Clinical Hypertension最新文献

Background: This systematic review aimed to evaluate the clinical effectiveness of sesame supplementation on cardiovascular health parameters in pre-hypertensive and hypertensive individuals.

Methods: A systematic search was conducted up to August 2024.Eligible studies evaluated the effects of sesame supplementation on blood pressure, anthropometric indices, lipid profiles, and oxidative stress markers. Study quality and evidence strength were assessed using the Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, respectively.

Results: Six trials, with interventions ranging from 4 to 8 weeks and involving 465 participants, reported reductions in body mass index (weighted mean difference [WMD], -3.00 kg/m²; 95% confidence interval [CI], -3.43 to -2.57; P < 0.001), weight (WMD, -7.51 kg; 95% CI, -8.64 to -6.37; P < 0.001), diastolic blood pressure (WMD, -16.29 mmHg; 95% CI, -25.37 to -7.22; P < 0.001), systolic blood pressure (WMD, -20.78 mmHg; 95% CI, -32.26 to -9.31; P < 0.001), high-density lipoprotein cholesterol (WMD, 2.21 mg/dL; 95% CI, 0.09 to 4.33; P = 0.041), total cholesterol (WMD, -49.29 mg/dL; 95% CI, -96.71 to -1.86; P = 0.042), triglycerides (WMD, -55.05 mg/dL; 95% CI, -79.51, -30.59; P < 0.001), catalase (WMD, 3.38 U/mg of protein; 95% CI, 3.24 to 3.52; P < 0.001), erythrocyte glutathione peroxidase (WMD, 0.93 U/min/mg of hemoglobin [Hb]; 95% CI, 0.38 to 1.47; P = 0.001), erythrocyte superoxide dismutase (WMD, 3.11 U/ mg of Hb; 95% CI, 2.92 to 3.29; P < 0.001), and thiobarbituric acid reactive substances (WMD, -2.94 nmol/dL; 95% CI, -3.99 to -1.89; P < 0.001). In contrast, no significant effects were observed on low-density lipoprotein cholesterol or malondialdehyde). However, the GRADE assessment rated the evidence as very low across all outcomes due to high heterogeneity, small sample sizes, and methodological limitations, rendering the clinical plausibility of these findings uncertain.

Conclusions: While sesame supplementation showed apparent improvements in several cardiovascular risk factors, the very low certainty of evidence, driven by study limitations and implausible effect sizes, precludes definitive conclusions. High-quality, well-designed randomized controlled trials are needed to clarify sesame's therapeutic role in prehypertension and hypertension.

Trial registration: PROSPERO Identifier: CRD42025634033.

Background: This study aimed to evaluate the effects of the Dietary Approaches to Stop Hypertension (DASH) diet on blood pressure (BP) indices and urinary metabolites in overweight and obese children over an 8-week period.

Methods: In this triple-blind randomized controlled trial, 60 children (8-12 years) were assigned to a DASH or control group for 8-week. Urinary sodium (UNa), potassium (UK), creatinine, UNa-UK ratio, systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), mid-BP (MBP), mean proportional arterial pressure (MPAP), and pulse pressure were measured before and after the intervention. Twenty-four-hour UNa excretion and salt intake were estimated using the INTERSALT equation. Outcomes were analyzed using analysis of variance on an intention-to-treat basis.

Results: The mean age and body mass index of participants were 11.8 ± 0.8 years (69% girls) and 25.9 ± 3.52 kg/m², respectively. Fifty-eight children completed the study (29 per group). After 8-week, the DASH group showed significantly lower UNa (110 vs. 123 mmol/L), UNa-UK ratio (1.84 vs. 1.99 mmol/L), SBP (97.7 vs. 105 mmHg), DBP (68.9 vs. 64.6 mmHg), MBP (88.1 vs. 81.2 mmHg), MAP (81.6 vs. 75.6 mmHg), and MPAP (92.3 vs. 84.7 mmHg) compared with controls (P for all < 0.05). The mean change percent in UNa, UNa-UK ratio, SBP, MBP, MAP, and MPAP was significantly greater in the control group than in the DASH group (P for all < 0.05). Salt intake increased in the control group, but decreased in the DASH group (8.32 vs. -2.88 gr/day; P-value = 0.001).

Conclusions: The DASH diet improved BP indices and urinary metabolites in overweight and obese children, suggesting its potential as a non-pharmacological intervention for hypertension management in pediatric populations.

Trial registration: Iranian Registry of Clinical Trials Identifier: IRCT20240623062229N1.

Background: The increase in obesity is becoming a world-wide health issue. However, no prospective cohorts in East Asia have thoroughly explored comprehensive nutritional and multiomic data in individuals with obesity. This study is designed to establish an obesity cohort that constitutes clinical characteristics, nutritional status, laboratory profiles, metabolic complication studies, and multiomic profiles with the goal of artificial intelligence platform-based nutriomic analysis.

Methods: This study aims to enroll at least 400 obese adults (aged ≥ 19 years; body mass index ≥ 25 kg/m²) and 100 non-obese adults as controls. Obese participants have to have at least one of the following chronic metabolic diseases: hypertension, type 2 diabetes mellitus, cardiovascular disease, and metabolic syndrome. Participants will undergo assessment for demographic data, clinical, lifestyle, and dietary assessments, laboratory examination, coronary calcium/visceral fat scan, liver fibroscan, carotid ultrasound, and continuous glucose monitoring. Metabolite analysis will be conducted for blood/stool/urine/saliva samples. Deoxyribonucleic acid methylation analysis, peptidomic analysis, and lipidomic analysis will be performed on blood samples. Obese individuals will have annual study visits for collection of clinical measures and multiomics data over a 5-year period. Control individuals will have a baseline hospital visit with annual telephone follow-up for clinical event monitoring.

Conclusions: The strength of this cohort will be as follows. First, the cohort will enable the integration of nutritional intake data with other multiomics data for a comprehensive analysis. Second, inclusion of both obese individuals with various metabolic traits and non-obese individuals as controls is advantageous for studying a wide range of obesity phenotypes in comparison with non-obese conditions. Third, diverse modalities to assess metabolic and complication status will facilitate multifaceted analysis. Lastly, beyond the typical blood and stool samples in multiomic studies, the inclusion of urine, saliva, and skin samples will further refine obesity characterization.

The optimal blood pressure (BP) target in patients with type 2 diabetes mellitus (T2DM) continues to be debated. The 2022 guidelines from the Korean Society of Hypertension (KSH) recommend intensive BP lowering only for patients with diabetes who are at high cardiovascular (CV) risk. However, recent trials have demonstrated favorable outcomes associated with intensive BP lowering in T2DM. In response, the updated KSH consensus statements provide evidence-based recommendations supporting the implementation of intensive BP control strategies in hypertensive patients with diabetes, including those at low to moderate CV risk. The KSH consensus statements are as follows: 1) Hypertension is a common comorbidity of T2DM, with a prevalence of 59.6% among adults with diabetes aged 30 years and older in Korea. 2) In patients with T2DM, coexisting hypertension increases the risk of both macrovascular and microvascular complications; however, tight BP control reduces diabetes-related morbidity and mortality. 3) Recent guidelines advocate tailored BP targets based on individual CV risk profiles to balance treatment safety and effectiveness, and recommend a BP target of < 130/80 mmHg for patients with T2DM. 4) The BPROAD (Intensive Blood-Pressure Control in Patients with Type 2 Diabetes) trial provides the strongest evidence for intensive BP control in patients with T2DM, while the STEP (Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension) and the ESPRIT (Effects of Intensive Blood Pressure Lowering Treatment in Reducing the Risk of Cardiovascular Events) trials support intensive BP lowering in high-risk diabetic patients and extend the findings to broader high-risk populations, respectively. 5) A nationwide Korean study suggests that, if patients with T2DM can safely tolerate it, lower BP levels in patients with T2DM may provide protection even without established CV disease. 6) As white coat hypertension becomes more frequent following treatment in diabetic patients, precise BP measurement is essential to avoid overtreatment, particularly in real-world clinical settings. 7) The proportion of patients with T2DM who are at low to moderate risk is small. Accordingly, the updated consensus statement from the KSH recommends a target BP of 130/80 mmHg for most patients with T2DM, provided that this target is well tolerated.

Background: Blood pressure (BP) control remains a therapeutic challenge in kidney transplant recipients (KTRs). Sodium-glucose cotransporter-2 inhibitors (SGLT2is) lower BP in diabetic and chronic kidney disease patients. Whether this effect extents to KTRs remains to be fully established. We explored the BP lowering potential of SGLT2i, by examining their effects on BP and their influence on antihypertensive drugs prescriptions.

Methods: Using the French observational multicenter ASTRE database, we collected systolic BP (SBP), diastolic BP (DBP), weight and drugs, at baseline and at 3 and 6 months after SGLT2i initiation. To evaluate the impact of SGLT2i on other anti-hypertensive drugs management, we used metric such as the defined daily dose (DDD) and the hypertensive index (HTi).

Results: Two hundred thirty-four patients were included in the analysis, nearly all had hypertension and 63% had diabetes. By the 3-month mark, there was a significant 4 mmHg reduction in SBP and DBP, which was sustained at 6 months, with decreases of 2.5 mmHg and 3 mmHg (respectively for SBP and DBP). The DDD remained stable. HTi decreased by 14 and 9.5 points at 3 and 6 months, respectively. In multivariate analysis, female sex was associated with a more significant reduction in SBP and HTi.

Conclusions: In KTRs newly treated with SGLT2i, BP decreased at 3 and 6 months, while the overall antihypertensive load, as assessed by DDD, remained stable. Similar effects were observed on HTi. These findings suggest SGLT2i as an effective adjunctive therapy for lowering BP in hypertensive KTRs, regardless of diabetes status.

Background: Several inflammatory cytokines (ICs) have been implicated in the development of hypertensive disorders. This study aimed to establish a causal relationship between 91 ICs and hypertensive disorders using Mendelian randomization (MR).

Methods: Single nucleotide polymorphisms associated with 91 ICs, hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were obtained from publicly available genome-wide association studies. MR analyses were conducted using inverse variance weighting as the primary method, complemented by MR-Egger and weighted median approaches. Significant ICs were further analyzed through Gene Ontology, Kyoto Encyclopedia of Genes and Genomes (KEGG), and protein-protein interaction (PPI) network analyses.

Results: A total of 18 ICs exhibited significant associations with at least 1 hypertensive disorder, with 8, 7, 7, and 5 ICs associated with hypertension, SBP, DBP, and MAP, respectively. Among these, fibroblast growth factor 5 (FGF5) was uniquely associated with all 4 hypertensive conditions. Additionally, FGF5 was identified as a central hub in the PPI network. KEGG pathway analysis highlighted the involvement of the mitogen-activated protein kinase (MAPK) signaling pathway.

Conclusions: This study underscores the pivotal role of FGF5 and MAPK signaling pathway in the pathogenesis of hypertensive disorders. Targeting inflammatory pathways may offer therapeutic strategies for hypertension management.

Background: Hypertension is a common health issue among elderly populations, substantially increasing morbidity and mortality risks. This meta-analysis aimed to determine optimal systolic blood pressure (SBP) targets in elderly hypertensive patients and their effects on clinical outcomes.

Methods: We conducted a systematic search of PubMed, Embase, and the Cochrane Library to identify randomized controlled trials involving antihypertensive therapy in participants aged 60 years and older. Mortality, cardiovascular events, and significant adverse events data were extracted and analyzed using random-effects models.

Results: The analysis included 24 studies, with 9 specifically examining elderly participants aged 60 and older. Targeting a lower SBP of less than 140 mmHg was associated with significant reductions in primary outcome events (relative risk [RR], 0.69; 95% confidence interval [CI], 0.56-0.86), all-cause mortality (RR, 0.64; 95% CI, 0.49-0.83), cardiovascular mortality (RR, 0.59; 95% CI, 0.39-0.87), and stroke (RR, 0.68; 95% CI, 0.47-0.98; I² = 0%). Achieving an intensive SBP target in the pooled range less than 130 mmHg reduced the risks of primary outcome events (RR, 0.73; 95% CI, 0.62-0.85), heart failure (RR, 0.57; 95% CI, 0.38-0.84), and stroke (RR, 0.72; 95% CI, 0.53-0.96), though it also led to an elevated risk of hypotension (RR, 1.43; 95% CI, 1.18-1.73).

Conclusions: In elderly hypertensive patients, lower SBP targets correlate with improved clinical outcomes, including reduced mortality and cardiovascular events. Nonetheless, the heightened risk of adverse effects underscores the need for careful, individualized treatment strategies. Additional research is warranted to refine these targets and achieve a balance between therapeutic efficacy and safety.

[This corrects the article e8 in vol. 31, PMID: 40083595.].