BackgroundMicroRNAs (miRNAs) play a key role in the development of heart failure, and recent studies have shown that the muscle‐specific miR‐1 is a key regulator of cardiac hypertrophy. We tested the hypothesis that chronic restoration of miR‐1 gene expression in vivo will regress hypertrophy and protect against adverse cardiac remodeling induced by pressure overload.Methods and ResultsCardiac hypertrophy was induced by left ventricular pressure overload in male Sprague‐Dawley rats subjected to ascending aortic stenosis. When the hypertrophy was established at 2 weeks after surgery, the animals were randomized to receive either an adeno‐associated virus expressing miR‐1 (AAV9.miR‐1) or green fluorescent protein (GFP) as control (AAV9.GFP) via a single‐bolus tail‐vein injection. Administration of miR‐1 regressed cardiac hypertrophy (left ventricular posterior wall thickness,; 2.32±0.08 versus 2.75±0.07 mm, P<0.001) and (left ventricular septum wall thickness, 2.23±0.06 versus 2.54±0.10 mm, P<0.05) and halted the disease progression compared with control‐treated animals, as assessed by echocardiography (fractional shortening, 37.60±5.01% versus 70.68±2.93%, P<0.05) and hemodynamic analyses (end‐systolic pressure volume relationship/effective arterial elastance, 1.87±0.46 versus 0.96±0.38, P<0.05) after 7 weeks of treatment. Additionally, miR‐1 replacement therapy lead to a marked reduction of myocardial fibrosis, an improvement in calcium handling, inhibition of apoptosis, and inactivation of the mitogen‐activated protein kinase signaling pathways, suggesting a favorable effect on preventing the maladaptive ventricular remodeling. We also identified and validated a novel bona fide target of miR‐1, Fibullin‐2 (Fbln2), a secreted protein implicated in extracellular matrix remodeling.ConclusionsTaken together, our findings suggest that restoration of miR‐1 gene expression is a potential novel therapeutic strategy to reverse pressure‐induced cardiac hypertrophy and prevent maladaptive cardiac remodeling.

Older adults are more likely to take more than two medications for medical conditions, and polypharmacy is associated with increased risk of adverse events (fall injury, hyperkalemia and hypokalemia, heart failure, and blood pressure exacerbation), polypharmacy mismanagement, drug-drug interaction, and increased costs. Knowledge of drugs that interact with known antihypertensive agents is paramount to avoiding or reducing adverse events, hospitalizations, and health care dollars. Innovative approaches such as use of a fixed-dose combination pill, ingestible sensor system, electronic reminder system, medical audits, and the integration of a pharmacist in the care of patients should be implemented to avoid polypharmacy mismanagement. J Clin Hypertens (Greenwich). 2016;18:10-18. ª 2015 Wiley Periodicals, Inc.Hypertension is the most frequently diagnosed chronic medical condition among adults 65 years and older in the United States 1 and is a major risk factor for cardiovascular (CV) disease (CVD). Affecting one in three US adults, 2 hypertension is independently linked to heart failure, stroke, atherosclerotic coronary artery disease (CAD), renal failure, and death.In addition, the prevalence of hypertension among US adults increases with age. A report from the 2013 National Center for Health Statistics (NCHS) on hypertension among adults in the United States showed that the prevalence of hypertension was 7.3% among adults aged 18 to 39 years, 32.4% among those aged 40 to 59 years, and 65% among those 60 years and older. 3Among those 60 years and older, 86.1% were aware of their diagnosis of hypertension and 82.2% were receiving treatment for hypertension but only 50.5% had their hypertension controlled. 1,3Initially, there is a higher prevalence of hypertension among adult men compared with women up to approximately the age of 45 years, then the burden of hypertension balances out between the ages of 45 to 64 years, and finally among adults older than 65 years, women have a higher prevalence compared with men.1 The US population is expected to grow by about 62 million from the year 2010 to 2030, and 50% of this growth is as a result of adults 65 years and older. 4 In 2010, older adults aged 65 years made up 13% (40 million) of the US population.5 Therefore, the burden of hypertension is expected to rise with the rapidly growing and aging population. Although both systolic blood pressure (SBP) and diastolic blood pressure (DBP) are independent risk factors for CVD, isolated systolic hypertension (ISH) is the most common form of hypertension among older adults and is also the most common form of uncontrolled hypertension in this age group. 7 The pervasiveness of ISH in older adults is caused by age-related loss of elasticity in the arteries, particularly the larger vessels such as the aorta. The loss of distensibility in the aorta also results from progressive atherosclerosis in the vessel wall, which reduces compliance in the arterial system. In younger adults with normal arterial compliance, distensibility of the ...

The Framingham Risk Score (FRS) has become the standard tool to determine coronary heart disease (CHD) risk. Recent studies have demonstrated that FRS underestimates CHD risk in a number of patient populations. One strategy that has been proposed to improve the diagnostic accuracy of FRS is to use imaging of subclinical atherosclerosis to define a "vascular age" and use this age to calculate FRS. Both computed tomography assessment of coronary artery calcium (CAC) and ultrasonographic assessment of carotid intima-media thickness (CIMT) have been proposed as modalities that can be employed to assess vascular age. In the present study, the authors compared CAC vs CIMT for the assessment of vascular age and adjustment of FRS. In the cohort as a whole, CAC- and CIMT-derived vascular age correlated well. Further study is needed to verify the accuracy of vascular age-adjusted FRS using both CAC and CIMT and to determine whether there are specific patient demographics that favor either imaging modality.

During the first year of follow-up, patients treated with BVS had a higher incidence of MI and scaffold thrombosis. The risk of DOCE was not significantly different. As BVS may pay off later, future robust data on long-term clinical outcome will be of paramount importance.