Current Hypertension Reports最新文献

Purpose of review: Survivors of childhood cancer and hematopoietic cell transplant are at risk for developing chronic health conditions, including hypertension. Studies have identified hypertension as an influential risk factor for late kidney dysfunction and cardiovascular disease in childhood cancer survivors. The overall risk of hypertension depends on the specific cancer treatment, from chemotherapy to surgery to radiation. In this report, we aim to review the main causes of hypertension in childhood cancer survivors, with a focus on newer therapies, as well as the current recommendations for screening and management of hypertension in this patient population.

Recent findings: Novel targeted therapies and immunotherapies are being increasingly used in pediatric cancer treatment, with unclear impact on long-term health. Screening guidelines for hypertension in the survivor population have been issued by various childhood cancer cooperative groups based on best available evidence and expert opinion. Newer studies have focused on individual risk prediction, which may help improve the diagnosis and management of hypertension, particularly in higher-risk individuals. Despite the importance of hypertension as one of the few modifiable risk factors for cardiovascular and renal health, studies have yet to define optimal blood pressure targets, screening parameters, or management strategies in childhood cancer survivors. Additionally, further studies are needed to demonstrate improvement in outcomes following interventions for hypertension specifically in this patient population.

Purpose of review: To review data regarding the association between hypertension and childhood obesity on target organ damage. We will also review data regarding the impact of intervening on hypertension and childhood obesity on target organ damage.

Recent findings: The prevalence of hypertension and obesity are rising in children despite efforts to address these risk factors. Health disparities play a role in contributing to the rise in prevalence. Hypertension and obesity promote pro-inflammatory cytokines that activate the renin-angiotensin-aldosterone system and sympathetic nervous system which result in adverse effects on blood pressure regulation and renal function. Adverse cardiac, vascular, renal, neurocognitive, and retinal changes can be seen with elevated blood pressure. Recent intervention studies are few, but adequate treatment of hypertension and obesity can result in improvement in target organ damage. Hypertension and obesity have significant impacts upon target organs. Interventions to decrease blood pressure and treat obesity are associated with reductions in left ventricular hypertrophy, improvement in measures of systolic and diastolic function, and improvement in renal outcomes. Appropriate screening and management of these conditions can lessen potential future cardiovascular impact.

Purpose of review: The growing burden of cardiovascular diseases has become a significant concern in both adult and youth populations. Urinary biomarkers of kidney function could provide useful insights that may aid in the early identification of individuals at higher risk of adverse cardiovascular outcomes. This systematic review aimed to assess associations between urinary biomarkers of kidney function and different measures of cardiovascular health.

Recent findings: PubMed, Scopus, and EBSCOhost were searched for articles published between January 2018 and December 2023. Studies exploring associations between urinary kidney biomarkers (alpha-1 microglobulin (uA1M), neutrophil gelatinase-associated lipocalin (uNGAL), uromodulin (uUMOD) and CKD273 classifier) and measures of cardiovascular health (blood pressure and markers of target organ damage) were included. We identified 1186 articles, with 22 studies eligible for inclusion. Among 12 studies reporting associations between uA1M and measures of cardiovascular health, six studies indicated positive associations with office blood pressure and three studies observed associations with different markers of target organ damage. Out of the nine studies that explored the link between uUMOD and cardiovascular health parameters, four found negative associations between uUMOD and blood pressure. With regard to uNGAL, only two out of the seven studies analysed reported varying associations with blood pressure, while neither of the two studies focusing on CKD273 observed any statistically significant results. Biomarkers of kidney tubule function, represented by uA1M and uUMOD, are relevant in the setting of cardiovascular health and should be assessed for utilisation in clinical practice to identify adverse cardiovascular outcomes at an early stage allowing for timely intervention.

Purpose of the review: Preeclampsia and the Hypertensive Disorders of Pregnancy (HDP) occur more frequently amongst Indigenous women and can have short- and long-term impacts on maternal and infant health and wellbeing. To understand factors associated with increased risk for Indigenous women a systematic review and meta-analysis was conducted. The PRISMA guidelines were adhered to, and the review protocol was registered on PROSPERO (Registration CRD42023381847). EndNote, Covidence and Excel were used to screen and extract data, with studies assessed using JBI critical appraisal tools.

Recent findings: Seven studies from Canada, Australia, and the United States (none from New Zealand) were included in this review. Meta-analysis showed women classified as overweight (OR 1.32, 95% CI: 1.09-1.60), obese (OR 1.88, 95% CI: 1.57-2.25), or having high mean BMI (MD 3.02 95% CI: 1.72-4.31), high mean systolic blood pressure (MD 15.19 95% CI: 12.83-17.541), or high mean diastolic blood pressure (MD 15.26 95% CI: 13.05-17.47), pre-pregnancy diabetes (OR 3.63, 95% CI: 1.66-17.94), or high microalbuminuria (OR 2.76, 95% CI: 1.40-5.43) were more likely to be diagnosed with preeclampsia. Smoking (OR 0.77, 95% CI: 0.58-1.03), alcohol consumption (OR 1.70, 95% CI: 0.76-3.81), and gestational diabetes (OR 1.74, 95% CI: 0.90-3.37) were not associated with preeclampsia. Understanding factors associated with increased preeclampsia/HDP risk amongst Indigenous women is important to minimising adverse perinatal events and future health complications. This review demonstrates current gaps in the evidence, specifically in relation to social, economic, and environmental factors.

Purpose of the review: Τhe association between nocturnal blood pressure (BP) and alterations in the retinal microvasculature remains understudied, with few available studies to provide conflicting results. Therefore, we conducted a systematic review and meta-analysis to determine whether an association exists between retinal microvascular alterations and nocturnal BP patterns, determined by 24h ambulatory BP measurement.

Recent findings: Our search concluded to 1002 patients (6 studies). A total of 3 studies (411 patients) were enrolled in the meta-analysis. Central retinal arteriolar equivalent found to be not different between patients with and without dipping status (mean differences [MD]: -0.01; 95% CI: -0.23 to 0.20; I²=0%; P < 0.610). Regarding central retinal venular equivalent, dippers showed significantly lower values compared to non-dippers (MD: -0.25; 95% CI: -0.47 to -0.03; I²=0%; P < 0.024). For the comparison between nighttime and daytime BP regarding the damage in small retinal vessels, we identified only 5 studies. Due to different evaluated outcomes as well as due to the heterogeneity of outcomes and different grouping of patients based on different BP cut-off values, these results couldn't be analyzed quantitatively. In summary, this is the first effort to summarize evidence on the effects of day-to-night variation of BP on the retinal small vessels. According to the findings of the present systematic review and meta-analysis, non-dipping status may be associated with retinal venular dilatation, and elevated nighttime BP with retinal arteriolar narrowing. Further studies are warranted to elucidate the impact of nocturnal BP patterns in the retinal microvasculature.

Purpose of review: Hypertension remains a major chronic disease morbidity across the world, even in the twenty-first century, affecting ≈40% of the global population, adversely impacting the healthcare budgets in managing the high incidence of cardiovascular disease (CVD) complications and mortality because of elevated blood pressure (BP). However, evaluation and management of endocrine hypertension are not optimal in clinical practice. With three unique clinical case scenarios, we update the evidence base for diagnostic evaluation and management of endocrine hypertension in this review to inform appropriate day-to-day clinical practice decisions.

Recent findings: Although most individuals with high BP suffer from essential hypertension (≈85%), some patients may have a clear underlying etiology (termed secondary hypertension), and a significant proportion of these patients have endocrine hypertension (≈10%) consequent to hormone excess from dysfunction of one or more endocrine glands. Even if a relatively common disease in the general population, the correct diagnosis and appropriate treatment of endocrine hypertension is often delayed because of poor awareness among clinicians, including primary care providers and physicians in the secondary care settings. An accurate and timely diagnosis of endocrine hypertension is crucial to potentially cure or at least properly manage these patients because the consequences of delays in diagnosis can be catastrophic, with markedly higher end-organ complications such as CVD, chronic kidney disease, and even premature mortality among sufferers.

Purpose of review: The role of the lymphatic system in clearing extravasated fluids, lipid transport, and immune surveillance is well established, and lymphatic vasculature can provide a vital role in facilitating crosstalk among various organ systems. Lymphatic vessels rely on intrinsic and local factors to absorb and propel lymph from the interstitium back to the systemic circulation. The biological implications of local influences on lymphatic vessels are underscored by the exquisite sensitivity of these vessels to environmental stimuli. This review is intended to highlight the role of sodium within the local environment in mediating lymphatic and immune cell interactions that contribute to changes in function and disease progression.

Recent findings: We discuss evidence that accumulation of interstitial sodium modulates lymphatic growth, pumping dynamics, and permeability of renal lymphatics, which involves activation of sodium potassium chloride co-transporter (NKCC1) in lymphatic endothelial cells. These recent findings complement observations that sodium activates immune cells via the epithelial sodium channel (ENaC), leading to the formation and accumulation of lipid oxidation products, isolevuglandins (IsoLGs), in antigen presenting cells, which in turn promotes T cell activation and vasculopathy. In addition, we will underscore the physiologic relevance of altered interplay between immune cells and lymphatics in the sodium avid state that characterizes kidney diseases and consider how sodium accumulation in the interstitial compartment of the kidney modulates the lymphatic network and the interactions between renal lymphatics and activated immune cells. Finally, this article calls attention to persisting knowledge gaps and stresses the need for additional studies to identify salt-sensing mechanisms, including sodium-activated immune cells and lymphatic endothelial cell interactions, for targeted therapeutic interventions in the setting of renal disease.

Purpose of review: To review the most current recommendations regarding assessment and treatment of asymptomatic hypertension treatment in the emergency department (ED) and to provide guidance for prescribing oral antihypertensive therapy for ED providers.

Recent findings: There are varying management strategies for the treatment of asymptomatic hypertension in the ED likely due to a lack of direct guidelines for treatment. There is an increasing body of evidence for the safety of initiating therapy to treat chronic asymptomatic hypertension in the ED. Initiation and optimization of oral antihypertensive therapy in indicated patients can be done by ED providers to enhance and expediate transition of care for patients and can ultimately aid in prevention of cardiovascular disease (CVD). This review provides guidance of when oral antihypertensive therapy can be initiated, medication options depending on the patient's blood pressure and other concurrent medications (if applicable), as well as other factors that may influence choice of therapy are described. Oral antihypertensive therapies can be initiated and optimized in the ED for patients with asymptomatic chronic hypertension.

Purpose of review: To review currently existing knowledge on a new type of antihypertensive treatment, small interfering RNA (siRNA) targeting hepatic angiotensinogen.

Recent findings: Targeting angiotensinogen synthesis in the liver with siRNA allows reaching a suppression of renin-angiotensin system (RAS) activity for up to 6 months after 1 injection. This might revolutionize antihypertensive treatment, as it could overcome non-adherence, the major reason for inadequate blood pressure control. Animal data support that its effects on blood pressure and end-organ damage are fully comparable to those of classical RAS blockers, and phase I and II clinical trials confirm its antihypertensive effectiveness and long-term action. Although its side effect profile is placebo-like, its long-term effects also pose a threat in patients who require immediate restoration of RAS activity, like in shock. Here tools are being developed, called REVERSIR, that allow immediate annihilation of the siRNA effect in the liver. One subcutaneous injection of angiotensinogen siRNA lowers blood pressure for 6 months without severe side effects. The decrease in angiotensinogen and blood pressure can be reversed with a drug called REVERSIR if needed.

Purpose of review: One of the challenges in the diagnosis and management of primary aldosteronism (PA), the most common type of secondary hypertension with curative potential, is the modification of antihypertensive medications. We seek to explore whether these medications can be continued during the diagnostic process of PA to minimize the duration and risks associated with medication adjustments.

Recent findings: We searched PubMed for eligible original literature between 1990 and 2024 using the following keywords: (screening) AND (primary aldosteronism); (confirmatory) AND (primary aldosteronism); (adrenal vein sampling) AND primary aldosteronism). Some recent studies support the feasibility of PA-related tests and even adrenal vein sampling (AVS) without the need to discontinue antihypertensive medications in certain cases. In this review, we propose a management approach that considers the specific effects of antihypertensive medications on the RAAS axis and the patient's disease phenotype. Based on this, we suggest a strategy that enables the diagnosis of PA in certain patients without discontinuing their antihypertensive medications.