Current Vascular Pharmacology - Current Issue

Among the organ damage mediated by hypertension, cardiac lesions hold significant importance. Numerous authors focus on hypertensive heart disease (HHD) rather than exclusively on left ventricular hypertrophy (LVH).

This narrative review aims to assess the incorporation of the concept of 'hypertensive heart disease' (HHD) in hypertension (HTN) guidelines. Furthermore, if HHD is not addressed, the review will evaluate the potential benefits of including this concept in future studies.

The following databases were searched: Scopus, Medline, Springer, Science Direct, Wiley, SAGE, Cambridge, Oxford Journals, and Google Scholar. Attention was given to the guidelines related to hypertension (HTN); the search items were “guidelines” and “hypertension.” Within these guidelines, we specifically sought references to ‘hypertensive heart disease’.

The concept of “HHD” is clearly advantageous compared to “HTN LVH,” as it not only addresses LVH but also considers other structures of the heart that may be severely affected, which can significantly influence treatment. The concept of “hypertensive heart disease” is mentioned in only 8 out of 36 guidelines on HTN. The therapeutic implications and recommendations are absent in the guidelines.

The concept of HHD is reasonable and evidence-based, and there is no reason to focus only on LVH when considering HTN-induced damage to the heart. It is time to update our recommendations for heart treatment by using the phrase “Treatment of hypertensive heart disease” instead of “Treatment of hypertensive LVH.” This update can enhance our awareness of the need to improve not only HTN LVH but the other parts of the heart as well.

Sodium Glucose cotransporter-2 inhibitors (SGLT2is) possess pleiotropic effects, such as antioxidant, antifibrotic, anti-inflammatory, and vascular remodeling activities. Considering the lack of literature, a network meta-analysis was conducted to explore the impact of SGLT2is on endothelial dysfunction and arterial stiffness in the diabetic population.

Electronic databases were searched to identify randomized clinical trials evaluating the effects of SGLT2is on outcomes, such as Flow-mediated Vasodilation (FMV), Pulse Wave Velocity (PWV), and Augmentation Index (AIx). Direct, indirect, and mixed treatment comparisons generated pooled estimates using random-effects modeling. Effect sizes were reported as Hedges' g with 95% Confidence Interval (95% CI). Bootstrap and permutation meta-analyses were performed using ranking plots. The certainty of evidence was graded.

Twelve articles (706 participants) were included. SGLT2is were associated with significant improvements in FMV (g: 0.48; 95% CI: 0.08, 0.88), confirmed by bootstrap meta-analysis (g: 0.48; 95% CI: 0.1, 0.85) and permutation meta-analysis of FMV (g: 0.48; 95% CI: 0.05, 0.9). Within SGLT2is, dapagliflozin (g: 0.39; 95% CI: 0.14, 0.65) significantly improved FMV, and dapagliflozin (g: -0.61, 95% CI: -0.98, -0.24) and tofogliflozin (g: -3.51; 95% CI: -4.05, -2.98) significantly improved PWV. A low risk of publication bias was observed, and the ranking plots revealed dapagliflozin to have the best probability (0.99) of being the most effective for improving FMV. Low certainty of evidence was observed for all outcomes.

SGLT2 inhibitors improve endothelial function and arterial stiffness in the diabetic population. Clinical studies evaluating the association between improvements in endothelial function with SGLT2is and reduced adverse cardiovascular and cardiorenal events and mortality are urgently needed.

The objective of this study was to explore the relationship among serum levels of the growth-stimulating expressed gene 2 protein (ST2), Galectin-3 (GAL-3), N-terminal pro-B-type natriuretic peptide (NT-proBNP) in elderly hypertensive patients and heart failure with preserved ejection fraction (HFpEF).

Eighty-five elderly hypertensive patients with HFpEF were registered as the HFpEF group, and 46 hypertensive patients without HF were registered as the Non-HF group. The levels of serum sST2 (soluble ST2), Galectin-3, and NT-proBNP were measured, and related indexes of heart function were performed with echocardiography in two groups, respectively. The obtained variables were applied to statistical software for analysis.

Age, BMI, SBP, DBP, TC, LDL-C, HCY, sST2, Galectin-3, NT- proBNP, LVEDD, IVSD, LVEF, and E/A were obviously different between the two groups (p<0.05). The levels of sST2, Galectin-3 and NT- proBNP in the HFpEF group were higher than in the Non-HF group (P < 0.05). ANOVA results indicated that sST2, Galectin-3, and NT- proBNP levels increased gradually with the increasing NYHA grades (P<0.05). BMI, SBP, DBP, TC, LDL-C, FBG, UA, HCY, LVEDD, IVSD, LVEF, and E/A were significant differences in patients with different NYHA classes (P < 0.05). Spearman indicated that sST2, Galectin-3, and NT-proBNP were positively correlated with BMI, SDP, DBP, LDL-C, FBG, and HCY (P < 0.05). Logistic analysis indicated that BMI, SBP, DBP, FBG, HCY, sST2, Galectin-3, NT-proBNP, LVEDD, LVEF, and E/A were risk factors for hypertension with HFpEF (P < 0.05). ROC indicated that the AUC of the diagnostic performance of sST2, Galectin-3, and NT-proBNP were all above 0.7, which may have some forecasting value for elderly hypertensive patients with HFpEF.

The levels of sST2, Galectin-3, and NT-proBNP were closely related to cardiac function grades. sST2, Galectin-3, and NT-proBNP have similar diagnostic performance and predictive value for elderly hypertensive patients with HFpEF. sST2 was more sensitive than NT-proBNP. It is recommended that measurements of sST2, Galectin-3 and NT-proBNP levels in elderly hypertensive patients may be useful in classifying early HFpEF.

This study aimed to investigate the factors influencing medication adherence in community-dwelling Chinese older adults with hypertension.

Empirical research–quantitative; Cross-sectional study.

A cross-sectional survey was conducted from September to December 2021, in which participants completed a self-administered questionnaire with detailed their demographic information. The Morisky Medication Adherence Scale-8, the Pittsburgh Sleep Quality Index, and the 10-item Kessler Psychological Distress Scale were used to assess medication adherence, sleep quality, and psychological well-being, respectively. Multivariate logistic regression analysis was performed with medication adherence as the dependent variable to identify factors influencing adherence.

The study included 867 patients with hypertension, comprising 566 women and 301 men with a mean age of 70.89 ± 7.50 years. Results indicated that 53.9% of participants exhibited high medication adherence, while 24.5% and 21.7% demonstrated medium and low adherence levels, respectively. Multiple logistic regression analysis revealed that individuals in the 50–59 age group had lower medication adherence compared to those aged 80 years and older (odds ratio [OR]: 0.468, 95% confidence interval [CI]: 0.245,0.894). In addition, participants with a primary school education or less (OR: 0.152, 95% CI: 0.095,0.245) and those living alone (OR: 0.362, 95% CI: 0.228, 0.575) exhibited poorer medication adherence. Conversely, living in an urban area was associated with better adherence (OR: 2.131, 95% CI: 1.402, 3.239, p < 0.001).

Our study showed that participants' medication adherence was below the desired level. It was observed that older adults, those with a junior high school education or higher, and those living in urban areas with their children had better medication adherence. These identified predictors may help to identify individuals at high risk of poor adherence, enabling the implementation of effective interventions to reduce the global burden of hypertension.