Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient’s values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide.

Systemic lupus erythematosus (SLE) is a chronic systematic autoimmune disease. Current methods of diagnosing SLE or evaluating its activity are complex and expensive. Numerous studies have suggested that neutrophil-to-lymphocyte ratio (NLR) is closely ...

Background: Severe bleeding and massive transfusion of blood products may be associated with increased morbidity and mortality of cardiac surgery. A transfusion algorithm incorporating thromboelastography (TEG) or rotational thromboelastometry (ROTEM) can help to determine the appropriate time and target for the use of hemostatic blood products, which may thus reduce the quantity of blood loss as well as blood products transfused. Methods: We conducted meta-analysis and trial sequential analysis to evaluate the effects of TEG or ROTEM-guided transfusion algorithms vs. standard treatments for patients undergoing cardiac surgery with cardiac pulmonary bypass. Results: Nineteen studies with a total of 15,320 participants, including 13 randomized controlled trials (RCTs), were included. All-cause mortality was not reduced either in overall studies or in RCTs. Blood loss volume was reduced by 132 mL in overall studies [mean difference (MD): −132.46, 95% CI: −207.49, −57.43; I² =53%, P<0.01], and by 103 mL in RCTs (MD: −103.50, 95% CI: −156.52, −50.48; I² =0%, P<0.01). The relative risks (RRs) in RCTs were 0.89 (95% CI: 0.80–0.98; I² =0%, P=0.02) for red blood cells transfusion, 0.59 (95% CI: 0.42–0.82; I² =55%, P<0.01) for fresh frozen plasma transfusion, and 0.81 (95% CI: 0.74–0.90; I² =0%, P<0.01) for platelet transfusion, respectively. Trial sequential analysis of continuous data on blood loss and dichotomous outcomes on transfusion of blood products suggested the benefits of a TEG/ROTEM-guided algorithm. Conclusions: TEG or ROTEM-guided transfusion strategies may reduce blood loss volume and the transfusion rates in adult patients undergoing cardiac surgery.

Background: Previous studies have demonstrated that metabolic score for visceral fat (METS‐VF), a novel surrogate indicator assessing visceral fat, was associated with the risk of hypertension, diabetes mellitus, cardiovascular disease (CVD) and mortality, predicting the risks based on a single METS‐VF measurement can increase limitations of the study. Few studies have investigated the association between cumulative exposure to METS‐VF and risk of CVD and all‐cause mortality. We aimed to examine the association of cumulative METS‐VF with risk for CVD and all‐cause mortality. Methods: All participants in the study were from the Kailuan Study, which is a large, prospective cohort study, and began in 2006 years. Cumulative METS‐VF was calculated by data from 2006 survey to 2010 survey and defined as the mean METS‐VF for each pair of consecutive surveys multiplied by the time intervals between these two consecutive surveys. The optimal cut‐off value for time‐averaged cumulative METS‐VF associated with CVD was determined using a survival‐time method to calculate maximally selected rank statistics and was used to assess exposure of high METS‐VF. A multivariate Cox proportional hazards regression model was used to assess the risk of CVD and all‐cause mortality during 2010–2022 years (hazard ratio [HR] and 95% confidence interval [95% CI]). Results: We included 41 756 participants (mean age, [52.72 ± 11.64] years, 78.53% males and 21.47% females). All participants were divided into four groups: Q1 (reference group), Q2, Q3 and Q4 according to the quartiles of cumulative METS‐VF, and exposure duration of high METS‐VF was quantified as 0, 2, 4, and 6 years. During the median follow‐up of 12.01 years, 4008 (9.60%) CVD events and 3944 all‐cause mortality events occurred. After adjusting for potential covariates, compared to participants in Q1 group, the HRs of incident CVD and all‐cause mortality were 1.55 (95% CI, 1.38–1.74) and 1.59 (95% CI, 1.40–1.81) for those in Q2 group, 2.13 (95% CI, 1.91–2.38) and 2.67 (95% CI 2.37–3.01) for those in Q3 group, 2.78 (95% CI, 2.49–3.17) and 4.90 (95% CI 4.36–5.50) for those in Q4 group. The HRs for CVD and all‐cause mortality were increased with exposure duration of high METS‐VF increasing. The result of ROC curve analysis showed that cumulative METS‐VF had the highest predictive for CVD among 4 indexes including cumulative METS‐VF, cumulative waist circumference, cumulative body mass index and cumulative WHtR. Conclusions: The high cumulative METS‐VF was associated with an increased risk of CVD and mortality, and this association was stronger as exposure to high METS‐VF was prolonged, emphasizing the importance of striving to control the METS‐VF.

LCZ696, a first-in-class angiotensin receptor neprilysin inhibitor, has been demonstrated to have greater advantages in the treatment of heart failure compared with angiotensin-converting enzyme inhibitors, enalapril, or angiotensin receptor blockers (ARBs). However, studies that compared the efficacy and safety of LCZ696 against valsartan in patients with hypertension are limited. To provide further evidence for the benefits of LCZ696 and to make this assessment, a meta-analysis of randomized controlled trials (RCTs) was performed. The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, PubMed, and ClinicalTrials.gov were searched for RCTs. Twelve studies involving 3816 patients were eligible for inclusion. Seven studies compared LCZ696 with valsartan, and 5 studies compared LCZ696 with olmesartan. LCZ696 showed a significantly greater reduction in systolic blood pressure (BP; mean difference [MD] = −5.43 mm Hg; 95% confidence interval [CI]: −6.36 to −4.49 mm Hg; P < .001), diastolic BP (MD = −2.34 mm Hg; 95% CI: −2.67 to −2.01 mm Hg; P < .001), 24-hour ambulatory systolic BP (MD = −3.57 mm Hg, 95% CI: −4.29 to −2.85 mm Hg; P < .001), and 24-hour ambulatory diastolic BP (MD = −1.32 mm Hg, 95% CI: −1.77 to −0.78 mm Hg; P < .001) from the baseline than ARBs. LCZ696 was more effective in reducing BP (odds ratio [OR] = 5.34; 95% CI: 4.49-6.36; P < .01) and had a higher rate of BP control compared with ARBs (OR = 1.52; 95% CI: 1.37-1.69; P < .01). LCZ696 had no difference in the incidence of adverse events (OR = 1.05; 95% CI: 0.94-1.18; P = .38) or serious adverse events (OR = 0.80; 95% CI: 0.51-1.24; P = .31) compared to ARBs. This meta-analysis revealed that LCZ696 has a greater antihypertensive efficacy and an equal tolerability profile.

Exercise and physiotherapy are accepted as an important contribution to the rehabilitation of patients with heart failure with preserved ejection fraction (HFpEF). But the previous results are unclear partly because of their limited power and small sample sizes. We aimed to understand better the effects of two exercise training interventions and two modalities of physiotherapies on exercise capacity, quality of life (QoL), and diastolic dysfunction in HFpEF patients. The Cochrane Library, EMBASE, and MEDLINE via PubMed were searched for randomized controlled trials from their inception to May 2021. The effect size was estimated as mean differences (MD) with 95% confidence intervals (CI). A total of 14 articles on 13 trials were included in this meta-analysis with 673 HFpEF patients. The pooling revealed that peak oxygen uptake was improved by endurance training, functional electrical stimulation (FES), and inspiratory muscle training (IMT). Similar results were observed for a 6-minute walk test and QoL. A combination of endurance and resistance training (combined exercise) was beneficial to the ratio of peak early to late diastolic mitral inflow velocities (MD [95% CI]: -2.90 [-4.97, -0.83]; P = 0.006) and the early diastolic mitral annual velocity (MD [95% CI]: 1.40 [0.68, 2.12]; P = 0.006]. IMT improved the ventilation/carbon dioxide ratio slope (MD [95% CI]: -3.36 ml/kg/min [-6.17, -0.54]; P = 0.019]. FES and IMT improve functional capacity and QoL without a change in diastolic function in HFpEF patients, and the outcomes are similar to endurance training. Notably, combined exercise may improve diastolic function. Key words: diastolic function, exercise training, functional electrical stimulation, heart failure with preserved ejection fraction, inspiratory muscle training.