Hipertension y Riesgo Vascular最新文献

Background: Blood pressure (BP) is linearly related to the incidence of cardiovascular disease from values as low as 115/75mmHg, even at young ages. A particularly concerning issue is the decrease representation of optimal BP among children and youth. The mechanisms by which minimal elevations in BP increase cardiovascular risk are not defined. The limitations of office BP measurements could be a possible explanation since 24-h ambulatory measurements (ABPM) better detect the risk of future cardiovascular events. Therefore, we aimed to compare healthy normotensive undergraduate students with optimal vs. non-optimal BP: ABPM, the cardiometabolic risk profile, and echocardiographic characteristics.

Methods: Medical students from La Plata voluntarily completed a survey to collect personal and family data on cardiovascular risk factors. Subsequently, anthropometric, BP (office and ABPM), and echocardiography determinations were recorded. Cholesterol, triglycerides, and glucose were measured in fasting blood samples. Statistical analyses were performed blinded, using SPSS software.

Results: Data from 135 students were analyzed (76% female, age 22.5±3.5 years). Mean office BP was 114.5±10.4 and 73.7±7.5mmHg. Forty percent of students had non-optimal BP (61% females) showing significantly higher BP values in all ABPM periods and higher left ventricular mass index, cardiac wall thicknesses, fasting glucose, TyG index, TG/HDL-c ratio. Seven students met diagnostic criteria for nocturnal hypertension, six of whom were in the non-optimal BP group (11.1% vs 1.2%).

Conclusions: Therefore, our study shows that apparently healthy young individuals with non-optimal BP, even if not hypertensive, exhibit differences in several cardiovascular risk markers compared to those with optimal BP.

Pharmacological management of HDP includes agents supported by extensive evidence ensuring their safety for use. Among those traditionally described in the literature are: alpha-methyldopa, labetalol, and sustained-release nifedipine (NIF-RETARD). These drugs, in addition to being compatible with pregnancy, present additional eligibility criteria. The discontinuation of NIF-RETARD has resulted in the off-label use of other dihydropyridine calcium cannel blockers with lower levels of evidence in pregnancy, such as amlodipine. The Working Group Hypertension in Women of the Argentine Society of Hypertension has proposed to develop a document that precisely and thoroughly addresses the concerns related to the use of amlodipine in pregnancy, providing responses based on the currently available scientific evidence.

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.

Objective: Ramipril is an important option in the management of hypertension, while the role of aliskiren is still up for debate. We aim to meta-analyse and compare the effect of aliskiren with ramipril by measuring mean difference in systolic blood pressure (mdSBP) and mean difference in diastolic blood pressure (mdDBP).

Methods: The search was conducted using the PubMed and Cochrane databases for eligible randomized clinical trials (RCTs) to perform a meta-analysis from January 2000 to May 2024. RCTs that included hypertensive patients who were under either aliskiren or ramipril treatment were included in the analysis. The risk of bias was evaluated using RoB 2.0. This study is registered with PROSPERO: CRD42024577105.

Results: Four studies were included: two studies were carried out for 2 months, and two were carried out for 6 months, including 693 and 329 patients, respectively, with mild to moderate hypertension and a mean age of 55.2 years. After 2 months, mdDBP was found to be significant (mdDBP=0.85mmHg, 95% CI: 0.73-0.97, I²=0%), but mdSBP was found to be non-significant (mdSBP=0.0mmHg, 95% CI: -0.17-0.17, I²=0%). There was a significant difference in the mdSBP (mdSBP=3.15mmHg, 95% CI: 2.13-4.17, I²=84%) and mdDBP (mdDBP=1.2mmHg, 95% CI: 1.09-1.31, I²=0%) at 6 months.

Conclusion: Aliskiren provides, in the short term, a slight improvement in BP in non-elderly hypertensive patients without diabetes or previous cardio-cerebrovascular disease.

Introduction: This study investigates the perceptions and knowledge of specialized Argentine physicians regarding renal denervation (RDN) as a treatment for resistant hypertension (R-HT).

Method: A survey was conducted among 206 physicians, mainly cardiologists and internists, to assess their awareness and perceptions of RDN. Data were analyzed using descriptive statistics and Spearman's Rho correlation.

Results: The survey revealed that 83% of the responders are aware of RDN. Despite this high awareness, only 60% believe in its safety, while 33.2% are uncertain, and 6.8% consider it unsafe. Significant correlations were found between the awareness of RDN and perceptions of its efficacy and safety.

Conclusions: The study highlights a gap between knowledge and confidence in RDN among specialized Argentine physicians. Continuous education and shared decision-making are crucial to improve the adoption of RDN in clinical practice. Long-term safety and efficacy data support RDN as a valuable tool for managing R-HT. Addressing safety concerns through targeted educational initiatives is essential.

The number of patients suffering from refractory hypertension and advanced-stage chronic heart failure (CHF) is progressively increasing. In recent years, device-mediated therapies have been developed as an alternative or adjunct to conventional medical treatment. Our primary objective is to describe the clinical experience in a series of patients with refractory hypertension following the implantation of baroreceptor activation therapy (BAT). We analyzed 5 patients with refractory hypertension, one of whom also had CHF, treated in a specialized cardiovascular risk clinic. After the implantation of the Barostim device with an average activation of 3.64mA (ranging from 2.80 to 5.4), there was a mean reduction of 30±7.68mmHg (P=0.001) and 13.40±9.07mmHg (P=0.03) in systolic and diastolic blood pressure, respectively, as measured by ambulatory blood pressure monitoring (ABPM), along with a heart rate reduction of 25±9.13 bpm (P=0.004). A reduction in the number of antihypertensive medications required for blood pressure control was observed, with an average of 5.2 medications, as well as an improvement in functional class. No adverse events were recorded in our patient series. Currently, BAT is considered a compassionate-use alternative for blood pressure control in patients with refractory hypertension and failure of pharmacological treatment and other invasive techniques, such as renal denervation.

Background: Sedentary behavior (SB) has been related to cardiovascular risk factors (CVRF) such as high BMI, waist circumference (WC) and blood pressure (BP), including pediatric populations. However, it is still unclear whether the association between SB and CVRF could be domain dependent. Therefore, this study aimed to analyze the relationship between sedentary at different domains (time spent in TV, videogames, computer, smartphone) with CVRF in adolescents.

Methods: A sample of 1011 adolescents (10-17 years old; 55.1% girls) was assessed. The different BS domains were obtained through a questionnaire, as well as socioeconomic status, habitual physical activity, smoking and alcohol consumption. BMI was calculated by objectively measured height and body mass, WC was assessed at middle point between the last rib and iliac crest, and BP was assessed by a digital oscillometric device. The relationship between SB and CVRF was determined by quantile regression, adjusted for sex, age, socioeconomic status, physical activity, smoking and alcohol consumption.

Results: Elevated time in smartphone use was associated with higher median values of WC (β=1.88; 95%CI: (0.27; 3.49) and SBP (β=2.70; 95%CI: 0.35; 5.05). High total time spent in SB was associated with higher median values of BMI (β=0.68; 95%CI=(0.02; 1.35), WC (β=1.95; 95%=0.47; 3.42) and SBP (β=2.52; 95%CI: 0.37; 4.68).

Conclusions: Smartphone use and total SB time were related to higher CVRF in adolescents. Cardiovascular health promotion strategies should focus on reducing SB in pediatric populations, especially smartphone use.