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: 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: 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.

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.

Introduction: FDA-approved GMRx2, a single-pill combination of telmisartan, amlodipine, and indapamide, has shown potential for improving blood pressure (BP) control.

Aim: We assessed the efficacy and safety of low-dose GMRx2 compared to placebo, or standard-care (monotherapy or dual therapy) in mild to moderate hypertension.

Methods: A meta-analysis of randomized controlled trials (RCTs) was conducted from PubMed, Embase, Cochrane, Scopus, and Web of Science from 2006 to June 2025. Random-effects model to pool mean difference (MD) for continuous outcomes and risk ratios (RR) for binary outcomes with 95% confidence intervals (CI).

Prospero-id: CRD420251108645 RESULTS: Four RCTs involving 1999 patients were included. Compared with control, low-dose GMRx2 significantly reduced office systolic BP at 4-6 weeks (MD -8.84 mmHg, 95% CI [-11.27; -6.46]) and 12 weeks (MD -5.52 mmHg, 95% CI [-6.85; -4.18]). It also increased the proportion of patients achieving target office BP at 4-6 weeks (66.7% vs. 50.2%, RR 1.20, 95% CI [1.08-1.43]) and 8-12 weeks (75.6% vs. 59.5%, RR 1.15, 95% CI [1.05-1.26]). No significant differences were observed in serious adverse events (P= 0.77) or treatment discontinuation (P= 0.30). However, low-dose GMRx2 had a higher incidence of hypokalemia (9% vs. 7%, RR 1.40, 95% CI [1.04-1.90]) and hyponatremia (5% vs. 3.7%, RR 1.59, 95% CI [1.04-2.42]).

Conclusion: Low-dose GMRx2 provides superior BP reduction and a well-tolerated safety profile in patients with mild to moderate hypertension. Nonetheless, it may increase the risk of hypokalemia and hyponatremia. Larger and longer-term RCTs are warranted to confirm.