Pub Date : 2024-08-01Epub Date: 2024-07-17DOI: 10.1161/HYPERTENSIONAHA.124.23088
Johan R Simonsen, Leena Vikatmaa, Pirkka Vikatmaa, Mika Laine, Hanna Granroth-Wilding, Per-Henrik Groop, Ilkka Tikkanen, Daniel Gordin
{"title":"Sham-Controlled Randomized Pilot Trial on Baroreflex Activation Therapy in Resistant Hypertension.","authors":"Johan R Simonsen, Leena Vikatmaa, Pirkka Vikatmaa, Mika Laine, Hanna Granroth-Wilding, Per-Henrik Groop, Ilkka Tikkanen, Daniel Gordin","doi":"10.1161/HYPERTENSIONAHA.124.23088","DOIUrl":"10.1161/HYPERTENSIONAHA.124.23088","url":null,"abstract":"","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-06-17DOI: 10.1161/HYPERTENSIONAHA.124.22704
Kendra D Sims, Pengxiao Carol Wei, Joanne M Penko, Susan Hennessy, Pamela G Coxson, Nita H Mukand, Brandon K Bellows, Dhruv S Kazi, Yiyi Zhang, Ross Boylan, Andrew E Moran, Kirsten Bibbins-Domingo
Background: The 2017 American College of Cardiology/American Heart Association blood pressure guideline classified 31 million US adults as having stage 1 hypertension and recommended clinicians provide counseling on behavioral change to the low-risk portion of this group. However, nationwide reductions in cardiovascular disease (CVD) and associated health care expenditures achievable by nonpharmacologic therapy remain unquantified.
Methods: We simulated interventions on a target population of US adults aged 35 to 64 years, identified from the 2015-2018 National Health and Nutrition Examination Survey, with low-risk stage 1 systolic hypertension: that is, untreated systolic blood pressure 130 to 139 mm Hg with diastolic BP <90 mm Hg; no history of CVD, diabetes, or chronic kidney disease; and a low 10-year risk of CVD. We used meta-analyses and trials to estimate the effects of population-level behavior modification on systolic blood pressure. We assessed the extent to which restricting intervention to those in regular contact with clinicians might prevent the delivery of nonpharmacologic therapy.
Results: Controlling systolic blood pressure to <130 mm Hg among the 8.8 million low-risk US adults with stage 1 hypertension could prevent 26 100 CVD events, avoid 2900 deaths, and save $1.7 billion in total direct health care costs over 10 years. Adoption of the Dietary Approaches to Stop Hypertension diet could prevent 28 000 CVD events. Other nonpharmacologic interventions could avert between 3800 and 19 500 CVD events. However, only 51% of men and 75% of women regularly interacted with clinicians for counseling opportunities.
Conclusions: Among low-risk adults with stage 1 hypertension, substantial benefits to cardiovascular health could be achieved through public policy that promotes the adoption of nonpharmacologic therapy.
{"title":"Projected Impact of Nonpharmacologic Management of Stage 1 Hypertension Among Lower-Risk US Adults.","authors":"Kendra D Sims, Pengxiao Carol Wei, Joanne M Penko, Susan Hennessy, Pamela G Coxson, Nita H Mukand, Brandon K Bellows, Dhruv S Kazi, Yiyi Zhang, Ross Boylan, Andrew E Moran, Kirsten Bibbins-Domingo","doi":"10.1161/HYPERTENSIONAHA.124.22704","DOIUrl":"10.1161/HYPERTENSIONAHA.124.22704","url":null,"abstract":"<p><strong>Background: </strong>The 2017 American College of Cardiology/American Heart Association blood pressure guideline classified 31 million US adults as having stage 1 hypertension and recommended clinicians provide counseling on behavioral change to the low-risk portion of this group. However, nationwide reductions in cardiovascular disease (CVD) and associated health care expenditures achievable by nonpharmacologic therapy remain unquantified.</p><p><strong>Methods: </strong>We simulated interventions on a target population of US adults aged 35 to 64 years, identified from the 2015-2018 National Health and Nutrition Examination Survey, with low-risk stage 1 systolic hypertension: that is, untreated systolic blood pressure 130 to 139 mm Hg with diastolic BP <90 mm Hg; no history of CVD, diabetes, or chronic kidney disease; and a low 10-year risk of CVD. We used meta-analyses and trials to estimate the effects of population-level behavior modification on systolic blood pressure. We assessed the extent to which restricting intervention to those in regular contact with clinicians might prevent the delivery of nonpharmacologic therapy.</p><p><strong>Results: </strong>Controlling systolic blood pressure to <130 mm Hg among the 8.8 million low-risk US adults with stage 1 hypertension could prevent 26 100 CVD events, avoid 2900 deaths, and save $1.7 billion in total direct health care costs over 10 years. Adoption of the Dietary Approaches to Stop Hypertension diet could prevent 28 000 CVD events. Other nonpharmacologic interventions could avert between 3800 and 19 500 CVD events. However, only 51% of men and 75% of women regularly interacted with clinicians for counseling opportunities.</p><p><strong>Conclusions: </strong>Among low-risk adults with stage 1 hypertension, substantial benefits to cardiovascular health could be achieved through public policy that promotes the adoption of nonpharmacologic therapy.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141330834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1161/HYPERTENSIONAHA.124.23029
Georgiana Constantinescu, Sven Gruber, Sybille Fuld, Mirko Peitzsch, Manuel Schulze, Hanna Remde, Lydia Kürzinger, Jun Yang, Tina Yen, Tracy Ann Williams, Lisa Müller, Martin Reincke, Jacques W M Lenders, Felix Beuschlein, Christina Pamporaki, Graeme Eisenhofer
Background: Diagnosis of primary aldosteronism (PA) is complicated by the need to withdraw antihypertensive medications that interfere with test results, particularly renin. This study examined whether machine learning-based steroid-probability scores offer a renin measurement-independent approach for testing less prone to interference than the aldosterone-to-renin ratio (ARR).
Methods: This prospective multicenter cohort study involved the use of plasma steroidomics and the ARR in 839 patients tested for PA, including 190 with and 578 without PA (71 indeterminate). Receiver operating characteristic curves for steroid-probability scores and the ARR were examined with and without interfering medications. Impacts of individual medications on plasma aldosterone, 18-oxocortisol, 18-hydroxycortisol, steroid-probability scores, renin, and ARRs were examined by multivariable and paired analyses in patients with and without PA.
Results: Receiver operating characteristic curves indicated a significant impact of interfering antihypertensive medications on the diagnostic performance of the ARR and minimal impact on steroid-probability scores. Mineralocorticoid receptor antagonists increased plasma aldosterone, 18-oxocortisol, and 18-hydroxycortisol in patients without PA and resulted in false-positive test results for steroid-probability scores and false-negative results for the ARR. Diuretics increased aldosterone, 18-oxocortisol, and steroid-probability scores in patients without PA, whereas angiotensin-converting enzyme inhibitors decreased aldosterone, steroid-probability scores, and ARRs. Beta-adrenoceptor blockers, dihydropyridine calcium channel blockers, and angiotensin receptor blockers had negligible impact on mineralocorticoids and steroid-probability scores.
Conclusions: Among antihypertensive drugs that impact plasma aldosterone, 18-oxocortisol, and 18-hydroxycortisol, mineralocorticoid receptor antagonists stood out as a cause of false-positive results for derived steroid-probability scores. Other antihypertensives have minimal or no impact, an advantage for use of steroid-probability scores over the ARR when those medications cannot be withdrawn.
背景:原发性醛固酮增多症(PA)的诊断因需要停用会干扰检测结果(尤其是肾素)的抗高血压药物而变得复杂。本研究探讨了基于机器学习的类固醇概率评分是否提供了一种与肾素测量无关的检测方法,该方法比醛固酮肾素比值(ARR)更不容易受到干扰:这项前瞻性多中心队列研究使用血浆类固醇组学和 ARR 对 839 例 PA 患者进行了检测,其中包括 190 例 PA 患者和 578 例无 PA 患者(71 例不确定)。在使用和不使用干扰药物的情况下,研究人员对类固醇概率评分和 ARR 的接收者操作特征曲线进行了研究。在有 PA 和无 PA 的患者中,通过多变量和配对分析研究了各种药物对血浆醛固酮、18-氧皮质醇、18-羟皮质醇、类固醇概率评分、肾素和 ARR 的影响:结果:受体操作特征曲线显示,干扰性降压药物对 ARR 诊断性能的影响很大,而对类固醇概率评分的影响很小。矿质皮质激素受体拮抗剂会增加无 PA 患者的血浆醛固酮、18-氧皮质醇和 18-羟皮质醇,导致类固醇概率评分出现假阳性检测结果,ARR 出现假阴性结果。利尿剂会增加无 PA 患者的醛固酮、18-羟皮质醇和类固醇概率评分,而血管紧张素转换酶抑制剂会降低醛固酮、类固醇概率评分和 ARR。β肾上腺素受体阻滞剂、二氢吡啶类钙通道阻滞剂和血管紧张素受体阻滞剂对矿物质皮质激素和类固醇概率评分的影响微乎其微:在影响血浆醛固酮、18-氧皮质醇和 18-羟皮质醇的降压药中,矿质皮质激素受体拮抗剂是导致类固醇概率评分出现假阳性结果的主要原因。其他降压药的影响很小或没有影响,当这些药物不能停用时,类固醇概率评分比 ARR 更有优势:URL: https://drks.de/; 唯一标识符:DRKS00017084。
{"title":"Steroidomics-Based Screening for Primary Aldosteronism: Impact of antihypertensive Drugs.","authors":"Georgiana Constantinescu, Sven Gruber, Sybille Fuld, Mirko Peitzsch, Manuel Schulze, Hanna Remde, Lydia Kürzinger, Jun Yang, Tina Yen, Tracy Ann Williams, Lisa Müller, Martin Reincke, Jacques W M Lenders, Felix Beuschlein, Christina Pamporaki, Graeme Eisenhofer","doi":"10.1161/HYPERTENSIONAHA.124.23029","DOIUrl":"https://doi.org/10.1161/HYPERTENSIONAHA.124.23029","url":null,"abstract":"<p><strong>Background: </strong>Diagnosis of primary aldosteronism (PA) is complicated by the need to withdraw antihypertensive medications that interfere with test results, particularly renin. This study examined whether machine learning-based steroid-probability scores offer a renin measurement-independent approach for testing less prone to interference than the aldosterone-to-renin ratio (ARR).</p><p><strong>Methods: </strong>This prospective multicenter cohort study involved the use of plasma steroidomics and the ARR in 839 patients tested for PA, including 190 with and 578 without PA (71 indeterminate). Receiver operating characteristic curves for steroid-probability scores and the ARR were examined with and without interfering medications. Impacts of individual medications on plasma aldosterone, 18-oxocortisol, 18-hydroxycortisol, steroid-probability scores, renin, and ARRs were examined by multivariable and paired analyses in patients with and without PA.</p><p><strong>Results: </strong>Receiver operating characteristic curves indicated a significant impact of interfering antihypertensive medications on the diagnostic performance of the ARR and minimal impact on steroid-probability scores. Mineralocorticoid receptor antagonists increased plasma aldosterone, 18-oxocortisol, and 18-hydroxycortisol in patients without PA and resulted in false-positive test results for steroid-probability scores and false-negative results for the ARR. Diuretics increased aldosterone, 18-oxocortisol, and steroid-probability scores in patients without PA, whereas angiotensin-converting enzyme inhibitors decreased aldosterone, steroid-probability scores, and ARRs. Beta-adrenoceptor blockers, dihydropyridine calcium channel blockers, and angiotensin receptor blockers had negligible impact on mineralocorticoids and steroid-probability scores.</p><p><strong>Conclusions: </strong>Among antihypertensive drugs that impact plasma aldosterone, 18-oxocortisol, and 18-hydroxycortisol, mineralocorticoid receptor antagonists stood out as a cause of false-positive results for derived steroid-probability scores. Other antihypertensives have minimal or no impact, an advantage for use of steroid-probability scores over the ARR when those medications cannot be withdrawn.</p><p><strong>Registration: </strong>URL: https://drks.de/; Unique identifier: DRKS00017084.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-30DOI: 10.1161/HYPERTENSIONAHA.124.23122
Linsay McCallum, Stefanie Lip, Alex McConnachie, Katriona Brooksbank, Iain MacIntyre, Alexander Doney, Andrea Llano, Alisha Aman, Thomas M Caparrotta, Gareth Ingram, Isla S Mackenzie, Anna F Dominiczak, Thomas M MacDonald, David J Webb, Sandosh Padmanabhan
Background: UMOD (uromodulin) has been linked to hypertension through potential activation of Na+-K+-2Cl- cotransporter (NKCC2), a target of loop diuretics. We posited that hypertensive patients carrying the rs13333226-AA UMOD genotype would demonstrate greater blood pressure responses to loop diuretics, potentially mediated by this UMOD/NKCC2 interaction.
Methods: This prospective, multicenter, genotype-blinded trial evaluated torasemide (torsemide) efficacy on systolic blood pressure (SBP) reduction over 16 weeks in nondiabetic, hypertensive participants uncontrolled on ≥1 nondiuretic antihypertensive for >3 months. The primary end point was the change in 24-hour ambulatory SBP (ABPM SBP) and SBP response trajectories between baseline and 16 weeks by genotype (AA versus AG/GG) due to nonrandomized groups at baseline (ClinicalTrials.gov: NCT03354897).
Results: Of 251 enrolled participants, 222 received torasemide and 174 demonstrated satisfactory treatment adherence and had genotype data. The study participants were middle-aged (59±11 years), predominantly male (62%), obese (body mass index, 32±7 kg/m2), with normal eGFR (92±17 mL/min/1.73 m²) and an average baseline ABPM of 138/81 mm Hg. Significant reductions in mean ABPM SBP were observed in both groups after 16 weeks (AA, -6.57 mm Hg [95% CI, -8.44 to -4.69]; P<0.0001; AG/GG, -3.22 [95% CI, -5.93 to -0.51]; P=0.021). The change in mean ABPM SBP (baseline to 16 weeks) showed a difference of -3.35 mm Hg ([95% CI, -6.64 to -0.05]; P=0.048) AA versus AG/GG genotypes. The AG/GG group displayed a rebound in SBP from 8 weeks, differing from the consistent decrease in the AA group (P=0.004 for difference in trajectories).
Conclusions: Our results confirm a plausible interaction between UMOD and NKCC2 and suggest a potential role for genotype-guided use of loop diuretics in hypertension management.
{"title":"<i>UMOD</i> Genotype-Blinded Trial of Ambulatory Blood Pressure Response to Torasemide.","authors":"Linsay McCallum, Stefanie Lip, Alex McConnachie, Katriona Brooksbank, Iain MacIntyre, Alexander Doney, Andrea Llano, Alisha Aman, Thomas M Caparrotta, Gareth Ingram, Isla S Mackenzie, Anna F Dominiczak, Thomas M MacDonald, David J Webb, Sandosh Padmanabhan","doi":"10.1161/HYPERTENSIONAHA.124.23122","DOIUrl":"https://doi.org/10.1161/HYPERTENSIONAHA.124.23122","url":null,"abstract":"<p><strong>Background: </strong>UMOD (uromodulin) has been linked to hypertension through potential activation of Na<sup>+</sup>-K<sup>+</sup>-2Cl<sup>-</sup> cotransporter (NKCC2), a target of loop diuretics. We posited that hypertensive patients carrying the rs13333226-AA <i>UMOD</i> genotype would demonstrate greater blood pressure responses to loop diuretics, potentially mediated by this UMOD/NKCC2 interaction.</p><p><strong>Methods: </strong>This prospective, multicenter, genotype-blinded trial evaluated torasemide (torsemide) efficacy on systolic blood pressure (SBP) reduction over 16 weeks in nondiabetic, hypertensive participants uncontrolled on ≥1 nondiuretic antihypertensive for >3 months. The primary end point was the change in 24-hour ambulatory SBP (ABPM SBP) and SBP response trajectories between baseline and 16 weeks by genotype (AA versus AG/GG) due to nonrandomized groups at baseline (ClinicalTrials.gov: NCT03354897).</p><p><strong>Results: </strong>Of 251 enrolled participants, 222 received torasemide and 174 demonstrated satisfactory treatment adherence and had genotype data. The study participants were middle-aged (59±11 years), predominantly male (62%), obese (body mass index, 32±7 kg/m<sup>2</sup>), with normal eGFR (92±17 mL/min/1.73 m²) and an average baseline ABPM of 138/81 mm Hg. Significant reductions in mean ABPM SBP were observed in both groups after 16 weeks (AA, -6.57 mm Hg [95% CI, -8.44 to -4.69]; <i>P</i><0.0001; AG/GG, -3.22 [95% CI, -5.93 to -0.51]; <i>P</i>=0.021). The change in mean ABPM SBP (baseline to 16 weeks) showed a difference of -3.35 mm Hg ([95% CI, -6.64 to -0.05]; <i>P</i>=0.048) AA versus AG/GG genotypes. The AG/GG group displayed a rebound in SBP from 8 weeks, differing from the consistent decrease in the AA group (<i>P</i>=0.004 for difference in trajectories).</p><p><strong>Conclusions: </strong>Our results confirm a plausible interaction between UMOD and NKCC2 and suggest a potential role for genotype-guided use of loop diuretics in hypertension management.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03354897.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-30DOI: 10.1161/HYPERTENSIONAHA.124.23399
Lunbo Tan, Martijn H van Heugten, Ans C M Kluivers, Leonie van Vark-van der Zee, Monique T Mulder, Xifeng Lu, A H Jan Danser, Koen Verdonk
{"title":"Lipoproteins and Exosomes as Novel Carriers of Soluble Fms-Like Tyrosine Kinase-1 and Placental Growth Factor During Pregnancy.","authors":"Lunbo Tan, Martijn H van Heugten, Ans C M Kluivers, Leonie van Vark-van der Zee, Monique T Mulder, Xifeng Lu, A H Jan Danser, Koen Verdonk","doi":"10.1161/HYPERTENSIONAHA.124.23399","DOIUrl":"https://doi.org/10.1161/HYPERTENSIONAHA.124.23399","url":null,"abstract":"","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-29DOI: 10.1161/HYPERTENSIONAHA.124.21359
Bonita Falkner, Barbara T Alexander, Anne Monique Nuyt, Andrew M South, Julie Ingelfinger
Hypertension has largely been viewed as a disorder of adulthood. Historically, blood pressure (BP) was not routinely measured in children because hypertension was considered uncommon in childhood. It was not until the 1970s that it was apparent that in childhood BP levels were normally lower compared with those in adults, were related to age and growth, and that abnormal BP in children needed different definitions. Based on the distribution of BP levels in available child cohorts, the 95th percentile of BP levels became the definition of hypertension in children and adolescents-an epidemiological definition. Subsequent clinical and epidemiological research identified associated risk factors in childhood that linked abnormal BP in youth with hypertension in adulthood. In the 1980s, the Barker hypothesis, based on observations that low birth weight could be linked to cardiovascular disease in adulthood, promoted further research spanning epidemiological, clinical, and basic science on the childhood origins of hypertension. This review focuses on recent findings from both longitudinal maternal-child cohorts and experimental models that examine both maternal and offspring conditions associated with risks of subsequent cardiovascular disease.
{"title":"Cardiovascular Health Starts in the Womb.","authors":"Bonita Falkner, Barbara T Alexander, Anne Monique Nuyt, Andrew M South, Julie Ingelfinger","doi":"10.1161/HYPERTENSIONAHA.124.21359","DOIUrl":"10.1161/HYPERTENSIONAHA.124.21359","url":null,"abstract":"<p><p>Hypertension has largely been viewed as a disorder of adulthood. Historically, blood pressure (BP) was not routinely measured in children because hypertension was considered uncommon in childhood. It was not until the 1970s that it was apparent that in childhood BP levels were normally lower compared with those in adults, were related to age and growth, and that abnormal BP in children needed different definitions. Based on the distribution of BP levels in available child cohorts, the 95th percentile of BP levels became the definition of hypertension in children and adolescents-an epidemiological definition. Subsequent clinical and epidemiological research identified associated risk factors in childhood that linked abnormal BP in youth with hypertension in adulthood. In the 1980s, the Barker hypothesis, based on observations that low birth weight could be linked to cardiovascular disease in adulthood, promoted further research spanning epidemiological, clinical, and basic science on the childhood origins of hypertension. This review focuses on recent findings from both longitudinal maternal-child cohorts and experimental models that examine both maternal and offspring conditions associated with risks of subsequent cardiovascular disease.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-29DOI: 10.1161/HYPERTENSIONAHA.124.23271
Mohamed Ridha, Yousef Hannawi, Santosh Murthy, Fernanda Carvalho Poyraz, Aditya Kumar, Soojin Park, David Roh, Padmini Sekar, Daniel Woo, James Burke
Background: Hypoperfusion due to blood pressure (BP) reduction is a potential mechanism of cerebral ischemia after intracerebral hemorrhage. However, prior evaluations of the relationship between BP reduction and ischemia have been conflicting. Untreated chronic hypertension is common in intracerebral hemorrhage and alters cerebral autoregulation. We hypothesized that the risk of diffusion-weighted imaging (DWI) hyperintensities from acute BP reduction is modified by premorbid BP control.
Methods: Individuals enrolled in the ERICH study (Ethnic/Racial Variations of Intracerebral Hemorrhage) from 2010 to 2015 were categorized as untreated, treated, or nonhypertensive based on preintracerebral hemorrhage diagnosis and antihypertensive medication use. The percent reduction of systolic BP (SBP) was calculated between presentation and 24 hours from admission. The primary outcome was the presence of DWI lesions. Using logistic regression, we tested the association between chronic hypertension status, SBP reduction, and their interaction with DWI lesion presence.
Results: From 3000 participants, 877 with available magnetic resonance imaging met inclusion (mean age, 60.5±13.3 years; 42.5% women). DWI lesions were detected in 25.9%. Untreated, treated, and no hypertension accounted for 32.6%, 47.9%, and 19.5% of cases, respectively. SBP reduction was not directly associated with DWI lesions; however, an interaction effect was observed between SBP reduction and chronic hypertension status (P=0.036). Nonhypertensive subjects demonstrated a linear risk of DWI lesion presence with greater SBP reduction, whereas untreated hypertension demonstrated a stable risk across a wide range of SBP reduction (P=0.023).
Conclusions: Premorbid BP control, especially untreated hypertension, may influence the relationship between DWI lesions and acute BP reduction after intracerebral hemorrhage.
{"title":"Premorbid Blood Pressure Control Modifies Risk of DWI Lesions With Acute Blood Pressure Reduction in Intracerebral Hemorrhage.","authors":"Mohamed Ridha, Yousef Hannawi, Santosh Murthy, Fernanda Carvalho Poyraz, Aditya Kumar, Soojin Park, David Roh, Padmini Sekar, Daniel Woo, James Burke","doi":"10.1161/HYPERTENSIONAHA.124.23271","DOIUrl":"10.1161/HYPERTENSIONAHA.124.23271","url":null,"abstract":"<p><strong>Background: </strong>Hypoperfusion due to blood pressure (BP) reduction is a potential mechanism of cerebral ischemia after intracerebral hemorrhage. However, prior evaluations of the relationship between BP reduction and ischemia have been conflicting. Untreated chronic hypertension is common in intracerebral hemorrhage and alters cerebral autoregulation. We hypothesized that the risk of diffusion-weighted imaging (DWI) hyperintensities from acute BP reduction is modified by premorbid BP control.</p><p><strong>Methods: </strong>Individuals enrolled in the ERICH study (Ethnic/Racial Variations of Intracerebral Hemorrhage) from 2010 to 2015 were categorized as untreated, treated, or nonhypertensive based on preintracerebral hemorrhage diagnosis and antihypertensive medication use. The percent reduction of systolic BP (SBP) was calculated between presentation and 24 hours from admission. The primary outcome was the presence of DWI lesions. Using logistic regression, we tested the association between chronic hypertension status, SBP reduction, and their interaction with DWI lesion presence.</p><p><strong>Results: </strong>From 3000 participants, 877 with available magnetic resonance imaging met inclusion (mean age, 60.5±13.3 years; 42.5% women). DWI lesions were detected in 25.9%. Untreated, treated, and no hypertension accounted for 32.6%, 47.9%, and 19.5% of cases, respectively. SBP reduction was not directly associated with DWI lesions; however, an interaction effect was observed between SBP reduction and chronic hypertension status (<i>P</i>=0.036). Nonhypertensive subjects demonstrated a linear risk of DWI lesion presence with greater SBP reduction, whereas untreated hypertension demonstrated a stable risk across a wide range of SBP reduction (<i>P</i>=0.023).</p><p><strong>Conclusions: </strong>Premorbid BP control, especially untreated hypertension, may influence the relationship between DWI lesions and acute BP reduction after intracerebral hemorrhage.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01202864.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-23DOI: 10.1161/HYPERTENSIONAHA.124.22884
Marco Marcelli, Caixia Bi, John W Funder, Michael J McPhaul
Background: In many practices, the screening for primary aldosteronism relies on a single-blood draw for plasma aldosterone concentration (PAC) and plasma renin activity (PRA) to establish an aldosterone-to-renin ratio (ARR). ARR levels vary between expert centers and repeated assays in the same individual, emphasizing the potential variability of this screening approach. A suppressed PRA to <1 ng/mL per h has been proposed as an alternative test to the ARR.
Methods: We compared 2 potential screening approaches to identify probable primary aldosteronism (ARR≥30 or ARR≥20 versus PRA suppressed below 1 ng/mL per h) in a cohort of 94 829 paired PRA and PAC samples submitted by clinicians to evaluate the presence of primary aldosteronism.
Results: Of 94 829 patients, 20.3% tested positive based on ARR≥20 (95% CI, 20.0%-20.5%), 13.9% based on ARR≥30 (95% CI, 13.6%-14.1%), versus 45.9% based on suppressed PRA (<1 ng/mL per minute [95% CI, 45.5%-46.2%]). In the PRA group, a range of aldosterone levels was observed: 5.5% had PAC >15 ng/dL, 25.2% had PAC 5 to 15 ng/dL, and 15.2% had PAC <5 ng/dL, compared with 6%, 12.7%, and 1.6% in the ARR≥20 group and 4.7%, 8.5%, and 0.7% in the ARR≥30 group.
Conclusions: In this cohort of individuals being screened for primary aldosteronism, substantially more individuals were identified using criteria focused on suppression of renin activity compared with using the aldosterone renin ratio as a screening tool.
背景:在许多临床实践中,原发性醛固酮增多症的筛查依赖于单次抽血检测血浆醛固酮浓度(PAC)和血浆肾素活性(PRA),以确定醛固酮-肾素比值(ARR)。不同专家中心的 ARR 水平不尽相同,同一个人的重复检测结果也不尽相同,这说明这种筛查方法存在潜在的可变性。抑制 PRA 的方法:我们在临床医生为评估原发性醛固酮增多症的存在而提交的 94 829 份配对 PRA 和 PAC 样本中,比较了两种潜在的筛查方法,以确定可能的原发性醛固酮增多症(ARR≥30 或 ARR≥20 与 PRA 抑制低于 1 纳克/毫升/小时):结果:在94 829名患者中,20.3%根据ARR≥20(95% CI,20.0%-20.5%)检测为阳性,13.9%根据ARR≥30(95% CI,13.6%-14.1%)检测为阳性,而45.9%根据抑制的PRA(15纳克/分升)检测为阳性,25.2%的PAC为5-15纳克/分升,15.2%的PAC为结论:在这批接受原发性醛固酮增多症筛查的患者中,与使用醛固酮肾素比值作为筛查工具相比,以抑制肾素活性为标准的筛查方法发现的原发性醛固酮增多症患者要多得多。
{"title":"Comparing ARR Versus Suppressed PRA as Screening Tests for Primary Aldosteronism.","authors":"Marco Marcelli, Caixia Bi, John W Funder, Michael J McPhaul","doi":"10.1161/HYPERTENSIONAHA.124.22884","DOIUrl":"https://doi.org/10.1161/HYPERTENSIONAHA.124.22884","url":null,"abstract":"<p><strong>Background: </strong>In many practices, the screening for primary aldosteronism relies on a single-blood draw for plasma aldosterone concentration (PAC) and plasma renin activity (PRA) to establish an aldosterone-to-renin ratio (ARR). ARR levels vary between expert centers and repeated assays in the same individual, emphasizing the potential variability of this screening approach. A suppressed PRA to <1 ng/mL per h has been proposed as an alternative test to the ARR.</p><p><strong>Methods: </strong>We compared 2 potential screening approaches to identify probable primary aldosteronism (ARR≥30 or ARR≥20 versus PRA suppressed below 1 ng/mL per h) in a cohort of 94 829 paired PRA and PAC samples submitted by clinicians to evaluate the presence of primary aldosteronism.</p><p><strong>Results: </strong>Of 94 829 patients, 20.3% tested positive based on ARR≥20 (95% CI, 20.0%-20.5%), 13.9% based on ARR≥30 (95% CI, 13.6%-14.1%), versus 45.9% based on suppressed PRA (<1 ng/mL per minute [95% CI, 45.5%-46.2%]). In the PRA group, a range of aldosterone levels was observed: 5.5% had PAC >15 ng/dL, 25.2% had PAC 5 to 15 ng/dL, and 15.2% had PAC <5 ng/dL, compared with 6%, 12.7%, and 1.6% in the ARR≥20 group and 4.7%, 8.5%, and 0.7% in the ARR≥30 group.</p><p><strong>Conclusions: </strong>In this cohort of individuals being screened for primary aldosteronism, substantially more individuals were identified using criteria focused on suppression of renin activity compared with using the aldosterone renin ratio as a screening tool.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-22DOI: 10.1161/HYPERTENSIONAHA.123.22437
Barbara J H Verhaar, Madelief Wijdeveld, Koen Wortelboer, Elena Rampanelli, Johannes H M Levels, Didier Collard, Marianne Cammenga, Vanasa Nageswaran, Arash Haghikia, Ulf Landmesser, Xinmin S Li, Joseph A DiDonato, Stanley L Hazen, Ingrid M Garrelds, A H Jan Danser, Bert-Jan H van den Born, Max Nieuwdorp, Majon Muller
Background: The microbiota-derived short chain fatty acid butyrate has been shown to lower blood pressure (BP) in rodent studies. Nonetheless, the net effect of butyrate on hypertension in humans remains uncovered. In this study, for the first time, we aimed to determine the effect of oral butyrate on BP in patients with hypertension.
Methods: We performed a double-blind randomized placebo-controlled trial including 23 patients with hypertension. Antihypertensive medication was discontinued for the duration of the study with a washout period of 4 weeks before starting the intervention. Participants received daily oral capsules containing either sodium butyrate or placebo with an equivalent dosage of sodium chloride for 4 weeks. The primary outcome was daytime 24-hour systolic BP. Differences between groups over time were assessed using linear mixed models (group-by-time interaction).
Results: Study participants (59.0±3.7 years; 56.5% female) had an average baseline office systolic BP of 143.5±14.6 mm Hg and diastolic BP of 93.0±8.3 mm Hg. Daytime 24-hour systolic and diastolic BP significantly increased over the intervention period in the butyrate compared with the placebo group, with an increase of +9.63 (95% CI, 2.02-17.20) mm Hg in daytime 24-hour systolic BP and +5.08 (95% CI, 1.34-8.78) mm Hg in diastolic BP over 4 weeks. Butyrate levels significantly increased in plasma, but not in feces, upon butyrate intake, underscoring its absorption.
Conclusions: Four-week treatment with oral butyrate increased daytime systolic and diastolic BP in subjects with hypertension. Our findings implicate that butyrate does not have beneficial effects on human hypertension, which warrants caution in future butyrate intervention studies.
背景:在啮齿类动物研究中,微生物群衍生的短链脂肪酸丁酸盐已被证明可降低血压(BP)。然而,丁酸盐对人类高血压的净影响仍未确定。在这项研究中,我们首次确定了口服丁酸盐对高血压患者血压的影响:我们对 23 名高血压患者进行了双盲随机安慰剂对照试验。研究期间停用抗高血压药物,开始干预前有 4 周的冲洗期。参与者每天口服含有丁酸钠或等量氯化钠的安慰剂胶囊,为期 4 周。主要结果是日间 24 小时收缩压。采用线性混合模型(组间时间交互作用)评估组间随时间变化的差异:研究参与者(59.0±3.7 岁;56.5% 为女性)的平均基线办公室收缩压为 143.5±14.6 mm Hg,舒张压为 93.0±8.3 mm Hg。在干预期间,与安慰剂组相比,丁酸盐组的日间 24 小时收缩压和舒张压明显升高,4 周内日间 24 小时收缩压升高 +9.63 (95% CI, 2.02-17.20) mm Hg,舒张压升高 +5.08 (95% CI, 1.34-8.78) mm Hg。摄入丁酸盐后,血浆中的丁酸盐含量会明显增加,但粪便中的丁酸盐含量不会增加,这表明丁酸盐可被人体吸收:结论:对高血压患者进行为期四周的丁酸盐口服治疗可增加其日间收缩压和舒张压。我们的研究结果表明,丁酸盐不会对人类高血压产生有益影响,因此在今后的丁酸盐干预研究中应谨慎从事:URL: https://clinicaltrialregister.nl/nl/trial/22936; Unique identifier:NL8924。
{"title":"Effects of Oral Butyrate on Blood Pressure in Patients With Hypertension: A Randomized, Placebo-Controlled Trial.","authors":"Barbara J H Verhaar, Madelief Wijdeveld, Koen Wortelboer, Elena Rampanelli, Johannes H M Levels, Didier Collard, Marianne Cammenga, Vanasa Nageswaran, Arash Haghikia, Ulf Landmesser, Xinmin S Li, Joseph A DiDonato, Stanley L Hazen, Ingrid M Garrelds, A H Jan Danser, Bert-Jan H van den Born, Max Nieuwdorp, Majon Muller","doi":"10.1161/HYPERTENSIONAHA.123.22437","DOIUrl":"https://doi.org/10.1161/HYPERTENSIONAHA.123.22437","url":null,"abstract":"<p><strong>Background: </strong>The microbiota-derived short chain fatty acid butyrate has been shown to lower blood pressure (BP) in rodent studies. Nonetheless, the net effect of butyrate on hypertension in humans remains uncovered. In this study, for the first time, we aimed to determine the effect of oral butyrate on BP in patients with hypertension.</p><p><strong>Methods: </strong>We performed a double-blind randomized placebo-controlled trial including 23 patients with hypertension. Antihypertensive medication was discontinued for the duration of the study with a washout period of 4 weeks before starting the intervention. Participants received daily oral capsules containing either sodium butyrate or placebo with an equivalent dosage of sodium chloride for 4 weeks. The primary outcome was daytime 24-hour systolic BP. Differences between groups over time were assessed using linear mixed models (group-by-time interaction).</p><p><strong>Results: </strong>Study participants (59.0±3.7 years; 56.5% female) had an average baseline office systolic BP of 143.5±14.6 mm Hg and diastolic BP of 93.0±8.3 mm Hg. Daytime 24-hour systolic and diastolic BP significantly increased over the intervention period in the butyrate compared with the placebo group, with an increase of +9.63 (95% CI, 2.02-17.20) mm Hg in daytime 24-hour systolic BP and +5.08 (95% CI, 1.34-8.78) mm Hg in diastolic BP over 4 weeks. Butyrate levels significantly increased in plasma, but not in feces, upon butyrate intake, underscoring its absorption.</p><p><strong>Conclusions: </strong>Four-week treatment with oral butyrate increased daytime systolic and diastolic BP in subjects with hypertension. Our findings implicate that butyrate does not have beneficial effects on human hypertension, which warrants caution in future butyrate intervention studies.</p><p><strong>Registration: </strong>URL: https://clinicaltrialregister.nl/nl/trial/22936; Unique identifier: NL8924.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-16DOI: 10.1161/HYPERTENSIONAHA.123.22347
Patrick Dunn, Asif Ali, Akash P Patel, Srikanta Banerjee
Recent breakthroughs in artificial intelligence (AI) have caught the attention of many fields, including health care. The vision for AI is that a computer model can process information and provide output that is indistinguishable from that of a human and, in specific repetitive tasks, outperform a human's capability. The 2 critical underlying technologies in AI are used for supervised and unsupervised machine learning. Machine learning uses neural networks and deep learning modeled after the human brain from structured or unstructured data sets to learn, make decisions, and continuously improve the model. Natural language processing, used for supervised learning, is understanding, interpreting, and generating information using human language in chatbots and generative and conversational AI. These breakthroughs result from increased computing power and access to large data sets, setting the stage for releasing large language models, such as ChatGPT and others, and new imaging models using computer vision. Hypertension management involves using blood pressure and other biometric data from connected devices and generative AI to communicate with patients and health care professionals. AI can potentially improve hypertension diagnosis and treatment through remote patient monitoring and digital therapeutics.
{"title":"Brief Review and Primer of Key Terminology for Artificial Intelligence and Machine Learning in Hypertension.","authors":"Patrick Dunn, Asif Ali, Akash P Patel, Srikanta Banerjee","doi":"10.1161/HYPERTENSIONAHA.123.22347","DOIUrl":"https://doi.org/10.1161/HYPERTENSIONAHA.123.22347","url":null,"abstract":"<p><p>Recent breakthroughs in artificial intelligence (AI) have caught the attention of many fields, including health care. The vision for AI is that a computer model can process information and provide output that is indistinguishable from that of a human and, in specific repetitive tasks, outperform a human's capability. The 2 critical underlying technologies in AI are used for supervised and unsupervised machine learning. Machine learning uses neural networks and deep learning modeled after the human brain from structured or unstructured data sets to learn, make decisions, and continuously improve the model. Natural language processing, used for supervised learning, is understanding, interpreting, and generating information using human language in chatbots and generative and conversational AI. These breakthroughs result from increased computing power and access to large data sets, setting the stage for releasing large language models, such as ChatGPT and others, and new imaging models using computer vision. Hypertension management involves using blood pressure and other biometric data from connected devices and generative AI to communicate with patients and health care professionals. AI can potentially improve hypertension diagnosis and treatment through remote patient monitoring and digital therapeutics.</p>","PeriodicalId":13042,"journal":{"name":"Hypertension","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}