High Blood Pressure & Cardiovascular Prevention最新文献

Resistant hypertension is a state characterized by sustained hypertension despite adherence to the standard pharmacological treatment with beta-blockers, calcium channel blockers, diuretics, and ACE inhibitors or ARBs. Resistant hypertension is a problem now in cardiovascular medicine because of its association with increased stroke, heart failure, kidney disease, and vision loss. Renal denervation (RDN) is an invasive treatment strategy for patients with hypertension who are unresponsive to pharmacological therapy. Therefore, this procedure has become a feasible alternative, and this review explores and compares with other possible novel options. RDN's mechanisms, efficacy, safety, and future directions are also discussed. No serious side effects have been reported in the short-term use of RDN, but some of the complications include renal stenosis and hypertensive urgencies in the long term. Despite this, RDN can benefit patients who are non-compliant with medications or are intolerant. However, it should also be pointed out that some clinical studies have not given consistent results. RDN may be employed as secondary therapy as opposed to the primary line of treatment in resistant hypertension. Subsequent studies should assess the technique's durability and establish customized approaches to deliver RDN safely while determining specific biomarkers that can predict patients' outcomes.

Introduction: Sex differences have a significant role on epidemiology of cardiovascular complications in chronic kidney disease. Among hemodialysis patients, central blood pressure (BP) levels and increased arterial stiffness parameters are independent predictors of cardiovascular and all-cause- mortality.

Aim: To examine the potential differences in ambulatory central BP and arterial stiffness parameters between male and female hemodialysis patients.

Methods: A total of 129 male and 91 female hemodialysis patients were included in this analysis. All participants underwent 48-h ambulatory BP monitoring with Mobil-O-Graph-NG; indices of central hemodynamics (SBP, DBP and pulse pressure), wave reflection (augmentation pressure (AP) and augmentation index (AIx)) and pulse wave velocity (PWV) were estimated.

Results: Age, dialysis vintage and history of major comorbidities did not differ between men and women. Male patients had higher 48-h cSBP (124.7±15.7 vs. 119.8±16.7 mmHg, p=0.027) and 48-h DBP (83.7±12.2 vs. 77.5±11.9 mmHg, p<0.001) compared to female patients; relevant differences were also evident during the 44-h (excluding hemodialysis), 1st 24-h and 2nd 24-h periods and the corresponding daytime and nighttime periods of the recording. Central pulse pressure did not differ between groups. Regarding wave reflection parameters, AP, AIx, and AIx(75) were significantly lower in males versus females during the 48-h (AIx, 25.6±8.2 vs. 32.3±8.6 mmHg, p<0.001), 44-h, 1st and 2nd 24-h and also during respective daytime and nighttime periods. The two groups displayed similar PWV during all studied intervals (48-h PWV, 9.6±1.9 vs 9.7±2.1 m/s, p=0.612).

Conclusions: Male hemodialysis patients present with higher levels of ambulatory central BP but significantly lower levels of AP, AIx and AIx(75) than females. PWV does not differ between sexes.

Introduction: Sex differences in the life course development of brachial blood pressure (Bi et al. N Engl J Med, 2024. https://doi.org/10.1056/NEJMoa2412006 ) and the association between brachial and central BP are well documented.

Aim: To explore if the associations of brachial and central BP with the presence of increased arterial stiffness differ between older women and men.

Methods: Data from 1135 women and 943 men aged 68 in the Hordaland Health Study were used. Brachial BP was categorised as normal (BP< 130/85 mmHg), high-normal (BP 130-139/85-89 mmHg) or hypertension (BP≥140/90 mmHg). Arterial stiffness was assessed from carotid-femoral pulse wave velocity (cfPWV), and central systolic BP from brachial pulse wave analysis. Sex-specific associations between BP and increased arterial stiffness (cfPWV >10 m/s) were tested in logistic regression analyses and reported as odds ratio (OR) and 95% confidence intervals (CI).

Results: In multivariable analyses, both hypertension and high-normal BP were more strongly associated with presence of increased arterial stiffness in women (OR 5.81 [95% CI 3.86-8.75] and OR 2.56 [95% CI 1.43-4.56], respectively) compared to men (OR 2.56 [95% CI 1.43-4.56] and OR 2.01 [95% CI 1.22-3.33], both p for sex-interaction <0.05). Additionally, central systolic BP showed a stronger association with increased arterial stiffness in women (OR 1.06 [95% CI 1.05-1.07]) than in men (OR 1.05 [95% CI 1.04-1.06], p for sex-interaction <0.05).

Conclusions: In 68-year-old individuals, a high normal BP, hypertension and higher central systolic BP were all more strongly associated with the presence of increased arterial stiffness in women than in men.

Introduction: Carotid Intima-Media Thickness (IMT) is a marker of subclinical atherosclerosis and cardiovascular risk. Dyslipidemia is a well-established risk factor for atherosclerosis and novel lipid parameters have recently emerged.

Aim: The aim of our study was to assess the association between IMT and novel lipid parameters in hypertensive patients.

Methods: We analyzed the IMT of 848 hypertensive patients followed at the Hypertension Unit of San Gerardo Hospital (Monza, Italy). Classic (total, HDL, LDL and non-HDL cholesterol and triglycerides) and novel indices (non-HDL/HDL, LDL/HDL, total cholesterol/HDL, log triglycerides/HDL and triglycerides-glycemia index) were measured and calculated.

Results: Univariable analyses showed a significant correlation between IMT and most lipid parameters. Multivariable linear regression with IMT as continuous dependent variable revealed a significant association with total cholesterol (β = 0.108, p = 0.001), LDL cholesterol (β = 0.119, p < 0.001), non-HDL cholesterol (β = 0.126, p < 0.001), non-HDL/HDL (β = 0.134, p < 0.001), LDL/HDL (β = 0.140, p < 0.001) and total cholesterol/HDL (β = 0.134, p < 0.001). Logistic multivariable regression with IMT categorized as ≥ or < 0.9 mm demonstrated a significant association with total cholesterol (OR = 1.100 per 10 mg/dL increase, p = 0.003), LDL cholesterol (OR = 1.130 per 10 mg/dL increase, p = 0.001), non-HDL cholesterol (OR = 1.110 per each unit increase, p = 0.001), non-HDL/HDL (OR = 1.368 per each unit increase, p = 0.002), LDL/HDL (OR = 1.583 per each unit increase, p = 0.001) and total cholesterol/HDL (OR = 1.368 per each unit increase, p = 0.002).

Conclusions: Carotid IMT is significantly associated with various lipid parameters, with the strongest association observed for non-HDL/HDL, LDL/HDL and total cholesterol/HDL.

Introduction: Olympic athletes represent a special subset of the athletic population and deserve a specialized medical approach. In view of the 2024 Paris Olympic Games, we developed and implemented a comprehensive medical protocol including (other than the standard screening with ECG, physical and history) cardiopulmonary exercise test, echocardiography and full blood and urine tests.

Aim: Our aim was to assess the prevalence and type of cardiovascular abnormalities in athletes candidate to Paris 2024 Olympic Games, after implementation of this Olympic medical program.

Methods: We enrolled 772 elite athletes, who underwent a comprehensive, multidisciplinary evaluation, including full panel of blood and urine tests, electrocardiography, trans-thoracic echocardiography (TTE) and a cardiopulmonary exercise test (CPET).

Results: Of the 772 elite athletes, 363 (47%) were female. A substantial subset of 145 athletes (18.8%) showed one or more abnormalities. Specifically, either abnormal basal ECG findings (n = 26, 17.9%), abnormal TTE results (n = 45, 31%), high blood pressure (n = 2, 1.4%) or exercise induced arrhythmias (n = 49, 33.8%) were detected. 10 athletes (6.9%) showed both abnormal ECGs and exercise induced arrhythmias, and 13 athletes (9%) showed both ECG and echocardiographic abnormal findings. After further and more detailed investigations, of the 145 athletes showing cardiovascular abnormalities at the initial screening, in 4 of them were cardiac conditions implying potential risk of sudden cardiac death were identified and therefore they were withdrawn from competitive sport. Full blood test analysis identified metabolic abnormalities in 200 subjects. Of these, 165 (21%) showed hypercholesterolemia.

Conclusions: Olympic athletes, despite the highest level of physical performance, are not exempt from cardiovascular and metabolic diseases, including a small proportion of cardiac conditions at risk of SCD. More advanced diagnostic tools, including CPET, echocardiography and full blood tests, implemented in our protocol, were required to identify hidden cardiovascular abnormalities that could have jeopardized athlete's health and performance.

In patient with arterial hypertension the whole aorta is exposed to increased wall stress due to pressure overload. Different blood pressure (BP) components have been reported as main determinant of aortic remodelling. In particular increased diastolic BP has been associated with aortic dilatation across all its segments with smaller increase in aortic root and ascending aorta related to increased systolic BP and pulse pressure. Optimal BP control is crucial to prevent development of aortic aneurysm and acute aortic disease. Many studies have evaluated the role of different antihypertensive drug classes for prevention of adverse aortic remodelling including beneficial effects of ACEIs, ARBs, dihydropyridinic calcium channel blockers and Beta-blockers. The present review discusses pathophysiological mechanisms, therapeutic interventions and preventive strategies for development of aortic remodeling in patients with arterial hypertension.

Introduction: The renal resistive index (RRI) has been widely shown to be related with subclinical vascular damage in individuals with essential hypertension, as well as in other populations. However, limited data exist regarding the association between RRI and cardiovascular (CV) events in hypertensive individuals. Additionally, it is unclear whether the 10-year risk of CV disease, as predicted by validated score equations, is associated with impaired intrarenal hemodynamics.

Aim: The aim of our study was to analyze the relationship between RRI and both the FS and ASCVD in hypertensive individuals with no history of CV events.

Methods: A total of 742 individuals with essential hypertension (40-75 years) were enrolled. RRI was assessed in all patients using Duplex-Doppler ultrasonography, and the 10-year risk of cardiovascular disease was calculated using both the Framingham risk score (FS) and atherosclerotic cardiovascular disease risk score (ASCVD) through validated equations.

Results: Higher RRI values were observed in patients with calculated CV risk ≥ 20% compared to those with lower risk (all p  <  0.001). RRI was closely associated with both FS and ASCVD scores in the overall cohort (all p < 0.001), with no significantly differences between groups with glomerular filtration rate ≥ or  <  60 mL/min/1.73m². In multivariate analyses, these associations remained significant after adjusting for traditional risk factors included in the FS and ASCVD equations (p = 0.007 and p = 0.047, respectively). Receiver-operating characteristic curves indicated that RRI values >0.67 and >0.65 were associated with a high CV risk (≥ 20%), as calculated through FS and ASCVD equations, respectively.

Conclusion: RRI can be considered a marker of overall CV risk in hypertensive patients, independent of renal function.