International Journal of Hypertension最新文献

Background: Hypertension is a growing public health concern in Ethiopia, contributing substantially to cardiovascular morbidity and mortality. Identifying predictors of hypertension is crucial for effective prevention and control.

Objective: To identify the lifestyle and anthropometric predictors of hypertension among adults attending Debark General Hospital, Northwest Ethiopia.

Methods: An unmatched case-control study was conducted from January to March 2025, including 640 participants (128 hypertensive cases and 512 normotensive controls) with a 1:4 case-to-control ratio. Cases were adults diagnosed with hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg or on antihypertensive treatment). Controls were normotensive adults attending the hospital for other health issues. Data were collected using a structured questionnaire and anthropometric measurements. Multivariable logistic regression was performed using Stata to identify independent predictors of hypertension.

Results: The multivariable analysis identified age ≥ 45 years (AOR = 3.62; 95% CI: 2.11-6.20), obesity (BMI ≥ 30 kg/m²) (AOR = 2.95; 95% CI: 1.78-4.89), low physical activity (AOR = 2.47; 95% CI: 1.45-4.19), high dietary salt intake (AOR = 2.33; 95% CI: 1.32-4.11), family history of hypertension (AOR = 3.14; 95% CI: 1.89-5.22), alcohol consumption (AOR = 2.01; 95% CI: 1.17-3.44), and low fruit intake (< 5 servings/week) (AOR = 1.89; 95% CI: 1.08-3.29) as significant predictors of hypertension (all p < 0.05).

Conclusion: The study identified key modifiable predictors of hypertension, including obesity, physical inactivity, high salt intake, alcohol use, and low fruit consumption, along with nonmodifiable factors such as older age and family history among adults in Northwest Ethiopia. These findings highlight the need for integrated preventive interventions targeting lifestyle modification and early screening in the Ethiopian healthcare system.

Background: A health check-up system (HCS) is one of the best ways to prevent complications and maintain health by diagnosing diseases and screening risk factors early. Here, we investigated how many people who detected elevated blood pressure through the HCS were finally diagnosed with "hypertension" and continuously treated. We also analyzed their cardiovascular risk and prognostic significance according to the multiple drug compliance patterns.

Methods: A total of 38,100 subjects without cardiovascular disease who were newly detected with elevated blood pressure in HCS between 2006 and 2011 were analyzed and followed up until 2019 using the Korean National Health Insurance Database. They were divided into five subgroups through subsequent prescription history and compared for epidemiological, laboratory performance and cardiovascular events.

Results: Of the total 38,100 subjects, 6981 (18.3%) cases were diagnosed with hypertension and started medication within 12 months. Of those cases, 3021 (7.9%) cases continued taking their medication, 2184 (5.7%) cases persistently discontinued medication, and 485 (1.3%) cases restarted medication again within 12 months of discontinuation. As a result of follow-up until 2019, the "drug-free group" showed the significantly lowest cardiovascular complication incidences (angina, heart failure, ischemic heart disease, CKD, and PAOD), and the highest were seen in the "re-initiation group" (cerebral infarct and atrial fibrillation) compared with the "continuous medication group."

Conclusions: A considerable proportion of individuals with high blood pressure detected in HCS were diagnosed with hypertension and at high cardiovascular risk. The group that needed to restart medication within 12 months after discontinuation showed a higher cardiovascular risk among them.

Obstructive sleep apnea (OSA) has been established as one of the independent risk factors for hypertension, and its coexistence substantially raises the risk of cardiovascular incidents. However, existing clinical predictive models mainly focus on populations in plain areas and fail to take altitude-specific factors into account. The objective of this study was straightforward: to develop and validate a nomogram that can predict hypertension in patients with OSA syndrome living at mid- to high altitudes. We carried out a detailed retrospective review of 1505 patient records from January 2021 to February 2024, all newly diagnosed with OSA through polysomnography (PSG). After applying the inclusion and exclusion criteria, 694 patients were included in the training cohort, and 358 patients were included in the validation cohort. Candidate predictors were selected using LASSO logistic regression, and a nomogram was subsequently established through multivariable logistic regression. The area under the receiver operating characteristic curve, calibrated curves, and decision curve analysis were employed to comprehensively evaluate the model's discriminative capacity, calibration, and clinical applicability. Six variables were identified as risk factors for OSA patients with hypertension, including age, BMI, tonsillar hypertrophy, IVSd, LVPWD, and T90. The nomogram was developed using these variables. The training and validation sequences demonstrate their effectiveness. The AUC of the training and validation cohort was 0.78 (95% CI: 0.74-0.81) and 0.72 (95% CI: 0.66-0.77), respectively. The development of this nomogram can help identify individuals with a higher likelihood of hypertensive conditions among OSA patients in mid- to high-altitude regions, thereby providing a basis for early clinical identification and intervention.

Background: Hypertension is a leading, yet modifiable, cause of mortality worldwide. While current treatment guidelines apply uniformly, variation in outcomes suggests unrecognized biological heterogeneity. Existing classifications based solely on systolic and diastolic blood pressure fail to capture this complexity. We identified data-driven clinical phenotypes of primary hypertension and examined their associations with mortality.

Methods: Pooled analysis of 10 cross-sectional surveys (NHANES 1999-2020). Data from 4084 adults (≥ 30 years) with newly diagnosed or undiagnosed hypertension were collected. Hypertension was defined by self-report (in the last 2 years) or those with undiagnosed high systolic or diastolic blood pressure (≥ 140/90 mmHg). Predictors: age, body mass index, systolic blood pressure, diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol (HDL-c), hemoglobin A1c, and estimated glomerular filtration rate (eGFR). We used these variables because they are readily available in primary care settings, enabling clinical translation of these findings. We used k-means clustering of eight variables to identify phenotypes. Using mortality data linked to the National Death Index, we estimated the risk of all-cause and cardiovascular mortality.

Results: Four phenotypes: Early-onset hypertension (EOH), late-onset hypertension (LOH), glucose-related hypertension (GRH), and lipid-related hypertension (LRH). EOH (37.3%) consisted of younger adults with high BMI and diastolic blood pressure, and low systolic blood pressure and HDL-c. LOH (32.6%) consisted of older adults with low diastolic blood pressure, total cholesterol, and eGFR. GRH (4.5%) consisted of adults with high BMI and HbA1c. LRH (25.6%) consisted of adults with high systolic blood pressure, total cholesterol, and HDL-c and low BMI and HbA1c. Compared to EOH, mortality was the highest in GRH (all-cause: 3.45 [1.80-6.61]; cardiovascular: 5.40 [2.18-13.37]), yet not significant for LOH (1.18 [0.74-1.87]; 1.04 [0.49-2.21]) and LRH (1.01 [0.62-1.63]; 0.93 [0.46-1.87]).

Conclusions: This data-driven cluster analysis identified four phenotypes with different mortality risks in people with newly diagnosed hypertension.

B-Type natriuretic peptide (BNP) levels below contemporary thresholds for diagnosing congestive heart failure are associated with subclinical heart disease (SHD) and adverse cardiovascular outcomes in community patients with uncontrolled asymptomatic hypertension. This study aimed to determine the accuracy of BNP for detecting SHD in emergency patients with sustained asymptomatic hypertension, where SHD is universally prevalent. Conducted at two urban academic emergency departments within a seven-hospital healthcare organization, this proof-of-concept study included adults with sustained asymptomatic hypertension (initial BP ≥ 160/100 mmHg and second BP ≥ 140/90 mmHg), excluding those with congestive heart failure, renal insufficiency, atrial fibrillation, pregnancy, incarceration, cognitive impairment, and symptomatic hypertension. Enrolled patients underwent bedside echocardiograms, BNP lab tests, and electrocardiograms. All 78 patients (100%) had SHD. The cohort was predominantly female (55.1%), middle-aged (mean age: 52 ± 15.2 years), with Class I obesity (mean BMI: 32.3 ± 8.3) and a high prevalence of hypertension history (55.1%). Common findings included left ventricular hypertrophy (86%), diastolic dysfunction (70.5%), and left ventricular systolic dysfunction (12.2%). The BNP lab test accurately detected SHD in nearly 60% of patients, with a Type II error rate of approximately 40%. In this proof-of-concept study, BNP underperformed in a cohort with universally present SHD, suggesting that sole reliance on BNP may lead to missed opportunities for early intervention.

Background: The Mediterranean diet (MedDiet) is a well-established cardioprotective dietary pattern with demonstrated efficacy in managing hypertension (HTN) and cardiovascular disease (CVD). Its rich array of bioactive compounds, including omega-3 polyunsaturated fatty acids, polyphenols and organosulfur compounds, targets multiple molecular pathways implicated in endothelial dysfunction, oxidative stress, inflammation and metabolic dysregulation.

Methods: This review employed a structured, integrative methodology following preferred reporting items for systematic reviews and meta-analyses, guidelines to analyze literature from PubMed, Scopus, Web of Science and Google Scholar (2000-2025). The population, intervention, comparator and outcomes (PICO) framework guided the research question, focusing on mechanistic, physiological and clinical evidence linking MedDiet components to HTN and vascular health. Inclusion criteria prioritized studies on the MedDiet -specific pathways, such as short-chain fatty acid (SCFA)-G-protein-coupled receptors 41/43 signaling, endothelial nitric oxide synthase (eNOS) activation, nuclear factor erythroid 2-related factor 2-antioxidant response element modulation and renin-angiotensin-aldosterone system regulation. Data were qualitatively synthesized to rank mechanisms by translational relevance and clinical tractability.

Mechanisms: The MedDiet exerts its antihypertensive effects through synergistic pathways: endothelial function enhancement via eNOS activation and nitric oxide bioavailability, oxidative stress reduction through nuclear factor erythroid 2-related factor 2-antioxidant response element pathway upregulation and nicotinamide adenine dinucleotide phosphate oxidase 4 inhibition. The third mechanism is anti-inflammatory actions via nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3 inflammasome suppression and cytokine modulation. The fourth is the renin-angiotensin-aldosterone system regulation through angiotensin-converting enzyme inhibition and angiotensin-converting enzyme 2 upregulation. Gut microbiota-derived SCFAs further amplify these effects by activating G-protein coupled 41/43 receptors, improving vasodilation and attenuating systemic inflammation.

Conclusion: Compelling evidence supports the MedDiet as a first-line strategy for HTN and CVD, but research must address adherence, implementation and precision-nutrition gaps to translate proven cardioprotection into personalized, scalable therapies across diverse and resource-limited populations.

Backgrounds: Obstructive sleep apnea (OSA) and hypertension both had significant impacts on human health. Whether OSA increases the risk of hypertension in relation to heredity remains unclear. We sought to clarify this issue using bidirectional Mendelian randomization (MR) analysis in large cohorts.

Methods: A bidirectional two-sample MR was conducted to evaluate the potential causality between OSA and hypertension by selecting single-nucleotide polymorphisms (SNPs) as instrumental variables (IVs) from meta genome-wide association studies (mGWAS). The inverse-variance weighted (IVW) method was the main approach for data analysis to estimate the possible causal effects. Alternative methods such as MR-Egger, the MR pleiotropy residual sum and outlier (MR-PRESSO), and leave-one-out analysis methods were also performed as sensitivity analysis approaches. In order to adjust the confounding factors, a multivariable MR (MVMR) was also performed.

Results: In the forward analysis, the IVW analysis demonstrated a significant association of OSA on increased hypertension risk (OR, 1.044; 95% CI, 1.012-1.076; and p=0.006), DBP value (β, 0.041; 95% CI, 0.012-0.071; and p=0.005), and hypertension of siblings risk (OR, 1.025; 95% CI, 1.003-1.049; and p=0.028), but after adjusting the confounding factors (BMI, smoking, and alcohol consumption), the association disappeared. The reverse analysis demonstrated the causal effect of hypertension of father on elevated OSA risk (OR, 3.803; 95% CI, 1.135-12.726; and p=0.030).

Conclusions: Our forward analysis found the association between OSA and increased hypertension risk, DBP, and hypertension risk of siblings, but after adjusting the confounding factors, the association disappeared; on the reverse analysis, we found the causal effect of hypertension of father on elevated OSA risk.

Background: Hypertension is a global health issue that affects millions of people in the world and is a significant risk factor for cardiovascular diseases, stroke, and kidney failure. Among the many lifestyle factors influencing hypertension, dietary salt consumption has emerged as a key determinant of blood pressure regulation. This study aimed to investigate the relationship between daily salt intake and blood pressure in a group of Cameroonian subjects living in Yaoundé.

Methods: We conducted a cross-sectional analytical study, with prospective data collection conducted from March to May 2024. We included people aged 21 and over with known or unknown hypertension, residing in the Biyem-Assi Health District and having given their free and informed consent. Pregnant women, people with chronic kidney disease, people who had recently taken diuretics, and people with secondary hypertension were excluded from the study. We used a stratified random sampling method. The measurement of the association between salt consumption and blood pressure was studied using Pearson's correlation test with a significance threshold of p < 0.05.

Result: Of the 203 participants included in our study, the median age was 36 [25-55] years. They were predominantly female (51.2%), overweight/obese (50.2%), living a sedentary lifestyle (90.6%), and had normal blood pressure (MAP: 97.79 ± 7.71 mmHg). All participants had a high salt intake (5067.23 ± 1195.23 mg), with extremes of 2005.94 mg and 8222.11 mg, the majority (80.8%) having more than double the recommended value, and the majority of family meals (75%) had a sodium content ≥ 0.6 g/100 g. There was a positive linear relationship between salt intake and mean daily blood pressure (r = 0.452, p < 0.001).

Conclusion: This study highlights the importance of reducing salt intake in the strategy for preventing and managing hypertension in Cameroon. Reducing salt intake through education, awareness, and policy changes could contribute to significantly reduce the burden of hypertension in Cameroon.

Background: Aortic dissection (AD) is the most dangerous disease in acute aortic syndrome and is associated with serious complications. Current studies have shown that sphingosine-1-phosphate (S1P) has a certain effect on AD. Therefore, this study focuses on exploring biomarkers related to S1P in AD.

Methods: Differentially expressed genes (DEGs) between AD and normal samples were identified from the GSE153434 dataset. Key module genes associated with the S1P score were then obtained using weighted gene coexpression network analysis (WGCNA). The DEGs were intersected with these key module genes to derive a set of intersection genes. Subsequently, a protein-protein interaction (PPI) network was constructed and screened to identify candidate genes. Further biomarker mining was performed through machine learning approaches followed by validation. Following this, gene set enrichment analysis (GSEA), immune infiltration analysis, investigation of regulatory mechanisms, and drug prediction were conducted. Finally, we quantified S1P concentration in human plasma using an ELISA kit, established an AD rat model, and validated gene expression levels using quantitative real-time polymerase chain reaction (qRT-PCR).

Results: A total of 651 intersection genes were identified from the overlap between the 702 DEGs and 7108 key module genes. Subsequently, 20 candidate genes were screened, yielding two biomarkers: CXCL5 and ITGA5. Both biomarkers were enriched in the p53 signaling pathway, porphyrin and chlorophyll metabolism, and the NOD-like receptor signaling pathway. Furthermore, eight types of immune cells, including central memory CD4 T cells and natural killer T cells, were significantly elevated in the AD group compared with controls. ELISA quantification confirmed elevated S1P levels in human plasma. Additionally, utilizing an established AD rat model, we provided the first experimental validation that ITGA5 is highly expressed in dissected aortic tissue. Notably, CXCL5 exhibited the strongest significant positive correlation with central memory CD4 T cells. Regulatory network analysis revealed a relatively complex lncRNA-miRNA-mRNA interaction network. Finally, seven potential small-molecule drugs targeting ITGA5 were predicted, including cilmostim, cilengitide, and dimethyl sulfoxide.

Conclusion: This study identifies ITGA5 as a novel biomarker for S1P-associated AD and reveals its potential underlying mechanisms and therapeutic candidates, providing a theoretical foundation for AD diagnosis and treatment.

This study investigated hypertension management in young adults in Korea using data from the 2023 Korean Community Health Survey. We examined treatment patterns and identified factors associated with untreated cases among adults aged 20-39 years diagnosed with hypertension. Among young adults, 21.2% were receiving both drug treatment and lifestyle modification, while 28.6% were neither receiving drug treatment nor lifestyle modification. In addition, 35.5% were receiving only drug treatment, and 14.8% were practicing only lifestyle modification. The percentage of young adults who were not practicing both drug treatment and lifestyle modification was higher than that of adults aged 40 or older. These were associated with male sex (OR: 1.427, 95% CI: 1.12-1.82), BMI (OR: 0.932, 95% CI: 0.91-0.95), current smoking (OR: 1.366, 95% CI: 1.06-1.77), alcohol consumption (≤ once/week, OR: 1.654, 95% CI: 1.14-2.39; ≥ twice/week, OR: 2.484, 95% CI: 1.59-3.87), awareness of one's own blood pressure (OR: 0.194, 95% CI: 0.15-0.26), knowledge of myocardial infarction symptoms (OR: 0.779, 95% CI: 0.71-0.86), education about hypertension management (OR: 0.648, 95% CI: 0.52-0.80), and social network level (OR: 0.934, 95% CI: 0.91-0.96). These findings highlight the need for tailored interventions to improve hypertension awareness and management in young adults.