High Blood Pressure & Cardiovascular Prevention最新文献

Introduction: Cardiovascular (CV) diseases are the leading cause of mortality worldwide, and preventive strategies are increasingly focusing on early detection and management of risk factors. Corporate Wellness Programs (CWPs) in workplaces play a crucial role in the primary prevention of chronic non-communicable diseases, especially for early CV modifiable risk detection and management in apparently healthy individuals.

Aim: This study explores the prevalence and age-related distribution of CV modifiable risk factors in a large cohort of Ferrari car manufacturer employees evaluated through a CWP.

Methods: A cross-sectional analysis was conducted among 1992 employees participating for the first time in the "Ferrari Formula Benessere" CWP in Maranello, Italy, throughout 2023. The program included a comprehensive medical evaluation, personal and family history, anthropometric measurements, blood testing, and blood pressure evaluation. Data on demographic characteristics, health behaviors, and CV modifiable risk factors were collected and analyzed.

Results: Most participants were males (82%), with a mean age of 40 ± 9 years. Findings revealed a notable prevalence of CV modifiable risk factors: 17.3% were active smokers, 43.2% reported physical inactivity, 34.8% were classified as overweight (body mass index ≥ 25), and 7.7% as obese. Early screening identified a significant proportion of employees with elevated CV risk according to the SCORE2 algorithm: 39% were categorized as having a high CV risk and 2% at a very high CV risk. In addition, 6.4% had impaired fasting glycemia (100-125 mg/dL), 3.8% had dyslipidemia and 6.8% had high blood pressure (systolic blood pressure 140-159 mmHg): almost none of them (98%) were on treatment.

Conclusions: The "Ferrari Formula Benessere" identified a wide range of CV modifiable risk factors in a cohort of apparently healthy employees, not routinely screened, highlighting the essential role of CWPs in the early detection and management of CV health risks. These findings underscore the importance of integrating regular health assessments into corporate wellness strategies to mitigate CV risk and promote overall employee well-being.

Introduction: Management of hypertensive disorders in pregnancy (HDP) remains challenging, with various healthcare providers involved and no uniform approach with variability in medications, monitoring, and intervention timing reflecting gaps in research.

Aim: To investigate Italian physicians' knowledge on the topic and examine their clinical practices.

Methods: We collected multi-regional data from Italian experts on Hypertension and Gynecologists. The survey consisted of 18 multiple choice questions. Questions involved patient access pathways for suspected HDP, diagnostic assessments, first- and second-line therapies, follow-up visits modalities, and postpartum recommendations.

Results: One-hundred and ten experts on hypertension and 31 gynecologists from third-referral centers of 16 over 20 Italian Regions participated in the survey. Only 27.7% of participants were aware of the actual risk of developing preeclampsia in women with chronic hypertension, and only one over two was aware of all long-term risks of cardiovascular disease. Hypertension specialists were in charge of the first antihypertensive prescription in less than 10% of HDP cases. Most common first-line agent was nifedipine and second-line agent nifedipine or methyldopa. Adding a second agent was slightly preferred over the use of maximum dosage of the first agent; 72.6% declared choosing the medication based on maternal hemodynamic profile. Consistent involvement of Hypertension Centers during both pregnancy and postpartum was reported only by 56.7% of physicians.

Conclusions: The survey revealed significant gaps in awareness and management practices for women with HDP.

Introduction: The teach-back method is an effective strategy for enhancing patient engagement in chronic disease management. However, no studies have explored the impact of combining this educational approach with wearable devices on patient engagement in hypertension management.

Aim: This study aimed to evaluate the effectiveness of a teach-back-based educational approach in promoting engagement with wearable devices among patients with hypertension.

Methods: A longitudinal study was conducted. The study included 76 patients and included three phases. In the first phase (T0), patients received training about the use of two wearable technology devices through the teach-back method. Immediately afterward, participants completed the TWente Engagement with E-health Technologies Scale (TWEETS) to measure engagement at T0. Patient engagement was reassessed at 6 (T1) and 12 weeks (T2) after the educational training. A repeated-measures ANOVA was performed to compare the mean scores across the three phases.

Results: The statistical analysis revealed no significant change in the TWEETS score between T0 and T1 (p = 0.42). However, the score significantly decreased at T2 compared to the previous two time points (p < 0.002).

Conclusions: Our results suggest that the teach-back method is effective for maintaining patient engagement in the short to medium term. However, its impact appears to decrease over time. Nurses can use the teach-back method to support education and enhance engagement with digital technology among hypertensive patients. Further research is needed to explore whether combining teach-back with additional strategies, such as gamification, telemedicine, remote monitoring, or peer support, can help sustain long-term patient engagement with digital health technologies.

Introduction: Moderate aortic stenosis (AS) has traditionally been considered a stable condition, but recent evidence suggests that some patients progress rapidly to severe AS, leading to earlier symptom onset and worse outcomes. Current guidelines primarily focus on severe AS, leaving a gap in risk stratification for moderate cases. This study aims to identify echocardiographic and clinical predictors of rapid progression in moderate AS to refine patient selection for closer monitoring and early intervention.

Aim: To identify clinical, echocardiographic, and imaging predictors of progression in moderate aortic stenosis, with particular focus on diastolic function, ΔV/Δt, myocardial fibrosis, and the impact of comorbidities and medical therapy on disease trajectory.

Methods: This prospective, multi-center cohort study enrolled 650 patients with moderate AS (AVA 1.0-1.5 cm², mean gradient 20-39 mmHg) across 10 cardiovascular centers in the Middle East between Egypt, Jordan, and Tunisia (2021-2024). Patients with prior valve interventions, severe comorbidities, or poor echocardiographic windows were excluded. Transthoracic echocardiography was performed at baseline and every six months to assess GLS, peak aortic jet velocity acceleration (ΔV/Δt), diastolic dysfunction, and aortic calcification (Agatston score in 300 patients). NT-proBNP and hs-Troponin T were measured at baseline and follow-up. Moreover, a pre-specified sub-study investigated the association between specific genetic polymorphisms and medication response in a subset of 87 patients.

Results: At 24 months, 31% of patients exhibited rapid AS progression. Independent predictors included GLS > - 16% (OR 3.2, p < 0.001), ΔV/Δt > 350 cm/s² (OR 2.8, p = 0.003), Agatston score > 2000 (HR 4.1, p < 0.001), E/e' > 15 (HR 2.3, p = 0.02), and NT-proBNP > 900 pg/mL (HR 3.0, p = 0.001). Patients with ≥ 3 risk factors had an 8-fold increased risk of rapid progression.

Conclusion: These findings provide novel evidence that GLS impairment, ΔV/Δt, aortic calcification burden, and diastolic dysfunction independently predict rapid AS progression. This supports the need for earlier echocardiographic surveillance and risk-based decision-making in moderate AS.

Introduction: Lipoprotein(a) [Lp(a)] has been linked to myocardial fibrosis and endothelial dysfunction, proposed mechanisms for diastolic dysfunction (DD). This study assessed the association between elevated Lp(a) (≥ 50 mg/dL) and DD in patients with preserved ejection fraction (EF).

Aim: We analyzed 1492 adults (median age59) with an Lp(a) measurement and echocardiogram (1997-2024).

Methods: Diastolicdysfunction required ≥ 3 abnormal echo parameters, as per recent guidelines. Logisticregression adjusting for potential confounders was performed.

Results: Seventy-sevenpatients (5.1%) had DD. Lp(a) ≥ 50 mg/dL was not associated with DD [adjusted oddsratio (aOR): 0.89, 95% confidence interval (CI): 0.49-1.54]. However, age (aOR:1.03, p = 0.026), hypertension (aOR: 1.83, p = 0.042), diabetes mellitus (aOR: 2.43, p =0.002), and cardiovascular (CV) diseases (aOR: 1.90, p = 0.043) were associated withDD, while statin therapy was associated with reduced risk (aOR: 0.51, p = 0.016).

Conclusions: In the setting of preserved EF, Lp(a) was not associated with DD,emphasizing management of traditional CV risks.

Introduction: While vitamin D is primarily recognized for its role in intestinal calcium absorption and bone mineralization, it had numerous extra-skeletal effects also regarding the cardiovascular (CV) systems.

Aim: To evaluate the correlation between vitamin D levels and cardiovascular risk factors and Target Organ Damage (TOD) in a healthy population.

Methods: We enrolled 311 healthy participants from a CV risk assessment program at Niguarda Hospital. Medical history, physical exams, Blood Pressure (BP), Body Mass Index (BMI) and laboratory tests (glucose, lipids, creatinine, eGFR) were collected. TOD was evaluated by echocardiography and carotid ultrasound.

Results: At multivariable models with age, sex and kidney function as covariates, vitamin D was significantly associated with BMI (β=-0.142, p = 0.007), SBP (β=-0.116, p = 0.039), triglycerides (β=-0.239, p < 0.001) and HDL (β = 0.141, p = 0.007). Furthermore, vitamin D deficiency (< 12 ng/mL) was significantly associated with hypertriglyceridemia (> 150 mg/dL) with an HR of 5.984 (p < 0.001). No significant association with TOD was found.

Conclusions: Our study found that low vitamin D levels are linked to metabolic disturbances, including lower HDL and higher TG, BP, and BMI, but showed no significant association with heart or carotid TOD. One could speculate that in an otherwise healthy population metabolic derangement determined by low vitamin D levels could precede TOD development.

Cardiovascular diseases (CVDs) remain the leading cause of death and disability worldwide. Over the last two decades, different risk score models, generally assessing the short-term (10-year) risk estimates, have been developed to predict risk and to provide guidance for informed decision-making regarding initiation or intensification of CVD prevention strategies. However, the short-term risk estimation of CVD mortality/morbidity deeply underestimates the lifetime CVD risk, especially in younger age individuals and in women. Moreover, the greatest number of CV events occurs in subjects with low/moderate short-term risk because they are prevalent in the general population. By contrast, estimates of the lifetime risk of CVD may provide a more comprehensive assessment by considering both traditional and non-traditional CV risk factors as well as the potential competing risks, which leads to a more accurate and tailored assessment of the patient's health status. Aim of the present manuscript is to review the latest proposed strategies regarding the estimation of lifetime CV risk and how these strategies may be helpful in daily clinical practice both in primary and secondary prevention.

Introduction: Low Low-dose triple single pill combination therapy is recommended for hypertension treatment. However, the efficacy and safety of these combinations in low- and middle-income countries (LMICs) remain unclear.

Aim: We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of low-dose triple single pill combination therapy in controlling blood pressure (BP) in LMICs.

Methods: We systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov for randomised controlled trials (RCTs) comparing low-dose triple single pill combination therapy with standard care for hypertension management up to 29 January 2025. Mean differences (MD) were computed for continuous outcomes and risk ratio (RR) with 95% confidence intervals (CI) for binary outcomes.

Results: Three RCTs comprising 1758 patients, of whom 752 (43%) received low-dose triple single pill combination therapy, were included. The proportion of patients that achieved target BP at six weeks was higher with this therapy (RR 1.89; 95% CI 1.29, 2.75; P < 0.001). Compared with standard care, it significantly reduced SBP (MD - 5.30 mmHg; 95% CI - 9.55, - 0.92; P = 0.017), DBP (MD - 3.50 mmHg; 95% CI - 4.95, - 2.05; P < 0.001), and urine albumin-to-creatinine ratio (RR 0.59; 95% CI 0.44, 0.80; P < 0.001). No significant differences in adherence, withdrawal, or adverse effects were observed between groups.

Conclusion: In this meta-analysis, the use of a low-dose triple single pill combination in hypertensive patients in LMICs led to earlier and sustained blood pressure control and reduced urine albumin-to-creatinine ratio, with a safety profile comparable to standard care. PROSPERO registration: Number: CRD42025647884, Date: 15 February 2025.

The European Society of Hypertension (ESH) in the guidelines document issued in 2023 made specific recommendations regarding the diagnostic and therapeutic approach for the different hypertensive phenotypes detectable in current clinical practice. The present paper will offer a critical review of these recommendations.The clinical hypertensive phenotypes of most frequent detection in current clinical practice, namely white-coat hypertension, masked hypertension, nocturnal hypertension and isolated systolic hypertension of the elderly will be reviewed. Other less common phenotypes will be also addressed. Recommendations for each clinical phenotype are made, emphasizing the need for an accurate diagnosis and treatment for specific clinical conditions, i.e. when target organ damage and/or high cardiovascular risk is detected. Areas of uncertainty related to clinical phenotypes in which pathophysiological and prognostic information are still lacking will be discussed. Future studies will allow to refine the guidelines recommendations, particularly for the clinical conditions for which pathophysiological and prognostic information are at present scanty.