(1) Background: Lifestyle changes, eventually coupled with a nutraceutical, are recommended strategies for managing high–normal blood pressure (BP) patients with low–moderate cardiovascular (CV) risk. In a real-life clinical setting, we evaluated the effects of generic written lifestyle advice, extrapolated from the 2018 ESC/ESH guidelines, and a beetroot-based nutraceutical on 24 h BP in a population with a high–normal office BP and low–moderate CV risk. (2) Methods: A longitudinal observational study was conducted in two ESH Hypertension Excellence Centres on 43 consecutive subjects with high–normal BP according to repeated office BP (OBP) measurements and a low–moderate CV risk based on SCORE2/SCORE2-OP. Additionally, 24 h ambulatory BP monitoring (ABPM) was carried out at baseline and three months after lifestyle changes, according to generic written advice from the 2018 ESC/ESH guidelines, coupled with a nutraceutical containing 500 mg of dry beetroot extract. (3) Results: The mean age was 50 ± 11 years, with male prevalence (54%). The prevalence of overweight/obesity was 58%. The mean OBP was 135 ± 3/85 ± 3 mmHg. At baseline, the mean 24 h BP, daytime BP, and night-time BP were 127 ± 7/80 ± 6 mmHg, 131 ± 8/83 ± 6 mmHg, and 118 ± 8/70 ± 5 mmHg, respectively, BP profiles compatible with hypertension status in some subjects. After a median follow-up of 98 (92–121) days, all BPs, except night-time diastolic BP, were significantly decreased: −3 ± 6/−2 ± 4 mmHg for 24 h BP, −3.9 ± 6.0/−3.0 ± 4.0 mmHg for daytime BP, and −3.3 ± 7.4/−1.3 ± 4.7 mmHg for night-time BP, respectively. No significant clinical changes in body weight were detected. BP decreased independently of baseline BP levels, sex, smoking status, and body mass index, while a more substantial BP decrease was observed in older patients. (4) Conclusions: Our exploratory study shows, for the first time, that written generic lifestyle advice taken from the ESC/ESH hypertension guidelines coupled with a beetroot-based nutraceutical may represent a valid initial non-pharmacological approach in subjects with a high–normal office BP and low–moderate CV risk, even without personalized diet interventions.

(1) Background: Lifestyle changes, eventually associated with a nutraceutical, are recommended strategies for managing high-normal blood pressure (BP) patients with low-moderate cardiovascu-lar (CV) risk. Nitrates-enriched products (i.e., red beet extracts) may help reduce BP, exerting vas-oactive properties and enhancing adherence to lifestyle advice. Our study aimed to evaluate the effectiveness in clinical practice of generic written lifestyle advice and a beetroot-based nutraceu-tical prescription based on the 2018 ESC/ESH guidelines on 24-hour BP in a population with high-normal BP and low-moderate CV risk.; (2) Methods: A longitudinal observational study was con-ducted in two ESH hypertension excellence centres on 43 consecutive subjects with high-normal BP based on repeated office BP (OBP) measurements and a low-moderate CV risk. Twenty-four-hour ambulatory BP monitoring (ABPM) was carried out at baseline and three months after ge-neric written ESC/ESH advice for lifestyle changes associated with a nutraceutical containing 500 mg of dry beetroot extract; (3) Results: Mean age 50±11 years, 54% males, 58% overweight/obese, mean OBP 135±3/85±3 mmHg. At baseline, 24-hour BP, daytime BP and night-time BP were 127±7/80±6 mmHg, 131±8/83±6 mmHg and 118±8/70±5 mmHg, respectively, BP profiles compat-ible with hypertension status in some subjects. After a median follow-up of 98 (92-121) days, all BPs, except night-time diastolic BP, were significantly decreased: -3±6/-2±4 mmHg for 24-hour BP, -3.9±6.0/-3.0±4.0 mmHg for daytime BP and -3.3±7.4/-1.3±4.7 mmHg for night-time BP, respec-tively. No significant clinical changes in weight were detected. BP decreased independently of baseline BP level, gender, smoking status and BMI, while a more substantial decrease in BP was observed in older patients; (4) Conclusions: Our pilot study shows for the first time that written generic lifestyle advice based on ESC/ESH hypertension guidelines coupled with a beetroot-based nutraceutical may represent a valid initial non-pharmacological approach in subjects with high-normal BP and low-moderate CV risk even without personalized diet interventions.

This clinical case report describes an 80-year-old no-option diabetic patient with chronic limb-threatening ischemia and severe vascular disease. The patient presented with wet gangrene and underwent an unsuccessful revascularization attempt, followed by minor amputation complicated by poor wound healing. Due to persistent ischemia and surgical dehiscence, the patient underwent a transcatheter deep venous arterialization procedure, resulting in improved perfusion, wound healing, and limb salvage. This case highlights the potential of venous arterialization as a limb-saving option in carefully selected elderly patients, emphasizing the importance of a multidisciplinary and individualized approach.