Hypertension Research最新文献

Prolonged P-wave duration on electrocardiogram (ECG) quantitatively reflects atrial remodeling and is associated with atrial fibrillation, cardiovascular death. We examined the association between P-wave duration and the risk of cardiovascular events with and without left ventricular hypertrophy (LVH) on ECG. The COUPLING Study, which examined prognosis in a Japanese population at cardiovascular risk, included 4288 subjects for whom digital ECG analysis was available. The primary event was a composite endpoint of stroke, ischemic heart disease, sudden death, hospitalization for heart failure, and aortic dissection. The cutoff value of the P-wave in ECG was 140 ms, and patients were divided into two groups: a control group with normal P-wave duration (n = 3975) and a prolonged P-wave duration group (n = 313). The association between prolonged P-wave duration and cardiovascular events was investigated in the presence of LVH using the Cornell product criteria for ECG. The mean age of subjects was 69 ± 11 years, and 50% were male. The median follow-up period was 5.0 years, and primary events were observed in 178 patients. The hazard ratio of primary events for prolonged P-wave duration was 2.20 (95% confidence interval [CI] 1.47-3.29, p < 0.001) after adjusting for age, gender, and comorbidity. In patients without LVH, prolonged P-wave duration was associated with a 1.86-fold higher primary endpoint risk (95% CI 1.17-2.96, p = 0.008), while prolonged P-wave duration was associated with a 2.76-fold higher primary event risk in patients with LVH (95% CI 1.10-6.89, p = 0.030), and the association was stronger in patients with LVH on ECG (synergistic effect: p = 0.007). Cardiovascular risk factors can advance atherosclerosis. Elevated sympathetic nerve activity affects the development of atrial fibrillation, and the renin-angiotensin-aldosterone system affects atrial and ventricular filling pressures as well as volume overload. In these processes, prolonged P-wave, reflecting atrial remodeling, and BNP, reflecting impaired ventricular function, indicates that atherosclerosis is developing. Prolonged P-wave in advanced ECG-LVH is a risk for the occurrence of cardiovascular events.

Hypertensive disorders of pregnancy (HDP) are associated with some patients with peripartum cardiomyopathy (PPCM). However, no studies have reported changes in the incidence of PPCM before and after the introduction of calcium channel blockers (CCBs) for HDP treatment in Japan. Thirteen patients (aged 25-43 years; mean age, 33 years) with PPCM from two hospitals in Nagasaki Prefecture were included. PPCM was defined as idiopathic cardiomyopathy that occurs in late pregnancy or the months following delivery, without other causes of heart failure and with a left ventricular ejection fraction <45%. We compared the incidence of PPCM between the nine years from January 2003 to December 2011 (prior to CCB initiation) and the nine years from January 2012 to December 2020 (after CCB initiation). The incidence of PPCM has decreased after CCB initiation compared to prior to CCB initiation (0.36/year, 1/1520 births vs. 1 patient/year, 1/610 births). Treatment with HDP, including CCB, may prevent the development of PPCM in Japan.

The prognostic significance of flat T-wave findings remains unclear. This study investigated the association between flat T-wave patterns and cardiovascular events. We analyzed data from 4508 patients with cardiovascular risk who were enrolled in the multicenter, prospective Coupling Study, with available electrocardiographic (ECG) records and follow-up outcomes (mean age 69 years; 51% male). Flat T waves were defined as T waves with an amplitude <0.1 mV and a T wave-to-R wave ratio of <10% in ≥2 of leads I, II, aVL, and V4-V6. Negative ST-T findings were defined as the area below the baseline in the ST-T segment. The primary endpoint was cardiovascular events, including stroke, myocardial infarction, hospitalization for heart failure, and aortic dissection. Over a median 5.0-year follow-up, 210 cardiovascular events occurred. Compared to the control group (N = 3426), both the flat T-wave (N = 539) and negative ST-T (N = 541) groups exhibited significantly greater risk of cardiovascular events after adjustment for age, gender, smoking, comorbidities, medications, office systolic blood pressure, N-terminal pro-B-type natriuretic peptide, and troponin T (flat T: hazard ratio [HR] 1.52, 95% confidence interval [CI], 1.01-2.29; p = 0.044; negative ST-T: HR 2.23, 95% CI, 1.58-3.15; p < 0.001). Findings in patients with hypertension (N = 4135) were consistent with those in the overall cohort: the flat T group had an HR of 1.54 (95% CI, 1.03-2.33; p = 0.037), and the negative ST-T group had an HR of 2.24 (95% CI, 1.57-3.18; p < 0.001) for incidence of cardiovascular events. In conclusion, flat T-wave findings on ECG were independently associated with cardiovascular events among patients with cardiovascular risk, including those with hypertension.

Our aim was a sex-specific analysis to characterize the phenotype for women with resistant hypertension (rHTN), an understudied population, referred for renal denervation (RDN) from the Global SYMPLICITY Registry DEFINE (N = 3332 patients). For this analysis, 2502 patients with uncontrolled hypertension (office systolic blood pressure (SBP) ≥140 mmHg, ≥3 antihypertensive drugs) were referred for RDN. Age at baseline was 18-88 years for men and 21-89 years for women. We used propensity score matching to account for demographic differences at baseline identified by multivariate regression analysis. Changes in BP, outcomes (all-cause death, cardiac death, stroke, myocardial infarction), and quality of life (QoL) after 36 months were assessed. Women had fewer comorbidities at baseline but had higher BP and worse QoL, anxiety, and depression compared to men. After propensity matching to minimize bias, BP changes were comparable by sex, and BP was significantly reduced from baseline following RDN. Women ≥55 years of age with resistant hypertension had a greater reduction in BP compared with women <55 years. At 36 months after RDN, there was a significant 12% reduction in anxiety/depression compared to baseline for women with resistant hypertension. When baseline office SBP was in the highest tertile (>178 mmHg), cardiac death was more prevalent in women (6.1%) than men (1.7%). Our sex-stratified analysis of the global registry allowed a longitudinal assessment, providing important insights into the phenotype of resistant hypertension in women. We identified sex-specific differences that highlight the need for early detection and management of hypertension in women.

The influence of partial pressure of oxygen (pO₂) is often overlooked during vasoreactivity testing by inhaling oxygen in congenital heart diseases (CHD). This study aims to evaluate the influence of pO₂ on hemodynamic data. Patients with simple CHDs and suspected pulmonary arterial hypertension undergoing right heart catheterization including vasoreactivity testing by inhaling O₂ were consecutively enrolled from June 2023 to March 2025. Patients with an arterial O₂ saturation below 98% after inhaling O₂ were excluded. Cardiac output was calculated using indirect Fick method, where blood O₂ content (1.39 × hemoglobin × O₂ saturation + 0.032 × pO₂) was excluded (unadjusted) or included (adjusted) with the pO₂ term. Hemodynamic data after inhaling O₂ calculated by both methods were compared. An over 20% decrease in pulmonary vascular resistance with stable blood pressure was considered a positive vasoreactivity testing. During the study period, a total of 136 patients with simple CHDs were enrolled and 129 of them were diagnosed with pulmonary arterial hypertension. In vasoreactivity testing, after adjustment, pulmonary / systemic blood flow ratio decreased from 4.32 ± 5.82 to 2.51 ± 1.67, while pulmonary vascular resistance was increased from 5.62 ± 4.18 WU to 7.04 ± 4.44 WU. The response to O₂ was adjusted to negative in 19 patients. The pO₂-adjusted indirect Fick method incorporates the effect of dissolved O₂ in hemodynamical data calculation, reducing overestimation of pulmonary / systemic blood flow ratio and underestimation of pulmonary vascular resistance in vasoreactivity testing by inhaling O₂ for patients with simple CHDs.

This prospective cohort study compared the associations between office blood pressure (OBP) and home blood pressure (HBP) measured before 20 weeks of gestation with the subsequent development of placenta-mediated pregnancy complications (PMPCs). A total of 975 pregnant women were included in the study. OBP and HBP were measured between 10 weeks 0 days and 19 weeks 6 days of gestation, using HBP values from the same gestational weeks as OBP. When both OBP and HBP were included simultaneously in a binary logistic regression model, per 1 standard deviation increase, the adjusted odds ratios (aORs) for office and home systolic blood pressure (SBP) were 1.16 (95% confidence interval [CI]: 0.95-1.42) and 1.68 (95% CI: 1.36-2.09), respectively. For diastolic blood pressure (DBP), the aORs were 1.36 (95% CI: 1.10-1.69) for office and 1.70 (95% CI: 1.37-2.12) for home measurements. The likelihood ratio test showed that adding home SBP to a model with office SBP improved model fit (P value < 0.0001), whereas adding office SBP to a model with home SBP did not (P value = 0.2). For DBP, adding either home or office values improved model fit (P value < 0.0001 and P value = 0.005, respectively). Home SBP was more strongly associated with PMPCs than office SBP. Although home DBP was not statistically stronger than office DBP, its effect estimate was higher. These findings support the added value of HBP monitoring during pregnancy for predicting PMPCs.

Binge drinking (BD) is the predominant pattern of alcohol consumption among adolescents. It is clinically associated with cardiovascular and hepatic alterations due to its strong pro-oxidant effects. Folic acid (FA), a cardioprotective vitamin, is related to caveolins (Cav), proteins involved in cellular nitrosative balance. This study aims to evaluate BD as a possible cardiometabolic risk factor (CMRF) during adolescence by examining its effects on cardiac nitrosative equilibrium as well as the potential of FA supplementation to mitigate these effects. Four groups of adolescent rats were employed: control, BD (intraperitoneal alcohol), control FA-supplemented, and BD-FA-supplemented. Diets contained 2 ppm FA (control) or 8 ppm FA (supplemented). BD promoted several CMRFs, including insulin resistance. BD also induced cardiac oxidative stress, primarily through NADPH oxidase (NOX) activation. Notably, BD caused cardiac nitrosative stress by increasing nitric oxide synthase (NOS) isoforms (iNOS and eNOS), resulting in abnormally high NO levels. This redox imbalance affected cardiac function by increasing heart rate (HR). BD further led to vascular dysfunction with decreased systemic NO and elevated VEGF and Cav-1, increasing mean blood pressure (MBP). FA supplementation restored cardiac oxidative/nitrosative homeostasis, normalizing NO levels. Consequently, HR and MBP decreased, vascular function improved, and CMRFs were attenuated. The action of FA was partly mediated by increased Cav-1 levels in the heart and serum. These findings suggest that FA supplementation could be a promising strategy to mitigate cardiovascular alterations induced by BD in adolescents and potentially prevent the development of future cardiometabolic diseases.

This study aimed to use real-world data obtained from a claim database based on the general population to indicate the optimal blood pressure (BP) level for preventing cardiovascular disease and bleeding in patients with atrial fibrillation (AF) undergoing anticoagulant therapy. We conducted a retrospective cohort study using claims data and health checkup data collected from multiple health insurance companies in Japan. A total of 4039 AF patients with health examination data who were receiving anticoagulant therapy were analyzed. BP is classified the Japanese Society of Hypertension Guidelines for the management of elevated blood pressure and hypertension 2025 (JSH 2025). Primary outcome was cardiovascular disease, Safety outcomes were intracranial bleeding and extracranial bleeding. During a mean follow-up period of 2.80 years, 133 cardiovascular disease events, 33 intracranial and 152 extracranial bleeding were observed. The incidence rates of cardiovascular disease and intracranial bleeding patients increased with the elevation of BP levels. The incidence of cardiovascular disease was lowest in those with BP levels <120/80 mmHg. The incidence of intracranial bleeding was lowest in those with BP < 130/80 mmHg. Extracranial bleeding found no clear association with BP. This real-world data of AF patients undergoing anticoagulant therapy, optimal systolic BP levels was <120-130 mmHg for prevention of cardiovascular disease and of intracranial bleeding.