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Blood pressure is characterized by short-term and long-term fluctuations, which are the result of complex interactions between environmental and behavioural factors, on the one side, and cardiovascular regulatory mechanisms on the other. Increased blood pressure variability (BPV) leads to cardiac, vascular, and renal damage and has been associated with an increased risk of cardiovascular morbidity and mortality. Parati et al. review the mechanisms, assessment and prognostic importance of BPV. They also address the question of whether BPV should be a target for antihypertensive treatment in the prevention of cardiovascular disease.
Tricuspid valve disease generally occurs secondary to other cardiac conditions, particularly mitral valve regurgitation or stenosis. Repair gives excellent results, but a substantial proportion of patients experience late failure, and appropriate selection of patients and repair technique remain a challenge. In this article, Shinn and Schaff review the pathophysiology of tricuspid valve disease and describe its surgical management.
Cigarette smoke is an aerosol that exerts multiple atherothrombotic effects on smokers and the individuals around them. In this Review, Drs Csordas and Bernhard describe the current knowledge of the mechanisms through which cigarette smoke affects all stages of plaque formation and development, as well as pathological thrombus formation.
Incidence of sudden cardiac death is elevated in elderly individuals owing to increasing prevalence of coronary heart disease and congestive heart failure in this population. A substantial proportion of primary prevention implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices are being implanted in these patients; thus, additional outcomes data are needed. In this Review, Tung and Albert examine the causes of SCD in elderly individuals and discuss the existing evidence for effectiveness of ICD therapy and CRT in this growing population.
The renin–angiotensin–aldosterone system (RAAS) is well established as a therapeutic target in patients with heart failure. Professors Lang and Struthers discuss new indications for existing drugs—angiotensin-converting-enzyme inhibitors, angiotensin II-receptor blockers, and mineralocorticoid-receptor antagonists—as well as novel ways of targeting the RAAS—direct inhibition of renin or dual blockade of the angiotensin II-receptor and neprilysin—in patients who have heart failure with or without reduced ejection fraction.
Pulmonary and peripheral oedema are fundamental features of heart failure; however, clinical data for optimal management of these conditions are lacking. In this Review, Clark and Cleland describe the pathophysiology of both types of cardiogenic oedema and discuss how knowledge of the pathophysiology can guide treatment.
Patients hospitalized for heart failure (HF) have a high risk of postdischarge rehospitalization or mortality. Phase III trials of HF drugs have failed to show safety or efficacy, despite encouraging results from phase II studies. Muthiah Vaduganathan and colleagues overview five drug development programs for HF and discuss the importance of choosing the 'right' drug, target population, and clinical end points to optimize trial design.
Gliptins are a novel class of oral antihyperglycaemic agent that inhibit dipeptidyl peptidase 4. Professor Scheen describes the pleiotropic beneficial effects of these drugs, beyond basic glycaemic control in patients with type 2 diabetes mellitus, to emerging data and ongoing trials on cardiovascular protection in patients with ischaemic heart disease or congestive heart failure.
