Aim: To assess the incidence and predictors of hypertensive response to exercise (HRE) of blood pressure during stress echocardiography (SE) with physical exercise in patients with known or probable coronary artery disease, and the effect of HRE on the results of the five-step SE. Methods: The single-center study included 193 patients who underwent ABCDE-SE. The incidence of HRE, predictors of its occurrence, and the relationship with positive results of the study protocol steps were investigated. Results: HRE was detected in 36.3% of patients (70 patients) and occurred more frequently during the bicycle ergometer test (p = 0.027). Patients with HRE had a significantly lower peak wall motion score index (p = 0.050) and achieved a preload ratio (p = 0.035), as well as higher left anterior descending coronary artery (LAD) blood flow velocity at rest and during exercise (p = 0.009 and p = 0.008, respectively). They also showed higher peak left ventricular (LV) contractile reserve and force (p = 0.002 and p = 0.006). Reduced contractile reserve was less common in patients with HRE (p = 0.013). Predictors related to HRE development were identified: history of LAD stenting, thickness of the LV posterior wall, LAD blood flow velocity, and normal LV force at rest (p = 0.006, p = 0.022, p = 0.004, and p = 0.003, respectively), as well as a positive step C (p = 0.005). Conclusions: The prevalence of HRE, its predictors, and the relationship with the ABCDE-SE results were revealed. The correlation between blood pressure response to exercise and SE steps, as well as its prognostic significance, needs further study.

Our cells and, therefore, our organism, need energy to function at their best, which is mainly produced by mitochondria. These intracellular organelles generate energy from food macromolecules across the Krebs cycle by oxidative phosphorylation. Energy is developed by converting adenosine triphosphate (ATP) to adenosine diphosphate (ADP). It is essential, for adequate mitochondrial energy production in the form of ATP, to have the right number of well-functioning mitochondria and the right amount of oxygen (O2) available. Unfortunately, the aging process and the chronic diseases that arise over the years are associated with a reduction in the number of mitochondria and their insufficient functioning. Among the chronic diseases related to significant damage of the arteries with a reduction in the supply of O2, there is atherosclerosis, where the process of atherothrombosis occurs. To keep our organs well-functioning despite aging, we must therefore protect our mitochondria and arteries. This can be achieved by intervening early in prevention with a lifestyle correction and diet integration with effective natural substances or, in some cases, with drugs. Among the many natural substances that have good scientific support, we have chosen four that have demonstrated benefits in the absence of side effects and that we know best: quercetin and pyrroloquinoline quinone to stimulate mitochondrial biogenesis and mitophagy, while L-arginine and nattokinase to protect the arteries from atherothrombosis.

L-Carnitine (LC) is integral to energy production and fatty acid metabolism, facilitating the transport of long-chain fatty acids into mitochondria for β-oxidation. It modulates metabolic pathways, including pyruvate dehydrogenase activity, proteolysis, and protein synthesis, while also having anti-inflammatory and antioxidant characteristics. LC can be commonly applied to win the battle against HIV and cancer cachexia. Also, it can be recruited with the aim of improving physical and cognitive functions in athletes and the elderly. Despite these benefits, long-term LC administration has been associated to cardiovascular risks due its conversion to trimethylamine-N-oxide (TMAO) by the gut microbiota. Elevated TMAO levels are linked to atherosclerosis, oxidative stress, and an increased risk of cardiovascular disease, diabetes, and chronic kidney disease. Managing TMAO levels using dietary treatments and gut microbiota-targeting techniques, such as probiotics, may reduce these risks. This comprehensive review presents the state-of-the-art information on LC’s dual role, emphasizing the balance between its therapeutic potential and the risks of prolonged supplementation. It aims to guide clinicians and researchers in optimizing LC’s benefits while addressing its long term cardiovascular safety concerns.