Hypertension Research最新文献

To explore the association between stage 1 hypertension before 20 weeks of gestation and twin pregnancy outcomes and to examine whether the association varies by prepregnancy BMI, conception mode, or chorionicity, we conducted a single-center, retrospective, hospital-based cohort study. All women who delivered twins between July 2014 and December 2020 were recruited. Logistic regression and linear regression models were used to identify associations. Among the 2069 included twin pregnancies, 1326 had normotension (< 130/80 mm Hg), and 743 had stage 1 hypertension (130-139/80-89 mm Hg). Compared with normotension, stage 1 hypertension was associated with higher risks of hypertension disorders of pregnancy (adjusted OR: 2.07, 95% CI: 1.62 ~ 2.64), gestational hypertension (adjusted OR: 3.99, 95% CI: 2.42 ~ 6.58), preeclampsia (adjusted OR: 1.71, 95% CI: 1.30 ~ 2.25), early preterm birth (adjusted OR: 1.58, 95%CI: 1.16 ~ 2.15), and small for gestational age (adjusted OR:1.45, 95%CI: 1.20 ~ 1.75). In particular, there were interaction effects between chorionicity and stage 1 hypertension on the risk of early preterm birth (P_interaction = 0.014). In conclusion, stage 1 hypertension before 20 weeks of gestation is associated with a higher risk of adverse outcomes in twin pregnancies, and the associations vary by prepregnancy BMI and chorionicity. Obstetricians should take this into careful consideration during prenatal care to mitigate the potential risks of twins.

Nocturnal blood pressure (BP) dipping is a risk factor for cardiovascular disease, independent of nighttime BP levels. We compared nocturnal BP dipping detected by conventional ambulatory BP monitoring (ABPM) with that detected by nocturnal home BP monitoring (HBPM), which can measure BP during sleep with a timer function. We analyzed data of 927 subjects in the nationwide practice-based J-HOP Nocturnal BP Study and observed that the prevalences of nocturnal BP dipping status for HBPM and ABPM respectively were: extreme dipper, 6.9% and 14.8%; dipper, 36.1% and 42.4%; non-dipper, 42.8% and 33.2%; riser pattern, 14.1%, and 9.6%. The agreement between nocturnal dipping classification by HBPM and ABPM was 41.0%, and when we used ≥3 days of HBPM data, the agreement rate increased to 42.8%. Obtaining an increased number of nighttime BP measurements at home for multiple days may increase the reliability of assessments of nocturnal BP dipping status detected by HBPM.

Home blood pressure (HBP) monitoring is a better prognostic predictor than clinical BP monitoring. However, the suggested number of HBP measurements in each occasion varies across guidelines. The study aimed to identify which HBP measurements in each occasion are more closely associated with new cardiovascular events in patients with type 2 diabetes. This retrospective cohort study included 1082 patients with type 2 diabetes without a history of macrovascular complications. HBP was measured three times each morning and evening for 14 days, and the average value over the 14 days was calculated. During a median follow-up of 7.0 years, 117 patients (11.1%) had cardiovascular events. The Cox proportional hazards model was used to examine the association between the average morning home systolic BP (MHSBP) for the 1st, 2nd, and 3rd measurements and cardiovascular events. The adjusted hazard ratios (HR) (95% confidence interval) for the onset of cardiovascular events in the 2nd and 3rd mean MHSBP were 1.129 (1.008-1.265) and 1.135 (1.010-1.275), respectively. The area under the receiver-operating characteristic curve (AUC) for the 2nd, 1st/2nd, 2nd/3rd, and 1st/2nd/3rd mean MHSBP was significantly greater than that of the 1st mean MHSBP (p = 0.040, p = 0.014, p = 0.020, and p = 0.021, respectively). No significant difference was observed between the AUC of the 2nd/3rd and 1st/2nd/3rd mean MHSBP and that of the 1st/2nd mean MHSBP. We recommend that HBP measurements be taken just twice per occasion to predict cardiovascular events in patients with type 2 diabetes.

The definition of hyperfiltration, the main pathogenesis in renal impairment in obesity and diabetes mellitus, is uncertain. Glomerular filtration rate (GFR) declines physiologically with aging, and there is inaccuracy in GFR in obesity due to body surface area (BSA) correction. Here, we defined hyperfiltration using GFR without BSA correction, but with inclusion of aging, and investigated hyperfiltration using this definition and absolute GFR > 125 mL/min. The subjects were 180 kidney donor candidates (56.4 ± 11.3 years old, 79 males). GFR was evaluated using inulin clearance. A two-hour 75-g oral glucose tolerance test was also performed. The subjects were divided into four groups with and without a combination of glucose tolerance disorder and BMI. Normal glucose tolerance (NGT) and BMI < 25 kg/m² were defined as normal, and hyperfiltration was defined as the upper 95% confidence interval of the relationship of aging and GFR in normal cases, and compared with GFR > 125 mL/min. RESULTS: GFR without BSA correction and UAE in non-NGT subjects with obesity were higher than in other groups, but GFR with BSA correction did not show this relationship. In multiple regression analysis, BMI was independently associated with GFR without BSA correction, but not with BSA correction. Aging was consistently associated with GFR. The prevalence of hyperfiltration by our definition (GFR = -0.883 × Age + 167.398) was significantly higher than that using GFR > 125 mL/min (P < 0.0001). Hyperfiltration in obesity and/or glucose tolerance disorder should be evaluated using GFR without BSA correction and including the decline of GFR due to aging.

The growing recognition of the importance of interpregnancy weight management in reducing hypertensive disorders of pregnancy (HDP) underscores the importance of effective preventive strategies. However, developing effective systems remains a challenge. We aimed to bridge this gap by constructing a prediction model. This study retrospectively analyzed the data of 1746 women who underwent two childbirths across 14 medical facilities, including both tertiary and primary facilities. Data from 2009 to 2019 were used to create a derivation cohort (n = 1746). A separate temporal-validation cohort was constructed by adding data between 2020 and 2024 (n = 365). Furthermore, the external-validation cohort was constructed using the data from another tertiary center between 2017 and 2023 (n = 340). We constructed a prediction model for HDP development in the second pregnancy by applying logistic regression analysis using 5 primary clinical information: maternal age, pre-pregnancy body mass index, and HDP history; and pregnancy interval and weight change velocity between pregnancies. Model performance was assessed across all three cohorts. HDP in the second pregnancy occurred 7.3% in the derivation, 10.1% in the temporal-validation, and 7.9% in the external-validation cohorts. This model demonstrated strong discrimination, with c-statistics of 0.86, 0.88, and 0.86 for the respective cohorts. Precision-recall area under the curve values were 0.90, 0.85, and 0.91, respectively. Calibration showed favorable intercepts (-0.02 to -0.00) and slopes (0.96-1.02) for all cohorts. In conclusion, this externally validated model offers a robust basis for personalized interpregnancy weight management goals for women planning future pregnancies.

The aim of this study was to determine whether pulse pressure (PP), an indicator of arterial stiffness, was independently associated with the risk of acute kidney injury (AKI) following intracerebral hemorrhage (ICH). We enrolled patients with acute ICH from a multicenter stroke registry in Fukuoka, Japan, from June 2007 to September 2019. The mean PP, measured three times on the third day after admission, was categorized into three groups based on tertiles: G1 < 54 mmHg, G2 54-64 mmHg, and G3 ≥ 65 mmHg. AKI was defined as an increase of ≥0.3 mg/dL or ≥150% in serum creatinine levels above baseline during hospitalization. The associations between PP and AKI were evaluated using logistic regression analyses. Overall, 1512 patients with acute ICH (mean age: 69.8 ± 13.5 years; 56.4% men) were included in the analysis. The incidence rates of AKI were 5.6%, 11.0%, and 13.2% in groups G1, G2, and G3, respectively. The odds ratio (95% confidence interval) of AKI was significantly elevated in G2 (1.77 [1.07-2.91]) and G3 (1.82 [1.10-3.03]) compared to G1, even after adjusting for initial systolic blood pressure (SBP) values on admission and subsequent SBP reductions. This significant association was observed in patients with an initial SBP < 200 mmHg (P for heterogeneity, 0.045) and those receiving intravenous antihypertensive therapy in the acute stage (P for heterogeneity, 0.03). High PP should be recognized as a novel potential risk factor for AKI following ICH. High pulse pressure was significantly associated with an increased risk of acute kidneyinjury following intracranial hemorrhage. Pulse pressure should be recognized as anovel potential risk factor and one of the predictors of acute kidney injury afterintracranial hemorrhage.