In hypertension, with or without orthostatic hypotension, more- vs. less-intensive BP therapy improves clinical outcomes.

SOURCE CITATION: Juraschek SP, Hu JR, Cluett JL, et al. Orthostatic hypotension, hypertension treatment, and cardiovascular disease: an individual participant meta-analysis. JAMA. 2023;330:1459-1471. 37847274.

In low-risk penicillin allergies, direct oral challenge was noninferior to skin testing followed by oral challenge.

SOURCE CITATION: Copaescu AM, Vogrin S, James F, et al. Efficacy of a clinical decision rule to enable direct oral challenge in patients with low-risk penicillin allergy: the PALACE randomized clinical trial. JAMA Intern Med. 2023;183:944-952. 37459086.

Sodium Homeostasis and Hypertension.

PURPOSE OF REVIEW: This review aims to summarize and discuss the relationship between sodium homeostasis and hypertension, including emerging concepts of factors outside cardiovascular and renal systems influencing sodium homeostasis and hypertension. RECENT FINDINGS: Recent studies support the dose-response association between higher sodium and lower potassium intakes and a higher cardiovascular risk in addition to the dose-response relationship between sodium restriction and blood pressure lowering. The growing body of evidence suggests the role of genetic determinants, immune system, and gut microbiota in sodium homeostasis and hypertension. Although higher sodium and lower potassium intakes increase cardiovascular risk, salt restriction is beneficial only to a certain limit. The immune system contributes to hypertension through pro-inflammatory effects. Sodium can affect the gut microbiome and induce pro-inflammatory and immune responses that contribute to salt-sensitive hypertension.

In adults with hypertension, effects of BP-lowering drug monotherapy varied by patient.

SOURCE CITATION: Sundström J, Lind L, Nowrouzi S, et al. Heterogeneity in blood pressure response to 4 antihypertensive drugs: a randomized clinical trial. JAMA. 2023;329:1160-1169. 37039792.

In BPPV, canalith repositioning maneuver increased symptom resolution vs. vestibular suppressants.

SOURCE CITATION: Sharif S, Khoujah D, Greer A, et al. Vestibular suppressants for benign paroxysmal positional vertigo: a systematic review and meta-analysis of randomized controlled trials. Acad Emerg Med. 2022. [Epub ahead of print.] 36268806.

In hypertension, evening vs. morning dosing of antihypertensive drugs did not differ for major CV outcomes at 5.2 y.

SOURCE CITATION: Mackenzie IS, Rogers A, Poulter NR, et al. Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial. Lancet. 2022;400:1417-25. 36240838.

USPSTF found insufficient evidence on benefits and harms of screening for vitamin D deficiency in asymptomatic adults.

SOURCE CITATION: Krist AH, Davidson KW, Mangione CM, et al. Screening for vitamin D deficiency in adults: US Preventive Services Task Force recommendation statement. JAMA. 2021;325:1436-42. 33847711.

A systematic review and meta-analysis of geographic differences in comorbidities and associated severity and mortality among individuals with COVID-19.

Several comorbidities have been shown to be associated with coronavirus disease 2019 (COVID-19) related severity and mortality. However, considerable variation in the prevalence estimates of comorbidities and their effects on COVID-19 morbidity and mortality have been observed in prior studies. This systematic review and meta-analysis aimed to determine geographical, age, and gender related differences in the prevalence of comorbidities and associated severity and mortality rates among COVID-19 patients. We conducted a search using PubMed, Scopus, and EMBASE to include all COVID-19 studies published between January 1st, 2020 to July 24th, 2020 reporting comorbidities with severity or mortality. We included studies reporting the confirmed diagnosis of COVID-19 on human patients that also provided information on comorbidities or disease outcomes. We used DerSimonian and Laird random effects method for calculating estimates. Of 120 studies with 125,446 patients, the most prevalent comorbidity was hypertension (32%), obesity (25%), diabetes (18%), and cardiovascular disease (16%) while chronic kidney or other renal diseases (51%, 44%), cerebrovascular accident (43%, 44%), and cardiovascular disease (44%, 40%) patients had more COVID-19 severity and mortality respectively. Considerable variation in the prevalence of comorbidities and associated disease severity and mortality in different geographic regions was observed. The highest mortality was observed in studies with Latin American and European patients with any medical condition, mostly older adults (≥ 65 years), and predominantly male patients. Although the US studies observed the highest prevalence of comorbidities in COVID-19 patients, the severity of COVID-19 among each comorbid condition was highest in Asian studies whereas the mortality was highest in the European and Latin American countries. Risk stratification and effective control strategies for the COVID-19 should be done according to comorbidities, age, and gender differences specific to geographical location.

Fully Inorganic CsSnI3-Based Solar Cells with >6% Efficiency and Enhanced Stability Enabled by Mixed Electron Transport Layer.

Fully inorganic black orthorhombic (B-γ) CsSnI3 has become a promising candidate for perovskite solar cell (PSC) thanks to its low toxicity and decently high theoretical power conversion efficiency (PCE). However, so far, the reported PCE of the B-γ CsSnI3 PSC is still not comparable with its lead-based or organotin-based counterparts. Herein, a mixed electron transport layer (ETL) composed of ZnO nanoparticles (NPs) and [6,6]-phenyl-C61-butyric acid methyl ester (PCBM) is incorporated into inverted B-γ CsSnI3 PSCs. The mixed ETL exhibits the merits of both ZnO and PCBM. The highest PCE of 6.08% was recorded for the PSC with mixed ZnO-PCBM ETL, which is 34.2% higher than that of the device with plain PCBM ETL (PCE of 4.53%) and 28.8% superior to that of plain ZnO ETL-based device (PCE of 4.72%). Meanwhile, the mixed ZnO-PCBM ETL-based PSC retained 71% of its initial PCE under inert conditions at room temperature after 60 days of storage and maintained 67% PCE after 20 days of storage under ambient air at 30% relative humidity and room temperature.

Insufficient evidence for benefits/harms of cognitive impairment screening in asymptomatic older adults.

SOURCE CITATION: US Preventive Services Task Force, Owens DK, Davidson KW, et al. Screening for cognitive impairment in older adults: US Preventive Services Task Force recommendation statement. JAMA. 2020;323:757-63. 32096858.

Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes.

PURPOSE OF REVIEW: The aims of this review are to summarize recent data on mortality and cardiovascular disease (CVD) in type 1 and type 2 diabetes and to determine the interventions that could have contributed to a reduction in mortality. RECENT FINDINGS: Recent studies found a downward trend in mortality and CVD among both diabetics and non-diabetics worldwide over the last few decades. The decline among diabetics is steeper than that among non-diabetics. Despite a parallel trend of decline, an approximately twofold difference in mortality and CVD between the two populations remains. A greater emphasis on glycemic control, management of cardiovascular risk factors, quality improvement programs, and advances in treatment of conditions associated diabetes are the factors that potentially contributed to the improvement. Although the trend is encouraging, a rising prevalence of diabetes will continue the absolute disease burden to the society. Future interventions should focus on prevention of diabetes.

Relationship Between Outpatient Clinic and Ambulatory Blood Pressure Measurements and Mortality.

PURPOSE OF REVIEW: This review aims to summarize and discuss the relationship between outpatient clinic and ambulatory blood pressure (BP) measurements and cardiovascular morbidity and mortality. RECENT FINDINGS: Contemporary clinical practice guidelines worldwide recommend ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension. Recent epidemiological studies and systematic reviews showed ABPM predicts cardiovascular events and mortality independent of clinic BP. Ambulatory BP appears to be prognostically superior to clinic BP. ABPM characterizes BP phenotypes that would not have otherwise identified with clinic BP measurement only. Identification of white coat hypertension, which carries a prognosis almost similar to normotension, and masked hypertension, which carries a prognosis almost similar to sustained hypertension, can be accomplished only by ABPM. Randomize controlled trials to assess the cardiovascular effects of hypertensive patients managed with ABPM vs. clinic BP measurement and cost-effective studies of ABPM are warranted.

The role of phospholipase A2 in multiple Sclerosis: A systematic review and meta-analysis.

Phospholipases A2 (PLA2) are a diverse group of enzymes that cleave the fatty acids of membrane phospholipids. They play critical roles in pathogenesis of neurodegenerative diseases such as multiple sclerosis by enhancing oxidative stress and initiating inflammation. The levels of PLA2 activity in MS patients compared to controls and role of inhibiting PLA2 activity on severity scores in different experimental models are not comprehensively assessed in the light of varying evidence from published studies. The objective of this systematic review is to determine the association between PLA2 activity and multiple sclerosis (MS) and its animal model, experimental autoimmune encephalomyelitis (EAE). We performed a systematic review of six studies that assessed PLA2 activity in MS patients compared to controls and nine studies that assessed PLA2 activity in EAE. sPLA2 nor Lp-PLA2 activity were not increased in MS compared to controls in five of those six studies. A difference in sPLA2 activity was only found in a study that measured the enzyme activity in urine. However, inhibiting cPLA2 or sPLA2 led to lower clinical severity or no signs of EAE in mice, and a lower incidence of EAE lesions compared to animals without cPLA2 inhibition. These findings indicate that PLA2 appears to play a role in the pathogenesis of EAE.