Antihypertensive Research Articles

Cost Variation Analysis Of Oral Antihypertensive Drugs Currently Available In Indian Pharmaceutical Market- A Pharmacoeconomic Study

Cost Variation Analysis Of Oral Antihypertensive Drugs Currently Available In Indian Pharmaceutical Market- A Pharmacoeconomic Study

Intracranial aneurysm stiffness assessment using 4D Flow MRI

BackgroundAlthough arterial stiffness is known as a biomarker for cardiovascular events and stroke, there is limited information in the literature regarding the stiffness of intracranial aneurysms. In this study, we aim to assess the stiffness of intracranial aneurysms using 4D Flow MRI. MethodsA total of 27 aneurysms in 25 patients with internal carotid artery aneurysms were included in this study. Using 4D Flow MRI, we measured the arterial pulse wave form during a cardiac cycle at planes proximal and distal to the target aneurysm. The damping of these waveforms through the aneurysm was defined as the aneurysm damping index (ADI) and compared to the contralateral side. We also investigated the clinical factors related to the ADI. ResultsADI assessment was successful in all cases. The average ADI was 1.18±0.28, which was significantly larger than 1.0 (P = 0.0027 [t-test]). The ADI on the aneurysm side was larger than on the contralateral side (1.19±0.30 vs 1.05±0.17, P = 0.029 [t-test]). On multivariate analysis, the use of beta-blockers (β=0.46, P = 0.015) and smoking history (β=-0.22, P = 0.024) showed a significant correlation with ADI. ConclusionWe have proposed a novel method to observe arterial pulse wave dumping through intracranial aneurysm using 4D Flow MRI. The damping can be quantitatively observed, and the ADI has correlations with clinical factors such as antihypertensive drugs and smoking. Further studies should focus more on evaluating aneurysm stiffness and its clinical applications.

Follistatin lowers blood pressure and improves vascular structure and function in essential and secondary hypertension.

Hypertension is characterized by resistance artery remodeling driven by oxidative stress and fibrosis. We previously showed that an activin A antagonist, follistatin, inhibited renal oxidative stress and fibrosis in a model of hypertensive chronic kidney disease. Here, we investigate the effects of follistatin on blood pressure and vascular structure and function in models of essential and secondary hypertension. 5/6 nephrectomised mice, a model of secondary hypertension, were treated with either exogenous follistatin or with a follistatin miRNA inhibitor to increase endogenous follistatin for 9 weeks. Blood pressure in mice was measured by tail cuff. Spontaneously hypertensive rats, a model of essential hypertension, were treated with follistatin for 8 weeks. Wistar Kyoto (WKY) rats were used as the normotensive control. Blood pressure in rats was measured by radiotelemetry. Mouse superior mesenteric arteries and rat first branch mesenteric arteries were isolated for structural and functional analyses. In both models, follistatin significantly lowered blood pressure and improved vascular structure, decreasing medial thickness and collagen content. Follistatin also reduced agonist-induced maximum contraction and improved endothelium-dependent relaxation. Increased vessel oxidative stress was attenuated by follistatin in both models. In ex vivo WKY vessels, activin A increased oxidative stress, augmented constriction, and decreased endothelium-dependent relaxation. Inhibition of oxidative stress restored vessel relaxation. This study demonstrates that follistatin lowers blood pressure and improves vascular structure and function in models of essential and secondary hypertension. Effects were likely mediated through its inhibition of activin A and oxidative stress. These data suggest a potential therapeutic role for follistatin as a novel antihypertensive agent. Follistatin, through antagonization of activin A, inhibits oxidative stress and improves vascular structure and function in resistance arteries from models of essential and secondary HTN. FST decreases collagen content and vascular ROS. Functionally, FST improves endothelium-dependent relaxation and decreases maximal vasoconstriction. Improved resistance artery structure and function are correlated with a decrease in BP in both models.

A Review on Stroke’s Pathophysiology, Associated Risk Factors, and Management

Background: Stroke is a medical disorder defined by focal neurological deficits caused by vascular impairment (hemorrhage or infarction) in the CNS (Central Nervous System). Currently the second biggest cause of morbidity worldwide, strokes continue to be a deadly disease. Objective: This review aimed to elucidate the stroke’s pathophysiology, both changeable and unchangeable risk factors associated with stroke, including prevention of stroke, its diagnosis, as well as treatment. Methods: The articles were collected involving the research on stroke with the help of different sources, like PubMed, Science Direct, and Google. Many manuscripts were collected and analyzed, and the relevant ones were considered for the present manuscript. Results: A brain CT scan has been found to be the first step in the management of Cerebrovascular Accident (CVA) in order to distinguish between ischemic and hemorrhagic stroke types. Beyond stroke classification, imaging has been observed to serve as a powerful tool for ruling out alternative diagnoses, predicting stroke outcomes, and facilitating appropriate treatment planning. Conclusion: Stroke is the second foremost cause of death as well as disability worldwide, leading to substantial economic losses. Therefore, better treatment and improved management after stroke are a global health priority. Modifying risk factors can decrease the chances of occurrence of stroke. Also, correct diagnosis should be done to diagnose the presence of stroke and its type. Proper treatment should be provided, like perfusion, glucose management, antiplatelet therapy, antihypertensive therapy, stem cell therapy, neural response and rehabilitation, increased awareness, lifestyle changes, stress management, etc. Exercise can also help positively to reduce the chances of stroke.

The impact of the COVID-19 pandemic on blood pressure control in patients with treated hypertension-results of the European Society of Hypertension Study (ESH ABPM COVID-19 Study).

We aimed to determine the influence of coronavirus disease 2019 (COVID-19) pandemic on blood pressure (BP) control assessed by ambulatory blood pressure monitoring (ABPM). Office BP and ABPM data from two visits conducted within a 9-15 months interval were collected from patients treated for hypertension. In the prepandemic group, both visits took place before, while in the pandemic group, Visit-1 was done before and Visit-2 during the pandemic period. Of 1811 collected patients 191 were excluded because they did not meet the required ABPM time frames. Thus, the study comprised 704 patients from the pandemic and 916 from the prepandemic group. Groups did not differ in sex, age, duration of hypertension, frequency of first line antihypertensive drug use and mean 24 h BP on Visit-1. The prevalence of sustained uncontrolled hypertension was similar in both groups. On Visit-2 mean 24 h BP, daytime and nighttime systolic BP and diastolic BP were higher in the pandemic compared to the prepandemic group ( P < 0.034). The prevalence of sustained uncontrolled hypertension on Visit-2 was higher in the pandemic than in the prepandemic group [0.29 (95% confidence interval (95% CI): 0.26-0.33) vs. 0.25 (95% CI: 0.22-0.28), P < 0.037]. In multivariable adjusted analyses a significant difference in BP visit-to-visit change was observed, with a more profound decline in BP between visits in the prepandemic group. This study using ABPM indicates a negative impact of the COVID-19 pandemic on BP control. It emphasizes the need of developing strategies to maintain BP control during a pandemic such as the one induced by COVID-19.

White coat hypertension in acute retinal vein occlusion

PurposeTo investigate the association between white-coat hypertension (WCH) and acute retinal vein occlusion (RVO).MethodsIn this retrospective case-control study, patients aged 40 years or older diagnosed with acute-phase RVO were included. Patients with other pathologies served as non-RVO controls. Blood pressure (BP) was measured in the office during their initial visit, and information about home BP and hypertension (HTN) medication was obtained through interviews. After 1:2 age and sex-matching between the RVO and non-RVO groups, the proportions of HTN cases were compared. A similar comparison was made in subgroups with or without HTN medication.ResultsFifty-one patients with RVO and 102 with non-RVO were included in the analysis. For the entire cohort, the RVO group exhibited a significantly greater proportion of WCH and sustained HTN compared to the non-RVO group. In the subgroup without HTN treatment, the proportion of WCH or sustained HTN was still significantly higher in the RVO group. However, in the subgroup receiving HTN treatment, the proportion of WCH or sustained HTN was higher in the RVO group than in the non-RVO group, though not statistically significant.ConclusionThis case-control study suggests that WCH may be associated with RVO, particularly in patients without HTN treatment. Given that interventions for WCH have not been standardized, a more detailed and prospective study is warranted to elucidate the risk of WCH for RVO and other retinal vascular diseases.

Serum uric acid-lowering effect of sacubitril/valsartan in hypertensive patients: evaluation by switching from angiotensin II receptor blockers.

Since hyperuricemia is a risk factor for cardiovascular disease and chronic kidney disease, it is necessary to pay attention to trends in uric acid levels when treating hypertensive patients with drugs. The present study investigated the effect of switching from angiotensin II receptor blocker (ARB) to sacubitril/valsartan on serum uric acid levels in treated hypertensive patients and further examined what factors could be associated with its effect. In 75 hypertensive patients under treatment with at least one antihypertensive agent including ARB, clinic blood pressure and biochemical parameters were assessed before and after drug switching to sacubitril/valsartan (200 mg/day). Clinic SBP and DBP significantly decreased after drug switching to sacubitril/valsartan (P < 0.0001, respectively). Serum creatinine, estimated glomerular filtration rate (eGFR), and urinary protein did not change after switching to sacubitril/valsartan, but serum uric acid significantly decreased (5.70 ± 1.44 to 5.40 ± 1.43 mg/dl, P = 0.0017). The degree of uric acid lowering was greater in patients switching from ARB plus diuretic than in those switching from ARB, but switching to sacubitril/valsartan from ARB only (except losartan) also significantly decreased uric acid levels. In all subjects, the change in serum uric acid after drug switching to sacubitril/valsartan was closely correlated with the change in eGFR (r = -0.5264, P < 0.0001). Our findings indicate that switching from ARB to sacubitril/valsartan reduces serum uric acid levels in hypertensive patients and suggest that this uric acid-lowering effect may be associated with an increase in eGFR.

Sodium-glucose cotransporter 2 inhibitors and renal cancer in the US FDA adverse event reporting system.

Recent evidence suggests an association between sodium-glucose cotransporter 2 (SGLT2) inhibitors and a higher risk of renal cancer. We conducted a pharmacovigilance analysis using the US FDA Adverse Event Reporting System (FAERS) to investigate the disproportionate association between SGLT2 inhibitors and renal cancer. We used AERSMine to mine data from FAERS, covering the period from 2014 Q1 to 2023 Q3. The control group was treated with other glucose-lowering medications (ATC-A10B). Disproportionality analysis results were performed using a proportional reporting ratio (PRR) with a 95% confidence interval (CI) and an information component (IC) with 95% credible interval. Compared to the control group, the SGLT2 inhibitor group had a higher disproportionate renal cancer reporting frequency (0.92 vs 0.27/1000 reports; PRR 3.38; 95% CI 2.68-4.25; p < 0.001) with an IC of 1.36 (0.60-2.06), comprising dapagliflozin (PRR 4.14; 2.95-5.80; p < 0.001), empagliflozin (PRR 2.74; 1.94-3.89; p < 0.001), and canagliflozin (PRR 3.56; 2.48-5.12; p < 0.001). Consistent results were obtained in the diabetes indication with the primary outcomes only for the SGLT2 inhibitors group (not individual molecule). The results of the sensitivity analysis (excluding hypertension indication or antihypertensive drugs, obesity, smoking, alpha-1 blockers, or anti-renal cancer drugs) were highly consistent with the main outcomes, indicating good robustness of the results. The results from 2004 Q1 to 2023 Q3 were similar to those from 2014 Q1 to 2023 Q3, with the exception of empagliflozin. There was a disproportionate association between SGLT2 inhibitors and renal cancer, which supports the current meta-analysis results indicating an increased risk of renal cancer associated with SGLT2 inhibitors.

Novel quantum dots-based assay for the determination of anti-hypertensive drugs minoxidil and timolol in different matrices

The present work reports a sensitive, affordable, and ecologically friendly spectrofluorimetric method for the assessment of two antihypertensive medications, namely minoxidil and timolol. Blue-emitting sulfur and nitrogen co-doped carbon quantum dots (S,N-CQDs) were generated by exposing soluble starch and thiourea to a 15-minute microwave treatment. The so- prepared nanodots displayed fluorescence at 276/430 nm with a quantum yield of 22 %. Inspection of the so-prepared nano-sensor verified their doping with nitrogen and sulfur, and their size was in the range of 4.5–9.03 nm. The proposed method was found to be rectilinear in the range of 0.20–5.0 and 2.0–30.0 µg/mL, with LOQs of 0.16 and 0.82 µg/mL for minoxidil and timolol, respectively. The developed method was employed to assess the concentrations of minoxidil and timolol in their pharmaceutical formulations, with %recoveries varying between 99.00 % and 101.94 %, and low RSD values (less than 2 %). The high sensitivity of the developed method allowed its use for timolol measurement in artificial aqueous humor, with % recoveries between 97.60 %.and 101.57 %. The study further examined how each analyte interacted with the prepared dots, leading to a quenching of their fluorescence. Additionally, an interference study was utilized to evaluate the specificity of the proposed approach through determining analyte levels in the existence of common additives, co-formulated drugs, and co-administered drugs. The analytical eco-scale, GAPI and AGREE assessment techniques were utilized to confirm the suggested method greenness.

The use of a clinical calculator to determine the rate of development of chronic kidney disease in elderly patients with type 2 diabetes mellitus

Aim – to develop an applied prognostic calculator for the rate of progression of CKD in elderly patients with type 2 diabetes, which makes it possible to identify a group of high rate of GFR reduction in conditions of routine outpatient admission. Material and methods. 69 clinical indicators were studied, the interrelationships and significance of differences in parameters in the groups identified according to the original diagnostic parameter, the glomerular filtration rate reduction index with a threshold value of 3.83 ml/min/1.73 m2 per year, above which the rate of progression of CKD was considered high. Results. By using regression analysis, significant factors for the prognostic calculator were identified: the duration of diabetes and insulin therapy, concomitant diagnosis of obesity, pulse in the ankle artery, severe stage of polyneuropathy, risk group IV of hypertension, treatment with sulfonylureas, the number of antihypertensive drugs taken. When evaluating the information capacity and predictive ability of the calculator, the area under the AUC ROC curve was 0.89 (0.80; 0.99) p 0.001, which characterizes the quality of the diagnostic technique as high. Conclusion. The presented calculator gives the doctor the opportunity to identify a group of patients with the risk of rapid progression of CKD directly on an outpatient basis.

The first description of mucous membrane pemphigoid induced by enalapril maleate: a case report

BackgroundMucous membrane pemphigoid (MMP) is an autoimmune blistering disease (AIBD). Some reports suggest that it has a drug-related pathogenesis especially anti-hypertensive drug.Case presentationA 67-year-old man with a 7-year history of essential hypertension was prescribed enalapril maleate for 5 months. He presented at our department with pain, ulcers, and blisters on the oral mucosa. We performed clinical, histopathology, and direct immunofluorescence examinations, and findings were consistent with the diagnostic criteria for MMP. Consequently, we consulted with the cardiovascular physician and agreed to discontinue the enalapril maleate replacing it with irbesartan/hydrochlorothiazide tablets and topical corticosteroid therapies instead. The lesions healed without recurrence.ConclusionsABID induced by antihypertensive drugs have been reported, and enalapril maleate has been implicated as an antihypertensive agent that may trigger AIBDs, such as MMP. This case highlights the potential relationship between antihypertensive drugs and MMP, of which clinicians should be aware to accurately diagnose and promptly relieve patients’ pain.

Modulation of left ventricular hypertrophy in spontaneously hypertensive rats by acetylcholinesterase and ACE inhibitors: physiological, biochemical, and proteomic studies

BackgroundThe consequences at the molecular level and the mechanisms involved in a possible cardioprotective effect of antihypertensive treatment are not yet fully understood. Here, the efficacy of pyridostigmine (PYR) and trandolapril (TRA) as antihypertensive and antihypertrophic agents was investigated and compared in hypertensive SHR and normotensive WKY rats. In parallel, we investigated the effects of these drugs on myocardial β-adrenergic and cholinergic signaling pathways and protein expression profiles.MethodsAge-matched male SHR and WKY rats were chronically (8 weeks) treated with PYR or TRA in drinking water. Blood pressure (BP) and heart rate (HR) were monitored telemetrically prior to tissue sampling for biochemical analysis. Baroreceptor reflex sensitivity (BRS) and methylatropine HR response as a measure of vagal tone were evaluated in separate groups of animals.ResultsPYR slightly lowered BP and HR in SHR rats during the dark phase of the day, while TRA effectively reduced BP during the light and dark phases without affecting HR. PYR enhanced BRS and improved vagal tone. There were no significant alterations in myocardial β-adrenergic and cholinergic signaling, with the exception of decreased forskolin-stimulated adenylyl cyclase (AC) activity in SHR rats, which was restored by TRA. Proteomic analysis revealed numerous differences induced by both treatments. Notable were changes in TGFβ-related signaling pathways as well as proteins involved in modifying hemodynamic parameters and cardiac hypertrophy.ConclusionsPYR is able to slightly decrease BP and HR in SHR rats but effectively increase BRS through vagal potentiation. The specific differences in protein expression profiles in rat myocardium induced by treatment with PYR and TRA reflect different mechanisms of action of these two agents at the molecular level.

What is New in the ESC Hypertension Guideline?

Blood pressure guidelines serve as a beacon of best practice for the diagnosis and management of hypertension. The many cultural and societal differences in hypertension risk factors and management patterns across geographic regions support the need for geographically distinct international guidelines. In 2018, the European Society of Cardiology (ESC) and European Society of Hypertension (ESH) released a joint guideline for the management of hypertension.1 This guideline represented a unified front across European hypertension-oriented societies. Similar to preceding hypertension guidelines, the 2018 guideline highlighted the myriad risks associated with inadequate blood pressure management and the importance of improving blood pressure control. The 2018 ESC/ESH guideline also offered a litany of nuanced recommendations on blood pressure measurement and management, including tiered blood pressure diagnosis and management thresholds across various ages and risk factors. For example, the guidelines recommended initiating antihypertensive therapy at a systolic blood pressure threshold of ≥140 mm Hg or a diastolic blood pressure of ≥90 mm Hg in individuals aged 18-79 years, and at a systolic blood pressure threshold of ≥160 mm Hg in individuals aged ≥80 years; treatment initiation could be considered at a blood pressure of ≥130/85 among individuals with established cardiovascular disease. Among individuals being treated for hypertension, the guideline recommended aiming for an initial blood pressure goal of <140/90 mm Hg in all individuals, and if tolerated, further aiming for a systolic blood pressure of 120-129 mm Hg in most individuals aged <65 years and considering a diastolic blood pressure of <80 mm Hg in all individuals. In contrast, contemporary to these guidelines, the 2017 American College of Cardiology/American Heart Association guidelines more broadly recommended stringent blood pressure diagnostic thresholds (≥140/90 mm Hg in lower risk individuals; ≥130/80 mm Hg in higher risk individuals including those with ≥10% 10-year risk of atherosclerotic cardiovascular disease) and management goals (<130/80 mm Hg in all individuals with hypertension). Thus, the 2018 ESC/ESH guideline focused much more on individualized goals. [See the full article for more].

ABC/VEN-analysis of baseline therapy for chronic heart failure: the position of physicians and patients

Introduction. Pharmacoeconomic studies of chronic heart failure (CHF) treat- ment remain relevant in primary care. Objective – ABC/VEN-, analysis of the three-component therapy of CCN from the perspective of physicians’ prescribing and its use by patients. Material and methods. Two groups of CHF patients were analyzed. The first group consisted of 71 patients selected from 745 outpatient records. The second group consisted of 31 CHF patients, obtained from 1,284 online questionnaires. They studied the use of angiotensin converting enzyme in- hibitors (iACE), angiotensin II receptor antagonists (APA II), beta blockers (BB), aldosterone antagonists (AA) and fixed combinations (FC) contain- ing antihypertensive drugs. ABC, VEN, and frequency analysis and the “cost minimization” method were used. The daily cost of treatment with the drug was estimated, taking into account its price in the “EAPTEK” and the target/maximum dose prescribed in the clinical recommendations (CR). Results. Physicians and patients used 4 groups of three-component therapy (iACE/APA II; BB and AA) as well as FC in the treatment of CHF. Three-com- ponent therapy was prescribed by physicians in single cases; patients took it more often. In physicians and patients, the choice of drugs from different groups of three-component therapy for CHF from the position of VEN analysis corresponded to class A, such was not the case in classes B and C. Physicians prescribed 9 drugs from the group of ACE inhibitors to half of the patients; one third of them took 6 items. Their use did not always take into account dosing frequency and cost, contributing to 2.5 times more spending per patient per day than the use of ramipril. Physicians prescribed 5 items from the ARA II group to every fifth patient; a third of them were taking 2 drugs. Both did not always take into account the CR and the cost of the drugs. The latter resulted in 1.5 times higher costs per patient per day than the use of Lorista®. Doctors and patients used the same BB only in 60.0% of cases. The choice of drugs from this group was rationalised in only half of the cases, resulting in one- third more costs compared to cheap Bisoprolol. Physicians prescribed AA to only one in ten patients; they took them in almost one in two cases. Both preferred Verospirone to Spironolactone, which was 0.2 roubles/day cheaper. Physicians and patients used FC equally rarely. Out of 9 drugs prescribed by doctors, patients took two. Many of them contained drugs not specified in the CR for treatment of CHF. The cost of treatment of one patient with them ex- ceeded the justified use of Valsartan+hydrochlorthiazide more than 1.5 times. Conclusion. Physicians in the outpatient clinic and patients at home rarely use three-component therapy of CHF. From the position of ABC- and VEN-analy- sis, the most optimal was class A in category V, which represents drugs from all groups (iAPP/APA II; BB, AA and FC) used in the treatment of CHF. Howev- er, both do not always focus on CR and drug cost when selecting them. The latter contributes to a greater financial cost compared to the proposed option. The situation can be improved through online interaction between doctors, patients, pharmacies and pharmaceutical companies.

Factors Contributing to Lack of Adherence to Antihypertensive Medications Among Patients at Nishtar Hospital in Multan, Pakistan.

Hypertension affects 26.7% of Pakistan's population, with only 6% achieving control. This study investigates antihypertensive medication adherence in Multan, focusing on socioeconomic and patient-related factors influencing non-adherence to study the lack of adherence to antihypertensive medications in hypertensive patients and its associated factors at Nishtar Hospital in Multan, Pakistan. This cross-sectional study was conducted among hypertensive patients admitted at Nishtar Hospital Multan, Pakistan. Patients under the age of 20 years were excluded from the study. A self-developed questionnaire was used to gather the demographic details of patients. The Hill-Bone Medication Adherence Scale was used via a non-probability convenience sampling technique to deduce the adherence level in patients. Data analysis was done using SPSS (Statistical Package for the Social Sciences) v23 (IBM Corp., Armonk, NY). p-value < 0.05 was considered significant. Out of 217 respondents, most were female, married, unemployed, and residing in urban areas. Most of them had a higher level of education and a monthly income averaging below 30,000 PKR (Pakistani Rupee). The insight into the hypertensive history showed that most of them had a positive family historyand comorbid conditions, and were hypertensive for more than five years. The majority of the patients had a complex regimen prescribed to them with multiple doses throughout the day. The minority were smokers and had medications provided to them for free, through public or government-funded institutions. More importantly, adherence to the antihypertensive therapy was negatively correlated with the age of the patients (p = 0.004, r = -0.195), complexity of regimen (p = 0.041), multiple dosing (p = 0.039), and cost of medication (p = 0.043). All of these relations were statistically significant. Lack of adherence to antihypertensive medications in hypertensive patients is more common inpopulations belonging to older age groups, complex regimens, multiple doses, and higher medicine fees.

Metabolic health in people living with type 1 diabetes in Belgium: a repeated cross-sectional study

Aims/hypothesisMetabolic abnormalities such as central obesity, insulin resistance, dyslipidaemia and hypertension, often referred to as ‘the metabolic syndrome’ (or ‘combined metabolic abnormalities’), are increasingly being identified in people living with type 1 diabetes, accelerating the risk for CVD. As a result, in recent years, treatment in people living with type 1 diabetes has shifted to improving overall metabolic health rather than glucose control alone. In Belgium, diabetes care for people living with type 1 diabetes is centrally organised. The Initiative for Quality Improvement and Epidemiology in Diabetes, imposed by the Belgian health insurance system, has systematically collected data from patients on intensive insulin therapy treated in all 101 diabetes clinics in Belgium since 2001. The aim of this real-world study is to describe the evolution of treatment and metabolic health, including the prevalence of obesity and combined metabolic abnormalities, in people living with type 1 diabetes over the past 20 years, and to compare the treatment and prevalence of complications between those with and without combined metabolic abnormalities.MethodsWe analysed data on adults (≥16 years old) living with type 1 diabetes, who were diagnosed at age ≤45 years and who had a diabetes duration ≥1 year, collected between 2001 and 2022. The evolution of HbA1c, BMI, LDL-cholesterol, systolic BP, lipid-lowering therapy and antihypertensive therapy over time was analysed. The prevalence of individual and multiple metabolic abnormalities according to various definitions of the metabolic syndrome/combined metabolic abnormalities was analysed, and the association between combined metabolic abnormalities and metabolic health indicators, complications and treatment was investigated in the 2022 data.ResultsThe final dataset consisted of 26,791 registrations of adults living with type 1 diabetes collected between 2001 and 2022. Although glycaemic and lipid control generally improved over time, the prevalence of obesity strongly increased (12.1% in 2001 vs 21.7% in 2022, p<0.0001), as did the presence of combined metabolic abnormalities (WHO criteria: 26.9% in 2001 vs 42.9% in 2022 in women, p<0.0001; 30.4% in 2001 vs 52.1% in 2022 in men, p<0.0001; WHO criteria without albuminuria: 22.3% in 2001 vs 40.6% in 2022 in women, p<0.0001; 25.1% in 2001 vs 49.2% in 2022 in men, p<0.0001; NCEP-ATPIII criteria: 39.9% in 2005 vs 57.2% in 2022 in women, p<0.0001; 40.8% in 2005 vs 60.9% in 2022 in men, p<0.0001; IDF criteria: 43.9% in 2005 vs 59.3% in 2022 in women, p<0.001; 33.7% in 2005 vs 50.0% in 2022 in men, p<0.0001). People with combined metabolic abnormalities had higher glucose levels compared to those without combined metabolic abnormalities (HbA1c >58 mmol in men: 48.9% vs 36.9%; HbA1c >58 mmol in women: 53.3% vs 41.1%, p<0.0001). People with combined metabolic abnormalities were more often treated with adjunct therapies such as metformin, sodium–glucose transport protein 2 inhibitors and glucagon-like peptide-1 receptor agonists. In both men and women, the presence of combined metabolic abnormalities was strongly related to the presence of eye complications, peripheral neuropathy, chronic kidney disease and CVD, corrected for age, diabetes duration and HbA1c.Conclusions/interpretationOverweight, obesity and combined metabolic abnormalities are increasingly being identified in people living with type 1 diabetes, further accelerating the risk of microvascular and macrovascular complications. Early identification of the presence of combined metabolic abnormalities should enable therapeutic interventions to be modified towards multifactorial approaches, with attention to education on avoidance of overweight (e.g. dietary counselling) in addition to strict glycaemic control and intensification of use of antihypertensive agents and statins. Use of adjunct therapies in this population as a tool should be explored more thoroughly to reduce risk of complications.Graphical

Impact of changes in left heart geometry on predicting new-onset atrial fibrillation in patients with hypertension.

Hypertension-induced left ventricular hypertrophy (LVH) increases end-diastolic LV pressure and contributes to left atrial enlargement (LAE), which are associated with development of atrial fibrillation. However, the impact of LVH and LAE and their regression following antihypertensive therapy on atrial fibrillation incidence remains unclear. This retrospective analysis included consecutive patients with sinus rhythm who underwent echocardiography at hypertension diagnosis and after 6-18 months between 2006 and 2021 at tertiary care centres in Korea. LVH was defined as LV mass index greater than 115 g/m2 (men) and greater than 95 g/m2 (women), and LAE was defined as LA volume index greater than 42 ml/m2. The occurrence of new-onset atrial fibrillation (NOAF) was assessed in relation to changes in LVH and LAE status. Among the 1464 patients included, 163 (11.1%) developed NOAF during a median 63.8 [interquartile range (IQR) 35.9-128.5] months of surveillance period. New-onset LVH [adjusted hazard ratio (aHR) 1.88, 95% confidence interval (CI) 1.20-2.94, P = 0.006] and LAE (aHR 1.89, 95% CI 1.05-3.40, P = 0.034) were significant predictors of NOAF. Conversely, regression of LVH (aHR 0.51, 95% CI 0.28-0.91, P = 0.022) or LAE (aHR 0.30, 95% CI 0.15-0.63, P = 0.001) was associated with a reduced risk for developing NOAF. Patients with both LVH and LAE at follow-up echocardiography had a higher risk for NOAF (aHR 4.30, 95% CI 2.81-6.56, P < 0.001) than those with either LVH or LAE or those with neither. The changes in left heart geometry can serve as a predictive marker for NOAF in patients with hypertension.

Blood pressure management strategies and podocyte health.

Hypertension (HTN) is one of the key global cardiovascular risk factors, which is tightly linked to kidney health and disease development. Podocytes, glomerular epithelial cells that play a pivotal role in maintenance of the renal filtration barrier, are significantly affected by increased glomerular capillary pressure in HTN. Damage or loss of these cells causes proteinuria, which marks the initiation of the HTN-driven renal damage. It goes without saying that effective BP management should not only mitigate cardiovascular risks but also preserve renal function by protecting podocyte integrity. This review offers a comprehensive examination of current blood pressure (BP) management strategies and their implications for podocyte structure and function and emphasizes strategies for the reduction of proteinuria in HTN. We explore primary and secondary antihypertensive agents, including ACE inhibitors, ARBs, calcium channel blockers, diuretics, as well as newer therapies (SGLT2 blocking and endothelin receptor antagonism), emphasizing their mechanistic roles in safeguarding podocytes and curtailing proteinuria.

Long-term exposure to antihypertensive drugs and the risk of cancer occurrence: evidence from a large population-based study.

Available data on the association between antihypertensive drugs and cancer are characterized by a few years follow-up. Our aim has been to evaluate the association between long-term exposure to antihypertensive drugs and the risk of cancer occurrence. Using the healthcare utilization databases of the Lombardy region (Italy), individuals aged 40-85 years who had no previous history of cancer and were newly dispensed with at least one antihypertensive drug from the major drug classes between 2009 and 2011 were followed from the first drug dispensation to December 31, 2020. Data were analyzed according to the first drug used and the intention to treat principle, but also via an "as treated" approach, that is, by considering changes of and exposure to drugs during follow-up. The association between the duration of exposure to each drug class and the risk of cancer occurrence was evaluated using the adjusted Cox regression models. The study cohort included 338 910 new drug users (median age, 59 years; 49.5% males). During a median follow-up of 10.2 years, 36 556 cancers occurred. There was no consistent significant association between the risk of cancer occurrence and angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers, or thiazides. A progressive, weak increase in cancer occurrence was associated with progressive exposure to calcium channel blockers and, limited to long-term exposure, to beta-blockers. A modest progressive increase in risk was observed also for thiazide-like and loop diuretics in the as treated, although not in the intention to treat approach. Long-term evaluation of exposure to antihypertensive drugs did not show consistent associations between thiazides, angiotensin-receptor blockers, or angiotensin-converting-enzyme inhibitors and the risk of cancer occurrence. A weak association was observed between cancer and the duration of exposure to calcium channel blockers and beta-blockers.

High blood pressure and glaucoma : an inextricable link

The relationship between glaucoma and hypertension is complex. Intraocular pressure is the main modifiable risk factor for glaucoma. Literature describes hypertension as being linked to glaucomatous damage, although the mechanisms are not fully understood. Therefore, glaucoma screening is recommended for hypertensive individuals over 60 years old. The relationships between ocular, arterial pressure, and ocular perfusion pressure, and their impact on optic nerve perfusion, make coordinated management of these elements crucial. Hypertension, hypotension, extreme variability, nocturnal dipping, and overtreatment with antihypertensive drugs can increase the incidence and/or progression of glaucoma. This critical review discusses the causative, clinical, and therapeutic elements to consider in the management of these two pathologies.