High Blood Pressure & Cardiovascular Prevention最新文献

Heart failure (HF) is characterized by poor exercise tolerance and reduced ability to perform routine daily activities. Cardiac rehabilitation (CR), which includes exercise training, has shown a role in improving cardiac remodeling, functional capacity and HF outcomes as a consequence of its beneficial effects on neurohormonal dysfunction, endothelial function, vascular tone and peripheral oxygen extraction. Although a multiparametric evaluation, including physical examination, blood sampling, echocardiographic and cardiopulmonary exercise testing parameters, is routinely performed during CR programs, the use of cardiac biomarkers, in particular natriuretic peptides (NPs), is still poorly adopted and characterized. In this article we analyze the potential role of biomarkers in monitoring the success of rehabilitation programs and the potential implications of their use in clinical practice. Indeed, NPs measurements might represent an important tool to modulate the rehabilitative interventions with a favorable cost-effectiveness profile.

Introduction: Hypertension is a leading risk factor of global morbidity and mortality. Reports indicate a rise in mortality linked to blood pressure (BP) levels exceeding 115/75 mmHg. Even with hypertension management based on redefined guidelines, many young individuals with early signs of target organ injury (TOI) may still go undetected AIM : We determined the most accurate diagnostic criteria of hypertension (using the 2017 ACC/AHA and the 2023 ESC/ESH guidelines) for detecting an increased risk of early vascular aging (EVA). We additionally estimated the effects of the guidelines' definitions on the distribution of BP phenotypes and risk of EVA.

Methods: A total of 1026 men and women (aged 20-30 years) were included. The primary data collected included office- and ambulatory blood pressure (ABPM) measurement, and carotid-femoral pulse wave velocity (PWV). The upper 25th percentile of PWV was regarded as having an increased risk of EVA. The frequencies of hypertension and BP phenotypes were calculated according to both guidelines and correlated with TOI by multiple linear regression. Receiver operating characteristic (ROC) curves were constructed to determine the best BP threshold for detecting increased risk of EVA.

Results: Pulse wave velocity was associated with all pathological BP phenotypes (SHT, WCHT and MHT), based on the ESC/ESH and with SHT and WCHT based on the ACC/AHA criteria (all p<0.024).

Conclusion: The ESC/ESH criteria, but not the ACC/AHA criteria, is sensitive to identify all BP phenotypes. The lower thresholds advised by the ACC/AHA guidelines however seem to favour early detection of increased risk for EVA.

Introduction: Serum uric acid (SUA), the final product of purine metabolism, is an independent risk factor for cardiovascular (CV) disease. Since SUA levels depend on renal function, SUA to serum creatinine ratio (SUA/sCr) is emerging as a more specific biomarker of CV risk.

Aim: To evaluate in hospitalized patients with cardiorenal multimorbidity (CRM) if the SUA/sCr ≥ 5.35 is associated with clinical outcomes. The primary outcome was in-hospital mortality. The secondary outcome was the composite of all-cause of mortality and adverse clinical events.

Methods: We conducted a retrospective review of medical records from consecutive CRM inpatients admitted to the medical ward. The composite endpoint was calculated as all-cause mortality and adverse clinical events such as acute coronary syndrome, stroke, infections, and renal replacement therapy.

Results: In our cohort, 141 patients (mean age of 75.6 ± 10.2 years) were identified with CRM. In-hospital mortality occurred in 17 patients (16%), and 64 patients (60.4%) experienced adverse clinical outcomes. Among the 106 patients, 20 (18.9%) had an SUA/sCr ≥ 5.35, while 86 (81.1%) had an SUA/sCr < 5.35. Male gender was significantly associated with SUA/sCr ≥ 5.35 (p = 0.007). In-hospital mortality was significantly higher in patients with SUA/sCr ≥ 5.35 (p = 0.010), and a positive correlation with adverse clinical outcomes was documented in this subgroup (p = 0.012).

Conclusion: in patients with CRM, SUA/sCr ≥ 5.35 is associated with increased in-hospital mortality and worse clinical outcomes. The ratio and related cut-off value of SUA/sCr could represent a useful biomarker to assess in-hospital complications in CRM patients.

Posterior reversible encephalopathy syndrome (PRES) may present with different clinical symptoms including visual disturbance, headache, seizures and impaired consciousness. Brain MRI shows oedema, usually involving the posterior subcortical regions. Triggering factors include hypertension and obstructive sleep apnea syndrome. The mechanism underlying PRES is under debate, but endothelial dysfunction is implicated. Treatment goals of PRES are gradual blood pressure (BP) lowering to avoid sudden hypoperfusion of vital organs and prevention and management of seizures. PRES usually has a favorable prognosis, but delayed diagnosis and treatment may lead to cardiovascular morbidity, mortality or irreversible neurological deficits.

Hypertension and hypercholesterolemia often occur in the same individuals, increasing the risk of major cardiovascular (CV) outcomes, including myocardial infarction, stroke, CV death, as well as other CV complications. Concomitant management of these condition now represent a crucial step to reduce individual global CV risk and improve CV disease prevention in daily clinical practice. Given the high prevalence of hypertension and hypercholesterolemia in general population and their impact on health status, several pharmacological options are currently available to achieve the recommended therapeutic targets. These drugs, mostly including statins, ezetimibe, bempedoic acid, proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors and inclisiran, can be used either in monotherapies or in combination therapies, with different clinical indications, therapeutic efficacy and tolerability profile. Decision among different drug classes and dosages, as well as choice between monotherapy or combination therapy (fixed or free), largely depend on individual global CV risk profile and therapeutic targets of low-density lipoprotein (LDL) cholesterol levels to be achieved under pharmacological therapy. The present consensus document represents an update of the previous document published on 2022 and endorsed by the Italian Society of Hypertension (SIIA) and the Italian Society of Cardiovascular Prevention (SIPREC). Here we propose a novel paradigm for the treatment of the patients with hypertension and hypercholesterolemia at high or very high cardiovascular risk. In addition, the pharmacological properties, and the clinical efficacy of novel agents recently approved for a tailored therapy of hypercholesterolemia in patients with atherosclerotic CV disease, including PCSK9 inhibitors and bempedoic acid, will be summarized.

Introduction: Increased serum uric acid (SUA) levels are found in cardiovascular and kidney diseases, associated with the development of vascular injury. Uric acid stimulates the inflammatory pathways, promotes vascular smooth muscle cells proliferation, activates renin-angiotensin system leading to the development and progression of vascular damage. Renal function-normalized uric acid [SUA to serum creatinine ratio (SUA/SCr)] has been suggested to be a better indicator of uric acid.

Aim: To investigate the correlation between SUA level and SUA/SCr in the development of chronic and vascular lesions (CVL) in patients with primary glomerulonephritis (GN).

Methods: A retrospective observational study was conducted in 95 consecutive renal native biopsies performed at Policlinico Umberto I of Rome (Italy). Patient inclusion criteria were age ≥ 18 years, a renal biopsy confirming diagnosis of primary GN, the availability of complete demographic, clinical, pathological, and laboratory data.

Results: Median SCr was 1.06 mg/dl (IQR 0.77;1.70) with a median eGFR of 70.40 ml/min (IQR 40.40;105). Median SUA was 5.90 mg/dl (IQR 4.30;6.90) and median SUA/SCr was 4.70 (IQR 3.20;6.80). CVL were reported in 56 (58.9%) patients. Median SUA/SCr was significantly lower in patients with CVL than patients without CVL [3.95 (IQR 2.65;6) vs 5.90 (IQR 4.30;7.20), p<0.01]. Logistic regression analysis showed that SUA/SCr ≤ 4.05 [OR 5.451 (95% CI 1.222;24.325), p<0.05] was independently associated with CVL.

Conclusions: CVL play a crucial role in the progression of kidney disease. SUA/SCr ≤ 4.05 is associated with CVL in patients with primitive GN.

Introduction: A strong and well-known association exists between salt consumption, potassium intake, and cardiovascular diseases. MINISAL-SIIA results showed high salt and low potassium consumption in Italian hypertensive patients. In addition, a recent Italian survey showed that the degree of knowledge and behaviour about salt was directly interrelated, suggesting a key role of the educational approach.

Aim: The present multicentre randomised controlled trial study aimed to evaluate the efficacy of a short-time dietary educational intervention by a physician, only during the first visit, on sodium and potassium intake in hypertensive patients.

Methods: Two-hundred-thirty hypertensive subjects participating in the MINISAL-SIIA study were enrolled for this study. After the randomisation, the participants were stratified into the educational intervention (EI) group (n = 109) and control group (C) (n = 121). Anthropometric indexes and blood pressure (BP) measurements were taken in the single-centre, and 24-hour urinary sodium (UrNa) and potassium (UrK) excretion were centrally measured.

Results: After 3 months, there was a reduction in BP, UrNa, and body weight, and an increase in UrK in EI. By contrast, a lower decrease in BP was found in the C group, and a slight rise in UrNa and no substantial change in UrK were revealed. BP changes were positively and significantly associated with changes in UrNa only in EI.

Conclusion: The main results of this trial indicate that a single brief educational intervention by a physician can lead to a reduction in salt intake and BP, and increased potassium consumption in hypertensive patients, without adverse effects.

Trail registration: ClinicalTrial.gov registration number: NCT06651437.

Introduction: Cardiovascular diseases (CVD) represent the leading cause of morbidity and mortality for women worldwide, yet they are often unaware of this heavy burden.

Aim: To assess cardiovascular risk awareness among Italian women.

Methods: Following World Heart Day 2023, a cardiovascular prevention campaign was conducted in Italian pharmacies to evaluate the effectiveness of screening activities offered by pharmacies and raise awareness of cardiovascular health status among Italian women. Cardiovascular risk profile and perception of CVD burden relative to other common female-specific diseases were assessed. Blood pressure (BP) measurement and ECG recording were performed.

Results: A total of 1510 women (84.7% < 70 years), enrolled at 91 pharmacies, were included. The most prevalent cardiovascular risk factor was sedentary lifestyle (57.9%), followed by overweight/obesity (44.3%), hypercholesterolemia (37.9%), hypertension (31.3%), family history of early CVD (28.7%), smoking (20.6%), and diabetes (5%). CVD and/or kidney disease were uncommon (3.6%), but 1 in 4 women was classified as being at increased cardiovascular risk, and 47.5% had some type of ECG abnormalities, requiring further assessments in 18% cases. Less than 1 in 3 women was aware of the burden represented by CVD, being the majority mostly concerned with breast cancer and osteoporosis as potential health threats.

Conclusions: The burden of cardiovascular risk factors is high, and the perception of related health threat is low among the examined sample of Italian women, supporting the urgent need to raise awareness of CVD in women as a major health issue and to undertake effective, tailored preventive strategies to reduce such risk in a timely fashion.

Introduction: Carotid IMT is a recognized marker for early atherosclerotic changes and a predictor of future CV events. Previous studies showed 11% increased risk of myocardial infarction with each 0.1 mm incremental increase of carotid IMT. In general population, LDL cholesterol levels are positively correlated with carotid IMT in both cross-sectional and longitudinal studies while its role in elite athletes remains understudied.

Aim: This study aimed to investigate the correlation between persistent lipid profile alterations and early markers of atherosclerosis, specifically carotid IMT, in a cohort of elite athletes.

Methods: We included 302 athletes serially evaluated for a prolonged time period. Anthropometric data, blood tests for lipid profiles, and carotid IMT measurements were collected. Dyslipidemia was defined as LDL ≥ 116 mg/dL, and persistent elevation when LDL values remained above the threshold limits in at least three pre-participation screenings. Categorical variables were expressed as frequencies and percentages and were compared using Fisher's exact test or Chi-square test, as appropriate.

Results: 91 athletes (30.1%) had persistently elevated LDL levels. Dyslipidemic athletes were older (30.7 ± 5.7 vs. 29.1 ± 4.1 years, p = 0.008), had higher BMI (p = 0.032), and a higher prevalence of obesity (5.5% vs. 0.5%, p = 0.004) compared to those with normal lipid profiles. Additionally, they had higher total cholesterol (p < 0.0001) and triglycerides (p < 0.0001) but similar HDL levels (p = 0.213). Globally, athletes with altered LDL profiles over long-time period showed higher IMT (0.60 ± 0.10 mm vs. 0.57 ± 0.07 mm, p = 0.014). In particular, longer exposure to elevated LDL was significantly associated with increased IMT (0.61 ± 0.12 mm vs. 0.57 ± 0.06 mm, p = 0.035).

Conclusions: Our study highlights the association between persistently elevated LDL-C and increased carotid IMT in elite athletes, with longer exposure time correlating with more pronounced carotid changes. These findings underscore the importance of regular monitoring of blood lipid profiles and carotid IMT measurements as a non-invasive, cost-effective method to prevent atherosclerotic vascular disease.

In view of the growing evidence supporting more marked reductions of low-density lipoprotein cholesterol (LDL-C), according to the concept of "the lower is better" and with the availability of powerful and well tolerated lipid-lowering drugs, physicians are facing today with the clinical management of patients with very low LDL-C levels. The fear of potential risks linked to extreme reductions of LDL-C down to very low levels may lead to the de-escalation of treatments with consequent paradoxical unfavorable consequences due to the exposure to a higher cardiovascular risk. The aim of this review is to point out evidence of very low LDL-C clinical impact, with a focus on potential adverse effects. Research on cholesterol homeostasis has identified complex mechanisms which guarantee cell functions even when circulating cholesterol levels are very low. The almost complete self-sufficiency of the human body in terms of cholesterol needs is confirmed by evidence derived from genetically determined models with very low LDL-C levels. Studies on the potential harm of lowering LDL-C to very low concentrations do not confirm an increased risk of cancer or neurodegenerative disease attributable to lipid-lowering treatments, whereas evidence suggests a potential benefit in these settings. A potential increased risk of hemorrhagic stroke has been reported, suggesting tight monitoring and control of blood pressure should be implemented in patients with very low LDL-C levels. With regard to statin treatment, a dose-dependent increased risk of newly diagnosed diabetes has been reported. This adverse effect has not been found with more recently approved lipid-lowering drugs.