Pub Date : 2025-12-01Epub Date: 2025-09-28DOI: 10.1016/j.cpcardiol.2025.103187
Shuting Tan , Yongheng Li , Zhenshuai Yao , Xiao Xu , Jin Wang , Xiaofang Zhu , Pingping He
Cardiovascular diseases remain the foremost cause of global morbidity and mortality, with atherosclerosis serving as the pathological basis for most related disorders. Despite the clinical benefits of statin therapy, a substantial residual risk persists, underscoring the need to explore novel therapeutic targets. Interleukin-36 (IL-36), a member of the interleukin-1 family, has emerged as a key regulator of immune and inflammatory responses. Beyond its established roles in tissue repair, host defense, and inflammatory signaling, IL-36 has been increasingly implicated in cardiovascular pathology, including myocardial infarction, ischemic injury, and myocarditis. Recent evidence highlights its pro-atherogenic functions mediated through sustained vascular inflammation, abnormal angiogenesis, impaired cholesterol metabolism, excessive neutrophil extracellular trap formation, and disrupted autophagy. These findings collectively suggest that IL-36 not only contributes to the initiation and progression of atherosclerosis but also holds promise as a potential therapeutic target. This review summarizes recent progress on the regulatory roles and signaling mechanisms of IL-36, emphasizing its contribution to atherogenesis.
{"title":"Interleukin-36: a novel therapeutic target for atherosclerosis","authors":"Shuting Tan , Yongheng Li , Zhenshuai Yao , Xiao Xu , Jin Wang , Xiaofang Zhu , Pingping He","doi":"10.1016/j.cpcardiol.2025.103187","DOIUrl":"10.1016/j.cpcardiol.2025.103187","url":null,"abstract":"<div><div>Cardiovascular diseases remain the foremost cause of global morbidity and mortality, with atherosclerosis serving as the pathological basis for most related disorders. Despite the clinical benefits of statin therapy, a substantial residual risk persists, underscoring the need to explore novel therapeutic targets. Interleukin-36 (IL-36), a member of the interleukin-1 family, has emerged as a key regulator of immune and inflammatory responses. Beyond its established roles in tissue repair, host defense, and inflammatory signaling, IL-36 has been increasingly implicated in cardiovascular pathology, including myocardial infarction, ischemic injury, and myocarditis. Recent evidence highlights its pro-atherogenic functions mediated through sustained vascular inflammation, abnormal angiogenesis, impaired cholesterol metabolism, excessive neutrophil extracellular trap formation, and disrupted autophagy. These findings collectively suggest that IL-36 not only contributes to the initiation and progression of atherosclerosis but also holds promise as a potential therapeutic target. This review summarizes recent progress on the regulatory roles and signaling mechanisms of IL-36, emphasizing its contribution to atherogenesis.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 12","pages":"Article 103187"},"PeriodicalIF":3.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-30DOI: 10.1016/S0146-2806(25)00218-X
{"title":"Guidelines for Authors","authors":"","doi":"10.1016/S0146-2806(25)00218-X","DOIUrl":"10.1016/S0146-2806(25)00218-X","url":null,"abstract":"","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 12","pages":"Article 103199"},"PeriodicalIF":3.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-10DOI: 10.1016/j.cpcardiol.2025.103192
Antonios A. Argyris , Alena Shantsila , D. Gareth Beevers , Eduard Shantsila , Gregory Υ.Η. Lip
Background
Malignant phase hypertension (MHT) is a severe form of hypertension with high morbidity and mortality; data on the association of visit-to-visit blood pressure (BP) variability and outcomes are lacking. Given that such high BP variability has been associated with poorer outcomes in the general hypertensive population, our aim was to examine the prognostic role of visit-to-visit BP variability with cardiovascular disease and mortality in this high risk MHT population.
Methods
Data from the West Birmingham MHT Registry were analyzed. We calculated quartiles of visit-to-visit BP variability and used Kaplan-Meier curves and Cox proportional hazard models to examine the association of BP variability with incidence of outcomes.
Results
A total of 339 patients (age 48 ± 13 years, 65 % male) were included, with a median follow-up 11 years (IQR 3-18). On Kaplan-Meier analyses, subjects in the highest variability quartiles had significantly lower risk of cardiovascular disease, all-cause mortality and all-cause mortality/dialysis than patients in the lower quartiles (log rank p < 0.001). In Cox proportional hazard models, higher systolic BP variability was associated with lower incidence of all outcomes [HR (95 % CI): 0.266 (0.128-0.552) for higher vs lower quartile for all-cause mortality]. Higher diastolic BP variability was associated with lower risk of mortality outcomes [HR (95 % CI): 0.236 (0.107-0.519)]. This effect was attenuated in the subgroup with better BP control at follow-up.
Conclusions
Higher visit-to-visit BP variability was associated with lower prevalence of cardiovascular disease and mortality in a MHT population. Given the extremely high initial BP of MHT patients, the high BP variability reflects likely better BP control in the follow up visits, re-emphasizing the crucial role of early and rapid control of BP in this high-risk population.
{"title":"An apparent paradox in visit-to-visit blood pressure variability and adverse outcomes in malignant hypertension patients: The West Birmingham malignant hypertension registry","authors":"Antonios A. Argyris , Alena Shantsila , D. Gareth Beevers , Eduard Shantsila , Gregory Υ.Η. Lip","doi":"10.1016/j.cpcardiol.2025.103192","DOIUrl":"10.1016/j.cpcardiol.2025.103192","url":null,"abstract":"<div><h3>Background</h3><div>Malignant phase hypertension (MHT) is a severe form of hypertension with high morbidity and mortality; data on the association of visit-to-visit blood pressure (BP) variability and outcomes are lacking. Given that such high BP variability has been associated with poorer outcomes in the general hypertensive population, our aim was to examine the prognostic role of visit-to-visit BP variability with cardiovascular disease and mortality in this high risk MHT population.</div></div><div><h3>Methods</h3><div>Data from the West Birmingham MHT Registry were analyzed. We calculated quartiles of visit-to-visit BP variability and used Kaplan-Meier curves and Cox proportional hazard models to examine the association of BP variability with incidence of outcomes.</div></div><div><h3>Results</h3><div>A total of 339 patients (age 48 ± 13 years, 65 % male) were included, with a median follow-up 11 years (IQR 3-18). On Kaplan-Meier analyses, subjects in the highest variability quartiles had significantly lower risk of cardiovascular disease, all-cause mortality and all-cause mortality/dialysis than patients in the lower quartiles (log rank <em>p</em> < 0.001). In Cox proportional hazard models, higher systolic BP variability was associated with lower incidence of all outcomes [HR (95 % CI): 0.266 (0.128-0.552) for higher vs lower quartile for all-cause mortality]. Higher diastolic BP variability was associated with lower risk of mortality outcomes [HR (95 % CI): 0.236 (0.107-0.519)]. This effect was attenuated in the subgroup with better BP control at follow-up.</div></div><div><h3>Conclusions</h3><div>Higher visit-to-visit BP variability was associated with lower prevalence of cardiovascular disease and mortality in a MHT population. Given the extremely high initial BP of MHT patients, the high BP variability reflects likely better BP control in the follow up visits, re-emphasizing the crucial role of early and rapid control of BP in this high-risk population.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 12","pages":"Article 103192"},"PeriodicalIF":3.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-09-25DOI: 10.1016/j.cpcardiol.2025.103186
Adam M. May MD , Sarah LoCoco MD , Krasimira M. Mikhova MD , Rugheed Ghadban MD , Phillip S. Cuculich MD , Daniel H. Cooper MD , Thomas M. Maddox MD, MSc , Prashanth Thakkar MD , Elena Deych MS , Ian Rowlandson MS , Alexander Siotis MD , Nandan Anavaker MD , Peter A. Noseworthy MD , Anthony Kashou MD
Background
Distinguishing wide complex tachycardia (WCT) as ventricular tachycardia (VT) or supraventricular WCT (SWCT) is critical yet challenging. Manual ECG algorithms require substantial expertise and are inconsistently applied, and contemporary computerized ECG interpretation (CEI) systems often return only a generic “wide complex tachycardia” label. Novel machine learning–based ECG models (Solo Model, Paired Model) can provide a VT probability or a direct VT/SWCT classification, but they have not yet been evaluated in a prospective, randomized, workflow-integrated trial.
Design
We will conduct a prospective, multicenter, investigator-initiated, open-label, four-arm randomized reader trial. Physicians (attendings and fellows in cardiology, emergency medicine, critical care) will be randomized 1:1:1:1 to: (1) Control #1—WCT ECG only; (2) Control #2—WCT ECG + baseline ECG; (3) Solo Model—WCT ECG + model output (no baseline ECG); (4) Paired Model—WCT ECG + baseline ECG + model output. Each participant will interpret 20 adjudicated WCT ECGs on a secure virtual platform, classify rhythm, rate confidence and percieved usefulness, and indicate likely next steps in clinical management. Primary endpoint: WCT classification accuracy. Secondary endpoints: sensitivity, specificity, PPV, NPV, F1 score, time to diagnosis, interpreation confidence, perceived usefulness, and intended management after diagnosis.
Conclusion
The AUTOMATED-WCT Trial will be the first randomized, multicenter evidence on machine learning–based ECG decision support for WCT differentiation.
{"title":"Design and methods of the AUTOMATED-WCT trial: evaluating machine learning–based ECG support for WCT interpretation","authors":"Adam M. May MD , Sarah LoCoco MD , Krasimira M. Mikhova MD , Rugheed Ghadban MD , Phillip S. Cuculich MD , Daniel H. Cooper MD , Thomas M. Maddox MD, MSc , Prashanth Thakkar MD , Elena Deych MS , Ian Rowlandson MS , Alexander Siotis MD , Nandan Anavaker MD , Peter A. Noseworthy MD , Anthony Kashou MD","doi":"10.1016/j.cpcardiol.2025.103186","DOIUrl":"10.1016/j.cpcardiol.2025.103186","url":null,"abstract":"<div><h3>Background</h3><div>Distinguishing wide complex tachycardia (WCT) as ventricular tachycardia (VT) or supraventricular WCT (SWCT) is critical yet challenging. Manual ECG algorithms require substantial expertise and are inconsistently applied, and contemporary computerized ECG interpretation (CEI) systems often return only a generic “wide complex tachycardia” label. Novel machine learning–based ECG models (Solo Model, Paired Model) can provide a VT probability or a direct VT/SWCT classification, but they have not yet been evaluated in a prospective, randomized, workflow-integrated trial.</div></div><div><h3>Design</h3><div>We will conduct a prospective, multicenter, investigator-initiated, open-label, four-arm randomized reader trial. Physicians (attendings and fellows in cardiology, emergency medicine, critical care) will be randomized 1:1:1:1 to: (1) Control #1—WCT ECG only; (2) Control #2—WCT ECG + baseline ECG; (3) Solo Model—WCT ECG + model output (no baseline ECG); (4) Paired Model—WCT ECG + baseline ECG + model output. Each participant will interpret 20 adjudicated WCT ECGs on a secure virtual platform, classify rhythm, rate confidence and percieved usefulness, and indicate likely next steps in clinical management. Primary endpoint: WCT classification accuracy. Secondary endpoints: sensitivity, specificity, PPV, NPV, F1 score, time to diagnosis, interpreation confidence, perceived usefulness, and intended management after diagnosis.</div></div><div><h3>Conclusion</h3><div>The AUTOMATED-WCT Trial will be the first randomized, multicenter evidence on machine learning–based ECG decision support for WCT differentiation.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 12","pages":"Article 103186"},"PeriodicalIF":3.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-09-25DOI: 10.1016/j.cpcardiol.2025.103185
Joaquin Perea , Daniel Martin , Marlon Ruiz Holguín , Diego Arluna , Oscar Gomez , Santiago Simone , Alvaro Sosa Liprandi , Maria Ines Sosa Liprandi
Background
Nocturnal hypertension (NHT) is associated with major adverse cardiovascular events (MACE) and heart failure (HF), and remains an area of growing interest, with evidence suggesting a differential impact compared to daytime hypertension (DTH).
Objectives
To evaluate the relationship between NHT and the risk of cardiovascular events, independently of daytime blood pressure.
Methods
We conducted an observational study based on a continuous registry of patients who underwent ambulatory blood pressure monitoring at a tertiary care center. Propensity score matching (1:1) was applied using relevant clinical factors to ensure comparability between groups. The primary outcome was the composite of MACE and HF. Cox regression and cubic spline models were used to explore non-linear associations and identify critical thresholds.
Results
After matching, 1,392 patients were analyzed (691 per group). In adjusted models, nocturnal systolic blood pressure was significantly associated with increased risk of MACE/HF (HR 1.04; 95 % CI: 1.01–1.07), whereas daytime systolic pressure showed no association (HR 0.98; 95 % CI: 0.95–1.01). In the multivariable model, NHT maintained its adverse effect (HR 1.03; 95 % CI: 1.01–1.04), together with other established clinical predictors. Risk curves demonstrated a non-linear association, with a significant increase in risk above 148 mmHg of nocturnal systolic blood pressure.
Conclusions
NHT independently increases the risk of cardiovascular events and provides prognostic thresholds that may improve risk stratification.
{"title":"Nocturnal hypertension and cardiovascular events: risk analysis using propensity score matching","authors":"Joaquin Perea , Daniel Martin , Marlon Ruiz Holguín , Diego Arluna , Oscar Gomez , Santiago Simone , Alvaro Sosa Liprandi , Maria Ines Sosa Liprandi","doi":"10.1016/j.cpcardiol.2025.103185","DOIUrl":"10.1016/j.cpcardiol.2025.103185","url":null,"abstract":"<div><h3>Background</h3><div>Nocturnal hypertension (NHT) is associated with major adverse cardiovascular events (MACE) and heart failure (HF), and remains an area of growing interest, with evidence suggesting a differential impact compared to daytime hypertension (DTH).</div></div><div><h3>Objectives</h3><div>To evaluate the relationship between NHT and the risk of cardiovascular events, independently of daytime blood pressure.</div></div><div><h3>Methods</h3><div>We conducted an observational study based on a continuous registry of patients who underwent ambulatory blood pressure monitoring at a tertiary care center. Propensity score matching (1:1) was applied using relevant clinical factors to ensure comparability between groups. The primary outcome was the composite of MACE and HF. Cox regression and cubic spline models were used to explore non-linear associations and identify critical thresholds.</div></div><div><h3>Results</h3><div>After matching, 1,392 patients were analyzed (691 per group). In adjusted models, nocturnal systolic blood pressure was significantly associated with increased risk of MACE/HF (HR 1.04; 95 % CI: 1.01–1.07), whereas daytime systolic pressure showed no association (HR 0.98; 95 % CI: 0.95–1.01). In the multivariable model, NHT maintained its adverse effect (HR 1.03; 95 % CI: 1.01–1.04), together with other established clinical predictors. Risk curves demonstrated a non-linear association, with a significant increase in risk above 148 mmHg of nocturnal systolic blood pressure.</div></div><div><h3>Conclusions</h3><div>NHT independently increases the risk of cardiovascular events and provides prognostic thresholds that may improve risk stratification.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 12","pages":"Article 103185"},"PeriodicalIF":3.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-10DOI: 10.1016/j.cpcardiol.2025.103189
Jumana Algheffari , Abdel Rahman Salameh , Lina Adil , Aamir Hameed , Kurdo Araz
Background
Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome with limited treatment options to improve long-term outcomes such as quality of life, exercise capacity, and mortality. Neuromodulation-based therapies have emerged as potential interventions to address autonomic dysregulation in HFpEF. This review discusses the long-term efficacy and safety of four key neuromodulation therapies: Renal Denervation (RDN), Baroreceptor Activation Therapy (BAT), Vagus Nerve Stimulation (VNS), and Greater Splanchnic Nerve (GSN) Ablation. Each therapy shows promise, but variability exists in terms of patient outcomes, procedural risks, and long-term durability. This paper evaluates the pros and cons of each approach, focusing on their potential to improve clinical outcomes in diverse HFpEF phenotypes.
Objective
To summarise and critically assess the role of neuromodulation-based devices in managing HFpEF, including their mechanisms, efficacy, and impact on patient outcomes.
Methods
We reviewed clinical trials and studies involving neuromodulation therapies for HFpEF, focusing on VNS, RDN, BAT, and GSN. The review includes randomised controlled trials and feasibility studies assessing various endpoints such as functional status, QoL, exercise capacity, and adverse events.
Results
Neuromodulation therapies show potential in improving symptoms and QoL for HFpEF patients. The ANTHEM-HFpEF trial demonstrated VNS's efficacy in enhancing functional status and autonomic tone, although cardiac mechanical function showed minimal change. RSD trials, including RDT-PEF and UNLOAD-HFpEF, indicated mixed results with some improvements in symptoms and cardiac function, though limitations like sample size and device effectiveness persist. BAT, through the BAROSTIM NEO System, has shown promise in reducing sympathetic activity and improving heart failure symptoms. The GSN ablation trials indicated significant reductions in pulmonary capillary wedge pressure (PCWP) and improved exercise capacity, though further large-scale studies are needed to confirm these findings.
Conclusions
Neuromodulation-based device interventions represent a promising frontier in HFpEF management, offering potential improvements in symptoms, QoL, and functional status. However, the variability in trial outcomes and the need for further research underscore the necessity for continued investigation to fully establish the efficacy and safety of these therapies.
{"title":"The role of neuromodulation in heart failure with preserved ejection fraction","authors":"Jumana Algheffari , Abdel Rahman Salameh , Lina Adil , Aamir Hameed , Kurdo Araz","doi":"10.1016/j.cpcardiol.2025.103189","DOIUrl":"10.1016/j.cpcardiol.2025.103189","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome with limited treatment options to improve long-term outcomes such as quality of life, exercise capacity, and mortality. Neuromodulation-based therapies have emerged as potential interventions to address autonomic dysregulation in HFpEF. This review discusses the long-term efficacy and safety of four key neuromodulation therapies: Renal Denervation (RDN), Baroreceptor Activation Therapy (BAT), Vagus Nerve Stimulation (VNS), and Greater Splanchnic Nerve (GSN) Ablation. Each therapy shows promise, but variability exists in terms of patient outcomes, procedural risks, and long-term durability. This paper evaluates the pros and cons of each approach, focusing on their potential to improve clinical outcomes in diverse HFpEF phenotypes.</div></div><div><h3>Objective</h3><div>To summarise and critically assess the role of neuromodulation-based devices in managing HFpEF, including their mechanisms, efficacy, and impact on patient outcomes.</div></div><div><h3>Methods</h3><div>We reviewed clinical trials and studies involving neuromodulation therapies for HFpEF, focusing on VNS, RDN, BAT, and GSN. The review includes randomised controlled trials and feasibility studies assessing various endpoints such as functional status, QoL, exercise capacity, and adverse events.</div></div><div><h3>Results</h3><div>Neuromodulation therapies show potential in improving symptoms and QoL for HFpEF patients. The ANTHEM-HFpEF trial demonstrated VNS's efficacy in enhancing functional status and autonomic tone, although cardiac mechanical function showed minimal change. RSD trials, including RDT-PEF and UNLOAD-HFpEF, indicated mixed results with some improvements in symptoms and cardiac function, though limitations like sample size and device effectiveness persist. BAT, through the BAROSTIM NEO System, has shown promise in reducing sympathetic activity and improving heart failure symptoms. The GSN ablation trials indicated significant reductions in pulmonary capillary wedge pressure (PCWP) and improved exercise capacity, though further large-scale studies are needed to confirm these findings.</div></div><div><h3>Conclusions</h3><div>Neuromodulation-based device interventions represent a promising frontier in HFpEF management, offering potential improvements in symptoms, QoL, and functional status. However, the variability in trial outcomes and the need for further research underscore the necessity for continued investigation to fully establish the efficacy and safety of these therapies.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 12","pages":"Article 103189"},"PeriodicalIF":3.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-10DOI: 10.1016/j.cpcardiol.2025.103191
Abdulhakim M. Alhazmi , Arif Albulushi
Background
Postpartum hypertension is a leading driver of emergency visits and readmissions within 6 weeks of delivery, yet optimal therapy must balance BP control with lactation safety.
Objective
To synthesize contemporary evidence (Jan 2015–Aug 2025) on postpartum antihypertensives with emphasis on breastfeeding compatibility, treatment thresholds/targets, and maternal–infant outcomes. Data Sources: PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane, ClinicalTrials.gov/ICTRP, and guideline repositories (AHA/ACOG/NICE), plus LactMed and UK Specialist Pharmacy Service (SPS). Eligibility: RCTs, comparative cohorts/case–control studies, and ≥10-patient case series reporting postpartum outcomes or lactation data.
Results
First-line postpartum agents compatible with breastfeeding in term, healthy infants are dihydropyridine calcium-channel blockers (nifedipine, amlodipine), ACE inhibitors (enalapril), and labetalol. Multiple large cohorts associate nifedipine (at discharge) with lower hypertension-related readmissions than labetalol. Small RCTs show signals for enalapril-related cardiac reverse remodeling and physician-optimized self-monitoring improving 9-month BP and cardiac structure. Severe BP ≥160/110 mmHg warrants urgent treatment (IV labetalol or hydralazine; oral IR nifedipine if no IV), while persistent ≥150/100 mmHg merits/continues oral therapy titrated toward ≤140/90 mmHg in clinic (≈≤135/85 mmHg at home). Early review within 3–10 days (≤72 h after severe disease) and remote/home BP programs reduce unplanned care.
Conclusions
For lactating patients, nifedipine ER/amlodipine, enalapril, and labetalol are appropriate first-line choices; real-world data favor nifedipine for lowering readmissions. Scaling home BP monitoring with early follow-up improves outcomes. Large pragmatic RCTs comparing step-care strategies and tracking infant outcomes remain a priority.
背景：产后高血压是分娩6周内急诊和再入院的主要原因，但最佳治疗必须平衡血压控制和哺乳安全。目的：综合当代（2015年1月- 2025年8月）关于产后降压的证据，重点关注母乳喂养适应性、治疗阈值/目标和母婴结局。数据来源：PubMed/MEDLINE， Embase, Scopus, Web of Science, Cochrane, ClinicalTrials.gov/ICTRP，指南库（AHA/ACOG/NICE），以及LactMed和UK Specialist Pharmacy Service （SPS）。入选条件：随机对照试验、比较队列/病例对照研究，以及≥10例报告产后结局或哺乳期数据的病例系列。结果：适合于足月龄健康婴儿母乳喂养的一线产后药物为二氢吡啶类钙通道阻滞剂（硝苯地平、氨氯地平）、ACE抑制剂（依那普利）和拉贝他洛尔。多个大型队列将硝苯地平（出院时）与拉贝他洛尔相比，高血压相关的再入院率更低。小型随机对照试验显示依那普利相关的心脏反向重构和医生优化的自我监测改善了9个月血压和心脏结构。严重的血压≥160/110 mmHg需要紧急治疗（静脉注射拉贝他洛尔或肼嗪，如果没有静脉注射则口服硝苯地平），而持续≥150/100 mmHg需要/继续口服治疗，在临床滴定到≤140/90 mmHg（≈≤135/85 mmHg在家中）。早期复查3-10天（严重疾病发生后≤72小时）和远程/家庭BP方案可减少计划外护理。结论：对于哺乳期患者，硝苯地平ER/氨氯地平、依那普利、拉贝他洛尔是合适的一线选择；实际数据支持硝苯地平降低再入院率。家庭血压监测与早期随访可改善预后。比较继步护理策略和跟踪婴儿结果的大型实用随机对照试验仍然是优先考虑的。
{"title":"Targeted antihypertensive therapy after hypertensive pregnancy: Lactation-safe choices, treatment thresholds, and outcomes (2015–2025)","authors":"Abdulhakim M. Alhazmi , Arif Albulushi","doi":"10.1016/j.cpcardiol.2025.103191","DOIUrl":"10.1016/j.cpcardiol.2025.103191","url":null,"abstract":"<div><h3>Background</h3><div>Postpartum hypertension is a leading driver of emergency visits and readmissions within 6 weeks of delivery, yet optimal therapy must balance BP control with lactation safety.</div></div><div><h3>Objective</h3><div>To synthesize contemporary evidence (Jan 2015–Aug 2025) on postpartum antihypertensives with emphasis on breastfeeding compatibility, treatment thresholds/targets, and maternal–infant outcomes. Data Sources: PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane, ClinicalTrials.gov/ICTRP, and guideline repositories (AHA/ACOG/NICE), plus LactMed and UK Specialist Pharmacy Service (SPS). Eligibility: RCTs, comparative cohorts/case–control studies, and ≥10-patient case series reporting postpartum outcomes or lactation data.</div></div><div><h3>Results</h3><div>First-line postpartum agents compatible with breastfeeding in term, healthy infants are dihydropyridine calcium-channel blockers (nifedipine, amlodipine), ACE inhibitors (enalapril), and labetalol. Multiple large cohorts associate nifedipine (at discharge) with lower hypertension-related readmissions than labetalol. Small RCTs show signals for enalapril-related cardiac reverse remodeling and physician-optimized self-monitoring improving 9-month BP and cardiac structure. Severe BP ≥160/110 mmHg warrants urgent treatment (IV labetalol or hydralazine; oral IR nifedipine if no IV), while persistent ≥150/100 mmHg merits/continues oral therapy titrated toward ≤140/90 mmHg in clinic (≈≤135/85 mmHg at home). Early review within 3–10 days (≤72 h after severe disease) and remote/home BP programs reduce unplanned care.</div></div><div><h3>Conclusions</h3><div>For lactating patients, nifedipine ER/amlodipine, enalapril, and labetalol are appropriate first-line choices; real-world data favor nifedipine for lowering readmissions. Scaling home BP monitoring with early follow-up improves outcomes. Large pragmatic RCTs comparing step-care strategies and tracking infant outcomes remain a priority.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 12","pages":"Article 103191"},"PeriodicalIF":3.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-30DOI: 10.1016/S0146-2806(25)00220-8
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