INTRODUCTION:Calcium channel blockers (CCBs), such as nifedipine, are commonly used to treat hypertensive disorders of pregnancy (HDP). With the withdrawal of Nifedipine-RETARD and the limitations in compounding formulations, the off-label use of amlodipine (AML) has increased. The primary objective of this study was to describe the frequency of AML use, while the secondary objective was to outline the professional profile of the surveyed physicians. MATERIALS AND METHODS:A descriptive, observational, cross-sectional study conducted in 2024 using closed digital surveys. The target population included physicians of both sexes involved in the care of HDP in Argentina, with access to electronic devices and the Internet. The survey was developed by the Working Group on Hypertension in Women of the Argentine Society of Hypertension (SAHA) and validated by experts. It was distributed through social networks and SAHA's email list. RESULTS:A total of 276 physicians were surveyed, with a mean age of 49.6±11.5 years, 46.6% of whom were women. Among the respondents, 213 (77.1%) used CCBs to treat HDP, and 176 (63.8%) reported prescribing AML. Of those prescribing AML, 51% were general practitioners, 12% cardiologists, 22% obstetrician-gynaecologists, and 14% belonged to other specialties. The initial dose reported was 5mg/day in 82.4% of cases. The main reasons cited for not prescribing AML were lack of experience (44.4%) and perceived insufficient scientific evidence (28.9%). CONCLUSIONS:The use of AML was frequent, with 6 out of 10 surveyed physicians reporting its use.
INTRODUCTION:The relationship between the American Heart Association's (AHA) new Predicting Risk of cardiovascular disease EVENTs (PREVENT) risk and long-term disease progression, like mortality, is unresolved. We investigated the associations of PREVENT cardiovascular disease (CVD) risk with all-cause, CVD, and non-CVD mortality among adults in the US. METHODS:This cohort study used data from 30,544 adults from 2003-2018 survey cycles of the National Health and Nutrition Examination Survey and linked to the mortality data until 2019. All-cause mortality, further stratified into CVD and non-CVD mortality, were defined by the leading cause of death using the International Classification of Diseases codes. Employing PREVENT's base model and component variables, we estimated 10-year total CVD risk stratified into low (<5%), borderline (5-7.4%), intermediate (7.5-19.9%), and high (≥20%). Multivariable Cox proportional hazards regression (hazard ratio [HR] and 95% confidence interval [CI]) analyses were used. RESULTS:Participants' mean±SD age was 50.3±13.1 years, with a balanced sex distribution. Compared to individuals with low CVD risk, those with borderline and intermediate risks had a greater risk of all-cause mortality (HR [95% CI], 1.08 [1.03-1.13] and 1.12 [1.08-1.16], respectively). Those with borderline, intermediate, and high risks had a greater risk of CVD mortality (HR [95% CI], 1.11 [1.06-1.16], 1.21 [1.18-1.25], and 1.40 [1.33-1.47], respectively), compared to low-risk individuals. Similar trends were observed for non-CVD mortality. With significant racial/ethnic group-interactions, the associations were evident in Mexican Americans. CONCLUSIONS:Higher PREVENT 10-year CVD risk is associated with higher risk of all-cause, CVD, and non-CVD mortality, and the associations differ by race/ethnicity.
Tobacco use is the leading cause of preventable diseases, disability, and death in Spain, causing 56,124 deaths annually, one-third of which are due to cardiovascular disease. The aim of this study is to review the relationship between the use of novel products and vascular risk and other health risks, as well as their impact on cessation and harm modification. Searches were conducted in PubMed, Tripadatabase.com, Truth Tobacco, Industry Documents, and Tobacco Tactics. There is some evidence that the harm of these products is less than the individual harm by cigarettes at vascular, cardiorespiratory, and metabolic levels. There is no evidence that replacing cigarettes with novel nicotine products reduces overall harm because: (a) they promote dual smoking in most users; (b) they increase vulnerability to relapse; (c) they delay or prevent cessation of nicotine addiction; and (d) they facilitate the transition to tobacco use in minors.
INTRODUCTION AND OBJECTIVES:Obesity has been considered the pandemic of the 21st century due to its high prevalence and the significant morbidity and mortality it entails. The aim of this study is to assess the prevalence of obesity in two occupational sectors and to determine the variables associated with it. METHODOLOGY:This is a cross-sectional and descriptive study involving 56,856 workers from the commerce and industrial sectors. Anthropometric, clinical, analytical, and sociodemographic data were collected during medical examinations conducted between 2017 and 2019. RESULTS:The prevalence of obesity was found to be significantly higher in the industrial sector compared to the commerce sector. Factors such as age, sex, educational level, physical activity, adherence to the Mediterranean diet, and smoking showed significant associations with the four scales of excess weight evaluated. Among these, age, physical activity level, and adherence to the Mediterranean diet demonstrated the strongest associations. In the industrial sector, obesity may be related to work-related stress, prolonged shifts, and limited access to healthy food, whereas in the commerce sector, sedentary behaviour and poor dietary habits were identified as key contributing factors. CONCLUSIONS:Specific strategies tailored to each occupational sector are recommended, including active breaks, the promotion of physical activity, and access to healthy foods. While the study has strengths such as its large sample size and multivariate analysis, the cross-sectional design and lack of control for certain confounding variables limit its ability to establish causality. The findings underscore the need for preventive policies adapted to workplace environments to mitigate the impact of obesity.
Patient with classic cardiovascular risk factors under treatment and apparently well controlled, with good adherence to the treatment, but with repeated acute coronary syndromes. After investigating these risk factors, arterial hypertension secondary to undiagnosed sleep apnoea-hypopnoea syndrome was detected. In addition, the patient's residual risk was addressed, prescribing treatment for his atherogenic dyslipidaemia and, in addition, elevated levels of lipoprotein (a) were discovered. This case illustrates holistic patient management, which involves actions to improve the patient's prognosis.
Hepatic steatosis is classified into several types according to its aetiology: metabolic; alcohol-related; metabolic with moderate alcohol consumption; associated with drugs or monogenic diseases, and cryptogenetic. An infrequent form of presentation is focal multinodular, and should be included in the differential diagnosis of solid liver lesions, which may simulate solid metastases. Magnetic resonance imaging is essential to identify the fat content and avoid unnecessary scans and invasive procedures such as biopsies. Focal multinodular hepatic steatosis is associated with vascular and metabolic risk factors, such as obesity, type 2 diabetes mellitus, and dyslipidemia. Treatment is based on modifying and controlling these underlying metabolic risk factors, with weight loss, a balanced diet, and regular physical activity being key strategies for lesion regression.
A 10-year-old boy with a history of febrile urinary tract infections presented with a hypertensive crisis and thrombotic microangiopathy (TMA). Functional and genetic complement testing was normal, and TMA resolved with blood pressure control, suggesting a primary hypertensive aetiology. Renal biopsy confirmed chronic tubulointerstitial nephritis (CTIN), likely secondary to recurrent pyelonephritis and renal scarring after ruling out other potential causes. High-grade vesicoureteral reflux was confirmed by voiding cystourethrography. After 4 years, he has progressed to stage III chronic kidney disease, and his blood pressure is well controlled on enalapril. This case highlights the importance of early diagnosis and blood pressure monitoring in patients with renal scarring to prevent severe complications like hypertensive crises and irreversible renal damage.
PURPOSE:Hypercholesterolemia represents a major risk factor in the onset and progression of cardiovascular diseases. While statins have long been the cornerstone of low-density lipoprotein cholesterol (LDL-C) reduction, the occurrence of adverse events associated with their use has prompted the development and adoption of alternative lipid-lowering agents. These include ezetimibe, bempedoic acid, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, such as alirocumab, evolocumab, and inclisiran. METHODS:This study aims to assess and compare the consumption patterns and associated costs of lipid-lowering medications during the first half of 2023 and 2024. The objective is to evaluate the economic implications of emerging therapies in the management of dyslipidemia and the extent of adherence to clinical guidelines. Data were collected from both private community pharmacies and public healthcare facilities, including hospital and district pharmacies. Drug utilization was analyzed using the Anatomical Therapeutic Chemical (ATC) classification system and expressed in defined daily doses (DDD). RESULTS:Findings indicate a declining trend in the use of traditional statin monotherapy, accompanied by an increase in the uptake of newer and combination therapies. Statin use declined significantly, from 42% in the first half of 2023 to 30% in the corresponding period of 2024. The use of combination therapy involving statins and ezetimibe remained stable at 17% across both timeframes. In contrast, PCSK9 inhibitors showed a notable rise in use, increasing from 33% to 40% between the two periods. The utilization of bempedoic acid, whether as monotherapy or combined with ezetimibe, remained marginal, consistently below 2%. CONCLUSION:The therapeutic landscape for dyslipidemia has evolved substantially in recent years with the introduction of multiple novel agents. Among these, bempedoic acid, characterized by a more favorable cost profile, may serve as a valuable adjunct to statins and ezetimibe, potentially enhancing therapeutic outcomes and minimizing adverse effects-thus delaying or avoiding the need for more costly injectable treatments such as evolocumab, alirocumab, and inclisiran. Ongoing monitoring of prescribing trends and expenditure is crucial to ensuring the sustainability of healthcare systems, facilitating the adoption of innovative and effective treatments while preventing unnecessary resource allocation.
A 25-year-old female was admitted to hospital due to a hypertensive crisis, presenting with ventricular dysfunction and renal impairment. Initial evaluations revealed a left ventricular ejection fraction of 46% with baseline inferolateral intramyocardial enhancement and a creatinine clearance of 45mL/min/1.73m2, with proteinuria. Further investigations led to diagnosis of primary hyperaldosteronism (PA), with computed tomography demonstrating bilateral adrenal hyperplasia. After a nine-month treatment period with spironolactone, there was a complete reversal of ventricular dysfunction and fibrosis, and improvement in renal function. This case highlights the importance of early screening and appropriate treatment of PA to mitigate and potentially reverse end-organ damage.
Psychosocial stress can result from a wide variety of causes and circumstances. The experience of stress is often unique and highly personal, but with common physiological responses. It is expected to increase in the modern world, which is undergoing rapid social, cultural and technological change. In this narrative review we present psychosocial factors impacting hypertension (HT) and vascular risk (VR) and propose strategies for detection and management of their main clinical consequences. Psychosocial stress more than doubles the risk of HT, with work-related stress and low socioeconomic status being the most related factors. The factors most strongly associated with increased VR were informal care of dependents, lower socioeconomic status, marital status (single, divorced or widowed) and loneliness. Individual and collective psychosocial stress prevention strategies may be crucial in reducing the prevalence of HT and VR.
Blood pressure oscillations during different time scales, known as blood pressure variability, have become a focus of growing scientific interest. Blood pressure variability can be measured at long-term (seasonal variability or visit-to-visit), at mid-term (consecutive days or weeks) or at short-term (day-night differences or changes induced by other daily activities and conditions). An increased blood pressure variability, either at long, mid, or short-term is associated with a poor cardiovascular prognosis independently of the amount of blood pressure elevation. There is scarce evidence on the effect of different antihypertensive treatments on such variability, but some observational and interventional studies suggest that reduction in blood pressure variability, and indirectly, increase of the time in therapeutic range, has a beneficial effect on cardiovascular prognosis. Antihypertensive drugs with a longer duration, and specifically, some calcium channel blockers, might represent an advantage.
Hypertensive disorders of pregnancy (HDP) affect 5-10% of pregnancies. Preeclampsia (PE) is a severe complication of HDP, associated with high maternal, fetal, and neonatal morbidity and mortality. The pathophysiology of PE involves endothelial dysfunction, vasoconstriction, and impaired placental perfusion, leading to systemic inflammation and multi-organ dysfunction. It has been suggested that statins, traditionally contraindicated during pregnancy, could play a role in this context. Some studies propose that pravastatin, a hydrophilic statin, may not have the same teratogenic effects as lipophilic statins, potentially improving maternal vascular status and significantly reducing the risk of PE. Considering this, the Working Group on Hypertension in Women of the Argentine Society of Hypertension undertook a review of the topic and its current implications.
Diastolic dysfunction (DD) refers to impaired relaxation or filling of the ventricles during the diastolic phase of the cardiac cycle. Left ventricular (LV) DD is common in hypertensive individuals and is associated with increased morbidity and mortality, particularly heart failure with preserved ejection fraction (HFpEF). The pathophysiology of DD involves alterations in cardiac structure and function, neurohormonal activation, and vascular stiffness. Diagnosis is primarily based on echocardiography, and there are no specific treatment guidelines. Recently, treatments such as sodium-glucose cotransporter 2 inhibitors (SGLT2i), GLP-1 receptor agonists, and finerenone have emerged, which may offer benefits in diastolic dysfunction and HFpEF. This review aims to present the pathophysiological mechanisms of DD in hypertension (HTN), its diagnosis, and its treatment.
Vascular risk is higher in patients with rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis than in the general population. In addition to classical vascular risk factors, chronic inflammation plays a crucial role in increasing this risk. In rheumatoid arthritis, the prevalence of hypertension is 41%. Moreover, the prevalence of hypertension has been associated with the duration of spondyloarthritis, as well as the presence of severe psoriasis in psoriatic arthritis. Although some drugs used in the treatment of inflammatory arthritis, such as NSAIDs, glucocorticoids, and Jakinibs, have been associated with an increased vascular risk, their ability to reduce inflammatory activity contributes to a decreased vascular risk in these patients. These drugs should be used with caution, and risk stratification should be performed in patients with vascular risk factors.
The following article is a narrative review on isolated nocturnal hypertension, conducted up to July 2024, with a search for primary and secondary articles in MEDLINE, LILACS, and gray literature. This review highlights aspects related to its current definition, epidemiology, and associated populations and risk factors, as well as specifics regarding its diagnosis, prognostic importance for target organ damage and cardiovascular events/mortality, and potential treatments. This condition has particular aspects and, although it is not very common in the general population, it reaches high prevalence in some at-risk populations. To date, there is much debate and many issues to investigate regarding diagnostic aspects, as well as its heterogeneity and clinical significance, which indicate different prognoses. Therapeutic aspects are even more a matter of debate, necessitating future research.
Atherosclerosis is the underlying disease in the entire spectrum of atherosclerotic vascular disease. Point of care ultrasound is a useful tool for its detection. Current guidelines recommend the use of scales such as SCORE 2 and SCORE 2OP in apparently healthy individuals and in those at intermediate-low risk, they recognize the role of the arterial plaque by ultrasound to refine risk stratification and the need for more aggressive preventive strategies. However, the way to evaluate the vascular territories in which there is presence of plaque, the amount or load of plaque is not homogeneous nor is it well protocolized. In this document, 2 protocols are proposed for the evaluation of vascular risk, VASUS and VASUS+, including the presence of ventricular hypertrophy with the objective of homogenizing clinical ultrasound in the assessment of vascular risk in clinical practice.
INTRODUCTION:Prehypertension and high normal blood pressure (HNBP) are important risk factors for the development of hypertension and cardiovascular diseases. However, their prevalence in Latin America has not been systematically evaluated. OBJECTIVES:To determine the prevalence of prehypertension and HNBP in Latin America through a systematic review and meta-analysis. METHODS:A systematic search was conducted in electronic databases until September 24, 2024. Observational studies with probabilistic sampling that reported the prevalence of prehypertension or HNBP in adult Latin American populations were included. Random-effects models were used for the meta-analysis, and subgroup analyses and meta-regression were performed. RESULTS:A total of 17 studies (n=227,741) from 7 countries were included. The pooled prevalence of prehypertension was 27.98% (95% CI: 21.17-35.34%), with significant heterogeneity (I2=100%, p<0.01). The prevalence of HNBP was 19.23% (95% CI: 11.43-28.49%). Considerable variations were observed between countries, with prehypertension prevalence ranging from 3.55% in Cuba to 46.10% in Puerto Rico. Meta-regression analyses identified a slight decreasing trend in prehypertension prevalence over time and with increasing sample size. CONCLUSION:This study reveals a high prevalence of prehypertension and HNBP in Latin America, with significant variations between countries. These findings underscore the need for tailored public health strategies to prevent and manage these prehypertensive states early in the region.
