Current Hypertension Reports最新文献

Purpose of review: Provide a synthesis of research from the past five years examining the relationship between insomnia, its phenotypes, and comorbidity with sleep apnea (COMISA), with hypertension. Offer a critical evaluation of current evidence and outline future research directions.

Recent findings: Meta-analytic evidence indicates that the risk of hypertension is higher in patients with insomnia disorder compared to those with insomnia symptoms, with the highest risk observed in the insomnia with objective short sleep duration phenotype. COMISA appears to further amplify this risk, although the evidence is limited to individual studies with no meta-analyses available. There is a clear need for clinical trials to confirm these associations and guide the development of more effective therapeutic strategies. Insomnia should be part of the diagnostic assessment of patients with hypertension. Objective sleep duration can serve as a biomarker, alongside respiratory indices, to guide therapeutic decision-making and optimize patient management.

Purpose of review: To discuss available data on renal denervation (RDN) for treating hypertension and how expanding access to RDN may improve rates of controlled hypertension while helping address hypertension treatment disparities.

Recent findings: RDN is an FDA-approved procedure for the treatment of patients with confirmed uncontrolled hypertension, with proven efficacy and safety in randomized sham-controlled trials. Centers for Medicare & Medicaid Services completed a national coverage analysis for RDN coverage for the treatment of uncontrolled hypertension. By summarizing the available data on RDN and hypertension statistics among different race and ethnicities in the United States, our review highlights the potential for RDN to improve treatment control rates, without increasing medication burden. By expanding coverage for the procedure, RDN may be an important tool to reduce significant treatment disparities in hypertension.

Hypertension affects over one billion individuals worldwide and remains the leading modifiable risk factor for cardiovascular disease. While first-line therapies including thiazide-type diuretics, angiotensin converting enzyme inhibitors / angiotensin receptor blockers, and calcium channel blockers can effectively control blood pressure in many patients, 10-20% develop resistant hypertension requiring additional therapeutic approaches. Steroidal mineralocorticoid receptor antagonists (MRAs) have emerged as essential fourth-line agents for resistant hypertension, with spironolactone demonstrating superior efficacy compared to other add-on therapies in the landmark PATHWAY-2 trial. The pathophysiological rationale for MRAs includes natriuretic effects, vasodilatory properties and target organ protection through anti-fibrotic mechanisms. Novel non-steroidal MRAs offer improved selectivity and reduced endocrine side effects compared to traditional agents, potentially expanding the therapeutic window for mineralocorticoid receptor blockade. In this review, we discuss the established role of MRAs in primary and resistant hypertension management and discuss consideration of MRAs in certain hypertension patient populations. We also briefly review patient selection strategies and future directions for this important therapeutic class.

Purpose of review: Obstructive sleep apnea (OSA) is common and strongly linked with systemic hypertension, including resistant and nocturnal forms. Traditional OSA therapies lead to modest blood pressure (BP) reductions, but optimal antihypertensive strategies in this population remain unclear. This review examines OSA driven hypertension mechanisms, differential responses to standard OSA therapies, and evaluates evidence for mineralocorticoid-targeted treatment - including blockade of aldosterone - as a tailored BP lowering and airway improving strategy.

Recent findings: OSA promotes hypertension via intermittent hypoxia, sympathetic overactivity, sleep fragmentation, renin-angiotensin-aldosterone system (RAAS)-mediated fluid retention, and nocturnal fluid shifts that increase airway collapsibility. While continuous positive airway pressure (CPAP), oral appliances, weight loss, and other standard OSA therapies consistently yield modest BP reductions (typically 2-5 mmHg), patients with resistant hypertension, obesity, or high CPAP adherence derive greater benefit. Recent clinical studies demonstrate that mineralocorticoid receptor antagonists (MRAs) such as spironolactone or eplerenone reduce both apnea-hypopnea index (AHI) and BP in OSA patients with resistant hypertension. Emerging data from trials of selective aldosterone synthase inhibitors (ASIs) support meaningful BP reduction in obese hypertensive individuals with data on OSA specific outcomes remain forthcoming.

Purpose: Chemerin, a recently identified adipokine, has emerged as a critical mediator in multiple physiological systems with significant implications for human health and disease. This review synthesizes current knowledge on chemerin's multifaceted roles across cardiovascular, renal, immune, and metabolic processes. Acting through its primary receptor CMKLR1, chemerin influences sympathetic nervous system activity in key brain regions including the nucleus tractus solitarius and paraventricular nucleus, thereby regulating blood pressure and cardiovascular function.

Recent findings: In the kidneys, elevated chemerin levels correlate with declining renal function, serving as both a biomarker and pathogenic factor in chronic kidney disease progression and diabetic nephropathy. As an immune modulator, chemerin facilitates leukocyte recruitment, promotes macrophage polarization toward pro-inflammatory phenotypes, and enhances endothelial inflammation, establishing it as a pivotal link between metabolic dysregulation and chronic inflammatory states. Chemerin plays a central role in hypertension by altering endothelial function, renal function and sympathetic outflow. In metabolic regulation, chemerin influences adipocyte differentiation, glucose homeostasis, and central appetite control, connecting obesity with systemic inflammation and insulin resistance. The convergence of these diverse functions positions chemerin as an integrative signaling molecule with considerable therapeutic potential. This review highlights chemerin's role as a promising target for novel interventions in hypertension, kidney disease, inflammatory disorders, and metabolic syndrome, potentially transforming treatment strategies for these interconnected conditions.

Purpose of review: This article summarizes the clinical effects of incretin therapies. We review data from recent clinical trials, beyond glycemic control and weight reduction.

Recent findings: Incretin therapies are associated with a lower risk of atherosclerotic cardiovascular events and improved clinical outcomes in patients with heart failure and preserved ejection fraction. Recent studies demonstrate a much wider spectrum of clinical benefits, including nephroprotection in patients with diabetic kidney disease, diabetes prevention, therapeutic potential in the management of metabolic dysfunction-associated steatotic liver disease and obstructive sleep apnea, and even neuroprotective effects. Possible adverse events, primarily involving the gastrointestinal system, and the need for long-term continuation are factors that need to be considered before initiation of treatment. Incretin receptor agonists have changed the landscape of diabetes and obesity management. Their clinical benefits expand to a wide spectrum of cardiovascular and metabolic disorders and have major implications for clinical practice.

Purpose of review: The prevalence of obesity continues to increase globally. There is accumulating evidence of the complex interplay between obesity, cardiovascular disease, particularly heart failure with preserved ejection fraction, and chronic kidney disease (CKD). Here, we review the diagnostic and management considerations for these co-existent conditions and the current evidence regarding the impact of obesity treatments on long term health outcomes.

Recent findings: Recent evidence suggests the pathophysiology of obesity, heart failure with preserved ejection fraction and CKD are inextricably linked as adipocytes appear to play a role in promoting renal sodium avidity and volume overload, which are the hallmarks of the cardiorenal syndrome. The clinical landscape of obesity management has changed significantly with the approval of glucagon-like peptide-1 receptor agonists, which have been shown to have cardiovascular and kidney benefit among patients with obesity and a range of comorbid conditions including diabetes, CKD, and heart failure. Improved recognition, diagnosis and management of clinically consequential obesity is emerging as a key factor in improving outcomes for patients with comorbid conditions such as heart failure with preserved ejection fraction and CKD. The incorporation of comprehensive multi-disciplinary management, shared decision making with patients and broader access to therapies is critical to improving clinical outcomes.