Aims The MY-3F [Fit & Fun with Football after myocardial infarction (MI) or coronary artery disease (CAD)] study was the first to investigate whether a structured and health-adapted football training programme can improve fitness and risk factors in patients with CAD and whether it is safe. The primary objective of this study was to improve fitness in maximum oxygen uptake in spiroergometry (VO2peak), blood pressure, weight, and safety. Methods and results The MY-3F study is a prospective randomized interventional study with 1-year follow-up in patients with MI or CAD. A football group (FG, n = 89) completed a structured ‘health’ football training (1 h/week, 75 min) led by licensed football coaches. The results were compared with a control group (CG, n = 88). VO2peak in the FG significantly increased from 18.0 to 19.7 mL/min/kg (P < 0.001), and VO2peak in the CG significantly decreased from 19.5 to 18.3 mL/min/kg (P = 0.046). In the FG, running performance per participant per training improved from 1.8 km at admission to 2.4 km at the end of study (P < 0.001). In the FG, blood pressure decreased from 132/81 to 125/76 mmHg (P < 0.001). In the CG, it changed slightly from 137/82 to 136/82 mmHg (ns). In addition, a significantly more antihypertensives were given in CG, but not in FB. In the FG, weight decreased from 92.3 to 90.4 kg (P = 0.003). In the CG, it increased slightly from 90.7 to 91 kg (P = 0.6 ns). Depressive symptoms showed a significant improvement in the FG (P = 0.034), but no changes were observed in the CG. There was no significant change in LDL cholesterol in both groups, but significantly more lipid-lowering therapy was administered in the CG (P = 0.049). Conclusion In My-3F, the preventive benefit on CVRF (cardiovascular risk factors) and fitness of football training in patients after MI or CAD was clearly demonstrated for the first time. The concept proved to be safe and cost-effective and could open the doors of football clubs to evidence-based cardiological prevention.

Background: This prospective cohort study examines the association between hyperuricemia (HU) and cardiovascular diseases. The aim of the current study was to assess whether there might be a correlation between hyperuricemia and cardiovascular risk and future cardiovascular events. Methods: We analyzed data from 4082 participants, dividing them into two groups based on serum uric acid levels. Results: Our findings reveal that participants with elevated serum uric acid or xanthine oxidase inhibitor (XOI) therapy had a significantly higher incidence of cardiovascular events such as coronary artery disease (8.4% vs. 3.3%), stroke (2.6% vs. 1.2%), heart failure (3.4% vs. 0.9%), and chronic kidney insufficiency (4.5% vs. 1.9%) compared to those with normal uric acid levels. Moreover, group 2, which had higher serum uric acid levels, also exhibited a higher burden of established cardiovascular risk factors, including hypertension, obesity, and diabetes. These results support the hypothesis that HU is not only a marker for metabolic dysfunction but may also serve as an independent risk factor for cardiovascular morbidity and mortality. Conclusions: We propose that routine measurement of uric acid levels could be a valuable tool for early identification of high-risk cardiovascular patients, particularly in individuals with multiple metabolic risk factors. Further prospective studies are needed to explore the potential benefits of early XOI therapy in reducing cardiovascular events.

Lipoprotein(a) [Lp(a)] is a known independent risk factor for cardiovascular disease, yet awareness and management remain limited. The psychosocial implications of elevated Lp(a)-levels have been poorly characterized. To compare cardiovascular outcomes and cardiovascular risk factor (CVRF) modification in individuals with normal vs. elevated Lp(a) levels, and to assess the impact of individualized prevention recommendations. For the first time, the individual psychological stress caused by Lp(a) is being surveyed. The ELITE study is a prospective, interventional cohort study conducted in north-western Germany. Participants were regularly assessed for CVRFs, including Lp(a), hypertension, dyslipidemia, diabetes mellitus, weight, nicotine – as well as lipoprotein (a), physical activity, dietary habits, depression and stress. They received written, personalized prevention recommendations. Follow-up averaged 4.4 years. Two groups were analyzed: Group 1 (Gr1, n=3,241) with normal Lp(a), and Group 2 (Gr2, n=841) with elevated Lp(a ≥75 nmol/l). Gr2 (mean Lp(a) 154.8 nmol/l) and Gr1 (mean Lp(a) 16.4 nmol/l) were comparable in age ( 53 years) and sex distribution ( 49

This prospective cohort study examines the association between hyperuricemia (HU) and cardiovascular diseases. We analyzed data from 4,082 participants, dividing them into two groups based on serum uric acid levels. Our findings reveal that participants with elevated serum uric acid or xanthine oxidase inhibitor (XOI) therapy had a significantly higher incidence of cardiovascular events such as coronary artery disease (8.4% vs 3.3%), stroke (2.6% vs. 1.2%), heart failure (3.4% vs. 0.9%), and chronic kidney insufficiency (4.5% vs. 1.9%) compared to those with normal uric acid levels. Moreover, group 2, which had higher serum uric acid levels, also exhibited a higher burden of established cardiovascular risk factors, including hypertension, obesity, and diabetes. These results support the hypothesis that HU is not only a marker for metabolic dysfunction but may also serve as an independent risk factor for cardiovascular morbidity and mortality. We propose that routine measurement of uric acid levels could be a valuable tool for early identification of high-risk cardiovascular patients, particularly in individuals with multiple metabolic risk factors. Further prospective studies are needed to explore the potential benefits of early XOI therapy in reducing cardiovascular events.

Background Patients with chronic heart failure (HF) show an increased risk for the occurrence of chronic kidney disease and cardiorenal syndrome. Urinary Dickkopf‐3 (uDKK3), a stress‐induced, tubular profibrotic glycoprotein, may be elevated in HF as early as in New York Heart Association class I HF and may indicate subsequent decline in estimated glomerular filtration rate (eGFR). Methods and Results uDKK3 levels in patients with HF and controls were measured by enzyme‐linked immunosorbent assay. eGFR was determined up to 5 years in HF. Change in eGFR was assessed with respect to baseline uDKK3 using (mixed‐effect) linear and logistic regression models. A total of 488 patients with chronic HF and 45 control patients were included. Patients with HF showed higher median uDKK3 levels than controls (259.6 pg/mg creatinine [interquartile range (IQR), 119.2–509.4 pg/mg creatinine] versus 107.5 pg/mg creatinine [IQR, 60.5–181.2 pg/mg creatinine], P <0.001). Regression models demonstrated a significant association between log uDKK3 and the decline in eGFR during a median of 13 months (IQR, 12–59 months) (estimated higher eGFR loss, 0.8039 mL/min per 1.73 m 2 /year [95% CI, 0.002–1.606 mL/min per 1.73 m 2 /year], P =0.049; odds ratio, 1.345 [95% CI, 1.049–1.741], P =0.021). uDKK3 levels ≥354 pg/mg creatinine were associated with a significantly higher risk for eGFR decline at 1‐year follow‐up (estimated higher eGFR loss, 4.538 mL/min per 1.73 m 2 [95% CI, 1.482–9.593 mL/min per 1.73 m 2 ]), P =0.004). Even patients with HF without chronic kidney disease (n=334) had higher uDKK3 levels compared with controls (233.4 [IQR, 109.0–436.9 pg/mg creatinine] versus 107.5 [IQR, 60.5–181.2 pg/mg creatinine], P <0.001). Conclusions The present findings indicate that uDKK3 is a promising prognostic biomarker for subsequent eGFR decline in patients with HF, irrespective of the presence of chronic kidney disease and even in the early stages of HF. This potential allows for early intervention to mitigate the deterioration of kidney function. Further investigation is warranted to validate its clinical utility.

Objective: Real-life management of hypertensive patients with chronic kidney disease (CKD) is unclear. Methods: A survey was conducted in 2023 by the European Society of Hypertension (ESH) to assess management of CKD patients referred to ESH-Hypertension Excellence Centres (ESH-ECs) at first referral visit. The questionnaire contained 64 questions with which ESH-ECs representatives were asked to estimate preexisting CKD management quality. Results: Overall, 88 ESH-ECs from 27 countries participated (fully completed surveys: 66/88 [75.0%]). ESH-ECs reported that 28% (median, interquartile range: 1550%) had preexisting CKD, with 10% of them (5- 30%) previously referred to a nephrologist, while 30% (15-40%) had resistant hypertension. The reported rate of previous recent (<6 months) estimated glomerular filtration rate (eGFR) and urine albumin- creatinine ratio (UACR) testing were 80% (50- 95%) and 30% (15- 50%), respectively. The reported use of renin-angiotensin system blockers was 80% (70-90%). When a nephrologist was part of the ESH-EC teams the reported rates SGLT2 inhibitors (27.5% [20- 40%] vs. 15% [10-25], P = 0.003), GLP1-RA (10% [10- 20%] vs. 5% [5- 10%], P = 0.003) and mineralocorticoid receptor antagonists (20% [1030%] vs. 15% [10- 20%], P = 0.05) use were greater as compared to ESH-ECs without nephrologist participation. The rate of reported resistant hypertension, recent eGFR and UACR results and management of CKD patients prior to referral varied widely across countries. Conclusions: Our estimation indicates deficits regarding CKD screening, use of nephroprotective drugs and referral to nephrologists before referral to ESH-ECs but results varied widely across countries. This information can be used to build specific programs to improve care in hypertensives with CKD.

AbstractAimsArterial hypertension (aHTN) plays a fundamental role in the pathogenesis and prognosis of heart failure with preserved ejection fraction (HFpEF). The risk of heart failure increases with therapy‐resistant arterial hypertension (trHTN), defined as inadequate blood pressure (BP) control ≥140/90 mmHg despite taking ≥3 antihypertensive medications including a diuretic. This study investigates the effects of the BP lowering baroreflex activation therapy (BAT) on cardiac function and morphology in patients with trHTN with and without HFpEF.MethodsSixty‐four consecutive patients who had been diagnosed with trHTN and received BAT implantation between 2012 and 2016 were prospectively observed. Office BP, electrocardiographic and echocardiographic data were collected before and after BAT implantation.ResultsMean patients' age was 59.1 years, 46.9% were male, and mean body mass index (BMI) was 33.2 kg/m2. The prevalence of diabetes mellitus was 38.8%, atrial fibrillation was 12.2%, and chronic kidney disease (CKD) stage ≥3 was 40.8%. Twenty‐eight patients had trHTN with HFpEF, and 21 patients had trHTN without HFpEF. Patients with HFpEF were significantly older (64.7 vs. 51.6 years, P < 0.0001), had a lower BMI (30.0 vs. 37.2 kg/m2, P < 0.0001), and suffered more often from CKD‐stage ≥3 (64 vs. 20%, P = 0.0032). After BAT implantation, mean office BP dropped in patients with and without HFpEF (from 169 ± 5/86 ± 4 to 143 ± 4/77 ± 3 mmHg [P = 0.0019 for systolic BP and 0.0403 for diastolic BP] and from 170 ± 5/95 ± 4 to 149 ± 6/88 ± 5 mmHg [P = 0.0019 for systolic BP and 0.0763 for diastolic BP]), while a significant reduction of the intake of calcium‐antagonists, α2‐agonists and direct vasodilators, as well as a decrease in average dosage of ACE‐inhibitors and α2‐agonists could be seen. Within the study population, a decrease in heart rate from 74 ± 2 to 67 ± 2 min−1 (P = 0.0062) and lengthening of QRS‐time from 96 ± 3 to 106 ± 4 ms (P = 0.0027) and QTc‐duration from 422 ± 5 to 432 ± 5 ms (P = 0.0184) were detectable. The PQ duration was virtually unchanged. In patients without HF, no significant changes of echocardiographic parameters could be seen. In patients with HFpEF, posterior wall diameter decreased significantly from 14.0 ± 0.5 to 12.7 ± 0.3 mm (P = 0.0125), left ventricular mass (LVM) declined from 278.1 ± 15.8 to 243.9 ± 13.4 g (P = 0.0203), and e′ lateral increased from 8.2 ± 0.4 to 9.0 ± 0.4 cm/s (P = 0.0471).ConclusionsBAT reduced systolic and diastolic BP and was associated with morphological and functional improvement of HFpEF.

Ein anhaltend hoher Blutdruck nach einer endovaskularen Thrombektomie (EVT) kann die klinischen Ergebnisse durch ein erhohtes Risiko fur intrazerebrale Blutungen oder Hirnodeme verschlechtern. Andererseits kann eine Blutdrucksenkung den Perfusionsdruck verandern und eine ischamische Schadigung verschlimmern. Nam et al. pruften, ob ein intensives Blutdruckmanagement in den ersten 24 Stunden nach Reperfusion zu besseren klinischen Ergebnissen fuhrt.

Background Cardiorenal syndrome is a common condition in clinical practice in which renal venous congestion (VC) plays an important role. Intrarenal Doppler ultrasound (IRD) is a non-invasive method to assess and quantify renal VC. The current study aims to investigate the effects of SGLT2 inhibitor (SGLT2i) therapy on IRD parameters of renal VC. Methods This prospective observational study included patients with chronic kidney disease (CKD) with or without type 2 diabetes mellitus and/or heart failure (HF) with reduced and preserved ejection fraction who had an indication for standard of care SGLT2i therapy. IRD, assessing venous impedance index (VII), and intrarenal venous flow pattern (IRVF) analysis were performed within the interlobar vessels of the right kidney before and 6 months after initiation of SGLT2i therapy. Results A number of 64 patients with CKD and a cardiorenal risk profile were included (mean eGFR 42.9 ml/min/1.73 m2; 56% with HF, and 38% with type 2 diabetes mellitus). 17 patients exhibited signs of VC in the IRD. VII was significantly correlated with levels of NT-proBNP, female gender, NYHA class, and was significantly negative correlated with body mass index. After 6 months, a notable decrease in the mean VII of the right interlobar veins by 0.13 (P < .01) was observed. Stratification according to IRVF pattern showed a significant shift towards reduced renal VC pattern after 6 months (P = .03). Conclusions In this study, SGLT2i therapy resulted in a reduction in renal VC as assessed by IRD. These findings underscore the potential haemodynamic benefits of SGLT2 inhibitors in cardiorenal syndrome and warrant further investigation into their clinical implications. Graphical Abstract

Background: The 3F study (Fit&Fun with Football) demonstrated a significant reduction in blood pressure, antihypertensive medication, body weight, stress and depression through health football. Health football could be a popular tool to unleash the full preventive potential of physical activity. This work analyses the effect of health football on hypertensive subgroups dipper, nondipper, white coat hypertension (WCH), sustained hypertension, (un)treated hypertensive patients (UH, TH). Methods: A prospective interventional study with 1-year follow-up. Football group (FG): n = 103, ‘health’-football training (1×/week, 90 min) led by licensed football coaches. Physical inactive, hypertensive patients older than 45 years were compared with a control group (CG) (n = 105). Subgroups were divided by ambulatory blood pressure monitoring (ABPM), casual blood pressure (CBP), medication schedule and compared by blood pressure (BP), laboratory results and weight. Results: In all three subgroups (WCH vs. sustained hypertension, TH vs. UH, D vs. ND), health football reduced BP and weight significantly compared with the CG, and compared with the admission. An even greater effect in CBP was found in people with WCH than in sustained hypertension (FG: WCH: 141–127 mmHg, sustained Hypertension (SH): 142–132 mmHg; CG: WCH: 141–143 mmHg, SH: 140–141 mmHg). In contrast, the significant reduction in CBP and ABPM was comparable in treated and untreated patients, although antihypertensive drugs were reduced significantly more frequently in FG than in CG. BP reduction in nondippers and dippers was also comparable. In the nondipper group, nocturnal BP was significantly reduced in the FB (122.0–111.5 mmHg), but not in the CG or the dippers. Conclusion: All evaluated football subgroups achieved a significant BP reduction (compared with CG). This applied to dipper, nondipper, (un)treated hypertension, WCH and SH. All mentioned subgroups displayed a clear benefit. The even greater reduction in BP in WCH demonstrates the importance of physical activity before the additional prescription of antihypertensive medications, underscoring the recommendations of the ESC and ISH in WCH.

Patients with resistant hypertension (HTN) demonstrate an increased risk of chronic kidney disease and progression to end-stage renal disease; however, the individual course of progression is hard to predict. Assessing the stress-induced, urinary glycoprotein Dickkopf-3 (uDKK3) may indicate ongoing renal damage and consecutive estimated glomerular filtration rate (eGFR) decline. The present study aimed to determine the association between uDKK3 levels and further eGFR changes in patients with resistant HTN. In total, 31 patients with resistant HTN were included. Blood pressure and renal function were measured at baseline and up to 24 months after (at months 12 and 24). uDKK3 levels were determined exclusively from the first available spot urine sample at baseline or up to a period of 6 months after, using a commercial ELISA kit. Distinctions between different patient groups were analyzed using the unpaired t-test or Mann–Whitney test. Correlation analysis was performed using Spearman’s correlation. The median uDKK3 level was 303 (interquartile range (IQR) 150–865) pg/mg creatinine. Patients were divided into those with high and low eGFR loss (≥3 vs. <3 mL/min/1.73 m²/year). Patients with high eGFR loss showed a significantly higher median baseline uDKK3 level (646 (IQR 249–2555) (n = 13) vs. 180 (IQR 123–365) pg/mg creatinine (n = 18), p = 0.0412 (Mann–Whitney U)). Alternatively, patients could be classified into those with high and low uDKK3 levels (≥400 vs. <400 pg/mg creatinine). Patients with high uDKK3 levels showed significantly higher eGFR loss (−6.4 ± 4.7 (n = 11) vs. 0.0 ± 7.6 mL/min/1.73 m2/year (n = 20), p = 0.0172 (2-sided, independent t-test)). Within the entire cohort, there was a significant correlation between the uDKK3 levels and change in eGFR at the latest follow-up (Spearman’s r = −0.3714, p = 0.0397). In patients with resistant HTN, high levels of uDKK3 are associated with higher eGFR loss up to 24 months later.

BACKGROUND:The COVID-19 pandemic and its interventions have led to a deficit in medical care and changes in people's lifestyles, which has consequently changed cardio- and cerebrovascular primary and secondary prevention. The existing data are mainly based on surveys. In addition to the problem of the accuracy of self-assessments, the pandemic per se and the massive public reporting may have biased the data.Only a few publications have compared data collected before the pandemic with results during the pandemic. The ELITE study has regularly monitored risk factors (RF) and psychosocial parameters (stress, depression, well-being, diet, brain performance, exercise) in over 5000 participants for years. From this study, data were analyzed from 1775 individuals collected before the onset and again during the pandemic (06/05/2020-25/01/2022). Thus, baseline values were unaffected by the pandemic. RESULTS:As expected, both improvements and worsening of the collected parameters were found. Blood pressure and depressive symptoms worsened significantly more often, with women more frequently affected. Weight and stress levels also increased more often than they improved. Only physical activity showed a slight increase. 24.1 % showed only deteriorations and no improvements in these parameters. In contrast, 19.6 % showed improvements exclusively. In the group with only worsening, there was a significant increase in individuals with the risk factors (RF) hypertension, obesity, elevated LDL cholesterol, nicotine, and diabetes mellitus. This resulted in an increase in individuals with 2 or more RF. In contrast, the number of individuals with 2 and more RF decreased in the group with only improvements. Strikingly, individuals with risk factors improved more frequently. CONCLUSION:A not insignificant part of the population experienced significant worsening of RF during the pandemic. This particularly affected blood pressure and depressive symptoms, and more often women.

Zusammenfassung Hintergrund Die COVID-19-Pandemie und deren Maßnahmen haben zu einem Defizit der medizinischen Versorgung und zu Änderungen in der Lebensführung der Menschen geführt, was in der Konsequenz auch die kardio- und zerebrovaskuläre Primär- und Sekundärprävention verändert hat. Die vorhandenen Daten beruhen im Wesentlichen auf Umfragen. Neben der Problematik der Korrektheit von Selbsteinschätzungen können die Pandemie per se und die massive öffentliche Berichterstattung die Daten verzerrt haben. Nur wenige Publikationen haben vor der Pandemie erhobene Daten mit den Ergebnissen im Verlauf der Pandemie verglichen. In der ELITE-Studie werden seit Jahren bei über 5000 Teilnehmern regelmäßige Kontrollen von Risikofaktoren (RF) und psychosozialen Parametern (Stress, Depressionen, Wohlbefinden, Ernährung, Hirnleistung, Bewegung) vorgenommen. Aus dieser Studie wurden die Daten von 1775 Personen ausgewertet, die vor Beginn und erneut während der Pandemie (06.05.2020–25.01.2022) erhoben wurden. Damit waren die Ausgangswerte unbeeinflusst von der Pandemie. Ergebnisse Erwartungsgemäß fanden sich sowohl Verbesserungen als auch Verschlechterungen der erhobenen Parameter. Blutdruck und depressive Symptome verschlechterten sich signifikant häufiger, wobei Frauen häufiger betroffen waren. Auch das Gewicht und die Stressbelastung stiegen häufiger an, als dass sie sich verbesserten. Nur die körperliche Aktivität zeigte eine geringgradige Zunahme. 24,1 % wiesen ausschließlich Verschlechterungen und keine Verbesserungen dieser Parameter auf. Demgegenüber zeigten 19,6 % ausschließlich Verbesserungen. In der Gruppe mit ausschließlich Verschlechterungen fand sich ein signifikanter Anstieg von Personen mit den Risikofaktoren (RF) Hypertonie, Adipositas, erhöhtes LDL-Cholesterin, Nikotin und Diabetes mellitus. Dies führte zu einer Zunahme von Personen mit 2 und mehr RF. Dagegen reduzierte sich die Zahl von Personen mit 2 und mehr RF in der Gruppe, die nur Verbesserungen aufwies. Auffällig war, dass sich Personen mit Risikofaktoren häufiger verbesserten. Folgerung Bei einem nicht unerheblichen Teil der Bevölkerung kam es in der Pandemie zu deutlichen Verschlechterungen der RF. Dies betraf besonders den Blutdruck und depressive Symptome – und dabei häufiger Frauen.

Introduction: It is well documented that insufficient physical activity (PA) contributes substantially to cardiovascular diseases. The number of physically active people in Germany is still too low. Methods: In ELITE study in Germany, 4602 participants are regularly examined for cardiovascular risk factors (CVRF). The aim is to motivate participants to improve their CVRF through individual recommendations and regular follow-up. Here, the PA data are presented in correlation with CVRF at baseline. A feature of this presentation is that the usual CVRF but also the effects on psychosocial factors were recorded simultaneously. Results: Participants were divided into 3 groups based on their PA: 1. frequent exercise (FE): daily to 2-3x per week (41.4%), 2. moderate exercise (ME): 1x/week to 2x/month (28.8%), 3. rarely exercise (RE): 1x/month to not at all (29.8%). Age did not differ in the 3 groups. The most common CVRF was arterial hypertension, which decreased significantly with an increase in PA. Diabetes, nicotine, and increased BMI were also significantly less frequent in group 1. Antihypertensives were taken less frequently in this group 1. Less physically active partici-pants were significantly more likely to have 3 or more additional CVRF. While group 1 consumed more fruit (64%) and considerably less pork, in group 2 and 3 only 58.3% and 50.3% respectively included fruit in their diet. FE also had a favorable effect on stress, depression and general well-being, all of which were significantly better in group 1. Conclusion: Results confirm the beneficial influences of exercise on known CVRF and on psychosocial parameters. The prevalence of several CVRF per person at low levels of sport is of particular concern, as these participants would benefit most. During a 5-year follow-up, participants will receive intensive education on the need to increase PA. It remains to be seen how successful the effort will be.

AbstractTherapy adherence significantly determines the success of antihypertensive therapy, especially in patients with resistant hypertension. Our study investigates the impact of drug adherence on the efficacy of Baroreflex‐activation‐therapy (BAT). In this retrospective analysis, the authors measured blood pressure (BP) and antihypertensive medication adherence (by gas chromatography‐mass spectrometry [GC‐MS] urine analysis) before and 6 months after BAT initiation. Adherence was defined as detection of ≥80% intake of prescribed medication at the time of follow‐up. Response to BAT was defined as BP drop ≥5 mmHg in systolic 24 h‐ambulatory BP (ABP) after 6 months. Overall patients (n = 38) median medication adherence was low, but rose from 60% (IQR 25%–100%) to 75% (IQR 38%–100%; p = .0194). After 6 months of BAT, mean systolic and diastolic office BP (‐21 ± 25 mmHg and ‐9 ± 15 mmHg; p < .0001 and .0004) as well as 24 h‐ABP dropped significantly (‐9 ± 17 mmHg and ‐5 ± 12 mmHg; p = .0049 and .0280). After 6 months of BAT, 21 patients (60%) could be classified as responders. There was neither significant difference in mean office systolic (‐21 ± 23 mmHg vs. ‐21 ± 28 mmHg; p = .9581) nor in 24 h‐systolic ABP decrease (‐11 ± 19 mmHg vs. ‐7 ± 15 mmHg; p = .4450) comparing adherent and non‐adherent patients. Whereas Antihypertensive Therapeutic Index (ATI) was unchanged in non‐responders, it significantly decreased in responders (from 50 ± 16 to 46 ± 16; p = .0477). These data are the first to show that BAT‐initiation leads to a clear BP reduction independently of patients´ medication adherence. Response to BAT is associated with a significant lowering of ATI, which might contribute to an underestimation of BAT efficacy.

Supplemental Digital Content is available in the text Objective(s): Football as the most popular sport could improve insufficient physical activity in patients with cardiovascular risk factors. A modified ‘healthy’ football training format could motivate hypertensive patients to return to sport and improve risk factors. Methods: The 3F study: ‘Fit and Fun with Football’ a prospective interventional study with 1 year follow-up. Football group: n = 103, structured ‘health’-football training (1×/week, 90 min) led by Deutscher Fußball Bund-licensed football coaches. Hypertensive patients at least 45 years who have not exercised for several years were compared with a control group (n = 105). Primary study objective: Reduction of office (OBP) and/or 24-h ambulatory blood pressure (BP) monitoring (ABPM) and/or reduction of number or dosage of antihypertensive medication. Main results: OBP values decreased significantly in the football group from 142.6/87.9 to 130.8/81.8 mmHg (P < 0.001), in the control group the values increased slightly (NS). ABPM values decreased significantly in the football group, while a slight increase was found in the control group. At the end of the study, the mean values in the football group of both OPB (P < 0.001) and ABPM (systolic P < 0.001, diastolic P = 0.017) were significantly lower than in the control group. Significantly more people in the football group were able to reduce antihypertensive patients than in the control group (football group:16, control group:6), while more participants in the control group intensified antihypertensive therapy (football group:3, control group:14) (P < 0.001). Among the secondary endpoints, there was a weight loss of 3 kg in the football group and an increase of 1.7 kg in the control group (P < 0.001). Conclusion: Offering modified ‘healthy’ football-training to middle-aged hypertensive patients can lead to better BP control and a reduction of antihypertensive medication. Therefore, the offer of ‘health football’ should be established and supported by clubs, insurances and authorities.

Lipoprotein(a) (Lp(a)) is becoming increasingly important as an independent risk factor for cardiovascular disease. Since no effective therapy currently exists other than lipid apheresis, the recommendation remains to optimally adjust all other cardiovascular risk factors (CVRF). In a Northwest German population study, the frequency of elevated Lp(a) levels and all other CVRF was investigated. The aim was to investigate whether individuals with elevated Lp(a) levels were also more likely to have other CVR Fs. To date, 4602 individuals have been enrolled in the study, and blood pressure, weight, lipids, diabetes, medications, and pre-existing conditions were recorded in addition to Lp(a). In addition, questionnaires assessed physical activity, psychological stress, depression, and brain dysfunction. All participants received detailed individual recommendation about their CVRF and its treatment. In the further follow-up of 5 years, it will be examined how persons with elevated Lp(a) implemented these recommendations in comparison with participants without elevated Lp(a). The first group Lp(a) <75 nmol/L consisted of 3550 (80.2%), the Lp(a) 75 120 nmol/L group of 341 (7.4%) and the Lp(a) >120 nmol/L of 538 (11.7%). 81 .6% of all participants hadoneor more CVRF. Age, sex, and prevalence of hypertension, diabetes, smoking, obesity, and exercise did not differ among the 3 groups. As expected, LDL-Cholesterol was significantly elevated in the Lp(a) >120 nmol/L group despite significantly more frequent use of statins. Significantly moreoften hypertensive patients werefound in the Lp(a) >120 nmol/L group who were inadequately controlled by medication and significantly less often persons without further CVRF. No differences existed in the frequency of psychological stress, depression, and mild cognitive impairment. CVRF occur with comparable frequency in individuals with elevated Lp(a) levels. However, individuals with Lp(a) above 120 nmol/L were more likely to have poorly controlled blood pressure, elevated LDL-C, and less likely to have no other risk factors. This underlines that in case of Lp(a) elevation all further CVRF should be intensively adjusted, especially in case of strongly elevated values >120 nmol/L. However, these recommendations have not been adequately implemented in clinical care in this population to date.

OBJECTIVES:The ELITE study (German acronym for "Nutrition, lifestyle and individual information for prevention of heart attack, stroke and dementia") prospectively collects data on hypertension, cardiovascular risk factors (RF), dietary habits, physical activity, cognitive function, and quality of life in North-West Germany, which will then be improved through targeted individual information. The aim of the study is to improve the health of the participants in the long term and to identify reasons for a lack of implementation of prevention measures. METHODS:Of 4,602 included subjects, 3,868 could be studied so far at one-year follow-up. Blood pressure (BP) was measured according to the guidelines at admission and blood pressure history, premedication, sports behaviour and BMI were recorded by means of questionnaires and compared with the data collected in the follow-up examination after one year. RESULTS:The participants were evaluated in 4 groups (G): G1 - normotensive patients (n = 1,558), G2 - controlled hypertensive patients (n = 502), G3 - untreated uncontrolled hypertensive patients (n = 1,080), G4 - treated uncontrolled hypertensive patients (n = 728). In G1 blood pressure (RR) remained unchanged from 126.3/77.8 to 127.8/78.5, in G2 there was a significant (p < 0.001) RR increase from 128.1/77.0 to 134.9/79.8. In G3 and G4 RR decreased significantly (p < 0.001) from 149.9/90.0 to 143.5/86.9 and from 153.1/87.5 to 146.2 84.1 mmHg, respectively. In G3 and G4, RR decreased in 56.1% and 56.3% of subjects and increased in 18% and 21%, respectively. In contrast, RR increase was found more frequently in G1 and G2 (34.3% and 51%, respectively), and RR decrease less frequently (25.4 and 20.7%, respectively). The main reasons for RR decrease were weight loss, more exercise, and more antihypertensives. Frequently, improved compliance and dietary changes were given as reasons. As expected, the opposite often led to RR increase. CONCLUSION:56% of the hypertensive participants succeeded in lowering their blood pressure, whereas there was a significant increase in blood pressure, especially in those who were well controlled with antihypertensives. This underlines the need to further motivate normotensive patients to maintain their normotension. The results show that the combination of individual written education and lifestyle interventions are an effective tool for the public health sector to combat hypertension. In our participants, lifestyle interventions have a significant impact on BP change. It should be noted critically that there are still too many patients who have not been reached.

BACKGROUND:In ELITE (Ernährung, Lebensstil und individuelle Information zur Verhinderung von Herzinfarkt, Schlaganfall und Demenz; german for: Nutrition, Lifestyle and Individual Information for the Prevention of Heart Attack, Stroke and Dementia) data on cardiovascular risk factors, cognitive function and quality of life are prospectively collected, which will be improved through targeted individual information. The aim is to improve the health of the participants and identify the reasons for the lack of implementation.METHODS:Risk factors of 4602 participants were linked to (controlled) hypertension and mild cognitive impairment (MCI). Blood pressure was measured according to the guidelines and the DEMTECT- test was used to detect MCI.RESULTS:The most common risk factor was hypertension (60%). Hypertensive patients were older (56.1 and 44.7 years), had a higher BMI (28 and 24.8 kg/m), frequently physical inactive (26 and 32.4%), diabetes (9.3 and 1.3%), higher LDL (134.7 and 124.1 mg/dl), higher triglycerides (169.6 and 124.8 mg/dl) and lower HDL (57.9 and 65.5 mg/dl) compared with normotensives (P < 0.001). Controlled hypertensive patients are less common men (46.1 and 52.1%, P < 0.001), have a lower BMI (28.3 and 29.1 kg/m, P < 0.001), lower LDL (129.0 and 135.6 mg/dl, P = 0.004) and lower triglycerides (162.5 and 182.3 mg/dl, P = 0.001) compared with treated uncontrolled hypertensive patients. Antihypertensives per person (2.015; 2.017) do not differ. The prevalence of MCI is highly significantly associated with the number of risk factors. in participants without risk factors, the prevalence is 3.9%, in participants with 4 risk factors, 16.3%. In hypertensive patients, the frequency is 11.8% compared with 4.8% for normotensives (P < 0.001). The occurrence of MCI depends significantly from age, blood pressure and diabetes CONCLUSION:: The frequency of MCI is highly significantly associated with the number of cardiovascular risk factors, regardless of age. The prevalence was particularly high among hypertensive patients, which is not often described. The occurrence of MCI depends significantly from age, blood pressure and diabetes. The metabolic syndrome and lack of exercise complicate blood pressure control.