AIMS:Uncontrolled blood pressure is a main issue in the management of hypertensive patients, while mobile health (mHealth) offers a new perspective. This study aimed to investigate the efficacy of an mHealth app-based intervention, the European Society of Hypertension (ESH) CARE, in the management of uncontrolled hypertensive patients. METHODS AND RESULTS:This was a two-arm randomized, controlled trial conducted among 107 hypertensive patients, with uncontrolled office (≥140/90 mmHg) and 24-h ambulatory blood pressure (≥130/80 mmHg). After antihypertensive drug treatment initiation or intensification, patients were 1:1 randomized to application assisted strategy (AAS) group or usual care group, with scheduled visits at 1 and 3 months. In ASS group there was a virtual visit, while in usual care group there was an office visit. At 6 months, there was a final visit assessment with office and ambulatory blood pressure (BP) measurement. The mean age of the total population (n = 107) was 52.9 ± 9.6 years, 50.5% were women, without any significant differences in the baseline characteristics. At 6 months, 50% in the usual care group and 78.2% in the AAS group (P = 0.002) achieved both systolic and diastolic ambulatory BP targets (<130/80 mmHg). Regarding office BP, there was a reduction of 19.9 ± 9.1/12.4 ± 7.7 mmHg in the usual care group and 25.1 ± 6.4/16.3 ± 6.3 mmHg in the AAS group, while regarding ambulatory BP, there was a reduction of 6.6 ± 9.2/3.3 ± 6.2 mmHg and 10.9 ± 9.1/6.4 ± 5.5 mmHg, respectively. CONCLUSION:Follow-up of hypertensive patients with the ESH Care App is feasible and contributes to a significantly better office and out-of-office BP control after 6 months.

BACKGROUND:Single-pill low-dose combination (LDC) antihypertensive therapy is an emerging strategy for improving blood pressure (BP) control. Although previous phase II and pragmatic studies suggested promise, these are the first phase III, double-blind, active-controlled trials comparing a single-pill ultra-low-dose triple combination with standard-dose monotherapy. OBJECTIVES:In these studies, we sought to compare a single-pill combination of 1.67 mg amlodipine, 16.67 mg losartan potassium, and 4.17 mg chlorthalidone (LDC-ALC) with standard-dose monotherapy-5 mg amlodipine or 50 mg losartan potassium-in patients with mild-to-moderate hypertension. METHODS:HM-APOLLO-301 (Study 301, May 2022-June 2023) and HM-APOLLO-302 (Study 302, March-December 2024) were multicenter, randomized, double-blind, active-controlled, phase III studies in South Korea. Study 301 compared LDC-ALC and amlodipine; Study 302 compared LDC-ALC and losartan. Adults (≥19 years of age) with systolic blood pressure (SBP) 140 to <180 mm Hg and diastolic blood pressure (DBP) <110 mm Hg after 4-week placebo run-in were randomized to 8 weeks of treatment. The primary endpoint was SBP reduction at week 8, assessed first for noninferiority, then for superiority. RESULTS:In Study 301, LDC-ALC exhibited noninferiority to amlodipine in reducing SBP at week 8 (upper bound of 1-sided 97.5% CI: 2.8 mm Hg [<3 mm Hg noninferiority margin]), and similar efficacy (least-squares mean change: -19.1 vs -19.9 mm Hg; 95% CI: -1.5 to 3.1; P = 0.495), with similar DBP reduction and blood pressure control rate. In Study 302, LDC-ALC was both noninferior (upper bound of one-sided 97.5% CI: -0.6 mm Hg) and superior to losartan (least-squares mean change: -19.9 vs -16.4 mm Hg; 95% CI: -6.6 to -0.2; P = 0.037) in SBP reduction at week 8, with greater DBP reduction and a higher blood pressure control rate than losartan. Adverse events were similar between groups (LDC-ALC vs amlodipine: 11.7% vs 13.9%; LDC-ALC vs losartan: 6.4% vs 3.3%), with ≤1% treatment withdrawals and no serious drug-related events. CONCLUSIONS:Single-pill LDC-ALC achieved BP reductions similar to those with amlodipine and greater than those with losartan monotherapy over 8 weeks, with similar short-term tolerability. These findings support LDC-ALC as an effective and well tolerated alternative initial therapy for mild-to-moderate hypertension, expanding the set of validated strategies alongside established monotherapies. (A Study to Evaluate Efficacy and Safety of HCP1803 in Patients With Essential Hypertension [HM-APOLLO-301; NCT05362110]; A Study to Evaluate Efficacy and Safety of HCP1803 Compared to RLD2001-1 in Patients with Essential Hypertension [HM-APOLLO-302, NCT06438172]).

Hypertension is the leading cardiovascular risk factor. However, despite the availability of safe and effective antihypertensive drugs, blood pressure (BP) control rates remain low worldwide. In this context, the recent European hypertension guidelines present an additional challenge by lowering the BP threshold for initiating pharmacological treatment to below 140/90 mmHg for selected high-risk patients and recommending that BP values be lowered to below 130/80 mmHg for most hypertensive patients. In this narrative review, we discuss the barriers to the implementation of guideline-defined standards of care in high-, low-, and middle-income countries and consider some possible solutions to improve this situation. We discuss strategies for detecting hypertension and monitoring its control, including new technologies and settings for BP measurement. Key issues related to the treatment of hypertension at the population level are also addressed, including lifestyle interventions, improving adherence to treatment, and organizational solutions, particularly for long-term follow-up of hypertensive patients. Finally, we identify key areas for future research into the implementation of hypertension care standards and attempt to suggest possible strategies that may be particularly relevant in the future, with the aim of improving global hypertension control rates and reducing the burden of its complications.

RATIONALE:Obstructive sleep apnea (OSA) and hypertension are common comorbidities and are associated with poor prognosis. Blood pressure (BP) trajectories using home BP monitoring after initiation of continuous positive airway pressure (CPAP) therapy for OSA are poorly documented. OBJECTIVES:To describe BP trajectories in the first 6 months after CPAP therapy initiation based on repeated longitudinal measurements of home BP, to evaluate the impact of CPAP on morning and evening home BP, and to identify predictors of home BP evolution during CPAP. METHODS:This prospective cohort study enrolled patients with OSA. Home BP monitoring was used to assess morning and evening home BP values over a 7-day period at baseline and over the first 6 months after starting CPAP therapy. RESULTS:A total of 98 patients were enrolled, and 36,600 home BP measurements were available for analysis. Morning and evening systolic/diastolic home BP decreased significantly during the first 6 months of CPAP therapy (P < 0.05 vs. baseline). Morning home BP was significantly higher than evening home BP throughout the study (P < 0.01). After adjustment for OSA severity at baseline and CPAP adherence, factors associated with limited home BP response to CPAP were older age, weight gain during CPAP therapy, current smoking, and previous hypertension. CONCLUSIONS:CPAP improved home BP trajectories during the first 6 months, but the response was heterogeneous and less marked for morning BP values. Based on the predictors of BP response during CPAP therapy, weight control appears key to the effective management of patients with OSA and hypertension.Clinical trial registered with www. CLINICALTRIALS:gov (NCT04963192 and NCT04054180).

BACKGROUND:Contemporary left ventricular assist devices (LVADs) improve survival, yet residual heart failure (HF) remains despite optimized device support. The extent to which right ventricular (RV)-pulmonary artery (PA) interaction, measured by single-beat elastance-based indices, identifies residual risk is unknown. METHODS:We studied 70 adults implanted with HeartMate3 LVADs (2018-2022) who underwent pre-discharge right heart catheterization after echocardiographic and invasive LVAD optimization. Using a single-beat method, RV end-systolic elastance (Ees), PA effective arterial elastance (Ea), and the Ees:Ea ratio (RV-PA coupling) were derived from high-fidelity pressure waveforms. Associations between these indices and surrogates of residual HF (cardiac output [CO] at discharge, need for high-dose outpatient diuretics, and 3-month 6-minute walking distance [6MWD]) were evaluated using multivariable regressions. RESULTS:Despite optimized LVAD support, patients demonstrated preserved RV Ees (0.40 ± 0.19mmHg/ml), elevated PA Ea (0.54 ± 0.21 mmHg/ml) and reduced Ees:Ea ratio (0.78 ± 0.36), consistent with RV-PA uncoupling. Higher PA Ea independently associated with lower CO and greater likelihood of high-dose diuretic use, while impaired RV-PA coupling (lower Ees:Ea) was the only hemodynamic parameter associated with reduced 6MWD. Traditional RV indices, including PAPi and CVP-to-wedge ratio, were not associated with outcomes. CONCLUSION:Single-beat RV-PA elastance metrics identify residual HF phenotypes in clinically optimized HM3 recipients not captured by standard right-sided indices. If prospectively validated, incorporating RV Ees, PA Ea ("flow obstruction") and Ees:Ea ("energy inefficiency") into pre-discharge assessment may be used to refine risk stratification and inform device-directed and pulmonary vascular interventions during LVAD.

Heart failure (HF) and cardiovascular (CV) diseases (CVD) are closely interconnected through a complex and bidirectional relationship. HF frequently represents the final common pathway of several CV conditions; in contrast, CV comorbidities often act as key drivers of disease progression along the HF continuum, from stage A (individuals at risk) to overt symptomatic HF (stages C–D). The coexistence of multiple CV comorbidities—including arterial hypertension, atrial fibrillation, coronary artery disease, peripheral artery disease, and valvular heart disease—is associated with a more severe clinical profile, reduced functional capacity, impaired quality of life, and increased risk of hospitalization and mortality. Importantly, CV comorbidities may significantly influence the implementation and optimization of guideline-directed medical therapy (GDMT), frequently limiting appropriate up-titration due to haemodynamic instability, drug intolerance, or increased susceptibility to adverse events. The prevalence, pathophysiological interactions, and prognostic impact of CV comorbidities vary across HF phenotypes, contributing to the heterogeneity of disease presentation and clinical outcomes. An integrated and phenotype-oriented approach is therefore essential to optimize risk stratification and personalize therapeutic strategies. Since the publication of the 2019 manifesto on HF comorbidities from the Working Group on Heart Failure of the Italian Society of Cardiology (SIC), substantial new evidence has emerged regarding the epidemiology, pathophysiology, and management of CV comorbidities in HF. In this updated position paper, the SIC Working Group on Heart Failure provides a comprehensive and clinically oriented overview of the current evidence on major CV comorbidities in HF, with the aim of supporting clinicians in improving diagnostic pathways, optimizing therapeutic strategies, and ultimately enhancing clinical outcomes.

Background: Aortic stiffness (AoS) is an established predictor of cardiovascular morbidity and mortality. Endovascular aneurysm repair (EVAR) introduces a rigid stent-graft into the aorta, potentially increasing AoS and impairing subendocardial perfusion. This prospective study aimed to evaluate changes in AoS and myocardial perfusion following EVAR, measured by carotid-to-femoral pulse wave velocity (cf-PWV) and the Subendocardial Viability Ratio (SEVR), and examined the influence of graft length on post-operative cf-PWV and SEVR. Methods: From October 2023 to April 2025, 38 patients undergoing elective EVAR were prospectively enrolled. Cf-PWV and the SEVR were measured <72 h preoperatively and 7 days postoperatively using the PulsePen® device. Descriptive statistics were used to summarize baseline characteristics. Data were assessed for normality with the Shapiro-Wilk test; non-normally distributed variables were analysed using the Wilcoxon signed-rank test and presented as median [interquartile range, IQR], while normally distributed variables were analysed using paired t-tests and presented as mean ± standard deviation (SD). Linear regression was applied to evaluate associations between graft length and postoperative changes in cf-PWV and SEVR. Results: Cf-PWV increased significantly after EVAR, with a median within-patient change of 1.0 m/s [IQR 3.1] (p < 0.001), corresponding to a 10.6% increase. The SEVR decreased significantly by 15.1% (p = 0.006). Graft length correlated positively with cf-PWV change, with a 0.2% increase in cf-PWV per millimetre of graft length (r = 0.41; p = 0.029), but not with SEVR (r = 0.058, p = 0.763). Conclusions: EVAR was associated with increased AoS and reduced subendocardial perfusion, with greater stiffness changes observed in patients receiving longer grafts. These preliminary findings highlight important haemodynamic consequences of EVAR and may inform patient selection, postoperative management, and the development of future stent-graft designs to mitigate long-term cardiovascular risk.

INTRODUCTION:In heart failure (HF) patients, guidelines recommend scores for assessing outcomes and heart transplant (HTX) eligibility. However, scores use remains limited and cut-off values for HTX listing not well established.Among the available tools, MECKI score is easy to calculate and likely offers the best prognostic accuracy. Compare MECKI score-based survival with that of HTX recipients and identify a MECKI threshold above which survival is inferior to that of HTX recipients at 5-year. METHODS:Consecutive ambulatory HF patients enrolled in MECKI score programme between January 2010 and January 2022 were evaluated. Primary endpoint was a composite of cardiovascular death, HTX, or left ventricular assist device implantation. Heart transplant survival data were obtained from the International Society of Heart and Lung Transplantation registry updated through 2023. To identify the MECKI score threshold beyond which prognosis is worse than that of HTX recipients, patients were stratified by deciles of MECKI score. RESULTS:We analysed 3865 HF patients (mean age 62.4 ± 12.6 years). Peak VO₂ was 58.2 ± 18.3% predicted; VE/VCO₂ slope 33.2 ± 8.2, haemoglobin 13.5 ± 1.7 g/dL, Na⁺ 139 ± 3 mmol/L, LVEF 33.7 ± 10.4%, and eGFR 73 ± 26 mL/min/1.73 m². Periodic breathing occurred in 15.8% of patients. At 5 years, mean survival was 83.7%.The average 5-year survival of HTX recipients (71.2%) lies between the eighth and ninth MECKI score deciles suggesting a MECKI score value ≥0.1368 as the proper cut-off for HTX listing. CONCLUSION:MECKI score ≥0.1368 may warrant HTX listing, while lower scores support clinical deferral.

Cardiovascular diseases, such as hypertension, coronary artery diseases (CAD), arrhythmias, and chronic heart failure (CHF), often require treatment with beta-blockers. These conditions frequently coexist with chronic obstructive pulmonary disease (COPD), which can complicate therapeutic decisions. Indeed, patients with moderate-to-severe COPD are frequently not given these agents out of concern for possible bronchoconstriction arising from blockade of β2-adrenoceptors in the airways. Observational studies, and meta-analyses support the cardiovascular benefits of β-blockade in people with COPD and cardiovascular diseases. Recent trials evaluating cardioselective β-blockade suggest that cardioselective beta-blockers such as bisoprolol, metoprolol and nebivolol are safe and likely beneficial in those patients that would benefit from their intake due to presence of cardiac comorbid diseases. The aim of this systematic review is to summarise the recent trials and indications for use of cardioselective β-blockers in patients with COPD.

Aims The InTakeCare Trial aims to develop, implement, and clinically validate a novel digital health solution (DHS) to improve medication adherence (MA) in patients with arterial hypertension. This initiative responds to the global issue of poor MA to long-term pharmacological treatments, compromising patient outcomes and increasing healthcare costs.Methods and results This study is structured as a multidisciplinary, single-centre, randomized, open, blinded-endpoint clinical trial. In the preliminary phase, focus groups and a survey are conducted to develop patient personas and fictional archetypes that represent real people in the development of interventions, informing the personalization of a mobile application for patients and a web dashboard for physicians. The developed DHS is designed to deliver tailored reminders, health messages, and real-time monitoring of MA. After a pilot usability phase, 206 hypertensive patients will be randomized to standard care or active intervention for a 3-month period, followed by a 2-month observational phase to assess the persistence of intervention effects on adherence. MA is measured via direct (e.g. plasma drug levels) and indirect (e.g. self-reports) methods, alongside ambulatory blood pressure monitoring and behavioural engagement scales.Conclusion This study offers a novel, theory-informed framework for the design of personalized DHS in chronic disease management. Leveraging user-centred design and machine learning-driven persona classification, InTakeCare introduces a scalable, evidence-based solution that addresses individual variability in adherence behaviours. The trial's findings are expected to generate insights into the efficacy, usability, and acceptability of personalized DHS in routine clinical practice, providing a replicable model for future DHS in other chronic conditions.

Workers native to sea level and employed in Chilean Andes mines (3800–4500 m) experience Chronic Intermittent Hypobaric Hypoxia (CIHH) due to 7-day high-altitude shifts alternating with 7-day sea-level rest. Hypobaric hypoxia can exacerbate Sleep-Disordered Breathing (SDB), raising cardiovascular risk. Evaluating miners before altitude exposure may help identify SDB risk factors. We described nocturnal respiratory alterations during CIHH and the anthropometric and biological characteristics measured at sea level. In this Cross-sectional study, nocturnal oximetry was performed in miners during high-altitude shifts. Blood samples, blood pressure, and anthropometric data were collected at sea level before ascent. Oxygen Desaturation Index (ODI) ≥ 15/h and time spent with SpO2 < 85

Heart rate variability (HRV) reflects the complex interplay of physiological systems, like the autonomic nervous system, which modulates HRV through parasympathetic and sympathetic branches. This study investigates the multiscale multifractal properties of HRV and the influence of autonomic control using an optimized Detrended Fluctuation Analysis (DFA) framework. Building on prior work, we applied a multifractal multiscale DFA to series of cardiac intervals recorded in 9 healthy volunteers before and during selective autonomic blocks (parasympathetic, sympathetic, combined, and central sympathetic). We quantified fractal components over the scales between 9 and 120 s, using moment orders from – 5 to +5 to differentiate between low- and high-amplitude fluctuations. Results reveal that HRV exhibits intrinsic multiscale multifractality, with distinct scale-dependent patterns for different amplitude components. Autonomic blocks alter these patterns: parasympathetic blockade significantly increases the coefficients at scales shorter than 30 s for high-amplitude components and between 20 and 50 s for low-amplitude components, and sympathetic blockade decreases the coefficients at scales around 50 s for the high-amplitude components. Furthermore, unlike sympathetic blockade, parasympathetic blockade increases the degree of multiscale multifractality. This suggests that the multifractal dynamics of high-amplitude components arise from the superposition of autonomic influences with distinct transfer functions—flat for vagal and low-pass for sympathetic modulation; and that the parasympathetic outflow may also contribute to the multifractality of low-amplitude components. In conclusion, this study underscores the potential of multiscale multifractal analysis in characterizing cardiovascular control and the valuable insights it may offer for diagnosing dysautonomia and monitoring therapeutic interventions.