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The distribution of fat in the human body is related to hemodynamic and metabolic homeostasis. Brown fat is inversely related to body mass index and is associated with a lower probability of developing diabetes. Beige adipose tissue shares some functional characteristics with brown adipose tissue. White adipose tissue constitutes the majority of the fatty tissue and is mainly distributed in the subcutaneous and abdominal cavity. Intra-abdominal white fat has gained prominence in recent years for its association with cardiovascular risk factors and higher cardiovascular mortality. This review article discusses the human adaptation in the environment, a sympathovagal and hypothalamic-pituitary-adrenal imbalance as a possible cause of increased visceral adiposity and its consequences on cardiometabolism.

Hypertension is one of the most important risk factors that contribute to incident cardiovascular events. A multitude of US and international hypertension guidelines, scientific statements, and policy statements have recommended evidence-based approaches for hypertension management and improved blood pressure (BP) control. These recommendations are based largely on high-quality observational and randomized controlled trial data. However, recent published data demonstrate troubling temporal trends with declining BP control in the United States after decades of steady improvements. Therefore, there is a widening disconnect between what hypertension experts recommend and actual BP control in practice. This scientific statement provides information on the implementation strategies to optimize hypertension management and to improve BP control among adults in the United States. Key approaches include antiracism efforts, accurate BP measurement and increased use of self-measured BP monitoring, team-based care, implementation of policies and programs to facilitate lifestyle change, standardized treatment protocols using team-based care, improvement of medication acceptance and adherence, continuous quality improvement, financial strategies, and large-scale dissemination and implementation. Closing the gap between scientific evidence, expert recommendations, and achieving BP control, particularly among disproportionately affected populations, is urgently needed to improve cardiovascular health. [ABSTRACT FROM AUTHOR]

The TIME study investigated whether taking blood pressure (BP) medications in the evening improves cardiovascular outcomes compared to taking them in the morning. The study involved 21,104 participants from the United Kingdom and found no difference in the primary outcome between the two dosing groups. There were also no differences in secondary outcomes or between pre-specified subgroups. The study concluded that patients can take their BP medications whenever it is convenient for them. However, adherence to medication is proven to be worse at bedtime, so taking medication in the morning is recommended. [Extracted from the article]

Losartan Intervention for Endpoint Reduction in hypertension (LIFE) is the only large clinical trial of antihypertensive treatment ever performed in hypertensive patients with left ventricular hypertrophy (LVH). During a median follow-up period of 3.34 years, primary outcome events occurred in 147 patients (3.5%) in the intensive treatment group, as compared with 196 patients (4.6%) in the standard treatment group (HR = 0.74; 95% CIs 0.60-0.92; I p i = 0.007). High-risk hypertensive patients who subsequently develop both AF and HF are at a particularly high risk of a composite outcome of myocardial infarction, stroke, or CV death. Thus, a number of patient characteristics predicted CV events in patients with hypertension and LVH, with age, gender, and urinary albumin excretion being the most important. [Extracted from the article]

One relatively simple and potentially scalable approach to improving hypertension control is greater use of single-pill combinations (SPC) containing two or more different classes of antihypertensive medications as initial and add-in therapy [[4], [6], [8], [10], [12]]. 5 ComboRx: combination treatment with two anti-hypertensive medication either as a single-pill or separate pill; SPC: single-pill combination antihypertensive therapy; FEC: free equivalent combination single antihypertensive medication, two antihypertensive medications as two separate pills with same medications comparator SPC. SPC accounted for 6.3% of antihypertensive medication prescriptions and 12.3% of antihypertensive medications within the top 300 (Table 3) [[21]]. Thus, it often takes two years or more of uncontrolled hypertension before antihypertensive medication is added or the dose increased for an existing medication. [Extracted from the article]