Clinical Hypertension最新文献

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.].

[This corrects the article 6 in vol. 30, PMID: 38424656.].

Background: Cuffless blood pressure (BP) measurement devices integrated into smartwatches have gained prominence, yet limited studies provide the feasibility and preciseness of daily BP monitoring. Here, we evaluated the trackability of daily BP variance and the precision of the calibration process.

Methods: We collected the data from 896 participants, reporting 35,592 BP values, and body composition analysis data measured by the Samsung Galaxy Watch 6 device. Participants were instructed to measure BP daily, in the morning (5 AM-9 AM) and evening (6 PM-10 PM) for 2 weeks, with initial calibration and re-calibration after the first week. Body composition data, obtained using the Galaxy Watch's bioelectrical impedance analysis sensor, was measured voluntarily during the campaign without specific time constraints.

Results: With BP readings collected using smartwatches, morning and evening BP values showed a significant difference, higher in the evening by 1.42 ± 5.25 mmHg (P < 0.05). Basal metabolic rate, skeletal muscle mass, total body water, morning systolic BP, morning pulse pressure, and morning heart rate were significantly associated with higher difference in morning-evening BP. The calibration stability was assessed by the difference in average BP before and after calibration, showing a substantial pre-post calibration BP difference by 4.64 ± 4.73 mmHg of systolic BP and 3.66 ± 3.62 mmHg of diastolic BP.

Conclusions: In conclusion, watch-based devices may not detect clinical-level BP variability, and substantial extent of pre-post calibration error has to be solved for their utility in regular real-life BP monitoring.

Background: Renin-angiotensin system (RAS) inhibitors have shown potential chemopreventive effects against colorectal cancer (CRC). However, little is known about the impact of RAS inhibitors on the risk of colorectal precancerous lesions.

Methods: Preclinically, we established mouse models of colitis-associated colon cancer and xenografts: vehicle, 1 mg/kg, 5 mg/kg enalapril groups. Body weight, colon length, and colorectal tumor size were evaluated on the euthanization day. Clinically, we retrospectively recruited 8,388 asymptomatic adults undergoing their first-ever colonoscopy for health check-ups (index cohort). From the index cohort, we selected individuals undergoing follow-up colonoscopy (follow-up cohort). The study outcome was incidental and recurrent colorectal neoplasms, including CRC. We evaluated the prevalence and risk of colorectal neoplasms associated with RAS inhibitor use of ≥ 1 year.

Results: In the experimental study, enalapril administration significantly attenuated weight loss and colon shortening, reduced tumor numbers in colitis-associated colon cancer models, and decreased tumor volume in the xenografts. In the index cohort, while the initial analysis showed a positive association with the RAS inhibitor use (unadjusted odds ratio [OR], 1.22), this shifted toward an inverse trend after adjusting for confounders (adjusted OR, 0.91). During follow-up (median, 41.0 months), incidental and recurrent colorectal neoplasms were less common in the RAS inhibitor group (32.6%) than in the other anti-hypertensives group (39.1%) (P < 0.001), despite similar intervals between the index and follow-up endoscopies. In the follow-up cohort, hypertension itself was a risk factor for colorectal neoplasm development (adjusted hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.00-2.53; P = 0.049), whereas RAS inhibitor use was significantly associated with a 27% lower risk (adjusted HR, 0.73; 95% CI, 0.59-0.95; P = 0.035).

Conclusions: Long-term, regular use of RAS inhibitors independently reduces the risk of colorectal neoplasms, irrespective of dosage or drug type. Given their potential chemopreventive effects on colorectal neoplasms, RAS inhibitors may serve as a preventive strategy starting from the precancerous stage.

Recent studies have renewed the debate over optimal systolic blood pressure (SBP) targets in hypertensive patients, particularly those at increased cardiovascular (CV) risk and with type 2 diabetes mellitus (T2DM). The Effects of Intensive Systolic Blood Pressure Lowering Treatment in Reducing Risk of Vascular Events (ESPRIT) and Blood Pressure Control Target in Diabetes (BPROAD) randomized controlled trials, both conducted in Chinese populations, offer new insights into intensive versus standard SBP-lowering strategies. ESPRIT enrolled 11,255 patients with high CV risk (including 38.7% with T2DM), while BPROAD included 12,821 hypertensive patients with T2DM and elevated CV risk. Both trials compared intensive SBP lowering (< 120 mmHg) with standard treatment (< 140 mmHg). Results from both studies showed that intensive treatment significantly reduced the incidence of major adverse cardiovascular events (MACE). ESPRIT reported a hazard ratio (HR) of 0.88 for MACE, along with notable reductions in CV and all-cause mortality. BPROAD similarly found a HR of 0.79 for MACE, although it did not demonstrate a statistically significant benefit in all-cause mortality. However, intensive treatment in both trials was associated with higher-though relatively low-absolute rates of adverse events, including hypotension, syncope, and renal impairment. When considered alongside previous trials, our meta-analysis suggests a consistent reduction in MACE risk with intensive SBP control. Nevertheless, concerns remain regarding the safety profile and generalizability of these findings, particularly given that both ESPRIT and BPROAD were limited to ethnically Chinese cohorts and reported unusually low adverse event rates compared to Western studies. In summary, the cumulative evidence suggests that an SBP target < 140 mmHg may be suboptimal. However, whether a target < 120 mmHg is superior to the current guideline-recommended range of 120-129 mmHg remains uncertain. No trials have directly compared < 120 mmHg with < 130 mmHg. Therefore, future research should determine whether the additional benefits of more aggressive SBP lowering outweigh potential risks, especially in diverse populations with and without diabetes.