News in brief: No COVID-19 cardiac complications for athletes; BP threshold change will have huge implications; Gut microbiome link to resistant hypertension

Thursday, 19 May 2022

No COVID-19 cardiac complications for athletes

Reassuring study findings from the US show that young athletes are unlikely to have adverse cardiovascular outcomes after SARS-CoV-2 infection.

Cardiac investigations including MRI conducted on 3675 young male and female college athletes (average age 20 years), found SARS-CoV-2 myocardial or myopericardial involvement in only 21 athletes (0.6%)

Only one athlete had a possible COVID-19 related adverse cardiac event (atrial fibrillation) and there were no life-threatening arrhythmias, heart failure, or sudden cardiac arrest related to SARS-CoV-2 infection.

All athletes with cardiac involvement were successfully cleared to return to sport after exercise restriction of a median of 86 days.

“We recommend that [cardiac MRI] be performed only in athletes with a clinical syndrome consistent with myocarditis and ≥1 abnormal cardiovascular test (eg, ECG, troponin, TTE, ventricular arrhythmias on monitor or stress test) or in athletes with symptoms concerning for myocarditis on return to exercise, and athletes with confirmed SARSCoV-2 infection should undergo exercise restriction per current guidelines,” the authors concluded in Circulation.

BP threshold change will have huge implications

The number of people labelled as hypertensive would leap by 72% if Australia adopted lower BP thresholds for the definition of hypertension as already used in the US, a study has found

Redefining hypertension from ≥140/≥90 to ≥130/≥80 mm Hg, as was recently recommended in American College of Cardiology/American Heart Association guidelines would increase the rates of diagnosed hypertension by 71.6% in high income countries such as Australia, according to an analysis by researchers at the Dobney Hypertension Centre at the University of WA.

Redefining the threshold from ≥140/90 to ≥120/70 mm Hg would results in an even greater impact, with a 167% increase in the number of people diagnosed as having hypertension, according to their findings based on BP measurements obtained from over 4 million opportunistic BP screenings in the 2017 to 2019 May Measurement Month initiatives from 104 countries worldwide

“This analysis highlights the tremendous impact changes in BP thresholds for the definition of hypertension could have at a population level and that any such changes, if implemented, require thorough preparation of the health care systems respon-sible for delivery,” they concluded in the journal Hypertension.

Gut microbiome link to resistant hypertension

Resistant hypertension may be caused by a stomach bug that inhibits the antihypertensive efficacy of ACE inhibitors, new research suggests.

The gut microbiota component Coprococcus comes has been identified as having esterase activity to modulate hydrolysis and reduce the gut absorption and efficacy of ACE inhibitors such as quinapril and ramipril.

In a series of animal experiments, researchers at the University of Toledo showed that co-administration of C. comes with ester ACE inhibitors such quinapril attenuated the BP-lowering effects of the drug compared with administration of the ACE inhibitor alone Furthermore, when the bacteria was eliminated by antibiotic use, there was decreased esterase activity, increased quinapril concentrations and enhanced BP-lowering effects.

The effects of the microbiota were limited to ester ACE inhibitors, while the nonester ACE inhibitor lisinopril was not impacted in the presence of C. comes

The researchers said their work had highlighted a “previously unrecognized role of gut microbiota in the development of resistant hypertension”.

“Identification of specific gut microbes and subsequent therapeutic targeting could provide a new avenue for the management of resistant hypertension,” they suggested in the journal Hypertension.

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