Journal of Hypertension最新文献

Introduction: Altered autonomic control has been proposed as a mechanism underlying postexercise hypotension (PEH). This meta-analysis examined the effects of acute aerobic exercise on blood pressure (BP) and autonomic outflow in adults with normal or elevated BP.

Methods: A systematic search identified trials involving adults who performed aerobic exercise, with BP and autonomic measures taken before and at least 30 min after exercise. Random-effects models were used to calculate Hedge's g effect sizes.

Results: Sixty-five trials (118 interventions; 1248 participants) were analyzed. Individuals were relatively young (mean age 37.5 ± 5.5 years) with average BP of 122.5 ± 8.8/75.2 ± 6.6 mmHg. Aerobic exercise significantly reduced systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) ( g  = -0.373 to -0.813, P  < 0.05). These reductions were accompanied by increased sympathetic (g = 0.279 to 0.436, P  < 0.01) and decreased parasympathetic ( g  = -0.535 to -0.414, P  < 0.003) activity. In individuals with normal BP, pressoric reductions were inversely related to sympathetic activity (overall BP: n  = 153, slope = -0.199, P  = 0.016) and positively related to parasympathetic activity (overall BP: n  = 147, slope = 0.134; P  = 0.046), though not all associations reached statistical significance. In those with elevated BP, the opposite pattern emerged from meta-regression: BP reductions were positively associated with sympathetic activity (SBP: n  = 43, slope = 0.402, P  = 0.002; overall BP: n  = 153, slope = -0.199, P  = 0.016) and negatively with parasympathetic activity (SBP: n  = 38, slope = -0.230, P  = 0.011; overall BP: n  = 73, slope = -0.140, P  = 0.018).

Conclusion: These findings support autonomic control as a mechanism of prolonged PEH in individuals with elevated, but not normal BP. Aerobic exercise induced BP reductions appear linked to differing autonomic responses depending on baseline BP status.

Background: Increased activity of the sympathetic nervous system (SNS) is a critical factor in the pathophysiology of hypertension. Centrally acting sympatholytic agents (CASA) and renal denervation (RDN) represent two distinct therapeutic strategies targeting the SNS.

Aims: This study explored whether the blood pressure (BP)-lowering effect of RDN is influenced by the presence of CASAs.

Methods: Patients from the Global Symplicity Registry (GSR) were categorized into two groups based on whether or not their antihypertensive medication regimen prior to RDN included CASAs. Changes in systolic and diastolic 24-h ambulatory BP from baseline to 3-, 6, 12 and 24-month follow-up were compared between groups with crude and adjusted ANCOVAs.

Results: A total of 2712 patients had medication data available at baseline, of whom 1036 (38.2%) were on CASAs, and 1676 (61.8%) were not. Systolic 24-h ambulatory BP lowering at all time points after RDN was consistently more pronounced in the non-CASA compared to the CASA group ( P  < 0.001). DBP lowering was greater in the non-CASA group at 3- and 6-month follow-up, but not at later time points.

Conclusion: Patients not treated with CASAs prior to RDN demonstrated a more pronounced ambulatory SBP reduction over 24 months compared to those on CASA treatment. These findings corroborate the notion that the RDN-induced BP reduction is at least in part mediated via modulation of central sympathetic outflow. Even in the presence of CASAs, RDN still results in significant BP lowering, yet to a lesser degree. These findings have implications for managing patient expectations prior to RDN.

This review examines current evidence on the effects of physical exercise in individuals with resistant hypertension, a population for whom the effects of exercise are less well understood compared to those with general hypertension. Emerging evidence indicates that aerobic exercise promotes clinically meaningful reductions in blood pressure in individuals with resistant hypertension, with potential to reduce medication reliance and improve cardiovascular health. Combined aerobic and dynamic resistance exercise, particularly in heated-water environments, may offer additional benefits. However, important research gaps remain, including limited data on resistance training (dynamic or isometric), and mind-body exercises such as Tai Chi or Yoga. While aerobic exercise is well established as an effective strategy for lowering blood pressure, further studies are needed to evaluate other exercise modalities and digital or remote interventions to enhance adherence. Expanding the evidence base will allow for more personalized and flexible exercise prescriptions, ultimately improving long-term blood pressure control and cardiovascular outcomes in this population.

Background: Hypertension is considered a significant modifiable risk factor for cardiovascular disease among hemodialysis patients. Aside from blood pressure (BP) levels, blood pressure variability (BPV) has been independently associated with all-cause and cardiovascular mortality in hemodialysis patients. Sodium load is associated with thirst, fluid retention, interdialytic weight gain (IDWG), and hypertension. This study investigated the effect of lowering dialysate sodium concentration on visit-to-visit BPV in hemodialysis patients.

Methods: Among 110 hemodialysis patients assessed for eligibility, 89 were randomized to receive hemodialysis either with standard dialysate sodium (143 mmol/l) or reduced dialysate sodium (140 mmol/l) for 3 months. Eighty-three patients completed the study. Predialysis BP readings were recorded with an automated device 2 weeks before and after the intervention. The visit-to-visit BPV was quantified at baseline and after 3 months by three metrics: the standard deviation (SD) of the BP, the coefficient of variation (CV), and the average real variability (ARV).

Results: SD ( P  = 0.02), CV ( P  = 0.034), and ARV ( P  < 0.001) of SBP were significantly decreased in the lower sodium dialysate group. No significant difference was observed between both groups in terms of diastolic BPV measures. Furthermore, IDWG was significantly decreased in the lowered sodium dialysate group after 3 months ( P  = 0.02). Intradialytic adverse events were comparable for both groups.

Conclusion: Lowering dialysate sodium concentration decreases visit-to-visit systolic BPV parameters and IDWG. Long-term studies are required to confirm postulated cardiovascular benefits.

Trial registration: The trial was registered with ClinicalTrials.gov (trial registration number NCT05169125, trial registration date 23/12/2021).

Resistant hypertension is a challenging condition and linked with considerable morbidity. We aimed to evaluate the efficacy and safety of aldosterone synthase inhibitors (ASIs) among patients with resistant hypertension. Four electronic databases were searched to identify randomized clinical trials (RCTs) evaluating ASIs compared with placebo for resistant hypertension. A frequentist network meta-analysis was conducted. Continuous outcomes were reported as mean differences and dichotomous outcomes as risk ratio, each with 95% confidence interval (95% CI), using a random-effect model. The primary outcomes were changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP). A total of 2725 patients from six RCTs were included. Baxdrostat and Lorundrostat significantly reduced SBP (Baxdrostat: MD -8.81 mmHg, 95% CI -10.94 to -6.67; Lorundrostat: MD -8.42 mmHg, 95% CI -11.05 to -5.78) and DBP (Baxdrostat: MD -3.28 mmHg, 95% CI -4.68 to -1.87; Lorundrostat: MD -3.13 mmHg, 95% CI -4.27 to -1.98). In contrast, Osilodrostat did not show a significant difference in SBP or DBP compared with placebo. Baxdrostat and Lorundrostat were associated with significant increases in serum potassium levels and hyperkalemia. None of the three drugs significantly increased the risk of serious adverse events. Highly selective ASIs (Baxdrostat and Lorundrostat) significantly lowered BP in patients with resistant hypertension without increasing the risk of serious adverse events, whereas the nonselective agent Osilodrostat did not reach significant difference. These findings suggest that selective aldosterone synthase inhibition represents a promising therapeutic option for resistant hypertension.

Introduction: Hypertension remains the leading modifiable risk factor attributable to 10.8 million premature deaths. Hence the study of hypertension and gut microbiome as a therapeutic target is very important. Yet the links between the gut microbiome and long-term incidence of hypertension are unknown.

Aim: This study assessed the association between gut microbiome and incident hypertension.

Method: The study sample consisted of 3311 nonhypertensive individuals (60.7% women) aged 25-74  years who were drawn from the general population in Finland. In the baseline examination performed in the year 2002, the participants underwent a health examination and provided a stool sample. The gut microbiome was assessed using shallow shotgun metagenomic sequencing. Microbiome analyses were performed with Cox proportional hazards model.

Results: In total, 675 participants developed hypertension over a follow-up period of nearly 20 years. In multivariable-adjusted models, overall gut microbiome composition was not related to risk of future hypertension. Eight genera, including Agathobaculum, Blautia_A_141780, Blautia_A_141781, Mediterraneibacter_A_155590, Enterocloster , Bariatricus , CAG-317-146760 , and CAG-628 were significantly associated with incident hypertension in the age-adjusted and sex-adjusted models, but none remained significant in the multivariable-adjusted models. No functional pathways were associated with hypertension risk.

Conclusion: Our results do not provide strong evidence for an association between the gut microbiome and risk of future hypertension, especially after adjusting for covariates that are known to influence the gut microbiome.

Introduction: Blood pressure variability (BPV) is a prognostic marker in hypertension and coronary artery disease (CAD), but its role in acute myocardial infarction (AMI) remains unknown. This study assessed the association of short-term (24-h ambulatory BP monitoring, ABPM) and mid-term BPV with adverse in-hospital and long-term outcomes in AMI patients.

Methods: Mid-term BPV was calculated as the standard deviation (SD) of daily in-hospital BP readings; short-term BPV was measured by average real variability (ARV) from ABPM. Patients were evaluated as continuous variables and by quartiles (Q1-Q4). Logistic regression and Cox models assessed in-hospital and 3-year outcomes.

Results: In this prospective, single-center cohort, 441 of 677 AMI patients were included. Each 1 mmHg rise in day-to-day systolic BPV (SBP-SD) increased in-hospital MACE risk by 24% [odds ratio (OR): 1.24, 95% confidence interval (CI): 1.17-1.31], with Q4 showing the highest risk (OR: 28.89, 95% CI: 8.58-97.28). ABPM-derived SBP-ARV predicted in-hospital mortality (OR: 1.58, 95% CI: 1.21-2.07) and MACE (OR: 1.35, 95% CI: 1.23-1.48). Diastolic ARV was linked to in-hospital myocardial infarction (MI), arrhythmias, and shock. At 3-year follow up, Q4 of SBP-SD showed higher risk of composite outcomes (hazard ratio: 29.88, 95% CI: 10.93-81.66) and all-cause mortality (hazard ratio: 11.85, 95% CI: 2.81-49.91). SBP-ARV independently predicted both all-cause mortality (hazard ratio: 1.37, 95% CI: 1.25-1.51) and adverse events (hazard ratio: 1.29, 95% CI: 1.22-1.36), while diastolic BPV was primarily associated with arrhythmias and heart failure hospitalization.

Conclusion: Systolic BPV independently predicts in-hospital and long-term outcomes in AMI. BPV assessment may aid post-MI risk stratification and guide novel therapeutic strategies in this high-risk population.

Objective: Hypertensive urgencies (HU) and hypertensive emergencies (HE) have significant clinical and public health implications, yet standardized management strategies are lacking. To address this gap, the European Society of Hypertension (ESH) initiated the ESH-URGEM registry to assess the epidemiology, clinical characteristics, and management of HU and HE across Europe over 12 months.

Methods: ESH conducted a prospective, observational study in emergency departments (EDs) of ESH-affiliated hospitals (ESH Excellence Centers). Adult patients (≥18 years) presenting with HU or HE were enrolled during ≥12-h shifts, once weekly, over 1 year.

Results: Among 115 169 ED visits, 998 cases (0.87%) were identified as hypertensive crises (HC): 77.3% HU and 22.7% HE. HE patients were older (mean age 70 vs. 66 years; P  = 0.004) and had more comorbidities, including coronary artery disease, heart failure, and chronic kidney disease. The most frequent triggers were emotional stress (44.8%), acute pain (33.7%), and medication nonadherence (15.5%). HE commonly manifested as acute coronary syndromes (39.6%), pulmonary edema (33.8%), or neurological complications (14.1%). HE treatment most often included intravenous nitrates (60.5%) and diuretics (45.8%). Also, 35.1% of HU cases also received intravenous therapy. Only 18.9% of HE patients were admitted to coronary or intensive care units, while 16.1% of HU patients were hospitalized, frequently for nonhypertension-related conditions. Guideline-recommended assessments for target organ damage and cardiovascular risk estimation such as fundoscopy and albuminuria testing were rarely performed.

Conclusions: This registry highlights critical issues in the ED management of HC and hypertension, including: underdiagnosis of chronic hypertension, insufficient admission of HE patients to intensive or coronary care units, overly aggressive treatment of HU, and underuse of fundoscopy and albuminuria screening. Addressing these deficiencies through guideline implementation, structured care pathways, and improved follow-up could enhance outcomes for this high-risk population.

Introduction: Sleep duration is associated with blood pressure (BP), the leading risk factor for cardiovascular disease. Yet, limited data exists on the relationship between objectively measured sleep duration and BP in a large population. We sought to examine this relationship using data from the 2011-2014 National Health and Nutrition Examination Survey cycles.

Methods: Average nighttime sleep duration was estimated from actigraphy using a validated algorithm among 6963 individuals [median age 47 (27) years, 52% women]. SBP and DBP were calculated as the average of up to three measures. Hypertension was defined as SBP at least 130 mmHg, DBP at least 80 mmHg, self-reported use of antihypertensive medication, or a self-reported physician diagnosis of hypertension. Linear and logistic regression assessed sleep duration's association with BP and hypertension.

Results: We observed a U-shaped association between sleep duration and SBP [B 2  = 0.29, 95% confidence interval (95% CI) = 0.10-0.49, P  = 0.0031], with higher SBP values observed at shorter and longer sleep durations. Optimal sleep duration was estimated at 7.5 h, corresponding to SBP of 122 mmHg for men and 115 mmHg for women. The association of sleep duration with DBP was nonsignificant (B 2  = 0.13, P  = 0.067). Sleep durations greater or less than 7 h were not associated with increased odds of hypertension (B = -0.30, 95% CI = -0.73 to 0.12, P  = 0.16).

Conclusion: An objectively measured sleep duration of 7.5 h was associated with optimal SBP in both men and women. Yet, neither short nor long sleep durations were associated with hypertension incidence.