International Journal of Hypertension最新文献

Introduction: Hypertension is the most prominent established risk factor for adverse cardiovascular outcomes. The influence of hypertension in combination with other major cardiovascular disease risk factors (CVD-RFs) on mortality and cardiovascular events has not been fully comprehended yet due to their overlapping and interconnected nature. This study was conducted to evaluate the impact of CVD-RFs quantity on the occurrence of cardiovascular events, CVD-related mortality, and all-cause mortality rates in hypertensive patients. Design and Method: In a secondary analysis of the Isfahan Cohort Study, demographic information, anthropometric measures, and laboratory results of participants were extracted. During the 15 years of follow-up, all-cause mortality, CVD-related mortality, and the occurrence of nonfatal cardiovascular events were assessed by separate panels of experts. Data analysis was performed using Cox proportional hazard models to estimate adjusted hazard ratios (HRs) among normotensive and hypertensive individuals in two subgroups of 3 CVD-RFs and≥ 3 CVD-RFs. Results: Among 5432 eligible participants, hypertensive patients (n = 1509) had 1.3, 2, and 1.4 times higher HRs for all-cause mortality, CVD-related mortality, and nonfatal cardiovascular events, respectively. Compared to the normotensives, HRs for the mentioned outcomes were 1.2, 1.7, and 1.3 for hypertensive participants with < 3 CVD-RFs and 1.7, 3.4, and 2.3 for hypertensive participants with≥ 3 CVD-RFs. These rises were shown to be highly significant (p = 0.003, p = 0.001) for CVD-related mortality and nonfatal cardiovascular events in hypertensives with ≥ 3 CVD-RFs compared with hypertensives with < 3 CVD-RFs. Conclusions: Hypertension alone or combined with other CVD-RFs increases the chance of all-cause mortality, CVD-related mortality, and nonfatal cardiovascular events. Rises in the quantity of other CVD-RFs (specifically to≥ 3) result in highly significant increases in fatal and nonfatal cardiovascular events. Therefore, to reduce mortality and cardiovascular events, hypertensive patients should be thoroughly evaluated for coexisting CVD-RFs, aiming to limit the synergistic effects of multiple CVD-RFs by properly managing modifiable RFs.

Background: Preeclampsia, a pregnancy complication marked by hypertension after 20 weeks of gestation, arises from placental factors that impair maternal vascular function. C-type natriuretic peptide (CNP), known for its vasodilatory role, may help counter preeclampsia-related vascular dysfunction. This study aimed to explore the effect of CNP on preeclampsia risk using the Mendelian randomization (MR) framework. Methods: Genetic instrumental variables that mimic the effects of CNP signaling (through natriuretic peptide receptor 2 [NPR2] activation or reduced NPR3-mediated clearance) were identified in the genes encoding the two receptors. This discovery emerged from a multiancestry genome-wide association study (GWAS) involving over 5 million individuals. Female-specific genetic association estimates were obtained from individual-level data comprising 198,402 female participants in the UK Biobank. Two-sample MR analyses were conducted to investigate the effects of NPR2 activation and NPR3 function on preeclampsia, utilizing the largest publicly available GWAS on preeclampsia, which included 296,824 female participants. Results: Genetically proxied reduced NPR3 function was associated with a lower risk of preeclampsia (odds ratio (OR): 0.46, 95% confidence interval 0.30-0.69). In contrast, genetically proxied increased NPR2 activation lacked significant association, likely due to underpowered genetic instruments. Sensitivity analyses indicated robust findings with minimal pleiotropy, meaning the genetic variants used primarily influenced preeclampsia through the intended biological pathway rather than affecting multiple unrelated traits. Conclusion: This study employed the MR paradigm to provide genetic evidence supporting the protective effects of CNP (through reduced NPR3 function) on the risk of preeclampsia. However, it is important to gather additional evidence from other sources before moving forward with clinical development efforts to explore CNP as a potential treatment for preeclampsia.

Objective: To assess serum magnesium mean levels in pregnant women with severe preeclampsia at three landmarks: prior to MgSO₄ intake, 30 min, and 6 h postintake of loading dose plus maintenance dose. Methodology: This cross-sectional study collected blood samples over a timeframe of 0-6 h from 64 pregnant women diagnosed with severe preeclampsia who were receiving MgSO₄ therapy at the emergency management department of Hung Vuong Hospital, Vietnam, in the period of November 2023 to April 2024. Serum magnesium levels were measured three times in the timeframe. Results: Prior to MgSO₄ intake, the serum magnesium mean level was 0.75 ± 0.13 mmol/L. At 30 min postloading dose intake plus maintenance, the level increased to 1.65 ± 0.32 mmol/L, and at 6 h, 1.6 ± 0.34 mmol/L, where 17.2% of patients had a serum magnesium level of 2 mmol/L or higher. Conclusion: There were no eclampsia incidents in patients with severe preeclampsia treated with a regimen of a loading dose of 4.5 g MgSO₄ followed by a 1 g-hourly maintenance. Nevertheless, about 17% of participants achieved the desired threshold of 2 mmol/L, indicating a need for additional research to refine the loading and maintenance doses of MgSO₄ for better management of severe preeclampsia in Vietnamese women.

Background: The relationship between different grades of compliance to antihypertensive medication and blood pressure (BP) control rate remains unclear. This study highlighted the Chinese Basic Public Health Service (BPHS) program upgraded antihypertension medication compliance to improve the blood pressure control rate contributing to the UN sustainable development goal of lowering chronic illness fatalities by one-third by 2030. Methods: In 2015, 1254 hypertensive patients aged ≥ 35 years were selected in the baseline survey in Yunnan Province by a multistage stratified random sampling method and followed up from 2018 to 2022. Then, they were divided into three groups by tertiles as antihypertensive medicine compliance "poor," "intermittent," and "sustained" groups. Then, the robust variance Poisson regression models were performed to estimate the association between three groups and the number of referrals. Kaplan-Meier curves calculated the cumulative risk of onset and survival probability of cardiovascular events from three medication compliance groups. Results: A total of 1254 hypertension patients were included in the study; 992, 1218, 1121, 1066, and 999 hypertension patients were followed up annually. From the baseline to last follow-up, systolic BP declined with the largest decrease in the sustained group (2015: 152.88 ± 21.64 mmHg vs. 2022: 134.61 ± 10.49 mmHg, p < 0.05) and the least decrease in the poor group (2015: 157.07 ± 15.37 mmHg vs. 2022: 140.33 ± 12.04 mmHg, p < 0.05). Under the management of BPHS, the BP control rate of all three groups increased significantly. Compared with the baseline, the control rate in the sustained group reached 70% in 2022 (p < 0.01). The number of referrals from the poor group was 11.5%, higher compared with the sustained group (IRR = 1.115 and 95% CI: 1.043-1.193). The poor group also had the highest probability of cardiovascular disease (CVD). The survival probability in the sustained group was the highest and kept at 0.950 at the end of 5 years. Conclusions: High-grade compliance to antihypertensive drugs significantly improves BP control rate and reduces the risk of CVD events and mortality. The decline of medication compliance grades is closely related to decreasing BP control rate and increased risk of CVD and mortality.

Genetic, demographic and environmental factors all play a role in the frequency of an intricate multifactorial condition known as hypertension. Approximately 30% and 50% of BP fluctuation are influenced by genetic variability. Many genetic studies have confirmed the link between genetic variability and susceptibility to essential hypertension; hence, identifying genes associated with essential hypertension susceptibility will aid in understanding the pathophysiology and their influence on how an individual responds towards the antihypertensive therapy. There are also controversial results highlighted in some reports. This review summarises genetic variants of the renin-angiotensin-aldosterone system (RAAS), angiotensinogen (AGT) (M235T), angiotensin converting enzyme (ACE) (insertion/deletion), angiotensin II type 1 receptor (AT1R) (A1166C) and aldosterone synthase (C344T) that are known and might contribute towards the pathophysiology of essential hypertension. Furthermore, the review highlights the response of certain RAAS gene polymorphisms (renin, ACE and AT1R genes) to antihypertensive drugs.

Hypertension remains a major public health challenge globally, with suboptimal adherence to treatment and lifestyle modifications exacerbating cardiovascular risks. This study evaluates multidimensional adherence (medication, diet, and behavior) and its determinants among hypertensive patients in rural Northeast China. A cross-sectional study enrolled 6352 adults aged ≥ 40 years with diagnosed and poorly controlled hypertension from rural villages across five cities (Benxi, Chaoyang, Dandong, Donggang, and Fuxin) in Liaoning Province, Northeast China, using multistage cluster sampling. Adherence was assessed via standardized questionnaires, with logistic regression analyzing sociodemographic, clinical, and behavioral predictors. Medication adherence was reported by 73.7% of participants, while dietary and behavioral adherence rates were 10.5% and 29.3%, respectively. Ethnic disparities emerged, with Han Chinese exhibiting lower medication adherence (aOR = 0.485, 95% CI: 0.377-0.624). Cohabiting with children enhanced dietary adherence (aOR = 2.184, 95% CI: 1.854-2.573), whereas widowed status reduced both dietary (aOR = 0.698, 95% CI: 0.528-0.924) and behavioral adherence (aOR = 0.726, 95% CI: 0.595-0.887). Higher hypertension knowledge scores positively influenced all adherence domains (p < 0.05). Adherence among rural hypertensive patients is multidimensional, shaped by cultural, socioeconomic, and behavioral factors. Targeted interventions addressing dietary sodium reduction, family-based support, and health literacy improvement are urgently needed. This study underscores the importance of integrating region-specific strategies into hypertension management programs to mitigate cardiovascular morbidity in high-risk populations.

Introduction: Hypertension poses a significant global health challenge, leading to serious health conditions and premature death. Effective blood pressure control is often hindered by patients' nonadherence to self-care behaviors. This study evaluates these behaviors and their influencing factors among hypertensive patients at Dessie Referral Hospital, Ethiopia. Methods: Conducted from October 20 to November 30, 2019, this mixed-methods study involved 370 hypertensive patients from the hospital's outpatient clinic. Data were collected via structured questionnaires and analyzed using multivariable logistic regression. Additionally, 14 in-depth interviews provided qualitative insights, analyzed thematically. Results: Only 29.4% of patients fully adhered to self-care recommendations. Urban dwellers showed 70% less adherence than rural counterparts. Adherence varied with the duration since diagnosis, with medium-duration patients being less likely to adhere. Interviews revealed personal strategies for managing diet, exercise, medication, and lifestyle, highlighting the struggle with adherence and innovative solutions to challenges. Conclusion: Adherence to self-care among hypertensive patients is alarmingly low, influenced by diagnosis duration, residency, and BMI. Addressing hindrances like living conditions, work, cultural norms, and peer influence is vital. Healthcare providers must focus on education that promotes behavior change and support. Patient engagement in self-care is essential. Future research should investigate healthcare organizational and provider influences. Implementing these strategies could markedly improve hypertension management and patient outcomes.

Background: Ultra-processed food (UPF) consumption is increasing rapidly due to large-scale food production. Being a public health issue, hypertension is affecting 1.28 billion adults globally. This study investigates the link between UPF consumption and hypertension. Methods: We included 8150 participants at the risk of hypertension in the final analysis. UPF consumption was assessed using data from the available Food Frequency Questionnaire (FFQ), and the amount of UPF consumption of each participant in a day was assessed. Cox proportional models with covariates including age, sex, residence type, marital status, socioeconomic status, physical activity, familial history of hypertension, and fasting blood sugar were used to assess the association between UPF consumption and hypertension in the main model and sensitivity analysis. Age, residence type, and the third tertile of UPF interacted with time in our model, which was addressed accordingly. Results: The mean participant age was 46.25 years (47.58% male) with a mean follow-up of 7.65 years. The mean daily UPF intake was 88.07 g. During follow-up, 862 hypertension cases were recorded. After adjusting the main model for confounders, the hazard ratios for the second and third tertiles of UPF consumption were 1.13 (95% CI, p value) (0.96-1.32, 0.13) and 0.65 (95% CI, p value) (0.46-0.91, 0.01), respectively, compared to the first tertile. Conclusion: We found significant association between the third tertile of UPF intake and hypertension; moreover, we identified significant associations between hypertension incidence and some demographic factors, warranting further investigation.

Objective: We aimed to determine the contribution of various types of body composition measures to the increased left ventricular mass index (LVMI) in young adult females. Methods: Data from the National Growth and Health Study (NGHS), including dual-energy x-ray absorptiometry (DEXA), magnetic resonance imaging (MRI), and echocardiogram, were analyzed (N = 589, 54.8% Black, mean age: 24.9 ± 0.7 years). Logistic and linear regressions were conducted to assess for the contribution of fat mass (FM) and fat-free mass (FFM) by DEXA and subcutaneous abdominal adipose tissue (SAT) mass and visceral adipose tissue (VAT) volume by MRI in relation to the increased LVMI or left ventricular hypertrophy (LVH; LVMI ≥ 38.6 g/m^2.7). Results: FM (β ± SE: 0.025 ± 0.002, p < 0.01, adjusted R ² = 0.313), FFM (0.059 ± 0.003, p < 0.01, adjusted R ² = 0.374), SAT (0.054 ± 0.005, p < 0.01, adjusted R ² = 0.291), and VAT (0.194 ± 0.019, p < 0.01, adjusted R ² = 0.256) were each significantly associated with the increased LVMI, with FFM having the greatest association. Black race was associated with the increased LVMI in models involving individual fat mass types (0.055 ± 0.020, p < 0.01 for FM; 0.054 ± 0.021, p = 0.01 for SAT; 0.119 ± 0.021, p < 0.01 for VAT). In logistic models considering all mass types, FFM (OR [95% CI]: 1.62 [1.46-1.79], p < 0.01) and systolic blood pressure (SBP) (1.04 [1.01-1.07], p < 0.01) were significant contributors to LVH (area under the receiver-operator characteristic curve 0.847), and only FFM was a significant contributor in the corresponding linear regression (β ± SE: 0.059 ± 0.003, p < 0.01, adjusted R ² = 0.374). Conclusions: FFM had the greatest association with LVH and LVMI, confirming previously published data. Through the use of MRI, we found that neither subtype of abdominal fat mass (SAT and VAT) better explained the variance in LVMI than FFM.

Inappropriate aldosterone production relative to sodium status is known to induce arterial hypertension and cause detrimental effects on endothelium and vascular remodeling. This study investigated whether microRNAs (miRs) serve as key mediators of aldosterone's effects on endothelial dysfunction. Using human umbilical vein endothelial cells (HUVECs) as a model system, we demonstrated that aldosterone treatment suppressed cellular proliferation and migration while promoting senescence. Mechanistically, we observed that aldosterone exposure significantly upregulated miR-34a expression in HUVECs. The functional significance of miR-34a was confirmed when specific inhibitors reversed aldosterone's antiproliferative and prosenescence effects. To elucidate the underlying molecular pathway, we performed comprehensive biological analyses, which revealed that miR-34a target genes were predominantly associated with the Notch signaling pathway. Western blot analysis further validated that miR-34a promotes senescence in HUVECs through negative regulation of NOTCH1. Collectively, our findings identify miR-34a as a crucial mediator of aldosterone-induced endothelial cell senescence via the NOTCH1 signaling pathway, suggesting its potential as a therapeutic target for aldosterone-related vascular diseases.