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Hu Z, Chen X. Primary aldosteronism in hypertensive patients with obstructive sleep apnea. Blood Press 2025; 34:2507680. [PMID: 40381611 DOI: 10.1080/08037051.2025.2507680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2025] [Revised: 04/25/2025] [Accepted: 05/09/2025] [Indexed: 05/20/2025]
Abstract
OBJECTIVE To investigate the prevalence and clinical characteristics of primary aldosteronism (PA) in patients with hypertension and obstructive sleep apnoea (OSA) in a newly established cohort, given inconsistencies in previous studies and intolerance to drug washout in some cases. DESIGN AND METHOD A single-centre cross-sectional study enrolled 316 hypertensive patients diagnosed with OSA via polysomnography. All participants underwent PA screening, followed by confirmatory testing for positive cases. Patients with confirmed PA underwent further subtype diagnosis and were assigned to the OSA and PA group. Those unable to undergo antihypertensive drug washout but with a high clinical suspicion of PA were categorised into the OSA and suspected PA group. RESULTS Among 316 patients, 41 (13.0%) were PA. The prevalence was 4.8% in OSA alone, and 50.0% in OSA with hypokalaemia. Compared to the OSA group, the OSA and PA group had a lower proportion of current smokers, a longer duration of hypertension, lower serum triglycerides, lower serum potassium, higher plasma aldosterone concentration, urinary aldosterone excretion, and lower renin. Multivariable logistic regression showed that the diagnosis of PA in OSA patients was positively associated with hypertension duration, and negatively associated with serum potassium levels and smoking. CONCLUSIONS PA screening may be considered in patients with hypertension and OSA; however, given the relatively low prevalence in those with OSA alone, routine screening may not be cost-effective. In contrast, the presence of hypokalaemia was strongly associated with a higher prevalence of PA, suggesting that targeted screening is warranted in this subgroup.
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Affiliation(s)
- Zhe Hu
- Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xin Chen
- Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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2
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Yang H, Xing H, Zou X, Jin M, Li Y, Xiao K, Cai L, Liu Y, Yang X. Efficacy and safety of intensive blood pressure control in patients over 60 years: A systematic review and meta-analysis. Clin Exp Hypertens 2025; 47:2465399. [PMID: 39950574 DOI: 10.1080/10641963.2025.2465399] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 01/02/2025] [Accepted: 02/02/2025] [Indexed: 05/09/2025]
Abstract
OBJECTIVES To evaluate the efficacy and safety of intensive blood pressure control in patients over 60 years. METHODS Databases including PubMed, Embase and Cochrane library were searched from inception through February 1, 2024. Randomized controlled trials evaluating the efficacy or safety of intensive blood pressure control in patients over 60 years were included in the meta-analysis. RESULTS Intensive blood pressure control in individuals with mild hypertension has been shown to reduce the risk of heart failure, stroke, myocardial infarction, major cardiovascular events, cardiovascular mortality, and all-cause mortality. The benefits of intensive blood pressure control in patients with moderate to severe hypertension are comparable to those observed in individuals with mild hypertension, with the exception of a reduced impact on all-cause mortality and cardiovascular mortality. Compared with maintaining systolic blood pressure (SBP) above 140 mmHg, SBP below 140 mmHg is associated with a decreased risk of major cardiovascular events in patients aged over 70, as well as a reduced risk of stroke in patients aged 60-69. Furthermore, compared to maintaining SBP above 130 mmHg, SBP below 130 mmHg is linked to a lower risk of major cardiovascular events, heart failure and myocardial infarction in patients over 60, a reduced risk of stroke and cardiovascular mortality in patients aged 60-69, and a decreased risk of all-cause mortality in patients over 70. However, a lower baseline blood pressure or more aggressive blood pressure control may be associated with an increased risk of hypotension. CONCLUSIONS Patients with hypertension aged over 60 years can derive benefits from intensive blood pressure management without experiencing significant adverse events, aside from hypotension.
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Affiliation(s)
- Huarong Yang
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Haiyan Xing
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Xue Zou
- Department of Cardiovascular Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Meihua Jin
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yang Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Ke Xiao
- College of Chemistry and Chemical Engineering, Chongqing University of Science and Technology, Chongqing, China
| | - Li Cai
- College of Chemistry and Chemical Engineering, Chongqing University of Science and Technology, Chongqing, China
| | - Yao Liu
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Xue Yang
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
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3
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Cheungpasitporn W, Krisanapan P, Suppadungsuk S, Thongprayoon C, Fülöp T, Miao J, Soliman KM, Ho YS. Research trends and performance of endothelin A receptor antagonist in kidney care: a bibliometric analysis. Ren Fail 2025; 47:2487212. [PMID: 40211733 PMCID: PMC11995767 DOI: 10.1080/0886022x.2025.2487212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 03/11/2025] [Accepted: 03/22/2025] [Indexed: 04/16/2025] Open
Abstract
BACKGROUND Endothelin A receptor antagonists (ERAs) have emerged as pivotal therapeutic agents in managing pulmonary hypertension (PH) and various kidney disorders, including chronic kidney disease (CKD) and proteinuric glomerular diseases such as IgA nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS). Although initially developed for pulmonary applications, recent research has highlighted their renoprotective effects, expanding their role in nephrology. This study presents a comprehensive bibliometric analysis of global research trends, key contributors, and emerging applications of ERAs in kidney care over the past three decades. METHODS A bibliometric analysis was performed using the Science Citation Index Expanded database (1992-2023). Relevant kidney-related publications were identified through specific keyword searches. Author performance was assessed using the Y-index. RESULTS ERA-related research has shown significant growth, particularly in nephrology. The United States and the University of Groningen lead in publication volume and international collaborations, with H.J.L. Heerspink emerging as a key contributor. While PH remains the dominant research focus, nephrology applications are rapidly increasing, particularly in CKD, diabetic nephropathy (DN), and glomerular diseases. A major milestone was the accelerated FDA approval of sparsentan for IgAN in 2023, followed by full approval in 2024 based on confirmatory efficacy data. However, challenges such as fluid retention and cardiovascular risks remain, necessitating further investigation into optimized ERA therapies, including combination strategies with SGLT2 inhibitors. CONCLUSIONS The expanding role of ERAs in nephrology underscores their potential in treating proteinuric kidney diseases. Ongoing international collaborations are advancing research on ERA safety, efficacy, and novel therapeutic strategies, supporting their broader clinical application.
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Affiliation(s)
| | - Pajaree Krisanapan
- Department of Medicine, Division of Nephrology, Mayo Clinic, Rochester, MN, USA
- Department of Nephrology, Department of Internal Medicine, Thammasat University, Khlong Nueng, Thailand
| | - Supawadee Suppadungsuk
- Department of Medicine, Division of Nephrology, Mayo Clinic, Rochester, MN, USA
- Faculty of Medicine Ramathibodi Hospital, Chakri Naruebodindra Medical Institute, Bang Pla, Thailand
| | - Charat Thongprayoon
- Department of Medicine, Division of Nephrology, Mayo Clinic, Rochester, MN, USA
| | - Tibor Fülöp
- Medical Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - Jing Miao
- Department of Medicine, Division of Nephrology, Mayo Clinic, Rochester, MN, USA
| | - Karim M. Soliman
- Medical Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - Yuh-Shan Ho
- Trend Research Centre, Asia University, Taichung, Taiwan
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4
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Kjeldsen SE, Brunström M, Burnier M, Egan B, Narkiewicz K, Kreutz R, Mancia G. Management of 'Elevated' blood pressure according to the 2024 European Society of Cardiology Guidelines: lack of supportive evidence and high risk of excessive treatment. Blood Press 2025; 34:2480608. [PMID: 40094350 DOI: 10.1080/08037051.2025.2480608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2025] [Accepted: 03/10/2025] [Indexed: 03/19/2025]
Affiliation(s)
- Sverre E Kjeldsen
- University of Oslo, Institute for Clinical Medicine, and Ullevaal Hospital, Departments of Cardiology and Nephrology, Oslo, Norway
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Brent Egan
- University of South Carolina School of Medicine-Greenville, Greenville, SC, USA
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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5
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DeJesus RS, Njeru JW, Beahm MR, Gullerud RE, Grimm JA, Copeland BJ, Lunde JJ, Croghan IT. An interactive care plan plus remote blood pressure monitoring in a rural primary care clinic: a pilot study. Blood Press 2025; 34:2490589. [PMID: 40219656 DOI: 10.1080/08037051.2025.2490589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 04/01/2025] [Accepted: 04/02/2025] [Indexed: 04/14/2025]
Abstract
BACKGROUND Remote blood pressure monitoring (RBPM), an effective method of enhancing BP control for patients with hypertension, can potentially helpovercome geographic limitations of health care services. We conducted a 90-day pilot to explore combining an interactive care plan (ICP) with RBPM. METHOD The pilot invited fifty adult patients with uncontrolled hypertension (BP ≥140/90 mm Hg) empanelled to a rural primary care practice in midwestern United States. Participants received instructions for downloading an ICP app and were given a wireless BP monitoring device that automatically transmitted readings to their care team. Patients were surveyed after 30 and 90 days about program experience. RESULTS Thirty-six patients enrolled. Mean participant age was 59.1 years; most were male, married, and White. Mean baseline BP was 153/89 mm Hg. Participants who engaged in the program for at least 75 days (n = 15) had a postintervention mean BP of 135/80 mm Hg. Sixteen participants (44%) had 1 outpatient visit (no multiple outpatient visits): only 4 (11%) had an emergency department visit. Among survey respondents, most strongly agreed or agreed that 1) ICP app was easy to use, 2) BP device was helpful in home care, 3) interacting remotely with care team was smooth, and 4) they were satisfied with functionality of the RBPM device. CONCLUSION An ICP paired with an RBPM device is a reasonable intervention for managing hypertension in a primary care practice particularly for patients in rural areas. New strategies must be developed to reduce barriers to meaningful engagement, achieve sustainability, and ensure successful widespread adoption.
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Affiliation(s)
- Ramona S DeJesus
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, Minnesota, USA
| | - Jane W Njeru
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark R Beahm
- Department of Family Medicine, Mayo Clinic Health System - Southwest Wisconsin region, Onalaska, Wisconsin, USA
| | - Rachel E Gullerud
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jessica A Grimm
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Julianne J Lunde
- Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA
| | - Ivana T Croghan
- Nicotine Dependence Center, Mayo Clinic, Rochester, Minnesota, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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6
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Laamech R, Giovannini D, Cellot E, Jost S, Franko B. Malignant hypertension, and if it was scleroderma? Lessons from two cases. Blood Press 2025; 34:2482741. [PMID: 40109088 DOI: 10.1080/08037051.2025.2482741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Revised: 03/14/2025] [Accepted: 03/14/2025] [Indexed: 03/22/2025]
Abstract
Inroduction : Scleroderma Renal Crisis (SRC) is characterised by acute hypertension, haemolytic anaemia (HA), and acute kidney injury (AKI). Often presenting as the first manifestation of scleroderma, it is frequently mistaken for malignant hypertension (MHT). Rapid recognition and differentiation of SRC from other hypertensive emergencies are essential for improving patient outcomes.We present two clinical cases that illustrate the diagnostic challenges of SRC in the context of MHT. Case 1: A 53-year-old man presented with severe hypertension (238/127 mmHg) and AKI (creatinine 390 μmol/L). He was diagnosed MHT due to the presence of grade III hypertensive retinopathy and HA. . However, a urine dipstick test detected haematuria, leading to further immune testing and, a renal biopsy, which confirmed SRC. Treatment with high-dose ramipril led to a sustained recovery of kidney function, 221 μmol/L after five years). Case 2: A 52-year-old man presented with chest pain, severe hypertension (253/132 mmHg), and AKI (creatinine 183 μmol/L). Initially managed as MHT, his kidney function worsened, prompting further investigation, which revealed haematuria and positive anti-nuclear antibodies. A renal biopsy confirmed SRC. High-dose ramipril was reintroduced, leading to partial kidney function recovery (creatinine 218 μmol/L after five years). Key findings : These cases underscore the importance of early detection of hematuria and autoimmune markers to expedite diagnosis of SRC in case of MHT. When SRC is suspected, high-dose angiotensin-converting enzyme inhibitors (ACEi) should be initiated immediately, even before biopsy confirmation and continued despite initial kidney function decline. Early intervention is crucial for optimising kidney outcomes and achieving effective blood pressure control.
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Affiliation(s)
- Réda Laamech
- Service de néphrologie et hypertension artérielle, Centre Hospitalier Annecy Genevois, Épagny Metz-Tessy, France
| | - Diane Giovannini
- Service d'Anatomie et de Cytologie Pathologiques, CHU Grenoble Alpes, Grenoble, France
| | - Etienne Cellot
- Service de néphrologie et hypertension artérielle, Centre Hospitalier Annecy Genevois, Épagny Metz-Tessy, France
| | - Sandra Jost
- Service de Cardiologie, Centre Hospitalier Annecy Genevois, Épagny Metz-Tessy, France
| | - Benoit Franko
- Service de néphrologie et hypertension artérielle, Centre Hospitalier Annecy Genevois, Épagny Metz-Tessy, France
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7
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Kmieć P, Świątkowska-Stodulska R. Glucocorticoids: The culprit behind metabolic disorders in primary Aldosteronism? A narrative review. J Clin Transl Endocrinol 2025; 41:100401. [PMID: 40519520 PMCID: PMC12166841 DOI: 10.1016/j.jcte.2025.100401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2025] [Revised: 05/14/2025] [Accepted: 05/26/2025] [Indexed: 06/18/2025] Open
Abstract
In recent years, a new approach toward aldosterone secretion autonomy has emerged as a consequence of studies demonstrating its continuum from subclinical, mild to overt and severe forms. These clinical insights were accompanied by immense progress in deciphering the tissue and cellular pathology underlying primary aldosteronism (PA). Thus far, research has not sufficiently elucidated the relationships between overt PA and metabolic disorders. Similarly, the role of glucocorticoid cosecretion in this patient group remains unclear. Milder than overt PA forms have been scarcely investigated. This review critically analyzes these issues on the basis of a literature search of the PubMed database.
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Affiliation(s)
- Piotr Kmieć
- Department of Endocrinology and Internal Medicine, Medical University of Gdańsk, Poland
- Department of Endocrinology and Internal Medicine, University Clinical Center, Gdańsk, Poland
| | - Renata Świątkowska-Stodulska
- Department of Endocrinology and Internal Medicine, Medical University of Gdańsk, Poland
- Department of Endocrinology and Internal Medicine, University Clinical Center, Gdańsk, Poland
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8
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Meiyan S, Zheng J, Ying W, Wen C, Kaizu X, Lin L. Influence of cuff size on the accuracy of supine blood pressure measurement. Blood Press Monit 2025; 30:169-174. [PMID: 40298137 DOI: 10.1097/mbp.0000000000000752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2025]
Abstract
OBJECTIVE The discrepancy in blood pressure (BP) measurements while in a supine position using an upper-arm automated sphygmomanometer equipped with cuffs of varying sizes remains unresolved. METHODS In this single-center, randomized crossover trial, a total of 223 inpatients from the Affiliated Hospital of Putian University were enrolled between August and September 2023. Three sets of triplicate BP measurements were obtained while the participants were in a supine position using an automated sphygmomanometer with randomly assigned appropriately sized, undersized, or oversized BP cuffs. RESULTS The average age of the subjects was 65.1 ± 18.4 years, with 109 (48.9%) being male and 78 (35%) having coexisting hypertension. Based on the measured mid-arm circumference, a small-sized, regular-sized, and large-sized BP cuff was deemed appropriate for 50, 113, and 60 participants, respectively. In patients requiring small-sized cuffs, the use of regular and large-sized cuffs resulted in a significant reduction in systolic BP by -4.0 [95% confidence interval (CI): -9.8 to 1.9] mmHg and -6.9 (95% CI: -8.0 to -5.8) mmHg, respectively, as well as diastolic BP by -3.4 (95% CI: -8.0 to 1.2) mmHg and -4.1 (95% CI: -5.3 to 2.8) mmHg, respectively. In contrast, among patients requiring large-sized cuffs, the use of small and regular-sized cuffs increased systolic BP by 6.2 (95% CI: 4.2 to 8.2) mmHg and 2.3 (95% CI: -1.4 to 6.1) mmHg, respectively, and diastolic BP increased by 2.6 (95% CI: 1.5 to 3.7) mmHg and 0.2 (95% CI: -4.7 to 5.2) mmHg, respectively. CONCLUSION Our findings suggest that miscuffing affects supine BP measured by an automated sphygmomanometer.
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Affiliation(s)
- Song Meiyan
- Department of Cardiology, Affiliated Hospital of Putian University, School of Clinical Medicine, Fujian Medical University, Fujian, China
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9
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Dozio E, Tassistro E, Orlando A, Giussani M, Beba G, Patti I, Lieti G, Antolini L, Vianello E, Corsi Romanelli MM, Parati G, Genovesi S. The soluble receptor for advanced glycation end products is independently associated with systolic blood pressure values and hypertension in children. Nutr Metab Cardiovasc Dis 2025; 35:103862. [PMID: 39934046 DOI: 10.1016/j.numecd.2025.103862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 12/14/2024] [Accepted: 01/09/2025] [Indexed: 02/13/2025]
Abstract
BACKGROUND AND AIM The advanced glycation end products-receptor for advanced glycation end products (AGE-RAGE) axis is a pro-inflammatory pathway promoting endothelial dysfunction and vascular remodelling. The soluble RAGE form (sRAGE), by blocking circulating AGE, protects against AGE-induced detrimental effects. We investigated the role of sRAGE as a marker of high blood pressure and hypertension risk in children. METHODS AND RESULTS sRAGE was quantified in 284 children/adolescents (mean age (SD) 11.1 (2.5); 52.1 % male) referred for high-normal blood pressure (systolic and/or diastolic values ≥ 90th, but both <95th percentile) or hypertension (systolic and/or diastolic blood pressure ≥95th percentile) and/or other cardiovascular risk factors (excess weight, dyslipidaemia and insulin resistance). In 22.2 % of the sample, systolic and/or diastolic blood pressure values were above the 90th percentile. The prevalence of excess weight (overweight/obesity), central obesity (waist-to-height-ratio >50%), and insulin resistance (HOMA-index ≥90th percentile) was high (82.7 %, 70.8 %, and 70.5 %, respectively). Few children had altered LDL cholesterol, triglyceride, and HDL cholesterol values (15.7 %, 15.4 %, and 13.6 %, respectively). The lowest sRAGE tertile was associated with the highest risk of having hypertension (p = 0.028), obesity (p < 0.001), central obesity (p = 0.007), and insulin resistance (p < 0.001). sRAGE levels were inversely associated with systolic blood pressure (p < 0.01) and BMI (p = 0.022) z-scores and waist-to-height-ratio (p = 0.001). sRAGE values were inversely associated with the presence of hypertension (p = 0.036) and obesity (p = 0.038). CONCLUSIONS The independent relationship between sRAGE, systolic blood pressure, and hypertension in children suggests that the AGE-RAGE axis may be altered early in life, and that sRAGE could be a compelling marker for pediatric cardiovascular risk stratification.
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Affiliation(s)
- Elena Dozio
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Experimental Laboratory for Research on Organ Damage Biomarkers, Istituto Auxologico, IRCCS, Italiano, Milan, Italy
| | - Elena Tassistro
- Biostatistics and Clinical Epidemiology, Fondazione San Gerardo dei Tintori, IRCCS, Monza, Italy; Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 centre), School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Antonina Orlando
- Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Marco Giussani
- Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Greta Beba
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Ilenia Patti
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Giulia Lieti
- UO Nefrologia e Dialisi, ASST-Rhodense, Garbagnate Milanese, Milan, Italy
| | - Laura Antolini
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 centre), School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Elena Vianello
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Experimental Laboratory for Research on Organ Damage Biomarkers, Istituto Auxologico, IRCCS, Italiano, Milan, Italy
| | - Massimiliano M Corsi Romanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Department of Clinical and Experimental Pathology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy; School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Simonetta Genovesi
- Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy; School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Milan, Italy.
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10
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Renna NF, Ramirez EI, Vissani S, Farez BG, Camaño B, Alcorta M, Diez ER, Ramirez JM. Optimizing hypertension management: the impact of drug class, socioeconomic factors, and simplified regimens on medication adherence. VATAHTA study. J Hypertens 2025; 43:1191-1197. [PMID: 40207600 DOI: 10.1097/hjh.0000000000004023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 03/15/2025] [Indexed: 04/11/2025]
Abstract
BACKGROUND Medication adherence is essential for managing hypertension, yet many patients fail to follow prescribed treatments. This study examines the relationships between drug class, treatment complexity, socioeconomic factors, and adherence in hypertensive patients from Argentina. METHODS A multicentre, cross-sectional study was conducted with 1144 hypertensive patients from the Cuyo region. Adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8). The impact of drug classes, number of prescribed drugs, dosing frequency, and socioeconomic factors (education, home ownership, employment status) on adherence was analysed using multivariate logistic regression. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated. RESULTS Patients on fixed-dose combinations demonstrated better adherence than those on monotherapy (OR 1.30, 95% CI: 1.15-1.45). Higher education (OR 1.20, 95% CI: 1.05-1.35) and home ownership (OR 1.15, 95% CI: 1.02-1.28) were associated with improved adherence, while unemployment was linked to reduced adherence. Patients taking more than three drugs showed lower adherence (OR 0.85, 95% CI: 0.75-0.95), and more frequent dosing (more than twice daily) was linked to reduced adherence (OR 0.78, 95% CI: 0.68-0.90). Beta-blockers (OR 2.5, 95% CI: 2.0-3.0) and potassium-sparing diuretics (OR 1.7, 95% CI: 1.3-2.1) were associated with the highest adherence, while ACE inhibitors such as ramipril (OR 0.75, 95% CI: 0.60-0.90) were linked to lower adherence. CONCLUSION Simplified regimens, particularly fixed-dose combinations, and the selection of drugs with favourable adherence profiles, like beta-blockers and potassium-sparing diuretics, can improve adherence. Addressing socioeconomic barriers should also be prioritized.
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Affiliation(s)
- Nicolás F Renna
- Department of Cardiology-Hospital Español de Mendoza, Godoy Cruz
- Area of Physiopathology, Department of Pathology, UNCuyo- IMBECU-CONICET, Mendoza
| | | | | | | | | | - Martha Alcorta
- Servicio de Clinica Médica. Hospital El Carmen, Mendoza, Argentina
| | - Emiliano Raul Diez
- Area of Physiopathology, Department of Pathology, UNCuyo- IMBECU-CONICET, Mendoza
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11
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Nikolopoulou L, Dimitriadis K, Pyrpyris N, Tatakis F, Iliakis P, Thomopoulos C, Konstantinidis D, Rallidis L, Tousoulis D, Tsioufis K. The Effect of Renal Denervation on Capillary Density in Patients With Uncontrolled Hypertension. Microcirculation 2025; 32:e70015. [PMID: 40544439 PMCID: PMC12182759 DOI: 10.1111/micc.70015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 05/26/2025] [Accepted: 06/06/2025] [Indexed: 06/28/2025]
Abstract
OBJECTIVE Hypertension is related to the pathogenesis of microvascular dysfunction. Renal denervation is a guideline-endorsed intervention for the management of uncontrolled hypertension. However, the effect of renal denervation on skin capillary density, as assessed by nailfold capillaroscopy, is unknown. METHODS Individuals with stage I/II uncontrolled hypertensions were enrolled and allocated to either undergo renal denervation or serve as controls. Nailfold capillaroscopy was performed at baseline and at 12 months. Furthermore, the albumin to creatinine ratio (ACR) and office/ambulatory blood pressure (BP) levels were monitored throughout the study. RESULTS A total of 45 individuals (28 renal denervation, 17 control) were enrolled in our study. No difference was found in baseline capillary density. At 12 months, all patients had controlled BP, while the denervation arm had a significantly greater number of capillaries, compared with control (90.9 ± 14.0 vs. 82.5 ± 10.6 capillaries/mm2; p = 0.036). However, the change from baseline capillary density was not significantly different between groups (4.6 ± 6.1 vs. 1.39 ± 8.8 capillaries/mm2; p = 0.150). Moreover, the change of ACR was not different between groups (-2.7 ± 13.8 vs. 0.46 ± 5.2; p = 0.365). CONCLUSION In patients with uncontrolled stage I/II hypertension, renal denervation may have a beneficial effect on skin capillary density.
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Affiliation(s)
- Lefki Nikolopoulou
- First Department of Cardiology, School of MedicineNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Kyriakos Dimitriadis
- First Department of Cardiology, School of MedicineNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Nikolaos Pyrpyris
- First Department of Cardiology, School of MedicineNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Fotios Tatakis
- First Department of Cardiology, School of MedicineNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Panagiotis Iliakis
- First Department of Cardiology, School of MedicineNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | | | - Dimitrios Konstantinidis
- First Department of Cardiology, School of MedicineNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Loukianos Rallidis
- Second Department of Cardiology, School of MedicineNational and Kapodistrian University of Athens, University General Hospital ATTIKONAthensGreece
| | - Dimitrios Tousoulis
- First Department of Cardiology, School of MedicineNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Konstantinos Tsioufis
- First Department of Cardiology, School of MedicineNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
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12
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Vazquez-Agra N, Barrera-Lopez L, Marques-Afonso AT, Cruces-Sande A, Lopez-Paz JE, Pose-Reino A, Hermida-Ameijeiras A. Assessing the relationship between short-term blood pressure variability and glycation profile in young and middle-aged nondiabetic hypertensive individuals. J Hypertens 2025; 43:1148-1157. [PMID: 40265460 PMCID: PMC12144551 DOI: 10.1097/hjh.0000000000004029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 03/14/2025] [Accepted: 03/16/2025] [Indexed: 04/24/2025]
Abstract
INTRODUCTION Elevated short-term blood pressure (BP) variability (BPV) has been associated with a poorer cardiovascular prognosis. The glycation profile is related to BPV in diabetic and prediabetic individuals. However, little is known about the relationship between glycation levels and BPV in hypertensive patients with optimal glycemic control. OBJECTIVES This observational study aimed to elucidate the relationship between glycated hemoglobin (HbA1c) levels and short-term BPV in young and middle-aged hypertensive patients over 18 years with HbA1c levels below 5.7%. METHODS We collected and analyzed data on 24-h ambulatory BP monitoring, demographic, epidemiological, clinical, and laboratory variables from 143 hypertensive patients. BPV was measured as the standard deviation (SD) and average real variability (ARV) in millimeters of mercury, as well as the dimensionless coefficient of variation (CV). RESULTS Depending on the index, each one unit increase in nighttime SD and CV indices was associated with a 17-24% higher likelihood of elevated HbA1c levels (higher than 5.2%). Regarding BPV dipping, each 1% decrease in nighttime SD and CV dipping was associated with a 10-20% higher risk of increased HbA1c levels. Additionally, each 1% decrease in nighttime ARV DBP dipping was also associated with a 10% higher risk of elevated HbA1c levels. A one-standardized-unit increase in the overall combined BPV index, as a pooled measure of BPV, was associated with a 45% higher likelihood of raised HbA1c levels. CONCLUSION Even within the optimal range, elevated HbA1c levels may reflect an underlying increase in BPV, which may be particularly relevant given the prognostic implications of short-term BPV.
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Affiliation(s)
- Nestor Vazquez-Agra
- Department of Internal Medicine, University Hospital of Santiago de Compostela
- Health Research Institute of Santiago de Compostela (IDIS)
- University of Santiago de Compostela (USC), Santiago de Compostela, A Coruña, Spain
| | - Lucia Barrera-Lopez
- Department of Internal Medicine, University Hospital of Santiago de Compostela
- Health Research Institute of Santiago de Compostela (IDIS)
| | - Ana-Teresa Marques-Afonso
- Department of Internal Medicine, University Hospital of Santiago de Compostela
- Health Research Institute of Santiago de Compostela (IDIS)
| | - Anton Cruces-Sande
- Health Research Institute of Santiago de Compostela (IDIS)
- University of Santiago de Compostela (USC), Santiago de Compostela, A Coruña, Spain
| | | | - Antonio Pose-Reino
- Department of Internal Medicine, University Hospital of Santiago de Compostela
- Health Research Institute of Santiago de Compostela (IDIS)
- University of Santiago de Compostela (USC), Santiago de Compostela, A Coruña, Spain
| | - Alvaro Hermida-Ameijeiras
- Department of Internal Medicine, University Hospital of Santiago de Compostela
- Health Research Institute of Santiago de Compostela (IDIS)
- University of Santiago de Compostela (USC), Santiago de Compostela, A Coruña, Spain
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13
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Tabarin A, Espiard S, Deutschbein T, Amar L, Vezzossi D, Di Dalmazi G, Reznik Y, Young J, Desailloud R, Goichot B, Drui D, Assié G, Lefebvre H, Mai K, Castinetti F, Laboureau S, Terzolo M, Ferriere A, Georget A, Frison E, Vantyghem MC, Fassnacht M, Gosse P, CHIRACIC Collaborators. Surgery for the treatment of arterial hypertension in patients with unilateral adrenal incidentalomas and mild autonomous cortisol secretion (CHIRACIC): a multicentre, open-label, superiority randomised controlled trial. Lancet Diabetes Endocrinol 2025; 13:580-590. [PMID: 40373786 DOI: 10.1016/s2213-8587(25)00062-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Collaborators] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 03/01/2025] [Accepted: 03/03/2025] [Indexed: 05/17/2025]
Abstract
BACKGROUND Adrenal incidentalomas are found in 3-10% of adults undergoing abdominal imaging. Of these, 30-50% are responsible for mild autonomous cortisol secretion (MACS), which is frequently associated with hypertension. The impact of adrenalectomy on hypertension in patients with unilateral incidentalomas and MACS remains uncertain. The aim of the CHIRACIC study was to prospectively assess the impact of surgical excision of the incidentaloma on blood pressure with a randomised trial combining accurate blood pressure measurement and standardisation of antihypertensive treatment. METHODS CHIRACIC was a multicentre, superiority, open-label, parallel, randomised controlled trial performed at 17 university hospitals in France, Italy, and Germany. Adults with hypertension with MACS entered a run-in phase to confirm hypertension with multiple home blood pressure measurements (HBPM) before blood pressure was normalised with standardised stepped-care antihypertensive treatment. Eligible participants were then randomly assigned (1:1) to adrenalectomy or conservative management. Randomisation was blocked (random block size of 4 and 6) and stratified by intensity of antihypertensive treatment. Participants were followed up for 13 months and systematic attempts were made to gradually reduce antihypertensive treatment. The primary endpoint was the proportion of normotensive participants using HBPM who reduced their antihypertensive treatment in the intention-to-treat population at study completion. Key secondary endpoints included 24 h ambulatory blood pressure measurement (ABPM), mean change in antihypertensive treatment, and the proportion of participants with antihypertensive treatment at study completion. This study was registered with ClinicalTrials.gov, NCT02364089, and is completed. FINDINGS Between April 9, 2015 and Nov 23, 2022, 78 patients were enrolled, and 52 eligible participants were randomly assigned to adrenalectomy (n=26, 23 underwent adrenalectomy and completed the study) or conservative management (n=26, 25 completed the study). The median age of participants was 63·3 years (IQR 57·4-68·2) and 36 (69%) were female. At study completion, a reduction in antihypertensive treatment with normal HBPM was observed in 12 (46%) of 26 participants treated with adrenalectomy and in four (15%) of 26 treated conservatively (adjusted risk difference [RD] 0·34 [95% CI 0·11 to 0·58]; p=0·0038). Similar results of smaller magnitude were observed for systolic blood pressure during 24 h ABPM. There were ten (43%) of 23 participants still needing antihypertensive treatment in the adrenalectomy group and 24 (96%) of 25 in the conservative management group (adjusted RD -0·58 [95% CI -0·78 to -0·38]; p<0·0001). Mean antihypertensive treatment step was 0·8 (SD 1·1) in the adrenalectomy group and 3·0 (1·4) in the conservative management groups (adjusted difference -2·05 [95% CI -2·61 to -1·50]; p<0·0001]. The number of patients with normal systolic HBPM and no hypertensive treatment was 12 (52%) of 23 in the adrenalectomy group and none in the conservative management group. Serious adverse events occurred in eight (35%) of 23 participants in the adrenalectomy group and eight (31%) of 26 participants in the conservative management group. Three serious adverse events for three (13%) participants were related to the surgery (post-surgical wall pain and hypotension). INTERPRETATION MACS associated with unilateral adrenal incidentalomas is responsible for secondary hypertension that can be safely improved by minimally-invasive adrenalectomy. FUNDING French Ministry of Health and the German Research Foundation.
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Affiliation(s)
- Antoine Tabarin
- Department of Endocrinology, Diabetology, Metabolism and Nutrition, CHU Bordeaux, Bordeaux, France.
| | - Stéphanie Espiard
- Department of Endocrinology, Diabetology, Metabolism and Nutrition, CHU Lille, Inserm U1190, EGID, University of Lille, Lille, France
| | - Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; Medicover Oldenburg MVZ, Oldenburg, Germany
| | - Laurence Amar
- Université Paris-Cité, AP-HP, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France; Adrenal referral center, Université Paris Cité, AP-HP, Paris, France; Inserm Paris Cardiovascular Research Center, Paris, France
| | - Delphine Vezzossi
- Department of Endocrinology, Diabetology, Metabolism, CHU Rangueil-Larrey, Toulouse, France
| | - Guido Di Dalmazi
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS AOU di Bologna, Bologna, Italy
| | - Yves Reznik
- Centre de Recherche Clinique, CHU Caen Normandie, Avenue de la Côte de Nacre, Caen, France
| | - Jacques Young
- Department of Endocrinology, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Rachel Desailloud
- Department of Endocrinology-Diabetology-Nutrition, CHU Amiens Picardie - Université Picardie Jules Verne, Amiens, France
| | - Bernard Goichot
- Department of Endocrinology, Hopital de Hautepierre-Hopitaux Universitaires de Strasbourg, Strasbourg, France
| | - Delphine Drui
- Department of Endocrinology, Diabetology and Nutrition, l'institut du thorax, CHU Nantes, Nantes Université, Nantes, France
| | - Guillaume Assié
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France; Department of Endocrinology, Center for Rare Adrenal Diseases, AP-HP, Hôpital Cochin, Paris, France
| | - Hervé Lefebvre
- Univ Rouen Normandie, Inserm, NorDiC UMR 1239, CHU Rouen, Department of Endocrinology, Diabetes and Metabolic Diseases, Rouen, France
| | - Knut Mai
- Department of Endocrinology and Metabolism, European Reference Network on Rare Endocrine Diseases (ENDO-ERN), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; Pituitary Tumor Center of Excellence, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; Department of Human Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Frédéric Castinetti
- Department of Endocrinology, Assistance Publique-Hopitaux de Marseille, French Reference Center for Rare Pituitary Diseases, EURACAN European Expert Center on Rare Pituitary Tumors, La Conception Hospital, Aix Marseille University, Marseille, France
| | - Sandrine Laboureau
- Department of Endocrinology Diabetology Nutrition, Hopitaux Universitaires d'Angers, Angers, France
| | - Massimo Terzolo
- Department of Internal Medicine, San Luigi Hospital, Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Amandine Ferriere
- Department of Endocrinology, Diabetology, Metabolism and Nutrition, CHU Bordeaux, Bordeaux, France
| | - Aurore Georget
- Medical information department, CHU Bordeaux, Bordeaux, France
| | - Eric Frison
- Medical information department, CHU Bordeaux, Bordeaux, France
| | - Marie-Christine Vantyghem
- Department of Endocrinology, Diabetology, Metabolism and Nutrition, CHU Lille, Inserm U1190, EGID, University of Lille, Lille, France
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; Medicover Oldenburg MVZ, Oldenburg, Germany
| | - Philippe Gosse
- Department of arterial hypertension, CHU Bordeaux, Bordeaux, France
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Collaborators
Jerome Bertherat, Bertrand Cariou, Tanguy Cariou, Sarah Cazenave, Mallory Cianferani, Audrey Ernoult, Edith Fonteneau, Amandine Galioot, Julie Gaudissard, Sebastien Gaujoux, Severine Gautier, Delphine Gaye, Pascale Guillot, Marlène Herting, Hind Khiar, Geraldine Lavergne, Kristell Le Mapihan, Eric Mirallié, Yvonne Möhres, Helene Mosnier-Pudar, Céline Mouly, François Pattou, Paul Perez, Sarah Pericart, Katy Piton, Joachim Reibetanz, Corentin Rouvray, Mouna Sahnoun, Meriama Saidi, Janina Sauerwald, Virginie Taillandier, Mathieu Thoulouzan, Guido Zavatta, Kathrin Zopf,
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14
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Si Y, Lu B, Ma L, Zheng J, Wang WE. Tolerable blood pressure control levels do not impact mortality of patients over 80-year-old: Insights from NHANES 2009-2018. Arch Gerontol Geriatr 2025; 134:105828. [PMID: 40186986 DOI: 10.1016/j.archger.2025.105828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Revised: 02/05/2025] [Accepted: 03/08/2025] [Indexed: 04/07/2025]
Abstract
OBJECTIVE This study aimed to investigate the impact of blood pressure levels on all-cause and cardiovascular disease (CVD) mortality in hypertensive patients over 80-year-old using data from the National Health and Nutrition Examination Survey (NHANES) 2009-2018. METHODS A total of 8406 hypertensive patients under 80-year-old and 1082 hypertensive patients over 80-year-old were included. Kaplan-Meier curves, Cox proportional hazards regression models, and restricted cubic spline plots were employed. RESULTS In patients over 80-year-old, neither systolic blood pressure (SBP) nor diastolic blood pressure (DBP) was significantly associated with all-cause or CVD mortality (P > 0.05). However, in hypertensive patients under 80-year-old, significant differences in mortality were observed across different SBP and DBP subgroups (P < 0.05), with an optimal SBP range of 120-140 mmHg associated with reduced all-cause mortality risk. In patients over 80-year-old, male patients, high urinary albumin-to-creatinine ratio, total cholesterol, red blood cells, and elevated lymphocyte and neutrophil percentages were associated with increased all-cause mortality; SBP interaction with these risk factors slightly reduced the hazard ratio values separately. CONCLUSION Based on NHANES data from 2009 to 2018, tolerable SBP and DBP levels appear to have no significant impact on all-cause or CVD mortality in hypertensive patients over 80-year-old".
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Affiliation(s)
- Yueqiao Si
- Department of Geriatrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400010, PR China; Department of General Practice, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, PR China
| | - Binjun Lu
- Department of Geriatrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400010, PR China
| | - Lanlan Ma
- Department of Geriatrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400010, PR China; School of Medicine, Chongqing University, Chongqing, 400044, PR China
| | - Juanjuan Zheng
- Department of Geriatrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400010, PR China
| | - Wei Eric Wang
- Department of Geriatrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400010, PR China.
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15
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Ibrahim M, Ba-Essa EM, Alvarez JA, Baker J, Bruni V, Cahn A, Ceriello A, Cosentino F, Davies MJ, De Domenico F, Eckel RH, Friedman AN, Goldney J, Hamtzany O, Isaacs S, Karadeniz S, Leslie RD, Lingvay I, McLaughlin S, Mobarak O, Del Prato S, Prattichizzo F, Rizzo M, Rötzer RD, le Roux CW, Schnell O, Seferovic PM, Somers VK, Standl E, Thomas A, Tuccinardi D, Valensi P, Umpierrez GE. Obesity and its management in primary care setting. J Diabetes Complications 2025; 39:109045. [PMID: 40305970 DOI: 10.1016/j.jdiacomp.2025.109045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2025] [Accepted: 04/17/2025] [Indexed: 05/02/2025]
Abstract
Obesity is a worldwide epidemic affecting adults and children, regardless of their socioeconomic status. Significant progress has been made in understanding the genetic causes contributing to obesity, shedding light on a portion of cases worldwide. In young children with severe obesity however, recessive mutations, i.e., leptin or leptin receptor deficiency should be sought. Much more has been learned about the far-reaching impact of obesity on complications, including cardiovascular disease, liver and kidney dysfunction, diabetes, inflammation, hypertension, sleep, cancer, and the eye. Preventive strategies, particularly in children, are crucial for reducing obesity rates and mitigating its long-term complications. While dietary modifications and lifestyle changes remain the cornerstone of obesity prevention or treatment, recent advancements have introduced highly effective pharmacological options complementing weight-reduction surgery. Newer medications, like incretin-based therapies including glucagon-like peptide-1 agonists (GLP-1RA), have demonstrated remarkable efficacy in promoting weight loss, offering new insights into margining obesity-related conditions. Primary care providers, whether treating adults or children, play a pivotal role in preventing obesity, initiating treatment, and making onward referrals to specialists to assist in managing obesity and obesity-related complications.
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Affiliation(s)
| | | | - Jessica A Alvarez
- Division of Endocrinology, Lipids, and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Vincenzo Bruni
- Bariatric Surgery Unit, Campus Bio-Medico University, Rome, Italy
| | - Avivit Cahn
- The Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Hebrew University Hospital, Jerusalem, Israel; The faculty of Medicine, Hebrew University of Jerusalem, Israel
| | | | - Francesco Cosentino
- Unit of Cardiology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK; NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Francesco De Domenico
- Research Unit of Endocrinology and Diabetes, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Robert H Eckel
- University of Colorado Anschutz Medical Campus and University of Colorado Hospital, Aurora, Colorado, USA
| | - Allon N Friedman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Jonathan Goldney
- Diabetes Research Centre, University of Leicester, Leicester, UK; NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Omer Hamtzany
- Division of Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Scott Isaacs
- Division of Endocrinology, Lipids, and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Richard David Leslie
- Blizard Institute, Centre of Immunobiology, Barts and the London School of Medicine, Queen Mary, University of London, London, UK
| | - Ildiko Lingvay
- Department of Internal Medicine/ Endocrinology and Peter O'Donnell Jr School of Public Health, UT Southwestern Medical Center at Dallas, USA
| | - Sue McLaughlin
- Department of Pharmacy and Nutrition Services, Nebraska Medicine, Department of Pediatric Endocrinology, Children's Nebraska, Omaha, NE, USA; Public Health Department, Winnebago Comprehensive Healthcare System, Winnebago, NE, USA
| | - Omar Mobarak
- Alfaisal University College of Medicine, Riyadh, Saudi Arabia
| | - Stefano Del Prato
- University of Pisa and Sant'Anna School of Advanced Studies, Pisa, Italy
| | | | - Manfredi Rizzo
- School of Medicine, Promise Department, University of Palermo, Italy; College of Medicine, Ras Al Khaimah Medical and Health Sciences University, United Arab Emirates
| | | | - Carel W le Roux
- Diabetes complications Research Centre, University College Dublin, Ireland
| | - Oliver Schnell
- Forschergruppe Diabetes eV at the Helmholtz Centre, Munich, Neuherberg, Germany
| | - Petar M Seferovic
- Academician, Serbian Academy of Sciences and Arts, Professor, University of Belgrade Faculty of Medicine and Belgrade University Medical Center, Serbia
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eberhard Standl
- Forschergruppe Diabetes eV at the Helmholtz Centre, Munich, Neuherberg, Germany
| | | | - Dario Tuccinardi
- Research Unit of Endocrinology and Diabetes, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Paul Valensi
- Polyclinique d'Aubervilliers, Aubervilliers and Paris Nord University, Bobigny, France
| | - Guillermo E Umpierrez
- Division of Endocrinology, Lipids, and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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16
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Tabrizchi R. Management of drug-resistant hypertension as a heterogeneous disorder. Pharmacol Ther 2025; 271:108875. [PMID: 40339756 DOI: 10.1016/j.pharmthera.2025.108875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Revised: 04/09/2025] [Accepted: 04/21/2025] [Indexed: 05/10/2025]
Abstract
Approximately 1.3 billion adults globally have hypertension, and are at higher risk of death associated with cardiovascular disease. Adjusted death rate primarily due to high blood pressure is 31.3 per 100,000. The prevalence of drug-resistant hypertension is estimated to be up to 20 % in hypertensive individuals, and is more common in those with chronic kidney disease and obstructive sleep apnea. It occurs in individuals on ≥3 antihypertensive drugs including a diuretic. The addition of spironolactone, as a fourth drug has been found at times to be effective in management of blood pressure. Other strategies include sequential nephron block (e.g., spironolactone + furosemide + amiloride), and use of drugs such as alpha2 agonists, endothelin antagonists, and nonsteroidal mineralocorticoid antagonists. Use of positive airway pressure and pharmacotherapy have been found to be of value in individuals with sleep apnea in lowering blood pressure. In contrast, baroreceptor stimulation and/or renal denervation combined with pharmacotherapy seem to offer little in a way of consistent efficacy of optimally lowering blood pressures. Remarkably, evidence in the literature strongly supports the view that life style changes including regular exercise and appropriate diet combined with pharmacotherapy can lead to positive outcomes in helping to significantly reduce blood pressure. There is also ample data in literature suggesting the non-compliance to antihypertensive medications as a significant barrier to lowering blood pressure in this group. Accordingly, education regarding pharmacotherapy, and appropriate exercise regimen, including changes to diet should underpin any strategy in the management of high blood pressure in this population.
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Affiliation(s)
- Reza Tabrizchi
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada.
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17
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Murphy L, Murphy G, Cornally N, McHugh S, Saab MM, Cotter P. Low adherence to cardiovascular risk assessment guidelines in patients with rheumatoid arthritis: a retrospective chart review of routine clinical practice. Rheumatol Int 2025; 45:158. [PMID: 40569458 DOI: 10.1007/s00296-025-05916-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2025] [Accepted: 06/14/2025] [Indexed: 06/28/2025]
Abstract
INTRODUCTION Patients with rheumatoid arthritis (RA) have an elevated risk of developing cardiovascular disease (CVD). Despite European guidelines recommending routine CVD risk assessment, implementation in clinical practice is challenging. The objectives of this review were to determine if patients attending an Irish tertiary rheumatology centre received CVD risk assessments in line with European guidelines and assess the extent of CVD risk factor screening over five years of routine rheumatology care. METHODS A retrospective chart review was conducted for patients newly diagnosed with RA in 2018, with five-year follow-up. Data were extracted to determine if CVD risk assessments were performed, and where absent, risk was retrospectively calculated. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist for cohort studies was used to guide the reporting of this study. RESULTS Among 21 patients, no documented CVD risk assessments were identified. CVD risk factor screening was consistently insufficient. There was a lack of documented clinical data necessary to conduct a CVD risk assessment on more than half of patients at study entry, and one quarter of patients at five-year follow up. Of those with data available (n = 10), retrospective calculations showed 80% had an undetected moderate or higher CVD risk at diagnosis. There was no documented referral to primary care for CVD risk assessment. CONCLUSION Implementation of CVD risk management guidelines in the routine care of patients with RA is challenging. The interpretation and operationalisation of guideline recommendations by rheumatology healthcare professionals in relation to implementation barriers needs to be explored.
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Affiliation(s)
- Louise Murphy
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, T12 AK54, Ireland.
- Department of Rheumatology, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland.
| | - Grainne Murphy
- Department of Rheumatology, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland
| | - Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, T12 AK54, Ireland
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, T12 XF62, Ireland
| | - Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, T12 AK54, Ireland
| | - Patrick Cotter
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, T12 AK54, Ireland
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18
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Kim HJ, Lee Y, Shin JH, Kim JH, Hwang SH, Kim WS, Park S, Rhee SJ, Lee EM, Ihm SH, Pyun WB, Shin J. Impact of Clinic Blood Pressure Target on the Prevalence and Predictors of Masked Uncontrolled Hypertension and White-Coat Uncontrolled Hypertension. J Korean Med Sci 2025; 40:e117. [PMID: 40551606 PMCID: PMC12185986 DOI: 10.3346/jkms.2025.40.e117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 12/05/2024] [Indexed: 06/28/2025] Open
Abstract
BACKGROUND Identifying masked uncontrolled hypertension (MUCH) and white-coat uncontrolled hypertension (WUCH) without ambulatory blood pressure (ABP) monitoring is challenging. Recent literature advocates intensive blood pressure (BP) control, but standard guidelines still suggest a clinic BP threshold of ≥ 149/90 mmHg to diagnose hypertension. This study explored the impact of different clinic BP targets on the prevalence and predictors of MUCH and WUCH. METHODS This multicenter prospective cohort study included 1,601 patients with hypertension from the Korean Ambulatory Blood Pressure registry, all with valid ABP records. Two clinic BP targets were evaluated: an intensive target (< 130/80 mmHg) and a conventional target (< 140/90 mmHg). Controlled hypertension was defined as a 24-hour mean ABP < 130/80 mmHg in patients treated with antihypertensive drugs who had a clinic BP below these targets. RESULTS The prevalence of MUCH decreased significantly with the intensive target (15.5%) versus the conventional target (45.8%). In contrast, the prevalence of WUCH increased only marginally with the intensive targets. Most patients with MUCH (75.9%) had a clinic BP between 130/80 mmHg and 139/89 mmHg when MUCH was classified using the conventional target. For predicting MUCH, factors such as angiotensin-converting enzyme inhibitor use, body mass index, left ventricular mass index (LVMI), and use of ≥ 2 antihypertensive drugs were significant under the intensive target, whereas clinic BP, LVMI, alcohol intake, stroke history, and use of ≥ 2 antihypertensive drugs were relevant under the conventional target. CONCLUSION Adopting the intensive clinic BP target (< 130/80 mmHg) notably reduced the prevalence of MUCH, with a slight increase in WUCH, offering a more accurate assessment of BP control than the conventional target.
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Affiliation(s)
- Hyun-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yonggu Lee
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ju Han Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sun Ho Hwang
- Division of Cardiology, Department of Internal Medicine, Gwangju KS Hospital, Gwangju, Korea
| | - Woo Shik Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Sungha Park
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Korea
| | - Sang Jae Rhee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Eun Mi Lee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Sang Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Wook Bum Pyun
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Theofilis P, Nakas N, Lamprou T, Touchantzidou K, Vordoni A, Thimis V, Smirloglou D, Kotsakis A, Kalaitzidis RG. Hypertensive urgencies and emergencies in the cardiology emergency department: epidemiology, patient profile, and management. J Hum Hypertens 2025:10.1038/s41371-025-01033-5. [PMID: 40542223 DOI: 10.1038/s41371-025-01033-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2025] [Revised: 05/17/2025] [Accepted: 05/27/2025] [Indexed: 06/22/2025]
Abstract
Hypertensive urgencies (HU) and hypertensive emergencies (HE) are common conditions in the cardiology emergency department (ED), often requiring urgent intervention. Despite their clinical significance, data on patient characteristics, etiologies, and management strategies remain limited. This study aimed to assess the epidemiology, clinical profile, and management of HU and HE in a tertiary cardiology ED. A single-center, observational study was conducted over 12 months, enrolling patients diagnosed with HU/HE (BP ≥ 180/120 mmHg). Demographic data, medical history, symptoms, etiologic factors, and antihypertensive treatments were recorded. Serial blood pressure (BP) measurements were taken to assess BP reduction during the ED stay. Of 4010 cardiology ED visits, 83 patients (2.1%) had HU/HE (median age 65 years, 45.8% male). Most had a history of hypertension (73.5%), with frequent coexisting smoking (56.6%) and dyslipidemia (43.4%). Common symptoms included dyspnea (19.3%) and chest pain (25.3%). Stress (26.8%) and increased salt intake (15.9%) were common etiologic factors. HE was diagnosed in 18 cases (21.7%), and 12.7% of HU cases required hospitalization. Mean BP on admission was 200/100 mmHg, with SBP and DBP reductions of 41 mmHg (-21%) and 18 mmHg (-17%), respectively. Nitrates, anxiolytics, and combination therapies resulted in the greatest BP reductions. In conclusion, HU and HE are frequently observed in hypertensive patients with additional cardiovascular risk factors. Target-organ damage is not solely related to BP levels, emphasizing the need for individualized management strategies.
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Affiliation(s)
- Panagiotis Theofilis
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Ag. Panteleimon", Ioannina, Greece
| | - Nikolaos Nakas
- 2nd Cardiology Department, General Hospital of Nikaia-Piraeus "Ag. Panteleimon", Nikaia, Greece
| | - Thomais Lamprou
- 2nd Cardiology Department, General Hospital of Nikaia-Piraeus "Ag. Panteleimon", Nikaia, Greece
| | - Kalliopi Touchantzidou
- 2nd Cardiology Department, General Hospital of Nikaia-Piraeus "Ag. Panteleimon", Nikaia, Greece
| | - Aikaterini Vordoni
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Ag. Panteleimon", Ioannina, Greece
| | - Vasilios Thimis
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Ag. Panteleimon", Ioannina, Greece
| | - Despina Smirloglou
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Ag. Panteleimon", Ioannina, Greece
| | - Athanasios Kotsakis
- 2nd Cardiology Department, General Hospital of Nikaia-Piraeus "Ag. Panteleimon", Nikaia, Greece
| | - Rigas G Kalaitzidis
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Ag. Panteleimon", Ioannina, Greece.
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20
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Jobe M, Beye SM, Gaye ND, Ka MM, Perel P, Perkins AD, Kane A, Prentice AM, Ojji DB, Jaiteh LE, Etyang AO, Shah AS, Gaye B. Hypertension in Sub-Saharan Africa: Burden, Barriers and Priorities for Improving Treatment Outcomes. Circ Res 2025; 137:106-118. [PMID: 40536937 PMCID: PMC12175831 DOI: 10.1161/circresaha.124.323889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2025]
Abstract
The burden of hypertension is rising rapidly in sub-Saharan Africa (SSA), posing significant health challenges and economic costs that hinder national development. Despite being well-studied in clinical medicine, the detection, treatment, and control of hypertension in SSA remain inadequate. This is due to barriers across the care continuum, including individual-, provider-, and system-level obstacles within the health system. A critical issue is the lack of contextualized mechanistic research to understand the mechanisms, phenotypes, and treatment responses in native SSA populations. Current treatment approaches are often based on data from diaspora Africans, particularly African Americans. Consequently, most guidelines do not recommend angiotensin system drugs as first-line agents for Black patients, a stance that should be reconsidered given some evidence of their effectiveness in native SSA populations. Addressing these barriers requires a comprehensive, multisectoral strategy that includes both preventative and clinical measures at the population and individual levels. Preventative approaches should encompass health and nutrition education, improving food supply quality, and implementing comprehensive transportation and environmental policies. In addition, strategies should be developed to increase the detection of undiagnosed cases through enhanced screening and treatment access to those not receiving care, and revisit current treatment approaches to ensure that they are more tailored to the specific populations and settings. In conclusion, innovative strategies are needed to identify and overcome barriers to hypertension diagnosis and management. A coordinated, multisectoral approach that includes a contextualized mechanistic research agenda, as well as task shifting and task sharing, will help prevent and reduce hypertension in SSA.
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Affiliation(s)
- Modou Jobe
- Nutrition & Planetary Health Theme, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul (M.J., A.M.P.)
| | - Serigne Mor Beye
- Unité de Formation et de Recherche (UFR) des Sciences de la Santé, Université Gaston Berger de Saint Louis, Senegal (S.M.B., A.K.)
| | - Ngone Diaba Gaye
- Department of Cardiac Rehabilitation, Ibra Mamadou Wane Medical Center, Dakar, Senegal (N.D.G.)
| | | | - Pablo Perel
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom (P.P., A.D.P., A.S.V.S.)
| | - Alexander D. Perkins
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom (P.P., A.D.P., A.S.V.S.)
| | - Adama Kane
- Unité de Formation et de Recherche (UFR) des Sciences de la Santé, Université Gaston Berger de Saint Louis, Senegal (S.M.B., A.K.)
| | - Andrew M. Prentice
- Nutrition & Planetary Health Theme, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul (M.J., A.M.P.)
| | - Dike B. Ojji
- Department of Internal Medicine, Faculty of Clinical Sciences, University of Abuja, Nigeria (D.B.O.)
| | - Lamin E.S. Jaiteh
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia (L.E.S.J.)
| | - Anthony O. Etyang
- Epidemiology and Demography Department, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya (A.O.E.)
| | - Anoop S.V. Shah
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom (P.P., A.D.P., A.S.V.S.)
- Department of Cardiology, Imperial College National Health Service (NHS) Trust, London, United Kingdom (A.S.V.S.)
| | - Bamba Gaye
- Department of Public Health, Cheikh Anta Diop University, Dakar, Senegal (B.G.)
- Alliance for Medical Research in Africa (AMedRA), Dakar, Senegal (B.G.)
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA (B.G.)
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21
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E L, C RO, G M, A D, S E, V HC, Z K, M L, D P, N P, T S, C S, S S, J R, B GLV. Blood pressure values in healthy normal weight children and adolescents in eight European countries: auscultatory and oscillometric measurements. Eur J Intern Med 2025:S0953-6205(25)00248-1. [PMID: 40541458 DOI: 10.1016/j.ejim.2025.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2025] [Accepted: 06/09/2025] [Indexed: 06/22/2025]
Abstract
AIM The aim of the study is to provide BP values adjusted for sex, age and height in a large sample of healthy and normal weight children and adolescents 3-17 years in eight European countries, using standardized BP measurement by oscillometric and auscultatory methods. SUBJECTS AND METHODS In 38.374 children (20.189 girls) BP values were measured following the European Society of Hypertension guidelines. To derive BP percentiles the estimated influences of age and height simultaneously on BP levels were estimated. RESULTS The estimated BP values corresponding to 90th, 95th, and 99th systolic and diastolic percentiles according to height percentiles, age and sex were calculated. In both methods, the 90th and 95th percentiles of systolic blood pressure, tended to increase with both age and height, higher in boys than in girls without differences in diastolic blood pressure. The study illustrates the differences in 95th Blood Pressure percentile obtained by oscillometric and auscultatory methods in both sexes at the 50th height percentile. The threshold corresponding to 95th percentile at age 13 is close to 130/80 mmHg in both sexes and measurement methods at median height and at age 17 it is around 140/90 mmHg for boys. CONCLUSIONS The progressive increment of blood pressure in children across age is largely influenced by height. In boys blood pressure values still increase after 13 years old, while in girls the BP increment after this age was lower. Differences in systolic blood pressure and diastolic blood pressure among the two used methods are minimal except in the oldest age group.
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Affiliation(s)
- Lurbe E
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; University of Valencia, Valencia, Spain; INCLIVA Research Institute, University of Valencia, Valencia, Spain.
| | - Regueiro-Ons C
- Department of Quantitative Methods in Economics and Management, University Las, Palmas de Gran Canaria, Campus de Tafira, Las Palmas de Gran Canaria, Spain
| | - Mancia G
- University of Milano-Bicocca, Milan, Italy
| | - Düzova A
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Erdine S
- University of Istanbul Cerrahpasa School of Medicine, Istanbul, Türkiye
| | - Herceg-Cavrak V
- Faculty of Health Sciences, Libertas International University, Zagreb
| | - Kulaga Z
- Public Health Department, The Children's Memorial Health Institute, Warsaw, Poland
| | - Litwin M
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Pall D
- Department of Medical Clinical Pharmacology, University of Debrecen, Debrecen, Hungary; Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Petricevic N
- Teaching Institute of Public Health Dr. Andrija Štampar, Zagreb, Croatia
| | - Seeman T
- Division of Pediatric Nephrology, University Children's Hospital, Charles University, Prague, Czech Republic; Department of Pediatrics, University Hospital Ostrava and Medical Faculty of University, Ostrava, Czech Republic
| | - Simão C
- Department of Pediatrics, Hospital Santa Maria-ULSSM-Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Portugal
| | - Stabouli S
- 1st Department of Pediatrics, Hippokratio Hospital, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Redon J
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; INCLIVA Research Institute, University of Valencia, Valencia, Spain
| | - González López-Valcarcel B
- Department of Quantitative Methods in Economics and Management, University Las, Palmas de Gran Canaria, Campus de Tafira, Las Palmas de Gran Canaria, Spain
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22
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Lee CJ, Ihm SH, Shin DH, Jeong JO, Kim JH, Chun KH, Ryu J, Lee HY, Choi S, Lee EM, Choi JH, Kim KI, Shin J, Pyun WB, Kim DH, Park S, Williams B. Spironolactone vs Amiloride for Resistant Hypertension: A Randomized Clinical Trial. JAMA 2025; 333:2073-2082. [PMID: 40366680 PMCID: PMC12079568 DOI: 10.1001/jama.2025.5129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Accepted: 03/24/2025] [Indexed: 05/15/2025]
Abstract
Importance Amiloride has been proposed as an alternative to spironolactone for treating resistant hypertension. However, no randomized clinical trials have compared the efficacy of spironolactone and amiloride in patients with resistant hypertension. Objective To determine whether amiloride is noninferior to spironolactone in reducing home-measured systolic blood pressure (SBP) in patients with resistant hypertension. Design, Setting, and Participants Prospective, open-label, blinded end-point randomized clinical trial conducted at 14 sites in South Korea. From November 16, 2020, to February 29, 2024, 118 patients with home SBP of 130 mm Hg or greater after a 4-week run-in period with a fixed-dose triple medication combination (angiotensin receptor blocker, calcium channel blocker, and thiazide) were enrolled. Intervention Patients were randomized in a 1:1 ratio to receive 12.5 mg/d of spironolactone (n = 60) or 5 mg/d of amiloride (n = 58). If home SBP remained 130 mm Hg or greater and serum potassium was less than 5.0 mmol/L after 4 weeks, dosages were increased to 25 mg/d and 10 mg/d, respectively. Main Outcomes and Measures The primary end point was the between-group difference in home SBP change at week 12, with a noninferiority margin of -4.4 mm Hg for the lower bound of the confidence interval. Secondary end points included achievement rates of home- and office-measured SBP of less than 130 mm Hg. Results The median age of the study population was 55 years, with 70% male. There were no differences between groups in demographic characteristics other than use of α-blockers (8.6% in the amiloride group and 0% in the spironolactone group). The mean baseline home SBPs were 141.5 (SD, 7.9) mm Hg and 142.3 (SD, 8.5) mm Hg in the amiloride and spironolactone groups, respectively. At week 12, mean home SBP measurements were changed from baseline by -13.6 (SD, 8.6) mm Hg and -14.7 (SD, 11.0) mm Hg in the amiloride and spironolactone groups, respectively (between-group difference in change, -0.68 mm Hg; 90% CI, -3.50 to 2.14 mm Hg), with amiloride demonstrating noninferiority to spironolactone. Home-measured achievement rates of SBP less than 130 mm Hg in the amiloride and spironolactone groups were 66.1% and 55.2%, respectively, and office-measured achievement rates of SBP less than 130 mm Hg were 57.1% and 60.3%, respectively, with no difference between the 2 groups. One case of hyperkalemia-related discontinuation occurred in the amiloride group, with no cases of gynecomastia in either group. Conclusions and Relevance Amiloride was noninferior to spironolactone in lowering home SBP, suggesting that it could be an effective alternative for treatment of resistant hypertension. Trial Registration ClinicalTrials.gov Identifier: NCT04331691.
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Affiliation(s)
- Chan Joo Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St Mary’s Hospital and the Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Ho Shin
- Division of General Internal Medicine, Department of Internal Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Jin-Ok Jeong
- Department of Cardiology in Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kyeong-Hyeon Chun
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
- Now with Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - JiWung Ryu
- Division of Cardiology, Department of Internal Medicine, Dankook University Hospital, Cheonan, Republic of Korea
- Now with Division of Cardiology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seonghoon Choi
- Now with Division of Cardiology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Eun Mi Lee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
| | - Jung Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Wook Bum Pyun
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, London, United Kingdom
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23
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Wenjie L, Wang Z, Li M, Jiang C, Hua C, Tang Y, Zhang H, Liu X, Zheng S, Guo H, Zhao M, Wang YF, Gao M, Lv Q, Dong J, Ma CS, Du X. The Impact of frailty on the effectiveness of intensive blood pressure control for patients with type 2 diabetes: a secondary analysis of a randomised controlled trial. Heart 2025; 111:626-633. [PMID: 39915072 DOI: 10.1136/heartjnl-2024-324360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 01/10/2025] [Indexed: 03/17/2025] Open
Abstract
BACKGROUND Frailty is an independent risk factor for cardiovascular events. It is uncertain whether frailty modifies the efficacy of intensive blood pressure (BP) control among participants with type 2 diabetes mellitus(T2DM). METHODS The Action to Control Cardiovascular Risk in Diabetes Blood Pressure (ACCORD BP) trial, a two-by-two factorial trial, examined the effects of systolic BP (<120 vs <140 mm Hg) and glycaemic control on cardiovascular events in T2DM. We constructed a frailty index using the Rockwood cumulative deficit approach. Cox proportional hazard models were used to estimate the effectiveness of intensive BP treatment according to frailty status. The primary composite outcome was non-fatal myocardial infarction, non-fatal stroke or death from cardiovascular causes. RESULTS There were 4733 participants (mean age: 62.7 years; 39.9% frailty). The mean average number of antihypertensive medications was higher in frail patients compared with non-frail patients in both the standard (2.2 vs 1.7) and intensive (3.1 vs 2.7) treatment groups. In the standard glycaemic arm, intensive BP treatment reduced the risk of the primary outcome (HR 0.75, 95% CI 0.58 to 0.97) regardless of frailty status (p value for interaction=0.86). The benefits of intensive BP intervention were consistent across the spectrum of the frailty index (p value for interaction=0.96) in the standard glycaemic arm. However, no benefits of intensive BP treatment (HR 1.08, 95% CI 0.82 to 1.43) were observed in the intensive glycaemic arm. CONCLUSIONS In the ACCORD BP study, the benefit of intensive BP treatment was consistent regardless of frailty in the setting of standard glycaemic control. Frailty should not be a barrier to intensive BP control in patients with T2DM treated with guideline-recommended standard glycaemic control.
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Affiliation(s)
- Li Wenjie
- Department of Cardiology, Anzhen Hospital, Beijing, China
- Department of Cardiology, West China Hospital, Chengdu, China
| | - Zhiyan Wang
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Mingxiao Li
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Chao Jiang
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Chang Hua
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Yangyang Tang
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Hao Zhang
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Xinru Liu
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Shiyue Zheng
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Hang Guo
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Manlin Zhao
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Yu Feng Wang
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Mingyang Gao
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Qiang Lv
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Anzhen Hospital, Beijing, China
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chang-Sheng Ma
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Xin Du
- Department of Cardiology, Anzhen Hospital, Beijing, China
- Heart Health Research Center (HHRC), Beijing, China
- The George Institute for Global Health (Australia),The University of New South Wales, Sydney, New South Wales, Australia
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24
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Sosnowski M, Parma Z, Syzdół M, Brożek G, Harpula J, Tendera M, Wojakowski W. A Novel Concept of the "Standard Human" in the Assessment of Individual Total Heart Size: Lessons from Non-Contrast-Enhanced Cardiac CT Examinations. Diagnostics (Basel) 2025; 15:1502. [PMID: 40564823 DOI: 10.3390/diagnostics15121502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2025] [Revised: 05/31/2025] [Accepted: 06/01/2025] [Indexed: 06/28/2025] Open
Abstract
Background: This single-center retrospective observational study reviewed data from 2305 persons examined for coronary artery calcium (CAC) with non-contrast-enhanced cardiac CT. Other cardiac structures, including chamber volumes, were evaluated besides the CAC scoring. We proposed a novel body size indexing measure that may outperform common indices for quantifying total heart volume (THV). Methods: This index is the sum of height and the difference between height (unitless) and body surface area (unitless), [h+(h-BSA)], and if the (h-BSA) equals "zero", it is a feature of the "standard human". Results: We found that, in subjects with a low cardiovascular (CV) risk, the THV normalized for the novel index was simply a function of BW gain, being the highest in obese. If high-CV-risk features (hypertension, diabetes) were present, the measured THV was larger than expected for BW gain, exceeding values observed in low-CV-risk ones. Differences were found to be sex-independent in all BMI categories. Conclusions: Common BSA correction hides these differences and makes the prognostication of CV risk error-introducing. The indexation we proposed might help distinguish the effects of body weight gain from the ones resulting from the presence of certain cardiovascular diseases.
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Affiliation(s)
- Maciej Sosnowski
- Unit of Noninvasive Cardiovascular Diagnostics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Poniatowskiego 15 Street, 40-055 Katowice, Poland
- Unit of Diagnostic Imaging, Upper Silesian Medical Center, Ziolowa 45 Street, 40-635 Katowice, Poland
| | - Zofia Parma
- Unit of Noninvasive Cardiovascular Diagnostics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Poniatowskiego 15 Street, 40-055 Katowice, Poland
| | - Marcin Syzdół
- Unit of Noninvasive Cardiovascular Diagnostics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Poniatowskiego 15 Street, 40-055 Katowice, Poland
| | - Grzegorz Brożek
- Department of Epidemiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Poniatowskiego 15 Street, 40-055 Katowice, Poland
| | - Jan Harpula
- Department of Cardiology and Structural Heart Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Ziolowa 45 Street, 40-635 Katowice, Poland
| | - Michał Tendera
- Department of Cardiology and Structural Heart Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Ziolowa 45 Street, 40-635 Katowice, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Ziolowa 45 Street, 40-635 Katowice, Poland
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Nonato LC, Prado AKG, Dos Santos DL, Tobar KDL, Araújo JA, Ferreira JC, Cambri LT. Acute Physical Exercise Reduces Mental Stress-Induced Responses in Teachers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2025; 22:924. [PMID: 40566350 DOI: 10.3390/ijerph22060924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2025] [Revised: 05/28/2025] [Accepted: 06/07/2025] [Indexed: 06/28/2025]
Abstract
This study assessed the correlation between obesity markers and mental stress reactivity. Mainly, it evaluated whether physical exercise (PE) influences cardiovascular reactivity to the Stroop color word test (SCWT) in teachers. Thirty-one school teachers were evaluated. The SCWT was carried out under (1) baseline and (2) 30 min after aerobic PE conditions. Teachers performed 30 min of PE. The reactivity to mental stress (Δ) during the SCWT for blood pressure (BP) was determined, with Δ being the highest value observed [Δ2 or Δ4: with pre-test values (0 min)]. Of the teachers, 64.52% were considered overweight/obese and 19.35% had a high clinical BP. However, 67.74% of teachers were considered physically active. Systolic BP (SBP) reactivity to SCWT correlated negatively with obesity markers (Rho = -0.36 to -0.60; p < 0.05). The SBP and diastolic BP (DBP) were higher at 2 and 4 min compared to 0 during the SCWT under both conditions (p < 0.01). Moreover, SBP was always lower after PE (p < 0.01) and DBP was lower at 2 and 4 min after PE (p < 0.01). In summary, SBP reactivity to mental stress correlated negatively with obesity markers. Moderate-intensity acute PE reduced BP reactivity to mental stress in teachers.
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Affiliation(s)
- Laura Cristina Nonato
- Postgraduate Program in Physical Education, Federal University of Mato Grosso, Cuiabá 78060-900, Brazil
| | | | - Daniela Lopes Dos Santos
- Physical Education and Sports Center, Federal University of Santa Maria, Santa Maria 97105-900, Brazil
| | | | - Jaqueline Alves Araújo
- Postgraduate Program in Physical Education, Federal University of Mato Grosso, Cuiabá 78060-900, Brazil
| | | | - Lucieli Teresa Cambri
- Postgraduate Program in Physical Education, Federal University of Mato Grosso, Cuiabá 78060-900, Brazil
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26
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Gromova MA, Tsurko VV, Starodubova AV, Kislyak OA. [Features of diet in patients with cardiometabolic diseases with gout and hyperuricemia: A review]. TERAPEVT ARKH 2025; 97:455-462. [PMID: 40561490 DOI: 10.26442/00403660.2025.05.203227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Accepted: 02/20/2025] [Indexed: 06/28/2025]
Abstract
Gout, like hyperuricemia, is often associated with serious cardiometabolic and renal comorbidities that lead to persistently elevated rates of premature mortality in the population. Traditional dietary recommendations given to patients to prevent purine load require revision. This article holistically reviews the relevant scientific rationale and available evidence to provide evidence-based dietary recommendations for the prevention and treatment of hyperuricemia and gout and its cardiometabolic comorbidities.
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Affiliation(s)
- M A Gromova
- Pirogov Russian National Research Medical University (Pirogov University)
| | - V V Tsurko
- Pirogov Russian National Research Medical University (Pirogov University)
| | - A V Starodubova
- Pirogov Russian National Research Medical University (Pirogov University)
| | - O A Kislyak
- Pirogov Russian National Research Medical University (Pirogov University)
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Tan SYL, Chai JX, Choi M, Javaid U, Tan BPY, Chow BSY, Abdullah HR. Remote Photoplethysmography Technology for Blood Pressure and Hemoglobin Level Assessment in the Preoperative Assessment Setting: Algorithm Development Study. JMIR Form Res 2025; 9:e60455. [PMID: 40479628 PMCID: PMC12165443 DOI: 10.2196/60455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 02/10/2025] [Accepted: 02/21/2025] [Indexed: 06/16/2025] Open
Abstract
Background Blood pressure (BP) and hemoglobin concentration measurements are essential components of preoperative anesthetic evaluation. Remote photoplethysmography (rPPG) is an emerging technology that may be used to measure BP and hemoglobin concentration noninvasively with just a consumer-grade smartphone, replacing traditional in-person measurements. However, there is limited data regarding the use of this technology in patients with diverse skin tones and medical comorbidities. Hence, widespread applicability is yet to be achieved. The potential benefits of achieving this would be immense, allowing for greater convenience, accessibility, and reduction in labor and resources. Objective Our study aims to be the first to develop an algorithm for noninvasive rPPG-based BP and hemoglobin concentration measurement that can be used for preoperative evaluation of patients in real-world clinical practice settings. Methods We conducted the study at Singapore General Hospital from March 1, 2023, to June 28, 2024. A total of 200 patients were recruited. Our primary analysis compared the accuracy of rPPG-based systolic and diastolic BP measurements against measurements taken with automated BP measuring devices. Our secondary analysis compared the accuracy of rPPG-based hemoglobin concentration measurement against traditional blood sampling. Results Our model performed best with diastolic BP predictions, with a mean absolute percentage error of 7.52% and a mean difference of 0.16 mm Hg (SD 3.22 mm Hg) between reference and measured readings. The 95% CI for the mean difference between predicted and measured diastolic BP was ±0.57 (-0.41 to 0.73) mm Hg. Systolic BP predictions yielded a mean absolute percentage error of 9.52% and a mean difference of 2.69 mm Hg (SD 7.86 mm Hg). The 95% CI for the mean difference between predicted and measured systolic BP was ±1.14 (-1.54 to -3.83) mm Hg. Hemoglobin concentration predictions had a mean absolute percentage error of 8.52%, with a mean difference of 0.23 g/dL (SD 0.67 g/dL). The 95% CI for the mean difference between predicted and reference measured hemoglobin concentration was ±0.10 (95% CI 0.13-0.33) g/dL. Conclusions Noninvasive rPPG-based measurement of BP and hemoglobin concentration at the preoperative evaluation setting has great potential for improving convenience, improving efficiency, and conserving resources for patients and health care providers. Our model was able to accurately predict diastolic BP in patients with diverse skin tones and medical comorbidities. The findings of this study serve as a basis for further studies to develop and validate the model for noninvasive rPPG-based BP and hemoglobin concentration measurement.
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Affiliation(s)
- Selene Y L Tan
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Jia Xin Chai
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | | | | | - Brenda Pei Yi Tan
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Belinda Si Ying Chow
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Hairil Rizal Abdullah
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Atti J, Kissow J, Bangsbo J. 12 Weeks of Supervised Team Sports in Danish Municipal Health Center Lowers Systolic Blood Pressure and Increases Performance in Hypertensive Chronic Obstructive Pulmonary Disease and Type 2 Diabetes Mellitus Patients. J Funct Morphol Kinesiol 2025; 10:209. [PMID: 40566459 DOI: 10.3390/jfmk10020209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 04/01/2025] [Accepted: 04/23/2025] [Indexed: 06/28/2025] Open
Abstract
Background: Hypertension is a significant public health issue, particularly in individuals with comorbidities such as COPD and T2DM, which exacerbate cardiovascular risk and impair quality of life. While physical activity is an effective intervention for reducing blood pressure and improving health markers, conventional therapies often lack the social and psychological benefits of team sports. Team sports conducted as small-sided games provide a dynamic, engaging approach that combines physical, social, and psychological advantages, making them particularly suitable for individuals with complex chronic conditions. Methods: This non-randomized intervention study involved twenty-eight hypertensive patients, including 16 individuals with type 2 diabetes mellitus (T2DM) (8 men and 8 women) and 12 with chronic obstructive pulmonary disease (COPD) (7 men and 5 women). Participants engaged in a training program, primarily consisting of team sports (floorball and cone ball), at a municipal health center twice a week for 12 weeks. Results: The intervention led to a significant reduction in systolic blood pressure (p = 0.006), with patients with COPD and T2DM showing decreases of 9.6 ± 12.7 mmHg and 12.4 ± 19.0 mmHg, respectively. Additionally, the time to complete the 2.45 m "Up and Go" test improved significantly (p < 0.001), with both COPD (p = 0.011) and T2DM (p = 0.005) patients demonstrating notable improvements. However, no significant changes were observed in body mass, chair stand performance, five-repetition sit-to-stand test, handgrip strength, or diastolic blood pressure following the intervention. Conclusions: Team sports training conducted in a municipality health center is effective in lowering blood pressure and improving functional capacity in hypertensive COPD and T2DM patients.
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Affiliation(s)
- Jesper Atti
- The August Krogh Section for Human and Molecular Physiology, Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Julie Kissow
- The August Krogh Section for Human and Molecular Physiology, Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Jens Bangsbo
- The August Krogh Section for Human and Molecular Physiology, Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, DK-2100 Copenhagen, Denmark
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Wetche JL, Schmedes AV, Sjøgren A, Bergmann ML, Fly LH, Madsen JS, Petersen ER, Højlund K, Olsen MH, Asyaei P, Stidsen JV, Olesen TB. High Plasma 18β-Glycyrrhetinic Acid Levels Are Associated With More Intensive Antihypertensive Treatment, Resistant Hypertension and Apparent Mineralocorticoid Excess in Patients With Type 2 Diabetes. J Nutr 2025:S0022-3166(25)00331-1. [PMID: 40467035 DOI: 10.1016/j.tjnut.2025.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2025] [Revised: 05/02/2025] [Accepted: 05/28/2025] [Indexed: 06/22/2025] Open
Abstract
BACKGROUND Excessive consumption of glycyrrhizin (GL), a licorice-derived substance, can cause blood pressure (BP) elevation and apparent mineralocorticoid excess (AME). However, self-reported intake can be unreliable due to unrecognized sources of GL. Plasma levels of 18β-glycyrrhetinic acid (GA), a major metabolite of GL, may serve as a biochemical marker of exposure. Identifying individuals with high plasma levels of GA could be relevant in BP management in at-risk patients. OBJECTIVES To examine whether plasma levels of GA are associated with BP, antihypertensive treatment intensity, resistant hypertension, and biochemical markers of AME in patients with type 2 diabetes (T2D). METHODS In this cross-sectional study, we measured GA in plasma from 1160 patients with T2D. Participants were divided into high GA (top quartile) and low GA (bottom 3 quartiles). Linear and logistic regression models assessed associations of GA levels with BP, antihypertensive treatment intensity (defined daily dose; DDD), resistant hypertension and markers of AME. Models were adjusted for confounders such as age, sex, sociodemographic, lifestyle, diabetes duration, estimated glomerular filtration rate, glycated hemoglobin, homoeostasis model assessment 2 for insulin sensitivity, and where appropriate systolic BP and treatment. RESULTS High GA was not significantly associated with higher BP but with more intensive antihypertensive treatment (+0.28 DDD [0.03-0.52], P = 0.03) compared with low GA. High GA was also associated with higher risk of resistant hypertension (adjusted odds ratio: 1.91 [1.12-3.24], P = 0.02). Additionally, high GA was associated with markers of AME (lower aldosterone (-41.5 pmol/L [-63.1 to -20.0]; P < 0.001), lower potassium (-0.06 mmol/L [-0.10 to -0.01]; P = 0.01), lower cortisone (-6.08 nmol/L [-7.78 to -4.38]; P < 0.001), and higher cortisol/cortisone ratio (+1.26 [1.00-1.52]; P < 0.001)). CONCLUSION High GA levels, a possible marker of excessive licorice consumption, were associated with greater antihypertensive treatment intensity, resistant hypertension and biochemical markers consistent with AME in patients with T2D. These findings suggest that licorice-related exposure may be relevant to BP management in this population.
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Affiliation(s)
- Jakob L Wetche
- Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark.
| | - Anne V Schmedes
- Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
| | - Amalie Sjøgren
- Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
| | - Marianne L Bergmann
- Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
| | - Line H Fly
- Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
| | - Jonna S Madsen
- Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Eva Rb Petersen
- Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
| | - Kurt Højlund
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Michael H Olsen
- Department of Internal medicine, Holbaek Hospital, Holbaek, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Parmida Asyaei
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Jacob V Stidsen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Thomas B Olesen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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Kuntic M, Hahad O, Al-Kindi S, Oelze M, Lelieveld J, Daiber A, Münzel T. Pathomechanistic Synergy Between Particulate Matter and Traffic Noise-Induced Cardiovascular Damage and the Classical Risk Factor Hypertension. Antioxid Redox Signal 2025; 42:827-847. [PMID: 38874533 DOI: 10.1089/ars.2024.0659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Significance: In all modern urbanized and industrialized societies, noncommunicable diseases, such as cardiovascular disease (CVD), are becoming a more important cause of morbidity and mortality. Classical risk factors for CVDs, such as hypertension, are reinforced by behavioral risk factors, e.g., smoking and diet, and environmental risk factors, e.g., transportation noise and air pollution. Recent Advances: Both transportation noise and air pollution have individually been shown to increase the risk for CVD in large cohorts. Insights from animal studies have revealed pathophysiologic mechanisms by which these stressors influence the cardiovascular system. Noise primarily causes annoyance and sleep disturbance, promoting the release of stress hormones. Air pollution primarily damages the lung, where it causes local inflammation and an increase in oxidative stress, which can propagate to the circulation and remote organs. Critical Issues: Both noise and air pollution converge at the vascular level, where the inflammatory state and oxidative stress cause dysfunction in vascular signaling and promote atherosclerotic plaque formation and thrombosis. Both inflammation and oxidative stress are key aspects of traditional cardiovascular risk factors, such as arterial hypertension. The similarities among the mechanisms of environmental risk factor-induced CVD and hypertension indicate that a complex interplay between them can drive the onset and progression of CVDs, leading to synergistic health impacts. Future Directions: Our present overview of the negative effects of noise and air pollution on the cardiovascular system provides a mechanistic link to the traditional CVD risk factor, hypertension, which could be used to protect patients with preexisting CVD better. Antioxid. Redox Signal. 42, 827-847.
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Affiliation(s)
- Marin Kuntic
- Department of Cardiology 1, Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Mainz, Germany
| | - Omar Hahad
- Department of Cardiology 1, Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Mainz, Germany
| | - Sadeer Al-Kindi
- Cardiovascular Prevention & Wellness and Center for CV Computational & Precision Health, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Matthias Oelze
- Department of Cardiology 1, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Jos Lelieveld
- Max Planck Institute for Chemistry, Atmospheric Chemistry, Mainz, Germany
| | - Andreas Daiber
- Department of Cardiology 1, Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology 1, Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Mainz, Germany
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31
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Ichikawa D, Kawarazaki W, Saka S, Kanaoka T, Ohnishi H, Arima H, Shibata S. Efficacy of renin-angiotensin system inhibitors, calcium channel blockers, and diuretics in hypertensive patients with diabetes: subgroup analysis based on albuminuria in a systematic review and meta-analysis. Hypertens Res 2025; 48:1880-1890. [PMID: 39953235 DOI: 10.1038/s41440-025-02146-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 01/11/2025] [Accepted: 01/24/2025] [Indexed: 02/17/2025]
Abstract
In hypertensive patients with diabetes, the effectiveness of renin-angiotensin system (RAS) inhibitors in improving mortality, cardiovascular events, and renal outcomes, compared to other antihypertensive drugs such as calcium channel blockers (CCBs) and diuretics, remains uncertain, particularly in the context of albuminuria. A comprehensive literature search was conducted using PubMed, the Cochrane Library, and the Japan Medical Abstracts Society databases up to October 2024. A meta-analysis of 12 randomized controlled trials, including 14,163 patients, was performed. RAS inhibitors showed no significant advantage over CCBs or diuretics for all-cause mortality (relative risk [RR]: 1.00, 95% confidence interval [CI]: 0.92-1.08, p = 0.98), myocardial infarction (RR: 0.64, 95% CI: 0.32-1.31, p = 0.22), stroke (RR: 1.14, 95% CI: 1.00-1.31, p = 0.05), composite cardiovascular events (RR: 0.93, 95% CI: 0.81-1.07, p = 0.45), or end-stage renal disease (RR: 0.88, 95% CI: 0.72-1.08, p = 0.21). Subgroup analyses stratified by albuminuria status revealed no significant benefits of RAS inhibitors, regardless of albuminuria presence. The findings emphasize the need for cautious interpretation due to limited sample sizes, wide confidence intervals, and low precision. These results highlight the importance of considering not only RAS inhibitors but also other antihypertensive drugs as the first-line choice for blood pressure control in diabetic patients, with careful attention to side effects and other relevant factors.
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Affiliation(s)
- Daisuke Ichikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - Wakako Kawarazaki
- Center for Basic Medical Research, International University of Health and Welfare (IUHW) Narita Campus, Narita, Japan
| | - Sanae Saka
- Department of Nephrology and Hypertension, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Tomohiko Kanaoka
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shigeru Shibata
- Division of Nephrology, Department of Internal Medicine, Teikyo University, Itabashi, Japan
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Kario K, Tomitani N, Hoshide S. Validation of the A&D BP UA-1100NFC/UA-1100NFC-W, hoseless upper arm-type home blood pressure devices, according to the ISO81060-2:2018/Amd 1:2020 protocol. Blood Press Monit 2025; 30:130-135. [PMID: 39831763 DOI: 10.1097/mbp.0000000000000741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2025]
Abstract
The aim of this study was to validate the performance of the A&D UA-1100NFC hoseless devices of two cuff sizes in monitoring blood pressure (BP) in the upper arm according to the International Organization for Standardization (ISO) 81060-2:2018/amendment (Amd) 1:2020 protocol. The accuracy of the UA-1100NFC (for arm circumferences of 22.0-32.0 cm) and the UA-1100NFC-W (for arm circumferences of 22.0-42.0 cm) was assessed using the same-arm sequence protocol as per the ISO 81060-2:2018/Amd 1:2020 standard. Individuals aged >12 years were recruited from the outpatients and volunteers of Jichi Medical University (Tochigi, Japan); 85 participants were included in the final analyses for each device. Both devices performed well against the standard; mean and SD values for the differences between the device-measured and observer-measured SBP and DBP values met both criterion 1 and criterion 2 of the standard [(UA-1100NFC) criterion 1: -3.71 ± 6.82 mmHg and 0.86 ± 6.33 mmHg, respectively; criterion 2: 5.65 mmHg and 5.87 mmHg, respectively; (UA-1100NFC-W) criterion 1: 0.73 ± 7.84 mmHg and 1.72 ± 6.44 mmHg, respectively; criterion 2: 6.49 mmHg and 5.86 mmHg, respectively]. The Bland-Altman plots did not show any systematic variation in the error. Both the UA-1100NFC and UA-1100NFC-W hoseless devices had a high level of accuracy and fulfilled the requirements of the ISO81060-2:2018/Amd 1:2020 validation standard. They are therefore suitable as home BP monitoring tools in patients with hypertension.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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Gnanenthiran SR, Delgado S, Mirabito Colafella KM, Schlaich MP, Schutte AE, Rodgers A. Changing the paradigm of long-term blood pressure control: a systematic review of novel therapies. J Hypertens 2025; 43:917-928. [PMID: 40353359 DOI: 10.1097/hjh.0000000000003984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 02/01/2025] [Indexed: 05/14/2025]
Abstract
Novel drug and device therapies have the potential to achieve long-term control of blood pressure (BP) and thereby overcome the barriers of nonadherence and undertreatment. We propose that ideal BP lowering therapy should meet six key criteria: (i) achieve a clinically relevant BP reduction; (ii) durable BP reduction; (iii) be well tolerated; (iv) have the ability to be safely combined with other BP lowering treatments; (v) have high patient acceptability and (vi) be cost-effective and simple to use to maximize scalability. In this paper, we systematically review emerging solutions for long-term control of BP including antibody-based therapies, sRNA therapies, and DNA-based gene editing which target the renin angiotensin system, and implant therapies, and interventional approaches (renal denervation and baroreceptor activation therapies). These novel therapies may substantially complement and, in some settings, even replace current antihypertensive therapies. Implementation will require significant progress in overcoming technological-, systems-, prescriber- and patient-level barriers.
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Affiliation(s)
- Sonali R Gnanenthiran
- The University of New South Wales, The George Institute for Global Health, Sydney
- Concord Repatriation General Hospital, Concord
| | | | - Katrina M Mirabito Colafella
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia
- Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Aletta E Schutte
- The University of New South Wales, The George Institute for Global Health, Sydney
| | - Anthony Rodgers
- The University of New South Wales, The George Institute for Global Health, Sydney
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Barreiro RG, Lopes MVDO. Clinical Validation of the Nursing Diagnosis 'Inadequate Health Self-Efficacy' in People With Hypertension. J Clin Nurs 2025; 34:2236-2247. [PMID: 39268894 DOI: 10.1111/jocn.17418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 08/12/2024] [Accepted: 08/15/2024] [Indexed: 09/15/2024]
Abstract
AIMS To test the clinical validity of clinical indicators and causal relationships of aetiological factors of the new nursing diagnosis of inadequate health self-efficacy in people with hypertension. BACKGROUND The diagnosis of inadequate health self-efficacy has both theoretical and content validity. However, a clinical validation study is needed to establish an appropriate framework for distinguishing individuals who manifest this unique human response. DESIGN The study adopts a cross-sectional clinical validation approach, adhering strictly to the STROBE guidelines throughout its design and implementation. METHODS Naturalistic sampling was used to identify 302 adults diagnosed with hypertension. Their data were subjected to latent class analysis, which facilitated the identification of a comprehensive set of clinical indicators that demonstrated better diagnostic accuracy and established posterior probabilities to guide the inference of inadequate health self-efficacy. In addition, logistic regression analysis was used to assess the magnitude of the impact of aetiological factors. RESULTS The prevalence of inadequate health self-efficacy was 76.61%. Among the 13 indicators examined, seven demonstrated notable sensitivity: 'risk-prone health behaviour', 'failure to take action that prevents health problems', 'inadequate self-control', 'avoidance behaviours', 'negative health self-perception', 'inadequate health-related quality of life' and 'difficulty feeling good about adopting a healthy lifestyle'. Additionally, two indicators showed high specificity: 'difficulty feeling good about adopting a healthy lifestyle' and 'inadequate adherence to treatment regimen'. Notably, 15 aetiological factors were identified as significantly associated with an increased risk of inadequate health self-efficacy. CONCLUSIONS A clinical framework consisting of eight clinical indicators and 15 aetiological factors was developed to characterise inadequate health self-efficacy in individuals with hypertension. RELEVANCE TO PRACTICE Clinical validation provides insight into the precision of clinical indicators and the magnitude of the effect of putative causal elements, thereby facilitating identification and tailored intervention for individuals with hypertension and inadequate health self-efficacy.
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Affiliation(s)
- Reinaldo Gutiérrez Barreiro
- Nursing Program, Federal University of Ceará, Fortaleza, Brazil
- Nursing Diagnosis, Interventions, and Outcomes Study Group (GEDIRE), Federal University of Ceará, Fortaleza, Brazil
- Department of Nursing, Surcolombiana University, Neiva, Colombia
| | - Marcos Venícios de Oliveira Lopes
- Nursing Program, Federal University of Ceará, Fortaleza, Brazil
- Nursing Diagnosis, Interventions, and Outcomes Study Group (GEDIRE), Federal University of Ceará, Fortaleza, Brazil
- Department of Nursing, Federal University of Ceará, Fortaleza, Brazil
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35
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Muin RI, Yamin M, Wijaya IP, Harimurti K, Shatri H, Irawan C, Soewondo P. Chronic kidney disease and increased LAVI as risk factors of new-onset heart failure in atrial fibrillation: A case-control study. J Arrhythm 2025; 41:e70061. [PMID: 40395862 PMCID: PMC12089698 DOI: 10.1002/joa3.70061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 03/23/2025] [Accepted: 03/27/2025] [Indexed: 05/25/2025] Open
Abstract
Background Atrial fibrillation (AF) increases heart failure (HF) risk and can eventually increase morbidity and mortality. Therefore, recognizing risk factors in AF patients is crucial to prevent heart failure. To date, there has been no research on this topic in Indonesia. Objective To determine risk factors of new-onset HF in AF patients. Methods Case-control study was undertaken at Cipto Mangunkusumo Hospital using medical record data from January 2018 to May 2023. AF patients aged ≥18 years with new-onset HF were included in the case group, and AF patients of similar age without HF were included in the control group. Patients with moderate or severe valvular heart disease, congenital heart disease, pacemakers, or implantable cardioverter defibrillators (ICD), or incomplete data were excluded. Logistic regression was used to identify significant risk factors for new-onset HF in AF patients. Results A total of 132 subjects consisting of 44 cases and 88 controls were included. Bivariate analysis revealed that the significant risk factors for new-onset HF in AF patients were CAD [p = .037; OR 2.34 (95% CI 1.11-4.93)], CKD [p = .000; OR 7.78 (95% CI 3.45-17.53)], and LAVI [p = .002; OR 3.23 (95% CI 1.52-6.85)]. In multivariate analysis, CKD [p = .000; OR 6.31 (95% CI 2.69-14.77)] and LAVI [p = .000; OR 3.49 (95% CI 1.42-9.97)] retained their statistical significance as risk factors of new-onset HF in AF patients. Conclusions CKD and increased LAVI may increase the likelihood of new-onset HF in AF patients, while hypertension, diabetes, CAD, smoking, and obesity were not significant risk factors for new-onset HF in our study.
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Affiliation(s)
- Resultanti Irwan Muin
- Division of Cardiology, Department of Internal Medicine, Faculty of MedicineCipto Mangunkusumo Hospital, Universitas IndonesiaJakartaIndonesia
| | - Muhammad Yamin
- Division of Cardiology, Department of Internal Medicine, Faculty of MedicineCipto Mangunkusumo Hospital, Universitas IndonesiaJakartaIndonesia
| | - Ika Prasetya Wijaya
- Division of Cardiology, Department of Internal Medicine, Faculty of MedicineCipto Mangunkusumo Hospital, Universitas IndonesiaJakartaIndonesia
| | - Kuntjoro Harimurti
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of MedicineCipto Mangunkusumo Hospital, Universitas IndonesiaJakartaIndonesia
| | - Hamzah Shatri
- Division of Psychosomatic, Department of Internal Medicine, Faculty of MedicineCipto Mangunkusumo Hospital, Universitas IndonesiaJakartaIndonesia
| | - Cosphiadi Irawan
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of MedicineCipto Mangunkusumo Hospital, Universitas IndonesiaJakartaIndonesia
| | - Pradana Soewondo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of MedicineCipto Mangunkusumo Hospital, Universitas IndonesiaJakartaIndonesia
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Nielsen SF, Duus CL, Buus NH, Bech JN, Mose FH. The effects of empagliflozin on systemic haemodynamic function: three randomized, placebo-controlled trials. J Hypertens 2025; 43:1021-1029. [PMID: 40156337 DOI: 10.1097/hjh.0000000000004007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 03/04/2025] [Indexed: 04/01/2025]
Abstract
BACKGROUND Sodium glucose cotransporter 2 inhibitors lower blood pressure. The underlying mechanisms are multifactorial and include effects on vascular function. We examined the systemic hemodynamic effects of empagliflozin in patients with type 2 diabetes mellitus (DM2) with and without chronic kidney disease (CKD) and in patients with nondiabetic CKD. METHODS Three double-blinded, randomized, placebo-controlled cross-over trials, including patients with DM2 and preserved renal function ( n = 16), DM2 and CKD ( n = 17) and nondiabetic CKD ( n = 16). Participants were randomized to 4 weeks of empagliflozin 10 mg or placebo and crossed over after a 2-week washout. We measured brachial and central 24-h ambulatory blood pressure (ABP), pulse wave velocity (PWV), augmentation index (AIx@75), markers of nitric oxide and erythrocyte sodium sensitivity (ESS), a marker of endothelial glycocalyx function. RESULTS Empagliflozin reduced PWV [-0.16 m/s, 95% confidence interval (95% CI): -0.26; -0.06, P = 0.002], AIx@75 (-2.17%, 95% CI: -3.31; -1.02, P < 0.001) and brachial and central ABP in the combined study population ( n = 49). Changes in PWV and AIx@75 correlated to changes in systolic brachial ABP. Markers of nitric oxide did not increase, but empagliflozin decreased ESS, which was correlated to an increase in haematocrit. CONCLUSION Empagliflozin decreased arterial stiffness, mediated partly by a decrease in brachial ABP. We found no increase in nitric oxide activity, but ESS decreased. While this may be explained partly by a change in haematocrit, it could indicate an improvement in endothelial glycocalyx function. TRIAL REGISTRATION EU Clinical Trials Register 2019-004303-12, 2019-004447-80 and 2019-004467-50.
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Affiliation(s)
- Steffen F Nielsen
- University Clinic in Nephrology and Hypertension, Gødstrup Hospital, Herning
- Department of Clinical Medicine, Aarhus University
| | - Camilla L Duus
- University Clinic in Nephrology and Hypertension, Gødstrup Hospital, Herning
- Department of Clinical Medicine, Aarhus University
| | - Niels Henrik Buus
- Department of Clinical Medicine, Aarhus University
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper N Bech
- University Clinic in Nephrology and Hypertension, Gødstrup Hospital, Herning
- Department of Clinical Medicine, Aarhus University
| | - Frank H Mose
- University Clinic in Nephrology and Hypertension, Gødstrup Hospital, Herning
- Department of Clinical Medicine, Aarhus University
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Xu H, Deng W, Pan Z, Yao K, Yang J, Wang Z, Gao H, Shu H, Zhao R, Yu Y, Han Y, Li X. Discrimination of Left Atrial Strain Patterns in Hypertensive Heart Disease and Hypertrophic Cardiomyopathy: a Cardiac Magnetic Resonance Feature. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2025; 38:1518-1530. [PMID: 39424667 DOI: 10.1007/s10278-024-01293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 09/23/2024] [Accepted: 10/03/2024] [Indexed: 10/21/2024]
Abstract
To assess left atrial (LA) strain parameters using cardiovascular magnetic resonance imaging feature tracking (cardiac MRI-FT) for differentiating hypertensive heart disease (HHD) from hypertrophic cardiomyopathy (HCM), which are two left ventricular hypertrophic diseases that could present with similar morphologies in early stage but differ in clinical symptoms and treatment strategies. 45 patients with HHD, 85 patients with HCM (non-obstructive hypertrophic cardiomyopathy [HNCM, n = 45] and obstructive hypertrophic cardiomyopathy [HOCM, n = 40]) and 30 healthy controls (HC) were retrospectively included. LA volumes, strain, and strain rate were determined by manually contouring on the two- and four-chamber views of the CMR-FT module using CVI 42 software. LA volume parameters including LA maximum, precontraction, and minimum volume index, and total, passive, and active emptying fractions were obtained using the biplane methods. The LA strain parameters, including total strain (εs), passive strain (εe), active strain (εa), peak positive strain rate (SRs), early peak negative strain rate (SRe), and late peak negative strain rate (SRa), were obtained from the LA strain curve. The LA strain and LA strain rate were impaired in both HHD group and HCM group, and they were the most severely impaired in the HOCM group. εs (AUC = 0.691, P = 0.006; the best cutoff value, 25.1%), εa (AUC = 0.654, P = 0.027; the best cutoff value, 10.5%), SRs (AUC = 0.710, P = 0.003; the best cutoff value, 0.81 1/s) and SRa (AUC = 0.667, P = 0.016; the best cutoff value, -1.30 1/s) showed significant differences in the identification between HHD and HNCM. All LA strain parameters were different in the identification between HHD and HOCM (all P < 0.05).LA strain parameters can be helpful for differentiating HHD from HCM, providing valuable insights for diagnosis.
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Affiliation(s)
- Huimin Xu
- Department of Radiology, Research Center of Clinical Medical Imaging, The First Affiliated Hospital of Anhui Medical University, Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China
| | - Wei Deng
- Department of Radiology, Research Center of Clinical Medical Imaging, The First Affiliated Hospital of Anhui Medical University, Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China
| | - Zixiang Pan
- Department of Radiology, Research Center of Clinical Medical Imaging, The First Affiliated Hospital of Anhui Medical University, Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China
| | - Kaixuan Yao
- Department of Radiology, Research Center of Clinical Medical Imaging, The First Affiliated Hospital of Anhui Medical University, Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China
| | - Jinxiu Yang
- Department of Radiology, Research Center of Clinical Medical Imaging, The First Affiliated Hospital of Anhui Medical University, Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China
| | - Zhen Wang
- Department of Radiology, Research Center of Clinical Medical Imaging, The First Affiliated Hospital of Anhui Medical University, Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China
| | - Hui Gao
- Department of Radiology, Research Center of Clinical Medical Imaging, The First Affiliated Hospital of Anhui Medical University, Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China
| | - Hongmin Shu
- Department of Radiology, Research Center of Clinical Medical Imaging, The First Affiliated Hospital of Anhui Medical University, Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China
| | - Ren Zhao
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui Province, China.
| | - Yongqiang Yu
- Department of Radiology, Research Center of Clinical Medical Imaging, The First Affiliated Hospital of Anhui Medical University, Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China.
| | - Yuchi Han
- Cardiovascular Division, Wexner Medical Center, College of Medicine, The Ohio State University Medical Center, Columbus, OH, USA
| | - Xiaohu Li
- Department of Radiology, Research Center of Clinical Medical Imaging, The First Affiliated Hospital of Anhui Medical University, Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China.
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Bawornthip P, Driscoll A, Khaw D, Hutchinson A. Effectiveness of Health Promotion Programs on Blood Pressure in People With Hypertension and Prehypertension in Southeast Asian Populations: Systematic Review and Meta-Analysis. Nurs Open 2025; 12:e70252. [PMID: 40525605 DOI: 10.1002/nop2.70252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Revised: 04/24/2025] [Accepted: 05/23/2025] [Indexed: 06/19/2025] Open
Abstract
AIM To evaluate health promotion programmes for managing hypertension in Southeast Asia. DESIGN Systematic review and meta-analysis. METHODS A systematic search was conducted across five databases: MEDLINE, APA PsycInfo, Scopus, Web of Science, and CINAHL, covering studies conducted in Southeast Asia and published in English from January 2003 to December 2023. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the protocol was registered in PROSPERO. Eligibility criteria included adults aged 18 years and older with prehypertension or hypertension, evaluating health promotion programmes focusing on exercise intervention, dietary modification, and health education compared with usual care. RESULTS Eleven of the twenty-six studies were included in meta-analyses and showed a statistically significant effect of the interventions on blood pressure. Two studies of dietary interventions demonstrated decreased systolic blood pressure with a pooled mean difference of 8.32 mmHg (95% CI -11.29, -5.34, p ≤ 0.001). Four studies of endurance exercise reduced systolic blood pressure with a pooled mean difference of 15.95 mmHg (95% CI -19.45, -12.46, p < 0.001). Two studies of combined diet and exercise with intensive coaching decreased systolic blood pressure with a pooled mean difference of 6.41 mmHg (95% CI -7.49, -5.33, p < 0.001). Two studies of health education show a clinically significant decrease in systolic blood pressure by 5-18 mmHg. PATIENT OR PUBLIC CONTRIBUTION Health promotion interventions are feasible and acceptable in Southeast Asian populations and significantly reduce blood pressure, particularly systolic blood pressure. Consuming a healthy diet such as the Dietary Approaches to Stop Hypertension Diet (DASH), restricting sodium, and increasing potassium intake is feasible and effective in the Southeast Asian context. To optimise impacts on blood pressure control, endurance exercise interventions should adhere to established exercise principles. Health education programs should incorporate effective coaching strategies to enhance their impact.
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Affiliation(s)
- Pataporn Bawornthip
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Center for Quality and Patient Safety Research - Epworth HealthCare Partnership, Deakin University, Geelong, Victoria, Australia
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Andrea Driscoll
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Center for Quality and Patient Safety Research - Monash Health Partnership, Melbourne, Victoria, Australia
| | - Damien Khaw
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Anastasia Hutchinson
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Center for Quality and Patient Safety Research - Epworth HealthCare Partnership, Deakin University, Geelong, Victoria, Australia
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Zou Q, Qiu T, Liang C, Wang F, Zheng Y, Li J, Li X, Li Y, Lu Z, Ming B. Multimodal prediction of major adverse cardiovascular events in hypertensive patients with coronary artery disease: integrating pericoronary fat radiomics, CT-FFR, and clinicoradiological features. LA RADIOLOGIA MEDICA 2025; 130:767-781. [PMID: 40117103 PMCID: PMC12185633 DOI: 10.1007/s11547-025-01991-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 03/05/2025] [Indexed: 03/23/2025]
Abstract
PURPOSE People with both hypertension and coronary artery disease (CAD) are at a significantly increased risk of major adverse cardiovascular events (MACEs). This study aimed to develop and validate a combination model that integrates radiomics features of pericoronary adipose tissue (PCAT), CT-derived fractional flow reserve (CT-FFR), and clinicoradiological features, which improves MACE prediction within two years. MATERIALS AND METHODS Coronary-computed tomography angiography data were gathered from 237 patients diagnosed with hypertension and CAD. These patients were randomly categorized into training and testing cohorts at a 7:3 ratio (165:72). The least absolute shrinkage and selection operator logistic regression and linear discriminant analysis method were used to select optimal radiomics characteristics. The predictive performance of the combination model was assessed through receiver operating characteristic curve analysis and validated via calibration, decision, and clinical impact curves. RESULTS The results reveal that the combination model (Radiomics. CLINICAL Imaging) improves the discriminatory ability for predicting MACE. Its predictive efficacy is comparable to that of the Radiomics.Imaging model in both the training (0.886 vs. 0.872) and testing cohorts (0.786 vs. 0.815), but the combination model exhibits significantly improved specificity, accuracy, and precision. Decision and clinical impact curves further confirm the use of the combination prediction model in clinical practice. CONCLUSIONS The combination prediction model, which incorporates clinicoradiological features, CT-FFR, and radiomics features of PCAT, is a potential biomarker for predicting MACE in people with hypertension and CAD.
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Affiliation(s)
- Qing Zou
- Department of Radiology, Deyang People's Hospital, 173# Section 3 Tai Shan Road, Deyang, 618400, Sichuan, China.
| | - Taichun Qiu
- Department of Radiology, Deyang People's Hospital, 173# Section 3 Tai Shan Road, Deyang, 618400, Sichuan, China
| | - Chunxiao Liang
- Department of Radiology, Deyang People's Hospital, 173# Section 3 Tai Shan Road, Deyang, 618400, Sichuan, China
| | - Fang Wang
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, 200232, China
| | - Yongji Zheng
- Department of Radiology, Deyang People's Hospital, 173# Section 3 Tai Shan Road, Deyang, 618400, Sichuan, China
| | - Jie Li
- Department of Radiology, Deyang People's Hospital, 173# Section 3 Tai Shan Road, Deyang, 618400, Sichuan, China
| | - Xingchen Li
- Department of Radiology, Deyang People's Hospital, 173# Section 3 Tai Shan Road, Deyang, 618400, Sichuan, China
| | - Yudan Li
- Department of Radiology, Deyang People's Hospital, 173# Section 3 Tai Shan Road, Deyang, 618400, Sichuan, China
| | - Zhongyan Lu
- Department of Radiology, Deyang People's Hospital, 173# Section 3 Tai Shan Road, Deyang, 618400, Sichuan, China
| | - Bing Ming
- Department of Radiology, Deyang People's Hospital, 173# Section 3 Tai Shan Road, Deyang, 618400, Sichuan, China.
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Lopes A, Mastracci TM. Blood pressure monitoring is key in aortic dissection. THE JOURNAL OF CARDIOVASCULAR SURGERY 2025; 66:247-257. [PMID: 40433737 DOI: 10.23736/s0021-9509.25.13352-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2025]
Abstract
Blood pressure (BP) control is essential for both the prevention and long-term management of aortic dissection. While office BP monitoring remains the most widely used method, its limitations in detecting BP variability, masked hypertension, and nocturnal hypertension highlight the need for alternative approaches. Ambulatory BP monitoring and home BP monitoring offer superior prognostic value, enabling more precise BP assessment and treatment optimization. However, challenges such as accessibility, patient compliance, and integration into clinical workflows persist. Digital health solutions, including telemonitoring, artificial intelligence-driven analysis, and wearable BP monitoring devices, hold promise in overcoming these barriers and improving long-term BP control. As strict BP management remains central to reducing complications, emerging evidence suggests it may also contribute to favorable aortic remodeling, potentially altering disease progression. Leveraging these advancements could shift BP management in aortic dissection from risk mitigation to proactive disease modification, optimizing patient outcomes in both prevention and follow-up.
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Affiliation(s)
- Alice Lopes
- Heart and Vessels Division, Department of Vascular Surgery, Unidade Local de Saúde Santa Maria, Lisbon, Portugal -
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal -
| | - Tara M Mastracci
- St. Bartholomew's Hospital, London, UK
- Department of Surgical and Interventional Sciences, University College London, London, UK
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Poulter N. ACE Inhibitors and Angiotensin Receptor Blockers for the Prevention of Cardiovascular Outcomes: Recommendations from the 2024 Egyptian Cardiology Expert Consensus. Cardiol Ther 2025; 14:117-121. [PMID: 39964662 PMCID: PMC12084454 DOI: 10.1007/s40119-025-00399-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Accepted: 02/05/2025] [Indexed: 05/18/2025] Open
Affiliation(s)
- Neil Poulter
- Preventive Cardiovascular Medicine, Imperial Clinical Trials Unit [ICTU], Imperial College London, London, UK.
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Han F, Li W, Duan N, Hu X, Yao N, Yu G, Qu J. Relationship Between Salt Intake and Cardiovascular Disease. J Clin Hypertens (Greenwich) 2025; 27:e70078. [PMID: 40551557 PMCID: PMC12185907 DOI: 10.1111/jch.70078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2025] [Revised: 04/29/2025] [Accepted: 05/24/2025] [Indexed: 06/28/2025]
Abstract
Cardiovascular disease (CVD) is a predominant global health issue, with dietary salt intake recognized as a crucial modifiable risk factor. This review elucidates the multifaceted relationship between salt consumption and CVD, exploring both its direct and indirect effects. While early research emphasized salt's influence on blood pressure, contemporary studies highlight the combined effects of dietary habits and genetic factors on CVD risk. The paper underscores the complex biological mechanisms linking high salt intake to CVD, including its impact on blood pressure, direct cardiovascular effects, immune responses, the role of prostanoids, epigenetic changes, and gut microbiome. Additionally, the review delves into the concept of salt sensitivity and its genetic underpinnings, emphasizing the heightened CVD risk in salt-sensitive individuals. The potential benefits and challenges of salt substitutes are also discussed. Drawing from various study designs, including epidemiological studies and randomized controlled trials, the review provides a comprehensive understanding of the detrimental effects of excessive salt intake on cardiovascular health, emphasizing the need for refined dietary guidelines and targeted interventions.
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Affiliation(s)
- Fuzhou Han
- Department of General SurgeryAerospace Center HospitalBeijingChina
| | - Wenqiang Li
- Department of General SurgeryAerospace Center HospitalBeijingChina
| | - Ning Duan
- Department of General SurgeryAerospace Center HospitalBeijingChina
| | - Xinlong Hu
- Department of General SurgeryAerospace Center HospitalBeijingChina
| | - Nan Yao
- Department of General SurgeryAerospace Center HospitalBeijingChina
| | - Guoyong Yu
- Department of NephrologyBeijing University of Chinese Medicine Affiliated Dongzhimen HospitalBeijingChina
| | - Jun Qu
- Department of General SurgeryAerospace Center HospitalBeijingChina
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Chen YT, Cheng HM. 2024 ESC guidelines for managing high blood pressure: comparisons with other organizations' guidelines. Blood Press Monit 2025; 30:140-144. [PMID: 40327338 DOI: 10.1097/mbp.0000000000000745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2025]
Affiliation(s)
| | - Hao-Min Cheng
- Division of Faculty Development, Department of Medical Education
- Division of Evidence-based Medicine, Taipei Veterans General Hospital
- College of Medicine
- Institute of Public Health and Community Medicine Research Centre, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
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Coca A, Borghi C, Stergiou GS, Ly NF, Lee C, Tricotel A, Castelo-Branco A, Khan I, Blacher J, Abdel-Moneim M. Long-term event rates, risk factors, and treatment pattern in 1.4 million individuals qualifying for dual blood pressure lowering therapy. J Hypertens 2025; 43:993-1002. [PMID: 40099552 PMCID: PMC12052041 DOI: 10.1097/hjh.0000000000004002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 10/30/2024] [Accepted: 02/26/2025] [Indexed: 03/20/2025]
Abstract
OBJECTIVES We assessed rates of cardiovascular events, all-cause death, baseline risk factors, and treatment patterns in a population qualifying for initiation of dual combination blood pressure (BP)-lowering therapy. We also evaluated the association between dual versus monotherapy during follow-up and incidence of cardiovascular events. METHODS This study utilized integrated databases in England: Clinical Practice Research Datalink, Hospital Episode Statistics, and Office for National Statistics. Individuals aged at least 18 years qualifying for dual therapy were identified during 15-year period (2005-2019). The primary endpoint was composite of nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, and cardiovascular death. The secondary endpoint was all-cause death. RESULTS Total 1 426 079 individuals met selection criteria. The 15-year event rates for the primary and secondary endpoints were 27.1 and 32.6%, respectively. Atherosclerotic cardiovascular disease, diabetes on insulin therapy, heart failure, atrial fibrillation, chronic kidney disease, and advanced age were associated with two to four-fold higher risk of primary and secondary endpoints. The estimated hazard ratio for dual versus monotherapy as a time-varying covariate was 0.82 (95% confidence interval 0.81-0.83) for the primary endpoint. At variance with guidelines, monotherapy was most common treatment pattern over 5-year follow-up. CONCLUSION Baseline characteristics conveying a multifold higher risk for cardiovascular events and all-cause death mostly represented nonmodifiable risk factors. Treatment with dual therapy as compared to monotherapy was associated with reduction in cardiovascular events. Monotherapy remained most common BP-lowering treatment indicating substantial opportunity for risk reduction by treatment intensification.
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Affiliation(s)
- Antonio Coca
- School of Health and Life Sciences, Universitat Abat Oliba, CEU Universities, Barcelona, Spain
| | - Claudio Borghi
- Department of Medicine, Science and Surgery, University of Bologna, Bologna, Italy
| | - George S. Stergiou
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | | | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hôpital Hôtel-Dieu, AP-HP, Université Paris Cité, Paris, France
| | - Mohamed Abdel-Moneim
- Sanofi, Dubai
- Department of Family Medicine, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Armoundas AA, Ahmad FS, Attia ZI, Doudesis D, Khera R, Kyriakoulis KG, Stergiou GS, Tang WHW. Controversy in Hypertension: Pro-Side of the Argument Using Artificial Intelligence for Hypertension Diagnosis and Management. Hypertension 2025; 82:929-944. [PMID: 40091745 DOI: 10.1161/hypertensionaha.124.22349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2025]
Abstract
Hypertension presents the largest modifiable public health challenge due to its high prevalence, its intimate relationship to cardiovascular diseases, and its complex pathogenesis and pathophysiology. Low awareness of blood pressure elevation and suboptimal hypertension diagnosis serve as the major hurdles in effective hypertension management. Advances in artificial intelligence in hypertension have permitted the integrative analysis of large data sets including omics, clinical (with novel sensor and wearable technologies), health-related, social, behavioral, and environmental sources, and hold transformative potential in achieving large-scale, data-driven approaches toward personalized diagnosis, treatment, and long-term management. However, although the emerging artificial intelligence science may advance the concept of precision hypertension in discovery, drug targeting and development, patient care, and management, its clinical adoption at scale today is lacking. Recognizing that clinical implementation of artificial intelligence-based solutions need evidence generation, this opinion statement examines a clinician-centric perspective of the state-of-art in using artificial intelligence in the management of hypertension and puts forward recommendations toward equitable precision hypertension care.
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Affiliation(s)
- Antonis A Armoundas
- Cardiovascular Research Center, Massachusetts General Hospital and Broad Institute, Massachusetts Institute of Technology, Boston (A.A.A.)
| | - Faraz S Ahmad
- Division of Cardiology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (F.S.A.)
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Z.I.A.)
| | - Dimitrios Doudesis
- British Heart Foundation (BHF) Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (D.D.)
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine (R.K.)
- Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, CT (R.K.)
| | - Konstantinos G Kyriakoulis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Athens, Greece (K.G.K., G.S.S.)
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Athens, Greece (K.G.K., G.S.S.)
| | - W H Wilson Tang
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH (W.H.W.T.)
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Barrett RB, Riesser B, Martin B, Sachdev N, Rakotz MK, Sutherland SE, Egan BM. Treatment in the First Month After Hypertension Diagnosis Improves Blood Pressure Control. Hypertension 2025; 82:1129-1136. [PMID: 40255193 PMCID: PMC12071505 DOI: 10.1161/hypertensionaha.124.23508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 03/28/2025] [Indexed: 04/22/2025]
Abstract
BACKGROUND Adults with hypertension have fewer cardiovascular events if controlled within the first 6 months of diagnosis, during which time they are excluded from many hypertension control metrics. We compared blood pressure (BP, mm Hg) control rates from 6 to 42 months in adults with hypertension who did or did not have antihypertensive treatment initiated (TI) with monotherapy during the first month after diagnosis, irrespective of subsequent changes in antihypertensive pharmacotherapy. METHODS A retrospective cohort of 15 422 patients, mean age 56.0±14.8 years, from 5 health care organizations, was identified with previously undiagnosed and untreated hypertension. BP control (<140/<90) and TI on visits with uncontrolled readings were assessed as a function of time since diagnosis, up to 42 months. Logistic regression models provided estimates of the odds of TI for initial BP, stratified by race, sex, and diagnosed diabetes. Cox proportional hazards regression estimated the hazard ratio of BP control over time. RESULTS Patients with TI during the first month versus later time points had better BP control at 6 (57.7% versus 47.8%, P<0.001) through 30 months (66.8% versus 62.2%, P<0.001), with similar control rates thereafter. CONCLUSIONS TI within the first month after diagnosis in contrast to later time points, leads to better BP control at 6 to 30 months, which is associated with better clinical outcomes and performance on standard hypertension control metrics. While better control is sustained for 30 months, treatment with monotherapy during the first month following diagnosis was insufficient to control hypertension in >30% of patients.
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Affiliation(s)
- Robert B. Barrett
- Improving Health Outcomes, American Medical Association, Greenville, SC (R.B.B., B.R., S.E.S., B.M.E.)
| | - Benjamin Riesser
- Improving Health Outcomes, American Medical Association, Greenville, SC (R.B.B., B.R., S.E.S., B.M.E.)
| | - Benjamin Martin
- Johns Hopkins University, School of Medicine, Baltimore, MD (B.M.)
| | - Neha Sachdev
- Improving Health Outcomes, American Medical Association, Chicago, IL (N.S., M.K.R.)
| | - Michael K. Rakotz
- Improving Health Outcomes, American Medical Association, Chicago, IL (N.S., M.K.R.)
| | - Susan E. Sutherland
- Improving Health Outcomes, American Medical Association, Greenville, SC (R.B.B., B.R., S.E.S., B.M.E.)
| | - Brent M. Egan
- Improving Health Outcomes, American Medical Association, Greenville, SC (R.B.B., B.R., S.E.S., B.M.E.)
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Crecca E, Di Giuseppe G, Camplone C, Vigiano Benedetti V, Melaiu O, Mezza T, Cencioni C, Spallotta F. The multifaceted role of agents counteracting metabolic syndrome: A new hope for gastrointestinal cancer therapy. Pharmacol Ther 2025; 270:108847. [PMID: 40216262 DOI: 10.1016/j.pharmthera.2025.108847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 01/27/2025] [Accepted: 04/03/2025] [Indexed: 04/24/2025]
Abstract
Metabolic syndrome (MetS) is defined by the presence of at least three of five clinical parameters including abdominal obesity, insulin resistance, elevated triglycerides, reduced high-density lipoprotein (HDL) and hypertension. Major features describing MetS have been recognized risk factors for cancer onset, with an alarming impact on gastrointestinal (GI) tumors. Intriguingly, therapeutic administration of drugs to improve glycemic control and dyslipidemia (including metformin, statins) has been shown to have a preventive role in the development and in prognosis improvement of several cancer types. Overall, these observations highlight the key role of altered metabolism prevalently in cancer risk development and unveil anti-MetS agent repurposing potential beyond their conventional pharmacological action. The objective of this review is to summarize the current knowledge about the antitumor activity of anti-diabetic and anti-lipemic agents in GI cancer onset and progression. Here, pre-clinical evidence of their therapeutic potential and of their integration in novel compelling therapeutic strategies will be discussed. Possible clinical outcomes of these novel therapeutic combined protocols specifically dedicated to GI cancer patients will be put under the spotlight. In the future, these novel therapeutic options should be considered to improve conventional chemotherapy response and prognosis of this group of patients.
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Affiliation(s)
- Elena Crecca
- Institute of System Analysis and Informatics "Antonio Ruberti", National Research Council (IASI-CNR), 00185 Rome, Italy
| | - Gianfranco Di Giuseppe
- Endocrinology and Diabetology Unit, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy; Department of Translational Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Claudia Camplone
- Department of Biology and Biotechnologies "Charles Darwin", Sapienza University, 00185 Rome, Italy; Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University, 00185 Rome, Italy
| | | | - Ombretta Melaiu
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Teresa Mezza
- Department of Translational Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy; Pancreas Unit, CEMAD Digestive Diseases Center, Internal Medicine and Gastroenterology Unit, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Chiara Cencioni
- Institute of System Analysis and Informatics "Antonio Ruberti", National Research Council (IASI-CNR), 00185 Rome, Italy.
| | - Francesco Spallotta
- Department of Biology and Biotechnologies "Charles Darwin", Sapienza University, 00185 Rome, Italy; Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University, 00185 Rome, Italy.
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Koraćević G, Stojanović M, Zdravković M, Janković Tomasević R, Ćirić Zdravković S, Božinović N, Cvetković P, Pavlović M, Pavlović D. Time to reconsider the way of selecting antihypertensives for hypertensive left ventricular hypertrophy. Expert Opin Pharmacother 2025; 26:1071-1077. [PMID: 40377910 DOI: 10.1080/14656566.2025.2508282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2025] [Accepted: 05/15/2025] [Indexed: 05/18/2025]
Abstract
INTRODUCTION Hypertensive left ventricular hypertrophy (HTN LVH) is a highly prevalent high-risk condition, and the recommendations for HTN LVH treatment are essentially unchanged for several decades. AREAS COVERED The current therapeutic approach to HTN LVH is to choose antihypertensive drugs according to their ability to reverse left ventricular (LV) remodeling. On the other hand, for the majority arterial hypertension (HTN) patients we should start treatment with a combination of different antihypertensive drugs. Therefore, the goal of antihypertensive treatment of HTN LVH should be adapted to the current recommendation in other parts of guidelines. The recommendation we need is not only which individual drug, but rather which combination of two antihypertensive agents is optimal for reversed LV remodeling. EXPERT OPINION In this paper, we pointed out that treatment recommendation for HTN LVH can be updated in a similar way as therapy for the whole HTN population - by recommending a combination of two or three antihypertensives in a single pill. Clinicians should be directly advised what is the first- and what the second-line combination of antihypertensives for HTN LVH in evidence-based medicine. Therefore, we suggest that combination treatment should be studied, compared and then recommended also for very prevalent higher-risk HTN LVH patients.
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Affiliation(s)
- Goran Koraćević
- Department of Cardiology, University Clinical Center Niš, Niš, Serbia
- Faculty of Medicine, University of Niš, Niš, Serbia
| | - Milovan Stojanović
- Faculty of Medicine, University of Niš, Niš, Serbia
- Department for Cardiovascular Diseases, Institute for Treatment and Rehabilitation Niška Banja, Niš, Serbia
| | - Marija Zdravković
- Department for Cardiovascular Diseases, University Hospital Medical Center Bežanijska kosa, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Snežana Ćirić Zdravković
- Department of Cardiology, University Clinical Center Niš, Niš, Serbia
- Faculty of Medicine, University of Niš, Niš, Serbia
| | - Nenad Božinović
- Department of Cardiology, University Clinical Center Niš, Niš, Serbia
- Faculty of Medicine, University of Niš, Niš, Serbia
| | - Predrag Cvetković
- Department of Cardiology, University Clinical Center Niš, Niš, Serbia
| | - Milorad Pavlović
- Department for Thoracic Surgery, University Clinical Center Niš, Niš, Serbia
| | - Dimitrije Pavlović
- Faculty of Medicine, University of Niš, Niš, Serbia
- Department of Plastic and Reconstructive Surgery, Clinical Center Niš, Niš, Serbia
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Rucker-Joerg IE, Cardona-Muñoz EG, Padilla-Padilla FG, Suarez-Otero R, Romero-Antonio Y, Canales-Vázquez E, Rios-Brito KF, Rodríguez-Vazquez IC, González-Canudas J. Optimizing Blood Pressure Control: A Randomized Comparative Trial of Losartan/Chlorthalidone vs. Losartan/Hydrochlorothiazide. Cardiol Ther 2025; 14:231-247. [PMID: 40274695 PMCID: PMC12084478 DOI: 10.1007/s40119-025-00407-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Accepted: 03/28/2025] [Indexed: 04/26/2025] Open
Abstract
INTRODUCTION Cardiovascular diseases are a leading cause of global mortality, with hypertension as a major risk factor. Low control rates are often attributed to monotherapy, while evidence and clinical guidelines support the effectiveness of combination therapies. This study aimed to evaluate blood pressure changes and the achievement of target levels in patients treated with losartan/chlorthalidone (L/C) compared to losartan/hydrochlorothiazide (L/H). METHODS A randomized, double-blind, prospective, multicenter clinical trial was conducted. Patients were assigned to one of two treatment groups, starting with a lower dose (50/12.5 mg of losartan/chlorthalidone or losartan/hydrochlorothiazide). Blood pressure was evaluated at 30 days, and patients not meeting therapeutic goals were escalated to a higher dose (100/50 mg of losartan/chlorthalidone or losartan/hydrochlorothiazide) and followed until the study end (60 days). RESULTS The study recruited 163 patients (83 for losartan/chlorthalidone [L/C] group and 80 for the losartan/hydrochlorothiazide [L/H] group), with a mean age of 53.1 years. Both treatment groups demonstrated significant reductions in systolic and diastolic blood pressure, with L/C achieving an average reduction in systolic blood pressure (SBP) of - 24.6 mmHg and - 13.3 mmHg for diastolic blood pressure (DBP), while L/H had reductions of - 25.3-mmHg and - 11.5 mmHg, respectively. The L/C group exhibited a higher likelihood of achieving blood pressure goals compared to the L/H. Adverse events were comparable between groups and were mostly mild. CONCLUSIONS The study showed that both combinations are effective for hypertension, with losartan/chlorthalidone demonstrating greater efficacy in reducing diastolic blood pressure and achieving target levels. Both treatments exhibited similar and favorable safety profiles. CLINICAL TRIALS REGISTRATION NCT04927299. Registered August 6, 2021- https://clinicaltrials.gov/study/NCT04927299.
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Affiliation(s)
- Isabel E Rucker-Joerg
- Clinical Research Institute, Blvrd. Manuel Avila Camacho #1994, San Lucas Tepetlacalco, Tlalnepantla, Estado de Mexico, Mexico
| | - Ernesto G Cardona-Muñoz
- Private Practice, Hidalgo 1750 Second Floor, Ladrón de Guevara, Guadalajara, Jalisco, Mexico
| | | | - Rodrigo Suarez-Otero
- Private Practice, Nicolas Bravo Sur #712, Colonia Universidad, Toluca, Estado de Mexico, Mexico
| | - Yulia Romero-Antonio
- Laboratorios Silanes, S.A. de C.V., Av. De las Palmas No. 340, 3th Floor, Lomas de Chapultepec, Miguel Hidalgo, 11000, Mexico City, Mexico
| | - Emmanuel Canales-Vázquez
- Laboratorios Silanes, S.A. de C.V., Av. De las Palmas No. 340, 3th Floor, Lomas de Chapultepec, Miguel Hidalgo, 11000, Mexico City, Mexico
| | - Kevin F Rios-Brito
- Laboratorios Silanes, S.A. de C.V., Av. De las Palmas No. 340, 3th Floor, Lomas de Chapultepec, Miguel Hidalgo, 11000, Mexico City, Mexico
| | - Ileana C Rodríguez-Vazquez
- Laboratorios Silanes, S.A. de C.V., Av. De las Palmas No. 340, 3th Floor, Lomas de Chapultepec, Miguel Hidalgo, 11000, Mexico City, Mexico
| | - Jorge González-Canudas
- Laboratorios Silanes, S.A. de C.V., Av. De las Palmas No. 340, 3th Floor, Lomas de Chapultepec, Miguel Hidalgo, 11000, Mexico City, Mexico.
- IMSS-Centro Médico Nacional Siglo XXI, Av. Cuauhtemoc 330, Doctores, Cuauhtemoc, Mexico City, México.
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Creinin MD, Foidart JM, Gemzell-Danielsson K, Flerin NC, Kubba A, Gaspard U, Douxfils J. Estetrol/Drospirenone safety in a population with cardiovascular risk factors. Contraception 2025; 146:110861. [PMID: 40024362 DOI: 10.1016/j.contraception.2025.110861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 02/04/2025] [Accepted: 02/25/2025] [Indexed: 03/04/2025]
Abstract
OBJECTIVES To evaluate cardiovascular safety outcomes in estetrol 15 mg/drospirenone 3 mg users with cardiovascular risk factors. STUDY DESIGN We performed a secondary analysis of two open-label contraceptive phase-3 trials that enrolled participants 16 to 50 years to use estetrol/drospirenone for up to 13 cycles. Study exclusion criteria included >35 years and smoking, body mass index >35 kg/m2, and baseline blood pressure (BP) >140/90 mmHg. We compared adverse event rates in participants with and without cardiovascular risk factors and assessed discontinuation rates for cardiovascular adverse events. RESULTS Of 3417 participants, 1410 (41.3%) had one or more, and 309 (9.0%) had two or more cardiovascular risk factors. We found no difference in discontinuation for any adverse events in participants with and without cardiovascular risk factors. Six (0.18%) participants discontinued for a cardiovascular complaint including four with risk factors: three (0.09%) due to hypertension (all had baseline BP ≥130/85 mmHg and one or more additional risk factors) and one due to venous thrombosis (BP ≥130/85 mmHg). Of 375 participants with baseline BP ≥130/85 mmHg, 0.8% (95% CI 0%-1.7%) discontinued for hypertension while among the 192 participants with baseline BP ≥130/85 mmHg and one or more additional cardiovascular risk factors, 1.6% (95% CI 0%-3.3%) discontinued for hypertension. CONCLUSIONS Among >1400 study participants with cardiovascular risk factors using estetrol/drospirenone, only three (0.2%) discontinued for hypertension, all of whom had high-normal baseline BP and at least one other risk cardiovascular risk factor. IMPLICATIONS Estetrol/drospirenone use demonstrates excellent cardiovascular tolerance in study participants with normal and high-normal blood pressure, even in those with cardiovascular risk factors. The very low rate of hypertension, even when cardiovascular risk factors were present, provides evidence to warrant clinical trials of estetrol/drospirenone in patients with hypertension desiring contraception.
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Affiliation(s)
- Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States.
| | - Jean Michel Foidart
- Department of Obstetrics and Gynecology, University of Liège, Liège, Belgium; Estetra SRL, a wholly owned subsidiary of Gedeon Richter PLC, Liège, Belgium
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Nina C Flerin
- Estetra SRL, a wholly owned subsidiary of Gedeon Richter PLC, Liège, Belgium
| | - Ali Kubba
- Department of Gynecological Oncology, Guy's Hospital, London, UK
| | - Ulysse Gaspard
- Department of Obstetrics and Gynecology, University of Liège, Liège, Belgium; Estetra SRL, a wholly owned subsidiary of Gedeon Richter PLC, Liège, Belgium
| | - Jonathan Douxfils
- Research Unit in Clinical Pharmacology and Toxicology (URPC), NAmur Research Institute for LIfe Sciences (NARILIS), Faculty of Medicine, University of Namur, Namur, Belgium; QUALIresearch, Qualiblood s.a, Liège, Belgium; Department of Biological Hematology, Centre Hospitalier Universitaire Clermont-Ferrand, Hôpital Estaing, Clermont-Ferrand, France
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