High Blood Pressure & Cardiovascular Prevention最新文献

{"title":"2024 consensus document of the Italian Society of Arterial Hypertension (SIIA) and the Italian Society of Cardiovascular Prevention (SIPREC): update on LDL cholesterol lowering in patients with arterial hypertension.","authors":"Maria Lorenza Muiesan, Agostino Virdis, Giuliano Tocci, Claudio Borghi, Arrigo F G Cicero, Claudio Ferri, Matteo Pirro, Alberto Corsini, Massimo Volpe","doi":"10.1007/s40292-024-00700-x","DOIUrl":"10.1007/s40292-024-00700-x","url":null,"abstract":"<p><p>Hypertension and hypercholesterolemia often occur in the same individuals, increasing the risk of major cardiovascular (CV) outcomes, including myocardial infarction, stroke, CV death, as well as other CV complications. Concomitant management of these condition now represent a crucial step to reduce individual global CV risk and improve CV disease prevention in daily clinical practice. Given the high prevalence of hypertension and hypercholesterolemia in general population and their impact on health status, several pharmacological options are currently available to achieve the recommended therapeutic targets. These drugs, mostly including statins, ezetimibe, bempedoic acid, proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors and inclisiran, can be used either in monotherapies or in combination therapies, with different clinical indications, therapeutic efficacy and tolerability profile. Decision among different drug classes and dosages, as well as choice between monotherapy or combination therapy (fixed or free), largely depend on individual global CV risk profile and therapeutic targets of low-density lipoprotein (LDL) cholesterol levels to be achieved under pharmacological therapy. The present consensus document represents an update of the previous document published on 2022 and endorsed by the Italian Society of Hypertension (SIIA) and the Italian Society of Cardiovascular Prevention (SIPREC). Here we propose a novel paradigm for the treatment of the patients with hypertension and hypercholesterolemia at high or very high cardiovascular risk. In addition, the pharmacological properties, and the clinical efficacy of novel agents recently approved for a tailored therapy of hypercholesterolemia in patients with atherosclerotic CV disease, including PCSK9 inhibitors and bempedoic acid, will be summarized.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":" ","pages":"151-163"},"PeriodicalIF":3.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491633","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":"Serum Uric Acid/Serum Creatinine Ratio and Chronic Vascular Lesions on Renal Biopsy: A Retrospective Observational Study.","authors":"Antonietta Gigante, Chiara Pellicano, Carmen Gallicchio, Michele Melena, Melania Fiorino, Edoardo Rosato, Konstantinos Giannakakis, Andrea Ascione, Maurizio Muscaritoli, Rosario Cianci","doi":"10.1007/s40292-024-00699-1","DOIUrl":"10.1007/s40292-024-00699-1","url":null,"abstract":"<p><strong>Introduction: </strong>Increased serum uric acid (SUA) levels are found in cardiovascular and kidney diseases, associated with the development of vascular injury. Uric acid stimulates the inflammatory pathways, promotes vascular smooth muscle cells proliferation, activates renin-angiotensin system leading to the development and progression of vascular damage. Renal function-normalized uric acid [SUA to serum creatinine ratio (SUA/SCr)] has been suggested to be a better indicator of uric acid.</p><p><strong>Aim: </strong>To investigate the correlation between SUA level and SUA/SCr in the development of chronic and vascular lesions (CVL) in patients with primary glomerulonephritis (GN).</p><p><strong>Methods: </strong>A retrospective observational study was conducted in 95 consecutive renal native biopsies performed at Policlinico Umberto I of Rome (Italy). Patient inclusion criteria were age ≥ 18 years, a renal biopsy confirming diagnosis of primary GN, the availability of complete demographic, clinical, pathological, and laboratory data.</p><p><strong>Results: </strong>Median SCr was 1.06 mg/dl (IQR 0.77;1.70) with a median eGFR of 70.40 ml/min (IQR 40.40;105). Median SUA was 5.90 mg/dl (IQR 4.30;6.90) and median SUA/SCr was 4.70 (IQR 3.20;6.80). CVL were reported in 56 (58.9%) patients. Median SUA/SCr was significantly lower in patients with CVL than patients without CVL [3.95 (IQR 2.65;6) vs 5.90 (IQR 4.30;7.20), p<0.01]. Logistic regression analysis showed that SUA/SCr ≤ 4.05 [OR 5.451 (95% CI 1.222;24.325), p<0.05] was independently associated with CVL.</p><p><strong>Conclusions: </strong>CVL play a crucial role in the progression of kidney disease. SUA/SCr ≤ 4.05 is associated with CVL in patients with primitive GN.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":" ","pages":"165-170"},"PeriodicalIF":3.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881947","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":"Cardiovascular Risk Factors and Diseases and Awareness of Related Burden in Women: Results of a Survey in Italian Pharmacies.","authors":"Rita Del Pinto, Maria Vitale, Maria Eugenia Morreale, Clara Mottinelli, Maria Lorenza Muiesan, Massimo Volpe, Claudio Ferri","doi":"10.1007/s40292-025-00701-4","DOIUrl":"10.1007/s40292-025-00701-4","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiovascular diseases (CVD) represent the leading cause of morbidity and mortality for women worldwide, yet they are often unaware of this heavy burden.</p><p><strong>Aim: </strong>To assess cardiovascular risk awareness among Italian women.</p><p><strong>Methods: </strong>Following World Heart Day 2023, a cardiovascular prevention campaign was conducted in Italian pharmacies to evaluate the effectiveness of screening activities offered by pharmacies and raise awareness of cardiovascular health status among Italian women. Cardiovascular risk profile and perception of CVD burden relative to other common female-specific diseases were assessed. Blood pressure (BP) measurement and ECG recording were performed.</p><p><strong>Results: </strong>A total of 1510 women (84.7% < 70 years), enrolled at 91 pharmacies, were included. The most prevalent cardiovascular risk factor was sedentary lifestyle (57.9%), followed by overweight/obesity (44.3%), hypercholesterolemia (37.9%), hypertension (31.3%), family history of early CVD (28.7%), smoking (20.6%), and diabetes (5%). CVD and/or kidney disease were uncommon (3.6%), but 1 in 4 women was classified as being at increased cardiovascular risk, and 47.5% had some type of ECG abnormalities, requiring further assessments in 18% cases. Less than 1 in 3 women was aware of the burden represented by CVD, being the majority mostly concerned with breast cancer and osteoporosis as potential health threats.</p><p><strong>Conclusions: </strong>The burden of cardiovascular risk factors is high, and the perception of related health threat is low among the examined sample of Italian women, supporting the urgent need to raise awareness of CVD in women as a major health issue and to undertake effective, tailored preventive strategies to reduce such risk in a timely fashion.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":" ","pages":"191-198"},"PeriodicalIF":3.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Minimal-Advice\" on Salt Intake: Results of a Multicentre Pilot Randomised Controlled Trial on Hypertensive Patients.","authors":"Lanfranco D'Elia, Pasquale Strazzullo, Antonio Del Giudice, Giovambattista Desideri, Rosario Di Quattro, Claudio Ferri, Alessandra Grossi, Lorenzo Malatino, Francesca Mallamaci, Andrea Maresca, Michele Meschi, Alessia Casola, Pietro Nazzaro, Marco Pappaccogli, Franco Rabbia, Carla Sala, Ferruccio Galletti","doi":"10.1007/s40292-025-00704-1","DOIUrl":"10.1007/s40292-025-00704-1","url":null,"abstract":"<p><strong>Introduction: </strong>A strong and well-known association exists between salt consumption, potassium intake, and cardiovascular diseases. MINISAL-SIIA results showed high salt and low potassium consumption in Italian hypertensive patients. In addition, a recent Italian survey showed that the degree of knowledge and behaviour about salt was directly interrelated, suggesting a key role of the educational approach.</p><p><strong>Aim: </strong>The present multicentre randomised controlled trial study aimed to evaluate the efficacy of a short-time dietary educational intervention by a physician, only during the first visit, on sodium and potassium intake in hypertensive patients.</p><p><strong>Methods: </strong>Two-hundred-thirty hypertensive subjects participating in the MINISAL-SIIA study were enrolled for this study. After the randomisation, the participants were stratified into the educational intervention (EI) group (n = 109) and control group (C) (n = 121). Anthropometric indexes and blood pressure (BP) measurements were taken in the single-centre, and 24-hour urinary sodium (UrNa) and potassium (UrK) excretion were centrally measured.</p><p><strong>Results: </strong>After 3 months, there was a reduction in BP, UrNa, and body weight, and an increase in UrK in EI. By contrast, a lower decrease in BP was found in the C group, and a slight rise in UrNa and no substantial change in UrK were revealed. BP changes were positively and significantly associated with changes in UrNa only in EI.</p><p><strong>Conclusion: </strong>The main results of this trial indicate that a single brief educational intervention by a physician can lead to a reduction in salt intake and BP, and increased potassium consumption in hypertensive patients, without adverse effects.</p><p><strong>Trail registration: </strong>ClinicalTrial.gov registration number: NCT06651437.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":" ","pages":"181-190"},"PeriodicalIF":3.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Persistently Elevated LDL Values on Carotid Intima Media Thickness in Elite Athletes.","authors":"Giuseppe Di Gioia, Lorenzo Buzzelli, Armando Ferrera, Viviana Maestrini, Maria Rosaria Squeo, Erika Lemme, Sara Monosilio, Andrea Serdoz, Antonio Pelliccia","doi":"10.1007/s40292-024-00698-2","DOIUrl":"10.1007/s40292-024-00698-2","url":null,"abstract":"<p><strong>Introduction: </strong>Carotid IMT is a recognized marker for early atherosclerotic changes and a predictor of future CV events. Previous studies showed 11% increased risk of myocardial infarction with each 0.1 mm incremental increase of carotid IMT. In general population, LDL cholesterol levels are positively correlated with carotid IMT in both cross-sectional and longitudinal studies while its role in elite athletes remains understudied.</p><p><strong>Aim: </strong>This study aimed to investigate the correlation between persistent lipid profile alterations and early markers of atherosclerosis, specifically carotid IMT, in a cohort of elite athletes.</p><p><strong>Methods: </strong>We included 302 athletes serially evaluated for a prolonged time period. Anthropometric data, blood tests for lipid profiles, and carotid IMT measurements were collected. Dyslipidemia was defined as LDL ≥ 116 mg/dL, and persistent elevation when LDL values remained above the threshold limits in at least three pre-participation screenings. Categorical variables were expressed as frequencies and percentages and were compared using Fisher's exact test or Chi-square test, as appropriate.</p><p><strong>Results: </strong>91 athletes (30.1%) had persistently elevated LDL levels. Dyslipidemic athletes were older (30.7 ± 5.7 vs. 29.1 ± 4.1 years, p = 0.008), had higher BMI (p = 0.032), and a higher prevalence of obesity (5.5% vs. 0.5%, p = 0.004) compared to those with normal lipid profiles. Additionally, they had higher total cholesterol (p < 0.0001) and triglycerides (p < 0.0001) but similar HDL levels (p = 0.213). Globally, athletes with altered LDL profiles over long-time period showed higher IMT (0.60 ± 0.10 mm vs. 0.57 ± 0.07 mm, p = 0.014). In particular, longer exposure to elevated LDL was significantly associated with increased IMT (0.61 ± 0.12 mm vs. 0.57 ± 0.06 mm, p = 0.035).</p><p><strong>Conclusions: </strong>Our study highlights the association between persistently elevated LDL-C and increased carotid IMT in elite athletes, with longer exposure time correlating with more pronounced carotid changes. These findings underscore the importance of regular monitoring of blood lipid profiles and carotid IMT measurements as a non-invasive, cost-effective method to prevent atherosclerotic vascular disease.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":" ","pages":"171-179"},"PeriodicalIF":3.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947809","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":"Reducing LDL-Cholesterol to Very Low Levels: Sailing Between Established Benefits and Potential Risks.","authors":"Stefania Angela Di Fusco, Massimo Volpe, Federico Nardi, Andrea Matteucci, Stefano Aquilani, Gaetano Marino, Alessandro Aiello, Furio Colivicchi","doi":"10.1007/s40292-025-00708-x","DOIUrl":"10.1007/s40292-025-00708-x","url":null,"abstract":"<p><p>In view of the growing evidence supporting more marked reductions of low-density lipoprotein cholesterol (LDL-C), according to the concept of \"the lower is better\" and with the availability of powerful and well tolerated lipid-lowering drugs, physicians are facing today with the clinical management of patients with very low LDL-C levels. The fear of potential risks linked to extreme reductions of LDL-C down to very low levels may lead to the de-escalation of treatments with consequent paradoxical unfavorable consequences due to the exposure to a higher cardiovascular risk. The aim of this review is to point out evidence of very low LDL-C clinical impact, with a focus on potential adverse effects. Research on cholesterol homeostasis has identified complex mechanisms which guarantee cell functions even when circulating cholesterol levels are very low. The almost complete self-sufficiency of the human body in terms of cholesterol needs is confirmed by evidence derived from genetically determined models with very low LDL-C levels. Studies on the potential harm of lowering LDL-C to very low concentrations do not confirm an increased risk of cancer or neurodegenerative disease attributable to lipid-lowering treatments, whereas evidence suggests a potential benefit in these settings. A potential increased risk of hemorrhagic stroke has been reported, suggesting tight monitoring and control of blood pressure should be implemented in patients with very low LDL-C levels. With regard to statin treatment, a dose-dependent increased risk of newly diagnosed diabetes has been reported. This adverse effect has not been found with more recently approved lipid-lowering drugs.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":" ","pages":"139-149"},"PeriodicalIF":3.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491635","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":"Discrepancies Between Physician-Perceived and Calculated Cardiovascular Risk in Primary Prevention: Implications for LDL-C Target Achievement and Appropriate Lipid-Lowering Therapy.","authors":"Arturo Cesaro, Vincenzo Acerbo, Francesco Scialla, Enrica Golia, Claudia Concilio, Gianmaria Scherillo, Gianantonio De Michele, Vincenzo de Sio, Antonio Capolongo, Luisa Di Donato, Maria Grazia Monaco, Simona Sperlongano, Alberto Ruggiero, Felice Gragnano, Elisabetta Moscarella, Carmine Riccio, Paolo Calabrò","doi":"10.1007/s40292-025-00705-0","DOIUrl":"10.1007/s40292-025-00705-0","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate risk assessment is critical in cardiovascular (CV) prevention, yet physicians often underestimate CV risk, leading to inadequate preventive measures.</p><p><strong>Aim: </strong>This study evaluates the concordance between physician-perceived CV risk and calculated CV risk in a primary prevention setting.</p><p><strong>Methods: </strong>This cross-sectional study included primary prevention patients from the Cardiology Outpatient Clinic of Caserta Hospital, Italy. Two independent cardiologists evaluated the physician-perceived risk, and a third resolved discrepancies. CV risk was calculated using SCORE2 for patients with 70 years or less and SCORE2-OP for those with more than 70 years. The concordance between perceived and calculated risks was assessed using Cohen's kappa coefficient. Multivariate logistic regression analysis was performed to examine the influence of risk estimation on achieving low-density lipoprotein cholesterol (LDL-C) targets recommended by the ESC.</p><p><strong>Results: </strong>389 patients had complete data for CV risk calculation. Physician-perceived risk categorized 8.7% of patients as low/moderate, 37.8% as high, and 53.5% as very-high risk. In contrast, calculated CV risk according to the SCORE2/SCORE2-OP classified 8% as low/moderate, 5.7% as high, and 86.4% as very-high risk. The concordance between perceived and calculated CV risk was poor (Cohen's kappa 0.208, p < 0.001). Underestimated patients reached LDL-C targets in 16% of cases, well-estimated in 34.5%, and overestimated in 76.9%. Statin use was significantly lower in patients with underestimated CV risk (29.2%) compared to well-estimated (50%) and overestimated (76.9%) groups (p < 0.001). Multivariate analysis showed that patients with overestimated risk were more likely to achieve LDL-C targets (OR 5.33, CI 1.33-21.42, p = 0.018), whereas underestimated patients were 47% less likely (OR 0.53, CI 0.3-0.93, p = 0.027).</p><p><strong>Conclusions: </strong>A significant discrepancy exists between physician-perceived and calculated CV risk, leading to risk underestimation in over one-third of patients. This underestimation is associated with lower LDL-C target achievement and reduced statin use.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":" ","pages":"199-208"},"PeriodicalIF":3.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship Between Blood Pressure and Heart Rate Response During Exercise Testing with Microcirculation Indices.","authors":"Ioannis Liatakis, Kyriakos Dimitriadis, Eleni Manta, Ioannis Andrikou, Nikolaos Pyrpyris, Fotios Tatakis, Dimitrios Konstantinidis, Konstantinos Thomopoulos, Antonios Manolis, Dimitrios Tousoulis, Konstantinos Tsioufis","doi":"10.1007/s40292-024-00695-5","DOIUrl":"10.1007/s40292-024-00695-5","url":null,"abstract":"<p><strong>Introduction: </strong>Hypertension is associated with changes in microcirculation, while increased blood pressure (BP) during exercise stress testing has been correlated with adverse outcomes.</p><p><strong>Aim: </strong>To evaluate the relationship of microcirculation with exercise BP response in hypertensive individuals.</p><p><strong>Methods: </strong>105 hypertensive individuals underwent exercise stress testing and nail-fold videocapillaroscopy assessment, in order to evaluate the relationship of BP response to exercise with capillary density.</p><p><strong>Results: </strong>A significant negative correlation between diastolic BP at 1-minute recovery and capillary density was revealed (Pearson's r = -0.365, p = 0.043). A significant negative correlation was also observed between capillary density and peak heart rate (HR) (Pearson's r = -0.364, p = 0.024) and HR increase from stage 1 to 2 (Pearson's r = -0.746, p = 0.013).</p><p><strong>Conclusion: </strong>Capillary rarefaction is associated with an abnormal BP and HR response to exercise, highlighting the role of microcirculation in BP regulation during exercise.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":" ","pages":"217-222"},"PeriodicalIF":3.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881950","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":"Comparative Efficacy of Continuous Positive Airway Pressure and Antihypertensive Medications in Obstructive Sleep Apnea-Related Hypertension: A Narrative Review.","authors":"Olumide Damilola Akinmoju, Gbolahan Olatunji, Emmanuel Kokori, Ikponmwosa Jude Ogieuhi, Adetola Emmanuel Babalola, Emeka Stanley Obi, Chidera Stanley Anthony, Odemona Glory Toluwanibukun, Adewunmi Akingbola, Adedoyin Esther Alao, Adenowo Goodness Boluwatife, Aarushi Venkatraman, Areesha Babar, Nicholas Aderinto","doi":"10.1007/s40292-024-00691-9","DOIUrl":"10.1007/s40292-024-00691-9","url":null,"abstract":"<p><strong>Introduction: </strong>Obstructive sleep apnea (OSA) presents a significant global health concern, affecting a substantial portion of the population, particularly among young and middle-aged adults.</p><p><strong>Aim: </strong>This review aims to assess the efficacy of continuous positive airway pressure (CPAP) compared to antihypertensive medications in managing OSA-related hypertension.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted across multiple databases, yielding studies published from 2000 to March 2024 that investigated CPAP, antihypertensives, or their combination therapy in OSA patients. Six definitive studies were analyzed, including two randomized controlled trials (RCTs), one randomized double-blind placebo-controlled crossover trial, one placebo-controlled trial, one open-label multicenter trial, and one longitudinal cohort study. These studies comprised 939 participants, with intervention durations ranging from four weeks to six months.</p><p><strong>Results: </strong>Analysis of CPAP monotherapy revealed variable efficacy, with some studies demonstrating significant reductions in 24-hour mean blood pressure and diastolic pressure, while others reported non-significant changes. CPAP therapy combined with antihypertensives showed additive effects, particularly in reducing office blood pressure measurements. Antihypertensive medications, such as valsartan, exhibited superior efficacy in reducing blood pressure compared to CPAP alone. Factors influencing therapy effectiveness included CPAP compliance, patient characteristics, and coexisting comorbidities. Patients with good CPAP adherence experienced greater reductions in blood pressure. The duration of exposure to OSA and the type of hypertension also impacted the therapy response.</p><p><strong>Conclusion: </strong>While CPAP and antihypertensive medications offer significant benefits in managing hypertension among OSA patients, challenges such as CPAP intolerance and medication side effects exist. Personalized treatment considering individual patient factors is crucial for optimal management.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":" ","pages":"127-137"},"PeriodicalIF":3.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881945","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":"Effect of nebivolol monotherapy or combination therapy on blood pressure levels in patients with hypertension: an updated systematic review and multilevel meta-analysis of 91 randomized controlled trials.","authors":"Athanasios Manolis, Paschalis Karakasis, Dimitrios Patoulias, Michalis Doumas, Manolis Kallistratos, Costas Thomopoulos, Maria Koutsaki, Guido Grassi, Giuseppe Mancia","doi":"10.1007/s40292-024-00687-5","DOIUrl":"10.1007/s40292-024-00687-5","url":null,"abstract":"<p><strong>Aims: </strong>To systematically appraise and summarize the available evidence from published randomized controlled trials considering the effect of nebivolol on blood pressure in patients with hypertension.</p><p><strong>Methods: </strong>Literature search was performed through Medline (via PubMed), Cochrane Library and Scopus until December 15, 2023. Double-independent study selection, data extraction and quality assessment were performed. Evidence was pooled with three-level mixed-effects meta-analysis.</p><p><strong>Results: </strong>In total, 7,737 participants with hypertension, who were treated with nebivolol, were analyzed across 91 RCTs. Nebivolol was associated with significantly greater reduction in office systolic and diastolic BP compared to placebo (MD = - 6.01 mmHg; 95% CI = [- 7.46, - 4.55] and MD = - 5.01 mmHg; 95% CI = [- 5.91, - 4.11], respectively). Moreover, resulted a similar reduction in systolic BP (MD = - 0.22 mmHg; 95% CI = [- 0.91, 0.46]) and a significantly greater reduction in diastolic BP compared to the active comparator (MD = - 0.71 mmHg; 95% CI = [- 1.27, - 0.16]). When considering the effect of nebivolol on 24-hour ambulatory BP, notable reductions were observed compared to placebo. In contrast, compared to the active comparators, there was no significant difference in systolic BP reduction, but a significant reduction in diastolic BP favoring nebivolol. Based on moderator analyses, the impact of nebivolol on the pooled estimates remained independent of the dose of nebivolol, age, male sex, trial duration, body mass index (BMI), baseline diabetes, heart failure, and baseline systolic and diastolic BP.</p><p><strong>Conclusion: </strong>Nebivolol, compared to placebo, showed a significant BP reduction and was non-inferior to other active comparators in terms of BP reduction.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":" ","pages":"7-31"},"PeriodicalIF":3.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521748","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}