Hypertension Research最新文献

The study investigates brain conductivity changes following a three-month antihypertensive treatment in 22 patients with essential hypertension. Utilizing a prospective, cross-sectional design, the research employed MREPT for brain conductivity mapping. Image analyses involved voxel-based and ROI-based techniques with statistical tests examining correlations between conductivity changes and age or blood pressure changes. Key findings included a significant increase in brain conductivity post-treatment, particularly in the anterior cingulate and right insula. Older patients exhibited smaller conductivity increases, notably in the corpus callosum. No significant correlation was found between changes in diastolic or systolic blood pressure and conductivity. Proposed mechanisms for these changes include improved cerebrospinal fluid dynamics, enhanced ion mobility, and normalized ion concentrations, suggesting brain conductivity as a potential biomarker for treatment efficacy. The study implies that brain conductivity could serve as a novel imaging biomarker for monitoring antihypertensive treatment efficacy in the brain.

In a large-scale randomized controlled study of heart failure (HF), angiotensin receptor-neprilysin inhibitors (ARNI) reduced cardiovascular events compared to enalapril, but resulted in more symptomatic hypotension. However, changes in blood pressure (BP) during hospitalization in patients with decompensated HF treated with ARNI remain unknown. We retrospectively analyzed BP during hospitalization for decompensated HF in a multi-center registry. Among 166 patients treated with newly prescribed renin-angiotensin system inhibitor (75.7 ± 13.4 years, 57.2% men, and ejection fraction 39 ± 17%), 114 were treated with newly prescribed ARNI (ARNI group) and 52 were treated with newly prescribed angiotensin converting enzyme inhibitors or angiotensin receptor blockers but without ARNI (ACEi/ARB group). The initial day of prescription was day 4 [2-6] for the ARNI group and day 3 [1-6] for the ACEi/ARB group. Three days after the initiation of each drug, systolic BP dropped from 132 ± 24 to 117 ± 19 mmHg (ARNI group, p < 0.001) and 131 ± 19 to 117 ± 21 mmHg (ACEi/ARB group, p < 0.001). A mixed-effects model showed similar BP reductions in both groups (p = 0.247). Herein we showed a downward trend in BP following ARNI initiation in decompensated HF. Early changes in BP after ARNI initiation were comparable with those in the ACEi/ARB group.

Elevated blood pressure is frequently observed during cancer treatment with vascular endothelial growth factor inhibitors, reflecting either a treatment-emergent adverse event or pharmacological effect. Appropriate blood pressure management is critical in minimizing cardiovascular risk and prevent treatment interruption. Although home blood pressure monitoring is recommended to detect masked or white-coat hypertension, longitudinal data on home blood pressure trajectories during therapy remain limited. This multicenter observational pilot study aims to evaluate the association between clinic and home blood pressure in patients with malignant tumors receiving vascular endothelial growth factor inhibitors, and to assess factors associated with blood pressure variability and the feasibility of home monitoring during therapy. Approximately 50 participants are being enrolled. Home blood pressure is measured twice daily throughout the treatment period, and clinical, laboratory, and treatment-related data and patient-reported data are collected at baseline, during therapy, and at follow-up. The primary outcome is the difference between clinic and home blood pressures at multiple time points during and after vascular endothelial growth factor inhibitor therapy. Blood pressure phenotypes will be classified according to clinic and home blood pressure thresholds, and their clinical characteristics will be compared. Longitudinal trajectory of home blood pressure will be assessed to explore patterns associated with clinical outcomes. This study will clarify the relationship between clinic and home blood pressure, explore factors influencing blood pressure variability, and provide preliminary evidence on the feasibility and clinical value of home blood pressure monitoring in patients receiving angiogenesis inhibitor therapy.

The administration of bevacizumab, ramucirumab, and aflibercept increases the incidence of hypertension; however, the risk of discontinuation of cancer therapy due to hypertension from these medications remains unclear. A systematic review and meta-analysis were conducted to assess the incidence and risk of hypertension associated with bevacizumab, ramucirumab, and aflibercept, as well as the risk of treatment discontinuation due to hypertension. Phase III randomized controlled trials (RCTs) of these therapies published through November 5, 2024, were identified through searches in PubMed, Cochrane Library, and Web of Science databases. The meta-analysis included 57 RCTs comprising 34,145 patients who received bevacizumab, ramucirumab, or aflibercept. The overall incidence of hypertension was 28% (95% confidence interval [CI]: 22-34%) for all-grade hypertension and 9% (95% CI: 7-11%) for grade ≥3 hypertension. Compared to control groups, treatment with these agents was associated with an increased risk of all-grade hypertension (odds ratio [OR]: 4.5; 95% CI: 3.7-5.5) and grade ≥3 hypertension (OR: 5.0; 95% CI: 4.0-6.3). The incidence of treatment discontinuation due to hypertension was 1% (95% CI: 1-2%), with a risk difference of 1.60% (95% CI: 0.76-2.38). VEGF inhibitor therapy-induced hypertension has been suggested to increase the risk of cancer treatment discontinuation. Therefore, careful monitoring and management of blood pressure in patients receiving these agents is essential.

Large Language Models (LLMs) demonstrate considerable potential in enhancing the retrieval of health information. However, the hallucinatory they produce poses a security challenge. This study aimed to improve the accuracy and reliability of LLMs in hypertension education through the integration of integrating Retrieval-Augmented Generation (RAG) technology. We constructed a hypertension supplement knowledge base, and subsequently integrated it into a RAG technology, resulting in the development of the HEART (Hypertension Enhancing Answer Retrieval Tool) framework. A set of 50 commonly asked questions related to hypertension was used to evaluate the performance of four base LLMs-ChatGPT-4o, Claude-3.5, Gemini-2.5, and Llama-3.3-as well as their corresponding HEART-enhanced versions. Clinical experts assessed each response in terms of accuracy, completeness, consistency, robustness, security, and overall quality. The integration with the HEART framework led to a significant improvement in the performance of all four LLMs across five key evaluation dimensions: accuracy, completeness, consistency, security, and robustness (all P < 0.05). The average overall quality scores for all models increased significantly: from 3.57 (SD 0.72) to 4.20 (SD 0.41) for Llama-3.3, from 3.92 (SD 0.70) to 4.38 (SD 0.42) for Claude-3.5, from 3.91 (SD 0.73) to 4.32 (SD 0.39) for ChatGPT-4o, and from 4.03 (SD 0.69) to 4.38 (SD 0.41) for Gemini-2.5 (all P < 0.001). This study highlights the importance of combining high-quality, domain-specific medical data with advanced artificial intelligence techniques to enhance accuracy and reduce misinformation in healthcare applications.

Pulmonary arterial hypertension (PAH) is a rare disease characterized by a progressive increase in pulmonary arterial pressure, leading to right heart failure. In clinical practice, reduced exercise tolerance is commonly observed in patients with PAH. Several studies have identified skeletal muscle abnormalities and muscle weakness as factors contributing to impaired exercise capacity in these patients. Recently, peak expiratory flow rate (PEFR) has been shown to correlate with skeletal muscle mass. Given that PEFR can be easily and noninvasively measured using respiratory function tests, we investigated the relationship between PEFR and prognosis in patients with PAH. We enrolled consecutive untreated patients diagnosed with PAH at Kagoshima University Hospital between July 2005 and July 2024. A total of 85 patients were included and divided into the preserved PEFR group and the reduced PEFR group. There were no significant differences in hemodynamic parameters between the two groups; however, the 6-minute walk distance was significantly shorter (p = 0.0062) in the reduced PEFR group. Kaplan-Meier analysis revealed that the cumulative event-free rate was significantly lower in the reduced PEFR group (Log-rank p = 0.0048). Reduced PEFR was independently associated with poorer outcomes after adjusting for age, plus each of right atrial pressure, cardiac index, and pulmonary vascular resistance. In conclusion, PEFR, a method for measuring skeletal muscle, was associated with poor prognosis in patients with PAH when assessed at the time of diagnosis. PEFR can be easily and repeatedly measured, making it potentially useful for prognostic prediction and exercise rehabilitation in these patients.