Inflammatory residual risk. An emerging target to reduce cardiovascular disease

Cardiovascular Residual Risk and Cardiovascular Preventio

ARB-based combination therapy for the clinical management of hypertension and hypertension-related comorbidities: a spotlight on their use in COVID-19 patients

Essential hypertension is the most common cardiovascular (CV) risk factor, being primarily involved in the pathogenesis of CV disease and mortality worldwide. Given the high prevalence and growing incidence of this clinical condition in the general population in both high and low-income countries, antihypertensive drug therapies are frequently prescribed in different hypertension-related CV diseases and comorbidities. Among these conditions, evidence are available demonstrating the clinical benefits of lowering blood pressure (BP) levels, particularly in those hypertensive patients at high or very high CV risk profile. Preliminary studies, performed during the Sars-COVID-19 epidemic, raised some concerns on the potential implication of hypertension and antihypertensive medications in the susceptibility of having severe pneumonia, particularly with regard to the use of drugs inhibiting the renin-angiotensin system (RAS), including angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These hypotheses were not confirmed by subsequent studies, which independently and systematically demonstrated no clinical harm of these drugs also in patients with Sars-COVID-19 infection. The aim of this narrative review is to critically discuss the available evidence supporting the use of antihypertensive therapies based RAS blocking agents in hypertensive patients with different CV risk profile and with additional clinical conditions or comorbidities, including Sars-COVID-19 infection, with a particular focus on single-pill combination therapies based on olmesartan medoxomil

Blood Pressure Target Achievement Under Monotheraphy. A Real-Life Appraisal

Introduction: Despite hypertension guidelines suggest that the most effective treatment strategy to improve blood pressure (BP) target achievement is to implement the use of combination treatment, monotherapy is still widely used in the clinical practice of hypertension. Aim: To investigate BP control under monotherapy in the setting of real-life. Methods: We extracted data from a medical database of adult outpatients who were referred to the Hypertension Unit, Sant'Andrea Hospital, Rome (IT), including anthropometric data, CV risk factors and comorbidities, presence or absence of antihypertensive therapy and concomitant medications. Among treated hypertensive patients, we identified only those under single antihypertensive agent (monotherapy). Office BP treatment targets were defined according to 2018 ESC/ESH guidelines as: (a) < 130/80 mmHg in individuals aged 18-65 years; (b) < 140/80 mmHg in those aged > 65 years. Results: From an overall sample of 7797 records we selected 1578 (20.2%) hypertensive outpatients (47.3% female, age 59.5 ± 13.6 years, BMI 26.6 ± 4.4 kg/m2) treated with monotherapies, among whom 30.5% received ACE inhibitors, 37.7% ARBs, 15.8% beta-blockers, 10.6% CCBs, 3.0% diuretics, and 2.0% alpha-blockers. 36.6% of these patients reached the conventional clinic BP goal of < 140/90 mmHg, whilst the 2018 European guidelines BP treatment targets were fulfilled only in 14.0%. In particular, 10.2% patients aged 18-65 years and 20.4% of those aged > 65 years achieved the recommended BP goals. All these proportions results significantly lower than those achieved with dual (18.2%) or triple (22.2%) combination therapy, though higher than those obtained with life-style changes (10.8%). Proportions of patients on monotherapies with normal home and 24-h BP levels were 22.0% and 30.2%, respectively, though only 5.2% and 7.3% of these patients achieved sustained BP control, respectively. Ageing and dyslipidaemia showed significant and independent positive predictive value for the achievement of the recommended BP treatment targets, whereas European SCORE resulted a negative and independent predictor in outpatients treated with monotherapies. Conclusions: Our data showed a persistent use of monotherapy in the clinical practice, though with unsatisfactory BP control, especially in light of the BP treatment targets suggested by the last hypertension guidelines

PULSE WAVE VELOCITY, IPERTENSIONE E LIVELLI DI ALDOSTERONE PLASMATICO

La pulse wave velocity (PWV) è un metodo semplice, riproducibile e non invasive per valutare la rigidità delle gradi arterie e può essere impiegato facilmente nella pratica. Dati presenti in letteratura evidenziano il ruolo di predittivo indipendente di mortalità e morbilità in pazienti affetti da ipertensione arteriosa. Diverse evidenze dimostrano altresi il ruolo pro fibrotico e proinfiammatorio dell’aldosterone a livello delle pareti vascolari, sebbene non sia ancora del tutto chiaro come i livelli di questo possano incidere clinicamente sul profilo di rigidità arteriosa. L’obiettivo del nostro studio è stato di valutare il profilo della PWV in pazienti ottenuto mediante metodo oscillometrico e valutarne la possibile correlazione la concentrazione plasmatica di aldosterone (PAC). I risultati mostrano come la PAC correli positivamente e in modo significativo con la PWV clinica (Pearson r: 0.241; P=0.003) e delle 24 ore (Pearson r: 0.260; P=0.009) oltre che con l’età vascolare, la pressione media clinica e delle 24 ore. Le attuali line guida riconoscono nella valutazione carotido femorale il gold standard per la misurazione della PWV, I nostri dati supportano l’importanza di ulteriori studi per valutare il possibile impiego nella pratica clinica della misurazione con metodo oscillometrico.Among different markers of vascular HMOD, pulse wave velocity (PWV) is a simple, non-invasive and reproducible tool for evaluate stiffness of large arteries, and thus, can be easily employed in the routine clinical practice. Data showed that PWV is an independent predictor of morbidity and mortality in patients with essential hypertension. Furthermore several studies performed in various populations demonstrated a significant pro-fibrotic and pro-inflammatory effect of aldosterone on vascular endothelium leading to arterial stiffness.The aim of the research was to analyse PWV profile obtained with a validated and simple oscillometric method in a population of hypertensive patients and evaluate potential correlation with plasma aldosterone levels and CV risk factors. In our study PAC resulted significantly and positively correlated with PWV at both clinic (Pearson r: 0.241; P=0.003) and 24-hour (Pearson r: 0.260; P=0.009) BP assessments, clinic Vascular Age, clinic and 24-hour systolic/diastolic BP levels, 24-hour central systolic and diastolic BP levels. Current Guidelines report carotid-femoral PW analysis as a gold standard for diagnosis of vascular HMOD but our data support the implementation in future studies investigating the role of oscillometric methods since the comfortable and non-invasive devices and relatively limited costs for the examination in a setting of clinical practice

Increased arterial stiffness and haemorrhagic transformation in ischaemic stroke after thrombolysis: A new marker of risk for cerebrovascular events and complications

Increased arterial stiffness is an independent risk factor for hemorrhagic transformation in ischemic stroke undergoing thrombolysis

Measuring central or peripheral blood pressure levels? That is the question in the modern clinical practice of Hypertension

Over the last decades, blood pressure (BP) levels have been measured at brachial level by conventional sphygmomanometers and, more recently, by validated and accurate automated devices. This method has been systematically applied in observational studies and in large randomized controlled clinical trials for both diagnostic and therapeutic purposes in the clinical management of essential hypertension. As an example, data from the Framingham cohort of individuals have demonstrated the strong and independent relationship between BP levels, mostly systolic, and increased risk of major cardiovascular outcomes, including myocardial infarction, stroke, renal disease, congestive heart failure and cardiovascular death [1]. Similar findings have been observed in various epidemiological surveys in almost all countries all over the world, including Italy [2]. On the other hand, pharmacological and non pharmacological interventions aimed at reducing high peripheral (brachial) BP levels have convincingly and independently demonstrated the beneficial effects of antihypertensive therapies in different clinical settings and across the whole spectrum of cardiovascular continuum. On the basis of these assumptions, current definition of hypertension has been founded on the assessment of peripheral BP levels, and therapeutic targets in hypertension have been set on clinic BP measurements, recorded at the brachial artery level. More recently, however, several other techniques for measuring BP in other conditions and different arteries have been progressively becoming available. These techniques provided additional BP data compared to conventional assessment. Indeed, innovative and comfortable devices for 24-h ambulatory BP monitoring, home BP measurement, intra-arterial or cuff-less assessment of beat-to-beat BP levels have made available for the clinical management of hypertensive outpatients and gradually adopted not only in randomized clinical trials, but also in real world practice of hypertension

Time trend analysis of hypertension prevalence, awareness, treatment and control in Italy. novel insights from recent national surveys in the general population

Systematic and periodic assessments of hypertension prevalence, awareness, treatment and control are available in various countries around the world. These reports have been used not only for epidemiological purposes, but mostly for planning educational and therapeutic interventions aimed at ameliorating the BP control rates and reducing the incidence of hypertension-related cardiovascular diseases at various levels or settings. Over the last few years, such analyses were made available also in Italy, thus confirming a high prevalence of hypertension in the general adult population, with relatively low rates of awareness and control. Among these surveys, the analysis provided by the National Institute of Health represents the first and most inclusive assessment of hypertension prevalence and control in the general population in our Countr

White-coat and masked hypertension and coronary artery disease. are they related or not?

Currently, high blood pressure (BP) may cover different hypertension phenotypes, including white coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT), all of which are characterized by substantially higher risk of cardiovascular (CV) events and mortality than normotension (NT) [1–5]. This has recently been reaffirmed by the latest sets of European guidelines [6], which emphasized the role of out-of-office BP assess- ment, such as 24-h ambulatory and home BP monitoring, to properly stratify apparently low-risk individuals with high- normal BP levels. The same guidelines also recommended that a search for hypertension-mediated organ damage or other risk factors and comorbidities should be performed in patients with WCHT or MHT, in view of the relative frequency of these risk factors and markers of organ damage in these hypertensive patients [6]. Despite this evidence, both WCHT and MHT are often undiagnosed or even untreated. Findings from large national databases or clinical studies have clearly demon- strated that both of these conditions are relatively common in the clinical practice of hypertension [7]. Other studies have also reported that, even in the presence of anti- hypertensive treatment, effective BP control is not achieved in patients with WCHT or MHT, with obvious and relevant consequences on the risk of developing major CV out- comes [8–10]

Predictive Role of High Blood Pressure for the Incidence of Metabolic Syndrome

Metabolic syndrome is a constellation of multiple con- comitant cardiovascular and metabolic factors, each one within the high-normal values. Factors considered for the definition of this condition include high levels of systolic/ diastolic blood pressure, fasting glucose, and waist cir- cumference and triglycerides, as well as low levels of low- density lipoprotein cholesterol levels. In the presence of at least three of these factors in the same individual, the diagnosis of metabolic syndrome can be considered, ac- cording to the diagnostic criteria proposed by current guidelines

Molecular and clinical implications of natriuretic peptides in aortic valve stenosis

Aortic valve stenosis (AS) is the most common heart valve disease in North America and Europe leading to an increased risk of heart failure and death. A multidisciplinary evaluation of symptoms, individual risk profile, echocardiographic parameters, biomarkers assessment is required for an appropriate clinical and therapeutic management of AS. The natriuretic peptides (NPs) represent an important biomarker for diagnostic, prognostic and therapeutic purposes in several cardiovascular diseases. The present review article provides an overview of the current knowledge on the role of NPs in the pathogenesis, diagnosis, risk stratification and potential therapeutic implications in AS. C-type natriuretic peptide (CNP) level is reduced in AS, favoring the formation of calcified aggregates and an increased expression of bone-related transcripts and proteins (Runx2, osteonectin, osteocalcin, alkaline phospahatase). Consistent results were obtained through the inhibition of the type A and B natriuretic peptide receptors (NPRA, NPRB) and of the proprotein convertase furin expression. Increased plasma B-type natriuretic peptide (BNP) level contributes to monitor the progression of AS and to identify patients who would most benefit from an early therapeutic intervention, such as surgical or transcatheter aortic valve replacement. Moreover, a risk stratification of AS patients that takes into account the NPs level has a major impact toward the occurrence of heart failure, syncope and sudden cardiac death. Finally, the development of novel therapeutic strategies, such as the neprilysin inhibition, may represent a suitable pharmacological approach for the treatment of AS. Due to the above mentioned multiple roles, NPs represent key players in AS development, management and treatment