Key hypertension breakthroughs and emerging trends from the AHA's scientific sessions.

We aim to summarize selected late-breaking science on hypertension management strategies and disease presented at the 2023 American Heart Association (AHA) conference. The trials discussed below encompass stricter goals of blood pressure management and were expanded into different population groups from different countries with varied socioeconomic backgrounds and settings, collectively advancing our understanding of hypertension treatment and its impact on public health. We summarized the china rural health care project (CRHCP), a four-year study involving over 34,000 participants in rural China, emphasizing the potential of stricter blood pressure goals in lowering the incidence of all-cause dementia and cognitive impairment. Next, we explore the US-based CARDIA-SSBP study, which highlights the impact of dietary sodium on systolic blood pressure in middle-aged individuals. Through a randomized-order cross-over design, the study provides compelling evidence supporting the effectiveness of sodium reduction as a non-pharmacological approach to blood pressure control. The UK-based POP-HT trial offers critical insights into postpartum women with a history of hypertensive pregnancy. The trial emphasizes the benefits of self-monitoring and physician-optimized antihypertensive titration, showcasing significant blood pressure reductions in the intervention group. Furthermore, the KARDIA-1 study introduces us to Zilebesiran, an innovative RNA interference drug. This phase 2 study highlights its potential for achieving sustained blood pressure reductions and its favorable safety profile, marking a significant step forward in hypertension treatment. Lastly, we expand the practical application of the previously conducted landmark SPRINT trial, which showed cardiovascular benefit with intensive SBP control to less than 120 mm Hg in high-risk non-diabetic patients with hypertension compared with routine BP control to <140 mm Hg. The ESPRIT trial and the IMPACTS trial build upon the SPRINT trial, demonstrating the effects of intensive blood pressure lowering in Asian hypertensive patients and in 36 health care clinics in medically underserved states in the US: Louisiana and Mississippi. The IMPACTS trial and the "Hypertension Treatment in Nigeria Program" demonstrate the effectiveness of implementing comprehensive blood pressure control strategies in real-world settings. These studies highlight the feasibility and scalability of such interventions, especially in low-resource environments, and their potential to significantly improve public health outcomes.

Spontaneous coronary artery dissection-associated takotsubo syndrome: A systematic review of case reports.

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is underdiagnosed and requires comprehensive angiographic findings. Few SCAD occurrences have a comparable clinical appearance as takotsubo syndrome (TTS) or exist simultaneously, making it challenging for clinicians to treat and manage. Case reports lack consolidated data. We examined SCAD-TTS case reports. AIM: To conduct a systematic review of available case reports on SCAD in order to investigate its potential association with TTS. METHODS: SCAD-associated TTS case reports were reviewed after thoroughly screening PubMed, EMBASE, Scopus, and Google Scholar databases till January 2023. Case reports described demographics, comorbidities, imaging, management, and results. RESULTS: Twelve articles about 20 female patients were analyzed. 30% of patients (n = 6, > 60 years) were elderly (mean age 56.2 ± 9.07 years, range 36-70 years). Canada has 9 cases, United States 3, Australia 3, Sweden 2, Japan, Denmark, and France 1. Only 5 reports identified emotional stressors in these cases while 4 reports showed physical triggers for TTS. Nine had hypertension, 2 had hyperlipidemia, and 1 had prediabetes. 5 patients (25%) smoked. 10 (50%) troponin-positive myocardial infarction patients reported chest discomfort. 11 (55%) of 20 instances had TTS/SCAD. 12 (60%) of 20 patients exhibited ST elevation and 3 (15%) had T wave inversion on electrocardiogram. 19/20 patients had elevated troponin. 9 (45%) of 20 people had apical akinesis with TTS ballooning on cardiac imaging. All 20 exhibited echocardiographic wall motion abnormalities. 19 (95%) of 20 coronary angiography cases had SCAD. 10 of 19 SCAD patients had left anterior descending, 2 diagonal, and 2 left circumflex coronary artery involvement. 7 of 20 patients had left ventricular ejection fraction (LVEF) data. LVEF averaged 38.78 ± 7.35%. 5 (25%) of the 20 cases underwent dual antiplatelet therapy. Three (15%) of 20 cases experienced occasional ectopic ventricular complexes, Mobitz ll AV block, and paroxysmal atrial fibrillation. All 20 cases recovered and survived. CONCLUSION: Given the clinical similarities and challenges in detecting TTS and SCAD, this subset needs more research to raise awareness and reduce morbidity.