Journal of Hypertension最新文献

Introduction: Fibromuscular dysplasia (FMD) is a rare disease with diverse clinical presentations. The need for a bespoke clinic providing individualized care was deemed a patient priority at the United Kingdom's (UK) first patient information day on FMD. In response, a multidisciplinary clinic was established at Salford Royal Hospital in November 2019, integrating renal, neurology, interventional radiology, and neuro-radiology expertise. It has since evolved into the UK's first national FMD clinic. This study aimed to describe baseline patient characteristics and identify contributing factors in disease progression.

Methods and results: This prospective observational study included 215 patients reviewed over 5 years. All underwent brain-to-pelvis imaging at least once to radiologically confirm FMD. FMD mimics were identified more often than expected ( n  = 87, 40.4%), predominantly due to sub-optimal imaging artefacts. Of 128 confirmed FMD patients, median age was 49 years; focal FMD patients were younger than multifocal FMD patients [median (interquartile range or IQR): 44 (27-58) vs. 45 (36-49) years; P  = 0.038]. Sixty-seven percent were Caucasian and 85.3% female, and 66.7% had multivessel disease, 29.3 and 19.6% had aneurysms or dissections at presentation. Multifocal disease, aneurysms and dissections were more common in multivessel disease. Follow-up data defined risk factors for clinical or radiological disease progression: younger age at FMD onset [odds ratio (OR) 0.97, P  = 0.042], current smoking (OR 3.78, P  = 0.006), baseline history of hypertension (OR 6.2, P  = 0.017).

Conclusion: This study emphasizes the importance of a dedicated multidisciplinary FMD service for confirming diagnosis and identifying FMD mimics to facilitate personalized care. Early diagnosis, smoking cessation and blood pressure management are key to preventing disease progression.

Objectives: Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are linked to later-life cardiovascular disease, but their impact on midlife cardiac health is unestablished. Therefore, we examined their associations with midlife left ventricular remodeling.

Methods: This study included 408 and 451 women from the Bogalusa Heart Study cohort with information on HDP and GDM, respectively. Of these, 34 had HDP and 41 had GDM. Mean echocardiographic follow-up was approximately 15 years after pregnancy. Outcomes included left ventricular mass index (LVMi), ejection fraction (LVEF), and left ventricular geometry (concentric remodeling, concentric or eccentric hypertrophy). Multivariable regression was adjusted for demographic and prepregnancy cardiometabolic factors. Effect modification by age and race and mediation by postpregnancy cardiometabolic factors were evaluated.

Results: Median age at first pregnancy was 22.0 years and 33.0% were Black. HDP was associated with greater LVMi in midlife (standardized β  = 0.37, 95% confidence interval [CI]: 0.01-0.72, P  = 0.04), but not with LVEF. HDP was also associated with greater odds of concentric remodeling (odds ratio = 2.48, 95% CI: 1.03-6.00, P  = 0.04). Postpregnancy BMI mediated 19.47% of the association between HDP and LVMi ( P  = 0.01). GDM was not associated with left ventricular structure or function after adjustment. Interaction terms by age and race were not significant.

Conclusion: HDP is associated with adverse left ventricular remodeling, partly mediated by postpregnancy BMI. These findings underscore the need for early echocardiographic monitoring and postpartum weight management in women with HDP to reduce long-term cardiovascular risk.

Introduction: Hypertensive urgency (HU) is a clinical condition characterized by rapid office blood pressure (BP) elevation in the absence of hypertension-mediated organ damage (HMOD).

Aim: To evaluate out-of-office BP levels and predictors of HU in adult outpatients with stage 3 hypertension.

Methods: We included patients who were consecutively referred for office and out-of-office BP assessment. All patients underwent BP measurements using a validated, oscillometric device (Mobil-O-Graph PWA Monitor, I.E.M. GmbH, Stolberg, Germany). Patients were stratified into two groups: grade 3 hypertension (either systolic BP ≥180 mmHg or diastolic BP ≥110 mmHg); HU (both systolic BP ≥180 and diastolic BP ≥110 mmHg).

Results: We identified 828 adult outpatients (42.6% women, age 56.5 ± 13.6 years, BMI 27.5 ± 5.2 kg/m 2 , 55.2% on therapy), among whom 655 (79.1%) had grade 3 hypertension and 173 (20.9%) had HU. HU patients consistently showed significantly higher home (157.0 ± 25.3 vs. 146.9 ± 20.4 mmHg), 24-h (155.6 ± 18.3 vs. 143.2 ± 13.7 mmHg), daytime (160.5 ± 18.2 vs. 147.7 ± 13.9 mmHg), and night-time (143.2 ± 20.1 vs. 131.0 ± 16.1 mmHg) systolic BP values than those with stage 3 hypertension, even when treated. Diastolic BP levels were also higher at all BP measurements. Female sex [odds ratio (OR) 0.53 (95% confidence interval (CI) 0.32-0.86); P  = 0.010], age >50 years [OR 2.57 (95% CI 1.48-4.69); P  = 0.001], smoking [2.03 (1.21-3.37); P  = 0.006], home diastolic [OR 1.02 (95% CI 1.00-1.04); P  = 0.013] and daytime systolic [OR 1.04 (95% CI 1.03-1.06); P  < 0.001] BP were independent predictors of having HU at multivariate analysis.

Conclusions: HU outpatients showed persistently higher out-of-office BP levels than those with stage 3 hypertension, even when treated.

Background: Hypertension is the leading modifiable risk factor for cardiovascular disease in the UK and Ireland, yet significant implementation gaps and health inequalities in hypertension management persist. The British and Irish Hypertension Society (BIHS), in collaboration with the British Heart Foundation Clinical Research Collaborative (BHF-CRC), undertook the first national initiative to identify priority areas for future hypertension research.

Methods: A modified Delphi approach, informed by James Lind Alliance methodology, was used to gather and rank research questions. The process involved clinicians, allied health professionals, researchers, and patients, supported by a multidisciplinary steering group. Questions were refined through iterative surveys and a final consensus workshop.

Results: From an initial list of 66 research questions, 38 were shortlisted for the prioritisation exercise, which resulted in a Top 10 list of national hypertension research priorities.Key themes included digital and remote monitoring, reducing health inequalities, supporting treatment adherence, and determining the role of blood pressure management in preventing dementia, frailty-related outcomes, and kidney disease. Priorities also addressed optimal treatment targets, home versus clinic monitoring, and the impact of new obesity therapies on cardiovascular health.

Conclusion: This is the first structured, consensus-driven national initiative to recommend hypertension research priorities in the UK and Ireland. The resulting Top 10 reflect a shift towards person-centred research that emphasises implementation, digital innovation, and equity, alongside pharmacological and mechanistic studies. These priorities provide a roadmap for funders, policymakers, and researchers to address unmet clinical needs and improve outcomes for people living with hypertension.

Objective: Blood pressure (BP) typically decreases during sleep, known as the "dipping" pattern. A "nondipper", characterized by <10% BP reduction during sleep, has an elevated cardiovascular risk. Intermittent hypoxia (IH) is used to model hypertension with sleep apnea, but its relation with BP dipping and its effect on the kidney remains unclear.

Methods: Male C57BL/6J (WT) mice were exposed to either normoxia (NX) or IH (O 2 concentration reduced to 5% in 90 s every 3 min during 8 h within the light period, for >1 week). BP was measured by radiotelemetry, and the dipping state was assessed by comparing mean BP (MBP) between light and dark periods. High- or low-salt diet (8% or 0.05% NaCl) and Slc12a3-/- mice (NCC-KO) were used to clarify the role of renal mechanism in the IH model mice.

Results: WT mice exhibited a dipping BP pattern under NX, but showed a nondipping pattern under chronic IH. Low-salt diet restored the dipping pattern and high-salt diet reinduced the nondipping one in the IH-model mice. Chronic IH increased the phosphorylation of Na-Cl cotransporter (NCC) and Na-K-Cl cotransporter (NKCC2) in the kidney, without affecting ENaCα cleavage. Even NCC-KO mice showed a dipping pattern of BP under NX, which shifted to a nondipping pattern under chronic IH. As expected, treatment with furosemide restored the dipping pattern in NCC-KO mice under chronic IH.

Conclusions: Chronic IH disrupts the physiological dipping pattern of BP through NCC and NKCC2 activation. This study underscores the kidney's role in the pathophysiology of nondippers with sleep apnea.

Background: Blood pressure variability (BPV) is an independent predictor of cardiovascular events, yet its relationship with daily sleep remains unclear. This study examined whether objective and subjective sleep measures are associated with short-term BPV among adults with elevated clinic blood pressure.

Methods: In a cross-sectional baseline analysis from a behavioral sleep-extension trial, adults aged 18-65 years with self-reported short sleep (<7 h/night) and clinic blood pressure 120-150/80-90 mmHg completed seven days of wrist actigraphy and 24-h ambulatory blood pressure monitoring. Objective sleep measures were actigraphy-derived sleep efficiency and total sleep time (TST). Subjective measures included the Insomnia Severity Index and PROMIS Sleep Disturbance and Sleep-Related Impairment scales. BPV was quantified as the average real variability of systolic and diastolic pressures. Linear regression models adjusted for age, sex, and race; additional adjustment for BMI left the diastolic association significant ( P  = 0.003) and the systolic association marginal ( P  = 0.056).

Results: Among 200 participants (mean age 42 ± 11 years), higher sleep efficiency was associated with lower systolic and diastolic BPV ( P  < 0.05). TST and subjective sleep measures were not independently related to BPV. Hourly BPV profiles showed peak variability in early morning and late afternoon periods.

Conclusions: Among adults with elevated blood pressure, better sleep efficiency, but no longer sleep duration or perceived sleep quality, was linked to lower short-term BPV. Interventions improving sleep efficiency may offer cardiovascular benefits beyond extending sleep duration.

Objective: We evaluated Australian adults' knowledge on the risk factors and complications of hypertension to identify areas of poor understanding.

Methods: In 2024, an adapted validated hypertension-knowledge survey was distributed to participants who had used kiosk BP stations in retail stores across metropolitan and remote Australia. Kiosk stations collected measured and self-reported data.

Results: A total of 826 participants (51% male; mean age 52 ± 16 years; 36% with a history of hypertension) completed the survey. Participants generally demonstrated a good understanding of hypertension risk factors, with 90% recognizing that being overweight increases risk, and that exercise helps lower BP. Twenty-seven percent were unaware that hypertension is usually asymptomatic; 41% did not know that stress is not its main cause; and 42% were unaware of the importance of medication adherence. Seventy-three percent and 77% were unaware of the increased risk of dementia and kidney disease, respectively.People with a history of hypertension (vs. no hypertension; P  = 0.01) and those in outer regional areas (vs. major cities, inner regional, or remote; P  = 0.011) had better knowledge. Individuals who were unemployed or had lower educational backgrounds (both P  < 0.001) had poorer knowledge. Kiosk BP readings and the use of antihypertensive medications were not associated with knowledge scores.

Conclusions: Public misconceptions regarding hypertension persist. With three in four participants unaware that hypertension increases the risk of dementia and kidney disease, and with limited understanding of the importance of medication adherence, educational efforts are essential, particularly among people who are unemployed or have lower educational backgrounds.

Objective: Hypertension and diabetes frequently coexist and may interact to induce organ damage. Herein, we evaluated whether persons with prediabetes already have impaired retinal and glomerular autoregulatory responses to higher blood pressure.

Methods: We used cross-sectional, population-based data of 6594 participants [4206 with normal glucose metabolism (NGM), 1023 with prediabetes, and 1365 with type 2 diabetes (oversampled); mean age 59.8 ± 8.6 years; 50.2% men] of the Maastricht Study. Using multiple linear regression models, we tested if glucose metabolism status modified the associations of 24 h systolic and diastolic blood pressure (SBP/DBP) with retinal arteriolar and venular diameters (CRAE/CRVE) and urinary albumin excretion (uAE).

Results: The total modification for CRAE was significant for diabetes but not for prediabetes. The association of SBP with CRAE was attenuated by prediabetes ( Pinteraction = 0.098) and diabetes ( Pinteraction < 0.001) in females (but not males), with a beta of -0.21 SD per 10 mmHg (95% CI: -0.25; -0.16), -0.14 (-0.24; -0.05) and -0.04 (-0.14; 0.07) for NGM, prediabetes, and diabetes, respectively. The association of SBP with uAE was stronger in prediabetes ( Pinteraction = 0.002) and diabetes ( Pinteraction < 0.001) than in NGM, for the whole study population (no sex difference). The corresponding beta was 0.13 (0.11; 0.16), 0.20 (0.15; 0.26), and 0.24 (0.18; 0.29) for NGM, prediabetes and diabetes, respectively. No substantial changes were observed when replacing SBP by DBP.

Conclusions: Our findings suggest that retinal and glomerular autoregulatory responses to higher blood pressure are impaired in persons with prediabetes and with diabetes. This emphasizes the importance of both blood pressure and glycemic control already in those with prediabetes.

Optimal blood pressure (BP) targets for type 2 diabetes remain controversial. Although intensive BP control reduces cardiovascular risk in the general population, its net benefit in diabetes is uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials comparing intensive BP control (target < 130/80 mmHg or achieved systolic <130 mmHg) with routine control in adults with type 2 diabetes. Databases (PubMed, Embase, Cochrane CENTRAL) were searched through November 2024; two reviewers independently extracted data and assessed bias. Random-effects meta-analysis estimated pooled relative risks (RRs) with 95% confidence intervals (CIs), and trial sequential analysis (TSA) assessed robustness. Eleven trials comprising 24,308 participants met inclusion criteria. Intensive BP control reduced stroke (RR: 0.64; 95% CI: 0.51-0.81) and major cardiovascular events (RR: 0.86; 95% CI: 0.72-1.03) with no significant differences in mortality or heart-failure hospitalization. TSA confirmed firm evidence for stroke reduction, mortality and heart failure results remained inconclusive.

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.