High Blood Pressure & Cardiovascular Prevention最新文献

Introduction: Most cardiovascular events can be prevented by controlling health conditions and behaviors that reflect cardiovascular health (CVH) classification as high, moderate, and low.

Aim: To evaluate the effect of weight loss through an 8-week hypocaloric diet on vascular function and sympathetic tone in individuals with obesity and moderate or poor CVH.

Methods: Individuals aged 40-70 years and body mass index  ≥ 30 kg/m² followed a low-calorie diet (800 kcal/day reduction) for 8 weeks. Central hemodynamics (Mobil-O-Graph®), heart rate variability (Polar® RS800), and microvascular reactivity (Laser Speckle Contrast Imaging) were assessed at baseline and post-intervention.

Results: Seventy-one patients were divided into moderate CVH (n = 44) and low CVH (n = 27) groups. After the intervention, both groups presented similar weight loss (3.4 vs 3.1%). Only the low CVH group showed a significant reduction in central systolic blood pressure (cSBP, 113 ± 12 to 109 ± 9 mmHg; p = 0.049) and an increase in cutaneous vascular conductance in post-occlusive reactive hyperemia (CVC-PORH, 0.99 ± 0.28 to 1.08 ± 0.28 APU/mmHg; p = 0.039). Conversely, only the moderate CVH group exhibited an increase in RR interval (933 ± 130 to 994 ± 131 ms; p = 0.006) and a decrease in sympathetic nervous system index (iSNS). Significant inverse correlations were observed in the low CVH group between the variations in CVC-PORH with pulse wave velocity (r = - 0.40, p = 0.044) and with iSNS (r = - 0.52, p = 0.021).

Conclusion: Even modest weight loss led to early improvements in vascular function and blood pressure in individuals with low CVH, while autonomic benefits were more evident in those with moderate CVH.

Introduction: Optimal blood pressure (BP) targets in type 2 diabetes mellitus (T2DM) remain uncertain, particularly following recent large-scale trials. The balance between cardiovascular protection and potential harms from intensive BP lowering continues to be debated.

Aim: This study aimed to update the evidence comparing intensive versus standard BP control in T2DM by incorporating data from the recent BPROAD trial and reassessing cardiovascular and microvascular outcomes across major randomized trials.

Methods: This meta-analysis included eight randomized controlled trials (ABCD, Mehler 2003, ABCD-2V, SANDS, INVEST, ACCORD-BP, J-DOIT3, and BPROAD), comprising a total of 25,686 participants. Intensive arms consistently achieved ~120/70 mmHg regardless of specific trial targets. Follow-up ranged 1.9-8.5 years. The primary end-point was a composite of fatal/non-fatal cardiovascular events; secondary endpoints were diabetic retinopathy, neuropathy and urine albumin excretion (UAE). Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with a random-effects model; heterogeneity was expressed as I².

Results: Compared to standard BP control, intensive BP lowering reduced composite cardiovascular events (OR 0.88, 95% CI 0.79-0.97; I² = 17%). Retinopathy likewise fell (OR 0.84, 95% CI 0.71-0.98; I² = 0%). UAE risk declined (OR 0.82, 95% CI 0.71-0.94; I² = 62%). The analysis showed an OR of 1.48 (95% CI 1.05-2.10; P = 0.03; I² = 0%) for neuropathy, but the small sample size and wide confidence interval limit confidence in this result.

Conclusion: Lowering BP to approximately 120/70 mmHg, representing a more stringent target than standard control (~135/80 mmHg) is associated with modest reductions in cardiovascular events and improvements in microvascular outcomes including retinopathy and albuminuria in type 2 diabetes. While these benefits are modest and neuropathy data remain limited, the findings support consideration of lower BP targets in this population, applied thoughtfully and tailored to individual risk and tolerability.

Introduction: Hypertensive crises are often managed in primary care, yet guideline-discordant use of short-acting oral antihypertensives remains common in low- and middle-income countries.

Aim: We aimed to describe prescribing patterns of captopril, nifedipine, furosemide, and metamizole in Peru.

Methods: We conducted a retrospective cohort study using nationwide data from the Peruvian Seguro Integral de Salud (2019-2024). Adults with hypertension and at least one hypertensive crisis episode (systolic blood pressure [BP] ≥ 180 mmHg and/or diastolic BP ≥ 110 mmHg) in primary care were included. Joinpoint regression assessed temporal trends, and multivariable logistic regression identified prescribing determinants.

Results: We analyzed 163,166 episodes from 101,894 patients (mean age 67.3 ± 13.7 years, 60.9% women). Captopril use declined from 40.3 to 34.5% (average monthly percent change [AMPC] - 0.22%; p < 0.001), with steepest decreases in level I-1 healthcare facilities and patients ≥ 80 years. Nifedipine showed no significant overall change (AMPC + 0.07%; p = 0.406) but rose mid-period before declining. Combined captopril or nifedipine use decreased modestly (AMPC - 0.21%; p < 0.001). Furosemide or metamizole were prescribed in 4.7% of episodes, with stable trends but increases in level I-1 healthcare facilities. Higher systolic BP increased the probability of prescribing all medications; diastolic BP showed a non-linear association peaking at 100-110 mmHg. Younger ages were associated with greater medication use.

Conclusions: Short-acting antihypertensives and other agents remain common in Peruvian primary care hypertensive crises. Targeted strategies are needed to align practice with evidence-based recommendations.

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.

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: 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.

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: 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.

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: 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.