Hypertension Research最新文献

Emerging evidence links maternal immune dysregulation to hypertensive disorders of pregnancy (HDP), yet gestational immune alterations preceding symptom onset remain unclear. This study aimed to evaluate the associations between first-trimester immune biomarkers and incident HDP risk across clinical subtypes. This retrospective cohort study enrolled pregnant women aged ≥18 years undergoing first-trimester antenatal screening at a tertiary hospital from March to November 2023. First-trimester peripheral immune markers-neutrophils, monocytes, lymphocytes, and platelets-were measured, with derived indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and aggregate index of systemic inflammation (AISI). Outcomes included HDP, gestational hypertension (GHTN), and preeclampsia confirmed via electronic medical records. Multivariable logistic regression models were performed to evaluate the relationship between peripheral immune markers and outcomes. Among the 2739 pregnant women who met inclusion criteria, 195 developed HDP, including 96 GHTN and 99 preeclampsia. Multivariable logistic regression demonstrated that first-trimester neutrophils, monocytes, platelets, lymphocytes, SII, and AISI were independently and positively associated with HDP risk in a linear dose-response manner (all FDR P < 0.05), with platelets exhibiting the strongest association (OR _{T3 vs. T1}: 2.20; per log-SD: OR = 1.55). Distinct biomarker profiles were identified between GHTN and preeclampsia: GHTN exhibited associations with neutrophils, platelets, SII, and AISI, while preeclampsia correlated with monocytes, platelets, lymphocytes, SII, and AISI (all FDR P < 0.05). Elevated first-trimester immune markers correlate with HDP, particularly platelet-related indices. Divergent immune signatures between GHTN and preeclampsia suggest subtype-specific pathophysiological mechanisms.

Mobile health (mHealth)-based disease management programs enable continuous monitoring of blood pressure (BP) and related health behaviors. Feature engineering may help to extract informative predictors from longitudinal data, potentially improving BP change prediction. This study aimed to evaluate whether feature-engineered predictors can improve the prediction of systolic BP (SBP) changes using an mHealth-based disease management program. We analyzed data from participants with hypertension, dyslipidemia, or diabetes mellitus who completed the 24-week Mystar program, which combined phone-based coaching, remote monitoring, and app-based logging of BP and behavioral data. The primary outcome was the change in morning SBP from baseline to the end of the program. Prediction models for SBP changes were developed using ElasticNet regression at weeks 4, 8, 12, and 22 by comparing models with and without feature-engineered variables generated by feature tools. In total, 2318 participants were included in the analysis. At week 4, the top feature after feature engineering showed a stronger correlation with SBP change (r = 0.561) than the best original predictor (r = 0.455), although the model-level performance was similar (r = 0.561 vs. 0.559). By week 22, both models achieved a high correlation of approximately 0.85 with no substantial difference in performance. Feature engineering increased the correlation between individual predictors and SBP change in the early phase; however, the overall prediction performance of the ElasticNet model remained largely unchanged. Further studies are required to confirm these findings and examine their applicability in broader clinical and implementation contexts. Data from a 24-week mHealth-based program were analyzed to predict systolic blood pressure SBP changes using feature-engineered variables and ElasticNet regression. In the early phase, feature-engineered predictors ranked highest in importance, although overall model performance remained similar with and without feature engineering. Prediction accuracy improved over time, with correlations reaching ~0.85 by week 22.

Hypertension, encompassing white-coat hypertension (WCH), masked hypertension (MH), and sustained hypertension (SH), is an established risk factor for cardiovascular diseases (CVDs), including atherosclerosis. However, among the general population, findings on which target organ is affected by the different phenotypes of hypertension remain unclear. In this community-based observational study of Shiga Epidemiological Study of Subclinical Atherosclerosis, 740 Japanese men underwent brain magnetic resonance imaging to assess the presence of lacunar infarction, white-matter hyperintensities, microbleeds, and intracranial artery stenosis (ICAS) between 2012 and 2015. They also underwent office blood pressure (BP) measurements, home BP monitoring for at least five consecutive days, and coronary artery calcification (CAC) assessments between 2010 and 2014. The final analysis included 686 participants without a history of CVDs. Of the 686 participants, the mean age ( ± SD) was 68.0 ( ± 8.3) years, and 39.3% were taking antihypertensive medication. In multivariable-adjusted models, each of WCH, MH, and SH was significantly associated with a higher risk of microbleeds compared to normotension. However, the association of WCH with microbleeds was evident only among those on antihypertensive medication (adjusted odds ratio [OR] 6.75 [95% CI 1.83-24.86]) and absent in those not on such medication (adjusted OR 1.20 [95% CI 0.31-4.73]). SH was associated with lacunar infarction, ICAS, and CAC. Among Japanese men, WCH, MH, SH were associated with subclinical cerebrovascular diseases, whereas only SH was associated with CAC. Moreover, any elevated BP phenotype increased the risk of microbleeds. Our findings suggest that different hypertension phenotypes distinctly affect target organs, particularly the brain and heart.

We investigated the prognostic value of within-visit and short- and long-term between-visit blood pressure variability (BPV) for all-cause and cardiovascular mortality, fatal and nonfatal cardiovascular events and incident atrial fibrillation in an elderly Chinese population. Participants were elderly (≥65 years) inhabitants, enrolled in a trial for atrial fibrillation screening. Blood pressure was measured three times consecutively at baseline and in a subset also at least two weekly visits during the first month of follow-up or at least two quarterly visits during the first year of follow-up. BPV indices included standard deviation, coefficient of variation, and other statistical measures. We computed hazard ratios (HR) for the risks of clinical outcomes associated with a 1-SD increase in these BPV indices, while accounting for confounding factors. Among 6711 participants, diastolic within-visit BPV indices were significantly (P ≤ 0.02) and positively associated with the risks of all-cause and cardiovascular mortality, and fatal and nonfatal cardiovascular events, but systolic BPV indices were negatively associated with the risk of incident atrial fibrillation (HRs 1.03-1.09 and 0.87-0.92, respectively). Among 362 participants, none of the short-term between-visit BPV indices were associated with the clinical outcomes (P ≥ 0.09). For the long-term between-visit BPV among 1582 participants, significant associations were observed for systolic BPV indices in relation to cardiovascular mortality (P ≥ 0.03), and diastolic BPV indices in relation to incident atrial fibrillation (P ≤ 0.03), with the HRs ranging from 1.05-1.43, and from 1.07-1.20, respectively. In conclusion, some of the BPV indices were weakly associated with the risk of mortality, cardiovascular events and incident atrial fibrillation.

Recent studies indicate a stronger association between the urinary sodium-to-potassium (Na/K) ratio and blood pressure (BP) than individual sodium (Na) or potassium (K) levels. This study aimed to examine whether urinary Na/K ratio could predict the onset of hypertension in the general population. The ratio was calculated using overnight urine samples from 23,014 adults (mean age; 51.4 ± 13.2 years, 13,525 men) who underwent annual physical checkups between 2010 and 2023. Cross-sectional analysis of first-visit data revealed significantly higher Na/K ratios among individuals with hypertension compared to normotensive individuals (5.05 ± 2.85 vs. 4.39 ± 2.47, p < 0.001). Multiple regression analysis showed a significant association between the Na/K ratio and systolic BP. After excluding participants with hypertension, 12,483 normotensive individuals (48.7 ± 11.9 years; 7087 men) were followed for a median of 1788 days. During the follow-up period, 4056 participants developed hypertension. Kaplan-Meier analysis indicated an increased risk of hypertension across baseline Na/K ratio quartiles (log-rank, p < 0.001). Univariate Cox regression analysis identified the Na/K ratio as a significant predictor of incident hypertension, with hazard ratios increasing across quartiles. Multivariate analysis confirmed the association (hazard ratio [HR] = 1.408, 95% confidence interval [CI]; 1.225-1.619), although the Na/K ratio was not independently associated with hypertension onset after additional adjustment for baseline systolic BP. These findings suggest that the urinary Na/K ratio is significantly associated with the risk of hypertension in the general population. Therefore, dietary interventions that lower the Na/K ratio may prevent the development of hypertension.