Hipertension y Riesgo Vascular最新文献

英文中文

Amlodipine use during pregnancy: Current status in the medical care field in Argentina 妊娠期间氨氯地平的使用：阿根廷医疗保健领域的现状。

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Hipertension y Riesgo Vascular

Pub Date : 2025-10-01 DOI: 10.1016/j.hipert.2025.04.003

M.P. Pérez , A.M. Ghelfi , G. Miranda , M.A. Del Sueldo , J.M. Zilberman , L.S. Voto , A. Delucchi , P. Rodriguez , N.F. Renna

Introduction

Calcium channel blockers (CCBs), such as nifedipine, are commonly used to treat hypertensive disorders of pregnancy (HDP). With the withdrawal of Nifedipine-RETARD and the limitations in compounding formulations, the off-label use of amlodipine (AML) has increased. The primary objective of this study was to describe the frequency of AML use, while the secondary objective was to outline the professional profile of the surveyed physicians.

Materials and methods

A descriptive, observational, cross-sectional study conducted in 2024 using closed digital surveys. The target population included physicians of both sexes involved in the care of HDP in Argentina, with access to electronic devices and the Internet. The survey was developed by the Working Group on Hypertension in Women of the Argentine Society of Hypertension (SAHA) and validated by experts. It was distributed through social networks and SAHA's email list.

Results

A total of 276 physicians were surveyed, with a mean age of 49.6 ± 11.5 years, 46.6% of whom were women. Among the respondents, 213 (77.1%) used CCBs to treat HDP, and 176 (63.8%) reported prescribing AML. Of those prescribing AML, 51% were general practitioners, 12% cardiologists, 22% obstetrician–gynaecologists, and 14% belonged to other specialties. The initial dose reported was 5 mg/day in 82.4% of cases. The main reasons cited for not prescribing AML were lack of experience (44.4%) and perceived insufficient scientific evidence (28.9%).

Conclusions

The use of AML was frequent, with 6 out of 10 surveyed physicians reporting its use.

钙通道阻滞剂（CCBs），如硝苯地平，通常用于治疗妊娠期高血压疾病（HDP）。随着硝苯地平- retard的退出和复方制剂的限制，氨氯地平（AML）的超说明书使用有所增加。本研究的主要目的是描述AML使用的频率，而次要目的是概述被调查医生的专业概况。材料和方法：一项描述性、观察性、横断面研究，于2024年使用封闭的数字调查进行。目标人群包括参与阿根廷HDP护理的男女医生，他们可以使用电子设备和互联网。该调查由阿根廷高血压学会（SAHA）妇女高血压工作组制定，并经专家验证。它通过社交网络和SAHA的电子邮件列表分发。结果：共调查276名医师，平均年龄49.6±11.5岁，女性占46.6%。在受访者中，213名（77.1%）使用CCBs治疗HDP， 176名（63.8%）报告使用AML。在开AML处方的患者中，51%是全科医生，12%是心脏病专家，22%是妇产科医生，14%属于其他专业。82.4%的病例报告的初始剂量为5mg/天。不开AML处方的主要原因是缺乏经验（44.4%）和认为科学证据不足（28.9%）。结论：AML的使用较为频繁，10位受访医生中有6位报告使用过AML。

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引用次数: 0

The predictive value of CRP/albumin ratio (CAR) in the diagnosis of ischemia in myocardial perfusion scintigraphy CRP/白蛋白比（CAR）在心肌灌注显像诊断缺血中的预测价值。

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Hipertension y Riesgo Vascular

Pub Date : 2025-07-01 DOI: 10.1016/j.hipert.2025.01.001

M. Arefnia , M. Bayat , E. Hosseinzadeh , E. Ahmadi Basiri , M.A. Ghodsirad , R. Naghshineh , H. Zamani

Introduction and objectives

Ischemic heart disease (IHD) is the leading cause of mortality worldwide, and finding cheap and accurate screening tests is crucial. This study aimed to evaluate the predictive value of C-reactive protein (CRP)/albumin ratio (CAR) in the diagnosis of IHD using myocardial perfusion imaging (MPI).

Methods

In this cross-sectional study, a total of 112 patients were investigated to find any relationship between CAR and myocardial ischemia by using myocardial perfusion scintigraphy. Data were analyzed using SPSS, with a P-value below 0.05 considered statistically significant.

Results

Eighty-eight patients had normal MPI. Twenty-two patients had some degree of myocardial ischemia in MPI. The normal MPI and pathological MPI groups were similar in terms of sex, weight, smoking, family history of IHD, albumin levels, diabetes mellitus status, hyperlipidemia, and chest pain type. The CRP, and CAR means in the patients with myocardial ischemia were significantly higher than those with normal MPI.

Conclusion

Although the value of CAR was significantly higher in patients with myocardial ischemia compared to subjects with normal MPI and it was an independent predictor of IHD, the capability of CAR in diagnosing myocardial ischemia was not very strong with a sensitivity and specificity of about 60%.

简介和目标：缺血性心脏病（IHD）是世界范围内导致死亡的主要原因，找到廉价和准确的筛查方法至关重要。本研究旨在评价c反应蛋白(CRP)/白蛋白比（CAR）在心肌灌注成像（MPI）诊断IHD中的预测价值。方法：采用横断面研究方法，对112例患者进行心肌灌注显像研究，探讨CAR与心肌缺血的关系。数据采用SPSS进行分析，p值小于0.05认为有统计学意义。结果：88例患者MPI正常。22例MPI患者有不同程度的心肌缺血。正常MPI组和病理MPI组在性别、体重、吸烟、IHD家族史、白蛋白水平、糖尿病状况、高脂血症和胸痛类型等方面相似。心肌缺血患者CRP、CAR均值明显高于MPI正常患者。结论：虽然心肌缺血患者的CAR值明显高于MPI正常的患者，是IHD的独立预测指标，但CAR诊断心肌缺血的能力不是很强，敏感性和特异性约为60%。

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引用次数: 0

Practices of low value or unnecessary practices in vascular prevention 低价值或不必要的血管预防措施。

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Hipertension y Riesgo Vascular

Pub Date : 2025-07-01 DOI: 10.1016/j.hipert.2025.01.002

C. Brotons , I. Moral , J.M. García Abajo , J. Caro Mendivelso , O. Cortés Rico , Á. Díaz , R. Elosua , D. Escribano Pardo , M.M. Freijo Guerrero , M. González Fondado , M. Gorostidi , M.M. Goya Canino , M. Grau , C. Guijarro Herraiz , C. Lahoz , E. Lopez-Cancio Martínez , N. Muñoz Rivas , E. Ortega , V. Pallarés-Carratalá , E. Rodilla , P. Armario

Background

Low-value practices are avoidable interventions that provide no health benefits. The objective of this study was to conduct a narrative review of the recommendations for practices of low value-care in vascular prevention.

Methods

A narrative review of all low value-care recommendations for vascular prevention published in the main European and North American scientific societies for clinical practice guidelines between 2014 and 2024 was carried out.

Results

A total of 38 clinical practice guidelines and consensus documents from international organizations in the United States, Canada, the United Kingdom, and Europe were reviewed, 28 of which included between 1 and 20 recommendations on practices of low value-care in vascular prevention. The total number of recommendations was 141. The American Heart Association is the society that offers the largest number of recommendations of low value-care, with 39 recommendations (27.7%) in 5 clinical practice guidelines (13.2% of the total guidelines with recommendations). The guideline for the management of arterial hypertension of the European Society of Hypertension is the guideline that concentrates the largest number of recommendations of low value-care in a single guideline, with 20 recommendations (14.2% of the total guidelines with recommendations).

Conclusions

There are more and more guidelines that explicitly describe diagnostic or pharmacological activities of low value-care or Do Not Do Class III or recommendation D. Some guidelines agree, but others show clear discrepancies, which can illustrate the uncertainty of the scientific evidence and the differences in its interpretation.

背景：低价值实践是指可避免的、对健康无益的干预措施。本研究的目的是对血管预防中的低价值护理实践建议进行叙述性回顾：方法：对欧洲和北美主要科学协会在 2014 年至 2024 年间发布的临床实践指南中有关血管预防的所有低价值护理建议进行了叙述性回顾：结果：共对来自美国、加拿大、英国和欧洲的38份临床实践指南和国际组织的共识文件进行了回顾，其中28份包含1至20条关于血管预防低值护理实践的建议。建议总数为 141 条。美国心脏协会是提出低价值护理建议最多的协会，在 5 份临床实践指南中提出了 39 项建议（占 27.7%）（占提出建议的指南总数的 13.2%）。欧洲高血压学会的动脉高血压管理指南是将最多低值护理建议集中在一份指南中的指南，共有 20 项建议（占所有提供建议的指南的 14.2%）：有越来越多的指南明确描述了低价值护理的诊断或药物治疗活动，或 "不做 "III级或建议D级。一些指南意见一致，但另一些则存在明显差异，这可以说明科学证据的不确定性及其解释上的差异。

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引用次数: 0

Narrative review: Isolated nocturnal hypertension – A frosted glass 叙述性回顾：孤立的夜间高血压-磨砂玻璃。

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Hipertension y Riesgo Vascular

Pub Date : 2025-07-01 DOI: 10.1016/j.hipert.2025.02.002

J. Minetto , G. Cerri , W. Espeche

The following article is a narrative review on isolated nocturnal hypertension, conducted up to July 2024, with a search for primary and secondary articles in MEDLINE, LILACS, and gray literature.

This review highlights aspects related to its current definition, epidemiology, and associated populations and risk factors, as well as specifics regarding its diagnosis, prognostic importance for target organ damage and cardiovascular events/mortality, and potential treatments.

This condition has particular aspects and, although it is not very common in the general population, it reaches high prevalence in some at-risk populations. To date, there is much debate and many issues to investigate regarding diagnostic aspects, as well as its heterogeneity and clinical significance, which indicate different prognoses. Therapeutic aspects are even more a matter of debate, necessitating future research.

以下文章是一篇关于孤立性夜间高血压的叙述性综述，进行到2024年7月，检索MEDLINE、LILACS和灰色文献中的主要和次要文章。本综述重点介绍了其当前定义、流行病学、相关人群和危险因素，以及其诊断、对靶器官损伤和心血管事件/死亡率的预后重要性以及潜在治疗方法等方面的细节。这种情况有特殊的方面，虽然在一般人群中并不常见，但在一些高危人群中发病率很高。迄今为止，关于诊断方面，以及其异质性和临床意义，存在许多争论和许多问题需要调查，这表明不同的预后。治疗方面更是一个有争议的问题，需要未来的研究。

引用次数: 0

Relationship between psychosocial stressors and hypertension and vascular risk 心理社会压力源与高血压和血管风险的关系。

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Hipertension y Riesgo Vascular

Pub Date : 2025-07-01 DOI: 10.1016/j.hipert.2025.06.001

Q. Foguet-Boreu , V. Abrines Bendayán , R. Nadal , L. Ayerbe García-Monzón , P. Armario

Psychosocial stress can result from a wide variety of causes and circumstances. The experience of stress is often unique and highly personal, but with common physiological responses. It is expected to increase in the modern world, which is undergoing rapid social, cultural and technological change. In this narrative review we present psychosocial factors impacting hypertension (HT) and vascular risk (VR) and propose strategies for detection and management of their main clinical consequences. Psychosocial stress more than doubles the risk of HT, with work-related stress and low socioeconomic status being the most related factors. The factors most strongly associated with increased VR were informal care of dependents, lower socioeconomic status, marital status (single, divorced or widowed) and loneliness. Individual and collective psychosocial stress prevention strategies may be crucial in reducing the prevalence of HT and VR.

社会心理压力可由各种各样的原因和情况引起。压力的体验通常是独特的和高度个人化的，但有共同的生理反应。在社会、文化和技术迅速变革的现代世界，预计这一数字将会增加。在这篇叙述性综述中，我们提出了影响高血压（HT）和血管风险（VR）的社会心理因素，并提出了检测和管理其主要临床后果的策略。社会心理压力使HT的风险增加一倍以上，其中工作压力和低社会经济地位是最相关的因素。与VR增加最密切相关的因素是对受抚养人的非正式照顾、较低的社会经济地位、婚姻状况（单身、离婚或丧偶）和孤独感。个体和集体的心理社会压力预防策略可能是降低HT和VR患病率的关键。

引用次数: 0

Statins and preeclampsia: An update from the Working Group on Hypertension in Women, Argentine Society of Hypertension 他汀类药物和先兆子痫：来自阿根廷高血压学会妇女高血压工作组的最新进展。

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Hipertension y Riesgo Vascular

Pub Date : 2025-07-01 DOI: 10.1016/j.hipert.2025.03.001

A.M. Ghelfi , G. Miranda , L.S. Voto , J.M. Zilberman , M.A. Del Sueldo , F. Waisman , M. Baroni , M.V. Ferretti , J.P. Moran , A. Corrales-Barboza , R. Mondino , M.P. Pérez , P.G. Irusta , L. Meccia , E. Martínez Marissi , M.L. Baiche , A.M. Delucchi , P.D. Rodríguez , N.F. Renna

Hypertensive disorders of pregnancy (HDP) affect 5–10% of pregnancies. Preeclampsia (PE) is a severe complication of HDP, associated with high maternal, fetal, and neonatal morbidity and mortality. The pathophysiology of PE involves endothelial dysfunction, vasoconstriction, and impaired placental perfusion, leading to systemic inflammation and multi-organ dysfunction. It has been suggested that statins, traditionally contraindicated during pregnancy, could play a role in this context. Some studies propose that pravastatin, a hydrophilic statin, may not have the same teratogenic effects as lipophilic statins, potentially improving maternal vascular status and significantly reducing the risk of PE. Considering this, the Working Group on Hypertension in Women of the Argentine Society of Hypertension undertook a review of the topic and its current implications.

妊娠期高血压疾病（HDP）影响5-10%的妊娠。先兆子痫（PE）是HDP的严重并发症，与母体、胎儿和新生儿的高发病率和死亡率相关。PE的病理生理包括内皮功能障碍、血管收缩和胎盘灌注受损，导致全身炎症和多器官功能障碍。有人建议，他汀类药物，传统禁忌在怀孕期间，可能在这种情况下发挥作用。一些研究认为，亲水他汀类药物普伐他汀可能没有亲脂他汀类药物那样的致畸作用，可能会改善母体血管状况，显著降低PE的风险。考虑到这一点，阿根廷高血压学会妇女高血压问题工作组审查了该专题及其目前的影响。

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引用次数: 0

Diagnosis and management of diastolic dysfunction in arterial hypertension 高血压患者舒张功能障碍的诊断与治疗。

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Hipertension y Riesgo Vascular

Pub Date : 2025-07-01 DOI: 10.1016/j.hipert.2025.06.002

P. Blanch, R. Freixa-Pamias

Diastolic dysfunction (DD) refers to impaired relaxation or filling of the ventricles during the diastolic phase of the cardiac cycle. Left ventricular (LV) DD is common in hypertensive individuals and is associated with increased morbidity and mortality, particularly heart failure with preserved ejection fraction (HFpEF). The pathophysiology of DD involves alterations in cardiac structure and function, neurohormonal activation, and vascular stiffness. Diagnosis is primarily based on echocardiography, and there are no specific treatment guidelines. Recently, treatments such as sodium-glucose cotransporter 2 inhibitors (SGLT2i), GLP-1 receptor agonists, and finerenone have emerged, which may offer benefits in diastolic dysfunction and HFpEF. This review aims to present the pathophysiological mechanisms of DD in hypertension (HTN), its diagnosis, and its treatment.

舒张功能障碍（DD）是指在心脏周期的舒张期心室的舒张或充盈受损。左室（LV） DD在高血压患者中很常见，并与发病率和死亡率增加有关，特别是保留射血分数（HFpEF）的心力衰竭。DD的病理生理包括心脏结构和功能的改变、神经激素的激活和血管僵硬。诊断主要基于超声心动图，没有具体的治疗指南。最近，钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）、GLP-1受体激动剂和芬烯酮等治疗方法已经出现，它们可能对舒张功能障碍和HFpEF有好处。本文就DD在高血压（HTN）中的病理生理机制、诊断及治疗进行综述。

引用次数: 0

Prevalence of antihypertensive medication adherence and associated factors in India: A systematic review and meta-analysis 印度抗高血压药物依从性患病率及相关因素：系统回顾和荟萃分析

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Hipertension y Riesgo Vascular

Pub Date : 2025-07-01 DOI: 10.1016/j.hipert.2024.11.005

B. Pal , A. Dutta , V. Chaudhary , S. Kumari , S. Meenakshi , K. Murti

Background

Non-adherence to antihypertensive medication is a key factor contributing to uncontrolled blood pressure and the subsequent complications of hypertension. Despite its importance, there is a lack of data regarding the prevalence of and factors associated with non-adherence to medication among individuals with hypertension in India. This review aimed to assess medication adherence rates among hypertensive patients in India and identify the factors influencing non-adherence.

Methods

A comprehensive search was conducted across PubMed, Scopus, Embase, and Google Scholar. Studies reporting medication adherence/non-adherence to antihypertensive medications in India, using the Morisky Medication Adherence Scale (MMAS), with publication dates up to July 2023, were included.

Results

Twelve studies were included, involving a total of 3164 participants. The pooled rate of medication adherence to antihypertensive medications in India was determined to be 15.8% (95% CI: 4.4; 43.4). The important factors associated with non-adherence included higher age, medication regimen complexity, low socioeconomic status, low education levels, uncontrolled blood pressure, and comorbidities.

Conclusions

The adherence rate to antihypertensive medication was observed to be quite low. Therefore, it is imperative to enhance the rate of medication adherence among individuals with hypertension in order to attain effective blood pressure control and reduce the burden of non-communicable diseases.

背景：不坚持降压药物治疗是导致血压失控和高血压并发症的关键因素。尽管它很重要，但缺乏关于印度高血压患者不坚持服药的患病率和相关因素的数据。本综述旨在评估印度高血压患者的药物依从率，并确定影响不依从性的因素。方法：在PubMed、Scopus、Embase和谷歌Scholar中进行综合检索。纳入了使用Morisky药物依从性量表（MMAS）报告印度降压药依从性/不依从性的研究，出版日期截止到2023年7月。结果：纳入12项研究，共涉及3164名受试者。印度抗高血压药物的总依从率为15.8% (95% CI: 4.4；43.4)。与不依从性相关的重要因素包括年龄较大、用药方案复杂、低社会经济地位、低教育水平、未控制的血压和合并症。结论：降压药物依从率较低。因此，提高高血压患者的服药依从率，以实现有效的血压控制，减轻非传染性疾病的负担，势在必行。

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引用次数: 0

Hypertension, inflammation and vascular risk in inflammatory rheumatic diseases 炎症性风湿病的高血压、炎症和血管风险。

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Hipertension y Riesgo Vascular

Pub Date : 2025-07-01 DOI: 10.1016/j.hipert.2025.04.001

D. Cerdà , D. Reina , H. Corominas , P. Armario

Vascular risk is higher in patients with rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis than in the general population. In addition to classical vascular risk factors, chronic inflammation plays a crucial role in increasing this risk. In rheumatoid arthritis, the prevalence of hypertension is 41%. Moreover, the prevalence of hypertension has been associated with the duration of spondyloarthritis, as well as the presence of severe psoriasis in psoriatic arthritis. Although some drugs used in the treatment of inflammatory arthritis, such as NSAIDs, glucocorticoids, and Jakinibs, have been associated with an increased vascular risk, their ability to reduce inflammatory activity contributes to a decreased vascular risk in these patients. These drugs should be used with caution, and risk stratification should be performed in patients with vascular risk factors.

类风湿性关节炎、脊椎关节炎和银屑病关节炎患者的血管风险高于一般人群。除了经典的血管危险因素外，慢性炎症在增加这种风险方面起着至关重要的作用。在类风湿关节炎中，高血压患病率为41%。此外，高血压的患病率与脊椎关节炎的持续时间以及银屑病关节炎中严重银屑病的存在有关。尽管一些用于治疗炎症性关节炎的药物，如非甾体抗炎药、糖皮质激素和Jakinibs，与血管风险增加有关，但它们降低炎症活性的能力有助于降低这些患者的血管风险。这些药物应谨慎使用，对有血管危险因素的患者应进行风险分层。

引用次数: 0

Blood pressure variability. Impact on antihypertensive treatment 血压变异性。对抗高血压治疗的影响。

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Hipertension y Riesgo Vascular

Pub Date : 2025-07-01 DOI: 10.1016/j.hipert.2025.03.002

A. de la Sierra

Blood pressure oscillations during different time scales, known as blood pressure variability, have become a focus of growing scientific interest. Blood pressure variability can be measured at long-term (seasonal variability or visit-to-visit), at mid-term (consecutive days or weeks) or at short-term (day-night differences or changes induced by other daily activities and conditions). An increased blood pressure variability, either at long, mid, or short-term is associated with a poor cardiovascular prognosis independently of the amount of blood pressure elevation. There is scarce evidence on the effect of different antihypertensive treatments on such variability, but some observational and interventional studies suggest that reduction in blood pressure variability, and indirectly, increase of the time in therapeutic range, has a beneficial effect on cardiovascular prognosis. Antihypertensive drugs with a longer duration, and specifically, some calcium channel blockers, might represent an advantage.

血压在不同时间尺度上的波动，即血压变异性，已成为科学界日益关注的焦点。血压变异性可以长期测量（季节性变异性或每次访问）、中期测量（连续几天或几周）或短期测量（昼夜差异或由其他日常活动和条件引起的变化）。长期、中期或短期血压变异性的增加与心血管预后不良相关，与血压升高的程度无关。关于不同降压治疗对这种变异性的影响的证据很少，但一些观察性和介入性研究表明，降低血压变异性，间接地增加治疗范围内的时间，对心血管预后有有益的影响。持续时间较长的抗高血压药物，特别是一些钙通道阻滞剂，可能是一种优势。

引用次数: 0

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