Hypertension Research最新文献

This real-world, non-interventional, retrospective cohort study evaluated the achievement rate of guideline-recommended target blood pressure (BP) and representative safety profile of the treatment incorporating sacubitril/valsartan (Sac/Val) in Japanese patients with essential hypertension. Data were collected from electronic health records from ~4700 clinics across Japan, covering ~11.4% of the nationwide population. Of the 1405 eligible patients, 1247 were included in the effectiveness analysis. The primary endpoint investigated the proportion of patients achieving the Japanese Society of Hypertension 2019-recommended antihypertensive goals within 8 weeks of initial Sac/Val administration (index date). Secondary endpoints included description of baseline characteristics and their relative contribution to BP goal attainment, description of prescription patterns, and safety. A total of 29.8% of patients achieved individual estimated BP goals, with significant mean reductions in systolic and diastolic BPs (-15.6 mmHg and -6.1 mmHg, respectively, p < 0.0001). Patients aged ≥75 years, those with cerebrovascular disease, and those classified as Grade I hypertension were more likely to meet BP goals. Among patients with BP reduction of ≥10 mmHg, the most common prescription pattern at index date was a combination of calcium channel blocker (CCB) and Sac/Val, and a majority switched from CCB and angiotensin receptor blocker combination or were on CCB monotherapy. The most common signs of adverse events were hypotension and diuresis-related events, particularly during summer. The discontinuation rates following these signs were 1.0% and 0.8%. This real-world study demonstrated the clinical utility and representative safety profile of treatments involving Sac/Val in Japanese patients with essential hypertension.

Patients with chronic kidney disease (CKD) frequently experience cardiovascular events, and as per current therapeutic guidelines, renin-angiotensin system inhibitors (RASi) can protect the cardiovascular system in those with proteinuric CKD. Effectiveness of RASi in treating non-proteinuric CKD is still unknown, yet. In order to evaluate the impact of RASi on cardiovascular morbidity and mortality in patients with non-proteinuric CKD, we performed a post-hoc analysis of the Frontier of Renal Outcome Modification-Japan study. A urine protein-to-creatinine ratio less than 0.15 g/g or negative/trace protein on urinalysis was considered as non-proteinuric CKD. Those who have undergone dialysis, kidney transplant recipients, and patients who refused to give their consent were excluded. A composite of cardiovascular events, initiation of renal replacement therapy, and all-cause mortality was studied as the primary outcome. Of 2379 patients with CKD, 630 met the criteria for non-proteinuric CKD. Among them, 490 used RASi, and 140 did not. Although the RASi group was considerably younger and had a higher prevalence of hypertension and calcium channel blocker use, baseline characteristics were comparable. 12.1% of the control group and 16.7% of the RASi group experienced the primary outcome during follow-up, with no significant difference (adjusted HR: 1.37; 95% CI: 0.81-2.31). Secondary outcomes and analyses of RASi use for the whole observation period did not show any significant differences (adjusted HR: 0.81; 95% CI: 0.43-1.56). These results imply that RASi was not linked to a decreased risk of mortality or long-term events in those with nonproteinuric CKD.

Elevated blood pressure (BP) has been linked to brain structure changes and cognitive decline. However, few studies have accounted for long-term cumulative BP exposure. We investigated the association between cumulative BP exposure, brain volume, cerebral blood flow (CBF), and cognitive decline. Furthermore, we explored whether alterations in brain volume and CBF mediated the association between cumulative BP and cognitive decline. We included 1012 adult participants from the Kailuan study. Cumulative BP exposure was calculated from 2006 to 2020. Brain MRI scans and the Montreal Cognitive Assessment (MoCA) were performed in 2020. Generalized linear regression models were used to investigate the associations between cumulative BP, brain volume, CBF, and cognitive function. Mediation analysis was performed to examine whether alterations in brain volume and CBF mediated the association between cumulative BP and cognitive decline. Compared with the lowest tertiles, the highest tertiles of cumulative SBP were associated with lower volumes in total brain (-9.11 [-16.25, -1.97]), total GM (-5.53 [-10.02, -1.04]), frontal lobe (-2.46 [-4.15, -0.78]), temporal lobe (-1.37 [-2.51, -0.23]) and hippocampus (-0.15 [-0.26, -0.03]), and the highest tertiles of cumulative DBP were associated with lower volume in frontal lobe (-2.33 [-3.98, -0.68]) and temporal lobe (-1.15 [-2.27, -0.04]). Higher cumulative SBP and DBP were associated with lower total and regional CBF and MoCA scores (all P < 0.05). The associations between cumulative DBP and cognitive decline were mediated by the volumes in total GM, frontal lobe and temporal lobe. Early intervention in cumulative BP may help preserve brain structure and function.

Whether high remnant cholesterol (RC) is associated with an increased risk of incident hypertension, independent of its well-known risk factors, in the general population remains unclear. We followed 5264 participants (3312 women; mean age 39.1 years) from Tehran Lipid and Glucose Study. RC was calculated as total cholesterol minus the sum of the high- and low-density lipoprotein-cholesterol. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg, or diastolic blood pressure (DBP) ≥ 90 mmHg, or using anti-hypertensive medications. Multivariable Cox proportional hazards regression models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). In a random-effects meta-analysis we combined our results with six previous studies. In our cohort study, during a median follow-up of 12.4 years, 2189 events of hypertension occurred. Accordingly, in multivariable analyses, the association between RC and hypertension reached non-significant after adjusting for baseline SBP and DBP as covariates in both continuous (per 1-SD increase: 1.00 (0.91-1.10)) and categorical analyses (Q4 vs. Q1: 1.02 (0.85-1.22) (P for trend = 0.343)). However, in the meta-analysis, elevated RC was significantly associated with hypertension (pooled 11 effect-sizes, 1.30 (1.14-1.48); I² = 99.80; N = 7 studies (6 studies used calculated RC); 2,559,478 participants). In subgroup analyses of meta-analysis, this association was generally more pronounced among individuals with lower baseline risk. In conclusion, in our cohort study, elevated RC was not significantly associated with higher risk of incident hypertension in the presence of large set of confounders, including baseline SBP and DBP levels. We investigated the association between remnant cholesterol and risk of hypertension through a prospective study and meta-analysis. In our cohort study, the association between RC and hypertension was not independent of baseline SBP and DBP levels among Iranian adults. However, the meta-analysis revealed a significant association, albeit with substantial heterogeneity.

Seasonal variations in blood pressure (BP) and cardiovascular risk represent one of the most consistently reproduced yet under-recognized phenomena in hypertension research. In Japan, where winter temperatures can fluctuate sharply in both outdoor and indoor environments, the burden of winter-associated cardiovascular events is strikingly visible in epidemiological data. The so-called "heat shock" phenomenon is defined as acute cardiovascular events triggered by sudden temperature changes. Recent statements by the Japanese Society of Hypertension, including the initiative "Morning BP Action in Winter," emphasize that winter mornings constitute a uniquely hazardous physiological "heat shock" window-one in which sympathetic activation, thermal stress, and behavioral triggers converge to sharply elevate BP and precipitate acute cardiovascular events. This editorial commentary expands on the scientific rationale, clinical implications, and public health significance of this initiative, aiming to contextualize winter morning BP management as an essential preventive strategy.

Hypertension is a major contributor to the global disease burden, affecting more than one billion individuals worldwide. Despite decades of recognition of its adverse health effects, hypertension control rates remain suboptimal. Epidemiology provides essential knowledge for understanding disease distribution and identifying risk factors at the individual, social, and environmental levels. Recent evidence emphasizes both traditional lifestyle determinants, including excess sodium intake, low potassium intake, obesity, physical inactivity, smoking, and alcohol consumption, and emerging contributors, such as gut microbiota dysregulation and infectious diseases. Among those, the urinary sodium-to-potassium ratio has gained attention as an important factor associated with hypertension risk. Additionally, social determinants of health, including socioeconomic disparities, neighborhood deprivation, and structural racism, exacerbate the risk of hypertension and impede its effective control. Environmental factors such as air pollution, extreme temperatures, and occupational stress further contribute to the complexity of hypertension epidemiology. Regarding contemporary epidemiological methodology, our proposed concepts of the "Bench and Real-World Cycle" and "Real-World Evidence Cycle" highlight the necessity of continuously integrating real-world evidence into practice. In addition to classical cohort studies, real-world data derived from electronic health records including health checkups and insurance claims data are indispensable tools for addressing previous research limitations. This multifaceted perspective will accelerate evidence-based epidemiological approaches for preventing and treating hypertension.

Home blood pressure monitoring (HBPM) is essential for long-term hypertension management, but its accuracy and reliability is questionable due to user inconsistencies and non-standard usage conditions. This study compared two validated HBPM devices - a wrist-based and a reference upper-arm monitor - in a home-like setup where participants placed the devices themselves. A total of 121 participants underwent four concurrent blood pressure (BP) measurements, with two taken in each arm, followed by a crossover of devices between arms after the initial two readings. Wrist-derived BP readings were higher than upper-arm measurements. With higher blood pressure levels, both devices exhibited greater bias, accompanied by reduced precision in systolic BP measurements. Additionally, hypertension classification showed only moderate agreement (Cohen's kappa=0.58). The wrist monitor tended to over-diagnose hypertension and exhibited greater variability than the upper-arm device. These findings highlight the need for more guidance and education as well as critical evaluation of home blood pressure measurements provided by patients.