Weekly Cardiology Research Analysis
This week’s cardiology literature was dominated by three high-impact randomized and translational findings: an ambitious cluster RCT showed intensive, non-physician-led blood-pressure lowering reduced all-cause dementia; a NEJM randomized trial demonstrated the aldosterone synthase inhibitor lorundrostat meaningfully lowered 24‑hour systolic BP in treatment‑resistant hypertension (with hyperkalaemia risk); and long-term randomized follow-up (PRAETORIAN‑XL) clarified device trade-offs, favouring
Summary
This week’s cardiology literature was dominated by three high-impact randomized and translational findings: an ambitious cluster RCT showed intensive, non-physician-led blood-pressure lowering reduced all-cause dementia; a NEJM randomized trial demonstrated the aldosterone synthase inhibitor lorundrostat meaningfully lowered 24‑hour systolic BP in treatment‑resistant hypertension (with hyperkalaemia risk); and long-term randomized follow-up (PRAETORIAN‑XL) clarified device trade-offs, favouring subcutaneous ICDs for patients without pacing needs due to fewer major and lead-related complications. Across the week there were recurring themes of AI-enabled opportunistic imaging, integrated anatomy–physiology risk models for coronary disease, and mechanistic work identifying ferroptosis/STING pathways as druggable targets in ischemia–reperfusion injury.
Selected Articles
1. Blood pressure reduction and all-cause dementia in people with uncontrolled hypertension: an open-label, blinded-endpoint, cluster-randomized trial.
A cluster‑randomized trial in rural China (n=33,995; 327 villages) randomized villages to a non‑physician‑led intensive BP program versus usual care. Over 48 months the intervention achieved a net −22/−9.3 mmHg systolic/diastolic reduction and reduced all‑cause dementia (RR 0.85) and serious adverse events versus usual care.
Impact: Provides the strongest causal, scalable evidence to date that intensive BP lowering prevents dementia and that task‑shifting to trained non‑physician providers can achieve large BP reductions in real‑world, resource‑limited settings.
Clinical Implications: Encourage adoption of team‑based intensive BP control (<130/80 mmHg) where feasible, with protocols for medication titration and monitoring; consider task‑shifting models to expand reach in resource‑limited areas while tracking cognitive outcomes.
Key Findings
- Cluster RCT (n=33,995) with 327 villages; non‑physician‑led intervention produced net −22.0/−9.3 mmHg BP change over 48 months.
- All‑cause dementia reduced (risk ratio 0.85; 95% CI 0.76–0.95); serious adverse events also lower (RR 0.94).
2. Lorundrostat Efficacy and Safety in Patients with Uncontrolled Hypertension.
A multicenter double‑blind RCT (n=285) in patients on 2–5 antihypertensives with uncontrolled BP showed lorundrostat reduced 24‑hour ambulatory systolic BP vs placebo by ~6.5–7.9 mmHg at 12 weeks. Early effects were seen at 4 weeks; hyperkalaemia >6.0 mmol/L occurred in 5–7% of treated patients.
Impact: First robust RCT evidence that aldosterone synthase inhibition yields clinically meaningful ambulatory BP reductions in resistant hypertension; opens a new drug class but flags electrolyte safety considerations.
Clinical Implications: Lorundrostat may become an option for resistant hypertension pending longer‑term outcome and safety data; implement potassium monitoring protocols and consider comparative studies versus MRAs.
Key Findings
- Placebo‑adjusted 24‑hour systolic BP reduction at 12 weeks: −7.9 mmHg (stable 50 mg) and −6.5 mmHg (dose‑adjustment arm).
- Hyperkalaemia >6.0 mmol/L occurred in 5–7% of lorundrostat recipients; none in placebo.
3. Device-Related Complications in Transvenous Versus Subcutaneous Defibrillator Therapy During Long-Term Follow-Up: The PRAETORIAN-XL Trial.
An 8‑year extension of a randomized trial comparing S‑ICD (n=426) vs TV‑ICD (n=423) found no difference in the composite of all device‑related complications, but transvenous ICDs had higher rates of major and lead‑related complications over median 87.5 months, supporting S‑ICD in patients without pacing indications.
Impact: Provides long‑term randomized data informing ICD selection, with direct implications for reducing lead‑related morbidity and shaping shared decision‑making for patients who do not require pacing.
Clinical Implications: For ICD candidates without a pacing indication, preferential consideration of S‑ICD is reasonable to reduce long‑term major and lead‑related complications; counsel patients on trade‑offs and integrate findings into implantation policies.
Key Findings
- Randomized 849 patients; median follow‑up 87.5 months.
- Overall device‑related composite not significantly different, but TV‑ICD had higher major and lead‑related complications.