Hypertension Research最新文献

This study is to determine peripheral sample collection timing impact on selectivity index (SI) and success of unstimulated adrenal venous sampling (AVS) for primary aldosteronism (PA) subtyping. In this study, a retrospective discovery and a prospective validation arm were conducted. 74 patients undergoing AVS before and after-ACTH stimulation were reviewed. Discovery dataset was divided into 1) "pre" group, peripherals collected 30-min before AVS and 2) "post" group, peripherals collected 1-min after AVS. SIs were calculated using 30-min-pre and 1-min-post values. Patients with samples having SIs < 2 and SIs ≥ 5 on before and after-ACTH were classified as false negative and those with SI ≥ 2 and SI ≥ 5 on before and after-ACTH as true positive. Data was analyzed using Chi-squared test. For validation, 27 patients were enrolled prospectively as a paired group. In each, two peripherals were collected approximately 30 min before and 1 min after AVS. Cortisol was compared using Wilcoxon matched-pair signed rank test. Retrospectively, 38% of "30 min-pre" patients had SI < 2 in right adrenals, compared to 14% in "1 min-post" patients (P = 0.007). For the left, 45.9% of "30 min pre" patients had SIs < 2 compared to 13.5% in "1 min-post" patients, (P = 0.002). Prospectively, peripheral cortisol 1 min post decreased by 28% compared to 30-min pre (median, 6.4 to 4.6 μmol/L; P < 0.001). SIs increased 40% bilaterally (P < 0.001). In conclusion, in unstimulated AVS, collecting peripheral samples after sampling the adrenal veins is more likely to give more accurate SI than before sampling the adrenal veins.

We sought to assess the validity of risk stratification table of Japanese Society of Hypertension (JSH) 2025 guideline, based on Scheie hypertensive fundus changes. We analyzed the data of medical checkup of Saitama Red Cross Hospital from 2017 to 2024 who underwent fundus examination (N = 6953). Based on the risk stratification table of JSH 2025 guideline, age, sex, comorbidities, past history, and blood pressure (BP) at the health checkup examination were used to stratify the risk into 12 groups. As the original of this study, those with BP < 130/80 mmHg were further examined and a total of 15 groups were analyzed. Risk 1st category and BP < 130/80 mmHg were set as a control group. As the risk category and BP level each increased, the rate of Scheie hypertensive changes significantly increased. Samely, the rate of Scheie sclerotic changes also significantly increased. In the range of BP < 130/80 mmHg, the rate of fundus changes significantly increased as the risk category increased. In conclusion, the risk stratification table of JSH 2025 guideline was valid based on Scheie hypertensive changes in subjects with medical checkup. Furthermore, those with BP < 130/80 mmHg could be added in the risk stratification table.

Identifying and prioritizing modifiable risk factors is crucial for the primary prevention of hypertension. However, large-scale data on the population attributable fraction (PAF) for a comprehensive range of modifiable risk factors for incident hypertension in the Japanese population have been scarce. This study analyzed 1,069,948 participants (median age 56, 43.7% men) without a history of hypertension from the DeSC database. Using Cox proportional hazards models, we evaluated the association between modifiable risk factors (obesity, diabetes mellitus, dyslipidemia, smoking, habitual alcohol consumption, physical inactivity, and sleep disorders) and incident hypertension to calculate their PAFs. Over a median follow-up of 3.64 years, 116,690 new hypertension diagnoses were recorded. Obesity had the highest PAF at 6.36%, followed by sleep disorder (4.11%), current smoking (3.39%), dyslipidemia (2.74%), habitual alcohol consumption (2.10%), physical inactivity (1.93%), and diabetes mellitus (1.55%). The PAF of obesity for incident hypertension decreased with age, from 15.10% among individuals aged <40 years to 7.93% among those aged 40-64 years and 3.70% among those aged ≥65 years. Similarly, obesity's PAF was higher in men (7.93%) than in women (5.02%). The total PAF for all evaluated modifiable risk factors showed a more pronounced contribution among younger adults and men. In conclusion, this research reveals that obesity is the largest modifiable contributor to incident hypertension in the Japanese population. Furthermore, the impact of modifiable risk factors for hypertension is more significant in younger adults and men. These findings offer valuable insights for developing effective public health policies aimed at preventing hypertension.

Intermittent hypoxia (IH), the key physiological stressor in obstructive sleep apnea, is commonly quantified by respiratory event frequency. However, clinical heterogeneity in hypertension among patients with comparable apnea-hypopnea index (AHI) suggests that episode timing, including the duration and frequency of desaturation-reoxygenation cycles, may exert distinct biological effects even under equal cumulative burden. To test this, male Wistar-Kyoto rats were exposed for 21 days (8 h/day) to IH with either 10-s hypoxia duration at 30 cycles/h (10s-30c) or 5-s hypoxia duration at 60 cycles/h (5s-60c), while room air served as a control. Cardiovascular regulation was evaluated by continuous measurement of mean arterial pressure, heart-rate variability, and baroreflex sensitivity, and broader systemic effects were assessed through sleep-wake architecture, EEG activity, spatial memory, and cortical/hippocampal protein markers. Both IH groups had elevated blood pressure and disrupted autonomic balance compared with controls. The 5s-60c group produced more sustained hypertension, blunted nocturnal dipping, greater baroreflex impairment, and enhanced beta power during sleep, indicating persistent sympathetic drive. By contrast, the 10s-30c group was associated with increased paradoxical sleep, impaired spatial memory, reduced NeuN expression, and stronger upregulation of IBA-1 and NF-κB. These findings demonstrate that equivalent cumulative hypoxic exposure with different temporal structures yields divergent cardiovascular and neurocognitive outcomes. High-frequency, short-duration episodes preferentially promoted cardiovascular dysregulation, whereas longer episodes were linked to neurocognitive vulnerability. Consideration of hypoxic episode duration may improve the mechanistic interpretation of cardiovascular heterogeneity associated with sleep-disordered breathing.

Multiple articles focused on the central arterial systolic (SPTI) and diastolic (DPTI) pressure-time indexes and the subendocardial viability ratio (SEVR). However, whether these indexes contribute to risk stratification in the general population is unknown. SPTI, DPTI and SEVR were noninvasively measured by the SphygmoCor technology. Incidence rates and standardized (per 1-SD increment) multivariable-adjusted hazard ratios (HRs) for cardiovascular (primary) and cardiac endpoints and stroke were evaluated in the International Database of Central Arterial Properties for Risk Stratification (n = 5099). Model refinement was assessed by the area under the curve (AUC) and the integrated discrimination (IDI) and net reclassification (NRI) improvement. Over 4 years (median), 215 cardiovascular, 133 cardiac endpoints and 79 strokes occurred. For SPTI, fully adjusted HRs were 1.37 (95% CI: 1.18-1.59), 1.35 (1.11-1.64) and 1.33 (1.05-1.69) for the cardiovascular and cardiac endpoints and stroke. The corresponding HRs for DPTI were 1.49 (1.31-1.69), 1.23 (1.02-1.48) and 1.74 (1.46-2.07). For SEVR, none of the HRs reached significance. Analyses with these indexes categorized by quartiles were confirmatory. Analyses stratified by various risk factors did not reveal subgroup differences. For the cardiovascular endpoint, adding SPTI or DPTI to the base model improved the AUC, while adding SPTI or DPTI combined with mean arterial pressure, increased IDI by ~1.7% and NRI by ~17% (P < 0.001 for all). Whereas cardiovascular and cardiac endpoints and stroke were related with the non-invasively measured SPTI and DPTI, SEVR was not.

Heart failure with preserved ejection fraction (HFpEF) is characterized by impaired relaxation and increased stiffness, leading to elevated filling pressures and inefficient cardiac performance despite preserved ejection fraction (LVEF ≥ 50%). These changes alter pressure-volume (PV) loop profiles. Noninvasive PV loop analysis using cardiovascular magnetic resonance (CMR) and brachial cuff pressure offers a novel approach to evaluating ventricular energetics. This study aimed to assess the prognostic value of CMR-derived PV loop parameters in HFpEF. Patients with HFpEF confirmed by invasive cardiopulmonary exercise testing who underwent CMR were included. PV loop parameters-including potential energy (PE), stroke work (SW), ventricular efficiency (VE), external power, and energy per ejected volume-were derived from CMR cine imaging and brachial cuff pressure measurement. The primary outcome was a composite of cardiovascular death and heart failure hospitalization. Associations were assessed using multivariable Cox proportional hazards models. Between February 2017 and August 2021, 161 patients (median age 55.1 years; 42.9% female) were enrolled. Nineteen (11.8%) experienced the primary endpoint over a median follow-up of 1.63 years. In unadjusted analysis, PE and VE were significantly associated with events (P < 0.05). In multivariable models adjusting for age, sex, hypertension, diabetes, hematocrit, and SW, PE remained an independent predictor (HR 3.59, 95% CI 1.24-10.42, P = 0.02). Noninvasive PV loop analysis using CMR and brachial cuff pressure identifies PE as a novel predictor of cardiovascular events in HFpEF, emphasizing impaired ventricular energetics as a key mechanism.