INTRODUCTION: Radiofrequency renal denervation (RF RDN) is a catheter-based therapy for uncontrolled hypertension. This model-based analysis examined the cost-effectiveness of RF RDN in Sweden. METHODS: Clinical events,...INTRODUCTION: Radiofrequency renal denervation (RF RDN) is a catheter-based therapy for uncontrolled hypertension. This model-based analysis examined the cost-effectiveness of RF RDN in Sweden. METHODS: Clinical events, costs, quality-adjusted life-years (QALYs) were projected over 10-year and lifetime horizons using a decision-analytic Markov model. Primary health states, included hypertension alone, myocardial infarction (MI), stroke, other symptomatic coronary heart disease (CHD), heart failure (HF), end-stage renal disease (ESRD), and death. Health state transitions were informed by multivariate risk equations. Clinical evidence from the SPYRAL HTN-ON MED trial informed the treatment effect modelled (-4.9 mmHg reduction in office systolic blood pressure (SBP) vs. sham). The base case was conducted from the Swedish healthcare payer perspective. The primary outcome was the incremental cost-effectiveness ratio (ICER),RF RDN vs. standard of care (SoC), evaluated against an assumed willingness-to-pay threshold of SEK 500,000 per QALY gained. Extensive sensitivity analyses were performed. RESULTS: At 10-years, the relative risks with RF RDN were 0.80 for stroke, 0.88 for MI, 0.89 for CHD, 0.72 for HF, 0.96 for ESRD, 0.86 for cardiovascular death and 0.93 for all-cause death. Over lifetime, RF RDN led to incremental costs of SEK 63,136 (total costs SEK 497,498 vs. SEK 434,362) and incremental QALY gain of 0.45 (14.79 vs. 14.34), yielding an ICER of SEK 139,280 per QALY gained. RF RDN was cost-effective across all scenarios and sensitivity analyses. CONCLUSION: Model projections suggest RF RDN to be a cost-effective therapy for uncontrolled including resistant hypertension in Sweden based on contemporary clinical evidence.
PURPOSE: The implementation of hypertension guidelines into the everyday practice of general practitioners (GPs) have an outmost importance to provide optimal care for patients. The aim of our study was, on the one hand...PURPOSE: The implementation of hypertension guidelines into the everyday practice of general practitioners (GPs) have an outmost importance to provide optimal care for patients. The aim of our study was, on the one hand to gain insight about the relationship between hypertension societies and GP societies, and on the other hand, to get feedback about the use of single pill combinations (SPC) in each country, as an indicator of guideline implementation. MATERIALS AND METHODS: The European Society of Hypertension (ESH) GP Nucleus initiated a survey containing 17 questions about the existence and number of national hypertension and GP societies, the relationship between them and with pharmacists and nurse associations, the authors of national guidelines and the availability of SPCs. The survey was sent to the national hypertension society representatives of ESH. Additionally, data about the number of SPCs sold yearly was also checked using IQVIA database. RESULTS: Responses were collected from 25 European countries. In most of the countries there is only one hypertension society (23/25) and one GP society (18/25), most of which having a relationship with each other (22/25). Of the countries with national hypertension guidelines most of them are written by the national hypertension society (45%) followed by the GP society (27%) or by public administration (27%). Two thirds of the national hypertension societies (16/25) have relationship with nurse societies and half of them (12/25) with pharmacists. In 65% (15/23) of the guidelines dual SPC therapy is recommended for treatment initiation however, marked differences are present in the number of yearly sold SPCs in different countries. CONCLUSIONS: National hypertension societies have remarkable impact on GPs for the management of hypertensive patients. However, improvement is needed in the collaboration with nurse and pharmacist societies and in some countries in the use of SPCs for hypertension therapy.
BACKGROUND: Evidence has linked blood pressure (BP) phenotypes with certain clinical, psychosocial, and occupational features, and characteristic BP variability. OBJECTIVE: We aimed to evaluate the value of a diagnostic...BACKGROUND: Evidence has linked blood pressure (BP) phenotypes with certain clinical, psychosocial, and occupational features, and characteristic BP variability. OBJECTIVE: We aimed to evaluate the value of a diagnostic score developed from these characteristics in predicting BP phenotypes, when used in a manner comparable to the application of out-of-office techniques. METHODS: Adult patients with no prior diagnosis of hypertension attending their office appointments, were prospectively enrolled. Their clinical, psychosocial, and occupational data were collected. 3-consecutive pre-appointment BP measurements, and BP variability with standing and the 6-minute walk test (6MWT) were obtained. All participants underwent 24-hour BP monitoring which was paired with office BP as the reference standard for BP phenotyping. Two scores were developed from the variables selected using linear regression analysis to differentiate between masked hypertension (MH) and normotension, and sustained hypertension (SH) and white coat hypertension (WCH). RESULTS: In total 212 participants completed the study. Among office-normotensives, a score of 7 (calculated from, variables (points): dyslipidemia (3), irritable bowel syndrome (IBS) (3), orthostatic increase in SBP >5 mmHg (1), SBP increase >10 after 6MWT (1), and BP ≥130/80 after 6MWT (3)) identified MH with 90% sensitivity, 86% specificity, 70% positive predictive value (PPV), and 96% negative predictive value (NPV). Conversely, among office-hypertensives, a score of 6 (male sex (2), no IBS (2), ≥3 metabolic syndrome criteria (3), obesity (3), standing BP ≥140/90 (3), BP ≥140/90 after 6MWT (1)) identified SH with 82% sensitivity, 78% specificity, 90% PPV, and 64% NPV. CONCLUSIONS: BP phenotypes correspond to distinct clinical phenotypes and can be predicted with acceptable sensitivity and specificity using BP phenotype scores. This novel approach to BP phenotyping provides an accessible addition, not a replacement, to available out-of-office techniques, particularly useful for screening for MH, and to support office diagnosis of SH when out-of-office measures are unavailable or not tolerated.
INTRODUCTION: To investigate the association between angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) and short-term prognosis in dialysis patients with hypertension admitted to intensive...INTRODUCTION: To investigate the association between angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) and short-term prognosis in dialysis patients with hypertension admitted to intensive care unit (ICU). METHODS: Patients with a diagnosis of hypertension and dialysis who received antihypertensive agents during hospitalisation were included. Based on whether treated with ACEI/ARB, patients were divided to ACEI/ARB group and non- ACEI/ARB group. In-hospital mortality and 30-day all-cause mortality were compared between the two groups in the overall participants and after propensity score matching. RESULTS: The study included 647 patients, among which 227 (34.70%) were treated with ACEI/ARB. Compared to the non-ACEI/ARB group, fewer patients in the ACEI/ARB group suffered from atrial fibrillation/flutter (17.2% vs 31.9%, < 0.001). The overall hospital mortality rate was 5.1%, and 9.0% of patients died during the 30-day follow-up period. ACEI/ARB group were with better clinical outcomes during hospitalisation (2.2% vs 6.7%, = 0.023) and after 30-day follow-up (5.3% vs 11.0%, = 0.016). ACEI/ARB treatment was independently associated with lower risk of hospital mortality (OR 0.24, 96% CI: 0.051 - 0.82, = 0.038) and 30-day mortality (HR 0.36, 95% CI:0.15-0.89, = 0.029) after adjusting confounding factors. After propensity score matching (PSM, 112 pairs), the ACEI/ARB group showed higher in-hospital (99.1% vs 91.1%, = 0.013) and 30-day (95.5% vs 88.4%, = 0.048) survival rates compared to the control group. ACEI/ARB was identified as an independent protector for 30-day mortality in the matched cohort (HR 0.33, 95% CI: 0.11-0.95, = 0.041). CONCLUSION: ACEI/ARB treatment showed a significant association with improved in-hospital and 30-day outcomes in dialysis patients with hypertension in the ICU.
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 mal...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. 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). 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). 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.
BACKGROUND: Heart failure (HF) is an increasing health problem globally. Profound sex-related differences have been observed regarding the cause, treatment, and prognosis of HF. AIM: To assess baseline predictors for ach...BACKGROUND: Heart failure (HF) is an increasing health problem globally. Profound sex-related differences have been observed regarding the cause, treatment, and prognosis of HF. AIM: To assess baseline predictors for achieving optimal medical treatment (OMT) and the prognostic importance of OMT for male and female patients who have attended a HF clinical program (HFCP). METHODS: OPTIHEART was a retrospective study that included 870 consecutive patients with left ventricular ejection fraction (LVEF)≤40% discharged from HFCP in 2018, 2019 or 2020 and followed in registers for a mean of 1083(SD 11.3) days. OMT was defined as receiving an angiotensin-converting-enzyme-inhibitor (ACEi), angiotensin-receptor blocker (ARB) or angiotensin-II-receptor blocker and nephrylisin-inhibitor (ARNI) AND a betablocker (BB) both in doses ≥ 50% of target doses. RESULTS: Achieving OMT was associated with male sex (OR: 2.05 95%CI 1.44-2.97; < 0.0001) independently of younger age, higher diastolic blood pressure (DBP), and lower creatinine. A lower rate of 5-point MACE was associated with achieved OMT (HR: 0.67 95%CI 0.50-0.90; = 0.007) independently of female sex (HR: 0.64 95%CI 0.48-0.84; = 0.002), younger age, never smoking and NYHA ≤ 2. The beneficial effect of OMT was insignificantly more pronounced in patients with male sex, older age, higher creatinine, lower DBP, and body mass index ≤25kg/m. CONCLUSION: OMT was more frequently achieved in patients with male sex independently of age, DBP, and creatinine. Achieving OMT was associated with less 5-point MACE independently of female sex, younger age, never smoking and NYHA ≤ 2.
PURPOSE: This study examined temporal trends in hypertension prevalence across China (2002-2019), analyzing age-, sex-, and region-specific disparities and identifying key risk factors. MATERIALS AND METHODS: A retrospec...PURPOSE: This study examined temporal trends in hypertension prevalence across China (2002-2019), analyzing age-, sex-, and region-specific disparities and identifying key risk factors. MATERIALS AND METHODS: A retrospective analysis was conducted using data from the China Chronic Disease and Risk Factor Surveillance (CCDRFS) program, involving 120,000 adults aged ≥18 years. Descriptive statistics were used to calculate prevalence rates, and multivariable logistic regression analyzed associations with age, sex, BMI, smoking, alcohol consumption, and physical inactivity. RESULTS: Hypertension prevalence increased significantly from 18.9% (2002) to 29.6% (2019) (P<0.001). The sharpest rise occurred among adults aged 18-44 years, tripling from 5.3% to 12.8%. By 2019, prevalence was higher in men (34.2%) than women (25.4%), with the western regions showing the highest rates (32.9%). Key risk factors included aging (OR=1.72), elevated BMI (OR=1.85), smoking (OR=1.32), alcohol use (OR=1.28), and physical inactivity (OR=1.18) (P<0.05 for all). CONCLUSIONS: Hypertension prevalence in China has surged over two decades, disproportionately affecting younger adults and men. Regional disparities and modifiable lifestyle factors underscore the urgency for tailored prevention strategies targeting high-risk populations. Future research should explore mechanisms driving these trends and optimize integrated interventions to curb this public health burden.
Naji Mansoor A, Choudhary V, Mohammad Nasser Z
… +11 more, Jain M, Dayanand Sharma D, Jaramillo Villegas M, Janarthanam S, Ayyan M, Ravindra Nimal S, Ahmad Cheema H, Ehsan M, Rehman MAU, Nashwan A, Dani SS
BACKGROUND: The optimum systolic blood pressure (BP) after endovascular thrombectomy for acute ischaemic stroke is uncertain. We aimed to perform an updated meta-analysis of randomised controlled trials (RCTs) to evaluat...BACKGROUND: The optimum systolic blood pressure (BP) after endovascular thrombectomy for acute ischaemic stroke is uncertain. We aimed to perform an updated meta-analysis of randomised controlled trials (RCTs) to evaluate the safety and efficacy of more intensive BP management compared to less intensive BP management. METHODS: We searched various electronic databases to retrieve relevant RCTs on the clinical effects of more intensive BP management after endovascular thrombectomy compared to the less intensive management. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes. RESULTS: Our meta-analysis included four RCTs with a total of 1560 patients. More intensive BP management (<140 mmHg) was associated with a statistically significant decrease in the number of patients showing functional independence (modified Rankin scale [mRS] score = 0-2) at 90 days (OR 0.69; CI = 0.51-0.94). Regarding 90-day mortality, our pooled results showed no statistically significant difference between the two groups (OR 1.21; CI = 0.89-1.65). There was no statistically significant difference between the two groups regarding the incidence of intracerebral haemorrhage (ICH) (OR 1.09; CI = 0.85-1.39) and the incidence of symptomatic intracerebral haemorrhage (sICH) (OR 1.11; CI = 0.75-1.65). CONCLUSION: According to our meta-analysis, the intensive BP lowering group decreased the number of patients showing functional independence at 90 days. We found no benefit of the intensive lowering of BP on mortality rates and incidence of ICH compared to the conservative BP management. Future large-scale trials should focus on other interventions to improve prognosis in these patients.
BackgroundIntradialytic hypotension (IDH) is the most prevalent complication during hemodialysis (HD) sessions, affecting 10% to 12% of patients. It is linked with temporary ischemic stress in vital organs, increasing pa...BackgroundIntradialytic hypotension (IDH) is the most prevalent complication during hemodialysis (HD) sessions, affecting 10% to 12% of patients. It is linked with temporary ischemic stress in vital organs, increasing patient mortality. Various definitions of IDH have been proposed, and a strong correlation has been found between patient outcomes and the absolute lowest systolic blood pressure. The most probable underlying pathophysiology of IDH involves a reduced effective blood volume and decreased plasma tonicity. Optimizing the dialysis prescription and interventions during and after the dialysis session is sometimes effective for reducing IDH risk.Aim and MethodThis review discusses the pathophysiology, prevention, and therapy of IDH updates. To achieve this aim, Scopus, EMBASE, PubMed, Google, and Google Scholar were searched for articles published in the last two decades using phrases and keywords.ConclusionIntradialytic pathophysiology is ambiguous and unclear. The evidence for the effectiveness of the known therapies and maneuvers is limited. Ideally, IDH prevention should be the target; however, IDH management is sometimes needed. Different obstacles require further clinical research.
OBJECTIVE: The optimal level of home blood pressure (HBP) for the prevention of cardiovascular complications is unknown. The Home Blood Pressure Intervention in the Community Trial (HomeBP, [NCT05858944]) is addressing t...OBJECTIVE: The optimal level of home blood pressure (HBP) for the prevention of cardiovascular complications is unknown. The Home Blood Pressure Intervention in the Community Trial (HomeBP, [NCT05858944]) is addressing this issue by randomising elderly hypertensive patients to standard or tight HBP control. METHODS AND ANALYSIS: HomeBP is an investigator-initiated randomised clinical trial with open design and blinded endpoint evaluation. Eligible patients of either sex, aged 60-80 years, having uncontrolled home hypertension (≥135/85 mm Hg) after medication for at least 2 weeks will be recruited nationwide in China at up to 200 community healthcare centres. After stratification for centre and the presence of office hypertension (≥140/90 mm Hg), 10,000 patients will be randomised in a 1:1 proportion to a target HBP of 125-134/75-84 mm Hg or <125/75 mm Hg and followed up for 4 years. The primary outcome is a composite of cardiovascular death, non-fatal myocardial infarction, coronary revascularisation, unstable angina pectoris or heart failure requiring hospitalisation, and non-fatal stroke. Follow-up visits are scheduled monthly for 3 months after randomisation and 3-monthly thereafter. Patients record HBP for 7 consecutive days before every visit. A unique feature of the trial is the information technology setup, allowing the secure and instantaneous flow of HBP and other data to the study coordinating centre, where a standardised HBP report is generated. Hypertension specialists at Ruijin Hospital, Shanghai and at local tertiary hospitals provide treatment recommendations, which are transmitted to the caregivers at the community centres, who then fine-tune the treatment recommendations in a shared decision process with the patients to meet the values and clinical needs of the patients. Currently, 2281 patients have been randomised with no between-group differences in the baseline characteristics. UNLABELLED: Trial registration number. URL: https://www.clinicaltrials.gov; Unique identifier: NCT05858944.
Chen B, Chen G, Jiang H
… +16 more, Sun Y, Chen J, Wang D, Chen M, Shi J, Peng Y, Cheng Y, Yang C, Ding Y, Su J, Liu M, Shen F, Qiu Y, Shen Y, Cao Q, Su J
PURPOSE: The accuracy of the Omron J760 electronic blood pressure (BP) monitor for upper arm BP measurement in the adult general population was validated following the AAMI/ESH/ISO (ISO 81060-2:2018) + Amd1:2020 protocol...PURPOSE: The accuracy of the Omron J760 electronic blood pressure (BP) monitor for upper arm BP measurement in the adult general population was validated following the AAMI/ESH/ISO (ISO 81060-2:2018) + Amd1:2020 protocol. We expect that this device can be used for home blood pressure monitoring, with its measurements serving as a clinical reference. METHODS: Subjects meeting the age, gender, BP, and cuff distribution criteria as specified by the AAMI/ESH/ISO (ISO 81060-2:2018) + Amd1:2020 were recruited. BP measurements were conducted using the same-arm sequential method. The test device cuff was suitable for arm circumferences ranging from 22.0 cm to 42.0 cm. RESULTS: Eighty-nine participants were initially recruited, 85 were evaluated after excluding 4 participants. The mean age of the participants was 48.5 ± 15.17 years. For validation criterion 1, the mean ± standard deviation (SD) of the differences between the test device and the reference BP measurements were 0.2 ± 5.74 mmHg for systolic BP and -0.9 ± 4.69 mmHg for diastolic BP. These results met the AAMI/ESH/ISO (ISO 81060-2:2018)+Amd1:2020 standard, which requires differences of ≤5 ± ≤8 mmHg. For validation criterion 2, the mean differences between the test device and the reference device were 0.2 ± 5.10 mmHg for systolic BP and -0.9 ± 4.30 mmHg for diastolic BP. This criterion was satisfied with criterion 2 of ≤6.95 mmHg for systolic BP and ≤6.88 mmHg for diastolic BP. CONCLUSION: The Omron J760 electronic BP monitor meets the requirements of the AAMI/ESH/ISO (ISO 81060-2:2018)+Amd 1:2020 validation standard.
PURPOSE: Ventricular-arterial coupling (VAC) is a crucial concept in cardiovascular physiology, representing the dynamic interaction between the left ventricle and the arterial system. This comprehensive literature revie...PURPOSE: Ventricular-arterial coupling (VAC) is a crucial concept in cardiovascular physiology, representing the dynamic interaction between the left ventricle and the arterial system. This comprehensive literature review explores the changes in VAC with ageing and various cardiovascular diseases (CVDs). MATERIALS AND METHODS: This literature review covers studies on changes in VAC with age and common CVDs, such as arterial hypertension, atrial fibrillation (AF) and heart failure with preserved and reduced ejection fraction and aortic stenosis (AS). The review discusses traditional measures of VAC, including arterial elastance (Ea) and ventricular elastance (Ees), as well as emerging parameters, such as global longitudinal strain (GLS) and pulse wave velocity (PWV). The review introduces the PWV/GLS ratio as a novel method for assessing VAC. RESULTS: With ageing, both Ea and Ees increase, while the Ea/Ees ratio remains relatively stable, reflecting balanced arterial and ventricular adaptations. Novel measures, such as PWV/GLS ratio, show greater impairment in older adults and provide a comprehensive evaluation of VAC. CONCLUSIONS: Ageing disrupts VAC through arterial stiffening and reduced heart function, often exacerbated by CVDs. Novel metrics like PWV/GLS may improve VAC assessment, helping clinicians manage age-related cardiovascular issues by identifying risks earlier and guiding treatment to support efficient heart-artery interaction.
OBJECTIVE: To determine the prevalence rate and risk factors for systemic arterial hypertension in infants with congenital heart diseases. METHODS: A retrospective cohort study of postoperative systemic arterial hyperten...OBJECTIVE: To determine the prevalence rate and risk factors for systemic arterial hypertension in infants with congenital heart diseases. METHODS: A retrospective cohort study of postoperative systemic arterial hypertension incidence in infants who underwent cardiac surgery was conducted. The primary diagnosis was retrieved. The general characteristics, surgical information, and blood pressure data at five periods were also collected. The five periods were at admission, 48 hours after cardiac surgery (postoperative), at discharge, at full-time, and at any time during hospitalisation. The risk factors for postoperative hypertension and hypertension at discharge were determined by multivariate logistic regression. RESULTS: This study enrolled 1205 eligible infants. The age and weight at surgery were 27.0 (13.0, 59.0) days and 3.53 ± 0.96 kg, respectively. The prevalence rates of postoperative hypertension and hypertension at discharge were 12.8 (10.9-14.7)% and 6.9 (5.5-8.3)%, respectively. The incidence of postoperative hypertension varies greatly across different types of congenital heart diseases. A low weight score, preoperative hypertension, patent ductus arteriosus, and coarctation of the aorta were risk factors for postoperative hypertension, whereas transposition of the great arteries grouped with pulmonary atresia, pulmonary stenosis, and total anomalous pulmonary venous connection was a protective factor. The ventricular septal defect was a risk factor for postoperative hypertension but not for hypertension at discharge. CONCLUSIONS: The incidence of postoperative systemic arterial hypertension is high in infants after cardiac surgery. The prevalence of hypertension decreased at discharge. Prospective long-term follow-up studies are needed to delineate the natural history of hypertension in high-risk children.
BACKGROUND: Resistant hypertension (RH) is linked to higher risks of cardiovascular events and there remains an unmet therapeutic need driven by pathophysiologic pathways unaddressed by guideline-recommended therapy. Whi...BACKGROUND: Resistant hypertension (RH) is linked to higher risks of cardiovascular events and there remains an unmet therapeutic need driven by pathophysiologic pathways unaddressed by guideline-recommended therapy. Whilst spironolactone is considered the preferred fourth-line therapy, its broad application is limited by its safety profile. Aprocitentan is a novel dual endothelin (ET) A and B receptors antagonist that has been recently approved by the FDA. OBJECTIVE: This review aims to summarise the available evidence on the discovery, pharmacokinetic, pharmacodynamic, efficacy, and safety of aprocitentan in the pharmacotherapy of RH. METHODS: We searched PubMed, Embase, and International Pharmaceutical Abstracts to identify relevant papers on aprocitentan use. Clinical trial registries were also searched. RESULTS: Aprocitentan targets the ET pathway which remains unopposed by contemporary alternative therapies for RH. It differs from other ET receptor antagonists in its pharmacological profile, as it is eliminated independently of CYP450 or BCRP, making it less likely to cause drug-drug interactions. Current evidence demonstrates that compared to placebo, aprocitentan significantly reduces blood pressure (BP) as measured unattended automated office BP and 24-hour ambulatory BP. The most frequently reported adverse effects were fluid retention/edema and anaemia. CONCLUSION: Aprocitentan is a novel therapy for the management of RH that significantly reduces BP when compared to placebo. It delivers exciting prospects for future therapeutic options in the setting of RH and expands insights into its pathophysiology. However there is lack of data in relation to broader cardiovascular and renal protection, as well as its long-term safety profile.
BACKGROUND: The relationship between sleeping habits and aortic stiffness remains inconclusive and is not fully explored in the European general population. METHODS: We examined cross-sectionally 8659 participants from t...BACKGROUND: The relationship between sleeping habits and aortic stiffness remains inconclusive and is not fully explored in the European general population. METHODS: We examined cross-sectionally 8659 participants from the Swedish population-based cohort Swedish CArdioPulmonary bioImage Study (SCAPIS), mean age 57.5 years, 52.1% women. A self-administered questionnaire on sleeping habits (duration, quality, insomnia, and daytime sleepiness) was administered. Aortic stiffness was examined by the gold-standard method, carotid-femoral pulse wave velocity (c-f PWV) using Sphygmocor XCEL, continuously and stratified by cut-off of >10 m/s. Multivariable linear and logistic regression were performed stratified by sex. RESULTS: Out of 8659 subjects (mean c-f PWV of 9.4 ± 1.9 m/s), 32.3% had c-f PWV >10 m/s, defined as aortic stiffness. Compared with subjects with c-f PWV ≤10 m/s, individuals with aortic stiffness reported more insomnia ( = 0.01) but less daytime sleepiness ( = 0.008). Men and women with poor sleep quality had 0.2 m/s lower mean c-f PWV compared with subjects with good sleep quality ( = 0.004). No difference in mean PWV was found in men and women with shorter/longer sleep duration ( > 0.05). In the multivariable regression models, no significant association was found between poor sleep quality, shorter (≤6 h) or longer (≥9 h) sleep duration and aortic stiffness in the total population, neither among men nor women (all > 0.05), independently of cardiovascular risk factors. CONCLUSIONS: Short and long sleep duration and poor sleep quality are not associated with aortic stiffness, measured with the gold-standard method c-f-PWV, in middle-aged men and women from the Swedish general population, independently of cardiovascular risk factors.
Despite dramatic medical advances over the last few decades, cardiovascular disease remains a leading cause of death globally. High BP is clearly established, but modifiable, risk factor for early disability and death. A...Despite dramatic medical advances over the last few decades, cardiovascular disease remains a leading cause of death globally. High BP is clearly established, but modifiable, risk factor for early disability and death. Although most of the adverse outcomes occur in adulthood it has become clear that high BP is a life course problem that can become evident in early life however, relatively little attention has been paid to the problem of high BP in children and adolescents. Being aware of the problem and the needs, the Task Force of the ESH Guidelines in children and adolescents took the initiative to move forward in the field, identifying the COST Action program. A proposal, HyperChildNET, was submitted, approved and funded for 4 years starting in October 2020. The aim of the Action has been to establish a European sustainable and multidisciplinary network of researchers, clinicians, early career investigators, health economists, decision-makers, regulatory bodies, and medical devices manufacturers under the umbrella of the European Commission in order to acquire a holistic understanding of those factors affecting high BP in children and adolescents in order to propose and implement preventive and corrective actions. All the activities carried out during the 4 years are described. HyperChildNET offers a European perspective of the issue giving us the opportunity to develop new strategies and objectives moving forward in the field.