Heart failure is a leading cause for hospitalisation and for readmission, especially in patients over the age of 65. Diabetes is an increasingly common companion to heart failure. The presence of diabetes and its associated comorbidity increases the risk of adverse outcomes and premature mortality in patients with heart failure. In particular, patients with diabetes are more likely to be readmitted to hospital soon after discharge. This may partly reflect the greater severity of heart disease in these patients. In addition, agents that reduce the chances of readmission such as β-blockers, renin-angiotensin-aldosterone system blockers, and mineralocorticoid receptor antagonists are underutilised because of the perceived increased risks of adverse drug reactions and other limitations. In some cases, readmission to hospital is precipitated by acute decompensation of heart failure (re-exacerbation) leading to pulmonary congestion and/or refractory oedema. However, it appears that for most of the patients admitted and then discharged with a primary diagnosis of heart failure, most readmissions are not due to heart failure, but rather due to comorbidity including arrhythmia, infection, adverse drug reactions, and renal impairment/reduced hydration. All of these are more common in patients who also have diabetes, and all may be partly preventable. The many different reasons for readmission underline the critical value of multidisciplinary comprehensive care in patients admitted with heart failure, especially those with diabetes. A number of new strategies are also being developed to address this area of need, including the use of SGLT2 inhibitors, novel nonsteroidal mineralocorticoid antagonists, and neprilysin inhibitors.

The concept of resistant hypertension may be changed during pregnancy by the physiological hemodynamic changes and the particularities of therapy choices in this period. This review discusses the management of pregnant patients with preexisting resistant hypertension and also of those who develop severe hypertension in gestation and puerperium.

Chronic kidney disease (CKD) is recognized as a worldwide epidemic. Hypertension commonly coexists with CKD and its prevalence is progressively increasing as kidney function declines.

Our aim is to describe the characteristics of the patients receiving sacubitril/valsartan (SV) in daily clinical practice. This is a prospective registry in 10 hospitals including all patients who started SV in everyday clinical practice.From October 2016 to March 2017, 427 patients started treatment with SV. The mean age was 68.1±12.4 years and 30.5% were women (22.0% in PARADIGM-HF, p<0.001). Comparing our cohort with patients included in PARADIGM-HF, baseline treatment was different, with a lower ratio of angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (2.7 Vs. 3.5, p<0.001), and a higher proportion of patients with implantable cardioverter defibrillator (53.8 vs. 15%, p <0.001), and cardiac resynchronization therapy (25.8% vs. 5%, p<0.001). Treatment with mineralocorticoids receptor antagonists was more frequent (76.7% vs. 60.0%, p <0.001) and the use of beta-blockers was similar (94.6% vs. 93.0%, p=0.43). We observed more patients in functional class III-IV (30.4 vs. 24.8, P=0.015), higher levels of Nt pro-BNP (3421 [904 - 4161] vs. 1631 [885 - 3154] pg/mL) and worse renal function (creatinine level 1.3±0.7 vs. 1.1±0.3 mg/dL, p<0.001).In real life, patients receiving SV have a higher risk profile than in the pivotal trial, poorer functional class, higher levels of natriuretic peptides, and worse renal function.