Hypertension Research最新文献

This study aims to investigate the association between visit-to-visit blood pressure variability (VVV) in early stage of continuous ambulatory peritoneal dialysis (CAPD) and long-term clinical outcomes, utilizing machine learning algorithms. Patients who initiated CAPD therapy between January 1, 2006, and December 31, 2009 were enrolled. VVV parameters were collected during the first six months of CAPD therapy. Patient follow-up extended to December 31, 2021, for up to 15.8 years. The primary outcome was the occurrence of a three-point major adverse cardiovascular event (MACE). Four machine learning algorithms and competing risk regression analysis were applied to construct predictive models. A total of 666 participants were included in the analysis with a mean age of 47.9 years. One of the six VVV parameters, standard deviation of diastolic blood pressure (SDDBP), was finally enrolled into the MACE predicting model and mortality predicting model. In the MACE predicting model, higher SDDBP was associated with 99% higher MACE risk. The association between SDDBP and MACE risk was attenuated by better residual renal function (p for interaction <0.001). In the mortality predicting model, higher SDDBP was associated with 46% higher mortality risk. This cohort study discerned that high SDDBP in early stage of CAPD indicated increased long-term MACE and mortality risks.

This study examined the association between the latest blood pressure (BP) classification and cardiovascular disease (CVD) mortality risk, using data from 70,570 individuals across 10 Japanese cohorts. Participants were stratified by age (40-64 and 65-89 years) and antihypertensive treatment use. BP was classified according to the 2019 Japanese Society of Hypertension Guidelines. During a follow-up period of approximately 10 years, 2304 CVD deaths occurred. Cox models demonstrated that CVD mortality risk increased stepwise with the BP category, with this association being especially pronounced in patients aged 40-64 years, where the Grade I hypertension group showed the highest population-attributable fraction (PAF). When the treated participants were included in the hypertension group, the overall PAF for CVD mortality was 41.1%. Similar patterns were observed for CVD subtype mortality risk, with hypertension showing particularly high PAFs for intracerebral hemorrhage. These findings highlight the importance of early-stage prevention and management of hypertension.

The brachial-ankle pulse wave velocity (baPWV) is useful for evaluating arterial stiffness. No longitudinal studies have examined the association between multiple arterial stiffness risk factors and increased baPWV. We sought to identify factors associated with baPWV ≥1400 cm/s within 5 years and create an equation and simple risk score to predict its occurrence, using data from a large-scale Japanese health examination database. Of 10,284 participants aged 30-69 years for whom follow-up data were available over a 5-year period, 3394 men and 2710 women with baseline baPWV<1400 cm/s were analyzed. We used age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), fasting blood sugar (FBS), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), estimated glomerular filtration rate (eGFR), habitual exercise, habitual drinking, and smoking history as variables. In the multivariate logistic regression analysis, baPWV≥1400 cm/s was associated significantly with age, BMI, SBP, DBP, HR, FBS, and TG in men and age, SBP, DBP, HR, and smoking history in women. A prediction score based on these factors yielded an area under the curve (AUC) for the 5-year incidence of baPWV≥1400 cm/s of 0.68 for men and 0.71 for women. Furthermore, a risk prediction equation for the 5-year incidence of baPWV≥1400 cm/s showed an AUC = 0.71 for men and 0.77 for women. The prediction equation and a simple prediction score are easy to implement clinically. The predictive ability of these scores and equations for arterial stiffness should be validated in prospective studies. The risk score is the sum of all points, which risk factors were significantly associated with the 5-year incidence of baPWV>1400 cm/s in the multivariate logistic regression analysis. The AUC for the 5-year incidence of baPWV>1400 cm/s was 0.68 for men and 0.71 in women.

This post hoc analysis of the ENGAGE AF-TIMI 48 trial assesses differences in cardiovascular and bleeding events according to visit-to-visit blood pressure variability (BPv) in 19,680 patients with a minimum of 4 blood pressure measurements post randomization. Patients were categorized into four groups based on the standard deviation of systolic blood pressure (SBP-SD). In comparisons of the fourth vs first quartile of SBP-SD adjusted for components of the CHA₂D₂-VASc score and baseline SBP, there were no differences in the odds of stroke, cardiovascular mortality, or all-cause mortality. However, there were statistically significant increases in the risk of major bleeding (OR 1.9, (1.6-2.25)). myocardial infarction (OR 1.42 (1.08-1.87)) and heart failure outcomes (OR 1.49 (1.3-1.72)) in the fourth quartile of BPv. This post-hoc analysis shows that BPv is independently associated with an increased risk of bleeding, MI, and heart failure outcomes in a population with AF on oral anticoagulation.

We investigated the impact of hypertension and high pulse wave velocity (PWV), each assessed in a single measurement, on target organ damage, proteinuria, and left ventricular hypertrophy (LVH). This observational cross-sectional study included 13,186 patients who underwent brachial-ankle PWV (baPWV) measurement, urinalysis, and electrocardiography during a health check-up. Blood pressure (BP) was measured at the time of baPWV measurement. Proteinuria and LVH were evaluated using a urine dipstick test and electrocardiography, respectively. Participants were categorized into four groups based on their hypertension (yes/no, defined as BP ≥ 140/90 mmHg) and baPWV (high/low, cutoff value of 14.0 m/s) statuses. The mean age of the participants was 53 ± 11 years, and the prevalence of proteinuria and LVH was 594 (4.5%) and 1716 (13.0%), respectively. Compared with the non-hypertension with low baPWV group, the non-hypertension with high baPWV (odds ratio [OR] 1.41 [95% confidence interval (CI), 1.07-1.86]), hypertension with low baPWV (OR 2.66 [95% CI, 1.78-3.97]), and hypertension with high baPWV groups (OR 2.80 [95% CI, 2.18-3.61]) exhibited a higher multivariate-adjusted risk for proteinuria. The hypertension with low baPWV group had a significantly higher risk of proteinuria than the non-hypertension with high baPWV group. Similar results were obtained for LVH. Hypertension and a high baPWV were independently associated with the prevalence of proteinuria and LVH. Hypertension assessed in a single BP measurement is likely to be a more important risk factor for proteinuria and LVH than high baPWV. Hypertension and high brachial-ankle pulse wave velocity were independently associated with the prevalence of proteinuria and left ventricular hypertrophy. Hypertension assessed in a single blood pressure measurement is likely to be a more important risk factor for proteinuria and left ventricular hypertrophy than high brachial-ankle pulse wave velocity.

The management of hypertension is one of the most important public health issues. Many patients with untreated hypertension in Japan require urgent treatment. This retrospective cohort study in Hiratsuka city aimed to evaluate the proportion of participants achieving target blood pressure and identify modifiable factors affecting the achievement. We retrospectively analyzed data from a merged database of claims, specific health checkup (SHC), and national health insurance data in Hiratsuka City, Japan, from June 2016 to March 2023. The study participants were adults aged 40-74 years without a history of hypertension treatment and with blood pressure ≥140/90 mmHg at SHC. The primary outcome was the achievement of target blood pressure <140/90 mmHg at the next SHC. Furthermore, multivariable logistic regression was performed to explore factors influencing the achievement. Of 5428 participants, 43.6% were female. The median age was 69 years, and 58.4% (95% confidence interval 57.1-59.7) achieved target blood pressure <140/90 mmHg. Multivariable logistic regression results showed that achievement of target blood pressure was associated with younger age (50-69 years), mild hypertension (grade I), no hypertension at the previous SHC, no record of SHC in the previous year, and willingness to improve lifestyle. One-third of people reported that their hypertension at SHCs failed to achieve target blood pressure. For community-level hypertension management, people who have the influencing factors must be educated by public health nurses, which might be effective for lifestyle improvement. Additionally, the elderly and people with persistent hypertension or severe hypertension should seek medical advice.

Glomerular hypertrophy promotes fibrosis by activating Piezo proteins.