Which influenza viruses will emerge following the SARS‐CoV‐2 pandemic?

The world has experienced five pandemics in just over one hundred years, four due to influenza and one due to coronavirus (SARS‐CoV‐2). In each case of pandemic influenza, the pandemic influenza strain has replaced the previous seasonal influenza virus. Notably, throughout the SARS‐CoV‐2 pandemic, there has been a 99% reduction in influenza isolation globally. It is anticipated that influenza will re‐emerge following the SARS‐CoV‐2 pandemic and circulate again. The potential for which influenza viruses will emerge is examined.     

Impact of the “atherosclerotic pabulum” on in‐hospital mortality for SARS‐CoV‐2 infection. Is calcium score able to identify at‐risk patients?

BackgroundAlthough the primary cause of death in COVID‐19 infection is respiratory failure, there is evidence that cardiac manifestations may contribute to overall mortality and can even be the primary cause of death. More importantly, it is recognized that COVID‐19 is associated with a high incidence of thrombotic complications.HypothesisEvaluate if the coronary artery calcium (CAC) score was useful to predict in‐hospital (in‐H) mortality in patients with COVID‐19. Secondary end‐points were needed for mechanical ventilation and intensive care unit admission.MethodsTwo‐hundred eighty‐four patients (63, 25 years, 67% male) with proven severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection who had a noncontrast chest computed tomography were analyzed for CAC score. Clinical and radiological data were retrieved.ResultsPatients with CAC had a higher inflammatory burden at admission (d‐dimer, p = .002; C‐reactive protein, p = .002; procalcitonin, p = .016) and a higher high‐sensitive cardiac troponin I (HScTnI, p = <.001) at admission and at peak. While there was no association with presence of lung consolidation and ground‐glass opacities, patients with CAC had higher incidence of bilateral infiltration (p = .043) and higher in‐H mortality (p = .048). On the other side, peak HScTnI >200 ng/dl was a better determinant of all outcomes in both univariate (p = <.001) and multivariate analysis (p = <.001).ConclusionThe main finding of our research is that CAC was positively related to in‐H mortality, but it did not completely identify all the population at risk of events in the setting of COVID‐19 patients. This raises the possibility that other factors, including the presence of soft, unstable plaques, may have a role in adverse outcomes in SARS‐CoV‐2 infection.     

Out‐of‐Office Blood Pressures—Are They Helpful in Guiding the Treatment of Hypertension Patients?

Following a hypertension symposium in Philadelphia in September 2005, a roundtable was convened to discuss the significance of out-of-office blood pressure. Dr. Marvin Moser of the Yale School of Medicine, New Haven, CT, moderated the panel discussion. Participants included Dr. Raymond Townsend of the University of Pennsylvania School of Medicine, Philadelphia, PA, and Dr. Norman Kaplan of the University of Texas Health Science Center in Dallas, Dallas, TX.     

Combination Therapy With Renin‐Angiotensin‐Aldosterone Receptor Blockers for Hypertension: How Far Have We Come?

In a large number of patients with hypertension, > or =2 antihypertensive agents are required to achieve blood pressure (BP) goals. There is good rationale for initial combination therapy based on clinical trials demonstrating that achievement of BP goals within a reasonably short period of time results in fewer cardiovascular events. One approach to attaining BP goals and improving medication adherence is fixed-dose combination therapy, the use of which dates back to the 1960s. Given some of the advantages of renin-angiotensin-aldosterone system (RAAS) blockers in patients with heart disease, kidney disease, and diabetes, many combinations include either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. In most studies, however, thiazide diuretics were necessary to achieve goal BP. Calcium channel blockers have also been used in combination with angiotensin-converting enzyme inhibitors to lower BP. Studies are now under way to determine the relative benefits of an RAAS blocker/diuretic compared with an RAAS blocker/calcium channel blocker as initial therapy.     

First‐Step Use of Fixed‐Dose Combination Treatment in Stage 2 Hypertensive Patients: Has the Time Come?

A panel discussion was convened on February 14, 2007, to discuss the use of fixed-dose combination therapy for stage 2 hypertensive patients. The panel was moderated by Michael A. Weber, MD, Professor of Medicine, SUNY Downstate College of Medicine, New York, NY. Participants included Luis Ruilope, MD, Chief, Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain, Thomas D. Giles, MD, Professor of Medicine, Tulane University School of Medicine, Metairie, LA, and Joseph L. Izzo, Jr, MD, Professor of Medicine, Department of Medicine, State University of New York at Buffalo, Buffalo, NY.     

Do Obese Individuals With Hypertension Have More Difficult‐to‐Control Blood Pressure and End Organ Damage Than Their Nonobese Counterparts?

The authors assessed whether individuals with elevated body mass index (BMI) and hypertension had more difficult‐to‐control blood pressure (BP) and more evidence of end organ damage using data collected prospectively over 11 years from a secondary care hypertension clinic. A total of 1114 individuals were divided by BMI criteria into normal (n=207), overweight (n=440), and obese (n=467). Mean daytime, nighttime, and 24‐hour systolic BP and diastolic BP were similar in all groups. There was less nocturnal dip in obese compared with overweight groups (P=.025). Individuals with a normal BMI were taking fewer antihypertensive medications than those in the obese group (P=.01). Individuals classified as obese had a higher left ventricular mass index than those with a normal BMI (female, P=.028; male, P<.001); this relationship remained after multivariate linear regression. Obese individuals with hypertension required more medication to achieve similar mean ambulatory BP values, had less nocturnal dip in BP, and had a higher prevalence of left ventricular hypertrophy. As such, obese patients are at potentially increased risk of cardiovascular events.     

Can Metabolic Syndrome Presence Predict Carotid Intima‐Media Thickness?

The aim of this investigation was to analyze metabolic syndrome (MS) impact on carotid intima‐media thickness (cIMT). Prospective study of 300 patients with suspected coronary artery disease admitted for an elective coronary angiography were evaluated. Patients with previously known cardiac disease were excluded. In the population, 23.0% were diabetics and 40.5% had MS (but no diabetes). cIMT was not significantly different in patients with MS, but was significantly higher in diabetic patients compared with MS and control patients. Independent predictors of cIMT were age, male gender, insulin, and high‐density lipoprotein (HDL) cholesterol (the last one with an inverse association). In patients without MS, only age and HDL cholesterol were associated. In patients with MS, independent predictors were age, male gender, and glucose, and abdominal obesity showed an inverse relationship. In patients with stable angina, MS is not an independent predictor of cIMT. Nonmodifiable variables (age and gender) are the most important determinants of cIMT, as well as blood glucose, in MS patients. Abdominal obesity was protective. J Clin Hypertens (Greenwich). 2012;00:00–00. ©2012 Wiley Periodicals, Inc.