Hypertension Research最新文献

Nephrosclerosis, influenced by aging and elevated blood pressure (BP), including prehypertensive levels, is a major contributor to end-stage kidney disease. However, the relationship between these risk factors and early renal pathological alterations remains insufficiently characterized. This study aimed to examine age- and BP-related renal pathology in individuals without chronic kidney disease (CKD). We analyzed zero-hour biopsies from 520 living kidney donors without CKD at Kyushu University Hospital (2008-2018). Donors were stratified by BP (Normal, Stage I, Stage II) and age ( < 40, 40-49, 50-59, 60-79 years). The primary outcomes were arteriolosclerotic change, specifically arteriolar hyalinization (AH), atherosclerotic change, characterized by intimal thickening of small- to medium-sized arteries (IT) and global glomerulosclerosis. All lesions increased with age and BP. Adjusted odds ratios (ORs) for AH were 1.25 [0.74-2.12] for Stage I and 1.63 [1.02-2.61] for Stage II hypertension (vs. normal BP). IT was significantly increased in individuals aged 50-59 (OR 3.56 [1.27-9.98]) and 60-79 years (OR 5.61 [1.81-17.41]) compared to those <40 years. A significant interaction between BP and obesity was observed for AH (p = 0.03): among obese individuals, both Stage I and Stage II hypertension were associated with AH (ORs 3.72 [1.06-13.1] and 4.05 [1.38-11.85], respectively), but not among non-obese individuals. In conclusion, subclinical nephrosclerosis begins in middle age, primarily driven by age-related vascular changes. Obesity significantly enhances BP-related arteriolar damage, even at prehypertensive levels. These findings support stratified hypertension management based on both BP and metabolic status.

ACTH-independent Cushing syndrome (CS), a form of endogenous CS and an adrenal cause of hypertension, presents specific challenges in localizing cortisol-producing lesions. This study compared the diagnostic utility of ⁶⁸Ga-Pentixafor PET/CT for lesion localization between ACTH-independent CS and non-functioning adrenal adenomas (NFAA). We retrospectively analyzed 73 subjects (52 with ACTH-independent CS; 21 with NFAA) undergoing ⁶⁸Ga-Pentixafor PET/CT. Visual analysis demonstrated high diagnostic accuracy, with a sensitivity of 91.95%, a specificity of 95.24%, and a Youden index of 0.87. In semi-quantitative analysis, the lesion-to-adrenal ratio (LAR) showed superior performance compared to SUVmax and lesion-to-liver ratio (LLR). Using a diagnostic cutoff of SUVmax > 1.30, the sensitivity and specificity were 100% and 76.20%, respectively, supported by an AUC of 0.935 (P < 0.001) and a Youden index of 0.762. ⁶⁸Ga-Pentixafor PET/CT effectively localizes functional adrenal lesions in ACTH-independent CS with high accuracy, supporting its role in guiding targeted management and surgical planning.

Aldosterone exerts its effects primarily through the activation of the mineralocorticoid receptor (MR), a nuclear receptor that mediates sodium reabsorption in the kidney and contributes to cardiovascular and renal injury through fibrosis, inflammation, and vascular remodeling. Recent evidence indicates that MR activation is not solely dependent on circulating aldosterone levels but can also be influenced by factors such as high salt intake and hyperglycemia. Mineralocorticoid receptor antagonists (MRAs) remain the cornerstone of the pharmacological MR blockade. Newer nonsteroidal MRAs offer greater receptor selectivity and improved tolerability. Finerenone has been demonstrated to have cardiovascular and renal benefits in patients with chronic kidney disease and type 2 diabetes, whereas esaxerenone has shown potent antihypertensive and antialbuminuric effects across diverse patient populations, including those with resistant hypertension and primary aldosteronism (PA), particularly in combination with renin-angiotensin system inhibitors. Aldosterone synthase inhibitors (ASIs) have recently emerged as novel therapeutic agents. Selective inhibition of aldosterone synthase (CYP11B2) reduces aldosterone production and may suppress both genomic and non-genomic effects. Several ASIs have been investigated in clinical trials for efficacy and safety in patients with resistant hypertension, chronic kidney disease, and PA. PA is characterized by excessive MR activation and is associated with an increased risk of cardiovascular and renal complications. Recent studies have highlighted the importance of post-treatment renin levels as a marker of therapeutic response, as reflected in Primary Aldosteronism Medical Treatment Outcome (PAMO) criteria. Nevertheless, clinical outcomes remain the most relevant endpoints, and MRAs continue to be a central therapeutic strategy in PA management. Mineralocorticoid receptor activation by aldosterone and modulatory factors: ASI aldosterone synthase inhibitor, ALDO aldosterone, HTN hypertension, MR mineralocorticoid receptor, MRA mineralocorticoid receptor antagonist, PA primary aldosteronism.

Recent advances in digital technology are remarkable, and they are driving profound transformations in healthcare and medical research. Within this context, digital hypertension has emerged as a multidisciplinary paradigm that integrates novel digital technologies into the prevention, diagnosis, and management of hypertension. Digital hypertension encompasses diverse domains such as advanced sensor development, continuous physiological monitoring, information processing, artificial intelligence, big data analytics, digital therapeutics, and telemedicine. These innovations enable more personalized, efficient, and data-driven hypertension care. A growing body of research has explored applications ranging from home-based blood pressure monitoring systems to AI-assisted risk prediction models and remote therapeutic interventions, producing promising and clinically relevant outcomes. This review summarizes the latest evidence, highlights technological and clinical advances, and discusses future perspectives and challenges for the broader adoption of digital hypertension strategies.

Hypertensive disorders during pregnancy increase the risk of long-term cardiovascular disease in postpartum women. Exercise-based rehabilitation may help manage blood pressure (BP) and improve physical activity levels in this population, but supporting evidence remains limited. This pre-post single-arm proof-of-concept study aimed to assess the feasibility of a 4-week cardio-obstetrics rehabilitation program for women following hypertensive pregnancy. Women 3-6 months postpartum with a history of gestational hypertension or pre-eclampsia were recruited. The intervention combined exercise and educational components delivered through in-person, live virtual, and independent sessions. Feasibility was evaluated through recruitment, retention, adherence, acceptability, and safety. Outcomes included BP, six-minute walk distance, body weight and BMI, physical activity levels, health-related quality of life, and depressive symptoms. Six of 20 screened participants (30% recruitment) completed the intervention (100% retention). Overall adherence to scheduled sessions was 71%. All participants expressed high satisfaction, and no adverse events were reported. Descriptive analysis indicated improvements across all measured outcomes after the intervention. A cardio-obstetrics rehabilitation program for postpartum women after hypertensive pregnancy is feasible. Improvements in cardiovascular, anthropometric, behavioral, and psychosocial outcomes suggest potential efficacy and support further investigation.

Studies on the effects of blood pressure (BP) control satisfaction and adherence to antihypertensive medication on frailty in older patients with hypertension are limited. We aimed to evaluate the effects of BP control satisfaction and antihypertensive medication adherence on frailty transitions. We obtained routinely collected data from the National Essential Public Health Service Package, involving community-dwelling older patients with hypertension from an administrative district in Shenzhen, China, from 2018 to 2022. BP control satisfaction and antihypertensive medication adherence scores were based on follow-up clinical assessments. The frailty index (FI) was evaluated by annual questionnaires and health examinations. Multi-state models were utilized to estimate the associations between BP control satisfaction and antihypertensive medication adherence scores with frailty transitions. The median age of the 10,391 patients was 70 years (interquartile range: 67-73) at baseline: 5062 (48.7%) were non-frail, 4726 (45.5%) were pre-frail, and 603 (5.8%) were frail. Over a median follow-up of 1.63 years, 5782 transitions were observed, with 2840 (49%) forward and 2942 (51%) backward transitions. High BP control satisfaction was associated with a lower likelihood of transitioning from a non-frail to a pre-frail or frail state. High antihypertensive medication adherence was associated with an increased risk of transitioning from a non-frail to a pre-frail state and impeded frailty reversion from the frail to the pre-frail state. Effective BP control has protective effects against the development of frailty, while antihypertensive medication adherence might have detrimental effects in community-dwelling older patients with hypertension; however, further studies are required to determine this effect.

Hypertension is both a driver and a consequence of brain dysfunction. The brain regulates circulation via control of autonomic nervous system tone by integrating neural and humoral signals. It is also a vulnerable target of blood pressure (BP)-related injury, ranging from overt stroke to covert small-vessel disease. Recognizing this bidirectional relationship is essential for advancing precision in prevention and treatment. On the mechanistic side, recent work has clarified how the brain renin-angiotensin system, sodium-glucose cotransporter 2, the melanocortin system, and the gut-brain axis shape autonomic output. In addition, renewed attention has been given to centrally acting sympatholytics, imidazoline receptor agonists, which demonstrate antihypertensive efficacy and metabolic neutrality in contemporary trials. Collectively, these studies reinforce that central pathways remain viable therapeutic targets for modulating sympathetic activity. Clinically, multiple investigations highlight that cerebrovascular outcomes depend not only on mean BP but also on patterns and cumulative injury. Total small-vessel disease burden integrates lifetime vascular damage and predicts prognosis after stroke. Nocturnal BP surges and visit-to-visit variability further stratify cerebrovascular risk, while beat-to-beat fluctuations after reperfusion influence recovery. Pulse pressure after intracerebral hemorrhage links systemic hemodynamics with renal and neurological outcomes, and prevention gaps such as untreated hypertension remain striking, especially in younger patients. Together, these advances emphasize that brain health and BP regulation are inseparable. This review highlights recent advances in both central mechanisms of sympathoexcitation and clinical perspectives on cerebrovascular outcomes in hypertension.