Background Rivaroxaban is primarily utilized in patients with atrial fibrillation (AF) to decrease the risk of thrombosis. Drug repositioning strategies have been regarded as beneficial in identifying the potential effects of clinical drugs, and the current study was conducted to explore the potential blood pressure reduction effect of rivaroxaban. Methods A combination of machine learning models was employed to screen 3285 non-antihypertensive drugs in the FDA database for potential antihypertensive effects. A comprehensive approach was adopted, encompassing retrospective clinical data analysis, animal experiments, and cell-based studies. This multifaceted strategy was employed to systematically assess the concordance between the outcomes of predictive models and the observed data. Results The machine learning predicted eight top non-antihypertensive drugs with pressure reduction effects. Next, the retrospective clinical data showed that the patients treated with Rivaroxaban were associated with greatly reduced systolic blood pressure (SBP) and diastolic blood pressure (DBP). Meanwhile, it demonstrated that rivaroxaban inhibited Ang II-induced Vimentin and Col 1a mRNA levels in human umbilical vein endothelial cells (HUVECs), and reduced the migration of human vascular smooth muscle cell (HUVSCs) after Ang II stimulation in vitro. In vivo, Rivaroxaban also exhibited an obvious effect on pressure reduction in hypertensive mice. The molecular docking revealed that rivaroxaban primarily exhibited strong binding affinity for glucose-dependent insulinotropic receptor (GIR, −10.6 kcal/mol). Conclusions This approach provides a potential new option for patients with AF with hypertension, to ameliorate cardiovascular remodeling when selecting rivaroxaban as the oral anticoagulant. While further validation should be conducted to explore the detailed mechanism by which rivaroxaban regulates GIR in hypertension.

Background The objective of this study was to ascertain whether cardiometabolic index(CMI), visceral adiposity index (VAI), dysfunctional adiposity index (DAI), and body adiposity index (BAI) are superior predictors of future hypertension risk when compared with conventional indicators such as waist circumference(WC), body mass index (BMI) and waist-to-height ratio(WHtR). Material and Methods: This is a post hoc analysis of the MONICA protocol. We selected 597 patients based on inclusions criteria. Data collection began in 1992, and follow-up was conducted on the same group of participants in 2007. The study collected anthropometric indexes and biochemical data. Results: After adjusting for confounding factors using multivariate Cox regression analysis, the following results were observed: CMI [HR: 1.754 (1.240–2.480); P = 0.001], VAI [HR: 1.533 (1.074–2.187); P = 0.018], DAI [HR: 1.382 (0.982–1.945); P = 0.064], BAI [HR: 2.791 (1.790–4.352); P < 0.001], WC [HR: 2.234 (1.510–3.307); P < 0.001], WHtR [HR: 2.303 (1.589–3.339); P < 0.001], and BMI [HR: 2.488 (1.778–3.561); P < 0.001] were all significantly associated with the incidence of hypertension. ROC curve analysis showed that the area under the curve (AUC) for WC product was the highest (0.649, 95

PURPOSE:The inflammatory activation and metabolic disorders of cardiomyocytes are essential mechanisms in sepsis-related cardiac dysfunction. Kaempferitrin (Kae), a flavonoid compound, possesses various properties including anti-inflammatory and anti-glycation effects. Hence, the current study is conducted to investigate the protective effects of Kae against sepsis-induced cardiac dysfunction. METHODS:C57BL/6 J mice were treated with Kae for 2 h, followed by lipopolysaccharide (LPS) treatment. After 12 h, the echocardiographic measurements were conducted. Serum test, pathological analysis, transcriptomics, western blotting, and RT-PCR were used for exploring mechanisms. Additionally, in vitro, H9c2 and AC16 cardiomyocyte cell lines were pretreated with Kae (10 μM) for 2 h, followed by LPS stimulation (1 μg/mL). RESULTS:In vivo, pretreatment with Kae mitigates LPS-induced cardiac dysfunction. Kae suppresses the levels of IL-6, TNF-α, IL-1β, and IL-18 in the cardiac tissue of mice mediated by LPS. Additionally, serological and histological assessments demonstrate that Kae exhibits protective effects against LPS-induced cardiomyocyte injury and apoptosis. Transcriptomic analysis reveals that the nuclear factor kappa-B (NF-κB)/NLRP3 signaling pathway may be a crucial mechanism. Meanwhile, it proved that LPS significantly activates NF-κB/NLRP3 to induce cardiomyocyte pyroptosis, which is attenuated by Kae. In vitro, H9c2 and AC16 cardiomyocyte cell lines were pretreated with Kae followed by LPS stimulation, showing an inhibition of NF-κB/NLRP3 pathway, with a decreased mRNA levels of Il-6, Tnf-α, Il-1β. The NLRP3-knock out (Nlrp3 -/- ) mice have verified that Kae ameliorating LPS-induced spetic cardiomyopathy by inhibiting NLRP3. CONCLUSIONS:This study confirms that Kae alleviates LPS-induced left ventricular remodeling and cardiac dysfunction by suppressing the NF-κB/NLRP3/pyroptosis pathway.

The hypertensive microvascular disorder is a significant complication that can lead to substantial target organ damages, including cognitive impairments, visual impairments, and deterioration in renal function. Recent studies have indicated that blood pressure variability (BPV) is an independent risk factor for the progression of this pathology. The present paper aims to systematically elucidate the concept, classification, and clinical significance of BPV, focusing on how it acts as a pathogenic mechanism independent of mean blood pressure to exacerbate endothelial injury and cause target organ damage. This review was conducted to evaluate the influences of multiple factors on BPV, including neurohumoral regulation, the behavioural environment and comorbidities. It also emphasises the intrinsic link between BPV and microvascular complication risk in specific populations, such as those with diabetes and obesity. In summary, it is evident that a comprehensive exploration of the underlying mechanisms of BPV is imperative for the early prevention and treatment of hypertensive microvascular diseases.

OBJECTIVE:Pathological cardiac hypertrophy is an independent risk factor for heart failure (HF). Early identification and timely treatment are crucial for significantly delaying the progression of HF. METHODS:Targeted amino acid metabolomics and RNA sequencing (RNA-seq) were combined to explore the underlying mechanism. In vitro, H9c2 cells were stimulated with angiotensin II (Ang II) or were incubated with extra valine after Ang II stimulation. The branched chain alpha-ketoate dehydrogenase kinase (Bckdk) inhibitor 3,6-dichlorobenzo[b]thiophene-2-carboxylic acid (BT2) and rapamycin were utilized to confirm the role of the mammalian target of rapamycin complex 1 (mTORC1) signaling pathway in this process. RESULTS:A significant accumulation of valine was detected within hypertrophic hearts from spontaneously hypertensive rats (SHR). When branched chain amino acid (BCAA) degradation was increased by BT2, the most pronounced decrease was observed in the valine level (Δ = 0.185 μmol/g, p < 0.001), and cardiac hypertrophy was ameliorated. The role of imbalanced mitochondrial quality control (MQC), including the suppression of mitophagy and excessive mitochondrial fission, was revealed in myocardial hypertrophy. In vitro, high concentrations of valine exacerbated cardiomyocyte hypertrophy stimulated by Any II, resulting in the accumulation of impaired mitochondria and respiratory chain dysfunction. BT2, rapamycin, and mitochondrial division inhibitor 1 (Mdivi-1) all ameliorated MQC imbalance, mitochondrial damage and oxidative stress in hypertensive models with high valine concentration. CONCLUSION:Valine exacerbated pathological cardiac hypertrophy by causing a MQC imbalance, probably as an early biomarker for cardiac hypertrophy under chronic hypertension.

The burden of isolated systolic hypertension (ISH) has doubled among the oldest-old population in China from 2002 to 2014. However, its epidemiological characteristics in Chinese older adults remains less understood. This study aimed to estimate the prevalence of ISH in Chinese older adults and identify associated factors, informing public health strategies and clinical practices. A cross-sectional analysis was conducted using data from 5327 participants aged ≥ 60 years in the 2015 China health and retirement longitudinal study. Blood pressure was measured 3 times via electronic monitors. ISH was defined as systolic blood pressure ≥ 140 mm Hg and diastolic blood pressure < 90 mm Hg, regardless of hypertension diagnosis or medication history. A multivariable logistic regression model was used to identify ISH risk factors. Sex- and age-standardized prevalence of hypertension and ISH in Chinese older adults was 49.7% and 28.0%, respectively. Among hypertensive individuals, 54.0% (1384) had ISH, with prevalence rising with age: 47.7% (60–69 years), 61.9% (70–79 years), and 71.8% (80–94 years) ( P trend < .001). Multivariable logistic regression analyses revealed that older age (aged 70–79 years: OR = 1.77, 95% CI = 1.52–2.05; aged 80–94 years: OR = 2.67, 95% CI = 2.03–3.52), central (OR = 1.19, 95% CI = 1.00–1.41) or eastern (OR = 1.26, 95% CI = 1.06–1.50) residence, general obesity (OR = 1.34, 95% CI = 1.05–1.71), abdominal obesity (OR = 1.65, 95% CI = 1.43–1.91), diabetes mellitus (OR = 1.67, 95% CI = 1.41–1.98), dyslipidemia (OR = 1.17, 95% CI = 1.02–1.36), and hyperuricemia (OR = 1.72, 95% CI = 1.35–2.18) was associated with higher odds of ISH. Conversely, marriage or cohabitation was associated with lower odds of ISH (OR = 0.75, 95% CI = 0.63–0.89). Despite its cross-sectional nature, this study demonstrates the substantial ISH burden and underscores the importance of managing cardiometabolic risk factors in Chinese older adults.

Previous studies have demonstrated that cardioversion of atrial fibrillation may alleviate atrial remodeling. We aimed to investigate whether left atrial (LA) tissue fibrosis assessed by LGE-MRI, may be reversed after conversion of persistent atrial fibrillation (PersAF) to sinus rhythm. Patients with PersAF underwent two LGE-MRI scans following cardioversion were prospectively recruited. LA fibrosis was categorized into core zone (IIR > 1.61) and border zone (0.97 Fifty-three patients were included. The area of the border [22.2 (11.8-37.0) vs. 18.1 (11.8-25.2) cm 2 , p = 0.037] and core zones [0.9±3.0 vs. 0.1±0.6 cm 2 , p = 0.010] decreased from baseline, along with reductions in LAV, increase of LA ejection fraction and strain. After multivariable adjustment, ΔLATEF was correlated with Δborder zone (r 2 =0.155, p = 0.015), baseline left ventricular mass and ΔLATEF was correlated with Δcore zone (r 2 =0.286, p <0.001). The cardiac reverse remodeling is not related with Δborder zone and Δcore zone. Atrial fibrosis improved concomitantly with LA shrinkage and enhanced LA function after PersAF to sinus rhythm. LA fibrotic reverse is an independent parameter compared with the traditional definition of cardiac reverse remodeling. The clinical implications warrant further investigation.

The aim of this study was to evaluate the efficacy of chronotherapy for patients with essential hypertension with a range of clinical characteristics. We searched the PubMed, EMBASE, and Cochrane Library databases for randomized controlled trials of antihypertensive therapies in which patients were randomized to morning or evening administration. The primary outcomes of the included studies were ambulatory blood pressure (BP) parameters and patient characteristics, including age, body mass index, percentage of female participants, and drug ingestion, which were described in subgroup analyses. In total, 56 studies were included in the analyses. Meta-analyses and subgroup analyses revealed that specific populations of patients benefited more from bedtime dosing than from morning dosing in both 24-h or 48-h ambulatory systolic BP (SBP) and nighttime SBP, including (1) groups aged < 60 years, (2) those with body mass index ≥ 30 kg/m2, (3) studies with ≥ 50

The Platelet-to-Lymphocyte Ratio (PLR) has emerged as a cost-effective biomarker for systemic inflammation and adverse cardiovascular outcomes, yet its prognostic value in critically ill patients with heart failure (HF) remains unclear. Leveraging the MIMIC-IV database, this study investigates the association between PLR and 1-year all-cause mortality in 7,217 ICU patients with HF. Patients were stratified into tertiles (0-126.45, 126.45-252.40, and 252.40-1000), and mortality risk was analyzed using Kaplan-Meier survival curves and Cox proportional hazards models. Elevated PLR was independently associated with higher mortality, with the highest tertile showing a 36% increased risk compared to the lowest (HR 1.36, 95% CI: 1.23-1.50, P < 0.001). Each tertile increment corresponded to a 17% rise in risk. Subgroup analyses revealed stronger associations in hypertensive patients and identified renal dysfunction and red cell distribution width as key modifiers. Integrating PLR with SOFA and APS III scores significantly enhanced predictive accuracy. By reflecting systemic inflammation and immune dysregulation, PLR offers a robust tool for long-term risk stratification and personalized management of ICU patients with HF. These findings highlight the potential of PLR to refine prognostic models, guide clinical decision-making, and improve critical care outcomes.

Background: Although the association of dietary nitrate intake and improved blood pressure and cardiovascular outcomes has been confirmed in healthy individuals and non-cardiovascular disease (CVD) population, it still remains uncertain whether the protective effect of inorganic nitrate remains significant in the hypertensive population. Methods: This study analyzed health data of 5,989 hypertensive participants based on the National Health and Nutrition Examination Survey (NHANES) database between 2005 and 2014. The correlation between urinary nitrate and blood pressure, the prevalence of CVD subtypes and cardiovascular mortality were assessed respectively. Mediating effect analysis and subgroup analysis was performed. Results: Within a range of 0-4.34 mg/dL, an inverse linear correlation between urinary nitrate and systolic blood pressure (SBP) was observed (β= -0.84; 95% CI -1.28, -0.41; P<0.001). The increase in urinary nitrate was associated with a decreased prevalence of heart failure (OR=0.914; 95% CI 0.859, 0.972; P=0.006). Urinary nitrate was inversely associated with cardiovascular mortality (HR=0.906; 95% CI 0.864, 0.951; P<0.001). Neither SBP nor coexisting heart failure at baseline mediated the association between urinary nitrate and cardiovascular mortality. Subgroup analysis showed that the inverse association between urinary nitrate and cardiovascular mortality was influenced by smoking, coexisting coronary heart disease and heart failure at baseline. Conclusions: In hypertensive individuals, an appropriate increase in urinary nitrate was associated with a reduction in SBP, a diminished incidence of heart failure, and a mitigated risk of cardiovascular mortality. These findings suggested urinary nitrate as a plausible marker for monitoring cardiovascular health.

PurposeTo systematically evaluate the clinical efficacy and safety of targeted drugs in patients with pulmonary arterial hypertension (PAH) with cardiac function grades III–IV, and conduct a meta-analysis.MethodsTwo researchers independently searched the PubMed, EMBASE, and Cochrane Library databases for relevant studies, with the search period extending from the establishment of the databases to March 2024. Meta-analysis was performed using statistical software Review Manager 5.4. Heterogeneity among studies was analyzed using either a random-effects model or a fixed-effects model. When the I2 value was < 50%, indicating good homogeneity, the fixed-effects model was adopted; otherwise, the random-effects model was used. For continuous variables, the 6-minute walk distance (6MWD) was expressed as the mean difference (MD), while hemodynamic parameters were represented by the standard mean difference (SMD). For categorical variables, the odds ratio (OR) was used. The confidence interval (CI) was set at 95%, and a p < 0.05 was considered statistically significant.ResultsTen randomized controlled trials (RCTs) involving 553 patients with PAH and cardiac function grades III-IV were ultimately included. Three RCTs targeted the endothelin pathway, five targeted the prostacyclin pathway, and two assessed the effects of combination therapy. Meta-analysis and subgroup analysis revealed that short-term monotherapy with bosentan significantly improved 6MWD by ~53.67 m (95% CI: [43.57, 63.77] meters, p < 0.0001) in patients with FC III-IV PAH. Additionally, prostacyclin analogs increased 6MWD by approximately 25.02 meters (95% CI: [19.22, 30.81] meters, p < 0.0001) in this patient population. Further hemodynamic assessments demonstrated that both bosentan monotherapy and prostacyclin analog therapy significantly reduced pulmonary vascular resistance, with SMDs of −1.07 (95% CI [-2.08, −0.06], p = 0.04) and −1.26 (95% CI = [−2.21, −0.32], p = 0.009), respectively. Analysis of the clinical efficacy of combination therapy in PAH patients revealed that while it did not significantly improve 6MWD, cardiac function improved in ~59.1% of patients (95% CI=[38.5%, 79.6%]). Safety analysis indicated that combination targeted therapy did not significantly increase the incidence of severe adverse events in PAH patients.ConclusionMonotherapy with targeted drugs is safe and effective for patients with PAH and cardiac function grades III-IV. Combination therapy can significantly improve cardiac dysfunction in these patients without significantly increasing the risk of severe adverse events. Therefore, bosentan and prostacyclin analogs are both safe and effective options for patients with PAH and cardiac function grades III-IV. However, early combination therapy may have added clinical value in improving exercise tolerance, cardiac function, and cardiovascular remodeling in this patient population.

Renal nerve stimulation (RNS) could localize the renal nerve innervation through rapid blood pressure (BP) changes for renal denervation (RDN). Recently, novel BP response patterns have been demonstrated in animals. The current study was to verify the presence of these patterns in humans and examine the feasibility of using them to guide selective RDN. Fourteen patients with mild resistant hypertension were included in this prospective analysis. RNS was performed before and after radiofrequency-based RDN. Invasive monitoring was used continuously to obtain beat-to-beat BP. Ambulatory BP (ABP) monitoring was measured at baseline, 5–7 days, and 6–12 months, respectively. Five types of BP responses were summarized during RNS before RDN, namely: (1) BP persistently elevated; (2) BP dropped and then elevated above the baseline; (3) BP dropped and then recovered, but not over the baseline; (4) BP fluctuated in the vicinity of the baseline; and (5) BP persistently dropped. Selective RDN was performed at the site with elevated BP. The 24-h ABP decreased from 141 ± 12/94 ± 9 mmHg at baseline to 130 ± 11/85 ± 8 mmHg at 5 – 7 days (P = 0.001 for systolic BP [SBP], P = 0.003 for diastolic BP [DBP]) and 127 ± 11/85 ± 8 mmHg at 6 – 12 months (P = 0.009 for SBP, P = 0.019 for DBP). The average heart rate fell from 77 ± 8 bpm to 71 ± 5 bpm (P = 0.01) and 72 ± 7 bpm (P = 0.043), respectively. Our study showed five types of BP responses elicited by RNS in humans. RDN guided by these BP responses was feasible and resulted in obvious BP reduction, and they may potentially provide precise guidance for RDN.

Background High-power short-duration (HPSD) ablation strategy has emerged as a popular approach for treating atrial fibrillation (AF), with shorter ablation time. The utilized Smart Touch Surround Flow (STSF) catheter, with 56 holes around the electrode, lowers electrode-tissue temperature and thrombus risk. Thus, we conducted this prospective, randomized study to investigate if the HPSD strategy with STSF catheter in AF ablation procedures reduces the silent cerebral embolism (SCE) risk compared to the conventional approach with the Smart Touch (ST) catheter. Methods From June 2020 to September 2021, 100 AF patients were randomized 1:1 to the HPSD group using the STSF catheter (power set at 50 W) or the conventional group using the ST catheter (power set at 30 to 35 W). Pulmonary vein isolation was performed in all patients, with additional lesions at operator’s discretion. High-resolution cerebral diffusion-weighted magnetic resonance imaging (hDWI) with slice thickness of 1 mm was performed before and 24–72 h after ablation. The incidence of new periprocedural SCE was defined as the primary outcome. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) test. Results All enrolled AF patients (median age 63, 60% male, 59% paroxysmal AF) underwent successful ablation. Post-procedural hDWI identified 106 lesions in 42 enrolled patients (42%), with 55 lesions in 22 patients (44%) in the HPSD group and 51 lesions in 20 patients (40%) in the conventional group ( p = 0.685). No significant differences were observed between two groups regarding the average number of lesions ( p = 0.751), maximum lesion diameter ( p = 0.405), and total lesion volume per patient ( p = 0.669). Persistent AF and CHA 2 DS 2 -VASc score were identified as SCE determinants during AF ablation procedure by multivariable regression analysis. No significant differences in MoCA scores were observed between patients with SCE and those without, both immediately post-procedure ( p = 0.572) and at the 3-month follow-up ( p = 0.743). Conclusions Involving a small sample size of 100 AF patients, this study reveals a similar incidence of SCE in AF ablation procedures, comparing the HPSD strategy using the STSF catheter to the conventional approach with the ST catheter. Trial registration Clinicaltrials.gov: NCT04408716. Graphical Abstract AF = Atrial fibrillation, DWI = Diffusion-weighted magnetic resonance imaging, HPSD = High-power short-duration, ST = Smart Touch, STSF = Smart Touch Surround Flow.

Renal denervation (RDN) is currently confronted with the considerable heterogeneity of different post-procedural blood pressure responses. The challenges predominantly arise from not only the lack of selection of appropriate responders but also the absence of detection for the successful endpoints of intervention. In this paper, we summarize the significant characteristics of potentially appropriate hypertensive patients and propose a hopeful way to improve the accuracy of RDN, that is, the application of three-dimensional reconstruction technology combined with electrical renal nerve stimulation to guide the radiofrequency catheter ablation, which may promote the development of selective and accurate RDN in real-world clinical practice. This paper focuses on two current critical concerns of renal denervation (RDN): appropriate patient selection and the improvement in the accuracy of selective RDN. A hopeful way of accurate RDN may be the combination of 3D electroanatomic mapping systems for the renal artery with modified renal nerve stimulation (RNS) techniques and technology for appropriate hypertensive candidates.

Background Renal denervation (RDN) was still performed without any intra-procedural method for nerve mapping. Whether renal nerve stimulation (RNS) is an efficient way to identify renal autonomic innervation and optimize the strategy for RDN remain to be worthy for further exploration. Methods The characteristics of renal autonomic innervation at the sites with different blood pressure (BP) responses to RNS were explored. Then, dogs anatomically eligible for RDN were randomly assigned into elevated BP response ablation group, reduced BP response ablation group, and RNS-control group. The postoperative outcomes were measured at baseline and after 4 weeks follow-up. Results The proportion of afferent sensory nerve was higher at elevated BP response sites (ERS) than reduced BP response sites (RRS) and non-response sites (NRS) (P = 0.012 and P = 0.004). Conversely, the proportion of parasympathetic nerve at RRS was the highest (RRS vs. ERS, P = 0.017; RRS vs. NRS, P = 0.023). More importantly, there was a significant correlation between systolic blood pressure changes and the area ratios of afferent sensory and parasympathetic nerve (R = 0.859; P < 0.001). In addition, ablation at BP-elevation sites can result in a significant decrease in BP and plasma norepinephrine (NE) after 4 weeks (P = 0.002; P = 0.008), while ablation at BP-reduction sites can lead to significant increases in BP and plasma NE (P = 0.016; P = 0.033). Conclusions RNS is an effective method to identify renal autonomic innervation. It could not only help to identify optimal target sites, but also avoid ablation of sympathetic-inhibitory areas during RDN.

目的 探讨依托网络教学平台的"线上+线下"混合式教学联合改良客观结构化临床考试(OSCE)模式在临床护理带教中的应用及效果.方法 选择该院2021年12月至2022年11月放射科轮转的护理实习生90名,将其分为观察组(n=45)和对照组(n=45).观察组通过线上直播教学联合线下情景模拟演练,对照组则采用传统教学模式实训教学.出科时采用改良OSCE对2组进行考核并进行问卷调查.结果 理论和操作技能方面观察组显著优于对照组,差异有统计学意义(P＜0.05).问卷调查结果显示,94.44％的实习生认为考站设置合理,83.33％的实习生适应该考核模式,但全部实习生均肯定该考核模式可客观评价临床综合能力.结论 混合式教学联合改良OSCE考核模式可有效提高临床护理实习生的培养质量,能真实反映学生综合素质,提升学员满意度.

Renal nerve stimulation (RNS) could localize the renal nerve innervation through rapid blood pressure (BP) changes for renal denervation (RDN). Recently, novel BP response patterns have been demonstrated in animals. The current study was to verify the presence of these patterns in humans and examine the feasibility of using them to guide selective RDN. Fourteen patients with mild resistant hypertension were included in this prospective analysis. RNS was performed before and after radiofrequency-based RDN. Invasive monitoring was used continuously to obtain beat-to-beat BP. Ambulatory BP (ABP) monitoring was measured at baseline, 5–7 days, and 6–12 months, respectively. Five types of BP responses were summarized during RNS before RDN, namely: (1) BP persistently elevated; (2) BP dropped and then elevated above the baseline; (3) BP dropped and then recovered, but not over the baseline; (4) BP fluctuated in the vicinity of the baseline; and (5) BP persistently dropped. Selective RDN was performed at the site with elevated BP. The 24-h ABP decreased from 141 ± 12/94 ± 9 mmHg at baseline to 130 ± 11/85 ± 8 mmHg at 5 – 7 days (P = 0.001 for systolic BP [SBP], P = 0.003 for diastolic BP [DBP]) and 127 ± 11/85 ± 8 mmHg at 6 – 12 months (P = 0.009 for SBP, P = 0.019 for DBP). The average heart rate fell from 77 ± 8 bpm to 71 ± 5 bpm (P = 0.01) and 72 ± 7 bpm (P = 0.043), respectively. Our study showed five types of BP responses elicited by RNS in humans. RDN guided by these BP responses was feasible and resulted in obvious BP reduction, and they may potentially provide precise guidance for RDN.

Sympathetic overactivation is one of the main contributors to development and progress of hypertension. Renal denervation (RDN) has been evidenced by series of clinical trials for its efficacy and safety to treat overactivated sympathetic nervous system induced diseases. However, the results were inconsistent and not all patients benefited from RDN. Appropriate patient selection and intraoperative factors to improve the efficacy of RDN need to be solved urgently. Over the decade, research studies on the correlations between indicators and the antihypertensive effects have been conducted and made a fairly well progress. Herein, we comprehensively reviewed the research studies on how to make RDN more predictable or improve the efficacy of RDN and summarized these potential indicators or devices which might be applied in clinical settings.

BackgroundExisting studies have shown that sacubitril-valsartan ameliorated atrial remodeling in atrial fibrillation (AF) and favored maintenance of sinus rhythm in patients with AF and heart failure. However, the effect of sacubitril-valsartan in patients with persistent AF is yet unknown. We aimed to evaluate the effect of sacubitril-valsartan on restoration and maintenance of sinus rhythm in patients with persistent AF who underwent electrical cardioversion (ECV).MethodConsecutive patients with persistent AF who underwent ECV between 1 January 2016 and 30 September 2020 were investigated in this retrospective cohort study. All eligible patients were categorized into sacubitril-valsartan users and sacubitril-valsartan non-users based on whether they received treatment with sacubitril-valsartan or not. The endpoint was ineffictive ECV, defined as the composite of failure to terminate AF or any recurrence of AF during 30 days follow-up.ResultsA total of 76 patients were enrolled in this study, including 28 sacubitril-valsartan users and 48 non-users. Within a follow-up of 30 days after ECV, the endpoint had occurred in 7 (25%) of 28 sacubitril-valsartan users and 25 (52%) of 48 non-users. Significantly lower rate of ineffictive ECV in sacubitril-valsartan users compared with non-users was shown in Kaplan-Meier survival curves (P = 0.02; Log-rank test). Multivariate Cox regression analysis indicated that sacubitril-valsartan use (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.14–0.91), amiodarone use (HR, 0.32; 95% CI, 0.13–0.78), left atrial diameter ≤ 39 mm (HR, 0.21; 95% CI, 0.06–0.71) were independently associated with a decreased rate of ineffective electrical cardioversion.ConclusionUse of sacubitril-valsartan is associated with a significantly decreased risk of ineffective ECV compared with non-users in patients with persistent AF.