Current Hypertension Reports最新文献

Purpose of review: We review our approach of using MSNA-coupled fMRI to identify how different regions of the brain interact to control blood pressure. By performing functional magnetic resonance imaging (fMRI) of the brain at the same time as recording muscle sympathetic nerve activity (MSNA), via a microelectrode in the common peroneal nerve, we can identify areas of the brain involved in the generation of sympathetic outflow to the muscle vascular bed, a major contributor to blood pressure regulation.

Recent findings: Together with functional connectivity analysis of areas identified through MSNA-coupled fMRI, we have established key components of the human sympathetic connectome and their roles in the control of blood pressure. Whilst our studies confirm the roles of nucleus tractus solitarius (NTS), caudal ventrolateral medulla (CVLM) and rostral ventrolateral medulla (RVLM) in the baroreflex-mediated control of MSNA, we have identified cortical areas - dorsolateral prefrontal cortex, precuneus and insula - that are coupled to RVLM via the hypothalamus and midbrain periaqueductal gray (PAG). This emphasizes the roles of areas above the brainstem in the regulation of blood pressure.

Purpose of review: Blood pressure (BP) is involved in the pathogenesis of cerebral small vessel disease (CSVD) and clinical research confirms this strong correlation. Data showing whether daytime or nighttime BP is the most important variable of CSVD are conflicting. Therefore, the purpose of this meta-analysis is to evaluate the impact daytime and nighttime BP in terms of CSVD correlation. Additionally, we evaluated the role of nocturnal BP variation for the same purpose.

Recent findings: We systematically searched PubMed and Scopus databases to extract data evaluating the association between different ABPM components (24 h, day- and nighttime BP, dipping patterns) and imaging features of CSVD (white matter hypersensitivies, lacunes, cerebral microbleeds). Study quality was evaluated with the Newcastle-Ottawa scale. In the qualitative synthesis, 24 studies with 6822 patients were included. The pooled analysis of 19 studies showed that increased 24 h SBP is associated with 41% increased risk of CSVD, and this is consistently observed for both daytime and nighttime SBP. this effect is largely driven by the impact of 24 h, day- and night-time SBP on CMBs. Impaired nocturnal BP patterns are strongly associated with CSVD, specifically non-dipping profile with an OR of 2.24 (95% CI: 1.31-3.16) compared to dipping pattern. Reverse dipping was associated with CMBs with an increased OR of 3.02 (95% CI: 1.61, 4.42). Obtaining information on different components of ABPM (24 h, day- and night-time BP, dipping profile) may allow identification of patients at higher risk for CSVD including its specific subtypes, specifically CMBs.

Purpose of review: Hypertension is the leading modifiable risk factor for cardiovascular disease. Despite multiple antihypertensive therapies, blood pressure (BP) control remains suboptimal in many individuals with persistent cardiovascular risk. This review evaluates the antihypertensive potential of sodium-glucose cotransporter-2 inhibitors (SGLT2-i) and glucagon-like peptide-1 receptor agonists (GLP-1RA), particularly in patients with comorbid diabetes, HF, CKD or resistant hypertension.

Recent findings: SGLT2-i consistently lower office SBP/DBP (2.5-4.0/1.5-2.0 mmHg) and 24-hour ambulatory BP (3.8/1.8 mmHg). GLP-1RAs show modest SBP reductions (1.8-5.1 mmHg) and minimal DBP effects (~ 0.5 mmHg), though tirzepatide shows greater efficacy (~ 10.6 mmHg) in select populations. Both classes have demonstrated cardio-renal benefits, favorable safety profiles, and reduced polypharmacy. SGLT2-i exert more consistent BP-lowering effects than GLP-1RA, largely due to their diuretic-like action. While not first-line therapies, both drug classes show promise as adjuncts in high-risk populations. Future research should further define their role in comprehensive hypertension management.

Purpose of review: Pediatric hypertension is an increasingly recognized public health issue and represents a key target for preventing long-term cardiovascular morbidity and mortality. Adverse childhood experiences-traumatic events related to abuse, neglect, and household dysfunction occurring before age 18-are emerging as significant risk factors for both pediatric and adult hypertension and cardiovascular disease (CVD).

Findings: While some studies report direct links between childhood adversity and cardiovascular outcomes, others suggest these associations may be mediated by the development of intermediate CVD risk factors such as obesity and mood disorders. Regardless of pathway, evidence indicates that even exposure to a single form of adversity can negatively impact cardiovascular health, with some studies demonstrating threshold and cumulative effects. Early identification of children exposed to adversity may offer a valuable opportunity to guide targeted interventions aimed at the primary prevention of CVD.

Purpose of review: In clinical practice, the diagnosis of hypertension is based on non-invasive upper-arm cuff blood pressure (BP) measurement. Most measurements are performed seated, although evidence indicates that supine BP may provide additional information. This review summarises recent findings on the influence of body posture on BP readings and cardiovascular (CV) risk prediction across office, ambulatory, and home BP monitoring (OBPM, ABPM, HBPM), their clinical implications and future research directions.

Recent findings: In OBPM, patients with supine-only hypertension demonstrated CV risk comparable to patients with hypertensive BP in both positions, and a higher risk than seated-only hypertensives. Supine hypertension was particularly predictive in individuals under 65 years of age. In ABPM, the strongest predictors of CV events are nocturnal hypertension and abnormal dipping patterns, particularly when patients are truly asleep, whereas supine nocturnal HBPM has been less extensively investigated. Current clinical practice remains primarily based on seated BP measurements. Recent trials have highlighted that supine OBPM may provide additional predictive power in the assessment of CV risk. These findings offer a partial explanation for the residual high predictive value of nocturnal BP values which can be derived from ABPM or specialised HBPM devices that goes beyond the correlation of breathing related sleep disorders Research should focus on homogenising supine risk data into composite risk scores combining seated and supine BP while new outcome studies should consider including supine BP measurement. Future guideline committees should consider recommending the structured clinical application of supine BP, given its demonstrated prognostic benefits.

Sleep is recognized in Life's Essential 8™ as an important behavioral factor for improving and maintaining cardiovascular health. While sleep duration is currently the focus in Life's Essential 8™, sleep health is multidimensional and encompasses regularity, satisfaction, next-day alertness, timing, efficiency, and duration. In addition to sleep, circadian factors have also been implicated in cardiovascular health. For example, shift work, which results in significant circadian misalignment, is associated with poor cardiovascular health. This review will describe methods for measuring, analyzing, and interpreting sleep and circadian rhythms in humans. Subjective and objective measurements of sleep are not always concordant and may reflect distinct constructs. Therefore, both subjective and objective sleep measurements are discussed. Assessment of the circadian system in humans typically relies on the measurement of circadian biomarkers (i.e., melatonin, core body temperature, and/or cortisol) during rigorous and burdensome research protocols. However, novel approaches are being developed to estimate circadian parameters with lower cost and participant burden. This review aims to inform cardiovascular scientists and clinicians of common practices in the assessment of sleep and circadian rhythms.

Purpose of review: This brief review provides background information about brain health and its definition and public health importance. Within the context of brain health, we focus on two important modifiable cardiovascular risks, obesity and hypertension, and discuss mechanisms by which these factors affect brain health and recent advances in our understanding of trajectories of these risks across the lifespan.

Recent findings: Our understanding of obesity, hypertension and brain health has advanced beyond the categorization of these factors as binary (present, absent) variables. The study of trajectories of obesity and hypertension have taught us that the presence of these factors as early as childhood and adolescence may be a signal of brain injury and eventual cognitive impairment as early as one's late 20s or early 30s. Over time each factor may show variability in measures and begin to decline prior to the onset of a clinical diagnosis of cognitive impairment (e.g., 5-10 years earlier). Both obesity and hypertension are key modifiable vascular factors affecting brain health via a complex relationship that exceeds a simple binary association. Primary care clinicians and public health officials are uniquely positioned to influence these factors during periods of susceptibility during the individual lifespan.

Purpose of review: Hypertensive disorders of pregnancy are associated with maternal morbidity, mortality, hospital readmissions, and significant costs to healthcare systems.

Recent findings: The incidence of hypertensive disorders of pregnancy (HDP) and maternal morbidity is higher in rural areas than in urban areas. The interaction of rural residence, race, and non-medical drivers of health can create significant barriers to post-partum care in rural communities. Novel models of care, including remote blood pressure monitoring, telehealth, and application-based approaches, may offer ways to reach rural patients after hypertensive pregnancy. There are significant opportunities to create novel multi-modal and multi-disciplinary approaches to post-partum care of HDP. Tailoring and evaluating the approach in rural communities is an important next step to improve care.