Abdelgalil, Mahmoud Shaaban

Mediastinal radiation potentiates aortic stenosis and complicates its treatment. We compared the short and midterm-outcomes with transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in patients with prior mediastinal radiation. Electronic databases were searched from inception through December 2024. Dichotomous outcomes were pooled as risk ratios (RRs), and continuous outcomes were pooled as mean differences (MDs) with respective 95% confidence intervals (CIs). Six observational studies were identified, including 2458 TAVR patients and 1873 SAVR patients. In the short-term, TAVR was associated with lower rate of mortality (RR: 0.54; 95% CI: 0.34–0.88), atrial fibrillation (RR: 0.31; 95% CI: 0.15–0.65), acute kidney injury (RR: 0.75; 95% CI: 0.59–0.95), bleeding (RR: 0.37, 95% CI: 0.33–0.42), and shorter length of hospital stay (MD: −4.30; 95% CI: −5.45 to −3.15). One-year mortality was comparable between the 2 groups (RR: 1.04; 95% CI: 0.50–2.13). This meta-analysis of observational studies of patients with prior mediastinal radiation demonstrated that TAVR was associated with better short-term outcomes compared to SAVR. While 1-year mortality appeared similar between the 2 interventions, this finding should be interpreted with caution. However, randomized controlled trials are needed to validate these findings.

Background: Hypertension is a major risk factor for cardiovascular disease, yet nearly 46% of adults with hypertension remain undiagnosed. Without timely intervention, it can lead to severe complications, including stroke, heart failure, and kidney disease. In sub-Saharan Africa (SSA), hypertension prevalence varies widely from 19.3% in Eritrea to 39.6% in Seychelles. Urbanization has played a key role in increasing hypertension rates through its impact on diet, physical activity, and obesity. Still, urban-rural differences remain modest. Understanding demographic and lifestyle predictors is crucial for SSA's targeted prevention and control efforts. Methods: We conducted a cross-sectional analysis using nationally representative, de-identified data from the Demographic and Health Surveys (2016–2024) in five SSA countries: Lesotho, Tanzania, Gabon, Benin, and South Africa. Adults aged ≥18 years with valid blood pressure and covariate data were included (N=38,085). Blood pressure was measured three times, and the average of the second and third readings was used when available. Hypertension was defined per the 2017 ACC/AHA guidelines (SBP ≥130 mmHg or DBP ≥80 mmHg). Independent variables included age, sex, BMI, education, wealth index, smoking status, and recent caffeine intake. Results: Urban residents (n=20,773) had a higher hypertension prevalence than rural residents (n=17,312) (44.8% vs. 36.7%, p<0.001), along with higher median BMI (24.9 vs. 22.3 kg/m 2 ) and obesity rates (23.5% vs. 11.3%). South Africa exhibited the highest rates (urban 68%, rural 61%), while Tanzania and Lesotho had the lowest (~39–40%). In pooled multivariable analysis, hypertension odds increased steadily with age (OR 4.57 for ≥60 vs 18–24, p<0.001). Obesity demonstrated a dose–response relationship: Class III obesity was associated with a fivefold increase in risk (OR 5.38, p<0.001). Men had higher odds than women (OR 1.65, p<0.001). Secondary education and middle wealth status conferred modest increases in risk. Caffeine use was marginally significant; smoking was not. Predictor importance ranked: age > BMI > sex > wealth > education > smoking > caffeine. Conclusion: Hypertension is highly prevalent in both urban and rural SSA, with age and obesity emerging as the most powerful predictors. South Africa stands out with younger adults most affected. Early detection, awareness campaigns, and obesity-focused interventions are needed to mitigate the growing burden of hypertension in SSA.