Objective: Increased urinary albumin excretion (UAE) is a potent predictor of future cardiovascular disease that corresponds to a state of generalized microvascular dysfunction, even below the threshold values usually considered for microalbuminuria. This holds true in patients with hypertension and particularly in those with diabetes mellitus (DM), in whom it is associated with macrovascular disease. At the same time, both hypertension and DM are associated with large artery stiffening, while hypertension often coexists with DM. In the present study, we investigated whether an association exists between UAE and arterial stiffness in newly-diagnosed patients with DM, independent of blood pressure (BP) levels. Design and method: Consecutive patients with newly-diagnosed DM were studied. All patients underwent office BP measurements and 24-hour ambulatory BP monitoring (Spacelabs 90207). Microalbuminuria was calculated from 24-hour urine samples. Arterial stiffness was evaluated with measurement of carotid-femoral pulse wave velocity (PWV) with applanation tonometry. Blood samples were drawn to estimate fasting glucose, glycated hemoglobin (HbA1c), lipid profile and renal function Results: A total of 65 patients aged 57 ± 11 years, 40 males and 25 females, with median DM duration of 2 months were included in the study. Fasting glucose was 121.5 (IR: 36) mg/dl and HbA1c 7.47 (IR: 2) %. The majority of patients (66.2%) had concomitant hypertension. In particular, 26 patients (40%) had a history of known hypertension with median duration of 8 (IR: 8) years, while 17 (26.2%) were simultaneously diagnosed with hypertension and DM. In our cohort, UAE was associated with fasting glucose (r = 0.294, p = 0.040), HbA1c (r = 0.426, p = 0.002), creatinine (r = 0.308, p = 0.035), glomerular filtration rate (r = 0.442, p = 0.002), office systolic (r = 0.403, p = 0.009) and diastolic (r = 0.447, p = 0.026) BP and PWV (r = 0.308, p = 0.031). However, in the multivariate analysis adjusting for BP and other variables, HbA1c (beta = 0.351, p = 0.015) was the only significant predictor of UAE, whereas the association between UAE and PWV no longer remained significant. Conclusions: In newly-diagnosed patients with DM, hyperglycemia is an independent predictor of UAE, emphasizing the need for early and effective glycemic control. The observed association between UAE and arterial stiffening seems to be mediated by hyperglycemia and increased BP.
Arterial stiffness and central hemodynamics attract increasing scientific interest within the hypertensive community during the last decade. Accumulating evidence indicates that aortic stiffness is a strong and independent predictor of cardiovascular events and all-cause mortality in hypertensive patients, and its predictive value extends beyond traditional risk factors. The role of central hemodynamics and augmentation index (a marker of reflected waves), remains less established and requires further investigation. Several lines of evidence indicate that antihypertensive therapy results in significant reductions of pulse wave velocity and central hemodynamics. However, beta-blockers seem to be the only exception with significant within-class differences. Conventional beta-blockers, although equally effective in reducing pulse wave velocity, seem to be less beneficial on central hemodynamics and augmentation index than the other antihypertensive drug categories, whereas the newer vasodilating beta-blockers seem to share the benefits of the other antihypertensive drugs. In conclusion, aortic stiffness seems ready for ‘prime-time’ in the management of essential hypertension, while further research is needed for central hemodynamics and augmentation index.
Inflammatory responses in small vessels play an important role in the development of cardiovascular diseases, including hypertension, stroke, and small vessel disease. This involves various complex molecular processes including oxidative stress, inflammasome activation, immune-mediated responses, and protein misfolding, which together contribute to microvascular damage. In addition, epigenetic factors, including DNA methylation, histone modifications, and microRNAs influence vascular inflammation and injury. These phenomena may be acquired during the aging process or due to environmental factors. Activation of proinflammatory signaling pathways and molecular events induce low-grade and chronic inflammation with consequent cardiovascular damage. Identifying mechanism-specific targets might provide opportunities in the development of novel therapeutic approaches. Monoclonal antibodies targeting inflammatory cytokines and epigenetic drugs, show promise in reducing microvascular inflammation and associated cardiovascular diseases. In this article, we provide a comprehensive discussion of the complex mechanisms underlying microvascular inflammation and offer insights into innovative therapeutic strategies that may ameliorate vascular injury in cardiovascular disease.
Arterial hypertension is the most important modifiable cardiovascular risk factor and a major cause of cardiovascular mortality worldwide. In daily clinical practice, the hypertensive patient is often treated in a uniform way, thus ignoring the significant effects of sex on several aspects of hypertension including its prevalence, pathophysiology, response to antihypertensive treatment, and outcomes. The substantial hormonal changes during a woman's life cycle along with the immune response and several cardiometabolic risk factors that frequently coexist are among the main pathophysiological mechanisms driving hypertension in women. Concurrently, women exhibit increased cardiovascular risk at lower blood pressure (BP) levels compared to age-matched men and present certain disparities in the incidence of cardiovascular events and subsequent hypertension-related cardiovascular prognosis. In addition, women respond differently to antihypertensive treatment, experiencing more drug-related side effects, and exhibit lower rates of BP control compared to men. Currently, international guidelines propose the same targets and the same therapeutic algorithms for the treatment of hypertension in both sexes, without taking into account the sex differences that exist. In this review we aim to describe the certain particularities of arterial hypertension in female sex, moving from pathophysiological aspects to clinical and therapeutical management.
This paper covers the facts on exponential growth and presents a thesis for the worldwide stabilization of population levels and the conservation of resources. Minimization of political barriers along with optimization and universal application of the current technological base are major considerations. Besides understanding, trust, and goodwill on the part of the political leadership around the world, a massive worldwide educational campaign is needed to achieve positive results. Examples are given using statistical data for four countries with different political and economic systems, and varying levels of development.
