CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 4, September/October 2023 230 AFRICA Med Assoc 2019; 322(5): 409–420. 18. Wang J, Shi X, Ma C, et al. Visit-to-visit blood pressure variability is a risk factor for all-cause mortality and cardiovascular disease. J Hypertens 2017; 35(1): 10–17. 19. Blacher J, Safar ME, Ly C, et al. Blood pressure variability: cardiovascular risk integrator or independent risk factor? J Hum Hypertens 2015; 29(2): 122–126. 20. Sluyter JD, Camargo CA Jr, Scragg RKR. Ten-second central SBP variability predicts first and recurrent cardiovascular events. J Hypertens 2019; 37(3): 530–537. 21. Wu M, Yan TM, Pan LL, et al. Detection rate for population at highrisk of cardiovascular diseases and its influencing factors in Liaoning province. Chinese J Publ Health 2019; 35: 139–143. 22. Sverre E, Peersen K, Husebye E, et al. Unfavourable risk factor control after coronary events in routine clinical practice. BMC Cardiovasc Disord 2017; 17(1): 40. 23. Monticone S, D’Ascenzo F, Moretti C, et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2018; 6(1): 41–50. 24. Hermida RC, Ayala DE, Mojón A, et al. Cardiovascular disease risk stratification by the Framigham score is markedly improved by ambulatory compared with office blood pressure. Rev Esp Cardiol (Engl Ed) 2021; 74(11): 953–961. 25. Wang JR, Liu Y, Ji ZL, et al. Study of synchronic heart rate variability and blood pressure variability and carotid–femoral pulse wave velocity in hypertensive patients with varying salt sensitivy. Chinese Heart J 2017; 29(6): 659–663. 26. Parati G, Torlasco C, Pengo M, et al. Blood pressure variability: its relevance for cardiovascular homeostasis and cardiovascular diseases. Hypertens Res 2020; 43(7): 609–620. 27. Wang W, Cui Y, Shen J, et al. Salt-sensitive hypertension and cardiac hypertrophy in transgenic mice expressing a corin variant identified in blacks. Hypertension 2012; 60(5): 1352–1358. … continued from page 223 He added there was some discussion in the heart failure community regarding older patients who typically have little muscle mass. ‘Creatinine may not be as good a reflection of their kidney function because the creatinine is a derivative of broken-down protein. And if you don’t eat a lot of protein or have a lot of protein in your body, then the creatinine clearance may be misleading,’ he said. If the loss of renal function is tied to heart failure as more than a symptom, can the loss be reversed? ‘Not really. Renal function declines steadily with age,’ said Morgan. While this loss is inevitable with time, it was possible to slow it down by about half with appropriate medicines, including ACE inhibitors. Does this mean new therapies for heart failure? ‘This study continues to connect the kidney and heart in a cardiorenal loop,’ said Morgan. ‘Early albumin excretion is an opportunity to be alerted to not only developing kidney disease but heart failure risk as well.’ She felt that the study’s findings might affect medications prescribed and medical follow up, ‘providing the opportunity for preventative cardiac care, as opposed to interventional cardiac care’. Dr Andrew Clark, chair of clinical cardiology and head of the department of Academic Cardiology at Hull YorkMedical School, who was also not involved in the study, cautioned against basing all patient care on these new findings. ‘The study looks at associations between abnormalities in renal function and outcomes and cannot prove a causative link,’ he said, pointing out a limitation of an observational study. ‘In more-or-less any clinical scenario, worsening renal function is associated with worse outcomes, but that doesn’t mean it is the renal dysfunction causing the problem. Any causative association might be the other way round: heart failure potentially causes proteinuria, (abnormal amounts of protein in the urine),’ he said. He also noted the link the researchers found between these substances and heart failure ‘might simply arise from the fact that the same precursors cause both outcomes. So, for example, high blood pressure and diabetes both cause renal and heart damage.’ Wright suggested including a simple urine test measuring UAE and serum creatinine during check-ups, a test he suspects few doctors prescribe. ‘It’s an inexpensive, easy-to-do test, and carries a lot of prognostic information.’ Source: European Journal of Heart Failure 7 June 2023
RkJQdWJsaXNoZXIy NDIzNzc=