High Blood Pressure & Cardiovascular Prevention最新文献

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.

Inflammaging is a chronic, low-grade inflammation that accompanies aging and contributes to the development of age-related diseases. Recent research has increasingly focused on its impact in women, recognizing that aging and inflammatory processes differ between sexes. Estrogens, known for their anti-inflammatory effects, offer protection during reproductive years. However, their decline during menopause and the climacteric period is linked to increased inflammation and a higher risk of chronic diseases such as osteoporosis, cardiovascular disease, and arthritis. X-linked immune-related genes play a critical role in immune system regulation. Epigenetic changes associated with aging can affect the expression of inflammation-related genes, with hormonal and genetic differences contributing to sex-specific responses. Women generally exhibit stronger immune responses than men, which can enhance infection resistance but also increase susceptibility to autoimmune diseases and inflammaging. Lifestyle factors, including diet and physical activity, significantly influence inflammation. Due to metabolic differences, women may respond differently to these interventions. Postmenopausal women, for example, often exhibit higher levels of inflammatory markers like C-reactive protein (CRP) and interleukin-6 (IL-6), which are associated with elevated risks of cardiovascular and other age-related conditions. These findings suggest that strategies to reduce inflammation-such as anti-inflammatory diets or medications-should be tailored to the unique hormonal and physiological context of women. Understanding the distinct manifestations of inflammaging in women is essential for developing gender-specific approaches to promote healthier aging and reduce the burden of chronic disease in later life.

Introduction: Telomere length is an acclaimed marker of aging, which has been previously shown to correlate with cardiovascular diseases and metabolic syndrome traits.

Aim: To identify the relationship between patient characteristics and telomere length.

Methods: The LIPIDOGEN was a random patient sample substudy of LIPIDOGRAM 2015 study (n = 13,724) conducted in primary care facilities in Poland. Data on risk factors, chronic diseases, treatment, and lifestyle were collected. Telomere length was determined with routine PCR from saliva. Factor Analysis for Mixed Data analysis was utilized to discern the principal components of patient clinical profiles. Furthermore, hierarchical clustering was used to obtain clusters of patients based on principal components.

Results: 1556 patients (60% female, mean age 51 years) were included in the analysis after the exclusion of outliers and low DNA quality samples. Three clusters of patients were identified. Cluster 1 was characterized by low cardiovascular risk, without significant risk factors. Cluster 2 consisted of patients with a higher incidence of metabolic syndrome (MetS, 62%) and the highest smoking rate (22%). Cluster 3 had the highest incidence of MetS (94%), treatment with statin (62%), and diabetes mellitus (61%), and contained nearly all patients with myocardial infarction (17% of this cluster). Patients in Cluster 1 had significantly longer telomeres than patients in Cluster 2 and 3 (p = 0.01 and p < 0.001 respectively).

Conclusions: The pattern of clinical characteristics marked by classical cardiovascular risk factors including components of MetS, is inversely related to telomere length, underlining the potential role of metabolic disturbances in cellular aging.

Cardiovascular and cerebrovascular diseases (CVDs), primarily driven by atherosclerosis, remain the leading cause of mortality worldwide and represent a major healthcare burden. Mounting evidence demonstrates that atherosclerotic processes begin in childhood, with lipid streaks detectable as early as the first decade of life. The increasing prevalence of obesity, hypertension, dyslipidemia, insulin resistance, and other modifiable cardiovascular risk factors (CVRFs) in children and adolescents highlights the urgent need for prevention strategies starting early in life. This document, jointly produced by the Italian Society of Pediatrics (SIP), the Italian Society of Hypertension (SIIA), the Italian Society for the Study of Atherosclerosis (SISA), and the Italian Society for Cardiovascular Prevention (SIPREC), emphasizes that atherosclerosis should be considered a disease with its roots in childhood and that true primary prevention must begin from pregnancy and birth. Two possible and complementary levels of intervention should be considered: (1) population-wide promotion of healthy diets, lifestyles, and supportive environments; and (2) early identification and management of specific CVRFs in children and adolescents. The involvement of multiple stakeholders-families, pediatricians, schools, healthcare professionals, policymakers, patient associations, and the media-is crucial to ensure the effectiveness of prevention interventions. Particular attention must be given to obesity, as both an independent risk factor and a driver of additional metabolic and vascular risks. Fighting CVDs requires a paradigm shift: preventive action must start early, be comprehensive, and mobilize all sectors of society. Only by addressing cardiovascular risk during childhood can the future burden of CVDs be effectively reduced.

Introduction: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) confer cardiovascular and renal protection, but their impact on blood pressure (BP) and vascular stiffness in chronic kidney disease (CKD) is not fully defined.

Aim: To investigate the effect of dapagliflozin on 24h-BP behavior and ambulatory arterial stiffness index (AASI) as a predefined secondary outcome of the GLUTREPRO trial.

Methods: In this randomized trial, 32 patients with albuminuric CKD received dapagliflozin 10 mg/day or placebo on top of optimized standard therapy. Laboratory tests, ambulatory blood pressure monitoring (ABPM), and bioimpedance were performed at baseline and during follow-up. The study comprised a 6-month randomized phase and a 12-month open-label phase, analyzed with mixed-effects models.

Results: Baseline characteristics were balanced (mean age 58 ± 14 years, 37% diabetes, eGFR 50.6 ± 17.3 ml/min/1.73 m², UACR 582 ± 893 mg/g). Dapagliflozin induced an early eGFR dip (-3 to -6 ml/min/1.73m²) followed by stabilization. Overall, UACR did not change significantly, but patients with baseline microalbuminuria showed lower UACR after six months versus placebo. ABPM revealed no significant differences in BP or dipping status. Conversely, dapagliflozin significantly reduced AASI at 6 months (0.50 vs. 0.62; p = 0.04), with a trend toward sustained improvement thereafter. Multivariable regression identified dapagliflozin as an independent predictor of lower AASI (β = - 0.067; 95% CI -0.130 to -0.002; p = 0.043), independent of diabetes, 24-h Systolic BP, heart rate, kidney function, fractional sodium excretion, and TyG index.

Conclusion: In patients with albuminuric CKD, dapagliflozin lowered AASI independently of BP control and sodium handling, suggesting favorable vascular remodeling in both diabetic and non-diabetic patients.

Trial registration: The study was registered in the EU Clinical Trials Register (EudraCT: 2020-004835-26) and online at the https://www.

Clinicaltrials: gov (Unique identifier: NCT05998837, 13th April 2021).

Despite advancements in pharmacological strategies, blood pressure (BP) control remains unsatisfactory in a significant proportion of hypertensive patients. This may be related to the multifactorial pathogenesis of hypertension, which makes treatment challenging and often requires the use of multiple BP-lowering pills that can reduce adherence. Transdermal clonidine, a central α₂-adrenergic agonist, offers a unique antihypertensive approach that may deserve renewed consideration. Although largely abandoned in the oral form due to side effects and withdrawal concerns, the transdermal patch provides a steadier drug release and improved tolerability. This review summarizes evidence from randomized and observational studies evaluating the efficacy, safety, and adherence profile of transdermal clonidine in the treatment of hypertension. Overall, the patch demonstrated blood pressure-lowering efficacy comparable to standard first-line agents, such as β-blockers, calcium channel blockers, and diuretics. It was particularly effective in improving treatment adherence and reducing the risk of rebound hypertension during discontinuation. Adverse effects, mainly dry mouth, sedation, and mild skin reactions, were generally well tolerated. These findings suggest that transdermal clonidine may serve as a useful adjunct or alternative therapy in patients with resistant hypertension, poor adherence to oral therapy, or intolerance to other drug classes, and that its role deserves to be reconsidered within contemporary, patient-centered antihypertensive strategies.

Introduction: Estimated pulse wave velocity (ePWV) is a non-invasive and low-cost method that uses age and blood pressure to assess cardiovascular risk. However, as it is not a true measure of arterial mechanics, its accuracy in diverse cohorts, such as Brazilian populations, is uncertain due to inherent genetic and environmental differences.

Aim: to externally validate existing European ePWV equations and develop new, population-specific models for ePWV estimation in a large, admixed Brazilian cohort.

Methods: We analyzed data from 2122 Brazilian adults, assessing carotid-femoral pulse wave velocity (cfPWV), age, mean arterial pressure (MAP), and sex. Linear regression models were developed, incorporating all these variables as predictors. Model performance was evaluated using root mean square error (RMSE) and coefficient of determination (R²). Bland-Altman analyses assessed agreement between estimated and measured cfPWV.

Results: The newly developed equations demonstrated superior performance compared to existing European models. Our best-performing model (Equation 2) achieved an RMSE of 0.744 in individuals without cardiovascular risk factor, demonstrating superior performance to the model derived by the Arterial Stiffness Collaboration Group (ASCG) (RMSE: 0.879). Inclusion of sex as a predictor further improved model accuracy. Bland-Altman analyses revealed narrower limits of agreement for the new models. Notably, higher prediction errors were observed in subgroups underrepresented in the sample, such as individuals with very high cfPWV, advanced age, or elevated MAP.

Conclusions: Population-specific ePWV equations tailored to the Brazilian cohort provide more accurate estimations of arterial stiffness. This improved precision is clinically meaningful, allowing for better stratification of cardiovascular risk using a low-cost tool readily applicable in the public health system. These findings underscore the importance of developing and validating cardiovascular risk assessment tools within diverse populations to enhance predictive accuracy and clinical utility.