Volume 10 Issue 8, August 2013

Adverse trends in blood pressure, diabetes mellitus, and other cardiometabolic risk factors, together with population growth and ageing, are contributing to the burden of cardiovascular diseases in Africa. This increasing problem, coupled with inadequate access to effective interventions for prevention, diagnosis, and treatment, is creating major public-health challenges across the continent.

Renal denervation for the treatment of resistant hypertension is approved in Europe and is being studied in the USA. A newly published ESC consensus document integrates all the published data on this procedure, and summarizes how best to define, evaluate, and follow up patients who are candidates for the procedure.

The BLOCK HF trial demonstrated that, during continual cardiac pacing, adverse left ventricular remodelling and deterioration of systolic function occurred more frequently with right ventricular than with biventricular pacing. These findings will increase the role of biventricular pacing for the preservation of left ventricular function in patients with atrioventricular block.

Fractional flow reserve is routinely used to estimate the extent of myocardial ischaemia caused by the narrowing of a coronary artery. In this Review, the physiological basis of this measurement, its limitations, and its clinical use are discussed.

Lipid lowering with statins for the secondary prevention of cardiovascular disease (CVD) is well established, but the use of these drugs for primary prevention is controversial. Željko Reiner expertly reviews the evidence for the use of statins, and their potential adverse effects, in individuals without a history of CVD, and discusses selection according to age, sex, and level of cardiovascular risk.

Increased sympathetic activity is associated with a number of diseases, including resistant hypertension. Renal denervation is becoming increasingly prevalent throughout Europe as a treatment for this condition. The pathophysiology of this technique, its use in treating hypertension, and its potential to treat other conditions are discussed in this Review.

Acute aortic syndrome refers to disruption of the medial layer of the aortic wall, and incorporates aortic dissection, intramural haematoma, and penetrating atherosclerotic ulcer. Evangelista and colleagues expertly review the various noninvasive imaging modalities available for the prompt and accurate diagnosis of these life-threatening conditions.