Current Hypertension Reports最新文献

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.

Purpose of review: Heart failure (HF) is characterized by a significant imbalance of the autonomic nervous system (ANS), with chronic sympathetic nervous system (SNS) overactivity leading to maladaptive cardiac remodeling, arrhythmia, and hemodynamic instability. In this review, we aim to discuss current and emerging therapies and the potential path forward for developing future novel neuromodulatory therapies in HF.

Recent findings: Neuromodulatory therapies including splanchnic nerve modulation (SNM), vagal nerve stimulation (VNS), baroreflex activation therapy (BAT), and renal denervation (RDN) reduce sympathetic output in individuals with HF, leading to improved cardiac function, neurohormonal regulation, and vascular resistance. However, implementation of these strategies in clinical practice is limited owing to variability in response, patient selection criteria, and insufficient long-term efficacy data. Gene therapy targeting Gαi2 proteins, and adenylyl cyclase isoforms have demonstrated potential in reducing sympathetic overactivation. Endovascular BAT such as the Mobius HD has shown early indications of improvements in symptoms, left ventricular function, and biomarkers in patients with HF. These emerging therapies warrant further investigation. Neuromodulation is a characteristic method for reducing disease progression and improving outcomes in individuals with autonomic dysfunction-driven HF. Although initial studies demonstrate benefits, long-term impact of neuromodulation on HF development, symptom load, and survival has not yet been thoroughly demonstrated. Future studies should prioritize deep phenotyping using genetic and biomarker profiles to improve patient selection. Comparative trials are required to assess the efficacy and safety of neuromodulatory therapies relative to conventional approaches. Large-scale trials are needed to optimize procedural procedures, and assess the long-term efficacy of treatment interventions.

Purpose of review: Since the FDA approved transcatheter renal denervation (RDN) for the treatment of uncontrolled hypertension in 2023, cardiologists have sought to answer a critical question: "Who benefits from RDN?" The blood pressure-lowering effect of RDN varies considerably among individuals, with some showing little to no response. Predicting individual response remains challenging due to the lack of reliable biomarkers. This review summarizes potential biomarkers for predicting the antihypertensive response to RDN, with a focus on their pathophysiological mechanisms.

Recent findings: Biomarkers reflecting renal efferent nerve activity, rather than afferent nerve activity, may serve as more reliable predictors of RDN response. Additionally, biomarkers linked to renin-angiotensin-aldosterone system (RAAS) activation, such as plasma renin activity and miR-133a, have shown promising predictive value. Further research is needed to validate these findings and identify novel biomarkers to optimize patient selection for RDN.

Background: This scoping review examines the existing literature to reveal consensus or absence thereof regarding the definition and management strategies for asymptomatic hypertension.

Methods: The review used Joanna Briggs Institute guidelines. We searched the CINAHL (EBSCO), Scopus, Ovid EMBASE, and PubMed (MEDLINE) databases using keywords and index terms to identify adult patients with hypertension in an emergency or outpatient setting. After review and quality assessment, we included 35 texts.

Results: The definition of "asymptomatic hypertension" varied widely. There was significant variation in which society or academic guideline served as the reference and what the blood pressure cut offs were; all specified a lack of end-organ damage. End-organ damage was poorly defined- studies instead described the absence of hypertensive emergency. Of the texts which provided recommendations, all recommended a thorough history and physical examination. Only one study recommended additional testing for asymptomatic patients. Treatment recommendations relied predominantly on ACEP clinical policy, with a majority of studies advocating for gradual reduction of blood pressure as well as referral for outpatient management.

Conclusion: Unified guidelines on the definition and management of asymptomatic hypertension are needed to ensure effective and consistent patient care. There is no consensus for diagnostic testing in patients with a negative history and physical exam, nor whether treatment should be initiated in the emergency department. Addressing this gap would enhance clinical outcomes and streamline healthcare processes across systems. Future research should focus on establishing consensus and developing management strategies that are adaptable to both emergency and primary care environments.