The aim of the present study was to compare the effects of dalcetrapib and voxelotor on the rheology of red blood cells (RBCs) from sickle cell patients, as well as on hemoglobin oxygen affinity. Oxygen gradient ektacytometry was used to determine RBC deformability in normoxia and hypoxia, as well as the propensity of RBCs to sickle. Hemoglobin oxygen affinity was also measured following dalcetrapib and voxelotor incubation. Both voxelotor and dalcetrapib increased RBC deformability in hypoxia and decreased the propensity of RBCs to sickle under deoxygenation. However, in contrast to voxelotor, the affinity of hemoglobin S (HbS) to oxygen was not affected by dalcetrapib. The combination of both voxelotor and dalcetrapib led to greater RBC rheological improvement. Our findings suggest that dalcetrapib could inhibit RBC sickling during deoxygenation.
Background:Intradialytic hypotension (IDH) is a frequent complication of hemodialysis that is associated with adverse cardiovascular consequences. The contribution of right ventricular (RV) functional reserve to hemodynamic stability during dialysis remains unclear. We investigated whether dynamic changes in RV strain are associated with IDH. Methods:In this prospective single-center study, 50 patients with end-stage renal disease undergoing maintenance hemodialysis underwent comprehensive echocardiography with speckle-tracking analysis immediately before and after dialysis. IDH was defined as a decrease in systolic blood pressure (SBP) of ≥ 20 mmHg from pre- to post-dialysis. Right ventricular free wall strain (RVFWS) was analyzed offline by a blinded specialist. Changes in RVFWS were compared between patients with and without IDH, and correlations between SBP change and RVFWS change were assessed. Results:In the analyzed 33 patients, 15 patients (45%) developed IDH. Baseline clinical characteristics, ultrafiltration volume (mean, 2.9 L), and pre-dialysis SBP were comparable between groups. Left ventricular ejection fraction was preserved in most patients, and baseline RVFWS did not differ significantly. However, the IDH group showed a significantly greater post-dialysis reduction in RVFWS than the non-IDH group (-7.0 ± 7.2% vs. -1.7 ± 4.6%, P = 0.017). Moreover, the magnitude of SBP decline correlated moderately with the decrease in RVFWS (r = 0.50, P = 0.003). Receiver operating characteristic analysis suggested a modest discriminatory ability of dialysis-induced changes in RVFWS for IDH (area under the curve, 0.74; 95% confidence interval, 0.56-0.92). Conclusions:IDH was associated with a greater dialysis-induced decline in RVFWS despite similar baseline RV function, suggesting that acute volume unloading may unmask impaired RV contractile reserve. These findings provide preliminary evidence that dynamic RV strain assessment could help identify patients vulnerable to intradialytic hemodynamic instability, warranting further validation in larger studies.
Background:Evidence shows that the weekend warrior physical activity (PA) pattern (1-2 days/week) is associated with a lower risk of hypertension, but it is unclear whether this association differs by socioeconomic status (SES). This study aimed to examine whether the association between the weekend warrior PA pattern and prevalent hypertension differs according to SES in Korean adults. Methods:We analyzed 28,039 adults (aged ≥ 19 years) from the 2018-2023 Korea National Health and Nutrition Examination Survey. PA patterns were categorized as inactive, insufficiently active, weekend warrior, or regularly active. Educational attainment (high school or less vs. college or higher) and household income (Q1-Q2 vs. Q3-Q4) were used as proxies of SES. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, a physician diagnosis, or use of antihypertensive medication. Multivariable logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for prevalent hypertension across PA patterns, stratified by educational attainment and household income level. Results:Among 28,039 adults, 8,842 (31.5%) had hypertension. In multivariable-adjusted models, compared with inactive participants, insufficiently active (OR, 0.85; 95% CI, 0.77-0.93), weekend warrior (OR, 0.74; 95% CI, 0.59-0.92), and regularly active (OR, 0.84; 95% CI, 0.77-0.91) PA patterns were each associated with lower odds of prevalent hypertension. There was no significant educational attainment-by-weekend warrior interaction for prevalent hypertension (P for interaction = 0.349), whereas a significant household income-by- weekend warrior interaction was observed (P for interaction = 0.049), with a more pronounced inverse association among lower-income adults. Conclusions:PA patterns, including the weekend warrior pattern, were associated with lower odds of prevalent hypertension among Korean adults. The inverse association between the weekend warrior pattern and hypertension appeared to differ by household income level, with a more pronounced inverse association among lower-income adults. Further studies in large longitudinal cohorts are warranted to confirm these findings.
Background:Assessing adherence to antihypertensive medication remains a major challenge for healthcare professionals. The objective of this study was to compare the evaluation of adherence to antihypertensive medication between direct and indirect methods, and to identify variables associated with nonadherence. Methods:A cross-sectional study was conducted with 253 persons with hypertension followed at a hypertension unit of a tertiary teaching hospital. Participants aged over 18 years and under antihypertensive drug treatment were included. Persons with secondary hypertension, end-stage chronic kidney disease, or pregnancy were excluded. Biopsychosocial, anthropometric, lifestyle, comorbidity, and medication data were collected. Indirect assessment of treatment adherence was performed using the 4-item Morisky-Green Medication Adherence Scale, while direct assessment was based on urine analysis using high-performance liquid chromatography coupled with mass spectrometry. Variables with P < 0.20 in the bivariate analysis were included in the multiple logistic regression model. The significance level was set at 5%. Cohen's Kappa coefficient (CKC) was used to assess agreement between the methods. Results:The sample consisted predominantly of women (61.7%), white individuals (63.2%), and married participants (52.8%), with a mean age of 65 ± 13.3 years and median education of 12.0 (7-12) years. Participants were using an average of 3.2 ± 1.3 antihypertensive drugs, and 69.2% had controlled blood pressure (BP). The prevalence of adherence according to the direct method was 32.4%, while 90.1% were adherent according to the indirect method. Agreement between the direct and indirect methods was low (CKC = 0.014). Variables independently associated with nonadherence according to the direct method were regular physical activity (odds ratio [OR], 0.370; 95% confidence interval [CI], 0.158-0.853), proteinuria (OR, 2.406; 95% CI, 1.066-5.751), number of antihypertensive medications (OR, 1.570; 95% CI, 1.127-2.225), and systolic BP (OR, 1.051; 95% CI, 1.010-1.097). Indirect adherence assessment was associated only with the presence of common mental disorders (OR, 1.163; 95% CI, 1.035-1.307). Conclusions:The prevalence of adherence to antihypertensive drug treatment assessed by the indirect method was substantially higher than that observed with the direct method. The results were inconsistent between the 2 approaches. Moreover, the direct method identified a broader range of variables associated with nonadherence.
Background: Although it is well-known that immune cells such as monocytes or macrophages play important roles during the early phase of inflammatory response following cardiac damage, little is known about the role of immune cell-derived exosomes, especially their contents such as micro RNAs (miRNAs), in the immune cell-mediated regulation of cardiac remodeling. This study investigated the role of macrophage-derived exosomal miR-210-3p, which was found to be increased following cardiac damage, on cardiac fibroblast activation using a rat myocardial infarction (MI) model. Methods: Cell population change in the heart following MI was assessed by single cell analysis. Differentially expressed miRNAs in the exosomes derived from THP-1 cultured under hypoxia/ischemia condition was evaluated by miRNA sequencing. The effect of macrophage exosome enriched miR-210-3p on cardiac fibroblast was examined. The effect of anti-miR-210-3p administration on the MI-induced cardiac fibrosis, cardiac function, and macrophage infiltration were evaluated. Results: Macrophages were identified as the major type of immune cells present in the ischemic tissue following MI. miR-210a-3p was one of the 10 miRNAs increased (>10-fold) in THP-1 in response to hypoxia/ischemia condition, and it exerted pro-fibrotic effect in cardiac fibroblasts. Conditioned media of THP-1 cultured under hypoxia/ischemia condition also activated cardiac fibroblasts, and this was abrogated by anti-miR-210 treatment. Intramuscular injection of anti-miR-210-3p improved cardiac fibrosis and cardiac function 14 day after MI. Conclusions: Macrophage derived exosomes were enriched with miR-210-3p under hypoxia/ischemic condition, and they activated cardiac fibroblast. Suppression of miR-210-3p improved cardiac fibrosis and cardiac function following MI. Macrophage-derived exosomal miR-210-3p may play a significant role in the regulation of early inflammatory response following cardiac injury.
Vascular aging represents the common pathological basis of aging-related diseases, with vascular smooth muscle cells (VSMCs) senescence playing a pivotal role. P300/CBP-associated factor (PCAF), a transcriptional coactivator linked to diverse physiological processes, has an undefined role in VSMCs aging. This study investigated PCAF's function in VSMC senescence and its underlying mechanisms. Using siRNA adenovirus to downregulate PCAF and angiotensin II (AngII) to induce senescence, we assessed β-galactosidase activity, senescence-associated secretory phenotypes (SASP), and cell cycle proteins (p53, p21, p16). Transcriptomic analysis revealed PCAF's association with oxidative stress and the Nrf2-ARE pathway. Results demonstrated that PCAF downregulation significantly attenuated VSMCs senescence and AngII-induced oxidative stress by enhancing Nrf2-ARE pathway activity. Crucially, Nrf2 silencing reversed these protective effects. In conclusion, PCAF inhibition mitigates VSMCs senescence via Nrf2-ARE-mediated antioxidant activation, identifying PCAF as a promising therapeutic target for vascular aging.
IntroductionStroke is the leading cause of morbidity and mortality, and its management differs among ischemic stroke, hemorrhagic stroke, and stroke mimics. Non-contrast CT has limited sensitivity for early ischemia. This study compared blood and plasma viscosity across different stroke types and identified cutoff values for predicting stroke type.MethodA cross-sectional study at the Emergency Department of Dr. Cipto Mangunkusumo National Referral Hospital (March-June 2025). Blood and plasma viscosity were measured using the Neo Digital Microcapillary device then compared using appropriate statistic tests. A p-value < 0.05 was considered statistically significant.ResultsSeventy of 97 suspect stroke patients were included (36 ischemic, 16 hemorrhagic, 18 mimics). There were significant differences of blood viscocity between ischemic and hemorrhagic stroke compared with stroke mimic (median 5.65 cP ischemic; 5.29 cP hemorrhagic; 4.84 cP mimic; p < 0.0001), whereas no significant difference was observed in plasma viscosity across the groups (p = 0.411). A blood viscosity cutoff of 5.17 cP yielded an AUC of 0.84 (p < 0.0001), 71.2% sensitivity, 94.4% specificity, 97.37% PPV, and 53.13% NPV for stroke prediction.ConclusionBlood viscosity shows potential as an adjunctive diagnostic tool for distinguishing stroke from stroke mimics with high specificity, aiding in predicting types of stroke.
Background: While the transgenerational impact of famine on adult health is well-documented, its impact on blood pressure (BP) trajectories from childhood to adolescence remains poorly understood. We aimed to capture multi-generational BP trajectories and identify the primary drivers of adolescent BP elevation. Methods: Utilizing data from the China Health and Nutrition Survey, we analyzed BP trajectories in the F1 (n = 5,357) and F2 (n = 2,349) generations. The F1 generation was categorized into 2 groups: famine exposed and non-exposed groups, while the F2 generation was divided into 4 groups: no parental exposure, father-only-exposed, mother-only-exposed, and both-parents-exposed. Linear mixed-effects models and causal mediation analyses were conducted to ascertain BP trajectories and the mediation of parental body mass index (BMI). Results: In the F1 generation, BP of famine-exposed individuals surpassed that of controls after age 40. In the F2 generation, BP trajectory divergence occurred at approximately age 14. By age 18, all exposed groups had significantly higher BP than controls, independent ofparental hypertension (P < 0.01). Notably, the mother-only-exposed group exhibited the highest velocity of BP elevation; however, after excluding offspring with hypertensive parents, the father-only-exposed group exhibited the fastest velocity of BP increase. Mediation analysis revealed that over 85% of this effect was direct, with parental BMI accounting for only 14.51% and 10.08% of the effect for systolic and diastolic BP, respectively. Conclusions: Individuals with direct famine exposure possess higher rate of BP elevation. Furthermore, parental famine exposure programs an accelerated BP velocity in offspring that manifests during early adolescence. These findings suggest that the famine exposure creates a subclinical vascular risk that requires early monitoring, independent of adiposity and hypertension.
Background:Patients with repaired coarctation of the aorta (CoAo) remain at risk for left ventricular hypertrophy (LVH) even in the absence of hypertension. Alterations in wave reflection and the timing of reflected pressure waves may contribute to ventricular remodeling beyond pressure load alone. Methods:We performed a cross-sectional analysis of patients with repaired CoAo. Office and ambulatory blood pressure (ABPM), non-invasive central hemodynamics, and echocardiographic indices of left ventricular structure were assessed. Linear and multivariable regression models evaluated associations with posterior wall thickness in diastole (PWTd) and interventricular septal thickness in diastole. Computational simulations were conducted to examine the impact of heart rate on ventricular remodeling. Results:Fifty-seven patients (median post-repair follow-up 11 years) were included. LVH prevalence was 15.2% (95% confidence interval [CI], 4.8, 25.6). Although 42% met criteria for hypertension based on ABPM, no patients exhibited elevated central blood pressure and LVH. Heart rate-adjusted augmentation index (AIX@75) was inversely associated with PWTd and remained independently associated after multivariable adjustment (R2 = 0.40, P < 0.01). Replacing AIX@75 by heart rate improved model performance (R2 = 0.44), with lower heart rate independently associated with greater PWTd. Simulation modeling showed that a 10% increase in heart rate reduced mean PWTd and decreased posterior wall hypertrophy prevalence from 30.9% to 2.4% (odds ratio, 0.10; 95% CI, 0.01, 0.44). Conclusions:Ventricular remodeling occurs despite normal central blood pressure in CoAo. A lower heart rate associates with increased ventricular mass. Heart rate-mediated modulation of wave reflection timing represents a potential mechanistic and therapeutic target.
Renal denervation (RDN) has re-emerged as a therapeutic option for hypertension following contemporary sham-controlled randomized trials demonstrating modest but consistent blood pressure (BP) reductions. Despite these advances, substantial heterogeneity in treatment response persists, sustaining debate regarding the clinical value and appropriate role of RDN. Increasing evidence suggests that patient-related factors, rather than device technology alone, may critically determine therapeutic success. This narrative review synthesizes evidence from randomized clinical trials, meta-analyses, and key observational studies published between 2009 and 2024. Relevant literature was identified through searches of PubMed, Embase, and major cardiovascular society publications. We evaluated the influence of hypertension phenotype, baseline BP, medication adherence, sympathetic nervous system activity, renal artery anatomy, and comorbid conditions on BP response to RDN. Accumulating data indicate that response to RDN is highly variable and strongly influenced by patient-specific characteristics. Sustained hypertension confirmed by ambulatory BP monitoring, higher baseline BP, features suggestive of sympathetic overactivity, favorable renal artery anatomy, and challenges with long-term medication adherence are consistently associated with greater BP reduction. In contrast, pseudoresistance, white-coat hypertension, advanced arterial stiffness, and unfavorable anatomy are linked to attenuated or inconsistent responses. Reassessment of sham-controlled trials highlights that observed BP reductions, although modest, are clinically meaningful when appropriately contextualized. The efficacy of RDN is highly context-dependent and should not be viewed as universal or ineffective. By shifting from a device-centered paradigm to mechanism-based patient phenotyping, RDN may be more accurately positioned as a targeted, adjunctive therapy within personalized hypertension management. A structured framework for patient selection may help reconcile prior controversies, optimize clinical implementation, and inform the design of future trials.
Hypertension remains a leading contributor to global cardiovascular (CV) morbidity and mortality, yet blood pressure (BP) control rates remain suboptimal worldwide. Therapeutic inertia, delayed treatment intensification, dose-dependent adverse effects, and limited healthcare access continue to hinder effective management. Low-dose combination therapy has emerged as a strategy to enhance efficacy while improving tolerability by targeting complementary pathophysiological pathways at reduced drug doses. This review describes the evolution of low- and ultra-low-dose combination therapy from its pharmacologic rationale and early proof-of-concept studies to contemporary randomized and pragmatic trials. Meta-analytic and clinical evidence have demonstrated that combining antihypertensive agents at fractional doses produces additive BP reductions with fewer dose-related adverse effects. Subsequent trials evaluating quarter-dose and one-third-dose multidrug regimens confirmed substantial BP lowering with favorable safety profiles. Pragmatic studies further supported the feasibility of simplified, protocol-based single-pill strategies in real-world and resource-limited settings. More recent phase III trials have shown that single-pill low- and ultra-low-dose triple combinations achieve BP reductions comparable to or greater than those of standard-dose monotherapy, without compromising safety. Current evidences support low- and ultra-low-dose single-pill combination therapy as a practical and scalable first-line approach to improving global hypertension control. However, the current evidence base is dominated by trials evaluating short-term BP lowering rather than long-term CV outcomes. Although the magnitude and consistency of BP reduction provide a strong rationale for this strategy, evidence for reductions in CV events and mortality is warranted.
Background: Childhood hypertension is strongly associated with the development of cardiovascular diseases in adulthood. Understanding the epidemiological patterns of disease burden is crucial for developing effective prevention strategies. Methods: This cross-sectional study utilized data from the Global Burden of Disease Study (GBD) 2021, including 204 countries and territories. The analysis estimated deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) attributable to high systolic blood pressure (sBP) among individuals under the age of 20 within the GBD comparative risk assessment (CRA) framework, covering the period from 1990 to 2021. Trends and regional disparities in disease burden were examined, emphasizing correlations between DALY rates and socio-demographic indices (SDI). Results: In 2021, the global DALY rate was 2.39 (95% uncertainty interval [UI], 1.75 to 2.88) per 100,000 population, representing a 20.11% decrease (95% UI, -35.02 to 10.21) compared to 1990. The YLL rate showed a decrease of 21.06% (95% UI, -36.21 to 9.95), contributing to the decline in the DALY rate, whereas the YLD rate showed an increase of 22.33% (95% UI, 4.16 to 40.74). The DALY rates were negatively correlated with Socio-demographic Index. Among the 21 GBD regions in 2021, Middle East and North Africa (MENA) showed the highest disease burden across all metrics. Western Sub-Saharan Africa (SSA) demonstrated a pronounced gender disparity. High-income North America experienced the largest increase in disease burden. Conclusions: Global DALYs and deaths attributable to high sBP among children and adolescents suggested a declining trend from 1990 to 2021, although the 95% UIs were compatible with no clear change. DALYs showed a negative correlation with SDI, with highest burden in MENA and notable gender disparities in Western SSA. High-income North America showed the largest increase since 1990.
BackgroundEpidemiological evidence suggests that endurance training improves musculoskeletal health and influence blood parameters, but the effects of RT were less clear.ObjectiveThe present study investigated the effect of 12-weeks of RT on resting (pre-exercise) values and responses of blood fluidity parameters to a resistance exercise trial (RET).MethodsEighteen untrained males (Mean ± SD; age, 24.8 ± 1.2 years) were randomly assigned to training (n = 10) or control (n = 8) groups. Subjects in the training group performed a 12-week progressive RT program with 4 sessions per week. The training program consisted of three distinct phases: adaptation, hypertrophy, and strength, increasing intensity from 40-50% to 80-85% of their one-repetition maximum (1RM). Prior and after the 12-week program, both groups underwent a RET. Blood samples were taken before and after each RET.ResultsSignificant (p < 0.05) increases in blood viscosity, plasma viscosity, plasma fibrinogen, and hematocrit were found following the acute RET. However, neither the resting values nor responses to RET were affected by RT. Interestingly, 12 weeks of progressive RT attenuated responses of RBC indexes significantly (p < 0.05).ConclusionsThe study concluded that although 12 weeks of RT does not alter resting blood fluidity, it reduces the acute changes in RBC indexes during high-intensity resistance exercise.
ObjectiveAortic stenosis is a common valvular disease in the elderly. This study aimed to investigate changes in whole blood viscosity (WBV), which reflects hemodynamic load and blood flow and is associated with cardiovascular diseases, after percutaneous and surgical interventions for aortic stenosis.MethodsFrom 2019 to 2022, 200 patients undergoing Transcatheter Aortic Valve Implantation (TAVI) (n = 100) or bioprosthetic Aortic Valve Replacement (bAVR) (n = 100) were analyzed. WBV at low shear rate (LSR, 0.5 s-1) and high shear rate (HSR, 208 s-1) was calculated from the hematocrit and total protein using the De Simone formula. Pre- and 3-month values were compared using paired and independent t-tests, and correlations and multivariable regression were performed.ResultsThe aortic valve area was negatively correlated with HSR (r = -0.340, p < 0.01) and LSR (r = -0.358, p < 0.01). At 3 months, HSR decreased by 0.95 ± 0.31 cP and LSR by 18.92 ± 6.32 cP (both p < 0.001). Reductions were significant in both groups without between-group differences and were mainly related to decreases in non-albumin protein fractions.ConclusionBoth TAVI and bAVR markedly reduced WBV, independent of the intervention type. WBV may be a useful biomarker for monitoring hemorheological and protein-based changes following valve intervention.
The aimof this study was to identify potential diagnostic markers of microcirculation disorders in patients with primary hypothyroidism.Materials and methodsThis cross-sectional study included patients with overt (OH, n = 14) and subclinical (SH, n = 37) hypothyroidism, and healthy volunteers (HV, n = 50). Using laser Doppler flowmetry (LDF), mean cutaneous blood flow in the dorsal forearm was assessed at rest (M), during cooling to 10 °C (M10°C), heating to 35 °C (M35°C) and to 42 °C (M42°C). The standard deviation (σ) and the coefficient of variation of cutaneous blood flow (Kv=σ/M) at rest were calculated. The amplitudes of microvascular blood flow oscillations in frequency ranges corresponding to the neurogenic, myogenic, respiratory, and pulse mechanisms of microcirculation modulation were also calculated (An, Am, Aresp, Acard). Laboratory parameters were evaluated.ResultsThe OH group had reduced blood flow variability (σ) compared to the HV (p=0.025) and SH (p=0.037) groups. Kv was lower in OH compared to SH (p=0.041). Acard was decreased in the OH group compared to the HV (p=0.001) and SH (p=0.012) groups. M42°C was reduced in OH compared to HV (p=0.014). Hypercholesterolemia and increased IL-6 were found in the OH and SH groups compared to HV. In OH, the red blood cell distribution width (RDW) was increased compared to HV (p=0.026).ConclusionOvert hypothyroidism is associated with decreased total and pulse variability of cutaneous microvascular blood flow, decreased cutaneous hyperemia during local heating to 42 °C, and increased RDW. These microcirculatory disorders are accompanied by hypercholesterolemia and increased IL-6 levels.
The recently released 2026 Korean Society of Hypertension (KSH) guidelines incorporate contemporary advances in the diagnosis and management of hypertension. This highlight summarizes the most important updates, focusing on the underlying evidence and key changes, particularly the newly introduced and revised recommendations. The major additions include the incorporation of isolated diastolic hypertension into blood pressure (BP) classification, the first integration of cuffless BP devices into clinical practice, and the incorporation of a new therapy with a BP-lowering effect (angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, and aldosterone synthase inhibitors). A dose-based classification of single-pill combination therapies has been introduced to enhance treatment adherence. In addition, obesity, hypertension in young adults, hypertensive emergencies, and patient-centered care have been incorporated and emphasized. Major updates include expanded screening for primary aldosteronism, adoption of more intensive BP targets, and risk-based initiation of pharmacological therapy in individuals with prehypertension. Lifestyle recommendations have been broadened to include e-smoking cessation and mind-body practices. Furthermore, the definition and management of uncontrolled (or resistant) hypertension have been updated, and BP targets in older adults are now individualized according to frailty status and overall cardiovascular risk; intensive BP lowering to 130/80 mmHg is recommended in selected high-risk older individuals. Finally, BP management during pregnancy has also been refined to emphasize active BP control at < 140/90 mmHg and the use of out-of-office BP measurements for more accurate diagnosis. Overall, the new KSH guidelines provide a more evidence-based framework for hypertension management, with the goal of improving BP control and reducing cardiovascular morbidity and mortality.
Background:Although catheter-based renal denervation (RDN) has emerged as a potential treatment for resistant hypertension, it has limitations, including incomplete denervation and anatomical constraints. To address these challenges, we introduce the HyperQure™ RDN System, a novel extravascular RDN procedure targeting the renal artery adventitia, where renal sympathetic nerves are primarily distributed, for a more complete denervation. Methods:This pilot, single-arm, multicenter, first-in-human trial will evaluate the efficacy and safety of an extravascular RDN system in patients with hypertension. Ten patients aged 19-79 years with uncontrolled hypertension despite using three or more antihypertensive medications will undergo extravascular RDN. The procedure involves a retroperitoneal laparoscopic approach to achieve circumferential ablation of the sympathetic nerves surrounding the renal artery. A repeat procedure can be performed at different locations on the artery or by targeting branch vessels and accessory arteries. The primary efficacy outcome is the change in 24-hour ambulatory systolic blood pressure at 3 months post-procedure. Safety endpoints include the incidence of overall, major, acute/procedural, and chronic adverse events. Conclusions:Extravascular RDN has the potential to overcome the limitations of catheter-based techniques by enabling more complete sympathetic denervation that targets a broader range of renal sympathetic nerve fibers. This trial will generate critical first-in-human data to guide future clinical applications of extravascular RDN. Trial registration:Clinical Research Information Service Identifier: KCT0009209.
Background:Fundoscopy is of pivotal importance in patients with suspected hypertensive emergency in order to detect hypertensive retinopathy and determine the need for prompt intravenous antihypertensive treatment. However, direct fundoscopy by an ophthalmologist is time-consuming and delays treatment. In this pilot study in the emergency department (ED), we evaluated whether smartphone ophthalmoscopy is a feasible and faster alternative. Methods:We evaluated duration of ED-treatment in patients who underwent smartphone ophthalmoscopy for suspected hypertensive emergency. Smartphone ophthalmoscopy included 30-second retinal video recordings captured by the attending physicians, which were remotely evaluated by an ophthalmologist. Patients in the smartphone-group were matched in a 1:2-ratio to a historical cohort who underwent direct fundoscopy by an ophthalmologist. We evaluated total ED-length-of-stay (total ED-LOS; defined as the interval between ED-admission and ED-discharge) and 'treatment time' (defined as total ED-LOS minus time in waiting room). Results:In the present analysis, we included 54 patients in the smartphone-group and matched them with 108 historical controls. On average, total ED-LOS was 29 minutes shorter in the smartphone-group as compared to controls (217 ± 73 minutes vs. 246 ± 73 minutes; P = 0.016). Treatment time was 40 minutes shorter in the smartphone-group (193 ± 68 minutes vs. 233 ± 71 minutes; P = 0.002). Stratified analyses suggested that the reduction in treatment time was most pronounced outside office hours. Smartphone ophthalmoscopy was feasible in 87% of the patients, the other 13% (n = 10) required additional direct fundoscopy by an ophthalmologist. Conclusions:Smartphone ophthalmoscopy in suspected hypertensive emergency was feasible and faster as compared to direct fundoscopy by an ophthalmologist, which may allow earlier treatment and reduce ED-crowding.
Background: The role of social isolation in the connections between the hypertension care cascade, cognitive function, and cardiovascular disease (CVD) remains unclear. This study aims to investigate the relationships between the hypertension care cascade, cognitive performance, and CVD among middle-aged and older adults with varying levels of social isolation. Methods: Eight thousand two hundred eighty-seven participants aged 45 years and older from the China Health and Retirement Longitudinal Study were included in the analysis. Participants were categorized based on their social isolation status, either as socially isolated or not. Both multivariable linear regression and logistic regression models were employed. All analyses were weighted to account for the multistage, probability-proportional-to-size sampling design of the study. Hypertension was defined according to European, Chinese, and American guidelines. Results: The weighted rates of hypertension awareness, treatment, and control were 55.0%, 44.5%, and 25.4%, respectively, with a more favorable performance in the hypertension care cascade observed among individuals without social isolation. When applying American guidelines to define hypertension, the rates of awareness, treatment, and control significantly declined, irrespective of social isolation status. Compared to non-hypertensive individuals, participants with treated and controlled blood pressure (BP) exhibited similar cognitive function and odds of CVD. In contrast, individuals with treated but uncontrolled BP and those who were unaware of hypertension demonstrated poorer cognitive performance and a heightened risk of CVD. Social isolation significantly exacerbated the negative effects of poor hypertension care cascade on cognitive function and CVD risk. Isolated individuals who are unaware of hypertension faced a more higher risk of worsen prognosis than that of the non-isolated individuals (P for interaction < 0.05). Conclusions: Individuals experiencing social isolation exhibited poor performance in the hypertension care cascade. Furthermore, social isolation significantly exacerbated the negative effects of poor hypertension care cascade on cognitive function and CVD. Our study emphasizes that addressing social isolation could be a significant factor for improving the hypertension care cascade and health outcomes among middle-aged and older adults in China.
