European Journal of Preventive Cardiology

Hypertensive patients are highly heterogeneous in cardiovascular prognosis and treatment responses. A better classification system with phenomapping of clinical features would be of greater value to identify patients at higher risk of developing cardiovascular outcomes and direct individual decision-making for antihypertensive treatment.

An unsupervised, data-driven cluster analysis was performed for all baseline variables related to cardiovascular outcomes and treatment responses in subjects from the Systolic Blood Pressure Intervention Trial (SPRINT), in order to identify distinct subgroups with maximal within-group similarities and between-group differences. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for cardiovascular outcomes and compare the effect of intensive antihypertensive treatment in different clusters.

Four replicable clusters of patients were identified: cluster 1 (index hypertensives); cluster 2 (chronic kidney disease hypertensives); cluster 3 (obese hypertensives) and cluster 4 (extra risky hypertensives). In terms of prognosis, individuals in cluster 4 had the highest risk of developing primary outcomes. In terms of treatment responses, intensive antihypertensive treatment was shown to be beneficial only in cluster 4 (HR 0.73, 95% CI 0.55–0.98) and cluster 1 (HR 0.54, 95% CI 0.37–0.79) and was associated with an increased risk of severe adverse effects in cluster 2 (HR 1.18, 95% CI 1.05–1.32).

Using a data-driven approach, SPRINT subjects can be stratified into four phenotypically distinct subgroups with different profiles on cardiovascular prognoses and responses to intensive antihypertensive treatment. Of note, these results should be taken as hypothesis generating that warrant further validation in future prospective studies.

A manned mission to Mars has been contemplated by the world's largest space agencies for a number of years. The duration of the trip would necessitate a much longer exposure to deep space radiation than any human has ever been exposed to in the past. Concern regarding cancer risk has thus far stalled the progress of deep space exploration; however, the effect of space radiation on the cardiovascular system is significantly less well understood.

Damage by radiation in space is mediated by a number of sources, including X-rays, protons and heavier charged atomic nuclei (HZE ions, the high-energy component of galactic cosmic rays). Previously, only lunar mission astronauts have been exposed to significant deep space radiation, with all other missions being low earth orbits only. The effect of this radiation on the human body has been inconclusively studied, and the long-term damage caused to the vascular endothelium by this radiation due to the effect of high-energy particles is not well known.

Current radiation shielding technology, which would be viable for use in spacecraft, would not eliminate radiation risk. Similar to how a variety of shielding techniques are used every day by radiographers, again without full risk elimination, we need to explore and better understand the effect of deep space radiation in order to ensure the safety of those on future space missions.

Hypertensive disorders of pregnancy (HDPs) are among the leading causes of maternal and perinatal morbidity and mortality worldwide and have been suggested to increase long-term cardiovascular disease risk in the offspring.

The objective of this study was to investigate whether HDPs are associated with cardiometabolic markers in childhood.

PubMed, The Cochrane Library and reference lists of included studies up to January 2019.

Studies comparing cardiometabolic markers in 2–18-year-old children of mothers with HDP in utero, to children of mothers without HDP.

Sixteen studies reported in 25 publications were included in this systematic review, of which three were considered as having high risk of bias. Thus 13 studies were included in the evidence synthesis: respectively two and eight reported pregnancy induced hypertension and preeclampsia, and three studies reported on both HDPs.

Most studies (n = 4/5) found a higher blood pressure in children exposed to pregnancy induced hypertension. Most studies (n = 7/10) found no statistically significantly higher blood pressure in children exposed to preeclampsia. No association was found between exposure to HDP and levels of cholesterol, triglycerides or glucose (n = 5/5). No studies investigated an association with (carotid) intima-media thickness, glycated haemoglobin or diabetes mellitus type 2.

Most studies showed that exposure to pregnancy induced hypertension is associated with a higher offspring blood pressure. There is no convincing evidence for an association between exposure to preeclampsia and blood pressure in childhood. Based on current evidence, exposure to HDP is not associated with blood levels of cholesterol, triglycerides and glucose in childhood.

Obesity defined by body mass index (BMI) is characterized by better prognosis and lower plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure. We assessed whether another anthropometric measure, per cent body fat (PBF), reveals different associations with outcome and heart failure biomarkers (NT-proBNP, high-sensitivity troponin T (hs-TnT), soluble suppression of tumorigenesis-2 (sST2)).

In an individual patient dataset, BMI was calculated as weight (kg)/height (m) ² , and PBF through the Jackson–Pollock and Gallagher equations.

Out of 6468 patients (median 68 years, 78% men, 76% ischaemic heart failure, 90% reduced ejection fraction), 24% died over 2.2 years (1.5–2.9), 17% from cardiovascular death. Median PBF was 26.9% (22.4–33.0%) with the Jackson–Pollock equation, and 28.0% (23.8–33.5%) with the Gallagher equation, with an extremely strong correlation (r = 0.996, p < 0.001). Patients in the first PBF tertile had the worst prognosis, while patients in the second and third tertile had similar survival. The risks of all-cause and cardiovascular death decreased by up to 36% and 27%, respectively, per each doubling of PBF. Furthermore, prognosis was better in the second or third PBF tertiles than in the first tertile regardless of model variables. Both BMI and PBF were inverse predictors of NT-proBNP, but not hs-TnT. In obese patients (BMI ≥ 30 kg/m², third PBF tertile), hs-TnT and sST2, but not NT-proBNP, independently predicted outcome.

In parallel with increasing BMI or PBF there is an improvement in patient prognosis and a decrease in NT-proBNP, but not hs-TnT or sST2. hs-TnT or sST2 are stronger predictors of outcome than NT-proBNP among obese patients.

For many women in low socioeconomic status communities, limited health literacy is an obstacle to following medical guidance and engaging in health-promoting behaviours. Low health literacy skills are also associated with an increased risk of cardiovascular disease.

A health literacy intervention was designed through focus groups with women in low socioeconomic status communities. The primary health literacy issue identified was communication challenges at doctors’ visits. A unique intervention tailored to the participants’ preferences was designed consisting of three workshops conducted in community women’s groups in low socioeconomic status Jerusalem communities. The intervention aimed to increase patient–physician communication skills through doctor visit preparation and better visit management, improve perceived efficacy in patient–physician interaction and expand cardiovascular disease knowledge.

Questionnaires were completed before and 3 months after the intervention, assessing knowledge of cardiovascular disease risk factors and symptoms, self-report of behaviours in preparations for a doctor’s visit, and perceived efficacy in patient–physician interaction.

A total of 407 women from low socioeconomic status communities completed questionnaires. Post-intervention, the percentage of women that reported preparing for doctors’ visits increased significantly. Women with initially low levels of perceived efficacy in patient–physician interaction showed a significant increase in perceived efficacy, while initially higher perceived efficacy in patient–physician interaction participants showed a decrease. Participants also demonstrated an increase in knowledge of several risk factors for cardiovascular disease and heart attack symptoms.

A community-based cardiovascular health literacy intervention improved cardiovascular knowledge and reported doctor visit preparation in low socioeconomic status women as well as increased perceived efficacy in patient–physician interaction among participants with low baseline perceived efficacy in patient–physician interaction. This may lead to improved health care utilisation, preventing chronic illness.

Registered at ClinicalTrials.gov, https://www.clinicaltrials.gov, registration number: NCT03203018