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Medicina
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New Insights into Hypertension and the Cardiovascular System
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New Insights into Hypertension and the Cardiovascular System

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (31 January 2025) | Viewed by 14188

Special Issue Editor

Prof. Dr. Gwo-Ping Jong

E-Mail Website
Guest Editor
Department of Internal Medicine, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung, Taiwan
Interests: clinical epidemiology; risk assessment; clinical pharmacology; cardiovascular disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cardiovascular diseases are one of the leading causes of death worldwide. The primary prevention of cardiovascular diseases has become a main goal to promote public health. Hypertension is a risk factor for cardiovascular diseases and is possibly the most powerful, modifiable risk factor for the development of cardiovascular diseases. Early detection and appropriate management are necessary to prevent both heart failure and cardiovascular diseases. Oxidative stress and chronic inflammation have been identified as being potentially responsible for the development of endothelial damage and vascular stiffness, which are two of the primum movens of hypertension and cardiovascular diseases. However, mechanisms, pathogenesis, sympathetic neural activity, risk factors, and differences in race/ethnicity have not been verified in hypertension-related cardiovascular disease. In this Special Issue, we emphasize the importance of the management and treatment of hypertension in the prevention of cardiovascular diseases and welcome all types of manuscripts (original articles and review articles).

Prof. Dr. Gwo-Ping Jong
Guest Editor

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hypertension
  • risk factors
  • oxidative stress
  • chronic inflammation
  • cardiovascular diseases

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Published Papers (6 papers)

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Research

Jump to: Review

12 pages, 1304 KiB  
Article
The Interplay of Cancer and Hypertension: Rising Mortality and Widening Disparities Across the United States (1999–2023)
by Ibrahim Ali Nasser, Shereen Asghar, Laraib Masud, Muhammad Ali Hafeez, Sonia Hurjkaliani, Eeshal Zulfiqar, Maryam Shahzad, Husain Ahmed, Shahrukh Khan, Sajeel Ahmed, Qadeer Abdul, Muhammed Ameen Noushad, Rabia Nusrat, Sana Azhar, Charles Dominic Ward, Mushood Ahmed and Raheel Ahmed
Medicina 2025, 61(5), 917; https://doi.org/10.3390/medicina61050917 - 19 May 2025
Viewed by 885
Abstract
Background and Objectives: Growing evidence suggests a strong relationship between hypertension and cancer, which can increase the risk of poor prognosis. However, data regarding mortality related to cancer and hypertension are limited. Our study aims to analyze the mortality trends related to [...] Read more.
Background and Objectives: Growing evidence suggests a strong relationship between hypertension and cancer, which can increase the risk of poor prognosis. However, data regarding mortality related to cancer and hypertension are limited. Our study aims to analyze the mortality trends related to cancer and hypertension in the United States from 1999 to 2023. Materials and Methods: A retrospective observational analysis was conducted using mortality data for the adult U.S. population from 1999 to 2023, retrieved from the CDC WONDER database using death certificates. Age-adjusted mortality rates (AAMRs) were calculated, and annual percentage changes (APCs) were analyzed using JoinPoint Regression. Results: From 1999 to 2023, a total of 1,406,107 deaths related to cancer and hypertension were recorded in the United States. The AAMR increased from 12.59 in 1999 to 35.49 in 2023. Males had a higher mortality rate compared to women throughout the study period (AAMR; 30.3 vs. 20.4). Non-Hispanic (NH) Black Americans, or African Americans had the highest mortality rates, followed by NH white, Hispanic or Latino groups, and other NH groups. The highest AAMR was observed in the South, followed by the Midwest, the Northeast, and the West. Rural areas had higher mortality rates compared to urban areas. Conclusions: Cancer- and hypertension-related mortality rates have consistently increased in the United States from 1999 to 2023, particularly affecting males, NH Black Americans, the southern region, and rural areas. The trends highlight the need for targeted prevention, including early screening, lifestyle changes, and treatment adherence. Full article
(This article belongs to the Special Issue New Insights into Hypertension and the Cardiovascular System)
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11 pages, 941 KiB  
Article
Evaluation of Coronary Artery Calcium Score (CACS) in Dipper and Non-Dipper Hypertensive Patients with Moderate and High Cardiovascular Disease Risks
by Ahmet Cinar, Omer Gedikli, Muhammet Uyanik and Ozlem Terzi
Medicina 2024, 60(12), 1999; https://doi.org/10.3390/medicina60121999 - 3 Dec 2024
Cited by 2 | Viewed by 1296
Abstract
Background and Objectives: Hypertension is typically classified into two main groups, “dipper” and “non-dipper”, based on nocturnal blood pressure decline. The coronary artery calcium score (CACS) is an essential biomarker used to assess the presence and severity of coronary artery disease (CAD). [...] Read more.
Background and Objectives: Hypertension is typically classified into two main groups, “dipper” and “non-dipper”, based on nocturnal blood pressure decline. The coronary artery calcium score (CACS) is an essential biomarker used to assess the presence and severity of coronary artery disease (CAD). This study aims to demonstrate the relationship between CACS and hypertensive patients with moderate-to-high cardiovascular disease (CVD) risk classified as either dipper or non-dipper. Participants and Methods: A total of 167 patients with moderate-to-high CVD risk were divided into two subgroups: 95 patients with dipper hypertension (HT) and 72 with non-dipper hypertension. CACS was measured using coronary computed tomography angiography. Results: In the dipper HT group, there were 60 females (63.2%) and 35 males (36.8%), whereas the non-dipper HT group included 28 females (38.9%) and 44 males (61.1%) (p = 0.002). The mean age was 57 in the dipper HT group and 62 in the non-dipper HT group (p = 0.011). The mean CACS was 93 in the non-dipper HT group and 10 in the dipper HT group (p < 0.001). A history of coronary artery disease was more common in the non-dipper HT group (p = 0.003). Smoking prevalence was higher in the non-dipper HT group (31 patients, 43.1%) compared to the dipper HT group (25 patients, 26.3%) (p = 0.023). Correlation analysis showed that CACS was positively correlated with age, BMI, and HbA1c and negatively correlated with eGFR. Higher CACS values were also observed in males and patients with a history of coronary artery disease, diabetes mellitus, and hyperlipidemia. In univariate analysis, age, male sex, smoking, CAD, CACS, and elevated creatinine were identified as significant risk factors for non-dipper HT (p < 0.05). However, in multivariate analysis, only CACS emerged as a significant independent risk factor (p = 0.001), while other variables were not significant (p > 0.05). The area under the curve (AUC) for CACS was 0.759, indicating statistically significant and excellent discriminative capability (p < 0.001, 95% CI: 0.680–0.839). Conclusions: It was concluded that non-dipper hypertension is associated with higher CACS and indicates a higher cardiovascular risk for this group. Full article
(This article belongs to the Special Issue New Insights into Hypertension and the Cardiovascular System)
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13 pages, 2220 KiB  
Article
Prevalence and Characteristics of Isolated Nighttime Masked Uncontrolled Hypertension in Treated Patients
by Kang Hee Kim, Jaehoon Chung, Suyoung Jang, Byong-Kyu Kim, Masanori Munakata and Moo-Yong Rhee
Medicina 2024, 60(9), 1522; https://doi.org/10.3390/medicina60091522 - 18 Sep 2024
Viewed by 3524
Abstract
Background and Objectives: We evaluated the prevalence and characteristics of isolated nighttime masked uncontrolled hypertension (IN-MUCH) in treated patients. Materials and Methods: Participants aged 20 years or older who were on antihypertensive medication underwent three-day office blood pressure (BP) and 24 [...] Read more.
Background and Objectives: We evaluated the prevalence and characteristics of isolated nighttime masked uncontrolled hypertension (IN-MUCH) in treated patients. Materials and Methods: Participants aged 20 years or older who were on antihypertensive medication underwent three-day office blood pressure (BP) and 24 h ambulatory BP measurements. Hypertension phenotypes were classified as controlled hypertension (CH), isolated daytime masked uncontrolled hypertension (ID-MUCH), IN-MUCH, and daytime and nighttime masked uncontrolled hypertension (DN-MUCH). Results: Among 701 participants, 544 had valid BP data and controlled office BP (<140/90 mmHg). The prevalence of IN-MUCH was 34.9%, with a higher prevalence of men and drinkers than in those with CH. Patients with IN-MUCH had higher office systolic BP (SBP) and diastolic BP (DBP) than those with CH. The prevalence of IN-MUCH was 37.6%, 38.5%, and 27.9% in patients with optimal, normal, and high-normal office BP levels, respectively. Among IN-MUCH patients, 51.6% exhibited isolated uncontrolled DBP and 41.1% uncontrolled SBP and DBP. Younger age (p = 0.043), male sex (p = 0.033), and alcohol consumption (p = 0.011) were more prevalent in patients with isolated uncontrolled DBP than in those with uncontrolled SBP and DBP. Age and alcohol consumption were positively associated, whereas high-normal office BP exhibited a negative association with IN-MUCH. Conclusions: The IN-MUCH was significantly more prevalent in patients with normal or optimal office BP, posing treatment challenges. Further investigation is needed to determine whether differentiation between isolated uncontrolled DBP and combined uncontrolled SBP and DBP is necessary for prognostic assessment of IN-MUCH. Full article
(This article belongs to the Special Issue New Insights into Hypertension and the Cardiovascular System)
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11 pages, 474 KiB  
Article
Cardiometabolic Risk Factors Related to Atrial Fibrillation and Metabolic Syndrome in the Pakistani Population
by Saira Rafaqat, Saima Sharif, Shagufta Naz, Sanja Gluscevic, Filiz Mercantepe, Ana Ninic and Aleksandra Klisic
Medicina 2024, 60(8), 1190; https://doi.org/10.3390/medicina60081190 - 23 Jul 2024
Viewed by 1919
Abstract
Background and Objectives: This study aimed to examine the relationship between cardiometabolic risk factors and atrial fibrillation (AF) and the simultaneous presence of AF and metabolic syndrome (MetS) in the Pakistani population. Materials and Methods: A total of 690 subjects were [...] Read more.
Background and Objectives: This study aimed to examine the relationship between cardiometabolic risk factors and atrial fibrillation (AF) and the simultaneous presence of AF and metabolic syndrome (MetS) in the Pakistani population. Materials and Methods: A total of 690 subjects were enrolled (n = 230 patients with AF, n = 230 patients with AF and MetS, and n = 230 controls). The associations between cardiometabolic parameters and AF with and without MetS were analyzed by univariable and multivariable binary regression analyses. Results: Body mass index (BMI), fasting blood glucose (FBG), and triglycerides (TG) were independently positively correlated, but the glomerular filtration rate (GFR) and sodium were independently negatively correlated with AF. An increase in BMI, FBG, and TG levels by one unit measure increased the probability by 55.1%, 20.6%, and 1.3%, respectively, for the AF occurrence. A decrease in GFR and sodium levels increased the probability by 4.3% and 33.6%, respectively, for the AF occurrence. On the other hand, uric acid was independently negatively correlated, whereas sodium was independently positively correlated, with MetS and AF. A decrease in uric acid levels and an increase in sodium levels by 1 unit measure increased the probability for MetS and AF by 23.2% and 7.5%, respectively. Conclusions: Cost-effective and routinely measured parameters, i.e., BMI, FBG TG, GFR, and sodium levels, can be reliable indicators of AF, whereas serum uric acid and sodium levels are independently associated with AF and MetS in the Pakistani population. Timely recognition and the control of modifiable cardiometabolic risk factors are of great significance in the prevention of AF development. Full article
(This article belongs to the Special Issue New Insights into Hypertension and the Cardiovascular System)
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Review

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13 pages, 1043 KiB  
Review
The Pathophysiology of Sex Differences in Stroke Risk and Prevention in Atrial Fibrillation: A Comprehensive Review
by Ibrahim Antoun, Georgia R. Layton, Ahmed Abdelrazik, Mahmoud Eldesouky, Mustafa Zakkar, Riyaz Somani and André Ng
Medicina 2025, 61(4), 649; https://doi.org/10.3390/medicina61040649 - 1 Apr 2025
Cited by 2 | Viewed by 886
Abstract
Atrial fibrillation (AF) is the most common chronic arrhythmia and is a leading cause of stroke, with well-documented differences in pathophysiology, clinical manifestations, and prognosis according to the sex of the patient. This review provides an overview of known or hypothesized sex differences [...] Read more.
Atrial fibrillation (AF) is the most common chronic arrhythmia and is a leading cause of stroke, with well-documented differences in pathophysiology, clinical manifestations, and prognosis according to the sex of the patient. This review provides an overview of known or hypothesized sex differences in physiology and stroke risk for patients with AF. Women are reported to have more extensive fibrosis of the left atrium, different functional properties of the atria, and higher sensitivity to prothrombotic stimuli, especially after menopause. Variations in stroke risk with AF are linked to age, hypertension, diabetes, and chronic kidney disease; overall, women have worse outcomes. The widely clinically implemented CHA2DS2-VASc score no longer considers sex as a variable, and its propriety for women is still debated. However, women are usually under prescribed anticoagulation despite having a higher long-term risk of stroke compared to men, suggesting a lack of equity of treatment for certain patient groups. New AI-based risk stratification models and precision medicine approaches are potentially useful in reducing these gaps. Future work should also aim to improve sex-based predictive models, considering different gender categories, and understanding the part played by hormonal alterations, atrial structural alterations, and thromboembolic risk in the treatment of AF. Full article
(This article belongs to the Special Issue New Insights into Hypertension and the Cardiovascular System)
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18 pages, 853 KiB  
Review
Hypertension and Atrial Fibrillation: Bridging the Gap Between Mechanisms, Risk, and Therapy
by Ibrahim Antoun, Georgia R. Layton, Ali Nizam, Joseph Barker, Ahmed Abdelrazik, Mahmoud Eldesouky, Abdulmalik Koya, Edward Y. M. Lau, Mustafa Zakkar, Riyaz Somani and Ghulam André Ng
Medicina 2025, 61(2), 362; https://doi.org/10.3390/medicina61020362 - 19 Feb 2025
Cited by 5 | Viewed by 4533
Abstract
Background and objectives: Atrial fibrillation (AF), the most prevalent sustained arrhythmia, poses a significant public health challenge due to its links with stroke, heart failure, and mortality. Hypertension, a primary modifiable cardiovascular risk factor, is a well-established risk factor for AF that facilitates [...] Read more.
Background and objectives: Atrial fibrillation (AF), the most prevalent sustained arrhythmia, poses a significant public health challenge due to its links with stroke, heart failure, and mortality. Hypertension, a primary modifiable cardiovascular risk factor, is a well-established risk factor for AF that facilitates structural and electrical changes in the atria, including dilation, fibrosis, and pressure overload. Material and Methods: we conducted a literature search regarding the shared mechanisms, risks and treatments of hypertension and atrial fibrillation. Results: The renin–angiotensin–aldosterone system plays a pivotal role in this remodelling and inflammation, increasing AF susceptibility. Uncontrolled hypertension complicates AF management, diminishing the effectiveness of mainstay treatments, including antiarrhythmic drugs, catheter ablation, and cardioversion. Effective blood pressure management, particularly with therapies targeting the renin–angiotensin–aldosterone system (RAAS), can lower the risk of new-onset AF and reduce the incidence of recurrent AF, enhancing the success of rhythm control strategies. These antihypertensive therapies mitigate myocardial hypertrophy and fibrosis and attenuate both atrial pressure strain and the inflammatory response, mitigating the substrates for AF. Conclusion: This review highlights the urgent need for integrated strategies that combine BP control, AF screening, and lifestyle modifications to minimise the burden of AF and its complications. Future research should investigate the specific mechanisms of cellular-level interactions associated with a hypertensive predisposition to AF, including systematic inflammation and the role of genetics, the impact of blood pressure variations on AF risk, and individualised treatment strategies specifically targeting the shared mechanisms, simultaneously propagating hypertension and AF. Full article
(This article belongs to the Special Issue New Insights into Hypertension and the Cardiovascular System)
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