High Blood Pressure & Cardiovascular Prevention最新文献

Introduction: Previous studies have shown a correlation between the triglyceride glucose index (TyG) and hypertension, as well as between body roundness index (BRI) and hypertension. However, there is limited research on the bidirectional mediation effects of TyG and BRI on their relationships with hypertension.

Aim: We aimed to assess the associations between the TyG with hypertension among participants with different BRI, and examine the potential mediating effect of BRI on the associations between TyG with hypertension.

Methods: This cross-sectional study involved 9,251 middle-aged and elderly individuals from the China Health and Retirement Longitudinal Study. Association between TyG and BRI, and hypertension was examined using multivariable logistic regression, restricted cubic spline analysis, and subgroup analysis. Bidirectional mediation analysis was conducted to determine the direct and indirect effects through BRI and TyG.

Results: After adjusting for potential confounders, TyG was associated with a 40% (OR: 1.40; 95% CI: 1.23-1.59) higher risk for hypertension, and BRI was associated with a 33% (OR: 1.33; 95% CI: 1.28-1.38) higher risk for hypertension. A linear association between TyG and hypertension was noted (P_overall<0.0001, P_{non-linearity}=0.173), and there was a nonlinear relationship between BRI and hypertension (P_overall<0.0001, P_{non-linearity}<0.0001). BRI was found to mediate 11.71%, 11.66%, and 11.76% of the associations between TyG and hypertension, SBP, and DBP. No significant multiplicative and additive interactions were found between TyG and BRI on hypertension (Additive: RERI = 1.25, 95% CI: -8.03-14.17; Multiplicative: OR = 0.90, 95% CI: 0.77-1.04).

Conclusions: BRI appeared to be associated with hypertension risk and played a mediating role in the association between TyG and hypertension. Managing visceral fat and monitoring TyG levels may contribute to alleviating hypertension.

Essential hypertension represents the main risk factor for coronary events, including acute myocardial infarction, coronary syndromes, and unstable angina, as well as for chronic coronary artery disease (CAD). It also increases the risk of peripheral artery disease and chronic kidney disease, thus contributing to worsen prognosis, deteriorating quality of life, favouring unplanned hospitalizations due to cardiovascular (CV) causes, and affecting elevated costs for health care systems. Moreover, hypertension may contribute to development and progression of left ventricular (LV) remodelling and dysfunction, which may, in turn, promote the onset of cardiac arrhythmias, mostly atrial fibrillation (AF), and congestive heart failure with preserved ejection fraction (HFpEF). All these clinical conditions related to hypertension can be included in the definition of high or very high CV risk profile. Lowering blood pressure (BP) levels to the recommended therapeutic targets is a mandatory step for reducing the burden of hypertension-related CV complications, as well as for improving quality of life and event-free survival in patients with hypertension at high or very high CV risk. Current guidelines recommend the use of combination therapies, possibly in fixed formulations, even as first-line therapy, in almost all patients with hypertension, including those at high or very risk CV risk profile. Such combination therapies have proven to lower BP, reduce CV morbidity and mortality, as well as the risk of hospitalization due to CV causes. In particular, combination therapies based on the use of an angiotensin-converting enzyme (ACE) inhibitor plus a beta-blocker (BB) have demonstrated to be effective in lowering BP and heart rate, promoting reverse cardiac and vascular remodelling, and reducing CV morbidity and mortality in patients with hypertension and chronic CAD, cardiac arrhythmias, or HFpEF. This consensus document, endorsed by the Italian Society of Hypertension (SIIA) and the Italian Society for Cardiovascular Prevention (SIPREC), will discuss the available evidence and clinical indications supporting the use of fixed combination therapies based on ACE inhibitors plus BBs in patients with hypertension and high or very high CV risk profile, including those with chronic CAD, cardiac arrhythmias, or HFpEF.

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).

The renin-angiotensin system (RAS) plays a pivotal role in the pathophysiology of several conditions such as hypertension, heart failure and chronic kidney disease. In the last fifty years different therapeutic strategies, including angiotensin converting enzyme inhibitors (ACEi), type 1 angiotensin II receptor blockers (ARBs) and angiotensin receptor neprilysin inhibitors (ARNi), have been developed to counteract this neurohormonal dysregulation. However, all these therapeutic strategies have a relatively short-term action and they need to be administered orally once or more times every day to achieve the therapeutic purposes with a risk of poor therapeutic adherence.More recently, the search for a new effective strategy to provide a long-term control of hypertension was recently boosted by the availability of novel technologies, such as the angiotensinogen suppression in the liver realized through the silencing of RNA with zilebesiran, a small interfering RNA (siRNA) agent.The purpose of this article is to review the available data on Zilebesiran and to discuss in detail potential advantages in the clinical use as well as the still unresolved potential risks.

Hyperuricemia is a metabolic disorder associated with an increased risk of gout, chronic kidney disease (CKD), and cardiovascular disease (CVD). The management of hyperuricemia in conditions where urate deposition has already occurred primarily relies on xanthine oxidase inhibitors (XOIs), such as allopurinol and Febuxostat. Febuxostat, a non-purine selective XOI, has demonstrated superior urate-lowering efficacy, particularly in patients with renal impairment. This review provides an in-depth analysis of Febuxostat's pharmacological properties, clinical efficacy, and safety profile, with a focus on cardiovascular and nephroprotective effects.

Introduction: Hypertension remains a leading modifiable risk factor for cardiovascular morbidity and mortality in the United States. Despite advances in detection and treatment, the burden of hypertension-related deaths continues to challenge public health systems. Understanding long-term mortality trends and projecting future patterns is essential to guide policy, allocate resources, and inform prevention strategies.

Aim: This study aimed to examine national trends in hypertension-related mortality in the U.S. from 1979 to 2023 using CDC WONDER data and to project mortality patterns through 2050 to support public health planning and intervention efforts.

Methods: We extracted age-adjusted mortality rates (AAMRs) per 100,000 population for hypertension as the underlying cause of death from the CDC WONDER database. Temporal trends were assessed using Joinpoint regression to identify significant changes in trajectory, calculating the annual percent change (APC) for specific periods and the average APC for broader trends. Future mortality rates were projected through 2050 using time series models trained on 1979-2015 data, validated against data through 2023, and refined using rolling forecasting techniques.

Results: From 1979 to 2023, 2,575,968 hypertension-related deaths occurred. AMRs rose from 27.0 (95% CI, 26.7-27.3) to 40.2 (95% CI, 40.0-40.5), peaking in 2020. Males had consistently higher AAMRs than females. In 2023, AAMRs were 46.7 in males and 33.9 in females. Racial disparities persisted, with Black individuals having a higher AAMR than Whites in 2023 (70.2 vs 35.5). The South remained the most affected region, with Oklahoma (164.1), Mississippi (101.7), and Tennessee (86.0) showing the highest AAMRs in 2023. Forecasts indicate rising hypertension-related mortality, with male AAMR reaching 88.8, Black AAMR 68.4, and older adult AAMR 267.5 by 2050.

Conclusion: Hypertension mortality will remain a major public health issue, with growing sex disparities and high rates in older adults and the South, underscoring the need for targeted, long-term interventions.

Introduction: Office blood pressure (BP) measurement is the cornerstone for the diagnosis of arterial hypertension.

Aim: To investigate how office BP is measured in clinical practice among the hypertension centers of the Italian Society of Hypertension in comparison to what is recommend by the latest guidelines.

Methods: Coordinators of hypertension centers affiliated to the Italian Society of Hypertension were invited by email to complete an online survey including 26 questions regarding the equipment (devices and cuffs) available in the centers, office BP measurement procedure and possible additional measures performed by the devices.

Results: We obtained answers from 72 of the 119 centers (response rate 60.5%). The majority of the responders were older than 55 years (55.5%) and were from the North of Italy (61.1%). 95.6% stated the use of a validated device: 65.3% used automatic oscillometric devices, 27.8% an aneroid device, while 6.9% a manual device with a digital column. Unattended BP measurements were performed in 1.4% of the cases. Normal size cuff was available among 97.2% and large cuff among 83.1% of the centers. The majority tested BP in two different positions supine or sitting and standing positions, but there was a quarter of centers that measured BP only in one position. 38% of the responders performed three BP recordings, 38% at least two, but 5.7% measured BP only once. 42.3% of the devices used were able to detect atrial fibrillation.

Conclusion: Our survey depicted a considerable heterogeneity of office BP measurement methodology in daily practice, not always aligned with current guidelines.

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.