Journal of Hypertension最新文献

Objective: White coat effect (WCE) is a debated risk factor for cardiovascular diseases (CVD), and the current findings regarding its association with arterial stiffness in hypertension remain inconsistent. This study aimed to explore the interaction between WCE and hypertension on arterial stiffness.

Methods: A total of 7584 participants, including 4679 controls and 2905 individuals with hypertension were enrolled and divided into four groups: control, white coat hypertension (WCH), hypertension, and white coat uncontrolled hypertension (WUCH). Arterial stiffness was assessed using arterial velocity pulse index (AVI) and arterial pressure volume index (API), measured through cuff oscillometry. Logistic regression was used to analyze the risk factors for high CVD risk. The association between API and pulse pressure (PP) was analyzed using restrictive cubic spline (RCS) analysis.

Results: Participants with WUCH were older than those with WCH (63 vs. 58 years, p < 0.05), had higher PP (73 vs. 62 mmHg, P  < 0.05), and a higher API (36 vs. 32, P  < 0.05). In multivariable analysis, WCH/WUCH remained a determinant of API. After adjusting for confounding factors, API ( β = 1.046, P  < 0.001), and WCH/WUCH ( β = 1.628, P  < 0.001) were identified as independent influencing factors for high CVD risk. The RCS analysis of API and PP demonstrated a significant J-shaped relationship.

Conclusions: Individuals with the WCE showed greater peripheral arterial stiffness, especially among women. A J-shaped relationship between API and PP was observed in both WCE and non-WCE individuals. WCE was independently associated with a higher CVD risk.

Aim: To investigate sex differences in the use of antihypertensive therapy and achievement of blood pressure targets among patients with hypertension in a real-world clinical setting.

Methods: Data were used from the PHARMO Data Network between 2010 and 2020. New users of antihypertensive medications with a diagnosis for hypertension were included. We assessed sex differences in antihypertensive intensity at initiation, time to first intensification, and achievement of blood pressure targets within 6 months after initiation.

Results: In total, 24 851 individuals (48% women) were included. Women were 34% [95% confidence interval (CI): 27-42] more likely than men to be dispensed low intensity antihypertensives at initiation and to start with a beta-blocker or diuretic. Women were less likely than men to be uptitrated (adjusted hazard ratio: 0.93 (95% CI: 0.90-0.96)), yet 16% (95% CI: 11-20) more likely to reach blood pressure target levels.

Conclusion: Among individuals with hypertension, women initiated antihypertensive therapy at lower intensities and were less likely to be uptitrated than men. Nonetheless, attainment of blood pressure targets within 6 months after initiation was higher in women than men.

Objectives: Humans born preterm have low nephron endowment and an increased risk for hypertension and chronic kidney disease (CKD) later in life. The risks of these sequelae are augmented by a higher incidence of postnatal kidney injury from ischemic, hypoxic and/or nephrotoxic insults.

Methods: To test the hypothesis that congenital nephron deficits in the absence of other renal insults are a risk factor for hypertension, and that salt intake modifies this response, we performed continuous ambulatory blood pressure (BP) monitoring before and after high salt diet in a novel mouse model of low nephron endowment (named Ret UB del ).

Results: We discovered that adult Ret UB del mice and controls have similar systolic and diastolic BP. After high salt diet, Ret UB del males and females had a greater rise in systolic BP, and Ret UB del females had a greater rise in diastolic BP than controls. In contrast, Ret UB del males had less of a rise in diastolic BP, revealing possible sex dimorphisms in mice with low nephron endowment. In females, salt loading was accompanied by less suppression of juxtaglomerular renin and a blunted rise in fractional excretion of urinary sodium, although sample stratification reduced the power to detect significant male-female differences. Ret UB del males had more of a CKD phenotype, suggesting that CKD did not contribute to salt-sensitivity.

Conclusions: This study shows the impact of a modifiable dietary factor on the development of hypertension in mice with low nephron endowment.

Background: Peripheral artery disease (PAD), assessed via the ankle-brachial index (ABI), is a recognized form of hypertension-mediated organ damage (HMOD). While alternative ABI calculations have shown improved sensitivity for PAD detection, their prognostic utility in hypertensive populations remains unclear.

Methods: In this prospective cohort study of 21 875 hypertensive individuals (ÉRV Study), we compared the prognostic performance of three ABI-based approaches: standard ABI using the higher ankle pressure (ABI-HIGH), ABI using the lower ankle pressure (ABI-LOW), and multivessel ABI scoring (number of vessels with ABI ≤0.90). The primary endpoint was all-cause mortality, assessed over a median follow-up of 5 years using interval-censored Cox regression.

Results: PAD prevalence was 14.4% using ABI-HIGH and 28.3% using ABI-LOW, with 13.9% of patients identified only by the latter. All PAD definitions were independently associated with mortality. ABI-LOW as a continuous variable demonstrated the strongest association (hazard ratio 1.87; 95% CI, 1.63-2.16). Multivessel ABI showed a dose-response relationship with mortality. However, overall discrimination was modest: time-dependent AUCs ranged from 0.608 to 0.635 for ABI-based models alone. When added to clinical predictors, ABI metrics improved the AUC to a range from 0.763 to 0.780, with added predictive value between 6 and 11%.

Conclusion: In hypertensive individuals, ABI-LOW and multivessel scoring identify more PAD cases and are independently associated with mortality. However, their incremental value in mortality risk prediction is limited. Alternative ABI methods may assist in identifying higher risk subgroups warranting further vascular assessment.

Background and objective: Blood pressure (BP) varies seasonally in inverse relation to temperature, although its impact on heart failure is poorly understood. The main objective was to compare BP readings between summer and winter using different measurement methods and to assess the clinical impact of these variations.

Materials and methods: This was an observational, prospective, cross-sectional study of 50 patients with reduced or improved heart failure and optimised treatment, conducted at a single centre in southern Spain. Each patient was evaluated in summer (June--August) and winter (December--February) using BP measurements in the clinic, 3 days of home self-measurement (HBPM), and 24-h ambulatory monitoring (ABPM), completing 1 year of follow-up.

Results: The mean age was 64 ± 12 years, 76% were men, with a mean ejection fraction of 43%. HBPM showed decreases in summer compared to winter in SBP (-7.6 mmHg; P  < 0.001), DBP (-3.2 mmHg; P  < 0.001) and mean BP (-4.6 mmHg; P  < 0.001). ABPM detected slight daytime reductions in systolic (Δ -1.5 mmHg; P  = 0.004), diastolic (Δ -2.2 mmHg; P  = 0.001) and heart rate (Δ -3 bpm; P  < 0.001), with no nocturnal changes. Nonsignificant concordant differences were observed in the clinic. Thirty-five per cent required therapeutic reduction in summer compared to 16% in winter ( P  = 0.006), with a greater tendency to dizziness. Fourteen per cent experienced events: two renal deteriorations and one syncope in summer-autumn, compared to three decompensations and one noncardiovascular death in winter-spring.

Conclusion: In patients with heart failure, summer is associated with a significant decrease in BP, best detected by HBPM, which requires therapeutic adjustments and clinical monitoring to prevent adverse events.

Objective: Cardiovascular disease (CVD) remains the leading cause of mortality and is often underestimated in women, particularly in those with a history of preeclampsia (PE). Obesity has increased every year, with countries being unsuccessful in reducing its prevalence. This study aimed to evaluate cardiovascular outcomes in women aged less than 40 years old, considering both PE history and central adiposity (CA).

Methods: We conducted a retrospective case-control study using data from a Brazilian cohort initiated in 1978/1979, with follow-up in 2016/2017. Of the 1775 individuals evaluated, 929 were women, and 188 reported their PE history. Women were categorized as having PE history or no PE history (CTL) and further classified by the presence of CA (waist circumference ≥88 cm). Cardiovascular events, blood pressure, and arterial stiffness were also recorded.

Results: Hypertension was present in 66.7 and 69.7% of women with PE_CA and PE_noCA, respectively. The risk was 19-fold higher in PE_CA and 24-fold higher in PE_noCA than in CTL_noCA. Conditional inference tree (CTree) analysis confirmed that PE preeclampsia (P < 0.0001) was the strongest determinant of hypertension, followed by CA (P < 0.0001) and dyslipidemia (P = 0.019). CA significantly worsened SBP [24-h ambulatory blood pressure monitoring (ABPM) +15.6 mmHg; daytime ABPM +15.9 mmHg; office + 15.3 mmHg] and increased pulse wave velocity (PWV) by 1.14 m/s among women with history of PE.

Conclusion: PE significantly increased the cardiovascular risk, with CA further exacerbating vascular impairment. Early cardiovascular risk assessment and prevention strategies are essential for young women with a history of PE to prevent future cardiovascular events.

Objectives: This study aims to estimate the current prevalence of suspected and diagnosed untreated hypertension in middle-aged Lithuanian men. In addition, it seeks to examine the cardiometabolic risk profile associated with these conditions.

Methods: This was a cross-sectional study of data collected from 2009 to 2019. The dataset included 52 012 male participants aged 40-54 years who participated in the Lithuanian High Cardiovascular Risk (LitHiR) Primary Prevention Programme. We compared the prevalence of dyslipidaemia, diabetes mellitus, smoking, family history of cardiovascular disease (CVD), overweight, obesity based on BMI and waist circumference, metabolic syndrome and cardiometabolic parameters between the normotensive, suspected hypertensive and diagnosed untreated hypertensive groups.

Results: All risk factors were more prevalent in suspected and diagnosed untreated hypertensive groups compared to normotensive individuals, with dyslipidaemia being the most prevalent risk factor (91.20 and 93.40%, respectively). The cardiometabolic parameters were also markedly elevated in these groups. Increased waist circumference, elevated total cholesterol, smoking and a family history of CVD were independently associated with both suspected and untreated hypertension. The prevalence of suspected hypertension and diagnosed untreated hypertension in Lithuania slightly increased between 2009 and 2019. Overall, 26.84% of middle-aged men with hypertensive blood pressure readings have no prior diagnosis, while 18.57% of diagnosed individuals are not receiving antihypertensive treatment.

Conclusion: A considerable number of hypertensive middle-aged men in Lithuania experience prolonged delays in initiating pharmacological interventions.