Hypertension Research最新文献

Hypertension is a common lifestyle-related disease and is influenced by various factors, including excessive salt intake. Recently, the gut microbiota (GM) has gained attention for its potential involvement in blood pressure regulation; however, polyamine metabolism involvement remains poorly understood. Sixty participants aged ≥40 years from Shika Town, Japan, were stratified into four groups (n = 15 each) based on mean blood pressure and urinary sodium chloride (u-NaCl) excretion. The clinical parameters were evaluated, and fecal samples were analyzed using shotgun metagenomic sequencing to assess the microbial composition and abundance of genes related to arginine-polyamine metabolism. Three major findings were observed: (1) Significant differences in the α-diversity of GM were observed between salt-sensitive and non-salt-sensitive hypertensive groups; (2) The abundance of spermidine synthase (EC 2.5.1.16), a key enzyme in polyamine metabolism with known antihypertensive effects, was significantly higher in normotensive individuals, independent of u-NaCl excretion; and (3) Bacterial species harboring polyamine metabolic enzyme genes, including EC 2.5.1.16, differed significantly between groups, suggesting group-specific microbial metabolic traits. These findings suggest that GM-mediated polyamine metabolism may contribute to the regulation of salt-sensitive blood pressure. While variations in spermidine-producing bacteria and the involvement of EC 2.5.1.16 were observed, these factors alone do not fully account for the intergroup differences related to salt intake. Thus, polyamine metabolism likely plays a part in salt sensitivity, but additional microbial and host factors are also involved. Further studies are needed to validate these findings and to explore microbiota-targeted strategies for the prevention and treatment of hypertension.

Non-adherence to antihypertensive therapy remains a major barrier to blood pressure (BP) control globally. The behavioural distinction between intentional (INA) and unintentional non-adherence (UNA) is underexplored in low- and middle-income countries. We aimed to validate the Spanish MMAS-8, identify adherence-complexity phenotypes, and assess the mediating role of adherence between regimen complexity and BP control. In this multicenter, cross-sectional study (2022-2024), 1144 hypertensive patients from Argentina were evaluated. Adherence was assessed using the Spanish MMAS-8. Psychometric validation included Cronbach's alpha and principal component analysis. INA and UNA were classified by domain-based response patterns. K-means clustering was applied to MMAS-8 items and regimen complexity (number of drugs, daily doses). Mediation analysis tested the indirect effect of adherence. The MMAS-8 showed acceptable reliability (α = 0.78) and a unidimensional structure. Full adherence was observed in 41.1%. Among non-adherent patients, 38.5% were INA, 33.6% UNA, and 27.9% mixed. Four phenotypes were identified: (1) high adherence/low complexity; (2) very low adherence/simple regimens; (3) moderate adherence/intermediate complexity; (4) low adherence/high complexity. Adherence significantly mediated the effect of complexity on BP control (β = 0.004; p < 0.001), while the direct effect was non-significant. Compared with phenotype 1, phenotype 2 showed 58% lower odds of control (OR 0.42; 95% CI 0.29-0.61) and phenotype 4 showed 32% lower odds (OR 0.68; 95% CI 0.49-0.94). The Spanish MMAS-8 is valid for this population. Adherence-complexity phenotypes reflect structural and behavioural barriers. Tailored interventions should address INA and UNA using adherence profiling, fixed-dose combinations, and social support.