Hypertension最新文献

Background: The association between systolic blood pressure and all-cause mortality differs between frail and nonfrail individuals, highlighting uncertainties about the effectiveness of antihypertensive treatments in frail populations.

Methods: Using data from the SHEP trial (Systolic Hypertension in the Elderly Program), a baseline frailty index (FI), including 55 variables, was constructed. Fine-Gray subdistribution hazard models and Cox proportional hazards regression models were used to explore the association between baseline FI and the risks of stroke, cardiovascular disease, and all-cause death, as well as to examine whether the impact of antihypertensive treatment on these outcomes was modified by baseline FI.

Results: A total of 4692 participants (mean age, 72.1 years; 56.7% women) were included, with a mean (SD) FI of 0.134 (0.061). During a median follow-up period of 4.4 years, FI was associated with a higher risk of stroke (subdistribution hazard ratio, 1.24 [95% CI, 1.10-1.39]; per SD higher FI), cardiovascular disease (subdistribution hazard ratio, 1.18 [95% CI, 1.09-1.26]), and all-cause death (hazard ratio, 1.37 [95% CI, 1.26-1.50]), after adjustment for age, sex, race, and treatment group. Although those with higher levels of frailty were at higher risk for all outcomes, there was no evidence of an interaction between baseline FI and antihypertensive treatment (P for interaction >0.05 for all outcomes).

Conclusions: In individuals with isolated systolic hypertension, antihypertensive treatment improved associated outcomes even among those with a higher degree of frailty. These findings from the SHEP trial reinforce evidence from other seminal antihypertensive trials, which collectively inform the appropriate treatment of frail individuals with hypertension.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00000514.

Background: Although the information on the validation status of electronic sphygmomanometer (ES) devices in use in health care institutions and households is much more clinically relevant than that of ES models available on the market, it remains insufficient.

Methods: A national survey was conducted across all administrative regions of mainland China to assess the validation status of ESs. Fifty-eight cities were selected with stratification by municipality, provincial capital, and other cities, and health care institutions and households in each city were chosen by convenience to identify ES devices in use according to the study protocol. Information on devices' model, type, was collected. The validation status of each device was ascertained through searching international online registries of its models.

Results: A total of 3230 ES devices (1924 from health care institutions and 1306 from households), encompassing 498 ES models, were actually selected. The weighted proportion of accuracy-validated devices was significantly higher in health care institutions (33.9% [95% CI, 31.8-36.0%]) compared with households (23.0% [95% CI, 20.8-25.4%]; P<0.001), and both exceeded the proportions for models (17.7% [95% CI, 13.7-22.6%] and 12.5% [95% CI, 9.5-16.3%], respectively). Regional economic development, device type, and years in use were associated with the proportion of accuracy-validated devices. Notably, 8.8% of devices used in secondary hospitals were wrist type.

Conclusions: The accuracy validation status of ESs in China in the number of devices in use shows a more favorable situation than that in the number of models but remains low and concerning. Policies are urgently needed to promote the widespread adoption of accuracy-validated models among all users.

Background: Blood pressure (BP) time in target range (TTR) reflects the proportion of time that BP measurement is within a specified target range. We aim to summarize the evidence for relationships between TTR and adverse health outcomes.

Methods: Seven databases were searched. After quality assessment and data extraction, meta-analyses were performed to generate pooled estimates of the association (hazard ratios) between TTR and health outcomes. Primary outcomes were all-cause mortality and cardiovascular death. Secondary outcomes included major adverse cardiovascular events, myocardial infarction, stroke, heart failure, atrial fibrillation, and adverse kidney events.

Results: In all, 21 studies were included, mostly rated at low risk of bias. TTR was defined by systolic BP (SBP) in 15 studies and by both SBP and diastolic BP in 6 studies. Per SD increase of TTR was associated with significantly decreased risks of all-cause mortality (110-130 mm Hg SBP TTR: hazard ratios, 0.85 [95% CI, 0.82-0.89]; 120-140 mm Hg SBP TTR: 0.81 [95% CI, 0.70-0.94]; and 70-80 mm Hg diastolic BP TTR: 0.88 [95% CI, 0.83-0.93]), cardiovascular death (110-130 mm Hg SBP TTR: 0.83 [95% CI, 0.78-0.87]; 120-140 mm Hg SBP TTR: 0.76 [95% CI, 0.65-0.89]; and 70-80 mm Hg diastolic BP TTR: 0.85 [95% CI, 0.80-0.90]), major adverse cardiovascular events (120-140 mm Hg SBP TTR: 0.76 [95% CI, 0.70-0.83]), and heart failure (110-130 mm Hg SBP TTR: 0.84 [95% CI, 0.76-0.93] and 120-140 mm Hg SBP TTR: 0.78 [95% CI, 0.68-0.89]). However, there was not sufficient support for the association of TTR with myocardial infarction, stroke, atrial fibrillation, or adverse kidney events.

Conclusions: Higher TTR was associated with reduced risks of all-cause mortality, cardiovascular death, major adverse cardiovascular events, and heart failure, highlighting the importance of sustained BP control in clinical practice.

Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023486437.

Background: Cardiomyocyte oxidative stress significantly contributes to the progression of hypertension-induced heart failure, highlighting the need for targeted therapies. We developed a novel peptide, NPA7, that coactivates the GC-A (guanylyl cyclase A)/cGMP and MasR (Mas receptor)/cAMP pathway. This study aimed to test NPA7's ability to inhibit oxidative stress by modulating the p62-KEAP1 (Kelch-like ECH-associated protein 1)-NRF2 (nuclear factor erythroid 2-related factor 2) pathway in human cardiomyocytes (HCMs) and a rat model of hypertension.

Methods: Oxidative stress was induced in HCMs using H₂O₂ with PBS or NPA7 treatment. Intracellular reactive oxygen species levels were assessed via dihydroethidium staining. Western blotting analysis measured p62, KEAP1, and NRF2 protein levels, while GSH/GSSG ratios and antioxidant gene expression were analyzed. HCMs were transfected with siRNA targeting GC-A, MasR, or p62 before NPA7 and H₂O₂ treatment. In vivo, spontaneously hypertensive rats received saline or NPA7, with normotensive WKY rats as control and cardiac oxidative stress, KEAP1 protein levels, NOX2, and p67 mRNA levels were measured.

Results: NPA7 reduced H₂O₂-induced reactive oxygen species levels and increased GSH/GSSG ratio in HCMs. Silencing GC-A and MasR reversed NPA7's effects. NPA7 activated the KEAP1-NRF2 pathway, enhancing NRF2's antioxidant target gene expression. In p62 knockdown HCMs, NPA7-induced KEAP1 degradation and NRF2 activation were diminished. Reactive oxygen species levels were elevated in spontaneously hypertensive rat versus WKY hearts however, NPA7 treatment reduced myocardial reactive oxygen species, suppressed KEAP1 protein, and decreased NOX2 and p67 mRNA levels.

Conclusions: NPA7 exhibits antioxidant properties in HCMs and spontaneously hypertensive rat hearts by targeting GC-A and MasR through the p62-KEAP1-NRF2 pathway, supporting a novel therapeutic approach against cardiovascular disease-related oxidative stress.

Background: Mechanosensitive Piezo1 channel plays a key role in pulmonary hypertension (PH). However, the role of Piezo2 in PH remains unclear.

Methods: Endothelial cell (EC)-specific Piezo2 knockout (Piezo2^flox/flox, Tek-Cre⁺; Piezo2^EC-/-) rats and primarily cultured pulmonary microvascular ECs were used to determine the role of Piezo2 in PH.

Results: Data analysis of publicly accessible single-cell RNA-sequencing data sets uncovered significant downregulation of Piezo2 in lung ECs from patients with idiopathic pulmonary arterial hypertension, which was verified in the lungs/ECs from PH rat models induced by hypoxia or monocrotaline. Comparing to wild-type rats, Piezo2^EC-/- rats exhibited exacerbated PH in both hypoxia-induced PH and monocrotaline-induced PH, characterized by the worsened hemodynamical and histological changes. Piezo2^EC-/- rats showed dramatic loss of pulmonary microvessels, in association with the decreased intracellular free calcium concentration ([Ca²⁺]_i) and downregulation of VEGFR2 (vascular endothelial growth factor receptor 2) and phosphorylated SRF (serum response factor) in pulmonary microvascular ECs. Knockout of Piezo2 or treatment with a calcium chelator, EDTA, impaired the ability of tube formation and migration in pulmonary microvascular ECs, which was restored by supplementation of extra calcium. A safflower oil diet rich in linoleic acid, which can enhance the stability and function of Piezo2, effectively alleviated PH development in a hypoxia-induced PH rat model.

Conclusions: This study demonstrates that EC-specific knockout of Piezo2 exacerbates PH pathogenesis, at least partially, through the suppression of [Ca²⁺]_i/phosphorylated SRF/VEGFR2 signaling axis in pulmonary vascular ECs. Targeted activation of Piezo2 could be a novel effective strategy for the treatment of PH.

Background: Obesity is a factor contributing to the occurrence of hypertension and a risk factor for adverse outcomes in populations with hypertension. The changes in the prevalence of obesity in populations with hypertension remain unclear. Investigating the changes in the prevalence of obesity in populations with hypertension can provide information for the treatment and management of hypertension.

Methods: The clinical data from adults aged ≥20 years with hypertension were extracted from the National Health and Nutrition Examination Survey 2001 to 2023. The primary outcome was the prevalence of obesity (body mass index≥30 kg/m²). The trend in the prevalence of obesity among American adults with hypertension was evaluated via a trend test.

Results: The age-standardized prevalence of obesity among populations with hypertension in America increased from 39.6% in 2001 to 55.4% in 2023 (P for trend<0.001). This trend was observed in male (35.4%-53.6%; P for trend<0.001) and female (45.6%-57.7%; P for trend<0.001) populations with hypertension. While the prevalence of grade II (35 kg/m²≤body mass index<40 kg/m²) and grade III obesity (body mass index≥40 kg/m²) increased significantly in both sexes, the prevalence of grade I obesity (30 kg/m²≤body mass index<35 kg/m²) increased significantly only in males (23.2%-30.0%; P for trend=0.003) and did not significantly change in females (22.2%-21.7%; P for trend=0.135).

Conclusions: The prevalence of obesity among American adults with hypertension increased from 2001 to 2023. In males, the prevalence of grades I, II, and III obesity increased. Among females, the prevalence of only grades II and III obesity increased.