{"title":"Better blood pressure control with the nanoformulation of antihypertensive drugs.","authors":"Steven G Chrysant","doi":"10.1080/14779072.2024.2438813","DOIUrl":"10.1080/14779072.2024.2438813","url":null,"abstract":"<p><strong>Introduction: </strong>Hypertension is very common and a major risk factor for cardiovascular disease, heart failure, chronic kidney disease, strokes, and death. However, at present only 14% of patients of developing countries have their blood pressure (BP) well controlled. The causes for the failure to control the BP are multiple and one of them could be the formulation of antihypertensive drugs.</p><p><strong>Areas covered: </strong>The recent development of nanotechnology by incorporating the drugs into nanoparticles is a new promising field of nanomedicine and preliminary studies have shown this nanoformulation to be more effective in the treatment of hypertension than the existing drug formulations. Another recent development is the nanoformulation of genes used for the treatment of hypertension and cardiovascular diseases. For current information, a Medline search was conducted between 2017 and 2024 and 36 pertinent papers were selected.</p><p><strong>Expert opinion: </strong>The nanoformulations of drugs help achieve better drug concentrations, improve drug stability, low solubility, short half life, oral bioavailability, narrow therapeutic index, and poor pharmacokinetic and pharmacodynamic profiles, and decrease the adverse effects of antihypertensive drugs. Also, the nanoformulation of genes for the treatment of hypertension has been shown in preliminary studies to be effective, but more research is needed.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"1-9"},"PeriodicalIF":1.8,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prasanna Sengodan, Ahmed Younes, Neeraj Shah, Ahmed Maraey, W Randolph Chitwood, Assad Movahed
{"title":"Contemporary review of the evolution of various treatment modalities for mitral regurgitation.","authors":"Prasanna Sengodan, Ahmed Younes, Neeraj Shah, Ahmed Maraey, W Randolph Chitwood, Assad Movahed","doi":"10.1080/14779072.2024.2427622","DOIUrl":"10.1080/14779072.2024.2427622","url":null,"abstract":"<p><strong>Introduction: </strong>Mitral regurgitation is one of the most common forms of valvular heart diseases for which there have been several innovative treatment strategies that have developed over the last several decades. We describe the various treatment modalities that have been used for the last several decades. All articles in PubMed, Cochrane, and Embase were screened from inception to August 2024 for the following - 'Mitral valve regurgitation' 'Mitral valve repair' 'Mitral valve replacement' 'Robotic mitral surgery' 'Transcatheter mitral valve repair.'</p><p><strong>Areas covered: </strong>Mitral regurgitation (MR) is classified into primary and secondary MR. Causes of primary MR include degenerative disease, rheumatic heart disease, and infective endocarditis. Secondary MR is observed in the setting of left ventricle (LV) pathology, including ischemic or dilated cardiomyopathy. In secondary MR, annular dilation, papillary muscle displacement, tethering of chordae tendineae and/or mitral valve (MV) leaflets result in leaflet restriction and malcoaptation.</p><p><strong>Expert opinion: </strong>In this review, we discuss various modalities for the treatment of mitral regurgitation, as well as newer treatment options for MR including robotic MV repair and other minimally invasive procedures. Several ongoing randomized controlled trials in this topic will help shed more light and provide guidance to deliver the optimal care for our patients.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"639-651"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fabio Angeli, Paolo Verdecchia, Alessio Mazzieri, Gianpaolo Reboldi
{"title":"Treatment of hypertension in the elderly: target the lowest well-tolerated blood pressure.","authors":"Fabio Angeli, Paolo Verdecchia, Alessio Mazzieri, Gianpaolo Reboldi","doi":"10.1080/14779072.2024.2427637","DOIUrl":"10.1080/14779072.2024.2427637","url":null,"abstract":"<p><strong>Introduction: </strong>Antihypertensive treatment provides substantial benefits in older people. However, many challenges remain, including the ideal blood pressure (BP) target to be achieved. Because the elderly population is particularly vulnerable to adverse events, BP control should be carefully managed. Some studies have evaluated the cardiovascular effects of different BP targets in older patients, with mixed results and uncertainty about the most appropriate BP target. However, pooled analyses suggest that intensive BP lowering provides greater cardiovascular protection than less intensive strategies in elderly hypertensive patients.</p><p><strong>Areas covered: </strong>Understanding the balance between the risks and benefits of intensive BP targets and individualizing treatment is essential to ensure that older patients receive appropriate treatment to reduce the risk of cardiovascular complications. We reviewed data from clinical trials which investigated the protective effects of BP lowering drugs in elderly hypertensive patients aged ≥65 years.</p><p><strong>Expert opinion: </strong>Evidence suggests that age does not preclude an aggressive strategy for treating hypertension in elderly patients. Being 'tolerant' with one hand and 'intensive' with the other should become a universal standard in the management of elderly hypertensive patients. The lowest well-tolerated BP could be a simple and universally applicable BP target in the management of hypertensive patients, including the elderly.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"615-624"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chiara Cirillo, Andrea Perillo, Emanuele Monda, Giuseppe Palmiero, Federica Verrillo, Marta Rubino, Gaetano Diana, Francesca Dongiglio, Martina Caiazza, Annapaola Cirillo, Adelaide Fusco, Carlo Fumagalli, Eduardo Bossone, Maria Giovanna Russo, Paolo Calabro, Giuseppe Limongelli
{"title":"Treatment options for hypertrophic obstructive cardiomyopathy: a patient-centric review.","authors":"Chiara Cirillo, Andrea Perillo, Emanuele Monda, Giuseppe Palmiero, Federica Verrillo, Marta Rubino, Gaetano Diana, Francesca Dongiglio, Martina Caiazza, Annapaola Cirillo, Adelaide Fusco, Carlo Fumagalli, Eduardo Bossone, Maria Giovanna Russo, Paolo Calabro, Giuseppe Limongelli","doi":"10.1080/14779072.2024.2436659","DOIUrl":"10.1080/14779072.2024.2436659","url":null,"abstract":"<p><strong>Introduction: </strong>Hypertrophic cardiomyopathy (HCM) is defined by an increased left ventricular wall thickness not solely explainable by abnormal loading conditions. Estimated prevalence is 1:200-500 with roughly 60% of cases showing a familiar trait. Medical treatment and surgical interventions significantly altered prognosis in HCM. Recently, new therapies have been introduced in clinical practice and a patient-centric approach is key to HCM optimal management. This review aims to summarize the current HCM therapies focusing on the importance of personalized care and delineate therapeutic approaches under investigation.</p><p><strong>Areas covered: </strong>The review summarizes and critically evaluates the available data on currently available pharmacological and non-pharmacological therapies for HCM. The evidence in support of the use of beta-blockers, non-dihydropyridine calcium channel blockers, disopyramide, and cardiac myosin inhibitors is discussed. Furthermore, data and controversies on sudden death prevention, surgical and non-surgical septal reduction therapies are reported. Finally, future perspectives in HCM management such as new drugs and gene therapies are explored.</p><p><strong>Expert opinion: </strong>The authors stress the need for a personalized and tailored approach to managing patients with HCM, which is not only based on phenotypes and risk stratification, but also patients' preferences, needs, and beliefs.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"625-637"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amer Harky, Roshni S K Patel, Maya Yien, Abdullah Khaled, Dang Nguyen, Sakshi Roy, Mohamed Zeinah
{"title":"Risk management of patients with multiple CVDs: what are the best practices?","authors":"Amer Harky, Roshni S K Patel, Maya Yien, Abdullah Khaled, Dang Nguyen, Sakshi Roy, Mohamed Zeinah","doi":"10.1080/14779072.2024.2427634","DOIUrl":"10.1080/14779072.2024.2427634","url":null,"abstract":"<p><strong>Introduction: </strong>Managing patients with multiple risk factors for CVDs can present distinct challenges for healthcare providers, therefore addressing them can be paramount to optimize patient care.</p><p><strong>Areas covered: </strong>This narrative review explores the burden that CVDs place on healthcare systems as well as how we can best optimize the risk management of these patients. Through a comprehensive review of literature, guidelines and clinical studies, this paper explores various approaches to risk management, lifestyle modifications and pharmacological interventions utilized in the management of CVDs. Furthermore, emerging technologies such as machine learning (ML) are discussed, highlighting potential opportunities for future research. By reviewing existing recommendations and evidence, this paper aims to provide insight into optimizing strategies and improving the outcomes for patients with multiple CVDs.</p><p><strong>Expert opinion: </strong>Optimizing risk factors can have a significant impact on patient outcomes, as such each patient should have a clear plan on how to manage these risk factors to minimize adverse healthcare results.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"603-614"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jean-Claude Asaker, Mridul Bansal, Aryan Mehta, Melvin G Joice, Rachna Kataria, Marwan Saad, J Dawn Abbott, Saraschandra Vallabhajosyula
{"title":"Short-term and long-term outcomes of cardiac arrhythmias in patients with cardiogenic shock.","authors":"Jean-Claude Asaker, Mridul Bansal, Aryan Mehta, Melvin G Joice, Rachna Kataria, Marwan Saad, J Dawn Abbott, Saraschandra Vallabhajosyula","doi":"10.1080/14779072.2024.2409437","DOIUrl":"10.1080/14779072.2024.2409437","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiogenic shock is severe circulatory failure that results in significant in-hospital mortality, related morbidity, and economic burden. Patients with cardiogenic shock are at high risk for atrial and ventricular arrhythmias, particularly within the subset of patients with an overlap of cardiogenic shock and cardiac arrest.</p><p><strong>Areas covered: </strong>This review article will explore the prevalence, definition, management, and outcomes of common arrhythmias in patients with cardiogenic shock. This review will describe the pathophysiology of arrhythmia in cardiogenic shock and the impact of inotropic agents on increased arrhythmogenicity. In addition to medical management, focused assessment of mechanical circulatory support, radiofrequency ablation, deep sedation, and stellate ganglion block will be provided.</p><p><strong>Expert opinion: </strong>We will navigate the limited data and describe the prognostic impacts of arrhythmia. Finally, we will conclude the review with a discussion of prevention strategies, research limitations, and future research directions.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"537-551"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nattokinase as an adjuvant therapeutic strategy for non-communicable diseases: a review of fibrinolytic, antithrombotic, anti-inflammatory, and antioxidant effects.","authors":"Mariana Granito, Livia Alvarenga, Marcia Ribeiro, Priscila Carvalhosa, Thaysi Andrade, Claudio Tinoco Mesquita, Milena Barcza Stockler-Pinto, Denise Mafra, Ludmila Fmf Cardozo","doi":"10.1080/14779072.2024.2416663","DOIUrl":"10.1080/14779072.2024.2416663","url":null,"abstract":"<p><strong>Introduction: </strong>Nattokinase (NK) is the primary ingredient of natto, a traditional Asian food made from fermented soybean by <i>Bacillus subtilis natto</i>. Studies have shown that natto reduces the risk of cardiovascular disease (CVD) mortality due to its fibrinolytic and antithrombotic properties. A new field of studies also demonstrates that NK can mitigate molecular pathways related to inflammation and oxidative stress and can be considered an adjuvant strategy for use in many non-communicable diseases (NCDs). This paper is a narrative review of the literature. A search was conducted in PubMed and ScienceDirect up to July 2024.</p><p><strong>Areas covered: </strong>This review discusses the possible effects of NK on mitigating the common complications of NCDs, such as inflammation and oxidative stress. In addition, it provides an update on the most addressed areas related to NK's fibrinolytic and antithrombotic activities.</p><p><strong>Expert opinion: </strong>Due to the fibrinolytic and antithrombotic activity of nattokinase, and more recently added to the anti-inflammatory and antioxidant effects, this enzyme can be used as a new adjuvant therapeutic strategy to mitigate inflammation and oxidative stress in NCDs, including CVD.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"565-574"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Colinda van Deutekom, Jeroen M L Hendriks, Marius Myrstad, Isabelle C Van Gelder, Michiel Rienstra
{"title":"Managing elderly patients with atrial fibrillation and multimorbidity: call for a systematic approach.","authors":"Colinda van Deutekom, Jeroen M L Hendriks, Marius Myrstad, Isabelle C Van Gelder, Michiel Rienstra","doi":"10.1080/14779072.2024.2416666","DOIUrl":"10.1080/14779072.2024.2416666","url":null,"abstract":"<p><strong>Introduction: </strong>Atrial fibrillation (AF) is often accompanied by comorbidities. Not only cardiovascular but also non-cardiovascular comorbidities have been associated with AF. Multimorbidity is therefore a common finding in patients with AF, especially in elderly patients. Multimorbidity is associated with adverse outcomes, adds complexity to AF management, and poses a significant burden on healthcare costs. It is expected that the prevalence of elderly patients with multimorbidity will increase significantly. It is therefore crucial to outline implications for clinical practice and guide comprehensive multimorbidity management.</p><p><strong>Areas covered: </strong>This perspective article outlines multimorbidity in AF and the importance of comprehensive comorbidity management. It addresses current clinical practice guided by international guidelines and the need for integrated care including a patient-centered focus, comprehensive AF management, coordinated multidisciplinary care, and supporting technology. Moreover, it proposes a novel model of care delivery following a systematic approach to multimorbidity management.</p><p><strong>Expert opinion: </strong>Providing comprehensive care by means of a multidisciplinary team and patient engagement is crucial to provide optimal personalized care for elderly patients with AF and multimorbidity. A systematic integrated care approach seems promising, but further studies are needed to investigate the feasibility of a systematic approach and prioritization of comorbidity management in patients with multimorbidity.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"523-536"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carlos Escobar, Pilar Mazón, Claudio Rivadulla, Shukrath Chandrappa
{"title":"The role of eprosartan in the management of essential hypertension: literature review and expert opinion.","authors":"Carlos Escobar, Pilar Mazón, Claudio Rivadulla, Shukrath Chandrappa","doi":"10.1080/14779072.2024.2418298","DOIUrl":"10.1080/14779072.2024.2418298","url":null,"abstract":"<p><strong>Introduction: </strong>Eprosartan is an angiotensin receptor blocker (ARB) used for management of essential hypertension. With unique pharmacological characteristics, dual action mechanism, and clinical effectiveness, eprosartan offers additional advantages over other ARBs in specific patient populations.</p><p><strong>Areas covered: </strong>A comprehensive review of the literature was performed across publicly available databases, with no time limitations, to ensure the inclusion of all relevant studies. The review focuses on presenting the efficacy and safety profile of eprosartan, alone or in combination with other agents. Additionally, it explores the etiology of hypertension concerning the structure and function of angiotensin II type 1 receptors. Further, the efficacy of eprosartan in special populations and its additional benefits are also discussed.</p><p><strong>Expert opinion: </strong>Eprosartan effectively reduces blood pressure (BP), with a 24-hour BP-lowering effect at 600 mg/day. Eprosartan demonstrates similar or better efficacy than other ARBs, such as telmisartan and losartan, particularly in managing coagulation-related abnormalities and peripheral resistance. In combination therapy, eprosartan with hydrochlorothiazide significantly enhances BP reduction. Eprosartan is well-tolerated, with a low incidence of adverse events, making it a reliable choice for long-term hypertension management across various patient populations, such as those with comorbid diabetes and renal disease and older adults.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"575-587"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"What are the early warning signs of myocarditis during the pathway of care?","authors":"Yasar Sattar, Aimen Shafiq, Sahithi Sharma, Krutarth Pandya, Karthik Gonuguntla, Harshith Thyagaturu, Fnu Zafrullah, Sudarshan Balla","doi":"10.1080/14779072.2024.2416676","DOIUrl":"10.1080/14779072.2024.2416676","url":null,"abstract":"<p><strong>Introduction: </strong>Myocarditis is an inflammatory disease of the myocardial layer of the heart that can be prone to dilation of chambers with presentation as heart failure secondary to dilated cardiomyopathy. Myocarditis can lead to remodeling and fibrosis that can affect the heart's relaxation-lusitropy and chronotropic function. The current techniques for identifying myocarditis, such as endomyocardial biopsy and imaging, are costly, and intrusive. The current literature aims to identify reliable, accurate, and prognostically educative biomarkers of myocarditis.</p><p><strong>Areas covered: </strong>This review covers the definition, clinical features, diagnostic markers, cardiac imaging, prognosis, and complications of myocarditis. PubMed, Embase, and the Cochrane data bank were searched from inception to 1 January 2024 for relevant articles.</p><p><strong>Expert opinion: </strong>By adopting these diagnostic and prognostic biomarkers, clinicians can have a better comprehension of the progression of the disease and provide early diagnosis and treatment for myocarditis.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"553-563"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}