Hypertension Research最新文献

Hypertension is the primary modifiable risk factor for both ischemic stroke and intracerebral hemorrhage (ICH), yet recommendations for blood pressure (BP) management vary across contemporary guidelines. This narrative review compares BP targets and therapeutic strategies in the 2025 American Heart Association (AHA), 2024 European Society of Cardiology (ESC), 2023 European Society of Hypertension (ESH), and 2025 Japanese Society of Hypertension (JSH) guidelines, with emphasis on acute and chronic phases of ischemic stroke and ICH. In acute ischemic stroke without reperfusion therapy, all four guidelines discourage routine BP lowering unless systolic BP (SBP) is ≥220 mmHg or diastolic BP ≥ 120 (110) mmHg, and then recommend only modest reductions of about 15% within 24 hours. For patients receiving IV thrombolysis or mechanical thrombectomy, the guidelines converge on pre-treatment BP<185/110 mmHg and maintenance <180/105 mmHg during the first 24 hours, with JSH specifying micro-infusion calcium channel blockers as preferred agents. In chronic ischemic stroke, AHA, ESH, and JSH generally endorse BP<130/80 mmHg, whereas ESC prioritizes an SBP range of 120-9 mmHg. For acute ICH, all guidelines support rapid but carefully titrated SBP reduction toward approximately 140 mmHg, while emphasizing avoidance of overshoot, large variability, and excessive early declines, particularly when baseline SBP exceeds 220 mmHg in the AHA and ESC guidelines. Long-term after ICH, targets of <130/80 mmHg are widely recommended. Thiazide diuretics, ACE inhibitors, and angiotensin receptor blockers remain foundational for secondary prevention, with calcium channel blockers central to acute parenteral therapy and β-blockers reserved for specific indications. Despite regional nuances, the guidelines converge on conservative acute management in ischemic stroke, proactive early lowering in ICH, and intensive long-term BP control as the global benchmark for secondary cerebrovascular prevention.

The measurement of an individual's blood pressure (BP) while he or she is in a seated position is the standard BP measurement method. The significance of BP measurements obtained from an individual while he or she is in the supine position has also been described. Supine BP values are usually lower than seated BP values, and thus the condition of high supine BP is abnormal and called 'supine hypertension.' Although the mechanisms that underlie supine hypertension are not completely understood, it has been speculated that fluid retention and abnormal sympathetic nervous activity can lead to supine hypertension. Hypertension-mediated organ damage and cardiovascular events have been shown to be associated with supine hypertension; not only supine hypertension with neurogenic orthostatic hypotension but also supine hypertension without it. The treatment of supine hypertension has not been established. Considering the pathophysiological background of this condition, the use of antihypertensive drugs and bedtime dosing may be effective. Further research is necessary to clarify the significance of supine hypertension and to establish the optimal treatment for this condition.

Chronological age is a well-established risk factor for Hypertension (HTN), yet while biological ageing markers such as epigenetic age acceleration (EAA), have been associated with HTN, findings are inconsistent. This study aimed to conduct a systematic review and meta-analysis to evaluate the association between EAA, HTN and blood pressure (BP) to provide an understanding of the role of EAA in HTN development and progression. Six databases were searched, and studies which reported associations between DNA and HTN, and/or BP were included. Functional enrichment analysis was conducted using DAVID and STRING to elucidate underlying molecular pathways. From 4334 studies, 165 met the inclusion criteria. Qualitative analysis indicated that 17.0% of studies reporting global methylation and 49.1% of studies reporting gene-specific methylation demonstrated significant associations with HTN and/or BP. A random effects meta-analysis of 16,136 participants from 8 studies using three epigenetic clock algorithms demonstrated that HTN was associated with increased EAA (β: 0.29, 95%Cl: 0.15-0.43; P < 0.0001). All three individual epigenetic clocks demonstrated a positive association between clinically measured HTN and EAA (Horvath β: 0.33, 95%Cl: 0.08-0.58, P = 0.010; Hannum β: 0.64, 95%Cl: 0.09-1.20; PhenoAge β: 1.21, 95%Cl: 0.56-1.86), whereas this relationship was not clear when using self-reported HTN. This study is the first to systematically demonstrate that HTN is associated with EAA. We recommend the use of clinically measured over self-reported HTN in appropriately powered studies of epigenetic age to obtain an accurate understanding of BP regulation/HTN on the epigenome, supporting pathways to translation and development of novel therapeutic targets for HTN.

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.