Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide and is increasingly recognized as a major contributor to cardiovascular morbidity and mortality. Beyond liver involvement, MASLD represents a systemic metabolic disorder closely linked to cardiovascular disease (CVD), the leading cause of death in affected patients. This association persists independently of traditional cardiometabolic risk factors and is driven by multiple mechanisms, including insulin resistance, chronic low-grade inflammation, atherogenic dyslipidemia, endothelial dysfunction, and prothrombotic states. Disease severity, particularly liver fibrosis, appears to further increase cardiovascular risk. This review summarizes current evidence on the epidemiological and pathophysiological links between MASLD and CVD, including its role in atherosclerosis, coronary artery disease, and heart failure. Clinical implications for cardiovascular risk stratification, screening, and multidisciplinary management are also discussed, highlighting the need for integrated strategies to reduce both hepatic and cardiovascular complications.

Resistant hypertension (RHTN) is estimated to affect approximately 15

Management of acute coronary syndromes (ACS) in the cardiac intensive care unit (CICU) requires rapid diagnosis, timely reperfusion or invasive assessment, appropriate antithrombotic therapy, and early recognition of haemodynamic, electrical, and mechanical complications. This narrative review examines contemporary evidence across ST-segment elevation and non-ST-segment elevation presentations, with emphasis on decisions during hospitalisation and early secondary prevention. High-sensitivity cardiac troponin algorithms support accelerated assessment of suspected non-ST-segment elevation ACS, whereas next-generation assays require further implementation validation. Twelve-month dual antiplatelet therapy remains the default after ACS in patients without high bleeding risk; abbreviated regimens, de-escalation, cangrelor, and combined antiplatelet–anticoagulant treatment are selective strategies. Contemporary care also includes risk-based invasive timing, complete revascularisation in suitable haemodynamically stable patients, culprit-lesion-only initial PCI in cardiogenic shock, and individualised management of frailty and renal impairment. High-intensity statin therapy, with early ezetimibe when needed, is guideline-supported. Early PCSK9 inhibition and low-dose colchicine are selective strategies, whereas SGLT2 inhibitors and GLP-1RAs are established for specific comorbid indications. hs-cTnT Gen 6 and AI-assisted tools remain evidence-evolving, while multiomics and targeted anti-inflammatory therapies remain investigational. Clear separation of guideline-supported, selective, evidence-evolving, and investigational approaches is essential for clinically appropriate ACS care.

La dénervation rénale est une stratégie innovante validée pour réduire efficacement la pression artérielle chez les patients hypertendus avec HTA résistante d’une part, légère d’autre part.Son efficacité moyenne équivaut à celle d’un médicament antihypertenseur à pleine dose, mais la réponse reste hétérogène selon les patients.L’identification de marqueurs prédictifs de réponse à la dénervation rénale constitue un enjeu majeur pour optimiser la sélection des candidats.En l’absence de tels biomarqueurs, le respect strict du parcours de soin proposé par le consensus français reste la meilleure garantie d’une indication appropriée.En France, la dénervation rénale est prise en charge pour les patients ayant une hypertension essentielle résistante à une quadrithérapie, après validation par un centre expert.

Cardiometabolic diseases continue to escalate in frequency and complexity across the Asia-Pacific region, with multimorbid patterns involving hypertension, diabetes mellitus, dyslipidemia, and atherosclerotic cardiovascular diseases posing clear challenges in adherence and pharmacotherapy. The Cardiometabolic Asia Summit 2025 brought together 188 clinicians and 22 expert faculty members with diverse specialties and practice backgrounds from 13 countries to examine these regional realities through interactive case discussions, live polling, and multidisciplinary discourse. Insights from Transdisciplinary dialogues revealed that multimorbidity affects more than half of patients in real-world practice and has become the clinical norm rather than the exception, with the diabetes-dyslipidemia-hypertension triad as the dominant pattern. The summit identified two interdependent pillars essential to addressing this complexity: achieving disease control through evidence-based Interventions and sustaining adherence through the physician-patient partnership. Discussions emphasized practical frameworks including structured hypertension management approaches using the ESH MASTER plan, organ-protective strategies in diabetes extending beyond glycemic targets, and goal-oriented lipid therapy. Emerging consensus, informed by randomized trials and real-world evidence, highlighted that artificial intelligence integration, enhanced therapeutic strategies, and multidisciplinary management models represent critical enablers of sustainable, patient-centered cardiometabolic care across diverse Asian populations. Keywords: Cardiometabolic Diseases; Multimorbidity;Asia-Pacific Region; Medication Adherence;Hypertension; Diabetes Mellitus; Dyslipidemias;Multidisciplinary Health Care

Hypertension is the most prevalent modifiable risk factor for cardiovascular disease and for cardiovascular and all-cause mortality globally. Suboptimal control of elevated blood pressure places a substantial burden on health-care systems worldwide. Several factors contribute to this suboptimal control, such as limited awareness of hypertension, lack of appropriate diagnosis and poor control of blood pressure among those with a diagnosis. These factors can be due to patient non-adherence to treatment, inertia among health-care professionals and low uptake and implementation of clinical guideline recommendations. From 2003 to 2018, the European Society of Hypertension and the European Society of Cardiology jointly published four sets of guidelines on hypertension. However, the two societies released separate guidelines on hypertension in 2023 and 2024, respectively. These two sets of European guidelines agree on most recommendations, but some differences have been identified. In this Expert Recommendation, we highlight the key consensus recommendations from the two guidelines; compare differing approaches to the definition, classification, diagnosis and treatment of hypertension; and aim to help health-care professionals in their decision-making to improve the management of hypertension and to reduce the burden of hypertension-associated outcomes and premature deaths. In this Expert Recommendation, Lauder and colleagues compare the latest European Society of Cardiology and European Society of Hypertension guidelines on hypertension, highlight the key consensus recommendations and compare differing approaches to definitions, classification, diagnosis and treatment, with the aim to help health-care professionals in their decision-making to improve the management of hypertension.

Obstructive sleep apnea (OSA) is a common chronic condition that is growing in prevalence, associated with important comorbidities, and has several different phenotypes. Continuous positive airway pressure (CPAP) is the gold standard OSA treatment, but its effectiveness relies on consistent adherence, which can often be difficult to maintain. This narrative review discusses current challenges in the care pathways for CPAP therapy management in OSA, including fragmented care/lack of continuity, inadequate management of comorbidities, suboptimal implementation of digital medicine solutions, and existing reimbursement paradigms. Key tasks to be shared between the appropriate healthcare professionals and providers include technical CPAP follow-up (adherence, effectiveness, alert management), management of comorbidities, and multimodal non-invasive monitoring. What this looks like and who provides the different aspects of care should vary by OSA phenotype, ranging from simple follow-up in primary care (uncomplicated OSA with good CPAP adherence) to multidisciplinary specialist management (high-risk OSA with comorbidities), with regular reassessment to ensure continued alignment with the chosen care plan. In addition to better defining these pathways, how they are reimbursed also needs to be addressed. We suggest that there should be a multidisciplinary approach to symptom reduction and adherence, longitudinal assessment of patient-reported outcomes, and a focus on long-term cardiometabolic health as part of managing CPAP-treated patients with OSA. Facilitated by the appropriate use of digital technologies, these approaches should lead to more personalized care and greater patient engagement, resulting in better long-term adherence and treatment effectiveness. The ultimate goal should be to do better for less.

Objective: The ESH 2023 guidelines stipulate that to measure a patient's blood pressure, 3 measurements should be taken at 1-minute intervals, and the last two should be kept for averaging to assess whether 2 consecutive 1-minute blood pressure measurements classify blood pressure levels in the same way as 3 measurements. Design and method: The French Fundation and Hypertension Comitee health data warehouse contains 4172 medical records of subjects aged 35 years who volunteered to participate in nationwide health surveys conducted in France between 2015 and 2022 (French League Against Hypertension Survey). Blood pressure was measured with an automatic blood pressure monitor in the morning in a seated position with 1 minute between each measurement. Each subject was categorized according to the systolic and diastolic blood pressure of measurement 2 and the mean of measurement 2 and 3. The subject was classified as H if SBP > 140 or DBP >90. Subject was N if SBP <= 130 or DBP <= 90. Concordance in classifications between measure 2 and the mean of measure 2 and 3 was performed for each subject. Results: Agreement between measurement 2 and the mean of measurements 2 and 3 was 98% for SBP and 95% for DBP for category H. Agreement for category N was 92.3% for SBP and 94% for DBP. These results are explained by the increased variability observed as early as measurement 2. Conclusions: Measuring blood pressure 2 times in a row with an automatic blood pressure monitor is sufficient to categorize a patient's blood pressure and to identify blood pressure variability.

Background: Effective patient-centered care requires an adequate understanding of patient preferences for different therapeutic options. We modelled patient preference for blood pressure (BP) management by pharmaceutical or interventional treatments such as renal denervation in patients with different profiles of uncontrolled hypertension. Methods: Modeling was based on the findings from a previously conducted quantitative discrete choice experiment (DCE). The likelihood of selecting either an interventional treatment option or additional antihypertensive medication option was calculated for three patient profiles that represent the range of patients with hypertension commonly encountered in clinical practice: treatment-naive, patients with uncontrolled BP while on one to three antihypertensive medications, and patients with drug-resistant hypertension. Variables in the preference model were treatment attributes from the DCE study: expected reduction in office SBP with each treatment, duration of treatment effect, risk of reversible drug side effects from drugs, and risk of temporary pain and/or bruising or vascular injury from interventions. Values of the variables were derived from published clinical studies or expert opinion. Results: The model predicted that the likelihood of choosing an intervention over initiating pharmacotherapy was 17.2% for previously untreated patients, 23.7% for patients with moderate hypertension currently on pharmacotherapy, and 41.8% for patients with drug-resistant hypertension. The dominant variable driving preference in these models was the expected BP reduction. Patient preferences for intervention are greater when drug nonadherence or increased SBP reduction at 3 vs. 1 year are included in the model. Baseline BP, drug side effects, or risks of the procedure had little influence on decisions. Conclusion: Modeling using patient preference weights predicts that a substantial minority of patients favor an interventional treatment such as renal denervation over initiation or escalation of medications. Awareness of a patient's interest in device-based versus pharmaceutical strategies should inform the shared decision-making process for hypertension treatment.

BACKGROUND: Renal denervation (RDN) has demonstrated clinically relevant reductions in blood pressure (BP) among individuals with uncontrolled hypertension despite lifestyle intervention and medications. The safety and effectiveness of alcohol-mediated RDN have not been formally studied in this indication. METHODS: TARGET BP I is a prospective, international, sham-controlled, randomized, patient- and assessor-blinded trial investigating the safety and efficacy of alcohol-mediated RDN. Patients with office systolic BP (SBP) ≥150 and ≤180 mm Hg, office diastolic BP ≥90 mm Hg, and mean 24-hour ambulatory SBP ≥135 and ≤170 mm Hg despite prescription of 2 to 5 antihypertensive medications were enrolled. The primary end point was the baseline-adjusted change in mean 24-hour ambulatory SBP 3 months after the procedure. Secondary end points included mean between-group differences in office and ambulatory BP at additional time points. RESULTS: Among 301 patients randomized 1:1 to RDN or sham control, RDN was associated with a significant reduction in 24-hour ambulatory SBP at 3 months (mean±SD, −10.0±14.2 mm Hg versus −6.8±12.1 mm Hg; treatment difference, −3.2 mm Hg [95% CI, −6.3 to 0.0]; P =0.0487). Subgroup analysis of the primary end point revealed no significant interaction across predefined subgroups. At 3 months, the mean change in office SBP was −12.7±18.3 and −9.7±17.3 mm Hg (difference, −3.0 [95% CI, −7.0 to 1.0]; P =0.173) for RDN and sham, respectively. No significant differences in ambulatory or office diastolic BP were observed. Adverse safety events through 6 months were uncommon, with one instance of accessory renal artery dissection in the RDN group (0.7%). No significant between-group differences in medication changes or patient adherence were identified. CONCLUSIONS: Alcohol-mediated RDN was associated with a modest but statistically significant reduction in 24-hour ambulatory SBP compared with sham control. No significant differences between groups in office BP or 6-month major adverse events were observed. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02910414.

Heart failure is a chronic condition that affects millions of people worldwide and is associated with high morbidity and mortality. Remote monitoring, which includes the use of non-invasive connected devices, cardiac implantable electronic devices and haemodynamic monitoring systems, has the potential to improve outcomes for patients with heart failure. Despite the conceptual and clinical advantages, there are still limitations in the widespread use of these technologies. Moreover, a significant proportion of studies evaluating the benefit of remote monitoring in heart failure have focused on the limited area of prevention of rehospitalization after an episode of acute heart failure. A group of experts in the fields of heart failure and digital health worked on this topic in order to provide a practical paper for the use of remote monitoring in clinical practice at the different stages of the heart failure syndrome: (1) discovery of heart failure; (2) acute decompensation of chronic heart failure; (3) heart failure in stable period; and (4) advanced heart failure. A careful and critical analysis of the available literature was performed with the aim of providing caregivers with some recommendations on when and how to use remote monitoring in these different situations, specifying which variables are essential, optional or useless.

DOCUMENT REVIEWERS:Luis Alcocer (Mexico), Christina Antza (Greece), Mustafa Arici (Turkey), Eduardo Barbosa (Brazil), Adel Berbari (Lebanon), Luís Bronze (Portugal), John Chalmers (Australia), Tine De Backer (Belgium), Alejandro de la Sierra (Spain), Kyriakos Dimitriadis (Greece), Dorota Drozdz (Poland), Béatrice Duly-Bouhanick (France), Brent M. Egan (USA), Serap Erdine (Turkey), Claudio Ferri (Italy), Slavomira Filipova (Slovak Republic), Anthony Heagerty (UK), Michael Hecht Olsen (Denmark), Dagmara Hering (Poland), Sang Hyun Ihm (South Korea), Uday Jadhav (India), Manolis Kallistratos (Greece), Kazuomi Kario (Japan), Vasilios Kotsis (Greece), Adi Leiba (Israel), Patricio López-Jaramillo (Colombia), Hans-Peter Marti (Norway), Terry McCormack (UK), Paolo Mulatero (Italy), Dike B. Ojji (Nigeria), Sungha Park (South Korea), Priit Pauklin (Estonia), Sabine Perl (Austria), Arman Postadzhian (Bulgaria), Aleksander Prejbisz (Poland), Venkata Ram (India), Ramiro Sanchez (Argentina), Markus Schlaich (Australia), Alta Schutte (Australia), Cristina Sierra (Spain), Sekib Sokolovic (Bosnia and Herzegovina), Jonas Spaak (Sweden), Dimitrios Terentes-Printzios (Greece), Bruno Trimarco (Italy), Thomas Unger (The Netherlands), Bert-Jan van den Born (The Netherlands), Anna Vachulova (Slovak Republic), Agostino Virdis (Italy), Jiguang Wang (China), Ulrich Wenzel (Germany), Paul Whelton (USA), Jiri Widimsky (Czech Republic), Jacek Wolf (Poland), Grégoire Wuerzner (Switzerland), Eugene Yang (USA), Yuqing Zhang (China).

Objective: To compare adherence to antihypertensive treatment between patients prescribed the perindopril/amlodipine/indapamide single-pill combination (SPC) vs the combination of an angiotensin-converting enzyme inhibitor (ACEI), a calcium-channel blocker (CCB), and a diuretic (D) as a SPC of two drugs plus the third drug separately. Design and method: Patients aged > = 40 years who received a prescription of perindopril/amlodipine/indapamide SPC during 2015-2018 were identified and the date of the first prescription was defined as the index date. For each patient prescribed the SPC, a subject who started ACEI/CCB/D treatment as a two-drug SPC plus a third drug separately (i.e. 2 pills) at the index date was identified. Adherence to the triple combination was assessed over the year after the index date as the proportion of the follow-up days covered (PDC) by prescription. The primary aim was to compare the odds of being highly adherent to the drug therapy (PDC>75%) between groups. Secondary aims were to compare (i) the risk of cardiovascular hospitalizations and (ii) the costs of cardiovascular health services (hospitalizations, drugs, and outpatient services). Log-binomial regression models were fitted to estimate the risk ratio, and its 95% confidence interval, of treatment adherence in relation to the drug strategy. A Cox model and a linear regression model were fitted to compare the risk of cardiovascular hospitalizations and mean of healthcare costs, respectively, between groups. Results: 28,210 patients prescribed the perindopril/amlodipine/indapamide SPC were identified and matched to 28,210 patients prescribed ACEI/CCB/D in two pills. Compared with patients under two-pill combination, those who were treated with the SPC had a higher propensity to be highly adherent to the triple combination (2.38, 2.32 – 2.44). Three-drug SPC users had a 13% lower risk of cardiovascular hospitalizations and a € 64 lower costs for cardiovascular healthcare services (p < 0.001) due to reduced hospitalization costs (€ 59). Conclusions: In a real-life setting, patients who were prescribed the perindopril/amlodipine/indapamide SPC exhibited more frequently a good adherence to antihypertensive treatment than those prescribed a combination of ACEI/CCB/D as a two drugs SPC plus a third drug separately.

Objective: To compare adherence to antihypertensive treatment between patients prescribed a three-drug single-pill combination (SPC) of perindopril/amlodipine/indapamide (P/A/I) vs. the combination of an angiotensin-converting enzyme inhibitor (ACEI), a calcium-channel blocker (CCB), and a diuretic (D) as a two-drug SPC plus a third drug given separately. Methods: Using the healthcare utilization database of the Lombardy Region (Italy), the 28 210 patients, aged at least 40 years, who were prescribed P/A/I SPC during 2015-2018 were identified and the date of the first prescription was defined as the index date. For each patient prescribed the SPC, a comparator who started ACEI/CCB/D treatment as a two-pill combination was considered. Adherence to the triple combination was assessed over the year after the index date as the proportion of the follow-up days covered by prescription (PDC). Patients who had a PDC >75% were defined as highly adherent to drug therapy. Log-binomial regression models were fitted to estimate the risk ratio of treatment adherence in relation to the drug treatment strategy. Results: About 59 and 25% of SPC and two-pill combination users showed high adherence, respectively. Compared with patients under a three-drug two-pill combination, those who were treated with the three-drug SPC had a higher propensity to be highly adherent to the triple combination (2.38, 95% confidence interval: 2.32-2.44). This was the case regardless of the sex, age, comorbidities, and number of co-treatments. Conclusions: In a real-life setting, patients under three-drug SPC exhibited more frequently a high adherence to antihypertensive treatment than those prescribed a three-drug two-pill combination.

Objective: To evaluate the frequency and determinants of the white coat effect in subjects performing a standardized self monitoring of blood pressure. Design and method: The French Hypertension Observatory is a non profit initiative set up by the Hypertension French Research Fundation to evaluate the cardiovascular risk of employees working in companies in France. During ‘prevention days’ organized in the company's premises between 9:00 a.m. and 5:00 p.m., volunteer employees performed a self-test of their blood pressure using a validated automatic blood pressure monitor with arm cuff. Self unattended BP measurements were performed with 3 measures 1 minute apart. 4012 subjects were included. The difference between SBP 1 and 3 measurements were considered to define the white coat effect (WCE). Results: The prevalences of WCE (for at least 10 or 20 mmHg of WCE) when first measure indicates 140 for SBP are detailed in the table. Conclusions: The white coat effect is also observed in subjects who measure their blood pressure unattended. During a blood pressure self-screening testing, subjects aged less than 35 years, those with a BMI < 20 or female participants more frequently present a white coat effect than other subjects.

Background: Discrete choice experiment is a survey method used to understand how individuals make decisions and to quantify the relative importance of features. Using discrete choice experiment methods, we quantified patient benefit–risk preferences for hypertension treatments, including pharmaceutical and interventional treatments, like renal denervation. Methods: Respondents from the United States with physician-confirmed uncontrolled hypertension selected between treatments involving a procedure or pills, using a structured survey. Treatment features included interventional, noninterventional, or no hypertension treatment; number of daily blood pressure (BP) pills; expected reduction in office systolic BP; duration of effect; and risks of drug side effects, access site pain, or vascular injury. The results of a random–parameters logit model were used to estimate the importance of each treatment attribute. Results: Among 400 patients completing the survey between 2020 and 2021, demographics included: 52% women, mean age 59.2±13.0 years, systolic BP 155.1±12.3 mm Hg, and 1.8±0.9 prescribed antihypertensive medications. Reduction in office systolic BP was the most important treatment attribute. The remaining attributes, in decreasing order, were duration of effect, whether treatment was interventional, number of daily pills, risk of vascular injury, and risk of drug side effects. Risk of access site pain did not influence choice. In general, respondents preferred noninterventional over interventional treatments, yet only a 2.3 mm Hg reduction in office systolic BP was required to offset this preference. Small reductions in office systolic BP would offset risks of vascular injury or drug side effects. At least a 20% risk of vascular injury or drug side effects would be tolerated in exchange for improved BP. Conclusions: Reduction in systolic BP was identified as the most important driver of patient treatment preference, while treatment-related risks had less influence. The results indicate that respondents would accept interventional treatments in exchange for modest reductions in systolic BP compared with those observed in renal denervation trials.