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Prehypertension affects 25–50% of adults worldwide and is associated with incident hypertension and cardiovascular disease. In this Review, Egan and Stevens-Fabry provide guidance to health-care professionals by summarizing the available data on the prevalence of prehypertension, the related risk of cardiovascular morbidity and mortality, and the effect of lifestyle and medical interventions on reducing incident disease.
Nearly 25% of patients hospitalized for heart failure are readmitted within 30 days after discharge and have poor clinical outcome, in a period known as the 'vulnerable phase'. In this Review, Greene and colleagues highlight the considerations and outline a progressive management approach for reducing mortality and morbidity in patients with heart failure during this early postdischarge period.
Mitral regurgitation (MR) can fluctuate physiologically in response to various stimuli such as exercise and ischaemia. This dynamic behaviour might also have prognostic value, as a marked increase in regurgitant volume or systolic pulmonary artery pressure is indicative of lower symptom-free survival. In this Review, Lancellotti et al. discuss the optimal treatment strategy for patients with dynamic MR, which include mitral valve surgery, cardiac resynchronization therapy, and new mitral valve approaches.
Atherosclerosis is a chronic inflammatory disease of the arterial wall with multiple immune mediators implicated in its pathogenesis. Despite the wide range of anti-inflammatory drugs already in use to treat immune disorders, studies to determine whether anti-inflammatory therapies can improve cardiovascular outcomes are necessary before these treatments become a part of cardiovascular prevention. In this Review, Bäck and Hansson describe existing therapies in use for inflammatory diseases and explore the therapeutic potential of targeting immune activation in patients with atherosclerosis.
Pulmonary arterial hypertension (PAH) is an important cause of morbidity and mortality in children. In this Review, Latus et al. describe the latest medical, interventional, and surgical approaches to treating paediatric PAH. The authors highlight new PAH-specific drugs that are in development, and combined hybrid procedures that are delaying the need for lung transplantation.
An increasing body of evidence suggests that proteins involved in the inflammatory response are also involved in the pathophysiology of atrial fibrillation (AF). Moreover, AF itself can induce inflammation. In this Review, Hu and colleagues discuss the interplay between inflammation and AF. The authors also highlight potential therapies that might be used to treat inflammation-induced AF.
Cardiovascular disease and cognitive decline share similar pathogenetic processes such as atherosclerosis and ischaemia. Evidence from multidisciplinary studies has shown that vascular risk factors present during young adulthood and mid-life can be risk factors for the development of cognitive decline and dementia in later life. In this Review, Qiu and Fratiglioni discuss the literature examining the association of cardiovascular burden with cognitive decline and dementia over the life-course.
Resistance to diuretic therapy to achieve decongestion is common in patients with acute heart failure. In this Review, ter Maaten and colleagues describe the pathophysiology and mechanisms of diuretic resistance, how to evaluate diuretic response, and propose a treatment strategy for patients with acute heart failure who are diuretic resistant.
