Abstract: Stillbirth remains a major global public health challenge, accounting for nearly two million deaths annually despite significant advances in antenatal and obstetric care. Reliable biomarkers for its early prediction are still lacking, highlighting the need to identify novel diagnostic strategies. Since preeclampsia and stillbirth share several underlying pathophysiological mechanisms, including placental insufficiency, impaired trophoblast invasion, endothelial dysfunction, angiogenic imbalance, oxidative stress, and systemic inflammation, biomarkers established for preeclampsia may also hold promise for stillbirth risk assessment. This tutorial review summarizes current evidence on protein- and metabolome-based biomarkers used for the early diagnosis of preeclampsia and evaluates their potential applicability for predicting stillbirth. A comprehensive literature search of Scopus, PubMed, and ScienceDirect was conducted for studies published between 2010 and 2024. Conventional fetal monitoring techniques such as ultrasonography, magnetic resonance imaging (MRI), and cardiotocography (CTG) remain valuable for assessing fetal well-being but offer limited predictive accuracy for stillbirth. Several biomarkers, including angiogenic factors (sFlt-1, PLGF, sEng), placental proteins (PP13, PAPP-A), cardiovascular markers (BNP, NT-proBNP), renal biomarkers (cystatin C), metabolic markers (uric acid), and emerging candidates such as growth differentiation factor- 15 (GDF-15), have demonstrated diagnostic value in preeclampsia. However, their clinical utility for stillbirth prediction remains insufficiently validated. Prospective studies involving dedicated stillbirth cohorts are essential to establish their predictive performance and facilitate translation into routine clinical practice.
Background: Non-dipping Blood Pressure (BP) patterns, which are highly prevalent among patients with Chronic Kidney Disease (CKD), are independent predictors of cardiovascular risk regardless of average BP levels. However, whether non-dipping independently predicts renal progression beyond overall BP burden remains uncertain. Methods: This review followed PRISMA guidelines across PubMed, Scopus, and Cochrane databases. Cohort studies evaluating non-dipping patterns using ambulatory blood pressure monitoring (ABPM) and renal outcomes in CKD were included. Result: Six cohort studies involving 4,303 patients were included. Across studies, renal outcomes appeared more strongly associated with overall BP control than with dipping status alone. Studies comparing normotensive and hypertensive groups showed that hypertensive dippers and non-dippers experienced faster renal decline and higher ESRD rates. Exploratory pooled data demonstrated that non-dipping with uncontrolled hypertension increased ESRD risk (HR 1.42; 95% CI 1.19-1.69; p < 0.0001). Among controlled patients, non-dippers with on-target BP had lower renal risk than dippers above target. Discussion: The findings suggest that the prognostic significance of non-dipping may depend on overall blood pressure control rather than dipping status alone. Among patients with uncontrolled hypertension, non-dippers appeared to be at greater risk of renal progression than dippers. Conclusion: Among patients with uncontrolled hypertension, non-dippers appeared to be at greater risk of renal progression than dippers. These findings suggest that the prognostic impact of nondipping may be influenced by overall blood pressure control and highlight the importance of achieving adequate 24-hour blood pressure control in patients with CKD.
Background: The rising incidence of congestive heart failure in younger adults, traditionally linked to older demographics, necessitates a thorough examination of relevant clinical and lifestyle factors. This study analyzes the factors influencing congestive heart failure in early adulthood, focusing on genetic predispositions, congenital cardiac defects, and acquired risk factors such as hypertension, diabetes, and obesity. Methods: An extensive and comprehensive literature search was undertaken across multiple scholarly databases, including PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar. The systematic review integrates findings from the selected relevant sources to provide a broad overview of the current state of knowledge in this field, distinguishing it from systematic reviews conducted in accordance with PRISMA guidelines. Results: Recent studies emphasize the interaction between genetic markers and environmental factors that contribute to the acceleration of cardiac dysfunction in younger populations. Prolonged diagnosis and insufficient screening expedite disease advancement, highlighting the essential need for early detection measures. Discussion: Various management approaches, including pharmacological interventions and lifestyle modifications, are examined with a focus on long-term outcomes. Preventive strategies, such as public health initiatives and patient education, are essential for reducing incidence rates. Conclusion: This review highlights the pressing need for targeted research and healthcare reforms to address the rising incidence of heart failure in early adulthood. Identifying key risk factors and promoting preventive strategies enable clinicians and policymakers to improve early intervention and patient outcomes.
One of the leading causes of mortality globally, cardiovascular diseases (CVDs) are mostly brought on by lifestyle choices such as excessive blood pressure, elevated cholesterol, insulin resistance, obesity, and poor blood flow. The potential of tea and its naturally occurring components, including theaflavins, catechins, and polyphenols, to lower these risks and promote heart health has drawn more attention from scientists. This review describes the potential of tea to affect several pathways involved in cardiovascular protection. Drinking tea regularly has been associated with improved vascular function, reduced oxidative stress, and better cholesterol levels, all of which support normal blood pressure management. Additionally, tea improves metabolic management by boosting insulin sensitivity and stabilizing blood sugar levels. Evidence of enhanced energy utilisation, higher fat metabolism, and hormonal balance pertaining to hunger and fat storage supports its involvement in weight management. Tea may also help reduce tissue damage caused by oxygen and blood flow restriction, a common problem in heart disease. Taken together, the evidence suggests that tea can serve as a simple, natural addition to a heart-conscious lifestyle. More clinical studies are necessary to confirm long-term benefits, but current findings are promising for cardiovascular support and prevention.
This review provides a general overview of the physiological effects and pharmacokinetic properties that affect the absorption, distribution, metabolism, and elimination of recently developed antihypertensive drugs, such as fimasartan, azilsartan, zilebesiran, aprocitentan, and esaxerenone. It provides an opportunity to understand the pharmacologic properties of drugs like esaxerenone, a non-steroidal selective mineralocorticoid receptor antagonist; aprocitentan, a dual endothelin receptor antagonist; and zilebesiran, a small interfering RNA (siRNA) therapeutic that inhibits hepatic angiotensinogen synthesis. Mechanistic differences among these agents are also highlighted; for instance, fimasartan and azilsartan inhibit the angiotensin II receptor, whereas other medications alter mineralocorticoid activity or endothelial pathways. The review further discusses the clinical implications of these mechanisms in hypertension management and supports informed therapeutic decisionmaking by providing a detailed understanding of the pharmacological and mechanistic profiles of these emerging antihypertensive therapies.
Myocardial infarction (MI), a major manifestation of coronary artery disease, remains a global health challenge despite significant advances in research and therapy. This review highlights current developments in diagnostic criteria, pathophysiology, treatment strategies, and emerging therapeutic targets. Type 1 MI, driven by atherosclerotic plaque rupture and thrombosis, continues to dominate, but growing recognition of type 2 MI and MINOCA (myocardial infarction with nonobstructive coronary arteries) underscores the need for refined diagnostic and therapeutic approaches. High-sensitivity cardiac troponins and advanced imaging have improved early detection, classification, and risk stratification. The management now emphasizes personalized, evidence-based care, including percutaneous coronary intervention or thrombosis, dual antiplatelet therapy, lipid-lowering agents, and cardioprotective drugs. Despite improved outcomes, challenges, such as late presentation, treatment disparities, recurrent events, and progression to heart failure, persist. A comprehensive literature search was conducted using electronic databases, such as Web of Science, Google Scholar, PubMed, SciFinder, Reaxys, and the Cochrane Library. By identifying persistent gaps, this work aimed to inform clinicians, researchers, and policymakers on innovative strategies for prevention, early detection, and optimal MI management.
Introduction: Isolated systolic hypertension (ISH) has a high mortality rate and a high prevalence of hypertension-mediated organ damage (HMODs). The aims of this paper are: (1) to search arterial hypertension (HTN) guidelines to determine whether mean blood pressure (BP) is mentioned as a treatment target for ISH patients with too-low pre-treatment dBP, and (2) to analyze whether there is a rationale for suggesting mean BP as a potential antihypertensive treatment target. Methods: We performed a search for HTN guidelines in Scopus, the Medline database, Springer Nature, Cambridge University Press, Oxford University Press, and Wiley-Blackwell. The scholarly search engine Google Scholar was also used. Results: Mean BP is already used to guide BP treatment in numerous settings, mostly in intensive care units, and guidelines recognize that mean BP can be used in several clinical scenarios to evaluate antihypertensive treatment. However, mean BP is not mentioned in half of the guidelines, and none of the 40 HTN guidelines mention mean BP as a chronic treatment target in ISH. Discussion: The main finding of this narrative review is that the problem of ISH with a too-low baseline dBP has been clearly identified but remains unresolved. This paper does not offer a definitive answer but presents an initial approach to addressing the problem. Conclusion: The problem of ISH with too-low dBP is clinically relevant, and such patients are difficult to treat. We propose mean BP for investigation and evaluation as a means of adjusting the intensity of antihypertensive treatment in large patient populations with ISH and too-low dBP.
INTRODUCTION:Hypertension is a chronic health problem affecting billions of people worldwide. Consequently, numerous studies have been conducted in the nursing field focusing on hypertension management. This study aims to conduct a bibliometric analysis of studies published between 2014 and 2024. METHODS:A detailed literature review was conducted using the RStudio Biblioshiny and VOSviewer software packages. A total of 724 studies published in journals indexed in the Scopus database were included in the analysis. RESULTS:Bibliometric data indicate that nursing research increased in parallel with the growing demand for nursing care during the COVID-19 pandemic. Furthermore, studies have focused on hypertension management across diverse patient populations. DISCUSSION:Nursing research has shown a steady increase over the years, indicating the growing importance that nurses place on hypertension management. The United States' leadership in research can be attributed to its strong research capacity and advanced healthcare system. Furthermore, the prominence of COVID-19 as a topic highlights its significant impact on nursing care. CONCLUSION:This study underscores the indispensable role of nurses in the management of hypertension. These findings can facilitate a better understanding of the current state of the literature and provide researchers with foundational data to guide future original studies on hypertension management.
INTRODUCTION:Cardiovascular Disease (CVD) continuum often begins with uncontrolled hypertension, progressing through structural/functional impairment of the cardiovascular system and atherosclerosis toward myocardial infarction, stroke, and cardiovascular death. Hypertension affects over one billion people globally, yet less than half have been diagnosed and received treatment. Suboptimal management of elevated Blood Pressure (BP) remains a challenge across low- and middle-income countries, including India. This review outlined the CVD continuum associated with hypertension, along with guideline-recommended new paradigm and emerging/ novel approaches for managing hypertension and CVD risk. METHODS:Data from PubMed and Google Scholar have been extracted using the following search terms: cardiovascular disease continuum, hypertension management, cardiovascular risk reduction, anti-hypertensive drugs, non-pharmacological approach, guideline recommendations, evolving strategies, and herbal medicine. RESULTS:A total of 101 articles, published between 2004 and 2025, were included, comprising 20 systematic reviews and meta-analyses, 27 trials, 24 research articles, 10 guidelines, 18 review articles, and 2 editorials. The evidence and guideline recommendations on clinical and therapeutic considerations for effective management of hypertension have been discussed. DISCUSSION:Several guidelines preferred initial treatment (BP threshold: 130-140/80-90 mmHg) with monotherapy (angiotensin-converting enzyme inhibitor/ angiotensin-receptor blocker/ calcium channel blocker/ diuretic/ beta-blocker) or combination therapy of two or more medications with complementary mechanisms (in a single-pill) for managing cardiovascular complications and improving treatment adherence. Beta-blockers are thought to be recommended for people with cardiovascular complications, but their effect in reducing stroke, infarction, and mortality is inferior to other drug classes. The addition of an anti-aldosterone drug to the first-line therapy is recommended for managing resistant hypertension. Recent pharmacological advancements, including anti- aldosterone agents, non-steroidal mineralocorticoid receptor antagonists, endothelin receptor antagonists, etc., have demonstrated remarkable efficacy in BP reduction with tolerable safety profiles. CONCLUSION:A holistic management strategy integrating standard medical care along with lifestyle modifications, herbal medicines, and digital health platforms could enhance treatment adherence and interrupt the CVD continuum.
Hypertension remains a major global health burden, with many patients exhibiting resistance to standard antihypertensive regimens. Oxidative stress-driven by reactive oxygen species (ROS) generated through the activation of the renin-angiotensin-aldosterone system (RAAS)-is increasingly recognized as a potential contributor to vascular dysfunction, inflammation, and elevated blood pressure. This review aims to synthesize current mechanistic evidence on the role of oxidative stress in hypertension and to evaluate clinical data on whether antioxidant interventions can mitigate hypertension and its associated organ damage. Preclinical and animal studies provide strong support for a causal link between elevated ROS, redox-sensitive signaling, and increased blood pressure, endothelial dysfunction, and end-organ injury. However, clinical trials investigating antioxidant therapies have produced inconsistent results. Differences in antioxidant type, dosage, timing, and study populations likely contribute to this heterogeneity. The discrepancy between robust mechanistic data and equivocal clinical outcomes underscores translational challenges. While oxidative stress appears to play a central role in hypertension pathophysiology, current evidence does not support the routine use of antioxidants as antihypertensive therapy. Future research should focus on welldesigned trials with standardized antioxidant regimens, stratified patient populations, and long-term follow-up to clarify whether targeting redox imbalance can yield meaningful clinical benefits.
Introduction The aim of the study was to examine the relationship between cognitive functions and gene polymorphism associated with cardiovascular risk in young adults and patients with arterial hypertension (AH). Methods The observational study involved 152 subjects, among whom there were 2 independent groups: a group of young healthy volunteers and a group of hypertensive patients. Cognitive functions were assessed using subtests 5 and 7 of the Wechsler Scale and the Bourdon test. Genetic testing was carried out for the following polymorphisms: APOC3 -482 C>T (rs2854117), PON1 L55M A>T (rs854560), and PON1 Q192R A>G (rs662). Identification of gene polymorphisms was performed via DNA pyrosequencing. Results In both groups (young individuals and patients with AH), the presence of the Q192R A>G polymorphism of the PON1 gene was associated with worse results on cognitive tests. In young people, lower levels of concentration of attention, as well as the degree of mastery of visual-motor skills, were also associated with the -482 C>T polymorphism of the APOC3 gene and L55M A>T of the PON1 gene. Discussion A relationship was identified between cognitive functions and polymorphism of genes associated with cardiovascular risk. The presence of the Q192R A>G polymorphism A allele of the PON1 gene accounted for the worst results of cognitive tests, both in young adults and patients with AH. Conclusion It should be noted that polymorphic variants of genes involved in lipid metabolism and antioxidant defense-namely, the -482 C>T variant of the APOC3 gene and the L55M A>T variant of the PON1 gene-are significantly associated with lower cognitive test scores in young individuals. The genetic analysis, including the determination of the Q192R A>G polymorphism of the PON1 gene and the -482 C>T polymorphism of the APOC3 gene, may be included in the examination of patients with arterial hypertension to predict the development of cognitive dysfunction.
Excessive sodium intake remains a critical global health concern, significantly contributing to cardiovascular diseases and associated mortality. Traditional sodium intake reduction strategies have faced limitations in accuracy, compliance, and scalability. This review explores the transformative role of artificial intelligence (AI) in sodium intake estimation and reduction, marking a paradigm shift in dietary management. AI-driven innovations-ranging from image-based nutrient analysis to machine learning models-offer real-time, personalized dietary assessments that surpass conventional methods in precision and user engagement. This review uniquely consolidates emerging AI applications, including smartphone-based sodium tracking, predictive analytics, and AIenhanced behavioral modification tools, highlighting their potential to revolutionize dietary interventions. AI-powered solutions, such as image recognition for food composition and intelligent dietary coaching, have demonstrated enhanced accuracy in sodium monitoring and behavioral adaptation. However, variations in efficacy necessitate further refinement and integration into public health frameworks. By systematically evaluating AI's capabilities and limitations in sodium management, this review underscores its potential to bridge the gap between theoretical advancements and realworld implementation. The novelty of this work lies in its comprehensive synthesis of AI applications, presenting a future-oriented perspective on how AI-driven technologies can personalize and optimize sodium intake regulation. Future research should focus on improving AI model accuracy, user engagement, and clinical applicability for widespread adoption.
INTRODUCTION:Resistant Hypertension (RH) is defined as Blood Pressure (BP) that remains uncontrolled despite the concurrent use of three antihypertensive agents from different classes, including a diuretic. This review examines the pathophysiology, diagnostic criteria, and emerging therapeutic strategies in RH management, with an emphasis on current clinical challenges and future directions. METHODS:This article is a narrative (non-systematic) review. PubMed and Scopus were searched for "English language" literature from January 2000 through June 2025, using terms including "resistant hypertension", "apparent treatment resistant hypertension", "renal denervation", "aldosterone", and "secondary hypertension". Guidelines, randomized controlled trials, and systematic reviews/meta-analyses directly relevant to the pathophysiology, diagnosis, and treatment of resistant hypertension were prioritized. Additional landmark observational studies were included when considered clinically informative. RESULTS:RH affects up to 10% of hypertensive patients globally, with higher prevalence in those with chronic kidney disease and obstructive sleep apnea. Misdiagnosis due to pseudo-resistance and poor medication adherence remains prevalent. Pathophysiology involves complex mechanisms, including sympathetic overactivity, dysregulation of the RAAS, and aldosterone excess. Diagnostic confirmation includes excluding pseudo-resistance and evaluating for secondary causes. Lifestyle modifications remain foundational. Mineralocorticoid receptor antagonists, aldosterone synthase inhibitors, renal denervation, and baroreceptor therapies show promise in treating cases resistant to other therapies. DISCUSSION:While conventional pharmacotherapy remains the cornerstone, inadequate BP control in RH necessitates a deeper understanding of underlying mechanisms and adherence assessment. Device-based approaches and emerging agents, such as zilebesiran and aprocitentan, may hold promise in revolutionizing RH management but require further validation. Limitations include a lack of large-scale comparative trials and accessibility concerns in low-resource settings. CONCLUSION:Resistant hypertension represents a multifactorial condition requiring a multidimensional diagnostic and therapeutic approach. Integrating lifestyle changes, optimized pharmacotherapy, and emerging options, including aldosterone synthase inhibition, dual endothelin receptor antagonism, small-interfering RNA strategies, and refined device-based approaches, offers incremental BP reductions in carefully selected patients. The synthesis emphasizes a pragmatic, stepwise strategy that couples adherence and secondary cause assessment with evidence-based pharmacologic intensification (notably mineralocorticoid receptor antagonists) and selective device therapy. This integrated approach may be critical for achieving durable BP control and reducing cardiovascular risk in patients with resistant hypertension.
Hypertension poses a significant global health burden due to its prevalence and serves as a major risk factor for cardiovascular diseases (CVDs) such as stroke, heart failure, myocardial infarction and renal dysfunction. Current clinical guidelines emphasize pharmacological management and lifestyle modifications. Despite the availability of effective pharmacological therapies, including diuretics, beta-blockers, calcium channel blockers, and ACE (angiotensin-converting enzyme) inhibitors, hypertension control remains suboptimal due to side effects, limited patient adherence, and the inability of single-target drugs to address the multifaceted nature of the disease. This has fuelled interest in herbal therapies as safer and more holistic alternatives, leveraging the therapeutic potential of plant-derived phytoconstituents. Medicinal plants are rich in bioactive phytoconstituents such as flavonoids, alkaloids, glycosides, coumarins, tannins, phenolic acids, and terpenes. These compounds exhibit diverse antihypertensive effects, including ACE inhibition, calcium channel blockade, vasodilation, diuretic action, and antioxidant activity. Flavonoids enhance nitric oxide (NO) bioavailability, improving endothelial function and reducing vascular resistance. Alkaloids modulate calcium channels and sympathetic activity, while phenolic acids and terpenes exhibit RAAS modulation and oxidative stress reduction. Preclinical and clinical studies have demonstrated the efficacy of these phytoconstituents in treating hypertension via various mechanisms. Advancements in research have highlighted the potential of these compounds as adjuvant therapies, offering synergistic effects when combined with standard antihypertensive treatments. Such combinations may reduce the required doses of synthetic drugs, minimize side effects, and enhance patient compliance.
INTRODUCTION:Hypertension impacts over one-third of the global population of adults and is a significant contributor to premature mortality, despite substantial progress in pharmaceutical interventions. Increasing evidence supports dietary strategies for the prevention and supplementary management of hypertension. METHODS:This systematic review was conducted in accordance with PRISMA 2020 guidelines. Literature was retrieved from PubMed, MEDLINE, and Cochrane databases for studies published between 1995 and 2025, using the keywords: "Hypertension," "DASH Diet," "Paleolithic Diet," "Ketogenic Diet," "Low-Carbohydrate Diet," "Blood Pressure," and "Cardiovascular Risk." Two investigators independently screened all titles and abstracts to determine eligibility for inclusion in the systematic analysis. RESULTS:This review examined 13 studies involving approximately 87,597 individuals to evaluate the effects of four dietary strategies, DASH, Paleolithic, low-carbohydrate, and ketogenic diets, on hypertension. The DASH diet demonstrated persistent decreases in systolic blood pressure, particularly among adults. Low-carbohydrate and ketogenic diets enhanced both blood pressure and weight in overweight persons. The Paleolithic diet, supported by the most extensive sample, demonstrated significant advantages for blood pressure and metabolic health. All diets showed potential, with the Palaeolithic and DASH diets emerging as the most effective approaches for hypertension management. DISCUSSION:Non-pharmacological dietary interventions are increasingly recognized as high-impact and sustainable strategies for the management of hypertension. This review emphasizes that dietrelated strategies, most importantly the DASH and Paleolithic diets, are providing clinically significant reductions in blood pressure and cardiometabolic risk. Short-term outcomes are encouraging, but long-term safety and compliance are important concerns, especially for the ketogenic and lowcarb diets. Variation in study quality, sample size, and measures of adherence complicates direct comparisons. Personalization and integration with lifestyle are central to outcomes. CONCLUSION:Dietary interventions showed the highest potential for blood pressure prevention and control. The DASH and Paleolithic diets offer the strongest evidence to support their usage among all the therapies studied. However, further high-quality, long-term clinical studies would be needed to support these results and give evidence-based diet recommendations. Future efforts should focus on nutritional adequacy and sustained adherence to optimize outcomes in the hypertensive population.
INTRODUCTION:Hypertensive emergencies are among the most common life-threatening acute medical conditions encountered in clinical practice. They are characterized by a sudden, severe elevation of blood pressure (systolic ≥180 mmHg and/or diastolic ≥120 mmHg) in association with acute target organ damage, leading to significant short-term mortality and long-term morbidity. In low- and middle-income regions, delayed detection, poor treatment adherence, and limited health infrastructure amplify this burden. This prospective observational study aimed to evaluate the clinical profile, organ involvement, and in-hospital outcomes of patients admitted with hypertensive emergencies to a tertiary care centre in northern India. METHODS:We enrolled 300 consecutive patients aged ≥18 years who fulfilled the diagnostic criteria for hypertensive emergencies over two years (Oct 2022-Sep 2024) at the Government Medical College, Srinagar. Demographics, medical history, presenting symptoms, blood pressure trends, target organ damage, laboratory and imaging findings, treatment measures, and outcomes were recorded. Statistical analysis was performed using SPSS v29.0 and R software, with categorical variables compared using the chi-square or Fisher's exact test, and statistical significance set at p<0.05. RESULTS:Of the 300 patients (58% men, 42% women), the predominant age group was 60-69 years (28%). Neurological involvement was the most frequent manifestation, with intracerebral haemorrhage and ischemic stroke occurring in 48% and 19% patients, respectively. Cardiac complications included left ventricular failure (15.7 %) and myocardial infarction (11.3 %). Fundoscopic changes indicative of hypertensive retinopathy were observed in 39% of the patients, and microalbuminuria was present in 28.3% of the patients. A significant proportion (72.3%) had known hypertension, although 42.4% reported poor treatment adherence. Serial monitoring revealed a consistent reduction in both systolic and diastolic pressures with prompt treatment initiation. Despite aggressive management, the in-hospital mortality rate was 21.7%, largely attributable to intracerebral hemorrhage. DISCUSSION:This study underscores the high burden of neurological, cardiac, and renal complications in hypertensive emergencies, with intracerebral hemorrhage emerging as the most frequent manifestation, in contrast to Western patterns, where ischemic events predominate. These findings highlight the impact of delayed diagnosis, limited access to emergency care, and suboptimal BP control. The high prevalence of target organ damage reflects chronic, uncontrolled hypertension and predicts adverse outcomes. Strengthening community screening, ensuring effective treatment adherence, and improving acute care capacity are essential for reducing mortality and morbidity in resource-limited settings. CONCLUSION:Hypertensive emergencies remain a public health challenge that requires timely recognition, aggressive management, and preventive strategies.
Introduction Hypertension is associated with hemostatic disorders and endothelial dysfunction. Understanding hemostatic potential and endothelial function under antihypertensive pharmacotherapy can help personalize treatment and reduce the risk of thrombotic complications. To conduct a comparative analysis of endothelial function and hemostatic potential in hypertensive patients receiving different types of pharmacological therapy.Methods This cross-sectional study included 185 patients diagnosed with hypertension. Participants were divided into four groups based on their therapy regimen: Group 1-no therapy, Group 2-monotherapy, Group 3-two-drug therapy, and Group 4-three-drug therapy. Differences in hemostatic potential and endothelial function, assessed using piezothromboelastography and the Celermajer DS test, were analyzed using the Kruskal-Wallis and Mann-Whitney tests.Results Piezothromboelastography revealed a progressive increase in maximum clot density amplitude (MA) from Group 1 to Group 4: 502 (437.75; 556.75) rel. units (Group 1), 525 (463; 572) rel. units (Group 2), 577 (536; 628) rel. units (Group 3), and 596 (504; 651) rel. units (Group 4) (p = 0.0001). The Celermajer DS test indicated the highest degree of endothelial dysfunction in Groups 3 and 4: 10.87 (7.14; 17.02) % and 7.84 (5; 9.76)% respectively (p = 0.006).Discussion In Group 1 the low frequency of endothelial dysfunction and "normocoagulation" status is determined by the duration of the disease. In Group 2, the endothelium protective effects of monotherapy reduce the incidence of endothelial dysfunction. However, in Groups 3 and 4 a chronometric hypocoagulation shift was observed.Conclusion Despite achieving target blood pressure, patients on combination antihypertensive therapy exhibit a procoagulant state and persistent endothelial dysfunction. These findings may guide the use of antithrombotic or vasoprotective therapies to prevent thrombohemorrhagic complications.
Introduction Asymmetric Dimethylarginine (ADMA), a natural NO production inhibitor, is a key indicator of endothelial dysfunction. ADMA damages vessels and endothelial function by inhibiting NO-mediated vasodilation. Periodontal disease and cardiovascular diseases, especially CHD, share risk factors and inflammatory pathways, suggesting a mechanistic relationship. ADMA may be a molecular mediator between periodontitis and cardiovascular disease. This study examines serum ADMA levels as a biomarker of endothelial dysfunction in periodontitis and CHD patients. The study also examines lipid profile and periodontal factors to better understand the complex relationship between dental and cardiovascular health. Methods In this case-control study, after the attainment of FRC and ERC approval, 22 subjects with Chronic Periodontitis (CP), 22 subjects with Coronary Heart Disease (CHD), 22 subjects with both periodontitis and Coronary Heart Disease (CHD), and 22 systemically healthy individuals aged between 30 and 60 years were recruited. All the male and female individuals were selected on the basis of inclusion criteria prior to taking written informed consent. The clinical and periodontal parameters (plaque index, probing depth, clinical attachment level, and bleeding on probing) were assessed in the participants of the study. The overnight fasting blood samples of patients were obtained for analysis of ADMA, C-reactive protein, and total cholesterol and triglycerides. Results The results were analyzed with SPSS version 23.0. Adma was significant in all the groups (CP, CHD, CP+CHD, and controls). Subsequently, the levels of TC and hs-CRP were significantly different among the groups. The periodontal clinical parameters, which include the number of teeth, PD, CAL, BoP%, and PI, were also significant among all the groups (p<0.05). Multivariate regression analysis showed a significant positive association for the case groups (CP, CHD, and CP+CHD) for ADMA. Discussion Chronic periodontitis patients, especially those with coronary heart disease, have raised ADMA levels and systemic inflammatory markers, according to the study. These data suggest that chronic periodontal inflammation may cause endothelial dysfunction, connecting oral and cardiovascular illness. The cumulative impact in the CP+CHD group shows that periodontal and vascular inflammation work together. Thus, elevated ADMA may identify cardiovascular-risk periodontitis patients.Conclusion Our results specified that serum ADMA levels may be a valuable measure of endothelial dysfunction in individuals with periodontal disease and coronary heart disease.
