High Blood Pressure & Cardiovascular Prevention最新文献

Introduction: Renal Functional Reserve (RFR) is a promising marker for detecting early nephron loss and functional renal mass.

Aim: We evaluated the relationship between RFR and changes in eGFR over time in hypertensive (HT) and normotensive (NT) individuals.

Methods: In this 24-month prospective study, newly diagnosed essential HT and NT individuals with eGFR ≥60 ml/min/1.73m² were included. At baseline, RFR was measured by endogenous creatinine clearance after an oral protein load in both groups, alongside 24-hour ambulatory blood pressure (BP) profile in HT. Serum creatinine was reassessed at months 12 and 24.

Results: A total of 51 HT and 20 NT subjects (mean age 53.2 ± 12.1 and 54.3 ± 10.0 years) completed the study. RFR levels did not differ between groups (25.1 ± 18.7 vs. 27.7 ± 15.7 ml/min, p = 0.6). No significant difference was found in the annual and the two-year eGFR change between HT and NT. At 24 months, HT and NT with RFR ≥30 ml/min showed less pronounced declines in eGFR compared to those with RFR <30 ml/min (0.5 ± 2.6 vs. - 1.4 ± 1.7 ml/min/1.73m², p =0.002 and - 0.6±1.3 vs. - 1.6 ± 0.7 ml/min/1.73m², p = 0.02 respectively). HT with high RFR were more frequently dippers (64.4% vs. 34.4%, p < 0.05).

Conclusions: RFR does not differ between HT and NT with preserved renal function but normal RFR is associated with slower eGFR decline. Reduced RFR correlates with non-dipping BP in HT.

Introduction: It is unknown whether the failure of antihypertensive drug treatment to normalize sympathetic cardiovascular (CV) function reported in previous studies selectively affects regional sympathetic CV outflow or it also involves whole body neuroadrenergic drive.

Aim: The present study examines the impact of antihypertensive drug treatment on regional and whole body sympathetic CV influences.

Methods: Fifthyfour essential hypertensive patients were included in the study. In each patient measurements consisted of the microneurographic recording of muscle sympathetic nerve traffic (MSNA) and the assay of venous plasma norepinephrine (NE). They were performed before and during an antihypertensive drug treatment (monotherapy or two-drugs combination) prolonged for a 3 months period. Measurements were also carried out in 31 age-matched normotensive controls.

Results: In the study population antihypertensive drug treatment lowered clinic blood pressure to values <140/90 mmHg and significantly (P<0.001) reduced both MSNA and NE. However, during treatment the values of these two adrenergic markers remained significantly greater (+70.8 % and +64.4%, respectively) than those detected in the normotensive subjects.

Conclusions: These data provide evidence that antihypertensive drug treatment reduces but not normalizes regional and whole body sympathetic CV drive, likely participating at determining the residual CV risk reported in different studies in treated hypertensives.

Introduction: The relationship between household air pollution from solid fuel use and hypertension remains uncertain, especially in low- and middle-income countries.

Aim: We aimed to examine the association between use of solid fuels in households and hypertension in a large, nationally representative sample from Peru.

Methods: We conducted a cross-sectional analysis of 137,012 adults using data from the 2020-2024 Demographic and Family Health Survey. Cooking fuel exposure was categorized as no exposure (clean fuels), moderate exposure (solid fuel with chimney), or high exposure (solid fuel without chimney). The primary outcome was hypertension, defined as a mean systolic/diastolic blood pressure ≥140/90 mmHg or self-reported diagnosis. The secondary outcomes were systolic and diastolic blood pressure. Modified Poisson and linear regression were used to estimate adjusted prevalence ratios (aPRs) and beta coefficients with their 95% confidence intervals (CIs), respectively.

Results: In the adjusted analysis, high exposure to solid fuel was modestly associated with a higher prevalence of hypertension (aPR 1.08, 95% CI 1.02-1.14) compared with clean fuel use. Moderate exposure showed no significant association (aPR 1.01, 95% CI 0.95-1.08). Stronger associations were observed in women (aPR 1.14, 95% CI 1.05-1.23) and urban residents (aPR 1.14, 95% CI 1.05-1.24). High exposure was also associated with small but significant increases in systolic (β = 0.65, 95% CI 0.20 to 1.1 mmHg) and diastolic (β = 0.54, 95% CI 0.26 to 0.81 mmHg) blood pressure.

Conclusion: High-intensity exposure to solid cooking fuels, particularly without adequate ventilation, was modestly associated with hypertension and small increases in systolic/diastolic blood pressure. These findings emphasize the importance of ensuring access to clean energy and enhancing kitchen ventilation, particularly among women and urban populations.

Introduction: Elevated lipoprotein(a) [Lp(a)] levels have been strongly related to cardiovascular (CV) risk. However, its association with Hypertension Mediated Organ Damage (HMOD) and CV events in the primary prevention setting remains unclear.

Aim: To evaluate in these patients, the correlation between Lp(a) levels and: (i) heart, vessels and kidney HMOD and; (ii) CV events and all-cause mortality in a primary prevention setting.

Methods: 747 low CV risk subjects were recruited between 2009 and 2014. HMOD was assessed through Pulse Wave Velocity, carotid Intima-Media Thickness (IMT), presence of carotid plaques, Left Ventricular Hypertrophy (LVH) and Ejection Fraction and glomerular filtration rate. All-cause mortality and CV events up to 2021 were retrieved by electronic health records, for a median follow-up time of 10 years (I-III quartiles 9.6-11.1).

Results: Mean age was 50.8 ± 13.0 years and 63.5% of the subjects were men. The prevalence of hypertension was 37.9%, dyslipidemia 67.2%, smoking 17.8%, and diabetes mellitus 8.7%. Median Lp(a) value was 17 mg/dL (5.9-56.0), and 26.5% of patients had values above 50 mg/dL. Regarding HMOD, 10.3% subjects had arterial stiffness, 7.2% increased IMT, 19.8% carotid plaques while only 0.7% had LVH. No significant correlation was found between Lp(a) levels and indices of subclinical HMOD. Furthermore, no relationship was found between CV events and all-cause mortality and Lp(a) levels.

Conclusions: In this primary prevention cohort, elevated Lp(a) levels were not associated with significant structural damage to the heart, carotid arteries, or increased aortic stiffness and were not associated with CV events and all-cause mortality.

Introduction: Patients with difficult to control hypertension (HTN) are often referred by general practitioners to specialized centers to estimate global cardiovascular (CV) risk profile, evaluate hypertension-mediated organ damage (HMOD), and optimize antihypertensive therapy. This referral provides a unique opportunity to analyse patients with high CV risk and HTN in a real-world setting, characterized by the rigorous adoption of uniform and state-of-the-art procedures by expert personnel.

Aim: To examine (1) global CV risk profile, office and out-of-office blood pressure (BP) levels, and markers of HMOD in adult patients referred to a high-volume European Hypertension center; (2) to evaluate how these clinical parameters impact on the choice of different antihypertensive therapies.

Methods: An observational, cross-sectional study was conducted in adult patients of both sexes, aged ≥ 18 years, with essential treated hypertension, who were consecutively evaluated at the Excellence Hypertension Center at Sant'Andrea Hospital in Rome, Italy. Office and out-of-office BP levels were measured, and different hypertension phenotypes were set according to European guidelines. CV risk profile was estimated according using SCORE2. Only patients with treated HTN were selected for the analysis and stratified according to antihypertensive therapies: (1) angiotensin receptor blockers (ARBs); (2) angiotensin converting enzyme (ACE) inhibitors; (3) other drugs (including diuretics, beta-blockers, calcium channel blockers, alpha-blockers, mineralocorticoid receptor antagonists).

Results: From an overall database of 11,168 outpatients, a total of 5,677 patients with treated HTN were analysed (46.3% females, age 63.6 ± 13.1 years, BMI 27.4 ± 4.8 kg/m2, office BP 140.6 ± 17.5/85.5 ± 11.5 mmHg, 24-hour BP 128.7 ± 13.7/77.2 ± 9.7 mmHg, SCORE2 5.4 ± 4.3%). Among these, 52.9% were treated with ARBs, 30.2% with ACE inhibitors and 17.0% with other drugs. Patients treated with ARBs were more frequently males, and significantly older, had more frequently obesity (P < 0.001), dyslipidaemia (p < 0.001), and diabetes (p < 0.001) than those treated with other drug classes. They also had more frequently CV comorbidities (P < 0.001) and resistant HTN (P < 0.001). They received more BP lowering agents (P < 0.001), being more frequently treated with triple (P < 0.001), quadruple (P < 0.001), or more complex (P < 0.001) combination therapies. Comparable office and out-of-office BP control were recorded between patients treated with ARBs and those patients managed with either ACE inhibitors or other drugs.

Conclusions: Among adult outpatients referred to an excellence hypertension center, the majority were treated with ARBs, alone or in combination therapies. ARB-treated patients presented more frequently CV risk factors, comorbidities, and difficult-to-treat HTN.

Introduction: Insulin resistance (IR) is a major determinant of cardiovascular disease and mortality, yet its direct measurement is limited by the need for insulin assays. The triglyceride-glucose (TyG) index has emerged as a simple and inexpensive surrogate marker of IR, but its prognostic relevance for mortality remains uncertain due to the heterogeneity of available studies.

Aim: This study aimed to: (i) evaluate the predictive value of the TyG index for all-cause and cardiovascular mortality risk in the general population; (ii) assess the shape and magnitude of the dose-response relationship; and (iii) identify the most appropriate threshold for mortality risk prediction.

Methods: A systematic review and dose-response meta-analysis was conducted, including prospective cohort studies that assessed baseline TyG and subsequent mortality. Random-effects models were used to pool hazard ratios, and restricted cubic splines were applied to examine potential non-linearity in the dose-response relationship.

Results: Twelve studies comprising 14 independent cohorts (≈10.8 million participants) were included. Each one-unit increase in TyG was associated with a 14% higher risk of all-cause mortality and a 16% higher risk of cardiovascular mortality starting from 6.9 units (or 3.79 units in the alternative scale). Associations were linear and consistent across sensitivity analyses. There was a significant heterogeneity among studies, but no evidence of publication bias.

Conclusion: The TyG index independently and linearly predicts all-cause and cardiovascular mortality, supporting its potential role as a clinically useful, low-cost marker for early cardio-metabolic risk stratification in population-based settings.

Introduction: The relation between obesity and blood pressure (BP) is well known; however, its relationship with night-time BP and BP variability (BPV) has not been adequately examined.

Aim: To examine the relationship between obesity and night-time BP/BPV.

Methods: Data from 6,767 adults (46.4% males), aged 56.0 ± 14.0, were collected during their visit to the Outpatient Hypertension Unit of a single institution and had valid ambulatory BP monitoring and anthropometric data. Body mass index (BMI) was estimated by weight and height measurements that took place at the office and categorized as normal weight [< 25 kg/m²; 1,719 (25.4%)], overweight [25-29.9 kg/m²; 2,976 (43.0%)] or obesity [≥ 30 kg/m²; 2,072 (30.6%)]. Standard deviation (SD) and coefficient of variation (CV) of BP were used as indices of BPV.

Results: After adjusting for confounders, BMI was significantly related to night-time systolic (b = 0.38, 95%CI: 0.31-0.46) and diastolic BP (b = 0.10 95%CI: 0.05-0.015). Similarly, after adjusting for confounders, obesity was related to SD (b = 0.25, 95%CI: 0.02-0.49) and CV (b = 0.23, 95%CI: 0.03-0.42) of night-time systolic BPV, while a similar pattern was found for diastolic BPV (p < 0.001). Restricted cubic spline models showed a significant joint effect of splines after adjusting for confounders, for all BPV indices (p < 0.05), but a trend for non-linearity found only for systolic BPV indices (χ² = 3.74, p = 0.053 for SD and χ² = 3.54, p = 0.060 for CV).

Conclusions: In conclusion, the relationship between obesity and both nighttime BP and BPV provides new insights into the possible effects of obesity on the cardiovascular system.

Introduction: Although recommended for cardiovascular (CV) risk stratification in adults, the role of lipoprotein(a) [Lp(a)] in hypertension is not fully established.

Aim: To evaluate Lp(a) levels in adult outpatients with essential arterial hypertension.

Methods: A retrospective, observational study was conducted in outpatients of both sexes, aged ≥ 18 years, with treated or untreated essential hypertension, who were consecutively evaluated at the Hypertension Unit, Excellence Hypertension Center, Sant'Andrea Hospital, Rome, Italy. Participants underwent office and out-of-office blood pressure (BP) measurements, as well as assessment of hypertension-mediated organ damage (HMOD). BP measurements were performed, and hypertension phenotypes were classified according to 2023 European hypertension guidelines. Lp(a) levels were measured, and the study population was stratified according to a Lp(a) cut-off value of ≥50 mg/dl. Due to the non-uniform distribution, absolute Lp(a) values were logarithmically transformed.

Results: A total of 230 patients with available Lp(a) values were included (42.6% women, mean age 66.3 ± 11.5 years, BMI 27.1 ± 4.5 kg/m2, office BP 137.1 ± 18.1/83.7 ± 11.0 mmHg, 24-hour BP 129.8 ± 14.5/79.6 ± 9.8 mmHg, Lp(a) 51.4 ± 65.3 mg/dL), among whom 32.2% had Lp(a) ≥50 mg/dl. There were significantly higher proportions of men (74.3% vs. 49.4%; P < 0.001), dyslipidaemia (97.3% vs. 75.0%; P < 0.001) and comorbidities (55.4% vs. 30.8%; P < 0.001) in patients with high Lp(a) than in those with normal Lp(a), who also received more frequently lipid lowering therapies (P < 0.001) and aspirin (P = 0.003). However, lower office systolic BP values (133.5±18.8 vs. 138.8±17.6 mmHg: P = 0.036) were observed in patients with Lp(a) ≥50 mg/dL than in those with < 50 mg/dl. Also, no significant differences for Lp(a) levels were observed among various hypertension phenotypes, as defined by office (P = 0.156) or out-of-office BP values (P = 0.065). No significant correlations were found between Lp(a) and office or out-of-office BP levels, both in treated and untreated hypertensive outpatients.

Conclusions: In our population, Lp(a) levels were not associated with either office or out-of-office BP values, irrespective of antihypertensive treatment status. The role of Lp(a) in hypertension warrants further investigation.

Introduction: Hypertension is a primary risk factor for cardiovascular mortality and frequently co-occurs with depression and anxiety, though their combined impact remains inadequately characterized in this high-risk population.

Aim: This study aimed to investigate the associations of depression and anxiety with cardiovascular mortality specifically in adults with hypertension.

Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES). Depression was assessed using the PHQ-9 questionnaire, while anxiety was measured through self-reported days. The associations were evaluated using weighted multivariable cox regression and restricted cubic spline (RCS) models.

Results: A total of 3728 participants were included, with a mean follow-up of 9.2 years and 285 cardiovascular deaths. In Model3, depression (PHQ-9) was positively associated with cardiovascular mortality (Hazard ratio (HR) [95% CI] 1.07 [1.03-1.10], P < 0.001). When PHQ-9 was categorized into quartiles, the greatest HR in men was observed in Q3 (2.65 [1.09-6.44], P = 0.032) but that for women was in Q4 (3.94 [1.39-11.2], P = 0.01). RCS curve revealed linear positive association between depression and cardiovascular mortality (P-overall < 0.001; P-nonlinear > 0.05). No interaction was observed in the stratified analyses (P > 0.05). Sensitivity analyses showed the HR of Q4 was attenuated in the overall population but remained stable in women (3.97 [1.29-12.2], P = 0.019). No significant association was found between anxiety and cardiovascular mortality (P > 0.05).

Conclusions: Depression, but not self-reported anxious days, was positively associated with cardiovascular mortality in hypertensive patients, with a stronger association observed in women.

Globally, hypertension remains inadequately controlled, despite the availability of effective therapies and guideline recommendations. This narrative review synthesises current evidence on the clinical rationale, efficacy and implementation of single-pill combination (SPC) therapy to control blood pressure (BP), with a focus on an SPC containing ramipril, amlodipine and hydrochlorothiazide. These agents offer complementary mechanisms of action and a favourable tolerability profile, supporting their use in dual and triple SPCs to overcome therapeutic inertia (failure to intensify therapy when BP goals are unmet) and improve BP control. Clinical trial and real-world data demonstrate that combination therapy leads to faster, more sustained reductions in BP, with better cardiovascular and renal outcomes compared with monotherapy. SPCs also improve adherence and persistence, reduce visit-to-visit BP variability and lower healthcare costs. The "LESS is BETTER" framework, advocating for Lower BP targets, Earlier BP control, Stronger therapy with SPCs for greater efficacy and Simpler regimens to improve adherence to therapy, provides a pragmatic approach for translating current guidelines into practice. However, barriers can hinder SPC adoption, such as physicians' limited attitudes to implement major international guideline recommendations, misconceptions about SPCs, limited use of ambulatory BP monitoring and suboptimal patient engagement. Strategies to overcome these barriers include clinician education, communication tools, flexible dose options and supportive healthcare policies. Taken together, the evidence supports broader adoption of the ramipril-amlodipine-hydrochlorothiazide SPC as an effective therapeutic approach to contemporary hypertension management.