High Blood Pressure & Cardiovascular Prevention最新文献

Background: Resistant hypertension (RH) persists despite use of three different antihypertensive drug classes. Additionally, people with persistent hypertension despite the use of multiple drugs, who do not fit the RH criteria are said to have uncontrolled hypertension. Both these populations have increased risk of cardiovascular, CNS, and renal complications. Aldosterone plays a key role in RH and uncontrolled hypertension. Lorundrostat, a selective aldosterone synthase inhibitor targeting CYP11B2 enzyme, shows promise in improving blood pressure control in these populations.

Aim: To evaluate lorundrostat's efficacy and safety in uncontrolled and treatment-resistant hypertension through a meta-analysis of randomized controlled trials.

Methods: We searched PubMed, Cochrane, Google Scholar, and clinicaltrials.gov through July 2025. Screening was done via rayyan.ai; data analyzed with Review Manager 5.4. Risk of bias and evidence certainty used Cochrane Risk of Bias 2.0 and GRADE.

Results: Three high-quality RCTs with 1426 patients were included. Stable dose lorundrostat significantly reduced mean systolic blood pressure compared to placebo (MD = - 9.81 mmHg; 95% CI [- 12.80, - 6.83]; p < 0.00001) and dose-adjusted lorundrostat also showed reduction (MD= - 7.35; 95% CI [- 10.81, - 3.89]; p < 0.0001). Adverse events; hypotension, hyponatremia, hyperkalemia, and reduced GFR were more frequent with lorundrostat, while hypertension-related events were more common in placebo. Certainty of evidence was high (except for any adverse event), and heterogeneity was low across outcomes (except for any adverse event with dose adjustment).

Conclusion: Lorundrostat effectively reduces systolic BP in uncontrolled and resistant hypertension but requires cautious monitoring due to safety concerns.

Introduction: Whether novel lipid parameters are related to arterial stiffness (pulse wave velocity-PWV), changes during follow-up (i.e ΔPWV) has never been evaluated.

Aim: To evaluate the relationship between standard and emerging lipid parameters (non-HDL/HDL, LDL/HDL, total cholesterol/HDL, TG/HDL, Log(TG)/HDL, Log(TG/HDL) and the triglyceride-glucose index [TyG]) and ΔPWV among hypertensive patients.

Methods: We included 469 hypertensive patients enrolled from September 2006 to October 2010 from the Hypertension Unit of San Gerardo Hospital (Monza, Italy). PWV was measured at baseline and after a mean follow-up of 3.8 years (I-III quartiles 3.5-4.2 years) and the relative change (ΔPWV) was calculated.

Results: The study cohort had a mean age of 53.6 ± 12.9 years and 58.4% were male. PWV significantly increased from baseline to follow-up (8.6 ± 2.1 vs. 9.2 ± 2.4 m/s; p=0.0001), with 51.6% of patients exhibiting a ΔPWV≥0.5 m/s. These patients had a significantly lower HDL cholesterol (51.5 ± 13.5 vs. 54.7 ± 13.3 mg/dL) with higher LDL/HDL ratio (2.5 ± 0.9 vs. 2.3 ± 0.9 p=0.049), non-HDL/HDL ratio (3.0 ± 1.1 vs. 2.8 ± 1.1), total cholesterol/HDL ratio (4.0 ± 1.1 vs. 3.8 ± 1.1), Log(TG)/HDL (0.043 ± 0.015 vs. 0.039 ± 0.014) and Log(TG/HDL) (0.351 ± 0.290 vs. 0.295 ± 0.278, p<0.05 for all comparison). A significant univariate association was found between ΔPWV and ΔPWV≥0.5 and Log(TG)/HDL (r = 0.121, p =  0.009 and r = 0.094, p =  0.042, respectively) but it didn't persist at multivariable analysis adjusted for age, sex, Δ systolic blood pressure, anti-hypertensive therapies and statins, diabetes, and glomerular filtration rate.

Conclusions: Our study found no significant associations between emerging lipid parameters and PWV/ΔPWV. Age and blood pressure values remains the main determinants of PWV and its changes over time.

Introduction: While the triglyceride-glucose (TyG) index is a recognized marker of cardiometabolic risk, its influence on blood pressure through body composition in children has not been fully elucidated.

Aim: This study aimed to investigate the associations between the TyG index and blood pressure in children and adolescents, and to examine the mediating role of body composition in this relationship.

Methods: A cross-sectional analysis was conducted using data from 408 children aged 6-17 years in Guangdong Province, representing a subsample of the National Nutrition and Health Systematic Survey for children aged 0-18 years in China. The participants underwent venous blood tests (TyG index calculation), body composition assessments (InBody 770 bioelectrical impedance analyzer), and blood pressure measurements. Linear/logistic regression and mediation analyses were performed to evaluate associations and mediating effects.

Results: The TyG index showed the strongest positive associations with systolic blood pressure (SBP: β = 4.49, 95% CI 2.36-6.61; P<0.001) and diastolic blood pressure (DBP: β = 2.07, 95% CI 0.56-3.58; P=0.007). Elevated blood pressure risk was significantly linked to the TyG index (OR = 2.04, 95% CI 1.29-3.22; P=0.002) and obesity-related parameters, particularly the fat mass index (FMI: OR = 1.50) and waist‒hip ratio (WHR-z: OR = 2.10). Mediation analysis revealed partial indirect effects of body composition on the TyG-SBP association (total effect: 4.49, 95% CI 2.36-6.61) but no mediation effect for the TyG-DBP.

Conclusions: Our findings demonstrate that the TyG index is independently associated with elevated blood pressure in children and adolescents. Importantly, obesity-related body fat composition, especially measured by the FMI and WHR, partially mediates the association between TyG index and SBP.

Introduction: Routine assessment of abdominal aorta (AA) is not currently advised by the available guidelines, although hypertension is a major risk factor for the development of AA aneurysm.

Aim: In the present study, we assessed correlations and predictive factors of AA dimension in a cohort of hypertensive patients.

Methods: 3083 Patients ≥ 18 years old with available AA ultrasound were included. AA dilatation was defined as an AA diameter ≥ 25 mm. Correlations of AA dimension and dilatation with demographics and metabolic profile were explored. Multivariable regression was also used to identify potential confounders influencing univariate correlations. To evaluate the prognostic impact of AA dilatation a propensity score model was implemented, and survival probability curves were constructed using the Kaplan-Meier method.

Results: Increased AA diameter was independently associated with older age, male sex, active smoking, higher diastolic and lower systolic blood pressure, higher LV mass index and aortic root dimension and less use of β-blockers at baseline (all p < 0.05). A significant effect of baseline use of β-blockers and calcium channel blockers therapy were found (all p < 0.01). During a mean follow-up of 4.76 ± 2.91 years, 32 MACE occurred. Kaplan-Meier analysis showed that having AA ≥ 25 mm is associated with significant risk of MACE compared to patients with AA < 25 mm.

Conclusions: AA remodeling is strongly influenced by the cardiovascular (CV) risk profile and hypertension mediated target organ damage and AA dilatation contributes to increased CV risk in treated hypertensive patients.

Introduction: Cardiovascular diseases are the leading cause of death. Women are more frequently affected by these diseases than men.

Aims: To investigate the relationships between subclinical organ damage markers: ankle-brachial index (ABI), pulse wave velocity (PWV), intima-media thickness (IMT) and cardiovascular risk assessed by SCORE2/SCORE2-OP scales, stratified by sex and the presence or absence of coronary artery disease (CAD) and/or hypertension (HT).

Methods: We studied 200 patients divided into groups: CAD + HT+, CAD + HT-, CAD-HT+, and CAD-HT-. Measurements included: ABI, PWV, IMT and cardiovascular risk assessed by SCORE2/SCORE2-OP scales. Statistical analyses were performed using StatSoft Statistica 10.

Results: In hypertensive and non-hypertensive groups, cardiovascular risk assessed by SCORE2/SCORE2-OP scales was higher in men than in women. In the group without CAD, women- with and without hypertension- showed a significant correlation between cardiovascular risk and both ABI and IMT. In men without CAD and hypertension, cardiovascular risk correlated significantly with PWV and IMT. In logistic regression models within the primary prevention group (with or without hypertension), significant correlations between ABI and SCORE2/SCORE2-OP were observed only in women, whereas significant correlations between PWV and SCORE2/SCORE2-OP were found only in men.

Conclusion: Sex-related differences in cardiovascular risk factor profiles and disease progression highlight the importance of sex-specific approaches in risk stratification and management. Logistic regression models suggest a dependence on patient sex in predictive accuracy and biomarker significance. These findings point to a potential role for sex-specific models in risk assessment, but must be interpreted cautiously as associative, not predictive, consistent with the observational design.

Introduction: Hypertension, frequently found in the population aged 60 years or older, is associated with multiple cardiovascular diseases (CVDs). BRICS-plus countries (Egypt, Ethiopia, Iran, Saudi Arabia, the United Arab Emirates, Brazil, Russia, India, China, and South Africa) account for over 40% of global population and are undergoing rapid economic development and population growth. The burden of CVDs attributable to hypertension in the elderly population of BRICS-plus remains uncharted.

Aim: To Explore the burden of CVDs attributable to hypertension in the elderly population in BRICS-plus.

Methods: Deaths and disability adjusted life years (DALYs) were used as indices of the burden of CVDs attributable to hypertension. This burden was investigated using joinpoint regression, age-period-cohort, and Nordpred analysis.

Results: Age-standardized DALYs rate and age-standardized mortality rate declined in Russia after 2002, but fluctuating in United Arab Emirates after 2003. The average age-standardized DALYs rate of stroke, ischemic heart disease (IHD), and hypertensive heart disease (HHD) had anisotropic features for nations (China: 58.02%, Russia: 54.64%, and Ethiopia: 37.81%) from 1990 to 2021.

Conclusion: The burden of CVDs attributable to hypertension in the elderly population from 1990 to 2021 in aging countries shows different decline trends. Egypt has the highest burden in none-aging countries. The United Arab Emirates remains elusive because the elderly female population has remained at a relatively low level. HHD, IHD, and stroke account for the highest proportion in Ethiopia, Russia, and China.

Introduction: Paralympic athletes (PA) represent a special part of the athletic population and deserve a specialized functional and medical care. In view of the 2024 Paris Paralympic Games, a comprehensive sport medical screening was carried out in Italy. This pre-participation medical assessment included clinical, laboratory and instrumental tests including cardiopulmonary exercise test (CPET) and trans thoracic echocardiography (TTE).

Aim: To assess prevalence and type of cardiovascular abnormalities in PA candidate to compete in 2024 Paralympic Games.

Methods: We enrolled 167 PA, 80 female and 87 male PA. All of them underwent a comprehensive, multidisciplinary evaluation, including a full panel of blood tests, resting ECG, TTE and CPET.

Results: 74 PA (44%) showed one or more cardiovascular abnormalities. In details, 12 PA showed abnormal basal ECG findings, 7 abnormal TTE results, 1 uncontrolled hypertension, 30 exercise induced arrhythmias, 8 abnormal basal ECG findings in combination with exercise induced arrhythmias and 7 abnormal basal ECG finding and abnormal echocardiographic findings. Furthermore, 9 PA showed exercise test induced arrhythmias with abnormal echocardiographic findings.

Conclusions: PA, despite their attitude high levels of performance, are not exempt from cardiovascular and metabolic abnormalities, including a small proportion of cardiac conditions at potential risk of sudden cardiac death. Comprehensive diagnostic tools, including CPET, echocardiography and full blood tests are important to identify hidden cardiovascular abnormalities potentially harmful to the athlete's health.

Introduction: Little is known about the relationship between pulse pressure (PP) and incident chronic kidney disease (CKD) in Asian populations, particularly when analyzed separately by hypertension status.

Aim: This study aimed to assess the association between PP and subsequent onset of CKD in Japanese adults.

Methods: This longitudinal study included middle-aged and older Japanese citizens who participated in administrative checkups (1998-2024) conducted by Zentsuji City. The relationship between PP (diastolic blood pressure subtracted from systolic blood pressure) and incident CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m²) was evaluated by hypertension status, using the Weibull accelerated failure time model. PP was treated as a time-varying variable and categorized into < 40 (reference), 40-< 60, and ≥ 60 mmHg. In addition to the crude model, two adjusted models were created to control for potential confounders.

Results: Among 15,788 participants, 8881 (men: 42.7%) were examined in the study. The mean follow-up time was 6.21 years for non-hypertensive participants and 6.27 years for hypertensive participants. Higher PP was associated with higher rate of CKD incidence regardless of prevalent hypertension. In non-hypertensive participants, PP ≥ 60 mmHg had a 10% shorter time to CKD onset (95% confidence interval: 3-16%) compared with PP < 40 mmHg. In hypertensive participants, attenuated results were observed, with all 95% confidence intervals crossing the null value.

Conclusions: Elevated PP may serve as a useful indicator for CKD development in non-hypertensive Japanese subjects. Regular BP monitoring may assist in developing public health strategies for CKD prevention, especially among non-hypertensive Asian populations.