Cardiovascular disease (CVD) is the leading cause of mortality worldwide and hypertension is one of the main cardiovascular risk factors. A large body of evidence have demonstrated the increased risk for CVD and mortality associated with uncontrolled hypertension and also the benefits of an adequate blood pressure (BP) control. In some cases, lack of adherence to treatment found during the evaluation of a subject with poor BP control may be part of a more complex scenario, as depression. It is known that individuals with depression have a higher risk of CVD-related morbidity and mortality, and early diagnosis and treatment have beneficial effects.

Hypertension is a well established cardiovascular risk factor and its deleterious effects had already been largely studied. Although the benefits of adequate blood pressure (BP) control have already been demonstrated, the prevalence of persons who fail to achieve such control is alarming. A number of causes for uncontrolled hypertension can be listed. According to recent guidelines, obstructive sleep apnea (OSA) is an important, although neglected cause of hypertension that is resistant to optimal medical therapy. Specific treatment for OSA with continuous positive airway pressure (CPAP) can be a helpful adjunct to conventional pharmacological therapy to attain controlled BP levels.

Cardiovascular disease and cardiovascular risk factors are global healthcare problems, given their high prevalence and the recognized low rates of adequate control despite the abundant body of evidence on different therapeutic options. The World Heart Federation has scrutinized the reasons for poor control of cardiovascular risk factors. Among these reasons, patients’ poor adherence to treatment regimens as well as limited rates of evidence-based therapy prescription from healthcare providers play a substantial role in the challenge of cardiovascular risk management. Polypills are fixed-dose combinations including two or more active drugs, from different pharmacological classes, combined in a single dosage form. Polypills were designed to simplify the clinical management of pharmacotherapy and increase adherence to treatment. From this perspective, we discuss the current literature on the use of polypills in the primary and secondary prevention of cardiovascular disease as well as future challenges and the potentials of this treatment strategy.

Coronary artery disease (CAD) remains the leading cause of death worldwide and has a multifactorial etiology involving genetic, metabolic, and behavioral factors. Hypertension and dyslipidemia contribute significantly to atherosclerosis progression, and these conditions may be influenced by microRNAs (miRNAs), which act as post-transcriptional gene expression regulators. In turn, miRNA expression can be modulated by nutrient-dense dietary patterns or cardioprotective foods, such as nuts. Despite growing interest in miRNAs and cardiovascular disease (CVD) risk, few reviews have specifically addressed the unique role of nuts in modulating miRNA expression, particularly regarding gaps in secondary prevention of CAD. This study summarizes the main miRNAs associated with blood pressure, lipid metabolism, and atherosclerotic disease, as well as the current evidence on how nut consumption influences their expression. Several miRNAs, including miR-1, miR-21, the miR-29 family, miR-30a/b, miR-133, miR-143, miR-145, and miR-221/222, are dysregulated in hypertension and associated with circadian blood pressure patterns, left ventricular hypertrophy, and antihypertensive response. Others, such as miR-122, miR-33a/b, miR-148a, miR-483-5p, and miR-145, are linked to lipid metabolism, plaque instability, and ischemic outcomes. Nut-rich diets, particularly the Mediterranean diet, seem to modulate miRNAs associated with pathways involved in lipid homeostasis, endothelial function, and inflammation. Data from clinical trials conducted in primary CVD prevention setting have shown changes in circulating miRNAs in response to diets rich in nuts. Additional studies with Brazil nuts, pistachios, almonds, and walnuts supplementation also reported modulation of miRNAs involved in lipid homeostasis, inflammation, and insulin resistance, including significant changes in expression of miR-15a, miR-21, miR-328, miR-454-3p, miR-29a-3p, miR-192, miR-330-3p, miR-32-5p, miR-29b-3p, and miR-551a. Nonetheless, it appears no studies have yet evaluated the effect of nut supplementation on miRNAs in secondary prevention of CAD. Although the evidence is promising, more research is needed to clarify the impact of nut consumption on miRNA modulation, particularly in secondary prevention of CVD.