Objective: Obesity and overweight represent a global public health crisis, due to the increased risk of cardiovascular diseases consequent to many factors such as metabolic dysregulation and chronic inflammation. This study aimed to compare the Heart Rate variability (HRV) between obese and non-obese hypertensive patients. Design and method: A cross-sectional study included 76 hypertensive patients, referred to the Functional Explorations department. Anthropometric and clinical data were collected. All patients underwent 24-hour Ambulatory Blood Pressure (BP) Monitoring. HRVs were measured (standard deviation in percentage) during 24-hour, diurnal and nocturnal periods. Patients were divided into two groups, according to their body mass index (BMI, whether < 30 kg/m 2 or = 30 30 kg/m 2 and more): G1 (obese, n=39) and G2 (non-obese, n=37). Results: Mean age was 55±10 vs. 52±15 years and mean BMI was 34±4 vs. 26±2 kg/m 2 in G1 and G2, respectively. Both groups were matched for sex (66.7% of females in G1 vs. 48.6% of females in G2) and comorbidities (mainly diabetes and dyslipidemia), but G1 included a higher proportion of metabolic syndrome (p<0.05). Mean values of 24-hour Systolic and Diastolic BPs were 136±10 mmHg vs. 130±11 mmHg (p=0.022), and 84±9 mmHg vs. 80±9 mmHg (p=0.066), respectively in G1 and in G2. Mean values of 24-hour, diurnal and nocturnal HRVs were 14±3% vs. 16±3%; 14±3% vs. 16±3%; 7±3% vs. 9±6%, respectively in G1 and in G2. Diurnal and 24-hour HRVs were statistically lower in G1 (p=0.010 and 0.035, respectively). However, no significant difference was observed in nocturnal HRV (p=0.279) between the two groups. Conclusions: This study revealed lower HRVs among obese patients which highlights a clear association between obesity and reduced autonomic nervous system function, particularly with diminished parasympathetic activity. This HRV reduction, resulting in an imbalance in autonomic regulation, increases cardiovascular risk. Managing weight seems to be the key to minimize these negative impacts.

Arterial stiffness is strongly associated with vascular aging and pathology and can be assessed in many ways. Existing devices for measuring central arterial stiffness, such as carotid-femoral pulse wave velocity (PWV), are limited by high costs and the need for specialized expertise, limiting widespread clinical adoption. This study introduces a semi- and non-occlusive PWV measurement system using phonocardiography (PCG) and plethysmography (PPG) and a single femoral pressure cuff, aiming to address these limitations. We conducted a study comparing a semi-occlusive (carotid-femoral PWV) and a non-occlusive (carotid-toe PWV) PCG-based PWV measurements across a cohort of 63 volunteers, as compared to literature reference PWV values. Results demonstrated strong correlations between our PCG-based PWV measures (PWVcarotid−femoral: 8.42 ± 3.99 m/s vs. PWVcarotid−toe: 10.62 ± 3.86 m/s) with age as a significant predictor (PWVcarotid−femoral: r2 = 0.45; PWVcarotid−toe: r2 = 0.28, p < 0.05). Ultrasound measured distensibility assessments confirmed the reliability of our PCG approach in reflecting central arterial stiffness dynamics, particularly at the aortic level. Test–retest reliability analyses yielded high intraclass correlation coefficients (0.75 ≤ ICC ≤ 90), indicating robust repeatability of our method. This study highlights the feasibility and accuracy of our low-cost, semi and non-occlusive PWV measurement systems to enhance accessibility in arterial stiffness assessments, potentially easing cardiovascular risk stratification.

ABSTRACT In the recent years, there has been a burgeoning interest in Takotsubo syndrome (TTS), which is renowned as a specific form of reversible myocardial dysfunction. Despite the extensive literature available on TTS, clinicians still face several practical challenges associated with the diagnosis and management of this phenomenon. This potentially results in the underdiagnosis and improper management of TTS in clinical practice. The present paper, the first part (part-1) of the consensus report, aims to cover diagnostic and therapeutic challenges associated with TTS along with certain recommendations to combat these challenges.

ABSTRACT Takotsubo syndrome (TTS) still remains as an enigmatic phenomenon. In particular, long-term challenges (including clinical recurrence and persistent symptoms) and specific entities in the setting of TTS have been the evolving areas of interest. On the other hand, a significant gap still exists regarding the proper risk-stratification of this phenomenon in the short and long terms. The present paper, the second part (part-2) of the consensus report, aims to discuss less well-known aspects of TTS including specific entities, challenges after recovery and risk-stratification.

Background Introduction: Vitamin D plays significant role in calcium metabolism and in bone and vascular calcifications. Objective: To investigate the association between vitamin D level, arterial hypertension, arterial stiffness and coronary calcifications detected by MSCT. Method: A 2 female case report comparative to each other investigated the correlation between vitamin D serum level, blood pressure, arterial stiffness and severity of the coronary calcification using MSCT diagnostic tool estimating the calcium score. Results: The first case report showed that decreased level of vitamin D is correlated with increased blood pressure, increased arterial stiffness and with a severe coronary calcifications. The second case report showed normal blood pressure, normal vascular age and low calcium score in a no-defficient vitamin D female. Conclusion: Vitamin D has impact on blood pressure, arterial stiffness, coronary calcifications and coronary heart disease. The lower vitamin D, the higher arterial blood pressure, arterial stiffness and coronary calcium score.

Abstract Objective Real-life management of patients with hypertension and chronic kidney disease (CKD) among European Society of Hypertension Excellence Centres (ESH-ECs) is unclear : we aimed to investigate it. Methods A survey was conducted in 2023. The questionnaire contained 64 questions asking ESH-ECs representatives to estimate how patients with CKD are managed. Results Overall, 88 ESH-ECS representatives from 27 countries participated. According to the responders, renin-angiotensin system (RAS) blockers, calcium-channel blockers and thiazides were often added when these medications were lacking in CKD patients, but physicians were more prone to initiate RAS blockers (90% [interquartile range: 70–95%]) than MRA (20% [10–30%]), SGLT2i (30% [20–50%]) or (GLP1-RA (10% [5–15%]). Despite treatment optimisation, 30% of responders indicated that hypertension remained uncontrolled (30% (15–40%) vs 18% [10%–25%]) in CKD and CKD patients, respectively). Hyperkalemia was the most frequent barrier to initiate RAS blockers, and dosage reduction was considered in 45% of responders when kalaemia was 5.5–5.9 mmol/L. Conclusions RAS blockers are initiated in most ESH-ECS in CKD patients, but MRA and SGLT2i initiations are less frequent. Hyperkalemia was the main barrier for initiation or adequate dosing of RAS blockade, and RAS blockers’ dosage reduction was the usual management. PLAIN LANGUAGE SUMMARY What is the context? Hypertension is a strong independent risk factor for development of chronic kidney disease (CKD) and progression of CKD to ESKD. Improved adherence to the guidelines in the treatment of CKD is believed to provide further reduction of cardiorenal events. European Society of Hypertension Excellence Centres (ESH-ECs) have been developed in Europe to provide excellency regarding management of patients with hypertension and implement guidelines. Numerous deficits regarding general practitioner CKD screening, use of nephroprotective drugs and referral to nephrologists prior to referral to ESH-ECs have been reported. In contrast, real-life management of these patients among ESH-ECs is unknown. Before implementation of strategies to improve guideline adherence in Europe, we aimed to investigate how patients with CKD are managed among the ESH-ECs. What is the study about? In this study, a survey was conducted in 2023 by the ESH to assess management of CKD patients referred to ESH-ECs. The questionnaire contained 64 questions asking ESH-ECs representatives to estimate how patients with CKD are managed among their centres. What are the results? RAAS blockers are initiated in 90% of ESH-ECs in CKD patients, but the initiation of MRA and SGLT2i is less frequently done. Hyperkalemia is the main barrier for initiation or adequate dosing of RAAS blockade, and its most reported management was RAAS blockers dosage reduction. These findings will be crucial to implement strategies in order to improve management of patients with CKD and guideline adherence among ESH-ECs.

Objective: Real-life management of hypertensive patients with chronic kidney disease (CKD) is unclear. Methods: A survey was conducted in 2023 by the European Society of Hypertension (ESH) to assess management of CKD patients referred to ESH-Hypertension Excellence Centres (ESH-ECs) at first referral visit. The questionnaire contained 64 questions with which ESH-ECs representatives were asked to estimate preexisting CKD management quality. Results: Overall, 88 ESH-ECs from 27 countries participated (fully completed surveys: 66/88 [75.0%]). ESH-ECs reported that 28% (median, interquartile range: 15–50%) had preexisting CKD, with 10% of them (5–30%) previously referred to a nephrologist, while 30% (15–40%) had resistant hypertension. The reported rate of previous recent (<6 months) estimated glomerular filtration rate (eGFR) and urine albumin–creatinine ratio (UACR) testing were 80% (50–95%) and 30% (15–50%), respectively. The reported use of renin-angiotensin system blockers was 80% (70–90%). When a nephrologist was part of the ESH-EC teams the reported rates SGLT2 inhibitors (27.5% [20–40%] vs. 15% [10–25], P = 0.003), GLP1-RA (10% [10–20%] vs. 5% [5–10%], P = 0.003) and mineralocorticoid receptor antagonists (20% [10–30%] vs. 15% [10–20%], P = 0.05) use were greater as compared to ESH-ECs without nephrologist participation. The rate of reported resistant hypertension, recent eGFR and UACR results and management of CKD patients prior to referral varied widely across countries. Conclusions: Our estimation indicates deficits regarding CKD screening, use of nephroprotective drugs and referral to nephrologists before referral to ESH-ECs but results varied widely across countries. This information can be used to build specific programs to improve care in hypertensives with CKD.

Background: Degenerative aortic stenosis is a prevalent and severe condition necessitating aortic valve replacement (AVR) when the valve area critically narrows to 0.7 cm² or when symptoms are manifested. Traditional AVR via median sternotomy, poses considerable risks for patients with comorbidities or advanced age. Objective: This study evaluates the efficacy and safety of mini sternotomy aortic valve replacement (MSAVR), a minimally invasive technique designed to reduce surgical trauma, improve postoperative recovery, and lower healthcare costs. Methods: A reversed L-type upper partial sternotomy (RLUPS) approach was performed in five patients focusing on standardized surgical procedures, and rigorous postoperative care. Key findings indicate that MSAVR markedly reduces postoperative complications, ICU stay, and overall hospital stay compared to traditional sternotomy. Results: The median postoperative length of stay was seven days for MSAVR versus 12 days for traditional sternotomy, with ICU stays of 52 hours and 119 hours, respectively. Our study also highlights the cost-effectiveness of MSAVR, with decreased hospital costs per patient due to reduced ICU resource utilization and shorter hospital stays. These findings suggest that MSAVR is a valuable and advantageous alternative to traditional sternotomy, offering substantial benefits in terms of patient outcomes and healthcare efficiency. Conclusion: Our work underscores the potential of minimally invasive techniques in improving the management of severe degenerative aortic stenosis, marking a significant advancement in the field of cardiac surgery.

Objective: To investigate the arterial stiffness and risk factors in adolescence. Arterial stiffness often (AS) results from the degenerative process of the media layer of elastic arteries causing rigidity of the arteries. Arterial stiffness increases with age and it is associated with several risk factors as a disease predictor. But, arterial stiffness can be also increased in a healthy arteries as well. The increased sympathetic activity promotes vasoconstriction of resistant blood vessels i.e. arteries and arterioles that result in peripheral vasoconstriction. Adolescence age is the most important period of life for promoting future health. The certain dynamic risk factors in adolescence like, emotional dysregulation, psychological family stress, education pressure, lack of sleep, gambling, substance abuse, smartphone overuse and obesity can cause arterial stiffness. Design and method: The prospective open randomized study was designed. Adolescence age between 10 and 19 years have been investigated for increased arterial stiffness and risk factors. The inclusion criteria was healthy adolescence, while exclusion criteria was any disorder present. Arterial stiffness, non-invasive blood pressure and pulse wave datas have been measured using Agedio device. The risk factors were evaluated in every subject. The vascular age have been outlined as the final measure. Results: The preliminary results indicate the increase of Augmentation Index and Coefficient of Reflection. The average percentage of Augmentation Index was 40% and Coefficient of Reflection 65% (normal value 28% and 60% respectively). The main risk factors were educational pressure, lack of sleep and smartphone influence. The vascular age was on average, 3 years higher than biological age. Conclusions: Arterial stiffness in adolescence is increased mainly by peripheral vasoconstriction, manifested with Augmentation index and Coefficient of wave Reflection.

Objective: To investigate the arterial stiffness and risk factors in adolescence. Arterial stiffness often (AS) results from the degenerative process of the media layer of elastic arteries causing rigidity of the arteries. Arterial stiffness increases with age and it is associated with several risk factors as a disease predictor. But, arterial stiffness can be also increased in a healthy arteries as well. The increased sympathetic activity promotes vasoconstriction of resistant blood vessels i.e. arteries and arterioles that result in peripheral vasoconstriction. Adolescence age is the most important period of life for promoting future health. The certain dynamic risk factors in adolescence like, emotional dysregulation, psychological family stress, education pressure, lack of sleep, gambling, substance abuse, smartphone overuse and obesity can cause arterial stiffness. Design and method: The prospective open randomized study was designed. Adolescence age between 10 and 19 years have been investigated for increased arterial stiffness and risk factors. The inclusion criteria was healthy adolescence, while exclusion criteria was any disorder present. Arterial stiffness, non-invasive blood pressure and pulse wave datas have been measured using Agedio device. The risk factors were evaluated in every subject. The vascular age have been outlined as the final measure. Results: The preliminary results indicate the increase of Augmentation Index and Coefficient of Reflection. The average percentage of Augmentation Index was 40% and Coefficient of Reflection 65% (normal value 28% and 60% respectively). The main risk factors were educational pressure, lack of sleep and smartphone influence. The vascular age was on average, 3 years higher than biological age. Conclusions: Arterial stiffness in adolescence is increased mainly by peripheral vasoconstriction, manifested with Augmentation index and Coefficient of wave Reflection.