Hypertension Research最新文献

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.

School-based programs represent a potential avenue for conducting population-wide paediatric blood pressure (BP) screening. The aim of this review was to systematically scope peer-reviewed literature reporting school-based BP screening, with respect to measurement protocols, diagnostic process coverage, and implementation considerations. Only peer-reviewed articles in English across PubMed, OVID Medline and OVID Embase were included. Two authors independently screened the article titles and abstracts prior to undertaking a full-text review. All disagreements were resolved through discussion and agreement. From each study, four categories of information were extracted: general information, BP measurement methodology, diagnostic process coverage, and implementation strategies. Each article was then assigned to one of three categories regarding the stated or implied study objectives: general school-based research incorporating BP measurement, hypertension prevalence studies, or hypertension screening studies. Of the 112 articles meeting the inclusion criteria, only 17 were categorised as hypertension screening studies. Within these, there was substantial variability in BP measurement techniques and adherence to the diagnostic process recommended by the American Academy of Pediatrics. Additionally, there was minimal reporting on implementation strategies. A pragmatic, standardised protocol for school-based BP screening is needed that includes recommended measurement methods, considers the trade-offs (in terms of feasibility and economics) of covering more or less of the diagnostic process in schools vs health care settings, and covers approaches to optimise implementability.

The renin-angiotensin system (RAS) plays a central role in regulating blood pressure and has recently been implicated in cancer biology. Although angiotensin II (AngII) receptor blockers (ARBs) have shown clinical benefit in bladder cancer, their mechanisms of action remain unclear. Here, we investigated the contribution of AngII type 1 receptor (AGTR1) to bladder cancer progression and assessed the therapeutic potential of the ARB losartan (LOS). In patients with primary non-muscle-invasive bladder cancer, intravesical recurrence following transurethral tumor resection correlated with AGTR1 expression levels. Public database analysis revealed that the expression of AGTR1 and its downstream kinases, extracellular signal-regulated kinase (ERK) 1 and ERK2, was associated with overall survival in bladder urothelial carcinoma. In AGTR1-overexpressing T24 bladder cancer cells, AngII promoted invasion and migration and upregulated neuronal nitric oxide synthase, without affecting proliferation. These effects were accompanied by rapid ERK phosphorylation alongside Akt dephosphorylation. RNA sequencing revealed that AGTR1 expression and AngII stimulation activated NF-κB, mTOR, and epithelial-mesenchymal transition (EMT) pathways. LOS suppressed these AngII-mediated responses, whereas the AngII-independent upregulation of EMT-related proteins and the enhancement of mitochondrial energy metabolism by AngII in AGTR1-overexpressing cells remained unaffected. In vivo, AGTR1 facilitated early tumor engraftment and promoted tumor progression, accompanied by reduced E-cadherin and elevated N-cadherin expression, with most of these changes suppressed by LOS treatment. In conclusion, our findings highlight the crucial role of AGTR1 in bladder cancer and support the repositioning of ARBs, such as LOS, as therapeutics for AGTR1-upregulated bladder cancer, while underscoring the importance of AGTR1 stratification for future clinical evaluation.

Dietary sodium and potassium intake play a key role in the regulation of blood pressure (BP). This study investigated whether 24- urinary sodium, potassium and sodium-to-potassium ratio were associated with blood pressure in Australian schoolchildren aged 4-12 years, and if the association between 24-h urinary sodium and blood pressure was moderated by body weight. Twenty-four-hour urine, blood pressure, and anthropometry were collected from 755 schoolchildren (mean age 9.3 (SD 1.8) years). Multiple linear regression with adjustment for covariates was conducted. The mean sodium excretion was 2419 (SD 1052) mg/d. Seventeen percent of children had elevated blood pressure. There were no overall associations between 24-h sodium or potassium excretion and blood pressure in adjusted regression models. However, in adjusted regression analysis stratified by sex, there was a positive association between 24-h urinary sodium and systolic blood pressure z-score among girls (b-coefficient 0.10 [95% CI 0.03, 0.18], pvalue = 0.01, n = 342). No other sex differences were observed. Body weight significantly moderated the association between sodium excretion and SBP (p for interaction = 0.002). In children living with obesity, sodium excretion was positively associated with systolic blood pressure z-score (b-coefficient 0.75 [95% CI 0.00, 1.51], pvalue = 0.05, n = 21). In conclusion, sodium excretion in this sample exceeded recommended levels for healthy development and almost a fifth of children had elevated blood pressure. For optimal health across life, public health interventions aiming to reduce the elevated cardiovascular risk of raised blood pressure in children are likely to be most effective by reducing sodium intake in conjunction with promoting healthy weight.