Cardiovascular Events In Hypertensive Patients Research Articles

Characterization of Diclofenac-induced Renal Damage in Normotensive and Hypertensive Rats: A Comparative Analysis.

Diclofenac is the non-steroidal anti-inflammatory drug (NSAID) mostly prescribed worldwide, but it is highly associated with hypertension and acute kidney injury. Despite that, little information is available about the renal effects of diclofenac in hypertensive individuals, which led us to carry out this comparative study between the renal effects of this NSAID in normotensive (NTR) and spontaneously hypertensive rats (SHR). Male Wistar NTR and SHR were orally treated with vehicle (V: 10 mL/kg) or diclofenac sodium (D: 100 mg/kg) once a day for 3 days. Urine volume, electrolytes excretion (Na+, K+, Cl-, and Ca2+), urea, creatinine, pH, and osmolarity were evaluated. Furthermore, blood samples and renal tissue were collected to perform biochemical and histological analysis. Diclofenac increased the renal corpuscle and bowman's space in the SHR, while no microscopic changes were observed in the renal tissue of NTR. Regarding the urinary parameters, diclofenac reduced urine volume, pH, osmolarity, and all electrolytes excretion, followed by decreased urea and creatinine levels in both lineages. Moreover, it also induced hyponatremia, hypokalemia, and hypocalcemia in SHR, while reduced glutathione-S-transferase activity, lipid hydroperoxides, and nitrite levels in renal tissue. The data presented herein demonstrated that diclofenac induces renal damage and impaired renal function in both NTR and SHR, but those effects are exacerbated in SHR, as seen by the histological changes and electrolytes balance disturbance, therefore, reinforcing that diclofenac may increase the risks of cardiovascular events in hypertensive patients.

Association between HDL-C and intensive blood pressure control in patients with hypertension: A post-hoc analysis of SPRINT.

Previous studies in patients with hypertension have demonstrated that there is a U-shaped association between HDL-C (high-density lipoprotein cholesterol) and the risk of cardiovascular events in male patients with hypertension. However, to the best of our knowledge, the relationship between HDL-C and intensive blood pressure control in specific cardiovascular events has never been investigated. To fill this knowledge gap, the authors analyzed the relationship between HDL-C levels and cardiovascular events in hypertensive patients within the Systolic Blood Pressure Intervention Trial (SPRINT). The SPRINT evaluated the impact of intensive blood pressure control (systolic blood pressure<120mm Hg) versus standard blood pressure control (systolic blood pressure<140mm Hg). The Cox proportional risk regression was used to investigate the association between different HDL-C status and clinical outcomes. Additional stratified analyzes were performed to evaluate the robustness of sex difference. A total of 9323 participants (6016 [64.53%] males and 3307 [35.47%] females) with hypertension from the SPRINT research were included in the analysis. The median follow-up period was 3.26years. Our population was divided into five groups based on the HDL-C plasma levels: HDL-C<30mg/dL, HDL-C between 30 and 40mg/dL, HDL-C between 40 and 60mg/dL, HDL-C between 60 and 80mg/dL and HDL-C>80mg/dL. Sensitivity analyzes showed that in the SPRINT, women in the HDL-C high population had a higher risk of mortality from all causes than men. In this cohort study, results suggest that patients with HDL-C levels higher than 80mg/dL had lower risk of SPRINT primary outcome, cardiovascular death, and stroke, but this study tested association, not causation. HDL-C levels were associated with composite cardiovascular outcomes in male but not female patients. Our results demonstrated that in patients with hypertension, the association between HDL-C and risk of cardiovascular events is L-shaped.

Pulse pressure is a predictive tool of cardiovascular events in hypertensive patients

Pulse pressure is a predictive tool of cardiovascular events in hypertensive patients

Baseline high sensitivity C-Reactive Protein predicts incident cardiovascular events and all-cause mortality in the ASCOT Study at 20-years

Abstract Introduction The prediction of future cardiovascular events in those at greatest risk is essential to optimise preventative therapies appropriately and effectively. The value of high sensitivity C-reactive Protein (hsCRP) has been questioned in this regard, and recent studies have suggested the utility of this widely assessed biomarker for predicting future mortality in those presenting with suspected myocardial infarction (MI), however the relationship in stable patients is still debated. Purpose To investigate the role of baseline hsCRP for predicting long-term incident cardiovascular events in hypertensive patients in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), with follow-up extending to 20-years. Methods This ASCOT legacy study reports events after 20-years of the UK participants in the original ASCOT trial. ASCOT was a multicentre randomised trial, randomising patients with hypertension into amlodipine-based or atenolol-based blood pressure-lowering (BPL) treatment. In addition, those with total cholesterol &amp;lt;6.5 mmol/L and no previous lipid-lowering treatment underwent further randomisation to either atorvastatin or placebo as part of the lipid-lowering (LL) arm of ASCOT. We examined outcomes related to hsCRP levels in the LL arm, dichotomously (&amp;lt; or &amp;gt; 2mg/L), in tertiles or continuously, adjusting in Model 1 (age, sex, socio-economic status [years of education] and ethnicity) and Model 2 (Model 1 plus current smoker, body mass index, baseline systolic blood pressure, creatinine, diabetes, history of vascular diseases, history of antihypertensive medication and allocation to BPL and LL). All-cause mortality, non-fatal and fatal MI, total coronary events and procedures and total cardiovascular events were assessed. Results 5,294 participants were included in the final cohort, after exclusion of 3,286 participants in the LL arm (n=8,580) without hsCRP data. There were no substantial differences in baseline characteristics between treatment allocation arms (non-randomised, placebo or atorvastatin). The highest tertile of hsCRP (median [IQR], 6.41 [4.81-10.44]) strongly related to all-cause mortality, withstanding adjustment in both Model 1 (HR 95% CI, 1.38 [1.27-1.53]; p&amp;lt;0.001; p&amp;lt;0.001 for interaction) and Model 2 (HR 1.25 [1.10-1.42]; p&amp;lt;0.001; p&amp;lt;0.001 for interaction). Moreover, the highest hsCRP tertile also related to fatal and non-fatal MI (Model 2 – HR 1.32 [1.05-1.67]; p=0.020; p=0.019 for interaction); total coronary events and procedures (Model 2 – HR 1.27 [1.09-1.47]; p=0.002; p=0.003 for interaction); and total cardiovascular events (Model 2 – HR 1.22 [1.08-1.37]; p=0.001; p=0.001 for interaction). Conclusions This study demonstrates that one hsCRP reading at baseline independently predicts cardiovascular events and all-cause mortality at very long-term follow-up in patients at high-risk for these events, and may help stratify patients into higher risk categories for intensive preventative strategies.

Linear Relationship between Hepatic Steatosis Index and Major Adverse Cardiovascular Events in Hypertensive Patients with Obstructive Sleep Apnea: A Real-World Cohort Study from China

Linear Relationship between Hepatic Steatosis Index and Major Adverse Cardiovascular Events in Hypertensive Patients with Obstructive Sleep Apnea: A Real-World Cohort Study from China

Long-Lasting Control of LDL Cholesterol Induces a 40% Reduction in the Incidence of Cardiovascular Events: New Insights from a 7-Year Study.

Recent studies have yielded controversial results on the long-term effects of statins on the risk of cardiovascular (CV) events. To fill this knowledge gap, we assessed the relationship between low-density lipoprotein cholesterol (LDL-C) levels and CV events in hypertensive patients without previous CV events and naïve to antidyslipidemic treatment within the "Campania Salute Network" in Southern Italy. We studied 725 hypertensive patients with a mean follow-up of 85.4 ± 25.7 months. We stratified our cohort into three groups based on LDL cholesterol (LDL-C) levels in mg/dl: group 1) patients showing during the follow-up a mean LDL-C value ≤100 mg/dl in absence of statin therapy; group 2) statin-treated patients with LDL ≤100 mg/dl; and group 3) patients with LDL-C >100 mg/dl. No significant difference among the groups was observed in terms of demographic and clinical characteristics and medications. The incidence of first CV events was 5.7% in group 1, 6.0% in group 2, and 11.9% in group 3 (P < 0.05 vs. group 1 and group 2). A stable long-term satisfactory control of LDL-C plasma concentration (≤100 mg/dl) reduced the incidence of major CV events from one event every 58.6 patients per year to one event every 115.9 patients per year. These findings were confirmed in a Cox regression analysis, adjusting for potential confounding factors. Collectively, our data demonstrate that a 7-year stable control of LDL-C reduces the incidence of CV events by 40%. SIGNIFICANCE STATEMENT: There are several discrepancies between Mendelian studies and other investigations concerning the actual effects of reduction of plasma concentration of low-density lipoprotein (LDL) cholesterol on the incidence of major cardiovascular events. Taken together, our data in nondiabetic subjects show that a 7-year stable control of LDL cholesterol induces a ∼40% reduction of the incidence of cardiovascular events.

Abstract P231: Lipoprotein Lipase Activation Is A Novel Anti-contractile Mechanism That Is Both Endothelium-dependent And Independent.

Risk factors such as hypertriglyceridemia and hypercholesterolemia are commonly attributed to the pathogenesis of atherosclerosis, however, lipoprotein metabolism is also associated with end organ damage and cardiovascular events in hypertensive patients. Lipoprotein lipase (LPL) is an important hydrolase for lipoprotein catabolism. Previous work from our lab has shown that LPL activator, NO-1886 (Ibrolipim), significantly decreased vascular contraction. Physiologically, endothelial function limits contractility and endothelial dysfunction is a hallmark of hypertension. Therefore, we hypothesized that LPL activation would cause endothelial-dependent hypocontractility. To test this hypothesis, mesenteric resistance arteries (MRA) were isolated from male Fischer 344 rats at 3 months of age (n=4-12) and mounted onto a wire myograph. Phenylephrine (PE) concentration-response curves were performed with and without LPL activator, NO-1886 (30 min). Some MRA were denuded of their endothelium or incubated with inhibitors of endothelium-dependent vasodilation. As expected, activating LPL exerted a significant anti-contractile effect in a concentration-dependent manner [KCl (%), Veh: 125±3 vs. NO-1886 (1 uM): 116.0±17 vs. NO-1886 (10 uM): 108±9* vs. NO-1886 (50 uM): 55±4* vs. NO-1886 (100 uM): 29±5*, *p&lt;0.05 vs. Veh]. However, contrary to our hypothesis, denudation only partially restored contraction [KCl (%),Veh: 125±3 vs. NO-1886 (50 uM): 55±4* vs. NO-1886+denuded: 76±4* # , *p&lt;0.05 vs. Veh, # p&lt;0.05 vs. NO-1886]. This suggests that there is both an endothelium-dependent and -independent mechanism by which LPL limits contractility. Endothelial-dependent hypocontractility was found to be mediated by nitric oxide synthase [KCl (%),Veh: 125±3 vs. NO-1886 (50 uM): 55±4 vs. NO-1886+L-NAME (100 uM): 90±5* # , *p&lt;0.05 vs. Veh, # p&lt;0.05 vs. NO-1886]. Endothelium-independent mechanisms by which NO-1886 causes hypocontractility have yet been clarified (data not shown). Overall, this suggests that LPL has an important physiological role in controlling vascular contraction through both endothelial-dependent and -independent means and loss of LPL activity could be a novel mechanism of endothelial dysfunction in hypertension.

Interaction effect of hypertension and obesity on left atrial phasic function: a three-dimensional echocardiography study.

Hypertension (HT) and obesity often coexist and contribute to left atrial (LA) dysfunction. The present study aimed to compare LA function in hypertensive individuals and control participants with different body mass index (BMI) categories and to explore whether there is an interaction effect between HT and obesity on LA function. In this cross-sectional study, a total of 258 individuals (145 hypertensive and 113 non-hypertensive patients) were prospectively enrolled from Fuwai Central China Cardiovascular Hospital from September 2020 to November 2021. Hypertensive and non-hypertensive patients were both divided into three study subgroups (n=35 per group) according to their BMI: normal weight (BMI 18.5-<25 kg/m2), overweight (BMI 25-<30 kg/m2), and obesity (BMI ≥30 kg/m2) groups. LA volume and strain parameters were obtained using three-dimensional echocardiography. A significant interaction effect between HT and obesity on LA function was observed [PInteraction =0.04, 0.03, 0.005, 0.01, and 0.002 for LA ejection fraction (LAEF), LA passive ejection fraction (LAPEF), LA active ejection fraction (LAAEF), LA reservoir longitudinal strain (LASr), and LA contraction longitudinal strain (LASct), respectively; PInteraction <0.001 for LA conduit longitudinal strain (LAScd)]. Univariate correlation analysis revealed that HT [LASr, r=-0.53, 95% confidence interval (CI): -0.62 to -0.42, P<0.001; LAScd, r=-0.49, 95% CI: -0.58 to -0.39, P<0.001; and LASct, r=-0.46, 95% CI: -0.55 to -0.34, P<0.001] and BMI categories (LASr, r=-0.68, 95% CI: -0.75 to -0.61, P<0.001; LAScd, r=-0.47, 95% CI: -0.57 to -0.35, P<0.001; and LASct, r=-0.73, 95% CI: -0.78 to -0.66, P<0.001) were negatively correlated with LA strains. A generalized linear model further demonstrated that there was an interaction effect between HT and obesity on LA strains after adjusting for confounding factors (Model 2: LASr, βHT*Obesity =-1.91, 95% CI: -3.48 to -0.35, P=0.01; LAScd, βHT*Obesity =-3.26, 95% CI: -4.83 to -1.70, P<0.001; LASct, βHT*Overweight =-1.97, 95% CI: -3.03 to -0.91, P<0.001; βHT*Obesity =-1.54, 95% CI: -2.67 to -0.41, P=0.007). Both HT and increasing BMI category had an adverse effect on LA function. The coexistence of HT and obesity further impaired LA performance in an interaction manner. Weight loss is essential to reduce the incidence of adverse cardiovascular events in hypertensive patients.

PS-BPC06-10: FATTY LIVER INDEX AND CARDIOVASCULAR RISK IN HYPERTENSIVE PATIENTS

Objective: The prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing rapidly worldwide affecting 25–30% of population. Fatty liver index (FLI) is a validated marker of NAFLD and can be used as a screening tool for hepatic steatosis. The purpose of the study was to evaluate the relationship between FLI and the risk of major cardiovascular events in hypertensive patients. Design and method: 903 hypertensive patients without history of cardiovascular disease participated in the study (mean age 52.7 ± 11.4 years; males 55%; baseline clinic BP 149.8 ± 15.2/95.5 ± 10.1 mmHg). Participants were prospectively evaluated for a mean follow-up period of 6.0 ± 3.3 years with at least one annual visit. The diagnosis of NAFLD was based on FLI and consequently patients were divided in two groups according to the presence of NAFLD. The primary endpoint was a composite of major cardiovascular events. Results: The incidence of cardiovascular events during the follow up was 8.5% (n = 77). Patients without NAFLD (n = 625) had better BP control compared to their counterparts with NAFLD (n = 278) during follow up (43% vs 33%, p = 0.02). A Cox-regression analysis indicated that age (hR 1.09 CI 1.04–1.13, p &lt; 0.01), smoking (hR 2.4 CI 1.1–5.2, p = 0.03) and FLI (hR 2.7 CI 1.9–4.1, p &lt; 0.001) were significant independent determinants of the outcome. The presence of NAFLD at baseline visit was also a significant independent determinant of the outcome (hR 5.2 CI 2.4–11.1, p &lt; 0.001). Conclusions: In conclusion, FLI has an independent prognostic value for the incidence of cardiovascular events in hypertensive patients. Therefore, it could be useful in identifying patients at higher risk of cardiovascular events. Further studies will clarify whether the early treatment of NAFLD could reduce the incidence of cardiovascular disease.

Arterial stiffness (from monitoring of Qkd interval) predict the occurrence of cardiovascular events and total mortality.

Arterial stiffness, most often assessed with carotido-femoral pulse wave velocity predicts cardiovascular events but its use in clinical practice remains limited. The 24 h ambulatory monitoring of Blood pressure and timing of Korotkoff sounds (QKD interval) allows an automatic assessment of arterial stiffness and is an independent predictor of cardiovascular events in hypertensive patients. The long term follow up of our cohort of hypertensive patients gave us the opportunity to test the consequences of increased arterial stiffness on the incidence of all causes deaths and to define the populations who could benefit of this measurement beyond risk scores. The sample includes 930 patients (502 males, age 53 ± 13 years, baseline risk SCORE2-OP = 6.70 ± 4.97%) with an average follow up of 12.11 ± 7.4 years (0.3-30). In this population 169 cardiovascular events and 155 deaths were recorded. SCORE2-OP, 24 h Systolic Blood Pressure and arterial stiffness (QKDh) as a continuous or discontinuous variable (normal or reduced) were significantly and independently linked to the occurrence of cardiovascular events or all cause deaths in multivariate Cox model. ROC curves analysis show that measuring arterial stiffness with QKD method offers the best predictive value in patients with low or very low risk scores.

164 HIGH HDL CHOLESTEROL INCREASES CARDIOVASCULAR RISK IN HYPERTENSIVE PATIENTS

Abstract Background Emerging evidence suggests that elevated circulating levels of HDL-C (high-density lipoprotein cholesterol) could be linked to an increased mortality risk. However, to the best of our knowledge, the relationship between HDL-C and specific cardiovascular events has never been investigated in patients with hypertension. Methods To fill this knowledge gap, we analyzed the relationship between HDL-C levels and cardiovascular events in hypertensive patients within the Campania Salute Network in Southern Italy. Results We studied 11 987 patients with hypertension, who were followed for 25 534 person-years. Our population was divided in 3 groups according to the HDL-C plasma levels: HDL-C&amp;lt;40 mg/dL (low HDL-C); HDL-C between 40 and 80 mg/dL (medium HDL-C); and HDL-C&amp;gt;80 mg/dL (high HDL-C). At the follow-up analysis, adjusting for potential confounders, we observed a total of 245 cardiovascular events with a significantly increased risk of cardiovascular events in the low HDL-C group and in the high HDL-C arm compared with the medium HDL-C group. The spline analysis revealed a nonlinear U-shaped association between HDL-C levels and cardiovascular outcomes (Figure 1). Interestingly, the increased cardiovascular risk associated with high HDL-C was not confirmed in female patients. Conclusions Our data demonstrate that there is a U-shaped association between HDL-C and the risk of cardiovascular events in male patients with hypertension.

Long-term cardiovascular events in hypertensive patients: full report of the Korean Hypertension Cohort.

This study evaluated the long-term cardiovascular complications among Korean patients with hypertension and compared them with that of controls without hypertension. The Korean Hypertension Cohort (KHC) enrolled 11,043 patients with hypertension and followed them for more than 10 years. Age- and sex-matched controls without hypertension were enrolled at a 1:10 ratio. We compared the incidence of cardiovascular events and death among patients and controls without hypertension. The mean age was 59 years, and 34.8% and 16.5% of the patients belonged to the high and moderate cardiovascular risk groups, respectively. During the 10-year follow-up, 1,591 cardiovascular events (14.4%) with 588 deaths (5.3%) occurred among patients with hypertension and 7,635 cardiovascular events (6.9%) with 4,826 deaths (4.4%) occurred among controls. Even the low-risk population with hypertension showed a higher cardiovascular event rate than the population without hypertension. Although blood pressure measurements in the clinic showed remarkable inaccuracy compared with those measured in the national health examinations, systolic blood pressure (SBP) ≥ 150 mmHg was significantly associated with a higher risk of cardiovascular events. This long-term follow-up study confirmed the cardiovascular event rates among Korean hypertensive patients were substantial, reaching 15% in 10 years. SBP levels ≥ 150 mmHg were highly associated with occurrence of cardiovascular event rates.

Elevated body mass index increases the risk of cardiovascular events in hypertensive patients accompanied with obstructive sleep apnea: A cohort study

BackgroundEffects of body mass index (BMI) on cardiovascular events are inconsistent. We aimed to investigate the association of BMI with cardiovascular events in hypertensives with obstructive sleep apnea (OSA). MethodsHypertensives with OSA diagnosed with polysomnography between 2011 and 2013 in UROSAH cohort were followed up till Jan 2021. Outcomes were non-fatal cardiovascular events and cardiac death. Cox regression was used to estimate the relationship of continuous and categorical BMI with total and specific outcomes. Sensitivity analyses were performed by excluding those on OSA treatment or underweight patients. Stratified analyses were conducted by parameters including sex and age. Results2239 hypertensives with OSA were included with 405 normal weight (BMI<25 kg/m2), 1164 overweight (25–29.9 kg/m2) and 670 obesity (≥30 kg/m2). 206 non-fatal cardiovascular events and 18 cardiac death were recorded during 6.6 years follow-up. Compared with normal weight group, overweight (HR=1.53, 95%CI: 1.01–2.32, P = 0.047) and obesity groups (1.85, 1.19–2.86, P = 0.006) showed increased risk for cardiovascular events, significant in obesity group and marginal in overweight group in fully-adjusted model. In specific events, obesity showed significantly elevated HR for non-fatal cardiovascular events (1.64, 1.04–2.60, P = 0.035). Continuous BMI showed significantly increased HR for total and specific events in all models. Sensitivity analysis yielded consistent results. In stratification analysis, stronger association between obesity and cardiovascular events was observed in the young (HR=5.97, P interaction=0.030). ConclusionsBMI is in positive association with cardiovascular events in hypertensives with OSA, emphasizing importance of maintaining healthy BMI for prevention of adverse events in this population, on the basis of guideline-recommended treatment.

Higher plasma aldosterone is associated with increased risk of cardiovascular events in hypertensive patients with suspected OSA: UROSAH data

ObjectiveTo evaluate the association of plasma aldosterone concentration (PAC) with incident cardiovascular disease (CVD) and all-cause mortality in hypertensive patients with suspected obstructive sleep apnea (OSA) and calculate the optimal cut-off value of PAC for this specific population.Patients and methodsParticipants with PAC at baseline in UROSAH in 2011-2013 were enrolled and followed up till 2021. Composite outcome included CVD and all-cause mortality. Cox proportional hazards model was used to evaluate the relationship between PAC and the composite outcome. Time-dependent ROC curve was used to determine the optimal cut-off value of PAC. Besides, we conducted subgroup analyses and sensitivity analyses.Results3173 hypertensive participants aged 18-84 years comprised analytical sample. During a median follow-up of 7.3 years and 22640 person-years, 69 deaths and 343 cases of incident CVD occurred. The incidence of composite outcome was increased with elevation in tertile of PAC. Compared with the first tertile, the risk of CVD and all-cause death was higher in third tertile (HR=1.81, 95%CI: 1.39-2.35, P<0.001). Time-dependent ROC curve showed optimal threshold for PAC was 12.5ng/dl. Whether renin was suppressed or not (≤0.5 or >0.5ng/ml per h), elevated PAC was associated with an increased risk of CVD. Our results remained stable and consistent in sensitivity analyses.ConclusionHigher PAC was associated with increased risk of CVD and all-cause mortality in hypertensives with suspected OSA, even in the absence of primary aldosteronism (PA). Hypertensives with PAC≥12.5ng/dl showed a significantly increased risk of CVD, indicating that special attention and treatment were required in this specific population.

High HDL (High-Density Lipoprotein) Cholesterol Increases Cardiovascular Risk in Hypertensive Patients.

Emerging evidence suggests that elevated circulating levels of HDL-C (high-density lipoprotein cholesterol) could be linked to an increased mortality risk. However, to the best of our knowledge, the relationship between HDL-C and specific cardiovascular events has never been investigated in patients with hypertension. To fill this knowledge gap, we analyzed the relationship between HDL-C levels and cardiovascular events in hypertensive patients within the Campania Salute Network in Southern Italy. We studied 11 987 patients with hypertension, who were followed for 25 534 person-years. Our population was divided in 3 groups according to the HDL-C plasma levels: HDL-C<40 mg/dL (low HDL-C); HDL-C between 40 and 80 mg/dL (medium HDL-C); and HDL-C>80 mg/dL (high HDL-C). At the follow-up analysis, adjusting for potential confounders, we observed a total of 245 cardiovascular events with a significantly increased risk of cardiovascular events in the low HDL-C group and in the high HDL-C arm compared with the medium HDL-C group. The spline analysis revealed a nonlinear U-shaped association between HDL-C levels and cardiovascular outcomes. Interestingly, the increased cardiovascular risk associated with high HDL-C was not confirmed in female patients. Our data demonstrate that there is a U-shaped association between HDL-C and the risk of cardiovascular events in male patients with hypertension.

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

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.

Hyperuricemia as a risk factor for cardiovascular events in hypertensive patients

Hypertension (HTN) remains one of the most important risk factors for cardiovascular events. Modification of additional risk factors, along with a blood pressure decrease, significantly affects the risk of cardiovascular events. Hyperuricemia is one of the new factors that has a high prevalence in the population and affects the risk for cardiovascular events in hypertensive patients. In the treatment with fixed-dose combinations in patients with hypertension and hyperuricemia, metabolic neutrality is of particular importance. When prescribing diuretics, the practitioner faces additional difficulties. These drugs are highly synergistic when added to other major antihypertensives’ classes, but, in some cases, may worsen the metabolic profile. The use of the thiazide-like diuretic indapamide largely avoids a negative effect on the metabolic profile, making it the preferred choice for patients with hyperuricemia.

The effect of continuing versus withholding angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers on mortality and major adverse cardiovascular events in hypertensive patients undergoing elective non-cardiac surgery: study protocol for a multi-centric open-label randomised controlled trial

BackgroundAngiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) are commonly prescribed to patients with hypertension. These drugs are cardioprotective in addition to their blood pressure-lowering effects. However, it is debatable whether hypertensive patients who present for non-cardiac surgery should continue or discontinue these drugs preoperatively. Continuing the drugs entails the risk of perioperative refractory hypotension and/or angioneurotic oedema, while discontinuing the drugs entails the risk of rebound hypertension and myocardial ischaemia. The aim of this study is to evaluate the effect of continuation vs withholding of ACEIs/ARBs on mortality and other major outcomes in hypertensive patients undergoing elective non-cardiac surgery.MethodsThe continuing vs withholding of ACEIs/ARBs in patients undergoing non-cardiac surgery is a prospective, multi-centric, open-label randomised controlled trial. Two thousand one hundred hypertensive patients receiving ACEIs/ARBs and planned for elective non-cardiac surgery will be enrolled. They will be randomised to either continue the ACEIs/ARBs including on the day of surgery (group A) or to withhold it 24–36 h before surgery (group B). The primary endpoint will be the difference in the composite outcome of all-cause in-hospital/30-day mortality and major adverse cardiovascular and non-cardiovascular events. Secondary endpoints will be to evaluate the differences in perioperative hypotension, angioneurotic oedema, myocardial injury, ICU and hospital stay. The impact of the continuation vs withholding of the ACEIs/ARBs on the incidence of case cancellation will also be studied.DiscussionThe results of this trial should provide sufficient evidence on whether to continue or withhold ACEIs/ARBs before major non-cardiac surgery.Trial registrationClinical Trials Registry of India CTRI/2021/01/030199. Registered on 4 January 2021

Association of red blood cell distribution width, systemic-immune-inflammation index and poor cardiovascular outcomes in patients with newly diagnosed hypertension

ABSTRACT Background Red cell distribution width (RDW) and the systemic immune-inflammation index (SII) have been extensively studied as predictors of morbidity and mortality in several cardiovascular diseases. This prospective study aimed to investigate the relationship between long term major adverse cardiac events (MACEs) and simple hematological parameters in hypertensive patients. Methods The study included a total of 1202 patients with newly diagnosed HT. Of the patients, 662 (55.1%) were female and 540 (44.9%) were male, with a mean age of 53.0 ± 11.4 years. The primary endpoint of the study was long term MACE, including cardiac death, stroke, and myocardial infarction. This is the first study focusing on the association of SII with major adverse cardiovascular outcomes in patients with HT. Results Eighty-nine patients (8.7%) developed at least one MACE during a mean follow-up period of 82.2 ± 1.3 months. RDW (13.0 ± 0.9 vs. 13.5 ± 1.2%, p < .001) and SII [465.0 (353.4–609.4) vs. 584.4 (468.9–794.0) x103/µL, p < .001] were significantly higher in patients with MACEs. The prevalence of MACEs was significantly higher in patients with RDW>13.1% (10.4 vs. 5%; p < .001) and in patients with SII>465 x103/µL (11.8 vs. 3.1%; p < .001). The multivariate logistic regression analysis showed SII and RDW were independent predictors of MACEs. Conclusion The results of the study demonstrated that the RDW and SII were independent predictors of long-term cardiovascular events in hypertensive patients. These simple hematological parameters may be used as prognosticators of MACE in patients with newly diagnosed HT.

THE PROGNOSTIC VALUE OF FATTY LIVER INDEX FOR CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS

Objective: The prevalence of on-alcoholic fatty liver disease (NAFLD) has been increasing rapidly worldwide affecting 25–30% of population. Fatty liver index (FLI) is a validated marker of NAFLD and can be used as a screening tool for hepatic steatosis. The purpose of the study was to evaluate the relationship between FLI and the risk of major cardiovascular events in hypertensive patients. Design and method: 903 hypertensive patients without history of cardiovascular disease participated in the study (mean age 52.7 ± 11.4 years; males 55%; baseline clinic BP 149.8 ± 15.2/95.5 ± 10.1 mmHg). Participants were prospectively evaluated for a mean follow-up period of 6.0 ± 3.3 years with at least one annual visit. The diagnosis of NAFLD was based on FLI and consequently patients were divided in two groups according to the presence of NAFLD. The primary endpoint was a composite of major cardiovascular events. Results: The incidence of cardiovascular events during the follow up was 8.5% (n = 77). Patients without NAFLD (n = 625) had better BP control compared to their counterparts with NAFLD (n = 278) during follow up (43% vs 33%, p = 0.02). A Cox-regression analysis indicated that age (HR 1.09 CI 1.04–1.13, p &lt; 0.01), smoking (HR 2.4 CI 1.1–5.2, p = 0.03) and FLI (HR 2.7 CI 1.9–4.1, p &lt; 0.001) were significant independent determinants of the outcome. The presence of NAFLD at baseline visit was also a significant independent determinant of the outcome (HR 5.2 CI 2.4–11.1, p &lt; 0.001). Conclusions: FLI has an independent prognostic value for the incidence of cardiovascular events in hypertensive patients. Therefore, it could be useful in identifying patients at higher risk of cardiovascular events. Further studies will clarify whether the early treatment of NAFLD could reduce the incidence of cardiovascular disease.