Journal of Hypertension最新文献

Background: Ambulatory blood pressure measurement (ABPM) data from the PRECISION study have shown that in patients with confirmed resistant hypertension (RHT), aprocitentan leads to substantial lowering of BP, particularly at night-time. Here, the ABPM data were used to define subgroups with substantial prognostic value (dipping pattern, BP load, heart rate, arterial stiffness, and salt sensitivity) and to evaluate the BP-lowering effect of aprocitentan on these subgroups.

Methods: The effects of aprocitentan on ABPM derivatives including dipping pattern, BP load, and heart rate were evaluated. The BP lowering effect of aprocitentan was assessed based on the subject's baseline arterial stiffness and salt sensitivity.

Results: At week 4, the placebo-corrected and dose-dependent decrease of ambulatory systolic BP was more marked for baseline non-dippers than dippers. The proportion of non-dippers at baseline whose dipping pattern normalized at week 4 was higher for the aprocitentan group compared to placebo. The decrease in BP load during daytime/nighttime was also more pronounced with aprocitentan compared to placebo. Despite the BP lowering effect of aprocitentan, heart rate remained unchanged at week 36. The BP lowering effect of aprocitentan was not diminished by increased arterial stiffness index or salt sensitivity risk at baseline.

Conclusion: In addition to a significant and sustained day and night-time ambulatory BP reduction, aprocitentan was associated with a higher proportion of patients experiencing dipping pattern normalization and more pronounced BP load reduction, indicating prognostic relevance. Increased arterial stiffness or salt sensitivity did not alter the BP response to aprocitentan, suggesting additional clinical benefit.

Background: Carotid-to-femoral pulse wave velocity (c-f PWV) is commonly used to assess large artery stiffness, particularly as a surrogate of aortic stiffness. Given that c-f PWV represents the average stiffness of all main arteries along the carotid-to-femoral arterial pathway, without specifically accounting for the stiffness of the proximal aorta, we hypothesized that c-f PWV may not represent stricto sensu the stiffness of the ascending aorta (AAO), which is the main contributor to total arterial compliance ( CT ).

Methods: To test our hypothesis, we recruited 45 healthy volunteers from different age groups. We evaluated the relation between c-f PWV and different indices of proximal aorta stiffness calculated from distensibility (AAO dist PWV) and characteristic impedance (Zc) in frequency (AAO Z c(f) PWV) and time domain (AAO Zc(t) PWV) and compared their relationships with age and CT . 2D phase contrast MRI was performed to measure AAO flow and cross-sectional area. Tonometry was used to obtain c-f PWV and pressure waveforms.

Results: In healthy individuals, AAO PWV indices demonstrated a strong relationship with each other ( R  ≥ 0.86), but c-f PWV did not show high correlations with AAO PWV indices ( R  ≤ 0.50). All AAO PWV indices increased with age ( P  ≤ 0.05); however, c-f PWV did not increase from young to middle-aged ( P  = 0.13) and middle-aged to old age groups ( P  = 0.28). AAO PWV indices correlated well with C T ( R2  ≥ 0.60), whereas c-f PWV did not ( R2  = 0.23).

Conclusion: The present study reveals that a complete understanding of large artery stiffness requires the direct assessment of proximal aortic stiffness rather than surrogate indices such as c-f PWV.

Background: Although 24-h ambulatory blood-pressure monitoring (ABPM) is widely available, its diagnostic potential beyond confirming different types of hypertension remains under-utilized.

Objective: To derive and externally validate against echocardiographic hemodynamic indices a purely ABPM-based classification of circulatory phenotypes that extends conventional blood-pressure staging.

Methods: We retrospectively analyzed 29 743 consecutive adults who underwent 24-h ABPM. After excluding anyone previously treated for hypertension, 12 876 de-novo participants (50.2 ± 13.6 years; 51.4% men; 24.7% obese) were included, 9195 of whom were hypertensive. Pearson correlation matrices identified diastolic blood pressure (DBP), pulse pressure (PP) and heart rate (HR) as the least-collinear variables. These were z -standardized and submitted to K-means clustering.

Results: Four reproducible phenotypes were yielded: cardiogenic - elevated HR and cardiac output (CO) without arterial dysfunction (ΔHR = +10.5 bpm vs. normotensives, 95% CI 10.0-10.9); vaso-resistive - raised DBP with reduced HR, resulting in a higher DBP/HR index (ΔDBP/HR = +0.23 mmHg bpm -1 , 95% CI 0.22-0.24); mixed - simultaneously increased HR and DBP, giving the highest DBP/HR index ( P < 0.001 vs. normotensives); arterial-stiffness - widened PP with lower DBP, reflected in an elevated PP/DBP index (ΔPP/DBP = +0.16, 95% CI 0.15-0.17). Cluster-derived proxies of CO, systemic vascular resistance, and arterial stiffness showed good agreement with echocardiographic measurements, confirming their physiological validity.

Conclusions: A simple, unsupervised cluster analysis of routine ABPM data uncovers four reproducible circulatory phenotypes that enrich traditional blood pressure staging. Incorporating these phenotypes into clinical practice could refine risk stratification and enable mechanism-targeted antihypertensive therapy.

Background: Carotid-femoral pulse wave velocity (PWV), a marker of arterial stiffness, is a recognized cardiovascular disease risk factor. As measuring PWV is time-consuming, reliable estimation methods have been developed, but their ability to inform cardiovascular risk prediction beyond what is achievable with current clinical risk tools is uncertain.

Methods: This study includes participants aged between 40 and 69 years from the population-based CARTaGENE cohort. PWV estimations (ePWV) were obtained using published formulas (ePWV f ) or algorithmic transformation of pulse waveforms (ePWV algo ) and 10-year cardiovascular risk for each participant was computed using the ASCVD and the SCORE-2 risk equations. Participants were followed during 10 years for major adverse cardiovascular events occurrence (MACE: cardiovascular death, myocardial infarction, stroke). Associations of ePWV f and ePWV algo with MACE were obtained using Cox models adjusted for ASCVD or SCORE-2 in the overall population and in a subpopulation representative of the ePWV f derivation cohort.

Results: Of 17 548 eligible participants, 2263 (12.9%) experienced a MACE during follow-up. Both ePWVf and ePWV algo were associated with MACE in unadjusted analyses, but only ePWV algo remained significant after adjustments for ASCVD [hazard ratio (HR) = 1.16 [1.09-1.22]] and SCORE-2 (HR = 1.07 [1.00-1.13]). In contrast, ePWV f was not associated with MACE after adjustment for either risk score, and only after adjustment with ASCVD when it was tested in the subpopulation representative of its derivation cohort.

Conclusions: Algorithm-based PWV improved cardiovascular risk prediction beyond what is achievable from recognized risk equations, whereas the predictive ability of ePWV f may not be generalizable outside of its reference population.

Background: Cold ambient temperatures are known to increase blood pressure (BP), but the influence of room temperature remains understudied. This study examined the impact of room temperature in morning, evening, and sleep BP measured at home.

Methods: The study included 779 adults (mean age: 70.7 years) from a community-based longitudinal study. Home BP was measured for 1 week using a conventional cuff-oscillometric device, whereas sleep BP was automatically recorded at 00 : 00, 02 : 00, and 04 : 00 using a timer-equipped BP monitor. Room temperature was measured concurrently using a thermometer in the BP monitor.

Results: A 1°C decrease in room temperature increased morning systolic and diastolic BPs by 0.863 and 0.342 mmHg, respectively ( P  < 0.001). The evening systolic and diastolic BPs increased by 0.721 and 0.320 mmHg, respectively ( P  < 0.001). However, sleep systolic (0.076 mmHg, P = 0.181) and diastolic (0.078 mmHg, P  = 0.039) BPs showed weaker associations. The association between morning systolic and diastolic BPs remained significant after adjusting for ambient temperature (0.809 and 0.304 mmHg, respectively; P  < 0.001). Age was the only factor associated with room temperature-related BP changes. Among 433 normotensive individuals (based on 1-week average morning BP), 93 were hypertensive on the coldest day. These participants had higher average morning BPs within the normal range and were more likely to use antihypertensive medication.

Conclusion: Room temperature significantly influenced home morning and evening BPs but not sleep BP, independent of ambient temperature. Maintaining appropriate room temperatures may aid in BP management at home.

Objective: Hypertension is a major risk factor for cardiovascular diseases. Insulin resistance is one of the main risk factor for hypertension. A simple index (triglyceride-glucose index - TyG) has been considered as a surrogate marker of insulin resistance. Although several studies have explored TyG and cardiovascular risk, few longitudinal data on the relationship between new-onset hypertension and this novel index are available so far, especially in European countries. Therefore, we aimed to estimate the predictive role of TyG, in comparison to that of the HOmeostatic Model Assessment of Insulin Resistance (HOMA-IR) index (a widely used tool to assess insulin resistance), on the development of hypertension, in an 8-year follow-up observation of a sample of adult men.

Methods: The analysis included 482 men (The Olivetti Heart Study), without hypertension at baseline. The optimal cut-off point of the association of continuous TyG or HOMA-IR index with new-onset hypertension was identified by receiver-operating characteristic (ROC) analysis.

Results: TyG was linearly associated with the occurrence of new-onset hypertension, whereas HOMA-IR was nonlinearly related to the risk of developing hypertension. After stratification by the optimal cut-off point, TyG greater than 4.91 were significantly associated with new-onset hypertension, also after adjustment for main confounders. In contrast, the HOMA-IR index greater than 1.82 was not associated with the risk of new-onset hypertension in the adjusted models.

Conclusion: The principal findings of this study suggest that the TyG index exhibits a significant predictive capacity for the development of new-onset hypertension. Although its limited sensitivity, the results support the potential utility of TyG as a simple, cost-effective, and noninvasive adjunctive tool for the early assessment of cardiovascular risk.

Objectives: Comprehensive and updated assessments of arterial hypertension (HTN)-attributable mortality trends across Europe are limited. We evaluated the HTN-attributed mortality trends in Europe between 2012 and 2021, examining variations by age, sex, and European region.

Methods: We extracted heart failure-attributed mortality data from the WHO mortality dataset for 2012-2021. Age-adjusted mortality rates (AAMRs) were analyzed using joinpoint regression modeling, expressed as average annual percentage change (AAPC) with 95% confidence intervals (CIs). A parallelism test compared trend differences across groups.

Results: From 2012 to 2021, 1 658 592 individuals (773 129 men and 885 463 women) died due to HTN, equating to 3932.3 deaths per 100 000 population. Overall, the AAMR increased (AAPC: +1.6%; 95% CI: 1.2-2.1; P  < 0.001), without significant differences between sexes ( P for parallelism 0.38). HTN-attributable mortality trend had a higher increase among patients aged 70 or older compared to those aged less than 70 years ( P for parallelism 0.007). Regionally, AAMRs increase in Northern (AAPC: +0.7%; 95% CI: 0.1-1.3; P  = 0.002) and Eastern (AAPC: +2.79%; 95% CI: 1.8-3.6; P  < 0.001) while plateaued in Western and Southern Europe (AAPC: -0.5%; 95% CI: -1.2 to 10.2; P  = 0.09). Disparities in hypertension-attributable mortality were observed among countries.

Conclusion: HTN-attributed mortality in Europe increased between 2012 and 2021. Substantial disparities persist across European regions and countries.

Background: Hypertension is closely associated with autonomic dysfunction. The role of the structural integrity of the central autonomic network (CAN) of the brain is insufficiently explored. Large-scale imaging data were used to investigate the relationship between the microstructural properties of the CAN with blood pressure (BP) and hypertension.

Methods: We analysed MRI data from 43 994 individuals to investigate whether BP levels were linked to the microstructural integrity of white matter tracts involved in autonomic control (CAN tracts). To test the specificity of these associations, we compared them to randomly selected white matter regions not specifically tied to the autonomic network, aiming to identify whether CAN tracts had a stronger connection to BP and which subsystems were particularly affected.

Results: Our findings showed that BP was more strongly linked to the microstructural integrity of CAN tracts than to other white matter regions. Further analysis revealed that specific CAN subsystems had distinct associations with BP, with higher levels of free water in these regions being associated with increased BP and hypertension. Additionally, the severity of hypertension was associated with the level of microstructural integrity in CAN tracts.

Conclusion: This study provides evidence of a specific relationship between BP levels and the microstructural integrity of the CAN. We found that, particularly in cortical parts of the CAN, higher levels of free water - indicating tissue not actively involved in neural signalling - were associated with elevated BP levels and a greater risk of hypertension. This evidence supports a close link between the central autonomic system and BP from a population-imaging perspective.