Journal of Hypertension最新文献

Objective: We aimed to evaluate the risks of death and cardiovascular death of different subtypes of masked hypertension, defined by either isolated daytime or nighttime blood pressure (BP) elevation, or both, compared with patients with normal both office and 24-h BP.

Methods: We selected 4999 patients with masked hypertension (normal office BP and elevated 24-h BP). They were divided in three different categories: isolated daytime masked hypertension (elevated daytime BP and normal nighttime BP, 800 patients), isolated nighttime masked hypertension (elevated nighttime BP and normal daytime BP, 1069 patients) and daytime and nighttime masked hypertension (elevation of both daytime and nighttime BP, 2989). All-cause and cardiovascular death (median follow-up 9.7 years) were assessed in each of these subtypes in comparison to 10 006 patients with normal both office and 24-h BP. Hazard ratios from Cox models after adjustment for clinical confounders were used for such comparisons.

Results: Compared with patients with normal both office and 24-h BP, isolated daytime masked hypertension was not associated with an increased risk of death in models adjusted for clinical confounders [hazard ratio 1.07; 95% confidence interval (CI): 0.80-1.43]. In contrast, isolated nighttime masked hypertension (hazard ratio: 1.39; 95% CI 1.19-1.63) and daytime and nighttime masked hypertension (hazard ratio: 1.22; 95% CI 1.08-1.37) had an increased risk of death in comparison to patients with BP in the normal range. Similar results were observed for cardiovascular death.

Conclusion: The risk of death in masked hypertension is not homogeneous and requires nocturnal BP elevation, either isolated or with daytime elevation. Isolated daytime masked hypertension is not associated with an increased risk of death.

Objectives: Cuffless blood pressure (BP) monitors represent an innovative approach to BP assessment, overcoming the traditional episodic nature of readings obtained from cuff-based, oscillometric modalities. Nonetheless, the comparison of these cuffless devices against their cuff-based counterparts remain debated.

Methods: This study evaluated BP readings from a cuffless, continual BP monitor (Aktiia monitor, Neuchâtel, Switzerland) and a standard 24-h ambulatory BP monitor (ABPM; Dyasis 3, Novacor, Paris, France) in 54 patients undergoing a 12-week cardiac rehabilitation program in Neuchâtel, Switzerland. Comparisons encompassed 24-h, daytime (9 a.m.-9 p.m.), and night-time (11 p.m.-7 a.m.) systolic and diastolic BP (SBP, DBP) using a 7-day average from Aktiia overlapping a 1-day average from ABPM. Nocturnal dip analysis was performed with 1-day average from Aktiia coinciding with ABPM measurements.

Results: No significant differences emerged between the Aktiia and ABPM monitors for 24-h and daytime SBP (24-h: 2.6 ± 12.3 [-0.2, 5.4] mmHg, r  = 0.57, P  = 0.06; daytime: 1.2 ± 12.4 [-1.6, 4.0] mmHg, r  = 0.60, P  = 0.38). Night-time SBP showed more evident differences (12.5 ± 14.4 [9.3, 15.8] mmHg, r  = 0.39, P  < 0.001). DBP were within clinical range across 24-h and daytime (24-h: -2.9 ± 7.9 [-4.7, -1.1] mmHg, r  = 0.63, P  = 0.002; daytime: -3.1 ± 8.2 [-5.0, -1.3] mmHg, r  = 0.64, P  = 0.001), and showed significant differences for night-time (4.1 ± 8.5 [2.2, 6.0] mmHg, r  = 0.57, P  < 0.001). The concordance rate with ABPM's nocturnal dip was 79% for 1-day average from Aktiia.

Conclusions: These results demonstrate that the Aktiia monitor yields BP measurements consistent with an ABPM monitor despite some systematic differences during night-time readings. The Aktiia monitor holds potential for future use in continual BP monitoring.

Clinical trial registration: NCT04548986. URL: https://clinicaltrials.gov/study/NCT04548986?tab=results.

In renal vasculitis, luminal narrowing can reduce blood flow and activate the renin-angiotensin-aldosterone system, causing renovascular hypertension. We present the case of a 47-year-old man with previous intestinal tuberculosis and episodes of lumbar pain, tender erythematous nodules and arthralgias. He had grade 3 hypertension, unresponsive to treatment, with left ventricular concentric hypertrophy and chronic kidney disease. He was admitted to the ICU due to a hypertensive emergency, with acute kidney failure and a large peri-renal hematoma. The computed tomography and angiography showed bilateral renal scarring, intrarenal pseudoaneurysms and irregularities in the renal, common hepatic and mesenteric arteries, suggesting a medium-vessel vasculitis, namely polyarteritis nodosa. Cyclophosphamide and corticosteroids were started. His blood pressure was controlled, and his kidney function remained stable. Renovascular hypertension is, in infrequent cases, caused by an inflammatory systemic disease. When this is the case, the diagnosis must be considered and appropriately addressed.

Objective: The study aimed to examine the individual and joint effects of hypertension and diabetes on cardiovascular diseases and all-cause mortality among the middle-aged and older Chinese population.

Methods: A total of 9681 individuals without preexisting CVD from the China Health and Retirement Longitudinal Study (CHARLS) were included. Participants were classified into four different groups: hypertension alone, diabetes alone, both conditions, neither condition. Multivariate Cox proportional hazards models were performed to estimate the risks of all-cause mortality and CVD.

Results: During the 7-year follow-up, 967 deaths and 1535 CVD events were documented. Compared to individuals without hypertension and diabetes, hypertension alone [adjusted hazard ratio (aHR) 1.571, 95% confidence interval (CI) 1.316-1.875, P  < 0.001], diabetes alone (aHR 1.618, 95% CI 1.187-2.205, P  < 0.01) and comorbid hypertension and diabetes (aHR 2.041, 95% CI 1.557-2.677, P  < 0.001) increased risks of all-cause mortality. The aHRs for CVD events in individuals with both conditions, hypertension alone and diabetes only were 2.011 (95% CI 1.651-2.449, P  < 0.001), 1.408 (95% CI 1.233-1.608, P  < 0.001) and 1.036 (95% CI 0.808-1.327, P  > 0.05), respectively. The risk of CVD among those with comorbid hypertension and diabetes exceeded the sum of the risks due to hypertension and diabetes alone (relative excess risk ratio = 0.567, 95% CI 0.136-0.999).

Conclusion: Individuals with comorbid hypertension and diabetes had greater risks of CVD and all-cause mortality, beyond those associated with either condition alone. The synergistic interaction between hypertension and diabetes aggravated the risk of CVD.

Background: Hypertensive nephropathy is increasingly prevalent and a leading cause of end-stage renal disease. Current treatment strategies for hypertensive nephropathy focus on blood pressure control and reducing urinary albumin. However, the use of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) medications carries risks, including a potential decrease in glomerular filtration rate (GFR). This report aims to assess the clinical effectiveness of Quanduzhong capsules (QDZCs) in early-stage hypertensive kidney damage, contributing to the evidence base for their use in traditional Chinese medicine for hypertension treatment.

Methods: The patients, two middle-aged gentlemen with over a decade of hypertension in their medical history, were currently in the early phase of grade 1 hypertension. Notably, their blood pressure readings consistently exceeded the normal parameters. Furthermore, they exhibited signs of microalbuminuria and proteinuria in their clinical presentations. Based on these symptoms, they received a diagnosis of hypertensive kidney damage, specifically at the microalbuminuria stage.

Results: After admission, the two patients took QDZCs for treatment. The medication method was: 2 times a day, 3 capsules each time. The results showed that the microalbuminuria of case 1 and the proteinuria of case 2 were reduced within 12 weeks after taking the medicine, and the average 24-h blood pressure was also reduced. Case 2 experienced a slight decrease in creatinine clearance and glomerular filtration rate after treatment, but the difference was not significant. During the 12-week follow-up period, there were no significant abnormalities in serum creatinine, blood urea nitrogen, creatinine clearance, and estimated glomerular filtration rate.

Conclusion: This case report shows that Quanduzhong capsule can lower blood pressure and improve symptoms of microalbuminuria and proteinuria in patients with early hypertensive renal damage, and may provide a promising treatment option for the management of early hypertensive renal damage. However, the evidence is preliminary and larger, controlled studies are needed to determine its efficacy and potential advantages.

Psoriasis is a chronic systemic autoimmune disease associated with an elevated risk of developing cardiovascular disease. In patients with psoriasis, arterial hypertension treatment requires careful selection of antihypertensive drugs, as some drugs may worsen the skin manifestations of psoriasis. In this review, we summarize the available evidence regarding the risks and benefits of each group of antihypertensive drugs. We also suggest a scheme for optimizing antihypertensive treatment in patients with psoriasis, with emphasis on achieving effective control of blood pressure and cardiovascular disease, while minimizing the worsening of cutaneous manifestations. Angiotensin receptor blockers appear to be the most appropriate treatment for hypertensive patients with psoriasis, with the potential addition of calcium channel blockers if blood pressure is not adequately controlled. Alternatives are angiotensin-converting enzyme inhibitors and/or mineralocorticoid receptor antagonists. Diuretics and beta blockers are associated with greater risk of worsening of psoriatic lesions.

The objective of this report is to characterize BP control among patients six months post stroke and measure time to first visit. Patients were discharged from the Yale New Haven Health System (YNHHS) and had visits in the EPIC system supported by YNHHS. The primary outcome was systolic blood pressure (SBP) values ≥140 mmHg or diastolic blood pressure (DBP) >90 mmHg during the visit closest to and before 6 months from hospitalization. The analysis included 3339 patients. The average proportion of patients with SBP values ≥140 mmHg or ≥DBP 90 mmHg was 31%. The average proportion of SBP values ≥130 mmHg or ≥DBP 80 mmHg mm Hg was 61%. Among patients who had a primary care professional visit within 1 year, 55.3% did not have any visit with a neurologist within 1 year. To the best of our knowledge, this study is the first to report poststroke BP control from a regional health system that is not self-insured or operating under a global budget.