High Blood Pressure & Cardiovascular Prevention最新文献

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.

The renin-angiotensin system (RAS) plays a pivotal role in the pathophysiology of several conditions such as hypertension, heart failure and chronic kidney disease. In the last fifty years different therapeutic strategies, including angiotensin converting enzyme inhibitors (ACEi), type 1 angiotensin II receptor blockers (ARBs) and angiotensin receptor neprilysin inhibitors (ARNi), have been developed to counteract this neurohormonal dysregulation. However, all these therapeutic strategies have a relatively short-term action and they need to be administered orally once or more times every day to achieve the therapeutic purposes with a risk of poor therapeutic adherence.More recently, the search for a new effective strategy to provide a long-term control of hypertension was recently boosted by the availability of novel technologies, such as the angiotensinogen suppression in the liver realized through the silencing of RNA with zilebesiran, a small interfering RNA (siRNA) agent.The purpose of this article is to review the available data on Zilebesiran and to discuss in detail potential advantages in the clinical use as well as the still unresolved potential risks.

Hyperuricemia is a metabolic disorder associated with an increased risk of gout, chronic kidney disease (CKD), and cardiovascular disease (CVD). The management of hyperuricemia in conditions where urate deposition has already occurred primarily relies on xanthine oxidase inhibitors (XOIs), such as allopurinol and Febuxostat. Febuxostat, a non-purine selective XOI, has demonstrated superior urate-lowering efficacy, particularly in patients with renal impairment. This review provides an in-depth analysis of Febuxostat's pharmacological properties, clinical efficacy, and safety profile, with a focus on cardiovascular and nephroprotective effects.

Introduction: Hypertension remains a leading modifiable risk factor for cardiovascular morbidity and mortality in the United States. Despite advances in detection and treatment, the burden of hypertension-related deaths continues to challenge public health systems. Understanding long-term mortality trends and projecting future patterns is essential to guide policy, allocate resources, and inform prevention strategies.

Aim: This study aimed to examine national trends in hypertension-related mortality in the U.S. from 1979 to 2023 using CDC WONDER data and to project mortality patterns through 2050 to support public health planning and intervention efforts.

Methods: We extracted age-adjusted mortality rates (AAMRs) per 100,000 population for hypertension as the underlying cause of death from the CDC WONDER database. Temporal trends were assessed using Joinpoint regression to identify significant changes in trajectory, calculating the annual percent change (APC) for specific periods and the average APC for broader trends. Future mortality rates were projected through 2050 using time series models trained on 1979-2015 data, validated against data through 2023, and refined using rolling forecasting techniques.

Results: From 1979 to 2023, 2,575,968 hypertension-related deaths occurred. AMRs rose from 27.0 (95% CI, 26.7-27.3) to 40.2 (95% CI, 40.0-40.5), peaking in 2020. Males had consistently higher AAMRs than females. In 2023, AAMRs were 46.7 in males and 33.9 in females. Racial disparities persisted, with Black individuals having a higher AAMR than Whites in 2023 (70.2 vs 35.5). The South remained the most affected region, with Oklahoma (164.1), Mississippi (101.7), and Tennessee (86.0) showing the highest AAMRs in 2023. Forecasts indicate rising hypertension-related mortality, with male AAMR reaching 88.8, Black AAMR 68.4, and older adult AAMR 267.5 by 2050.

Conclusion: Hypertension mortality will remain a major public health issue, with growing sex disparities and high rates in older adults and the South, underscoring the need for targeted, long-term interventions.

Introduction: Office blood pressure (BP) measurement is the cornerstone for the diagnosis of arterial hypertension.

Aim: To investigate how office BP is measured in clinical practice among the hypertension centers of the Italian Society of Hypertension in comparison to what is recommend by the latest guidelines.

Methods: Coordinators of hypertension centers affiliated to the Italian Society of Hypertension were invited by email to complete an online survey including 26 questions regarding the equipment (devices and cuffs) available in the centers, office BP measurement procedure and possible additional measures performed by the devices.

Results: We obtained answers from 72 of the 119 centers (response rate 60.5%). The majority of the responders were older than 55 years (55.5%) and were from the North of Italy (61.1%). 95.6% stated the use of a validated device: 65.3% used automatic oscillometric devices, 27.8% an aneroid device, while 6.9% a manual device with a digital column. Unattended BP measurements were performed in 1.4% of the cases. Normal size cuff was available among 97.2% and large cuff among 83.1% of the centers. The majority tested BP in two different positions supine or sitting and standing positions, but there was a quarter of centers that measured BP only in one position. 38% of the responders performed three BP recordings, 38% at least two, but 5.7% measured BP only once. 42.3% of the devices used were able to detect atrial fibrillation.

Conclusion: Our survey depicted a considerable heterogeneity of office BP measurement methodology in daily practice, not always aligned with current guidelines.

Introduction: Chronic kidney disease (CKD) is associated with dyslipidaemia. Renal dysfunction changes the level, composition and quality of blood lipids in favor of a more atherogenic profile, resulting in increased risk of cardiovascular diseases (CVD). There is emerging interest in identifying protective cut-off levels of triglycerides (TG), cholesterol, both low density lipoprotein (LDL) and high density lipoprotein (HDL) and new prognostic markers like TyG index and TG/HDL ratio in CVD.

Aim: To evaluate if higher levels of TG, TG/HDL-ratio and TyG index are associated with increased in-hospital mortality and to identify a prognostic cut-off value of TG and TG/HDL ratio for in-hospital mortality in a population of patients with CKD.

Methods: We retrospectively analyzed medical records of consecutive hospitalized CKD patients. Clinical and laboratory data were collected and TyG index, TG/HDL-ratio were calculated.

Results: We collected data of 122 inpatients with a median age of 75.5 years (70-84); 73 females (65.2%). In-hospital mortality was observed in 18 cases (16.1%) and patients who died showed increased value of TG and TG/HDL ratio (p = 0.024 and p = 0.022). ROC curve analysis showed that a TG level of 115.5mg/dl (AUC = 0.67; 95% CI 0.52-0.8; p = 0.024) and a TG/HDL ratio of 3.19 (AUC = 0.67; 95% CI 0.51-0.83; p = 0.022) had the highest predictive power for in-hospital mortality. The primary outcome in-hospital mortality was more frequently observed in patients with TG ≥ 115.5 mg/dl (p = 0.006) and in patients with TG/HDL ratio ≥ 3.19 (p = 0.032). Multivariate logistic regression models showed that TG levels [OR 1.025 (CI 1.007; 1.044), p = 0.008] were significantly associated with in-hospital death.

Conclusions: TG levels were found to be prognostic for in-hospital mortality in our population. Crucially, this study identified specific thresholds of TG (≥ 115.5 mg/dL) and the TG/HDL ratio (≥ 3.19) as prognostic values for in-hospital mortality in CKD patients. The ability of these biomarkers to identify hospitalized patients with an elevated mortality risk underscores the need for their early detection to facilitate effective assessment of both cardiovascular risk and mortality.

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.

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.