Clinical Hypertension最新文献

Background: This cross-sectional study investigated the multi-stage and phenotype-specific association between urine-estimated salt intake and hypertension (HTN) in the Tehran Lipid and Glucose Study.

Methods: Adult participants (n = 1,782, mean age of 43.0 ± 13.7 years and 46.0% were men) were recruited (2015-2017) for 24-hour urine (24hU)-estimated salt intake and blood pressure (BP) measurements. Multivariable-adjusted multinomial logistic regression was used to estimate the association between 24hU-estimated salt intake (quintile categories and per each 1 g increment over recommended level) and HTN stages (Pre-HTN, stage 1 [S₁-HTN], and stage 2 [S₂-HTN]) and HTN phenotypes (isolated systolic HTN [ISH], isolated diastolic HTN [IDH], and systolic-diastolic HTN [SDH]).

Results: The prevalence of Pre-HTN, S₁- and S₂-HTN was 5.7%, 29.3%, and 9.1%, respectively. The prevalence of ISH, IDH, and SDH was 2.5%, 27.9%, and 8.0%, respectively. 24hU-estimated salt intake > 10.9 vs. < 6.7 g/day was associated with an elevated probability of Pre-HTN and S₁-HTN, IDH, and SDH by 2.50, 1.65, 1.74, and 2.03-fold, respectively. Every 1 g-increment of salt intake over 5 g/day was associated with an increased chance of having Pre-HTN, S₁-HTN, and IDH by 15%, 8%, and 8%, respectively.

Conclusions: The contribution of high salt intake to the development of HTN might be more pronounced during the initial stages of BP elevation, potentially impacting diastolic BP to a greater extent than systolic BP.

Background: The aim of this study was to determine the association between low density lipoprotein cholesterol (LDL-C) and risks of stroke and mortality in the hypertensive patients with high risk of atherosclerotic cardiovascular disease (ASCVD).

Methods: A total of 19,507 hypertensive patients with high risk of ASCVD from the Kailuan cohort study were included in the present study. Patients were categorized into 5 groups by the levels of LDL-C: < 1.40 mmol/L (55 mg/dL), 1.40-1.79 mmol/L (55-69 mg/dL), 1.80-2.59 mmol/L (70-99 mg/dL), 2.60-3.39 mmol/L (100-130 mg/dL), and ≥ 3.40 mmol/L (131 mg/dL). The primary outcomes of this study included hemorrhagic stroke (HS), ischemic stroke (IS), and all-cause mortality. Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of incident HS, IS, and all-cause mortality among hypertensive patients with high risk of ASCVD across LDL-C groups.

Results: During a median follow-up of 15.81 years, 3,055 cases of stroke (including 500 cases of HS and 2,555 cases of IS) and 5,340 cases of all-cause mortality were documented. Patients with LDL-C < 1.40 mmol/L had the highest incidences of HS and all-cause mortality among the 5 LDL-C groups. After adjusting for potential confounders, the HRs of HS, IS, and all-cause mortality were 1.34 (95% CI, 1.01-1.80), 1.08 (95% CI, 0.94-1.24), and 1.10 (95% CI, 1.01-1.21) for patients with LDL-C < 1.40 mmol/L compared with those with LDL-C 1.80-2.59 mmol/L. Similar results were generated across LDL-C groups with several sensitivity analyses.

Conclusions: LDL-C < 1.40 mmol/L was associated with increased risk of HS and all-cause mortality in hypertensive patients with high-risk of ASCVD.

Background: Although the association between C-reactive protein (CRP) and hypertension has been acknowledged, the associations between parental high-sensitive CRP (hs-CRP) levels and offspring hypertension remain unexplored. To investigate the relationship between parental and offspring hs-CRP levels, as well as the association between parental hs-CRP levels and offspring hypertension.

Methods: We included 6,848 father-offspring and 1,588 mother-offspring pairs from the Kailuan study. Time-weighted average hs-CRP (TWA-CRP) was calculated by cumulative hs-CRP/Time_start-end. Hypertension were defined as systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg. The generalized estimating equation model was used to explored the relationship between parental TWA-CRP and offspring TWA-CRP, and the association between parental TWA-CRP and offspring hypertension. The Cox proportional hazard model was applied to examine the relationship between offspring TWA-CRP and hypertension risk.

Results: The regression coefficient and 95% confidence intervals (CIs) for offspring TWA-CRP were 0.50 (0.38-0.62) in father-offspring pairs and 0.53 (0.29-0.76) in mother-offspring pairs with high parental TWA-CRP. The odds ratios (ORs) and 95% CIs for offspring hypertension were 1.30 (1.11-1.52) in father-offspring pairs and 1.32 (0.95-1.84) in mother-offspring pairs with high parental TWA-CRP. When both parent and offspring had a high TWA-CRP, the ORs (95% CIs) for offspring hypertension were 1.92 (1.43-2.56) in father-offspring pairs and 2.44 (1.35-4.35) in mother-offspring pairs. The hazard ratios and 95% CIs for offspring hypertension were 1.43 (1.15-1.76) in father-offspring pairs and 2.48 (1.18-5.22) in mother-offspring pairs with high offspring TWA-CRP.

Conclusions: Parental high TWA-CRP may increase the risk of offspring hypertension.

Trial registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000029767.

Background: Hypertension, a significant risk factor for global public health, is well-known to be preventable and manageable through physical activity (PA). However, many studies suggest that excessive PA may not provide additional benefits. Thus, we aimed to conduct a quantitative analysis of the relationship between hypertension and PA levels.

Methods: This study analyzed the association between PA and hypertension using data from 2,429,588 South Korean adults aged 30 years and older from the Korean Community Health Survey conducted from 2009 to 2022. We used weighted binary logistic regression and generalized additive models to examine the relationship, adjusting for various sociodemographic factors. PA was categorized into moderate-intensity PA (MPA) and vigorous-intensity PA (VPA) based on World Health Organization guidelines to study the association between hypertension and PA intensity.

Results: The greatest reduction in hypertension risk was associated with 1,090 metabolic equivalent of task (MET) minutes per week, with no additional reduction beyond this point. Additionally, MPA (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.90-0.93) had a stronger association with reducing hypertension risk compared to VPA (OR, 0.95; 95% CI, 0.94-0.97) at higher levels of PA (> 1,800 MET minutes per week). Subgroup analyses showed that older age, lower education level, and lower income were associated with greater reductions in hypertension risk at the same PA levels.

Conclusions: Moderate amounts of PA are associated with a lower risk of hypertension, but additional activity beyond this may not provide further benefits. With a high amount of PA, MPA is more effective than VPA in reducing hypertension risk. Since the effectiveness of PA in preventing hypertension varies across different sociodemographic factors, appropriate policies tailored to specific groups are necessary.

Hypertensive disorders of pregnancy (HDPs) are the leading cause of global maternal mortality and morbidity. Moreover, HDP is associated with an increased risk of cardiovascular disease later in the lives of affected women. The prevalence of hypertension during pregnancy is expected to increase as women's age at first pregnancy rises, as does the prevalence of cardiovascular comorbidities such as obesity, maternal diabetes, and hypertension. Due to a lack of data, there has been controversy over the optimal treatment for HDP. The purpose of this review is to address the management of HDP in pregnant women before, during, and after pregnancy as well as its definition and pathophysiology, including recent trials and updated guidelines.

Background: This study aimed to evaluate the progress of treatment with intensive targeted therapy in high-risk pulmonary arterial hypertension (PAH) patients and focused on setting an appropriate hemodynamic target of pulmonary vascular resistance (PVR) ≤4 Wood units (WU) and mean pulmonary arterial pressure (mPAP) ≤ 40 mmHg.

Methods: We retrospectively evaluated high-risk PAH patients who were administered treprostinil at a single tertiary pulmonary hypertension center between January 2020 and December 2022. Echocardiography, right heart catheterization, 6-minute walk distance (6MWD), and blood tests were obtained 6 and 12 months after the initiation of parenteral treprostinil administration.

Results: Twelve patients (1 male and 11 female; median age, 47.0 years [interquartile range, 33.8-49.8 years]) were included. Five of the 12 patients had 6- and 12-month follow-up data. The median PVR decreased by 22.9% at 6 months and 50.6% at 12 months compared to baseline. The median mPAP decreased by 24.6% at 6 months and 29.8% at 12 months. Importantly, the 6MWD showed a significant improvement of 55.7%, and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels demonstrated a notable decrease of 16.0%, reflecting substantial enhancements in patients' functional status and heart health. Three of these 5 patients reached the hemodynamic target by 12 months and successfully transitioned from parenteral treprostinil to oral selexipag.

Conclusions: This study showed that 3 of 5 patients (60.0%) with high-risk PAH reached PVR ≤ 4 WU and/or mPAP ≤ 40 mmHg by receiving intensive parenteral treprostinil therapy with significant improvements in 6MWD and NT-proBNP levels, and successfully transitioned to oral selexipag. We proposed that transition strategies from parenteral treprostinil to selexipag aiming at hemodynamic targets.

Background: Our study investigates the temporality of factors that modulate the risk for developing hypertension (HTN) among patients with obstructive sleep apnea (OSA) without preexisting HTN at baseline.

Methods: Our cohort consisted of OSA cases (based on International Classification of Diseases, 9th/10th Revision) with 20 common comorbidities selected using a previously validated electronic health record (EHR)-based algorithm. We constructed a survival model to estimate time-to-first HTN diagnosis (among patients with OSA without preexisting HTN). Our survival model included those comorbidities along with sex, body mass index, race, and age. We also performed a validation of the date of diagnosis of OSA and HTN identified from our algorithm by utilizing chart reviews in 400 randomly chosen EHR-defined cases.

Results: Among 53,035 OSA cases diagnosed between 2012 and 2021, 31,741 cases (59.8%) were without preexisting HTN at the date of OSA diagnosis and thus met our inclusion criteria. Within our survival cohort, 15,830 OSA cases (50.1%) did not develop HTN. Cardiovascular conditions (including atrial fibrillation, coronary atherosclerosis, hypercholesterolemia, diabetes), tobacco use, anemia, osteoarthrosis, and gastroesophageal reflux disease were observed to increase risk of incident HTN. Allergic rhinitis, fatigue, joint pain, and vitamin D deficiency did not increase risk of incident HTN. Chart review demonstrated diagnoses of OSA and HTN were documented in notes a median of 38 days and 738 days, respectively, prior to being coded in the EHR.

Conclusions: In a large EHR sample, we identified conditions that are associated with increased risk of incident HTN among patients diagnosed with OSA. These findings may help guide counseling efforts among patients newly diagnosed with OSA regarding factors that may modulate risk for developing HTN.

Background: Essential hypertension is a most prevalent global health concern. Despite extensive research, the exact mechanisms contributing to essential hypertension remain unclear. Several factors contribute to the pathogenesis of essential hypertension. Klotho, a membrane-bound and soluble protein, has been found to modulate hypertension through physiological processes like vascular function and sodium balance. This study aimed to determine the association of klotho protein with essential hypertension.

Methods: The study included 164 hypertensive cases and 164 normotensive controls, after imposing certain inclusion and exclusion criteria with written consent from all subjects. Subject's details were obtained using structured proforma to account for potential confounding variables. To estimate klotho protein activity using sandwich enzyme-linked immunosorbent assay, 2 mL blood was collected in a plain vial. All data were tested at a 5% significance level.

Results: The analysis revealed a significant decrease in klotho protein levels in cases compared to controls (1.52 ± 0.87 vs. 2.45 ± 0.90, P < 0.001), suggesting an inverse relationship of klotho protein with risk of essential hypertension. All indices in the structural equation model have suggested that the final model fitted the data reasonably (chi-square to df ratio, 1.153; goodness of fit index, 0.990; adjusted goodness of fit index, 0.945; normed fit index, 0.936; standardized root mean square residual, 0.953; root mean square error of approximation, 0.031). Also, klotho was negatively associated with blood pressure. The area under the receiver operating characteristic curve for klotho and blood pressure was 0.765 (95% confidence interval, 0.716-0.815; P < 0.001).

Conclusions: Klotho levels were significantly reduced in essential hypertension cases compared to controls, Also, klotho had a negative direct association with essential hypertension indicating a potential role for klotho as a prognostic and predictive marker for essential hypertension. This suggests that klotho may have a role in the pathogenesis of essential hypertension. Understanding klotho's role in essential hypertension may lead to the development of novel therapeutic strategies for this disease.

Background: We aimed to assess the incidence of infective endocarditis (IE) and evaluate the impact of hypertension (HTN) with underweight on the risk of IE among patients with diabetic mellitus (DM) using a nationwide population-based cohort in Korea.

Methods: We identified 2,603,012 participants (57.4 ± 12.3 years) in the national health insurance database. Of these, 374,586 were normotensive, 750,006 were at pre-HTN status, and the remainder had HTN. The risk of IE was compared between the groups, and the impact of being underweight (body mass index < 18.5) was also evaluated.

Results: During follow-up (7.14 years; interquartile range 6.01-8.08 years), 1,703 cases of IE occurred; 168 (0.0647 person per 1000 person-years [PY]), 303 (0.05836 per 1000 PY), and 1,232 (0.12235 per 1000 PY) in normotensive, pre-HTN and HTN group, respectively. Hypertensive participants presented a higher risk of IE (subdistribution hazard ratio, 1.360; 95% confidence interval, 1.152-1.607) than normotensive participants. Being underweight increased the risk of IE by 90% among subjects with HTN. In subgroup analysis, age, duration of DM, insulin use, and habitual factors were not associated with the incidence of IE.

Conclusions: Diabetic patients may require rigorous blood pressure control and simultaneous avoidance of excessive weight loss to prevent IE.

Background: The triglyceride-glucose (TyG) index is an alternative biomarker of insulin resistance that may be associated with elevated blood pressure. However, the relationship between the TyG index and the risk of prehypertension remains unclear. This longitudinal, retrospective cohort study aimed to investigate the connection between the TyG index and the risk among Japanese population.

Methods: We enrolled 17,758 participants who underwent medical health checkups in 2017 (baseline) and 2022. At baseline, all participants were normotensive and normoglycemic state, and none were using triglyceride-lowering medications. Participants were divided into four groups according to quartiles of the TyG index at baseline. The risk of progressing to prehypertension was evaluated using multivariable Cox proportional hazard models. In addition, multivariate restricted cubic spline analysis was conducted to examine the dose-response relationship. Furthermore, receiver operating characteristic (ROC) curve analysis was performed to determine the predictive value of the TyG index for progression to prehypertension.

Results: Compared with the lowest quartile (Q1) of the TyG index group, the adjusted hazard ratios (95% confidence intervals) for progression to prehypertension in the Q2, Q3, and Q4 groups were 1.05 (0.95-1.19), 1.14 (1.02-1.30), and 1.28 (1.11-1.50), respectively. The restricted cubic spline analysis demonstrated a dose-response relationship between the TyG index and the risk of prehypertension. The area under the ROC curve was 0.60 (0.59-0.61), demonstrating a sensitivity of 56.2% and specificity of 58.8%.

Conclusions: The findings suggest that an elevated TyG index may be independently and positively associated with an increased risk of progression to prehypertension in the Japanese population.