited consecutively. Logistic regression was used to assess the association between body composition and hypertension risk. Mediation analysis was conducted to explore the mediating role of IR between body composition and hypertension risk.

Results: Individuals with higher body fat percentage (BF%) (OR = 2.44, 95% CI 1.64-3.65, P < 0.001) and Visceral adiposity index (VAI) (OR = 2.22, 95% CI 1.39-3.55, P < 0.001) had significantly higher odds of hypertension. Conversely, higher levels of skeletal muscle mass percentage (SMM%) (OR = 0.35, 95% CI 0.21-0.56, P < 0.001), total body water percentage (TBW%) (OR = 0.36, 95% CI 0.23-0.59, P < 0.001), and bone mineral content percentage (BMC%) (OR = 0.34, 95% CI 0.21-0.54, P < 0.001) were all linked to lower odds of hypertension. IR significantly mediated the associations between body composition and hypertension risk. The mediation proportions were as follows: 29.4% for BF%, 61.5% for VAI, 33.7% for SMM%, 34.9% for TBW%, and 31.4% for BMC%.

Conclusion: Our study demonstrated that, in middle-aged individuals, lower BF% and VAI, as well as higher SMM%, TBW%, and BMC%, were independently associated with a reduced risk of hypertension. IR partially mediated the associations between body composition and hypertension.

Introduction: Right ventricular-pulmonary artery (RV-PA) coupling evaluates the relationship between right ventricular contractility and afterload. It is normal when both are well-matched. A reduction in RV contractility or an increase in RV afterload leads to RV-PA uncoupling, decreasing left ventricular filling, stroke volume, and causing peripheral hypoperfusion and congestion. The TAPSE/PASP ratio is a reliable non-invasive method to assess this coupling. An impaired TAPSE/PASP ratio is associated with poor prognosis in conditions of elevated RV afterload, but its role in acute coronary syndrome (ACS) is unclear.

Aim: The aim of this study is to investigate the in-hospital prognostic value of the TAPSE/PASP ratio and the predictors of a low TAPSE/PASP ratio.

Methods: This retrospective, pilot study included 152 patients admitted for ACS (77.6% STEMI, 22.4% NSTEMI) between November 2023 and March 2025, with available TAPSE/PASP data from echocardiography performed at admission. The primary objective was to assess whether the TAPSE/PASP ratio predicts in-hospital major adverse cardiovascular events (MACE). Secondary objectives included evaluating whether TAPSE/PASP predicts in-hospital ventricular arrhythmias, intraventricular thrombosis, prolonged hospital stay, and identifying predictors of a low TAPSE/PASP ratio.

Results: TAPSE/PASP < 0.55 was significantly associated with MACE and prolonged hospital stay in univariate analysis, but not in multivariate analysis. TAPSE/PASP < 0.55 was largely explained by E/e' >14 (OR 6.600; p = 0.0008), RV involvement (OR 9.430; p = 0.0007), and age >75 years (OR 3.243; p = 0.0389).

Conclusions: Low RV-PA coupling (TAPSE/PASP < 0.55) is associated with MACE and prolonged hospital stay in ACS, but lacks independent prognostic value in multivariate analysis.

Introduction: Hypertension and hypercholesterolemia are endemic key risk factors influencing cardiovascular prognosis.

Aim: Our study aimed to detect the co-occurrence of these two risk factors in medical practices and to determine the rate of guideline-compliant medical treatment.

Methods: We conducted a nationwide survey in German outpatient medical facilities. Data on the prevalence, control, and management of hypertension and hypercholesterolemia were collected using an anonymized questionnaire and analyzed. Results are presented as numbers and percentages for categorical variables, and as means with standard deviations (SD) for continuous variables.

Results: A total of 5,020 questionnaires from 534 German physicians were analyzed. Hypertension and hypercholesterolemia were concurrently diagnosed in 56% of patients. Despite antihypertensive therapy, only 53% of hypertensive patients achieved controlled office blood pressure values (< 140/90 mmHg). Nevertheless, physicians rated blood pressure control as adequate in 77% of cases; one-third of these patients had uncontrolled OBP. Fewer than 26% of patients with arterial hypertension received a combination therapy recommended by current clinical guidelines. 1,079 out of 4,287 hypertensive patients were treated with monotherapy only. Among patients at high cardiovascular risk (e.g., with a history of myocardial infarction), 10% achieved the recommended LDL cholesterol target of < 55 mg/dl, while 8% had LDL levels ≥ 160 mg/dl.

Conclusion: These findings suggest a persistent gap between evidence-based guidelines and their implementation in everyday practice. These data are largely consistent with findings from previous decades, indicating that insufficient progress has likely occurred in improving disease control at the population level.

Introduction: The timing of anti-hypertensive medication may influence cardiovascular outcomes and blood pressure control, yet the evidence remains inconclusive.

Aim: We conducted a meta-analysis to compare the effects of bedtime versus morning dosing of anti-hypertensives on mortality, cardiovascular events, and ambulatory blood pressure.

Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) comparing bedtime versus morning administration of antihypertensive therapy. A comprehensive literature search was performed in PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases up to June 2025. Pooled risk ratios (RRs) were calculated for categorical outcomes, and mean differences (MDs) for continuous variables. All statistical analyses were performed using R version 4.3.3. PROSPERO registration ID: CRD420251113957.

Results: Pooled analysis of six RCTs with 49,983 patients was included. Bedtime dosing of anti-hypertensive medications resulted in a lower incidence of heart failure (1.3% vs. 2.0%; RR 0.63, 95% CI 0.47-0.85) but not myocardial infarction (1.4% vs. 1.6%; RR 0.87, 95% CI 0.64-1.17), stroke or transient ischemic attack (0.9% vs. 1.3%; RR 0.71, 95% CI 0.49-1.05), all-cause mortality (2.6% vs. 3.1%; RR 0.75, 95% CI 0.53-1.06), or cardiovascular mortality (1.0% vs. 1.5%; RR 0.52, 95% CI 0.22-1.21). For blood pressure, bedtime dosing significantly reduced evening systolic blood pressure (MD - 4.71 mmHg, 95% CI - 6.64 to - 2.78) and evening diastolic blood pressure (MD - 1.66 mmHg, 95% CI - 1.92 to - 1.40), with no significant differences observed in morning readings.

Conclusion: Bedtime administration of anti-hypertensive medications may be associated with reduction in MACE and heart failure incidence. No significant effect was observed in mortality, myocardial infarction, or stroke.

Chronic diseases represent one of the most significant challenges for Public Health in Italy, involving approximately 24 million people and generating an annual cost of more than 66.7 billion euros. Among these, arterial hypertension affects 31% of the population, and it is the leading risk factor for cardiovascular diseases. However, the management of arterial hypertension presents several challenges, including inconsistencies in care pathways, poor integration between healthcare settings, and low therapeutic adherence. This document aims to share the findings of a national-level project that defined the recommended care pathway for managing hypertensive patients, identified potential areas for improvement, and proposed supporting solutions, including a list of indicators for evaluation and monitoring. The key areas for improvement, particularly the promotion of therapeutic adherence and the strengthening of communication between community-based and hospital services, serve as a foundation for optimizing the management of this condition and fostering more effective collaboration among the various stakeholders and levels of care within the healthcare system.