Current Hypertension Reviews - Current Issue

Flavonoids in various fruits and vegetables exert multifaceted biological effects. They are widely explored for cardiovascular, antitumor, antioxidant, antibacterial, antifungal, neuroprotective, and anti-inflammatory effects. Flavonoid cardioprotection is helpful in the management of myocardial injury, stroke, atherosclerosis, hypertension, and ischemia. Cardiovascular disease (CVD) has become a global threat in recent years due to increased mortality and morbidity rates. The increased mortality due to CVD among women, children, and poor economic groups has boosted the socio-economic burden on health care. Various researchers have explored the commercial applications of flavonoids, including quercetin, apigenin, luteolin, and catechin, as dietary supplements.

The findings were searched in the Google Scholar, Scopus, PubMed, and PubChem databases.

Preclinical and clinical investigations have promoted the safety of flavonoids, such as apigenin and quercetin, for use as nutraceuticals that promote health. Flavonoids and their potential mechanisms of action and clinical applications offer insights for researchers and scientists to explore in the fields of medical and nanomedicine sciences. Nanomedicine, like liposomes, carbon nanotubes, nanosponges, and nanoparticles containing flavonoids, is used for its efficacy, potency, and target delivery.

Flavonols have the potential to regulate vasodilation and prevent apoptosis. Furthermore, their supplementation may reduce the risk of cardiovascular complications. Flavonoids function as antioxidants and exhibit potent anti-inflammatory effects by mediating inflammatory pathways, thereby contributing to the management of cardiovascular complications. Emerging evidence from researchers suggests flavonoids improve endothelial function and reduce blood pressure. Furthermore, flavonoids derived from cocoa, such as catechins, and those found in tea also enhance endothelial function. Nanosystems can enhance the solubility, permeability, and effectiveness of flavonoids as antioxidants, while also promoting controlled drug delivery. Nanoformulations can enhance the effects of morin, rutin, quercetin, and other flavonoids, significantly improving therapeutic outcomes.

These findings offer researchers and scientists a novel technological approach utilizing flavonoids to address metabolic syndromes and related health conditions, thereby supporting personalized care and improving patient outcomes.

Hypertension is a major contributor to disability-adjusted life years (DALYs) worldwide, as highlighted by the Global Burden of Disease study (GBD 2021). Effective management of hypertension through medication can significantly lower the risks associated with the condition. It is important to recognize that not adhering to antihypertensive therapy often leads to negative health outcomes.

We conducted a thorough search of databases such as “Embase, PubMed, Web of Science, Cochrane Library, EBSCOHost, and Scopus” from their inception up to December 4th, 2023. This search focused on studies involving patients with hypertension. Our review specifically targeted studies conducted in India, published in English, and focused on the prevalence of non-adherence to antihypertensive medication. We used a random-effects model to pool the findings and assessed heterogeneity using the I² statistic, with a significance level set at p < 0.05. Subgroup analyses were performed to identify areas with a higher prevalence. This review was prospectively registered in PROSPERO (CRD42024489527).

This review included 40 studies from India, encompassing 18,808 patients with hypertension. The pooled prevalence of non-adherence to antihypertensive medication was 48% (95% CI 39%-56%, PI = 9%-90%), with a high degree of heterogeneity (I²=98%). Meta-regression showed that non-adherence was linked to younger age (p<0.01). Subgroup analysis revealed a varying prevalence across India, with the eastern region showing the highest prevalence at 76% (95% CI 31%-96%), followed by the order East > North > West > South (p < 0.01). A higher prevalence was also observed in community settings (51%) and rural areas (57%).

Findings of this study shed light on the growing prevalence of nonadherence to antihypertensive medication among Indian hypertensive patients. Nonadherence patterns vary across settings and contexts, reinforcing the need for more longitudinal studies and context-specific targeted interventions. Subgroup analyses revealed no significant reduction in heterogeneity, highlighting the need for more qualitative studies.

Given the high and regionally variable prevalence of non-adherence to antihypertensive medication in India, it is crucial to develop localized strategies to improve adherence to hypertension treatment.

Left Ventricular Dysfunction (LVD) is a frequent complication in Diabetes mellitus (DM) patients, often worsened by cardiovascular disease. This study explores the role of dipyridamole (DP)-induced heart rate variability and G-SPECT imaging in evaluating LVD in DM patients. This study aimed to evaluate the relationship between heart rate ratio (HRR) during DP stress and LVD parameters derived from gated SPECT (G-SPECT) in DM patients, aiming to identify if HRR can serve as a marker for early LVD assessment.

A cross-sectional study of 125 patients referred for cardiac scanning. Patients were grouped by diabetic status and HRR (≤ 1.2 vs. > 1.2) post-DP. G-SPECT-derived left ventricular parameters were compared between groups.

G-SPECT showed that peak filling rate (PFR) was higher in non-DM patients. In the HRR ≤ 1.2 group, DM patients had significantly higher end-diastolic volume (EDV) and end-systolic volume (ESV) than non-DM patients (EDV: 66.41±31 vs. 51.34±18, p-value:0.009; ESV: 27.88±11.21 vs. 18.63±15.5, p- p-value: 0.015).

This study evaluated the role of heart rate response during dipyridamole stress testing combined with G-SPECT imaging in assessing left ventricular dysfunction (LVD) in diabetic patients. The findings indicate that changes in ventricular volume parameters, along with heart rate response, may serve as early markers of cardiac impairment, potentially facilitating earlier detection and improved management of cardiac complications in this population.

Reduced HRR during DP stress, combined with G-SPECT, may aid in the assessment of LVD in DM patients, potentially facilitating earlier diagnostic insights.