High Blood Pressure & Cardiovascular Prevention最新文献

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.

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.

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.

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 prognostic significance of isolated morning hypertension (IMH) in treated hypertensive patients remains unclear. Although overall blood pressure (BP) control is often considered adequate, morning BP surges may still pose cardiovascular risks.

Aim: To determine whether the presence of IMH in treated hypertensive patients with globally controlled BP is associated with an increased risk of cardiovascular events.

Methods: This cohort study included hypertensive patients on stable antihypertensive treatment for ≥ 4 weeks who underwent home blood pressure monitoring (HBPM) between September 1, 2008, and December 31, 2015. BP was measured in duplicate over four days (morning, afternoon, and evening) using an OMRON 705 CP device. IMH was defined as an average morning BP > 135 and/or 85 mmHg, despite overall mean BP < 135/85 mmHg. Patients were followed until April 30, 2020, for fatal and non-fatal cardiovascular and cerebrovascular events. Cox proportional hazards models were used to assess the prognostic value of IMH.

Results: A total of 925 patients were included, with a prevalence of IMH of 17.4% (95% CI 15.1-20%). During a median follow-up of 6.2 years, 126 cardiovascular events occurred. Compared to well-controlled hypertensive patients without IMH, those with IMH had a significantly higher risk of cardiovascular events after adjusting for sex, age, body mass index, number of antihypertensive drugs, smoking status, diabetes, and office BP (HR 1.6, 95% CI 1.1-2.2; p = 0.02).

Conclusions: IMH detected through HBPM was associated with an increased risk of fatal and non-fatal cardiovascular and cerebrovascular events in treated hypertensive patients with otherwise adequate global BP control. Monitoring and addressing IMH may be essential to further reducing cardiovascular risk.