Hypertension Research最新文献

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.

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.