Clinical Hypertension最新文献

[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.

Although some evidence shows the beneficial effects of meal replacement (MR) on blood pressure (BP) and inflammation as one of the main factors of cardiovascular disease, there are still no comprehensive findings in this field. Therefore, we investigate the effects of total and partial MRs on BP and C-reactive protein (CRP) in this comprehensive study and meta-analysis. In order to identify all randomized controlled trials that investigated the effects of MRs on BP and CRP levels, a systematic search was conducted in the original databases using predefined keywords. The pooled weighted mean difference (WMD) and 95% confidence intervals (CIs) were computed using the random-effects model. Forty studies were included in this article. The findings indicated significant reductions in systolic blood pressure (SBP) (WMD, -2.51 mmHg; 95% CI, -3.48 to -1.54; P < 0.001), diastolic blood pressure (DBP) (WMD, -1.43 mmHg; 95% CI, -2.02 to -0.85; P < 0.001), and CRP (WMD, -0.50 mg/L; 95% CI, -0.89 to -0.11; P = 0.012) levels following MR consumption compared to the control group. The findings obtained from the subgroup analysis showed that MRs cause a greater reduction in SBP in people over 50 years of age, and the duration of the intervention ≤ 24 weeks. Also, the subgroup analysis shows the greater effect of DBP and CRP, respectively, in the type of intervention with total meal replacement and less equal to 50 years. In conclusion, it appears that MR, along with other lifestyle factors, can lead to significant improvements in BP and CRP.

Background: Poor adherence to antihypertensive medication remains a significant barrier to blood pressure control in young patients. The objective of this study was to identify factors associated with antihypertensive medication adherence among young adults with hypertension.

Methods: From the Korean National Health Insurance Service database, we included 141,132 participants aged 20 to 39 years (80.4% male), without cardiovascular disease, who initiated antihypertensive medication between 2013 and 2018. Participants were categorized as exhibiting good adherence (proportion of days covered [PDC] ≥ 0.8) or poor adherence (PDC < 0.8) to antihypertensive medication during the first year of treatment. We investigated the associations of demographic, lifestyle, and clinical factors with good medication adherence based on logistic regression analysis.

Results: Only 43.3% (n = 61,107) of young adults with hypertension showed good adherence to antihypertensive medication. Male sex, older age, higher income, urban residence, non-smoking, and higher physical activity were associated with good medication adherence. Initial combination therapy, especially with single-pill combination (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.07-1.18), was associated with good adherence. Among patients under monotherapy, initial use of renin-angiotensin blockers (OR, 5.24; 95% CI, 4.47-6.15) or calcium-channel blockers (OR, 4.07; 95% CI, 3.47-4.78) was associated with better adherence than initial diuretics.

Conclusions: Although antihypertensive medication adherence is generally poor among young adults, we identified potential demographic and clinical factors associated with good adherence to antihypertensive treatment. Initial use of a single-pill combination may promote adherence in young patients, and its long-term clinical outcomes warrant further investigation.

Background: Despite extensive research on blood pressure (BP) progression, the impact of cardiometabolic risk factors on different stages of hypertension (HTN) remains poorly understood. This study aimed to investigate how these factors affect HTN progression.

Methods: A community-based study of 1,740 women aged > 20 years was followed from 1999 to 2019. A multi-state model with six transitions was employed to analyze the data.

Results: Our findings revealed that the hazard of transition from normal BP to elevated BP intensified by age (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.04-1.08), body mass index (BMI) (HR, 1.07; 95% CI, 1.04-1.09), and a family history of HTN (HR, 2.65; 95% CI, 1.27-5.38). In addition, age (HR, 1.04; 95% CI, 1.01-1.06), BMI (HR, 1.03; 95% CI, 1.01-1.07), and parity (HR, 0.87; 95% CI, 0.77-0.97) were significantly associated with the hazard of transition from normal BP to HTN stage 1. BMI was the only risk factor in the transition from normal BP to HTN stage 2 (HR, 1.12; 95% CI, 1.01-1.24). Moreover, the family history of HTN (HR, 3.01; 95% CI, 1.02-6.83) and the type 2 diabetes mellitus (T2DM) (HR, 3.98; 95% CI, 1.81-7.73) were strongly related to the transition risk from elevated BP to HTN stage 1. Furthermore, T2DM (HR, 3.21; 95% CI, 1.11-7.26) and menopausal status (HR, 3.33; 95% CI, 1.11-7.95) were significantly associated with an increased risk of progression from HTN stage 1 to HTN stage 2.

Conclusions: This study demonstrates that age, BMI, and family history of HTN are key risk factors for the initial progression of HTN in women with normal BP, whereas T2DM and menopausal status play a more critical in the progression to higher stages of HTN.

Background: The distribution of cardiovascular health (CVH) and its association with vascular health among Asian adolescents is understudied. We examined the distribution of optimal CVH metrics and their association with carotid intima-media thickness (cIMT) in Korean adolescents.

Methods: We analyzed data from a cohort of 694 healthy Korean adolescents with an average follow-up period of 2.4 years. CVH scores were assessed at baseline and follow-up using 6 metrics from Life's Essential 8 (LE8), excluding diet and sleep. Additionally, we developed an experimental set of 7 metrics by incorporating a psychological health indicator. We examined the association between CVH and cIMT using 2 approaches: 1) aggregated CVH, calculated as the average of the 2 time points, and 2) changes in CVH over time. High cIMT, defined as the highest sex-specific quartile measured at the follow-up visit, was analyzed using multivariable logistic regression.

Results: Among participants (mean age, 15.9 years at baseline), approximately 25% maintained an optimal-level CVH, with physical activity being the most challenging metric. Higher CVH was associated with lower odds of high cIMT; gradually decreasing odds according to higher aggregated CVH were evident. Maintaining optimal CVH resulted in 50% lower odds of high cIMT compared to those with persistently suboptimal CVH. The results remained consistent when the psychological health metric was incorporated into CVH.

Conclusions: Among Korean adolescents, CVH scores for 6 of LE8 metrics, excluding diet and sleep, were comparable to those of non-Hispanic Asian adolescents in the U.S. Higher CVH was associated with lower odds of high cIMT at age 18.

Background: In order to ascertain the impact of the Dietary Approach to Stop Hypertension (DASH) diet on blood pressure (BP), a systematic review and meta-analysis of randomized controlled trials were carried out. DASH is advised for lowering BP.

Methods: Scopus databases were searched from the beginning of 2024. A total of 579 articles from 2019 to 2023 from PubMed: 15, Scopus: 164 and Crossref: 400. There were 8 articles included in the meta-analysis.

Results: Systolic BP (1.29 mmHg to 4.6 mmHg, 95% CI, -2.17, -0.41; P < 0.005) and diastolic BP (0.76 mmHg to 1.1 mmHg, 95% CI, -1.39, -0.13; P < 0.005) were found to be significantly reduced by the DASH diet, while total cholesterol concentrations (5.2 mmol/L; P < 0.005), low-density lipoprotein (8.2 mmol/L; P = 0.03), and high-density lipoprotein increased by 8.2% (P < 0.005) were lowered by 0.9 points.

Conclusions: When followed consistently, the DASH diet can reduce BP's systolic and diastolic readings.

Trial registration: PROSPERO Identifier: CRD42023494005.

Background: This study evaluated the effectiveness of inspiratory muscle strength training (IMST) as a time-efficient alternative to widely recommended aerobic exercise (AE) for reducing and maintaining blood pressure in hypertensive patients.

Methods: Twenty-eight hypertensive patients (aged 61 ± 7 years) were randomly assigned to IMST (n = 14) and AE (n = 14) groups. The IMST performed 30 breaths/session at 75% of maximal inspiratory pressure (PI_max), totaling about 8 minutes, 5 days/week. The AE group exercised at 70% of heart rate reserve for 30 minutes/session, 5 days/week. Both supervised interventions lasted 8 weeks, followed by a 4-week detraining period. Brachial and central systolic blood pressure (SBP) were taken at baseline, 8-week post-intervention, and post-detraining.

Results: The mean (standard deviation) change in brachial SBP from baseline to 8 week post-intervention significantly decreased in both the IMST group [-9.1 (12.1) mmHg, P = 0.01] and the AE group [-6.2 (7.2) mmHg, P = 0.01], with no significant difference between groups (P = 0.46). Central SBP also significantly reduced in the IMST group [-9.0 (11.9) mmHg, P = 0.01] and in the AE group [-5.7 (6.2) mmHg, P = 0.01], with no significant difference between groups (P = 0.37). However, the IMST group did not show significant persistence in SBP reduction, whereas the AE group did.

Conclusions: Both IMST and AE effectively reduced brachial and central BP after 8-week interventions in hypertensive patients. While IMST presents a time-efficient adjunctive option to AE, its long-term effectiveness remains uncertain.