Obesity Phenotypes, Diabetes, and Cardiovascular Diseases
Hypertension And Cardiovascular Disease: Silent Killers In Our Midst
When we talk about cardiovascular diseases, we refer to diseases of the heart and the blood vessels. While we know that the heart is a vital organ that pumps blood to the entire body, we should understand a few facts about blood vessels.
Blood vessels circulate oxygen, nutrients, hormones, and much more, and maintain the body's homeostasis, that is, a stable internal environment despite changes in the external environment. The collective length of the entire vasculature, including arteries, veins, and capillaries, is approximately 96,000 kilometres in a human adult! The thin inner lining of the blood vessels, called the endothelium, is an important endocrine organ regulating the body's metabolism, immune response, inflammation, coagulation, and blood flow. By caring for the health of our blood vessels we are indirectly caring for all our organs and our overall health.
The term blood pressure, or BP, refers to the force of blood flow in our arteries, produced by the pumping action of the heart. Normal BP is less than 120/80 mmHg in healthy adults; values above this are classified as elevated, hypertension stages 1 and 2, and a hypertensive crisis based on the level of deviation from normal. Both BP and heart rate are vital parameters that help us understand the cardiovascular health of a person. More so, how one's BP and heart rate respond to exercise is an important indicator of a person's exercise capacity and fitness level.
The 'deadly triad'Hypertension or elevated blood pressure is one of three silent killers ravaging the health and well-being of people today. Together with diabetes and cholesterol imbalance, hypertension forms the 'deadly triad' that creeps up on us without any symptoms to cause a myriad of cardiovascular diseases (CVD) such as heart attacks, heart failures, strokes, and sudden cardiac deaths, as well as other organ damage such as kidney failure, liver dysfunction, loss of vision and dementia. Heart attacks and strokes are amongst the major noncommunicable diseases (NCDs) causing premature deaths in the current era. When the health of our blood vessels is compromised, they become a nidus for plaque build-up or atherosclerosis, ultimately causing coronary artery disease and heart attacks or cerebral artery disease and strokes. There are nine modifiable risk factors for heart attack as shown in Figure 1.
Figure 1. Risk factors for coronary artery disease
Hypertension poses an enormous burden to the health economy of our country as almost one in four men and over one in five women are hypertensive. Recent research has shown that a very high proportion of patients (around 53%) are unaware that they have high BP. On the other hand, the number of hypertensive patients who have their BP under control is abysmally low, around 20%. Rural India is unfortunately fast catching up with urban India in the high prevalence of all NCDs including hypertension. The loss of productive life-years due to hypertension, and the cost of hospitalisation and treatment of CVD and other NCDs is so high that the only way out of this vicious cycle is to improve awareness about hypertension and empower people with simple and cost-effective strategies to prevent it.
Causes and prevention strategiesThe story of how hypertension develops is long and complex, the main characters being too much salt in our diet, inadequate fruits and vegetables, excessive saturated fats and trans-fat, lack of exercise, abnormal body weight, poorly managed stress, lack of sleep, tobacco use, and alcohol consumption. Genetic factors, environmental pollution, ethnicity and age act as supporting characters in the hypertension plot. The moral of the story is simple: the lifestyle choices we make on a daily basis are the biggest contributors to the development of hypertension.
The key steps to curbing the growing incidence of hypertension are:
What this means is that all individuals should have their first health-related lifestyle assessment along with BP, blood sugar (BS) and lipids checked at the age of 20 and thereafter every five years, moving to annual checks from the age of 40 onwards.
Figure 2 outlines the population-level approach for hypertension prevention through lifestyle changes and medical examination.
Figure 2. Population-level approach to prevent hypertension
Lifestyle mantras to prevent hypertensionWhat to eat? At least five portions of vegetables and fruits, at least 1-2 portions of whole grain dishes, adequate proteins and limited healthy fats daily; limiting salt while cooking at home and avoiding packaged/ready foods; the healthy eating plate concept should be followed for every meal.
How to prepare the meal and eat it: Prepare meals at home as much as possible, eat food mindfully, slowly and enjoy every bite, and have at least one meal a day with family members/ friends. Eat when hungry or work up an appetite before sitting for a meal, and finish eating at least 2-3 hours before bedtime.
Is exercise a must? Regular exercise, at least five days a week, is a must for all, irrespective of whether you are physically active throughout the day or not. At least 30 minutes of brisk aerobic exercise five days of the week (total of 150 minutes) and strength training two days of the week are mandatory for all; intersperse every 30 minutes of a sedentary period with five to 10 minutes of activities such as stretching, brisk walking, stair climbing or workstation exercises; remember, "sitting is the new smoking".
What type of exercise is needed? A combination of aerobic exercises (brisk walking, cycling, swimming, jogging, dancing), strengthening exercises (using equipment or weights), flexibility exercises (yoga, tai chi), and balance exercises should be followed by all.
How to manage stress? Stress management techniques such as meditation, deep breathing, regular exercise, and active hobbies (dancing, gardening, sports, creative arts) should be practised on a daily basis to keep stress at bay.
Is sleep a risk factor? Lack of sufficient and good quality sleep can cause hypertension; aim for 7 to 9 hours of undisturbed sleep daily.
Is tobacco harmful? Tobacco use in any form (even passive smoking) is an important risk factor for hypertension, heart disease and stroke; quitting tobacco completely is the best gift of health to oneself; professional help may be sought to quit tobacco use.
Is alcohol good or bad for the heart? Alcohol in any form is harmful to the body; excessive/binge alcohol consumption can lead to hypertension and other ailments and should be avoided.
Early detection of hypertensionEffective population screening programmes are the ideal way to identify hypertension early. As the age cut-off for initial CVD screening is 20 years, basic health screening with BP measurement should become mandatory in all higher educational institutions as well as a criterion that employers must implement. Individuals who do not fall under either the formal education system or employment channels should be screened by innovative strategies such as while appearing for their driving licence or voter ID issuance.
As a single reading of high BP is not sufficient to diagnose hypertension, those with an elevated BP should be referred to a physician for a further physical examination and structured BP evaluation. It is important to rule out medical causes of hypertension such as kidney disease, endocrine abnormalities, arterial disorders and sleep apnoea before arriving at a diagnosis of primary or essential hypertension.
Adequate control of hypertensionOnce someone is diagnosed with mild to moderate hypertension, a personalised approach to modify the causative lifestyle habits should be tried first. A comprehensive CVD prevention programme provided by a multidisciplinary team of healthcare professionals and comprising education, exercise, nutritional and psychosocial interventions has been proven to reverse elevated BP in a vast majority of newly diagnosed hypertensive patients. A close watch on the BP trajectory and close supervision of the adherence to lifestyle changes are mandatory during this three to six-month intensive lifestyle modification phase.
A poor response to the above step or a very high BP at initial diagnosis should prompt the initiation of BP-lowering medications, choosing either one drug or combination therapy, taking into consideration the individual's clinical and sociodemographic background. The crucial thing in pharmacotherapy is once again frequent BP checks and fine-tuning of the type and dosage of the drug(s) to achieve target BP with as few side effects as possible.
Non-compliance to drug therapy being the commonest cause of poor BP control, medication education is key to ensuring adherence to the prescription. Both the physician and the patient should take joint responsibility in achieving the target BP through a health plan that is drafted for the patient and by the patient, with the physician's expert help.
Figure 3. Components of a multidisciplinary prevention programme
Preventing organ damageAs hypertension, just like diabetes and cholesterol imbalance, is known to cause multi-organ damage, constant surveillance for heart disease, impaired kidney function, vision abnormalities, fertility issues, and lung disease is a must. Early detection of signs of organ damage will enable referral to specialist care and escalation of medical management to stall the damage and potentially reverse it. Just like a multidisciplinary prevention programme helps reverse hypertension, a comprehensive cardiac rehabilitation programme is key to addressing the multipronged needs of individuals with heart disease and reversing their disease process.
For a preventive cardiologist, the biggest medical challenge today is managing individuals with multimorbidity, a combination of conditions such as hypertension, diabetes, cholesterol abnormalities, obesity, chronic lung disease, fatty liver, impaired renal function, poor mental health, and heart ailments. Elderly patients with frailty, musculoskeletal issues, and weakened immune systems are even more difficult to treat when they have multi-organ damage.
While medical and surgical therapy should be deployed as and when deemed necessary, in addition to medication, reinforcing the building blocks of a healthy lifestyle will help improve functional status, quality of life, and resilience to infections at any stage in the disease spectrum.
The way forwardA close collaboration amongst all stakeholders, namely the public, healthcare professionals, and policymakers, is important, moving forward, to halt the hypertension epidemic before it becomes an untameable beast. Epidemiological, basic scientific and clinical research should progress hand in hand to help us unravel some of the persisting dilemmas and challenges in the domain of hypertension, CVD and NCDs. In this era of superpowers, each one of us should recognise the superpower within us, our mind, that is capable of adopting health-promoting habits and adapting to the changing environment to protect our health and well-being. The collective power of our minds in changing the course of deadly diseases should also be harnessed through education, awareness and adherence.
Myths around hypertensionMyth 1: I am feeling fine and hence do not see the need for a BP check.
High BP usually does not cause any symptoms. In other words, individuals who are feeling fine can still have hypertension and should get their BP checked.
Myth 2: Hypertension is in my family and genes and there is nothing I can do to prevent it.
While genetic factors play a role in the causation of hypertension, there is scientific evidence to show that healthy lifestyle choices can overrule genetic predispositions and protect us from the disease.
Myth 3: Once diagnosed, hypertension is a lifelong disease.
Early diagnosis can help reverse hypertension through lifestyle changes and prevent end organ damage.
Myth 4: If my BP comes down with medicines, I can stop taking the pills.
BP medications should not be modified or stopped without the advice of your physician.
Myth 5: I don't have to watch my diet or exercise when I am on BP medication.
It is extremely important to lead a healthy lifestyle even while on BP medications, as otherwise your hypertension will worsen, become resistant to treatment and lead to end organ damage within a short time.
(Dr. Priya Chockalingam is the clinical director, Cardiac Wellness Institute, Chennai.)
Published - May 28, 2025 04:30 pm IST
Novel Treatment May Help Treat Hard-to-control Hypertension, Global Trial Shows
A clinical trial has seen promising results from a new class of medication to treat hypertension. Design by MNT; Photography by Peca King/500px/Getty Images & MementoJpeg/Getty ImagesThis article originally appeared on Medical News TodayA novel treatment for hard-to-control high blood pressure has shown strong results in a major global clinical trial.
The Phase 3 Launch-HTN study found that lorundrostat, an aldosterone synthase inhibitor, safely and consistently lowered blood pressure in a large, diverse group of patients who had not responded to other medications.
These findings mark a significant step forward in the development of the first targeted aldosterone synthase inhibitor for these conditions.
Blood pressure refers to the force exerted by blood against the walls of the arteries.
Hypertension, or high blood pressure, happens when this force is consistently higher than normal. Hypertension impacts one in three adults globally and significantly raises the risk of heart disease, heart attacks, and strokes.
Resistant hypertension is a form of high blood pressure that remains elevated despite a person taking three different blood pressure medications at their maximum recommended doses.
Up to 15% of individuals with hypertension have abnormal regulation of aldosterone, a hormone that helps control blood pressure.
When aldosterone levels are elevated due to this dysregulation, it can lead to hypertension.
A new study, presented at the 34th European Meeting on Hypertension and Cardiovascular Protection, shows that lorundrostat — a drug that inhibits aldosterone synthase — is both safe and effective for treating individuals with uncontrolled or resistant hypertension.
The findings are yet to be published in a peer-reviewed journal.
How does lorundrostat treat hypertension?Lorundrostat is specifically designed to lower aldosterone levels by targeting and inhibiting CYP11B2, the enzyme that drives its production.
The study demonstrated consistent reductions in blood pressure across a large and diverse group of patients and represents the largest phase three trial to date for this class of treatment.
Manish Saxena, MD, Clinical Co-Director of the William Harvey Heart Centre at Queen Mary University of London and Hypertension Specialist from Barts Health NHS Trust and the study's lead Investigator, spoke to Medical News Today.
"Despite available treatments, more than 40% of adults with hypertension worldwide are not reaching their blood pressure goal. Aldosterone pathway plays important role in blood pressure regulation, and leads to blood pressure related complications such as heart failure and kidney problems. In the Launch-HTN trial we explored the safety and effectiveness of lorundostat, which belongs to a new class of drugs called aldosterone synthase inhibitors that block production of hormone aldosterone from the adrenal glands."
— Manish Saxena, MD
"The Launch-HTN trial is the largest phase 3 hypertension study with a novel drug," Saxena explained. "We tested lorundostat in a large, diverse patient population recruited globally and found that it has good safety profile and lowered blood pressure consistently in all of our patient groups."
"Hormone aldosterone secreted from adrenal glands in the body plays an important role in driving blood pressure. Now there is more awareness of dysregulated aldosterone secretion in patients with difficult to treat blood pressure. Lorundrostat blocks biosynthesis of hormone aldosterone in the body and helps reduce blood pressure."
— Manish Saxena, MD
Lorundrostat shows sustained efficacy in resistant hypertensionThe Launch-HTN trial was a global, Phase 3 study that was randomized, double-blind, and placebo-controlled.
It included adult participants whose blood pressure remained uncontrolled despite taking two to five antihypertensive medications.
Designed to reflect real-world clinical practice, the trial used automated office blood pressure (AOBP) measurements and allowed participants to continue their existing treatments.
Lorundrostat, administered once daily at a 50 mg dose, showed meaningful and sustained reductions in systolic blood pressure — dropping by 16.9 mmHg at Week 6 (a 9.1 mmHg reduction compared to placebo) and by 19 mmHg at Week 12 (an 11.7 mmHg reduction versus placebo).
"The LAUNCH-HTN trial demonstrated blood pressure lowering efficacy and safety of lorundrostat in a very diverse patient group with uncontrolled and difficult to treat hypertension that were on background 2-5 blood pressure lowering medication. The blood pressure reduction observed was consistent across key sub-groups, significant and clinically meaningful."
— Manish Saxena, MD
A new tool to control hypertensionTwo experts, not involved in the study, also spoke to MNT.
Cheng-Han Chen, MD, board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, noted that "aldosterone synthase inhibitors are a new class of drugs being studied for the treatment of hypertension."
"This trial found that lorundrostat, one of these new types of drugs, was safe and effective for patients with uncontrolled or resistant hypertension. This puts us one step closer to having another tool in our arsenal for patients with difficult to control blood pressure despite being on multiple medications," Chen explained.
"Many patients have high blood pressure that are not under control with multiple classes of medications. By having another class of blood pressure medications at our disposal, we will better be able to reduce rates of hypertension in our population and improve health outcomes."
— Cheng-Han Chen, MD
Needing fewer medications to treat hypertensionRigved Tadwalkar, MD, FACC, consultative cardiologist and director of Digital Transformation Pacific Heart Institute in Santa Monica, CA told MNT that "this is a meaningful step forward."
"We still see far too many patients with uncontrolled or resistant hypertension, even when they're on three, four, sometimes five medications. The reality is that for a significant subset of these patients, aldosterone is driving the problem and until now, we haven't had a way to target that mechanism directly in a safe, practical way," Tadwalkar explained.
"Lorundrostat appears to change that. It inhibits aldosterone synthesis at the enzymatic level, and based on this trial, it does so with a good safety profile and consistent efficacy across a diverse population. The blood pressure reductions– nearly 17 mmHg at 6 weeks and close to 19 mmHg at 12– are significant, especially when you consider that these were already heavily treated patients. That kind of additional drop is not something we usually see at this stage of therapy."
— Rigved Tadwalkar, MD, FACC
"Since patients stayed on their background medications, these results feel more clinically relevant than more tightly controlled washout studies," Tadwalkar added. "It's a welcome addition to the field, even as we continue to see the limitations of existing therapies, including newer device-based approaches like renal denervation."
Tadwalkar said that lorundrostat had potential to make a real difference in patients' lives.
"If lorundrostat becomes widely available, it could offer a new option for patients who've exhausted standard pathways. For people living with resistant hypertension, many of whom are already dealing with co-morbidities like kidney disease or heart failure, having another tool, especially one that targets the underlying hormonal dysregulation, could make a real difference in long-term outcomes," he said.
Saxena said that once lorundostat becomes commercially available, it could become a novel treatment option for hypertension for many patients.
Tadwalkar continued by noting that "at the population level, we're still facing a huge burden from poorly controlled blood pressure." He said untreated hypertension was a major contributor to chronic diseases and cardiovascular problems.
"A drug like this, if used properly, could help narrow that treatment gap. It's certainly not a silver bullet, but it's a step toward more personalized, mechanism-specific care. This is something the hypertension field has needed for a long time."
— Rigved Tadwalkar, MD, FACC
View the original article on Medical News Today
Rare Diagnosis And Revolutionary Surgery: How Ashland Twins Beat Rare Aorta Heart Disease
Marti and Mary Alice Mullins are twins from a tight-knit family in Ashland.
In her late 50s, Marti started experiencing strange and painful symptoms. Every time she ate, she became nauseated and would sometimes vomit. She also had abdominal pain with eating.
"I kept going back to the doctors. At first, they thought it was acid reflux, but it never got any better," she said. "I started having to go to the emergency room, the pain was so bad."
Eventually, during one trip to the emergency department, a doctor ordered a CT scan. That's when they discovered a problem with her aorta, the largest artery in the body that carries oxygen-rich blood from the heart to all other organs.
Diagnosis: A coral reef in the aortaImaging showed Marti had coral reef aorta (CRA), a rare condition characterized by the formation of large, calcified plaques in the aorta that can block blood flow. Marti's was located in the part of the aorta where blood vessels to the liver, stomach and kidneys originate. The disease gets its name because the plaques are different from other typical types of plaque and are irregular and bulky resembling a coral reef.
Marti Mullins and Mary Alice Mullins are identical twin sisters. Each, at different times, were diagnosed with the same rare aorta heart disease. The both had surgeries, but because different healh circumstances, the procedures were different, one more complicted than the other.
People suffering from CRA may experience pain with eating and digestion because blockages keep proper blood flow from getting to the stomach, kidneys, and liver. Other symptoms can include high blood pressure and pain in the legs.
Because of the pain associated with the condition, Marti had trouble with basic daily tasks like doing chores and mowing the lawn. It impacted her ability to live a normal, enjoyable life.
Treatment of CRA can be complicated. The condition is considered inoperable by many specialists, but not experienced vascular surgeons like Dr. Benjamin Colvard and Dr. Jae Cho with University Hospitals Harrington Heart & Vascular Institute.
In March 2022, Marti underwent surgery with both of them at UH Cleveland Medical Center.
Basically, her aorta was replacedThe surgery involved a multi-branched thoracoabdominal bypass graft with limbs going to the kidneys, liver, stomach, and the lower half of the body on partial cardiopulmonary bypass. This approach is seldom done because it requires a vascular surgeon not just trained in aortic surgery, but with thoracoabdominal experience, as well as pump privileges. There are only a small number of centers in the US that can support this extensive of a case.
"To explain in layman's terms, this repair was done by replacing her aorta," Colvard said. "We bypassed the aortic segment with CRA, which involved the branches going to both kidneys and all abdominal organs. We replaced it with a fabric graft. Essentially, we replaced a clogged pipe, and made sure all the connections from the pipe going to all the sinks (organs) were still connected correctly."
Marti had a prolonged recovery, but eventually did fully recover and gain a happier and more independent life.
Through it all, Marti's identical twin sister, Mary Alice, was by her side.
"When they're hurting, you hurt, too," said Mary Alice. "We're very close and I wanted to support her through everything."
Once Marti was doing better, her care team suggested Mary Alice get tested for the same disease since they're identical twins and have the same genetics. They discovered Mary Alice did have CRA, but at the time wasn't experiencing any problems.
Same heart disease, different twinOne day, unlike Marti's case that built slowly and lingered, Mary Alice's symptoms came on hard, heavy, and suddenly. She was rushed to the hospital.
"One day she was fine and laughing and the next day she was deathly ill," Marti said. "We almost lost Mary Alice a few times."
But Mary Alice's case was even more complicated than her sister's. She not only had a coral reef aorta, but another lesion in her thoracic aorta as well. In March 2024, she was admitted into the medical ICU at UH Cleveland Medical Center with severe lower leg pain, acute kidney failure pulmonary edema, acute right sided heart failure and in a hypertensive crisis. She deteriorated quickly requiring dialysis and was eventually intubated. Her condition in the MICU was critical and heading toward palliative care.
With her unique anatomy and critical state, Mary Alice was not an optimal candidate for the same surgery her sister had undergone. But Cho and Colvard conceived and performed an innovative technique that provided a solution for a patient with little to no chance of survival otherwise.
Mary Alice received a distal thoracic aorta and paravisceral aorta transaortic endarterectomy with the Sonopet device (an ultrasonic aspirator).
"This technique had never been reported before," said Cho, also chief of vascular surgery at UH Harrington Heart & Vascular Institute. "Instead of replacing her aorta with a fabric graft like her sister, we opened up Mary Alice's aorta, temporarily disconnecting it from blood flow. We cleaned it with a tool that resembles a dentist's drill for addressing cavities. These aortic lesions are hard and full of calcium, much like a tooth, and this instrument, while having been used in heart surgery and face surgery, had never been used in vascular surgery to our knowledge. It essentially drills down the calcium and suctions it out."
The origins of Mary Alice's arteries to her organs also were cleaned with this tool. It saved time, which is incredibly important for someone as sick as Mary Alice because she may not have survived a long operation like her sister.
After the team cleaned out her aorta through the opening, they sewed it back up, but she still needed the bottom part of her aorta fixed.
Recovery and reflection: Two survivors and one grateful familyAfter the coral reef was removed, she also had aortobifemoral bypass with cryograft. The standard treatment is to replace the calcified aorta with a new one. Typically, a fabric graft is used for this, but because Mary Alice had signs of sepsis or infection – the origins never identified – the team could not use a fabric graft, because prosthetic materials can get infected from the blood in septic patients and graft infections cause their own problems. So, the team chose to use a cryograft which is an aorta donated from a cadaver. Human tissue is more resistant to infection.
Mary Alice made a remarkable recovery and one day after surgery was extubated and continued doing well. Several weeks later she resumed normal activities and sent her care team a picture of herself grocery shopping.
"We know how unique our cases were, and we're so grateful to have this expertise to help and treat us right here in Northeast Ohio," Marti said.
The twins are retired and enjoy spending quality time with their mother, Gloria Jean, and brother Stacy, which they're now able to do much better that they're recovered and healthy.
Carly Belsterling is the senior media relations strategist for University Hospitals.
This article originally appeared on Ashland Times Gazette: Twins suffered rare heart disease battled at University Hospitals
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