Journal of Hypertension最新文献

Background: While emerging evidence suggests guideline-defined nonhypertensive blood pressure (BP) may encompass heterogeneous risk, the relationship between BP variations within nonhypertensive ranges and mortality risk remains inadequately characterized among individuals without traditional cardiovascular risk factors. This study investigated whether nonhypertensive range of SBP, DBP, and pulse pressure (PP) are associated with long-term mortality in a healthy population.

Methods: This study included 80 730 UK Biobank participants without traditional cardiovascular risk factors and with nonhypertensive BP (SBP <140 mmHg, DBP <90 mmHg, and PP <60 mmHg). Participants were followed up for all-cause, cardiovascular, and noncardiovascular mortality. Associations were assessed using multivariable Cox proportional hazards models with restricted cubic splines.

Results: Over a median follow-up of 13.7 years, 2553 deaths occurred. SBP and PP showed significant nonlinear associations with all-cause mortality ( P -overall <0.01), while DBP showed a linear inverse association ( P -overall = 0.049). Compared to the third quintile, the lowest PP quintile (<40 mmHg) was associated with 26% higher mortality risk (hazard ratio 1.26, 95% confidence interval [95% CI] 1.10-1.44), and the highest quintile (53-60 mmHg) with 14% higher risk (hazard ratio 1.14, 95% CI 1.01-1.28). The lowest SBP quintile (<114 mmHg) was associated with 16% higher risk (hazard ratio 1.16, 95% CI 1.02-1.32) compared to the third quintile (120-126 mmHg).

Conclusion: Even within nonhypertensive ranges, the lowest and highest quintiles of PP level, as well as low-normal SBP and DBP levels, were associated with increased mortality risk in a healthy population.

Objective: To investigate the effects of combined exercise training associated with enalapril maleate on blood pressure variability (BPV) and renal morphofunctional, inflammatory and oxidative stress parameters in an experimental model of arterial hypertension.

Methods: Male spontaneously hypertensive rats (SHR) were randomly allocated into sedentary placebo (SP), trained placebo (TP), sedentary enalapril (SE) or trained enalapril (TE). Both enalapril treatment (3 mg/kg) and combined exercise training (3 days/week) were performed for 8 weeks. Blood pressure (BP) was recorded intra-arterially for BPV analysis. Renal function, morphology, inflammation and oxidative stress were assessed.

Results: Combined exercise training alone (TP group) did not alter systolic BP. However, TP group showed lower media/lumen ratio of interlobular arteries and NADPH oxidase activity, as well as higher interleukin (IL)-10 and superoxide dismutase activity in renal tissue compared to the SP group. In addition to similar benefits induced by exercise training alone, the combination of approaches (TE group) resulted in lower vascular sympathetic modulation (TE: 10.6 ± 1.7 vs. SP: 22.0 ± 3.1 mmHg 2 ), higher creatinine clearance, lower NADPH oxidase activity, lower areas with severe tubulointerstitial fibrosis (injury range 51-100%, TE: 10.0 ± 0.2 vs. SP: 27.5 ± 0.1, TP: 22.5 ± 0.1 and SE: 22.5 ± 0.1%), as well as a lower media/lumen ratio. Positive correlations were obtained between vascular sympathetic modulation with SBP ( r  = 0.61), media/lumen ratio ( r  = 0.74) and renal tubulointerstitial fibrosis ( r  = 0.69).

Conclusions: The combination of exercise training with enalapril provided additional renal morphofunctional benefits, which may result from interactions involving BPV, inflammation, and oxidative stress, and could contribute to the observed renal improvements. Our findings also suggest that BPV may play a role in hypertension-related renal changes and that combining pharmacological and nonpharmacological therapies might offer effective strategies to reduce residual cardiovascular risk in arterial hypertension.

Objective: Arterial stiffness, a well established cardiovascular risk factor, is accelerated in metabolic conditions such as diabetes and chronic kidney disease. It is typically assessed by measuring pulse transit time along an arterial path in the supine position. We hypothesized that introducing a hydrostatic pressure gradient by changing body position could reveal additional vascular biomechanical properties. This study aimed to quantify the increase in finger-to-toe pulse wave velocity (Δft-PWV) from supine to sitting and identify its determinants across varying cardiovascular risk profiles.

Methods: In this cross-sectional study, 248 adults were recruited, and 210 had reliable ft-PWV measurements in both positions. Ft-PWV was determined from pulse transit time between the finger and toe using two photoplethysmographic sensors.

Results: The mean age of participants was 55 ± 19 years; 112 (53%) were male, 104 (50%) had hypertension, 76 (36%) had diabetes, and 75 (36%) were on hemodialysis. Mean SBP and DBPs were 127 ± 17 and 77 ± 12 mmHg (mean ± standard deviation). Ft-PWV increased significantly from 8.5 ± 3.3 m/s (supine) to 14.3 ± 9.1 m/s (sitting; P  < 0.001). In univariable analyses, Δft-PWV was significantly associated with supine ft-PWV ( r  = 0.405, P  < 0.001), age ( r  = 0.337, P  < 0.001), diabetes ( r  = 0.219, P  < 0.001), and cardiovascular disease ( r  = 0.188, P  = 0.006). Sex, dialysis status, weight, height, and mean BP changes were not significantly associated with Δft-PWV. In stepwise multivariable regression, Δft-PWV was independently associated with supine ft-PWV (β = 0.379, P  < 0.001) and diabetes (β = 0.154, P  = 0.016).

Conclusion: Ft-PWV increased significantly from supine to sitting. The magnitude of change was independently associated with supine ft-PWV and diabetes, highlighting biomechanical insights from postural change.

Objectives: Accurate blood pressure measurement is essential for cardiovascular risk management, but conventional oscillometric devices are unreliable for atrial fibrillation and arterial stiffness. We evaluated the accuracy of a novel automated Korotkoff sound-based monitor (Ksens-BP), integrating a semiconductor strain-gauge sensor and artificial intelligence waveform classification, compared to oscillometric (Oscillo-BP) and manual auscultatory (Auscl-BP) methods.

Methods: This single-center prospective observational study enrolled adults with cardiovascular disease at National Cheng Kung University Hospital, Douliu Branch (October 2023-January 2024). Eligible conditions included hypertension, diabetes, atrial fibrillation, myocardial infarction, coronary artery disease, peripheral artery disease, stroke, or heart failure. Participants underwent three paired blood pressure (BP) measurements with Ksens-BP, Oscillo-BP, and Auscl-BP using a unified cuff system. Agreement was assessed with Auscl-BP assessed by concordance correlation coefficient (CCC). Hierarchical linear models (HLMs) examined the effects of comorbidities on measurement differences.

Results: A total of 178 patients (mean age 67.4 years; 80% men) contributed 686 valid paired measurements. Ksens-BP demonstrated excellent agreement with Auscl-BP (SBP CCC = 0.952; DBP CCC = 0.945) compared with Oscillo-BP (SBP CCC = 0.903; DBP CCC = 0.851). Mean absolute differences were smaller with Ksens-BP than Oscillo-BP (SBP: 2 vs. 4.4 mmHg; DBP: 2.3 vs. 5.4 mmHg). Oscillo-BP accuracy was negatively affected by PAD and atrial fibrillation, whereas Ksens-BP performance was unaffected by comorbidities.

Conclusion: The Ksens-BP system demonstrated superior accuracy and robustness, providing reliable BP measurement across complex cardiovascular populations.

Background: Epidemiological studies indicate that the unique high-altitude environment may promote the prevalence of hypertension. Nevertheless, whether chronic plateau exposure affects antihypertensive efficacy in hypertensive highlanders remains unknown.

Methods: This is a post hoc analysis of the OMAN Trial, a randomized controlled study that compared the antihypertensive efficacy of morning versus bedtime administration of olmesartan/amlodipine. Hypertensive patients from the OMAN Trial were stratified into highlanders (Sichuan-Tibet Plateau, altitude ≈ 3000 m) and lowlanders (Sichuan-Chengdu Plain, altitude ≈ 500 m) based on 1 : 1 propensity score matching. After 4-week treatment of olmesartan/amlodipine (20/5 mg once daily), between-group differences in office/ambulatory blood pressure (BP) reduction, control rates, and rhythms were analyzed.

Results: Each group comprised 171 hypertensive patients with balanced baselines. While office BP reductions were comparable between groups, highlanders showed significantly smaller reductions in 24-h ambulatory BP compared with lowlanders (between-group difference in 24-h SBP reduction: -2.39 mmHg, P  = 0.048; between-group difference in 24-h DBP reduction: -1.60 mmHg, P  = 0.025). More pronounced between-group differences in BP reduction were observed during the morning (ΔSBP: -7.18 mmHg, P  < 0.001; ΔDBP: -4.01 mmHg, P  = 0.002) and daytime (ΔSBP: -3.81 mmHg, P  = 0.005; ΔDBP: -2.29 mmHg, P  = 0.005) periods. Similarly, both office BP control (lowlanders: 77.2% vs. highlanders: 60.2%, P  = 0.001) and 24-h BP control rates (lowlanders: 50.9% vs. highlanders: 34.5%, P  = 0.002) were significantly lower in highlanders. Intriguingly, nocturnal BP reduction and control rates showed no significant intergroup differences.

Conclusion: Our findings suggest chronic plateau exposure may attenuate antihypertensive efficacy, potentially necessitating intensified treatment regimens for BP control in highlanders.

Registration: URL: https://www.chictr.org.cn/ ; Registration number: ChiCTR2200059719.

Objectives: Vascular aging (VA) is a prognostically relevant aspect of biological aging. We investigated its prevalence and determinants in Austria.

Methods: The LEAD (Lung, Heart, Social, Body) study is an ongoing, longitudinal, population-based observational study, which started in 2011 in Vienna and six villages from Lower Austria. Within the study, carotid-femoral pulse wave velocity (cfPWV) was measured using applanation tonometry. Based on a reference population (no history of overt cardiovascular disease, no diabetes, no pharmacological treatment for hypertension or dyslipidemia), sex-, and age-specific Z -scores for cfPWV were calculated. Healthy (HVA), normal (NVA), and early (EVA) vascular aging were defined as cfPWV Z -score <10th, 10th-90th, and >90th percentile, respectively.

Results: In the overall population ( n  = 7926, 54.2% women, age 18-82 years), the prevalence of HVA/NVA/EVA was 9.1/78.6/12.2%, respectively, with EVA prevalence increasing in older age. The risk of EVA, as compared to HVA, was independently and directly associated with female sex (odds ratio, OR 2.8), systolic (OR 1.04) and diastolic (OR 1.02) blood pressure, heart rate (OR 1.06), body height (OR 1.03), and diabetes mellitus (OR 3.0), and inversely related to appendicular lean mass index (OR 0.82), postbronchodilation FEV1 (OR 0.81), and healthy nutrition (OR 0.69). The results were similar for the comparison of EVA and NVA, adding an independently increased risk for EVA with regular alcohol intake (OR 1.37) and low income (OR 1.21).

Conclusions: We observed a high percentage of EVA in Austria, determined by classical and nonclassical risk factors. The latter may offer novel targets for prevention.

Although Nogo-B has been studied in neural development and vascular biology, its integrative role across renal, vascular and inflammatory pathways in hypertension has not yet been systematically reviewed. Here, we synthesize emerging evidence positioning Nogo-B as a central modulator of blood pressure control. Its expression in the aldosterone-sensitive distal nephron and vascular endothelium suggests a central role in electrolyte and fluid balance, as well as vascular physiology. By bridging insights from the renal, vascular and immune systems, we position Nogo-B as an emerging contributor to blood pressure regulation and highlight its potential both as a biomarker for vascular dysfunction and as a therapeutic target in salt-sensitive and treatment-resistant hypertension.

Objective: Preeclampsia imposes significant cardiovascular stress and frequently diastolic dysfunction. New recommendations advise multimodal assessments of cardiac function. The Heart Failure Association - Pretest assessment, Echocardiography and Functional testing, and Final etiology (HFA-PEFF) scoring system integrates echocardiographic indices and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and provides a structured way to characterize cardiac function. This study applied the HFA-PEFF algorithm to assess cardiac function in preeclampsia and its association with maternal and fetal outcomes.

Methods: This prospective observational study was conducted between 2019 and 2022. Ninety women with preeclampsia and 46 normotensive controls were assessed using echocardiography and NT-proBNP levels according to the HFA-PEFF scoring system. Patients were categorized into high (≥5 points), intermediate (2-4 points), or low (0-1 points) score groups. Maternal and fetal outcomes were recorded.

Results: Women with preeclampsia were more frequent in the high (27 vs. 0%) and intermediate (56 vs. 28%) score groups and less frequent in the low-score group (18 vs. 72%, P  < 0.001) compared to controls. The median HFA-PEFF score was 3 points [interquartile range (IQR) 2-5] in women with preeclampsia and 1 point (IQR 0-2) in controls ( P  < 0.001). The HFA-PEFF score groups did not relate to core outcomes overall but small-for-gestational age neonates and higher soluble fms-like tyrosine kinase-1/placental growth factor ratio (sFLT/PlGF) ratios were more common in the HFA-PEFF high-score group ( P  = 0.011, P  = 0.036).

Conclusion: The HFA-PEFF algorithm effectively detected cardiac dysfunction - reflected in structural changes, functional impairment, and elevated heart failure biomarkers - in women with preeclampsia. NT-proBNP may serve as potential screening tool for HFA-PEFF score.

Objectives: The association between blood pressure (BP) and the mortality risk may vary depending on the comorbidities. This study was conducted to investigate the subgroup-specific correlation between systolic BP (SBP) and mortality in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI).

Methods: The Clinical Deep Data Accumulation System for PCI (CLIDAS-PCI), a nation-wide multicenter database with seven tertiary medical hospitals in Japan, retrospectively collected data on patients undergoing PCI for acute coronary syndrome or stable coronary artery disease. Cubic spline curves modeled the relationship between SBP and all-cause death in the entire cohort and subgroups stratified by age, sex, diabetes, left ventricular (LV) hypertrophy, renal function and LV systolic function. We assessed the SBP, which minimizes mortality risk.

Results: A total of 8384 patients [71 [IQR 64, 78] years, 6494 (77%) male] with SBP at hospital discharge were analyzed. During 2.7 years of median follow-up, 695 deaths occurred. In the overall population, spline analysis demonstrated a nadir range of mortality risk around an SBP of 110-130 mmHg. Subgroup analyses revealed that elderly (age ≥ 80 years), those with renal dysfunction, and those with preserved LV systolic function had higher SBP levels associated with lowest risk. Conversely, patients <80 years, those with better renal function, and those with LV systolic dysfunction exhibited lower SBP levels at lowest risk.

Conclusion: This study demonstrated differential association between SBP and mortality risk in various subgroups, highlighting the need for personalized BP management in multimorbid patients with coronary artery disease.

Introduction: Given Croatia's high and rising prevalence of arterial hypertension, we aimed to investigate the population-level determinants of hypertension.

Materials: Out of 2049 individuals recruited in the EHUH 2 study (random sample), in this analysis, we included 864 individuals (men 34.5%) who provided valid 24-h urine samples. Data on demographics, lifestyle, clinical and laboratory parameters were collected. Hypertension was defined as blood pressure at least 140/90 mm Hg or antihypertensive use.

Results: Key determinants of hypertension included male sex [odds ratio (OR) 2.27], salt intake more than 5 g/day (OR 2.46), presence of diabetes (OR 1.95), residence in rural areas (OR 1.63) and a high sodium-to-potassium ratio (OR 1.24). Current smokers had fewer odds than nonsmokers (OR 0.55). When estimated pulse wave velocity (ePWV) was added, model 2 became stronger ( R2  = 0.455), and each increase of 1 m/s of ePWV increased odd for hypertension by 3.73. The higher prevalence of hypertension observed in rural areas was linked to low socioeconomic status, obesity and high sodium/potassium ratio. Ex-smokers had a higher risk obviously because they replaced one poor habit with another one.

Conclusion: Based on our results, we can recommend in low-medium-income countries like Croatia tailor screening programs for hypertension not only for individuals with chronic kidney disease, diabetes, or obesity but also for those with low socioeconomic status and rural residents. We can suggest that two low-cost methods, sodium-to-potassium ratio and ePWV, become a regular routine part of these screening programs. In smoking cessation programs, smokers should be educated how to quit smoking, but also how to live healthier.