Journal of Clinical Medicine

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10 pages, 256 KiB

Open AccessArticle

Pulse Wave Velocity and Blood Pressure Variability as Prognostic Indicators in Very Elderly Patients

by Alejandro de la Sierra, Cristina Sierra, Marcos Murillo, Tomasso F. Aiello, Aina Mateu and Pedro Almagro

J. Clin. Med. 2023, 12(4), 1510; https://doi.org/10.3390/jcm12041510 - 14 Feb 2023

Cited by 5 | Viewed by 1311

Abstract

There is scarce evidence for the prognostic importance of hemodynamic measures, such as blood pressure (BP), BP variability, and arterial stiffness, in the very elderly population with advanced chronic conditions. We aimed to evaluate the prognostic importance of 24 h BP, BP variability, [...] Read more.

There is scarce evidence for the prognostic importance of hemodynamic measures, such as blood pressure (BP), BP variability, and arterial stiffness, in the very elderly population with advanced chronic conditions. We aimed to evaluate the prognostic importance of 24 h BP, BP variability, and arterial stiffness in a cohort of very elderly patients admitted to the hospital due to a decompensated chronic disease. We studied 249 patients older than 80 (66% women; 60% congestive heart failure). Noninvasive 24 h monitoring was used to determine 24 h brachial and central BP, BP and heart rate variabilities, aortic pulse wave velocity, and BP variability ratios during admission. The primary outcome was 1-year mortality. Aortic pulse wave velocity (3.3 times for each SD increase) and BP variability ratio (31% for each SD increase) were associated with 1-year mortality, after adjustments for clinical confounders. Increased systolic BP variability (38% increase for each SD change) and reduced heart rate variability (32% increase for each SD change) also predicted 1-year mortality. In conclusion, increased aortic stiffness and BP and heart rate variabilities predict 1-year mortality in very elderly patients with decompensated chronic conditions. Measurements of such estimates could be useful in the prognostic evaluation of this specific population. Full article

(This article belongs to the Special Issue Hypertension and Cardiovascular Disease: Pathology, Clinical Advances and Current Management)

14 pages, 1208 KiB

Open AccessArticle

The Use of Aspirin Increases the Risk of Major Adverse Cardiac and Cerebrovascular Events in Hypertensive Patients with Obstructive Sleep Apnea for the Primary Prevention of Cardiovascular Disease: A Real-World Cohort Study

by Nanfang Li, Wen Wen, Xintian Cai, Qing Zhu, Junli Hu, Mulalibieke Heizhati, Yujuan Yuan, Lin Gan, Yujie Dang, Wenbo Yang, Jing Hong and Xiangyang Zhang

J. Clin. Med. 2022, 11(23), 7066; https://doi.org/10.3390/jcm11237066 - 29 Nov 2022

Cited by 6 | Viewed by 2839

Abstract

(1) Background: Hypertensive patients with obstructive sleep apnea (OSA) are at high risk for cardiovascular diseases (CVDs), and the utility of aspirin for primary cardiovascular prevention in this population remains uncertain. (2) Methods: In this retrospective cohort study using data from the Urumchi [...] Read more.

(1) Background: Hypertensive patients with obstructive sleep apnea (OSA) are at high risk for cardiovascular diseases (CVDs), and the utility of aspirin for primary cardiovascular prevention in this population remains uncertain. (2) Methods: In this retrospective cohort study using data from the Urumchi Hypertension Database (UHDATA), hypertensive patients older than 18 years old with a first-time diagnosis of OSA were divided into three groups depending on aspirin history. Major adverse cardiac and cerebrovascular events (MACCE) were the primary outcome. Secondary outcomes included MACCE components, ischemic events, cardiac events, cerebrovascular events, and gastrointestinal bleeding risk. The inverse probability of treatment weighting (IPTW) method was used to balance the confounding factors among the groups, and the Cox proportional hazards model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI). (3) Results: In persistent aspirin users, the risk of MACCE events (HR 2.11, 95%CI 1.23–3.63), ischemic events (HR 2.58, 95%CI 1.42–4.69), cerebrovascular events (HR 2.55, 95%CI 1.44–4.51), and non-fatal cerebral infarction (HR 3.14, 95%CI 1.69–5.84) was significantly elevated. (4) Conclusions: Continuous aspirin use increases the incidence of cardiovascular adverse events in hypertensive patients with OSA receiving aspirin for primary prevention of cardiovascular disease. Full article

(This article belongs to the Special Issue Hypertension and Cardiovascular Disease: Pathology, Clinical Advances and Current Management)

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13 pages, 1555 KiB

Open AccessArticle

Differences in Diagnosis and Management of Hypertensive Urgencies and Emergencies According to Italian Doctors from Different Departments Who Deal With Acute Increase in Blood Pressure—Data from Gear (Gestione Dell’emergenza e Urgenza in ARea Critica) Study

by Francesca Saladini, Costantino Mancusi, Fabio Bertacchini, Francesco Spannella, Alessandro Maloberti, Alessandra Giavarini, Martina Rosticci, Rosa Maria Bruno, Giacomo Pucci, Davide Grassi, Martino Pengo and Maria Lorenza Muiesan

J. Clin. Med. 2022, 11(11), 2986; https://doi.org/10.3390/jcm11112986 - 25 May 2022

Cited by 3 | Viewed by 2412

Abstract

Background: Diagnosis and treatment of hypertension emergency (HE) and urgency (HU) may vary according to the physicians involved and the setting of the treatment. The aim of this study was to investigate differences in management of HE and HU according to the work [...] Read more.

Background: Diagnosis and treatment of hypertension emergency (HE) and urgency (HU) may vary according to the physicians involved and the setting of the treatment. The aim of this study was to investigate differences in management of HE and HU according to the work setting of the physicians. Methods: The young investigators of the Italian Society of Hypertension developed a 23-item questionnaire spread by email invitation to the members of Italian Scientific societies involved in the field of emergency medicine and hypertension. Results: Six-hundred and sixty-five questionnaires were collected. No differences emerged for the correct definitions of HE and HU or for the investigation of possible drugs that may be responsible for an acute increase in BP. The techniques used to assess BP values (p < 0.004) and the sizes of cuffs available were different according to the setting. Cardiologists more frequently defined epistaxis (55.2% p = 0.012) and conjunctival hemorrhages (70.7%, p < 0.0001) as possible presentation of HE, and rarely considered dyspnea (67.2% p = 0.014) or chest pain (72.4%, p = 0.001). Intensive care (IC) unit doctors were more familiar with lung ultrasound (50% p = 0.004). With regard to therapy, cardiologists reported the lowest prescription of i.v. labetalol (39.6%, p = 0.003) and the highest of s.l. nifedipine (43.1% p < 0.001). After discharge, almost all categories of physicians required home BP assessment or referral to a general practitioner, whereas hypertensive center evaluation or ambulatory BP monitoring were less frequently suggested. Conclusion: Management and treatment of HE and HU may be different according to the doctor’s specialty. Educational initiatives should be done to standardize treatment protocols and to improve medical knowledge. Full article

(This article belongs to the Special Issue Hypertension and Cardiovascular Disease: Pathology, Clinical Advances and Current Management)

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11 pages, 405 KiB

Open AccessArticle

A Multimarker Model for Aberrant Cardiac Geometry after Preeclampsia

by Zenab Mohseni-Alsalhi, Sophie A. J. S. Laven, Emma B. N. J. Janssen, Anique L. Wagenaar, Sander M. J. van Kuijk, Marc E. A. Spaanderman and Chahinda Ghossein-Doha

J. Clin. Med. 2022, 11(7), 1900; https://doi.org/10.3390/jcm11071900 - 29 Mar 2022

Viewed by 1782

Abstract

One out of four women with a history of preeclampsia shows abnormal cardiac remodeling consistent with subclinical heart failure (HF) in the first decade postpartum. Since these women are susceptible for developing remote symptomatic HF, development of a model for aberrant cardiac geometry [...] Read more.

One out of four women with a history of preeclampsia shows abnormal cardiac remodeling consistent with subclinical heart failure (HF) in the first decade postpartum. Since these women are susceptible for developing remote symptomatic HF, development of a model for aberrant cardiac geometry as a first screening tool after delivery, is urgently needed. In this cross-sectional study, 752 preeclamptic women were included. Cardiovascular evaluation was conducted between six months and five years postpartum including cardiac ultrasound, systolic and diastolic blood pressure (SBP and DBP), plasma volume (PV) and biomarker assessment. We developed a multimarker model using uni- and multivariable linear regression and used the regression coefficients (RC) to develop a formula and estimate the aberrant cardiac remodeling in our population. Both SBP and PV were shown to be independently correlated with relative wall thickness (RWT) and left ventricular mass index (LVMi). C-reactive protein (CRP) and uric acid were independently correlated with RWT. Fibrinogen did not relate to either LVMi or RWT. This study displays markers of abnormal cardiac remodeling in former preeclamptic women, suggesting a combination of mechanical and biochemical factors that should be involved in worrisome chamber remodeling before clinical symptoms arise. Full article

(This article belongs to the Special Issue Hypertension and Cardiovascular Disease: Pathology, Clinical Advances and Current Management)

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15 pages, 4653 KiB

Open AccessArticle

Medication Adherence and Treatment-Resistant Hypertension in Newly Treated Hypertensive Patients in the United Arab Emirates

by Akshaya Srikanth Bhagavathula, Syed Mahboob Shah and Elhadi Husein Aburawi

J. Clin. Med. 2021, 10(21), 5036; https://doi.org/10.3390/jcm10215036 - 28 Oct 2021

Cited by 8 | Viewed by 3438

Abstract

(1) Background: The present study aimed to analyze medication adherence and its effect on blood pressure (BP) control and assess the prevalence of treatment-resistant hypertension (TRH) among newly treated hypertensive patients in the United Arab Emirates (UAE); (2) Methods: A retrospective chart review [...] Read more.

(1) Background: The present study aimed to analyze medication adherence and its effect on blood pressure (BP) control and assess the prevalence of treatment-resistant hypertension (TRH) among newly treated hypertensive patients in the United Arab Emirates (UAE); (2) Methods: A retrospective chart review was conducted to evaluate 5308 naïve hypertensive adults registered for the treatment across Abu Dhabi Health Services (SEHA) clinics in Abu Dhabi in 2017. After collecting data regarding basic details and BP measurements, patients were followed up for six months. Patients who did not reach BP targets despite taking three or more antihypertensive medications were defined as TRH; (3) Results: The overall adherence to antihypertensive treatment was 42%. At 6-month, a significant reduction in BP was observed in patients adherent to medications (systolic: −4.5 mm Hg and diastolic: −5.9 mm Hg) than those who were nonadherent to antihypertensive therapy (1.15 mm Hg and 3.59 mm Hg). Among 189 patients using three or more antihypertensive medications for six months, only 34% (n = 64) were adherent to the treatment, and only 13.7% (n = 26) reached the BP target. The prevalence of TRH was 20.1%; (4) Conclusions: Medication adherence and BP control among the participants were suboptimal. The study shows a high prevalence of TRH among newly treated hypertensives in the UAE. More extraordinary efforts toward improving adherence to antihypertensive therapy and more focus toward BP control and TRH are urgently needed. Full article

(This article belongs to the Special Issue Hypertension and Cardiovascular Disease: Pathology, Clinical Advances and Current Management)

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11 pages, 505 KiB

Open AccessArticle

Resting Heart Rate and Cardiovascular Outcomes during Intensive and Standard Blood Pressure Reduction: An Analysis from SPRINT Trial

by Piotr Sobieraj, Maciej Siński and Jacek Lewandowski

J. Clin. Med. 2021, 10(15), 3264; https://doi.org/10.3390/jcm10153264 - 24 Jul 2021

Cited by 10 | Viewed by 3223

Abstract

The association between elevated resting heart rate (RHR) as a cardiovascular risk factor and lowering of systolic blood pressure (SBP) to currently recommended values remain unknown. Systolic Blood Pressure Intervention Trial (SPRINT) data obtained from the NHLBI were used to describe the relationship [...] Read more.

The association between elevated resting heart rate (RHR) as a cardiovascular risk factor and lowering of systolic blood pressure (SBP) to currently recommended values remain unknown. Systolic Blood Pressure Intervention Trial (SPRINT) data obtained from the NHLBI were used to describe the relationship between RHR and SBP reduction to <120 mmHg compared to SBP reduction to <140 mmHg. The composite clinical endpoint (CE) was defined as myocardial infarction, acute coronary syndrome, decompensation of heart failure, stroke, or cardiovascular death. Increased RHR was associated with a higher CE risk compared with low RHR in both treatment arms. A more potent increase of risk for CE was observed in subjects who were allocated to the SBP < 120 mmHg treatment goal. A similar effect of intensive and standard blood pressure (BP) reduction (p for interaction, 0.826) was observed in subjects with RHR in the 5th quintile (hazard ratio, 0.78, with 95% confidence interval (CI), 0.55–1.11) and in other quintiles of baseline RHR (hazard ratio, 0.75, with 95% CI, 0.62–0.90). Lower in-trial than baseline RHR was associated with reduced CE risk (hazard ratio, 0.80, with 95% CI, 0.66–0.98). We concluded that elevated RHR remains an essential risk factor independent of SBP reduction. Full article

(This article belongs to the Special Issue Hypertension and Cardiovascular Disease: Pathology, Clinical Advances and Current Management)

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10 pages, 402 KiB

Open AccessArticle

Subclinical Cardiac Organ Damage in Patients with Moderate to Severe Psoriasis

by Anja Linde, Eva Gerdts, Kåre Steinar Tveit, Ester Kringeland and Helga Midtbø

J. Clin. Med. 2021, 10(11), 2440; https://doi.org/10.3390/jcm10112440 - 31 May 2021

Cited by 1 | Viewed by 2532

Abstract

We explored the association between subclinical cardiac organ damage (OD) with comorbidities and psoriasis severity in 53 psoriasis patients on infliximab treatment (age 47 ± 15 years, 30% women) and 99 controls without psoriasis (age 47 ± 11 years, 28% women). Cardiac OD [...] Read more.

We explored the association between subclinical cardiac organ damage (OD) with comorbidities and psoriasis severity in 53 psoriasis patients on infliximab treatment (age 47 ± 15 years, 30% women) and 99 controls without psoriasis (age 47 ± 11 years, 28% women). Cardiac OD was assessed by echocardiography as the presence of increased left ventricular (LV) relative wall thickness (RWT), LV hypertrophy or dilated left atrium. Psoriasis severity was graded using the psoriasis area and severity index (PASI). The prevalence of hypertension was 66% in psoriasis vs. 61% in controls (p = 0.54) and cardiac OD seen in 51 and 73%, respectively (p = 0.007). Psoriasis was associated with a lower prevalence of cardiac OD (odds ratio (OR) 0.32, 95% confidence interval (CI) 0.13–0.77, p = 0.01) independent of age, sex, smoking, body mass index, and hypertension. Among psoriasis patients, hypertension was associated with increased risk of subclinical cardiac OD (OR 6.88, 95% CI 1.32–35.98, p = 0.02) independent of age, sex, and body mass index. PASI at treatment initiation was associated with a higher RWT at follow-up, independent of sex, age, and hypertension (β 0.36, p = 0.006) while no association with current PASI was found. In conclusion, cardiac OD was less prevalent in psoriasis patients on infliximab treatment than controls. Hypertension was the major covariable for subclinical cardiac OD in psoriasis. Full article

(This article belongs to the Special Issue Hypertension and Cardiovascular Disease: Pathology, Clinical Advances and Current Management)

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12 pages, 838 KiB

Open AccessArticle

Sex-Specific Associations between Blood Pressure and Risk of Atrial Fibrillation Subtypes in the Tromsø Study

by Hilde Espnes, Jocasta Ball, Maja-Lisa Løchen, Tom Wilsgaard, Inger Njølstad, Ellisiv B. Mathiesen, Eva Gerdts and Ekaterina Sharashova

J. Clin. Med. 2021, 10(7), 1514; https://doi.org/10.3390/jcm10071514 - 5 Apr 2021

Cited by 8 | Viewed by 2741

Abstract

The aim of this study was to explore sex-specific associations between systolic blood pressure (SBP), hypertension, and the risk of incident atrial fibrillation (AF) subtypes, including paroxysmal, persistent, and permanent AF, in a general population. A total of 13,137 women and 11,667 men [...] Read more.

The aim of this study was to explore sex-specific associations between systolic blood pressure (SBP), hypertension, and the risk of incident atrial fibrillation (AF) subtypes, including paroxysmal, persistent, and permanent AF, in a general population. A total of 13,137 women and 11,667 men who participated in the fourth survey of the Tromsø Study (1994–1995) were followed up for incident AF until the end of 2016. Cox proportional hazards regression analysis was conducted using fractional polynomials for SBP to provide sex- and AF-subtype-specific hazard ratios (HRs) for SBP. An SBP of 120 mmHg was used as the reference. Models were adjusted for other cardiovascular risk factors. Over a mean follow-up of 17.6 ± 6.6 years, incident AF occurred in 914 (7.0%) women (501 with paroxysmal/persistent AF and 413 with permanent AF) and 1104 (9.5%) men (606 with paroxysmal/persistent AF and 498 with permanent AF). In women, an SBP of 180 mmHg was associated with an HR of 2.10 (95% confidence interval [CI] 1.60–2.76) for paroxysmal/persistent AF and an HR of 1.80 (95% CI 1.33–2.44) for permanent AF. In men, an SBP of 180 mmHg was associated with an HR of 1.90 (95% CI 1.46–2.46) for paroxysmal/persistent AF, while there was no association with the risk of permanent AF. In conclusion, increasing SBP was associated with an increased risk of both paroxysmal/persistent AF and permanent AF in women, but only paroxysmal/persistent AF in men. Our findings highlight the importance of sex-specific risk stratification and optimizing blood pressure management for the prevention of AF subtypes in clinical practice. Full article

(This article belongs to the Special Issue Hypertension and Cardiovascular Disease: Pathology, Clinical Advances and Current Management)

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13 pages, 628 KiB

Open AccessReview

From Structural to Functional Hypertension Mediated Target Organ Damage—A Long Way to Heart Failure with Preserved Ejection Fraction

by Costantino Mancusi, Maria Lembo, Maria Virginia Manzi, Christian Basile, Ilaria Fucile and Carmine Morisco

J. Clin. Med. 2022, 11(18), 5377; https://doi.org/10.3390/jcm11185377 - 13 Sep 2022

Cited by 9 | Viewed by 2298

Abstract

Arterial hypertension (AH) is a major risk factor for the development of heart failure (HF) which represents one of the leading causes of mortality and morbidity worldwide. The chronic hemodynamic overload induced by AH is responsible for different types of functional and morphological [...] Read more.

Arterial hypertension (AH) is a major risk factor for the development of heart failure (HF) which represents one of the leading causes of mortality and morbidity worldwide. The chronic hemodynamic overload induced by AH is responsible for different types of functional and morphological adaptation of the cardiovascular system, defined as hypertensive mediated target organ damage (HMOD), whose identification is of fundamental importance for diagnostic and prognostic purposes. Among HMODs, left ventricular hypertrophy (LVH), coronary microvascular dysfunction (CMVD), and subclinical systolic dysfunction have been shown to play a role in the pathogenesis of HF and represent promising therapeutic targets. Furthermore, LVH represents a strong predictor of cardiovascular events in hypertensive patients, influencing per se the development of CMVD and systolic dysfunction. Clinical evidence suggests considering LVH as a diagnostic marker for HF with preserved ejection fraction (HFpEF). Several studies have also shown that microalbuminuria, a parameter of abnormal renal function, is implicated in the development of HFpEF and in predicting the prognosis of patients with HF. The present review highlights recent evidence on the main HMOD, focusing in particular on LVH, CMD, subclinical systolic dysfunction, and microalbuminuria leading to HFpEF. Full article

(This article belongs to the Special Issue Hypertension and Cardiovascular Disease: Pathology, Clinical Advances and Current Management)

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12 pages, 2653 KiB

Open AccessReview

The Antihypertensive Effects and Safety of LCZ696 in Patients with Hypertension: A Systemic Review and Meta-Analysis of Randomized Controlled Trials

by Su-Kiat Chua, Wei-Ting Lai, Lung-Ching Chen and Huei-Fong Hung

J. Clin. Med. 2021, 10(13), 2824; https://doi.org/10.3390/jcm10132824 - 26 Jun 2021

Cited by 20 | Viewed by 2745

Abstract

Background: The management of hypertension remains suboptimal throughout the world. Methods: We performed a random-effects model meta-analysis of randomized controlled trials to determine the effectiveness and safety of sacubitril/valsartan (LCZ696) for the treatment of high arterial pressure. Relevant published articles from PubMed, Cochrane [...] Read more.

Background: The management of hypertension remains suboptimal throughout the world. Methods: We performed a random-effects model meta-analysis of randomized controlled trials to determine the effectiveness and safety of sacubitril/valsartan (LCZ696) for the treatment of high arterial pressure. Relevant published articles from PubMed, Cochrane base, and Medline were examined, and the last search date was December 2020. Only published randomized controlled trials and double-blind studies were selected for further analysis. The mean reductions in systolic blood pressure (msSBP) and diastolic blood pressure (msDBP) in the sitting position, as well as the mean reductions in ambulatory systolic blood pressure (maSBP) and ambulatory diastolic blood pressure (maDBP), were assumed as efficacy endpoints. Adverse events (AEs) were considered as safety outcomes. Results: Ten studies with a total of 5931patients were included for analysis. Compared with placebo, LCZ696 had a significant reduction in msSBP (weight mean difference (WMD) = −6.52 mmHg, 95% confidence interval (CI): −8.57 to −4.47; p < 0.001), msDBP (WMD = −3.32 mmHg, 95% CI: −4.57 to −2.07; p < 0.001), maSBP (WMD = −7.08 mmHg, 95% CI: −10.48 to −3.68; p < 0.001), maDBP (WMD = −3.57 mmHg, 95% CI: −5.71 to −1.44, p < 0.001). In subgroup analysis, only 200 mg and 400 mg LCZ696 showed a significant BP reduction. There was no difference in the AE rate between the LCZ696 and placebo groups (WMD = 1.02, 95% CI: 0.83 to 1.27, p = 0.54). Egger’s test revealed a potential publication bias for msSBP (p = 0.025), but no publication bias for other outcomes. Conclusion: LCZ696 may reduce blood pressure more efficaciously than traditional therapy in hypertensive patients without increasing adverse effects. Full article

(This article belongs to the Special Issue Hypertension and Cardiovascular Disease: Pathology, Clinical Advances and Current Management)

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Other

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17 pages, 2244 KiB

Open AccessSystematic Review

Acute Coronary Syndrome, Stroke, and Mortality after Community-Acquired Pneumonia: Systematic Review and Meta-Analysis

by Edinson Dante Meregildo-Rodriguez, Martha Genara Asmat-Rubio, Mayra Janett Rojas-Benites and Gustavo Adolfo Vásquez-Tirado

J. Clin. Med. 2023, 12(7), 2577; https://doi.org/10.3390/jcm12072577 - 29 Mar 2023

Cited by 5 | Viewed by 2150

Abstract

One-third of adult inpatients with community-acquired pneumonia (CAP) develop acute coronary syndrome (ACS), stroke, heart failure (HF), arrhythmias, or die. The evidence linking CAP to cardiovascular disease (CVD) events is contradictory. We aimed to systematically review the role of CAP as a CVD [...] Read more.

One-third of adult inpatients with community-acquired pneumonia (CAP) develop acute coronary syndrome (ACS), stroke, heart failure (HF), arrhythmias, or die. The evidence linking CAP to cardiovascular disease (CVD) events is contradictory. We aimed to systematically review the role of CAP as a CVD risk factor. We registered the protocol (CRD42022352910) and searched for six databases from inception to 31 December 2022. We included 13 observational studies, 276,109 participants, 18,298 first ACS events, 12,421 first stroke events, 119 arrhythmic events, 75 episodes of new onset or worsening HF, 3379 deaths, and 218 incident CVD events. CAP increased the odds of ACS (OR 3.02; 95% CI 1.88–4.86), stroke (OR 2.88; 95% CI 2.09–3.96), mortality (OR 3.22; 95% CI 2.42–4.27), and all CVD events (OR 3.37; 95% CI 2.51–4.53). Heterogeneity was significant (I² = 97%, p < 0.001). Subgroup analysis found differences according to the continent of origin of the study, the follow-up length, and the sample size (I² > 40.0%, p < 0.10). CAP is a significant risk factor for all major CVD events including ACS, stroke, and mortality. However, these findings should be taken with caution due to the substantial heterogeneity and the possible publication bias. Full article

(This article belongs to the Special Issue Hypertension and Cardiovascular Disease: Pathology, Clinical Advances and Current Management)

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