Khadka, Sulochana

Background: Supine hypertension, or elevated blood pressure while lying down, is often underrecognized in clinical settings. Though more common in older adults and those with autonomic dysfunction, its long-term cardiovascular impact remains unclear. Growing evidence suggests it may contribute to higher risks of cardiovascular disease (CVD), stroke, heart failure, and mortality. Methods: A meta-analysis evaluated the association between supine hypertension and primary cardiovascular outcomes were searched using standard electronic databases. MeSh term including “supine hypertension” and “cardiovascular outcomes” were used for Search. Studies reporting hazard ratios for CVD events, stroke, heart failure, cardiovascular, and all-cause mortality were included. Random-effect models were used for pooled analysis, with heterogeneity assessed using the I2 statistic and p value <0.05 considered significant. Results: A total of 13 studies were included in the analysis, comprising a combined study population of 241,765 individuals with a mean age of 59 years and follow up for 12.4 years. Cardiovascular Events: Six studies showed a significant association between supine hypertension and increased CVD events (HR = 1.41, 95% CI: 1.28–1.55, p<0.05). Cardiovascular Mortality: Five studies indicated elevated supine systolic BP was linked to higher cardiovascular mortality (HR = 1.57, 95% CI: 1.40–1.75, p<0.05). Heart Failure: Three studies demonstrated a strong, consistent association between supine hypertension and heart failure (HR = 1.83, 95% CI: 1.72–1.95, p<0.05). Mortality: Eight studies showed a modest but significant increase in all-cause mortality (HR = 1.23, 95% CI: 1.02–1.45, p<0.05). Stroke: Three studies revealed significantly increased stroke risk in individuals with supine hypertension versus standing hypotension (HR = 1.69, 95% CI: 1.41–1.97, p<0.05). Conclusion: Supine hypertension was significantly associated with increased risks of CVD events, cardiovascular mortality, stroke, heart failure, and all-cause mortality. These findings highlight the need to consider supine blood pressure patterns in clinical evaluations to improve risk detection and guide preventive care strategies.

Background: According to the American Cancer Society, there are currently over 18 million adult cancer survivors in the US, and by 2030, that figure is estimated to rise to over 22 million. While this is positive, more and more survivors are now at risk for cardiovascular disease (CVD). Hypothesis: This meta-analysis aims to evaluate the association between cancer survivors and cardiovascular event. Methods: A systematic search was conducted in electronic databases from inception until March 2024 using appropriate Mesh terms for ‘Cancer’, and ‘cardiovascular risk’. Pooled risk ratios (RR) with their corresponding 95% confidence intervals (CI) were calculated using random effects models. A p-value of <0.05 was considered statistically significant. Results: A total of nine studies with 1,209,168 people (Cancer survivor: 140697 and non-cancer: 1068471) were included in our study. The mean follow-up duration was 12.4 years. The risk of cardiovascular events was seen in all cancer survivors (RR: 1.69, 95%CI: 1.31-2.08, P <0.05). The cardiovascular risk was statistically significant in patients with leukemia (RR: 1.71, 95%CI: 1.54-1.88), lung cancer (RR: 1.99, 95%CI: 1.38-2.6) and lymphoma (RR: 1.65, 95%CI: 1.29-2.01), and comparable in breast cancer (RR: 1.22, 95%CI: 0.98-1.46), colorectal cancer (RR: 1.13, 95%CI: 0.89-1.37), prostate cancer (RR: 1.08, 95%CI: 0.99-1.17) and thyroid cancer (RR: 0.96, 95%CI: 0.57-1.35). Conclusion: Our study showed that overall cancer survivors had significant risk for cardiovascular events; mainly leukemia, lung cancer, and lymphoma patients had a significant result. Early identification, continuous monitoring, and proactive management strategies are essential to mitigate the long-term cardiovascular effects of cancer treatments.