Environmental pollution-including air, noise, and light-and progressive climate change are major contributors to global health burdens, responsible for over 9 million premature deaths annuallysa. Among environmental exposures, air and noise pollution show the strongest epidemiological links to hypertension and cardiovascular disease, while emerging evidence also implicates light pollution, toxic metal exposure, and climate-related factors. Hypertension, the leading global cause of mortality, is increasingly recognized as a sentinel marker of environmental damage. Fine particulate matter (PM2.5) and road traffic noise exposure are associated with significant increase in hypertension prevalence and incidence. While historical guidelines overlooked environmental contributors, recent updates by the European Society of Hypertension (ESH) and European Society of Cardiology (ESC) have integrated environmental risk factors into hypertension management frameworks. This position paper from the ESH Working Group on Environment and Hypertension synthesizes current evidence on the epidemiology and pathophysiology of environmental pollution in the development of hypertension. It highlights the mechanistic pathways involving oxidative stress, vascular dysfunction, and neurohormonal dysregulation triggered by pollution exposure. Importantly, the paper outlines mitigation strategies at both population and individual levels, including legislative initiatives, urban planning, and personal exposure reduction techniques. Considering hypertension as an early manifestation of environmental harm offers a critical opportunity for preventive intervention. It is vital to emphasize strict blood pressure control, enhanced screening in high-risk populations and the integration of environmental exposure monitoring into clinical practice. This comprehensive document seeks to raise awareness among healthcare professionals and inform evidence-based strategies for reducing pollution-related hypertension and cardiovascular morbidity.
Introduction: The appropriate use of antibiotic prophylaxis (AP) in surgical procedures is an ongoing debate. There is a lack of evidence, and urological guidelines provide limited, procedure-specific recommendations. Our aim was to develop a generic model of an audit to define the need for AP in urological procedures, as well as in other surgical specialties. Material and Methods: Based on our experience with the Global Prevalence of Infections in Urology (GPIU) study and a literature review, we defined benchmark standards for 30-day infection rates, including sepsis, and estimated the number of patients needed to be included in a comparative study of AP versus no AP for a surgical procedure within one year. The generic study model was developed during a modified consensus process within the UTISOLVE research group. Urology departments giving and not giving AP were invited to join our development project as an extension of GPIU. Results: Radical prostatectomy was used as a model procedure. Ca. 60 urology centers performing more than 50 radical prostatectomies per year signed up. There was variation in AP practice among sites. Our own review showed that infection rates were ca. 5%, with severe infections, including sepsis, occurring in <0.5% of cases. A sample of 1825 patients would be required to achieve a 95% confidence interval half-width of ±1.0% for general infections. For sepsis, assuming an incidence of 0.5%, a sample of 2124 patients would be needed to reach a 95% confidence interval precision of ±0.30%. Enrollment of 2070 consecutive procedures would be needed to yield precisions of ±0.94% for infection and ±0.30% for sepsis. Based on the number of procedures performed and the number of interested study sites, we agreed on a prospective, multi-center, non-interventional service evaluation, expected to collect standardized data over a 3-month period. The primary outcome was defined as the 30-day incidence of infectious complications. All patients will undergo 30-day post-procedure follow-up through routine clinical care pathways. Conclusions: Our audit model is based on benchmarking of relevant outcomes. It defines how to assess AP in surgical procedures and clarifies a series of issues necessary to defend the status of a generic study model. We regard DEEP-URO to be a comprehensive, multi-center-based initiative that will help balance infection prevention with antimicrobial stewardship and improve the quality of clinical practice and personalized medicine.
Die linksventrikuläre Druck-Volumen-Beziehung ist ein Kernkonzept der Herzphysiologie, das durch das nichtlineare Verhalten des Herzens gekennzeichnet ist, bei dem eine erhöhte Vorlast zu einer größeren Kontraktionskraft führt. Die endsystolische Druck-Volumen-Beziehung (ESPVR) definiert die maximale Kontraktilität des Ventrikels. Ihre Steigung, die endsystolische Elastanz (Ees), dient als lastunabhängiger Marker für die Kontraktilität.
Arterial waveforms are altered in left ventricular systolic dysfunction. We aimed to investigate the diagnostic implications of automatically analyzed pressure waveforms and their changes over time in patients with reduced ejection fraction (EF). Arterial waveforms were recorded noninvasively using applanation tonometry in patients with heart failure with reduced ejection fraction (HFrEF) and in matched controls. Waveform parameters were analyzed with respect to the left ventricular ejection time index (LVETI), the characteristics of antegrade and reflected waves, their interaction as quantified by the augmentation index, and wave intensity, expressed as the ratio of the S and D peak intensities (SDR). Overall, 78 HFrEF patients [ejection fraction (EF) 28 ± 9%] and 78 controls (EF 66 ± 8%), matched for sex, age, presence of hypertension and diabetes, systolic and diastolic blood pressure, and heart rate, were included. All waveform parameters were statistically different between patients and controls. In receiver-operator characteristic (ROC) analysis, HFrEF patients and controls could be separated best using LVETI [area under the ROC curve (AUC) 0.897; P < 0.0001] and SDR (AUC 0.911; P < 0.0001). In newly diagnosed and treated HFrEF patients, the AUC for discrimination between HFrEF patients and controls was almost ideal (0.978; P < 0.0001), when a combination of LVETI and SDR was used. Finally, in 46 HFrEF patients with available follow-up (FU) data, concordance analysis showed a high agreement of up to 0.8 between changes in the cardiac function (e.g., using EF) and changes in several waveform parameters. Pulse waveform parameters may be useful for screening and follow-up of patients with HFrEF.NEW & NOTEWORTHY Arterial pulse waveforms carry distinct signatures of heart failure with reduced ejection fraction (HFrEF). In this study, tonometry revealed differences in waveform timing, wave reflection, and wave intensity between HFrEF patients and matched controls. Combining left ventricular ejection time index and wave intensity ratios enabled near-perfect discrimination in newly diagnosed patients and closely tracked longitudinal changes in cardiac function. These findings highlight pulse waveform analysis as a promising tool for HFrEF screening and follow-up.
