Cardiovascular disease prevention strategies for type 2 diabetes mellitus.

Type 2 diabetes mellitus (T2DM) is associated with several cardiovascular (CV) risk factors such as insulin resistance, obesity, hypertension, dyslipidaemia, non-alcoholic fatty liver disease as well as platelet and haemostatic abnormalities increasing the risk of thrombosis. Therefore, T2DM patients are at an increased risk for CV disease (CVD). Areas covered: This narrative review discusses the treatment of T2DM.

The Co-Existence of NASH and Chronic Kidney Disease Boosts Cardiovascular Risk: Are there any Common Therapeutic Options?

Non-alcoholic fatty liver disease (NAFLD) is becoming the most common chronic liver disease. NAFLD may evolve to non-alcoholic steatohepatitis (NASH), which is causally related to cirrhosis and cardiovascular disease (CVD) mortality. There is no generally accepted effective treatment for NAFLD/NASH.

A Critical Approach of Guideline Therapeutic Recommendations for NAFLD.

Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) as progressive form of the disease are associated with cardiovascular risk factors including obesity, dyslipidaemia, hyperglycaemia and hypertension. When NAFLD is associated with cardiovascular disease, mortality of NAFLD patients is increased due to cardiovascular disease. Prevalence of NAFLD and NASH is high, but it seems that epidemic of the disease is under-recognized and under-appreciated.

Left ventricular ejection fraction as therapeutic target: is it the ideal marker?

Heart failure (HF) consists the fastest growing clinical cardiac disease. HF patients are categorized on the basis of underlying left ventricular ejection fraction (LVEF) into HF with preserved EF (HFpEF), reduced LVEF (HFrEF), and mid-range LVEF (HFmrEF). While LVEF is the most commonly used surrogate marker of left ventricular (LV) systolic function, the implementation of two-dimensional echocardiography in estimating this parameter imposes certain caveats on current HF classification.

Non-pharmacological Modulation of the Autonomic Nervous System for Heart Failure Treatment: Where do We Stand?

Introduction: An imbalance in the Autonomic Nervous System (ANS) is a central pathophysiologic mechanism in Heart Failure (HF) and has been a principal target of treatment in these patients. Traditional pharmacologic agents do not provide specific modulation of discrete arms of the ANS, while side effects may lead to poor tolerance. Technological advances have provided a series of invasive methods that may provide a focused effect on the ANS in selected patient groups.

Clinical Value of Measuring the Renin/Aldosterone Levels: Optimising the Management of Uncontrolled/Resistant Hypertension.

Introduction: Resistant hypertension (HT) is a common clinical entity with debilitating cardiovascular consequences. The highly heterogeneous nature of resistant HT requires a meticulous workup to exclude 'pseudo-resistance' and secondary forms of arterial HT. Resistant HT has recently gained wide scientific interest due to the introduction of interventional methods (renal sympathetic denervation and carotid baroreceptor stimulation) for blood pressure (BP) reduction in this patient population.

Renal Denervation Therapy: Can it Contribute to Better Blood Pressure Control in Hypertension?

Introduction: Although the first results from studies suggested important benefits regarding blood pressure (BP) control in resistant hypertension by the use of diverse systems of renal denervation (RDN) in the setting of resistant hypertension, the Symplicity HTN-3, randomized sham-controlled trial reduced the enthusiasm and led to a more critical approach towards this neuromodulation innovative therapy. Nowadays there is an ongoing research attempt to justify the pathophysiological background of RDN since overdrive of the sympathetic nervous system is one of the key mechanisms leading to the development and progression of the hypertensive and cardiovascular diseases.

Conclusion: Future RDN trials based on the clinical findings and gaps from previous works will try to identify those parameters to help identify better BP response, target the most suitable population and conclude whether this interventional approach can contribute to the clinical problem of uncontrolled hypertension.

Renal Denervation Therapy for Drug-Resistant Hypertension: Does It Still Work?

Hypertension is a global public health problem affecting one-fourth of the world's population. A subset of these patients with resistant hypertension presents a particular management problem and suffers a marked increase in cardiovascular risk. Treatment options have been limited, but the past decade has witnessed the emergence of catheter-based renal denervation to interrupt the sympathetic nervous system, long considered to play an important role in the development and maintenance of hypertension.

Effect of renal sympathetic denervation on short-term blood pressure variability in resistant hypertension: a meta-analysis.

Background/objectives: Short-term blood pressure variability (BPV) is affected by multiple factors including the sympathetic nervous system drive. Regarding the latter, the novel interventional technology of renal denervation (RDN), by modulating the sympathetic system activation, could have a beneficial impact on BPV. The aim of the current study is to review and meta-analyze the available evidence on the effect of RDN on short-term BPV.

Hypertension and Heart Failure with Preserved Ejection Fraction: Connecting the Dots.

Introduction: Heart failure (HF) with preserved ejection fraction (EF) (HFpEF) accounts for approximately 50% of HF cases and its prevalence relative to HF with reduced EF is rising. Hypertension (HT) is the most common co-morbidity in HFpEF patients and it is implicated in both the pathogenesis and the prognosis of the disease. Therefore, HT is a modifiable risk factor of high yield in HFpEF.

The Clinical Problems of Hypertension Treatment in Hemodialysis Patients.

Hypertension (HT) is present in more than 80% of patients undergoing Hemodialysis (HD). Elevated Blood Pressure (BP) in hemodialysis patients is associated with cardiovascular events and mortality only when BP is recorded with home or ambulatory monitoring, since pre- and post-dialysis measurements are not valid estimates of BP levels during the interdialytic interval. Sodium and water overload is the most important of several mechanisms involved in HT development in HD.

Arterial hypertension and aortic valve stenosis: Shedding light on a common "liaison".

Arterial hypertension and aortic valve stenosis are common disorders and frequently present as concomitant diseases, especially in elderly patients. The impact of hypertension on heart haemodynamics is substantial, thus affecting the clinical presentation of any coexisting valvulopathy, especially of aortic stenosis. However, the interaction between these 2 entities is not thoroughly discussed in the European or/and American guidelines on the management of hypertension or/and valvular heart disease.

Effects of multielectrode renal denervation on elevated sympathetic nerve activity and insulin resistance in metabolic syndrome.

Objective: This study aimed to investigate the effects of renal denervation (RDN) on sympathetic nerve activity and insulin resistance in patients with metabolic syndrome.

Methods: Seventeen patients fulfilled at least four of five criteria for metabolic syndrome and under stable use of at least two antihypertensive drugs were randomized in 3 : 1 ratio to RDN (n = 13, 12 men, age: 58 ± 7 years) and control groups (n = 4, three men, age: 60 ± 5 years) and followed up for 3 months. Muscle sympathetic nerve activity (MSNA) at rest and during standard 75 g oral glucose tolerance test (OGTT) was assessed.

Risk of hypertensive disorders in pregnancy following assisted reproductive technology: overview and meta-analysis.

The extent of the increased risk of pregnancy hypertensive disorders following assisted reproductive technology (ART) was investigated. PubMed and the Cochrane Collaboration Library were used as data sources to identify and select longitudinal cohorts comparing pregnancies following ART with spontaneously conceived pregnancies, between 1978 and June 2016. Risk ratios and 95% confidence intervals (CIs) of three outcomes, ie, gestational hypertension (GH), preeclampsia (PE), and their sum (PHD), were calculated.