High Blood Pressure & Cardiovascular Prevention最新文献

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.

Introduction: The long-term efficacy of renal denervation (RDN) has not been extensively documented.

Aim: To describe the long-term follow-up of patients after RDN.

Methods: We evaluated patients with resistant hypertension (RH) who underwent RDN with irrigated catheter from 2012 to 2014 at a single centre. Office blood pressure (BP) and 24-hour ambulatory BP were assessed. Clinical event (stroke, myocardial infarction, need for dialysis, or death from any cause), left ventricular mass index (LVMI), estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (uACR) were evaluated.

Results: The analysis included 20 individuals (age 51 ± 10 years, 75% female, ambulatory systolic BP [SBP] 168 ± 22 mmHg, ambulatory diastolic BP [DBP] 101 ± 19 mmHg, taking 7 [IQR: 6-8] antihypertensive medications). The median follow-up period was 8.5 (IQR: 5.6-9.4) years. Mean (± SD) changes from baseline were: -47 ± 41 mmHg for office SBP, -25 ± 20 mmHg for office DBP, -29 ± 26 mmHg for ambulatory SBP, and -15 ± 16 mmHg for ambulatory DBP. The number of antihypertensive drugs markedly decreased one month after RDN and a gradual upward trend was observed over time. A clinical event occurred in 9 (45%) participants. LVMI decreased from 152 ± 37 to 120 ± 31 g/m² (p = 0.015), the eGFR declined from 88.9 ± 15.6 to 73.1 ± 24.2 mL/min/1.73 m² (p = 0.034), and the uACR did not significantly change from baseline to follow-up.

Conclusions: In this observational study of patients with uncontrolled RH, RDN with an irrigated catheter was associated with a sustained BP reduction for up to a decade. However, a potential waning efficacy was suggested by the increasing use of antihypertensive medications over time.

Introduction: Several studies investigated the implication of the gut microbiota (GM) in the formation and progression of aneurysms, suggesting a key role for GM metabolites in aneurysmal pathogenesis and prognosis.

Aim: This systematic review aims to collect key findings concerning the impact of gut bacterial compositions, GM-related metabolites, probiotics administration, and inflammatory markers in aneurysmal development and rupture.

Methods: A PubMed, Medline, Embase, and Web of Science database search was conducted in accordance with PRISMA guidelines for systematic reviews, targeting all studies assessing the GM's role in aneurysms till 2023.

Results: Data from 19 out of 292 non-duplicated studies were included. Based on the published literature, aneurysmal incidents in several locations were accompanied by an alteration in specific intestinal bacteria that may affect the prognosis of the aneurysm. The gut dysbiosis was also accompanied by modifications in the metabolic pathways. Hence, the administration of specific probiotics showed a significant implication in reversing the GM-related changes that were affecting the aneurysm, leading to a decrease in its severity, a better prognosis, and even serving as a prophylactic approach.

Conclusions: The outcomes of this review highlight the role of GM in the pathogenesis of aneurysms, assessing some involved mechanistic pathways such as gut dysbiosis, inflammation, and the alteration of gut-derived metabolites levels, which orient new research on developing therapeutic strategies.

Introduction: Atrial fibrillation (AF) is common with advanced aging and is often asymptomatic and undiagnosed.

Aim: A blood pressure (BP) monitor with embedded algorithm for detecting AF with high diagnostic accuracy during routine automated BP measurement was used to screen individuals aged ≥ 65 years.

Methods: The EMENO health survey (2013-2016) applied a multi-stage stratified random sampling method to select a random general adult population sample in Greece. Participants aged ≥ 65 years were screened for AF using an automated oscillometric device with AF detecting algorithm (Microlife BPA100 Plus AFIB) with triplicate measurements on a single occasion.

Results: A total of 975 individuals with AF data on at least one BP measurement were analysed [(mean (SD) age 73.2 (6.6) years, men 45%, hypertensives 79.3%). AF was detected in all 3 BP readings in 65 individuals (6.3%, AF group), in none of 3 readings in 661 (73.6%, non-AF group), and in 1-2 readings of 3 or less readings in 249 (20.1%, uncertain AF group). AF group individuals were older (p < 0.001), had lower systolic BP (p < 0.05) and more frequent cardiovascular disease (p < 0.01) compared to the non-AF and uncertain AF group. Moreover, 44.6% were unaware of their AF and all required anticoagulant therapy (CHA₂DS₂-VASc ≥ 1/≥ 2, men/women).

Conclusions: About 6% of individuals aged ≥ 65 years in Greece appeared to have AF, and 44.6% of them were unaware and requiring anticoagulant treatment. AF screening during routine automated BP measurement appears to be a useful tool for early detection of asymptomatic AF in individuals aged ≥ 65 years.

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.

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.

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: Phytosterols are recognized for their cholesterol-reducing effects and are commonly used as dietary supplements or added to foods due to their potential cardiovascular benefits. However, evidence regarding the impact of phytosterol supplementation on inflammatory markers remains inconclusive.

Aim: This systematic review and meta-analysis aim to evaluate the effect of phytosterols in reducing levels of C-reactive protein (CRP) and high-sensitivity CRP (hs-CRP).

Methods: A systematic literature search of the primary databases was conducted up to May 2024 to identify eligible studies. The measurement of effect sizes was determined using WMD (weighted mean difference) and 95% CI.

Results: For the meta-analysis, 14 publications (19 study arms) for hs-CRP and 10 publications (16 study arms) for CRP were included. The pooled analysis showed that the administration of phytosterol did not significantly reduce CRP compared to control with WMD= -0.04 mg/l (95% CI: -0.28 to 0.20, P = 0.74). However, phytosterol supplementation significantly decreased the hs-CRP level compared to the control group with WMD of -0.25 mg/l (95% CI: -0.42 to -0.07, P = 0.006). The WMD for hs-CRP reduction was - 0.36 mg/l (95% CI: -0.53 to -0.18, P < 0.001) for supplementation with a phytosterol dose ≥ 2000 mg/day compared to the control group.

Conclusions: Phytosterol supplementation may be effective in reducing hs-CRP levels.

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.