Hypertension Research最新文献

Hypertensive emergencies (HE) and urgencies (HU) are significant challenges for emergency physicians and hypertension specialists. The Eridano study is a prospective multicenter investigation assessing acute blood pressure (BP) disorders, subclinical hypertension-mediated organ damage (HMOD), and short- and long-term prognosis, including cardiovascular complications, new ED admissions, and BP control. Patients with symptomatic BP ≥ 180/110 mmHg admitted to the ED were enrolled and managed by ED personnel. Clinical evaluation and subclinical-HMOD assessment were performed at a Hypertension Centre within 72 h, followed by a 3-month follow-up. A total of 252 patients (21 HE, 231 HU) were included (mean age 61 ± 14 years, 52% males). Subclinical-HMOD was more common in HE (90% vs. 65%), including cardiac (76% vs. 43%), renal (40% vs. 11%), and cerebral (73% vs. 12%) damage. Vascular-HMOD was similar between the groups (54%), with increased pulse wave velocity (PWV) in 44% of patients. BP control (<140/90 mmHg) was achieved in 36% at 72 h. At 3 months, both groups showed lower systolic BP, and 29% of patients with uncontrolled BP at baseline achieved control. Female sex, lower ascending aorta diameter, and lower E/e' ratio were associated with BP control. The composite endpoint (cardiovascular events and new ED admissions) occurred in 12% of patients at 3 months (4% major events, 7% new HU). Multivariate analysis showed female sex and PWV were associated with adverse outcomes. Two-thirds of patients had subclinical HMOD, primarily affecting large arteries and the heart. Female sex and PWV were associated with worse outcomes.

Conceptual framework illustrating differential fluid dynamics between SGLT2 inhibitor monotherapy and combination therapy with conventional diuretics in patients with chronic kidney disease. Combination therapy preferentially reduces interstitial fluid while preserving plasma volume, potentially through attenuation of vasopressin activity, natriuresis, and transcapillary fluid shift.

Hypertension is a major public health challenge globally and in Iran. Given the role of inflammation in hypertension development, this study aimed to examine the association between the inflammatory potential of diet, quantified using the energy-adjusted Dietary Inflammatory Index (E-DII™), and the incidence of hypertension. The data of the present study were extracted from the Fasa Adult Cohort Study database. In this prospective cohort study, 10,138 participants were recruited at the baseline phase. Participants were contacted by telephone at regular intervals over 7 years. A selected group was also revisited after 5 years. Survival analysis was conducted to investigate the association between E-DII and hypertension incidence over a 7-year follow-up period, using Cox regression. Participants in the highest E-DII tertile (most pro-inflammatory diet) had a significantly higher risk for hypertension incidence during 7 years (HR_{T3 vs. T1} = 2.24, P value < 0.001). Moreover, the association of E-DII with hypertension incidence after 5 years was examined using logistic regression. Logistic regression revealed a significantly higher hypertension incidence after 5 years among participants in the highest E-DII tertile (OR_{T3 vs. T1} = 2.62, P value < 0.001). Linear regression showed positive and significant associations between E-DII and change in blood pressure components over 5 years. However, the associations in all models were attenuated and became statistically insignificant after adjustment for body mass index. Our findings indicate that consuming a pro-inflammatory diet was associated with an increased risk of developing hypertension. Moreover, body mass index emerged as a key covariate in this relationship.

Prevention of hypertension (HT), a risk factor for cardiovascular diseases, and blood pressure (BP) control are important. For the prevention and management of high BP, increased physical activity (PA) is recommended as a lifestyle intervention. Although various PA assessment methods exist, their associations with clinical BP have been inconsistent. This study aimed to compare self-reported and accelerometer-measured PA in relation to home HT prevalence based on home BP, which has better reproducibility than office BP. We conducted this cross-sectional study of 5895 participants (mean age: 57.5 years, 70.4% women) in the Tohoku Medical Megabank Project Cohort Study. Total PA was assessed using two methods: self-reported activities (leisure, occupational/household) and accelerometer-measured values. Home HT was defined as morning home BP ≥ 135/85 mmHg or under HT treatment. Modified Poisson regression analysis showed no statistically significant association between self-reported total PA and the prevalence of home HT. In contrast, higher levels of accelerometer-measured total PA were associated with lower prevalence of home HT (P for trend <0.05). Regarding other accelerometer-measured components, higher light PA and more steps were also significantly associated with lower prevalence of home HT. These associations were largely mediated by body mass index. In conclusion, accelerometer-measured PA, unlike self-reported PA, was associated with home HT, suggesting that PA assessed by accelerometers is useful for understanding the relationship between PA and HT, preventing HT, and managing high BP.

The incremental value of 24-hour central systolic blood pressure in identifying target organ damage based on blood pressure phenotypes remains unclear. This multicenter, cross-sectional study enrolled 2589 non-dialysis patients with chronic kidney disease. Clinic and ambulatory brachial blood pressure were used to define blood pressure phenotypes. The net reclassification index and logistic regression analyses were performed. 24-h central systolic blood pressure gradually elevated across four blood pressure phenotypes with a linear trend (P-trend <0.001). Incorporating 24-h central systolic blood pressure into blood pressure phenotypes significantly improved target organ damage discrimination, particularly 24-h central systolic blood pressure with c2 calibration (mean arterial pressure and diastolic blood pressure calibration method) for left ventricular hypertrophy (NRI = 0.192, 95% CI [0.085-0.298], P < 0.001). Multivariable logistic regression revealed that, compared with normotension without central systolic hypertension (c2 calibration), only masked hypertension and sustained hypertension with central systolic hypertension (c2 calibration) had significantly increased odds of both left ventricular hypertrophy (ORs: 3.220 [95% CI, 1.861-5.537; P < 0.001] and 4.054 [95% CI, 2.772-5.996; P < 0.001]) and carotid hypertrophy (ORs: 2.059 [95% CI, 1.240-3.461; P = 0.006] and 1.368 [95% CI, 1.001-1.860; P = 0.049]). Moreover, the prevalence of kidney injury was higher in the masked hypertension and sustained hypertension groups with central systolic hypertension (c2 calibration) than in the group without central systolic hypertension (c2 calibration). 24-h central systolic blood pressure may provide additional value for target organ damage risk stratification based on blood pressure phenotypes in non-dialysis patients with chronic kidney disease.