Journal of Hypertension最新文献

Background: Paternal preconception alcohol exposure affects fetal development; however, it is largely unknown about the influences on offspring vasculature and mechanisms.

Methods: Offspring born form paternal rats treated with alcohol or water before pregnant was raised until 3 months of age. Vessel tone of mesenteric arteries was detected using myograph system; whole-cell calcium channel current in smooth muscle cells was tested using patch-clamp; molecule expressions were detected with real-time PCR, western blotting, and Dihydroethidium (DHE); DNA methylations were determined using targeted bisulfate sequencing assay. Following 5-aza-2'-deoxycytidine incubation, vessel tone in offspring mesenteric artery and Cacna1c expression in A7r5 was tested.

Results: When comparing with the control, stress-strain curve was left-shifted in alcohol. There was lower incremental distensibility and endothelium-dependent dilation associated with endothelial nitric oxide synthase. Agonists-induced constrictions were greater in alcohol offspring than that in control, associated with higher expression of AT1R, Cacna1c, and reactive oxygen species (ROS). Baseline and Ang II-stimulated calcium channel currents were higher in alcohol group. Tempol and apocynin could restore Ang II-increased constriction and calcium channel current in alcohol offspring. When comparing with the control, there was lower DNA methylation of Cacna1c promotor in alcohol offspring mesenteric artery and in paternal sperm. 5-aza-2'-deoxycytidine increased contraction in control offspring mesenteric artery and Cacna1c expression in A7r5.

Conclusion: Paternal preconception alcohol exposure-affected offspring mesenteric artery was via ROS-Cacna1c. Abnormal offspring vascular functions might be inherited via DNA hypomethylation of Cacna1c promotor from paternal sperm exposed to alcohol. These data gained provided important clues for cardiovascular disorders at germ cell origin.

Objectives: Aortic pulse wave velocity (aPWV) predicts cardiovascular risk. Being the reference method for aortic stiffness evaluation, invasive aPWV is also recommended for validation of noninvasive devices. Because of intrinsic haemodynamic variability and processing issues, aPWV shows beat-to-beat variability. We aimed to quantify this variability and evaluate its implications for the reliability and use of aPWV as reference in validation and clinical application studies.

Methods: The study included n  = 84 patients, in whom two datasets of invasive data were recorded: 1) simultaneous ascending aorta and iliac pressure acquisitions using a dual-tip intra-aortic catheter, and 2) an additional ascending aorta pressure acquisition. By combining the iliac and ascending aorta pressure recordings from the first and second acquisitions, respectively, we evaluated how a sequential acquisition protocol affects variability. We compared three pressure waveform foot identification methods to investigate the effect of data processing on variability. Furthermore, we estimated how averaging over nbeats consecutive heartbeats affects the standard deviation (SD) of such nbeats -averaged estimate of aPWV.

Results: The simultaneously acquired invasive aPWV showed a 5% beat-to-beat SD (variability), with small but significant differences between foot identification methods. The sequential acquisition protocol doubled aPWV variability compared to simultaneous acquisition. However, because averaging had a much stronger effect on sequentially measured aPWV, the two acquisition protocols yielded comparable variabilities at nbeats  = 10 (2% vs. 3%).

Conclusions: Our study suggests that, independently from the acquisition protocol and data processing, the intrinsic beat-to-beat variability of aPWV becomes manageable when aPWV values of at least ten heartbeats are averaged.

Introduction: Hypertension is the leading preventable cause of cardiovascular morbidity and mortality globally, with a disproportionate impact on low-income and middle-income countries like Sri Lanka. Effective blood pressure (BP) control improves outcomes in patients with hypertension. This study aimed to assess the prevalence of uncontrolled hypertension, and its correlates among Sri Lankan patients with hypertension in clinic settings.

Methods: A cross-sectional study was done at the largest tertiary care hospital in Sri Lanka and patients with hypertension presenting to its medical clinics over a 6-month period were recruited. An interviewer-administered questionnaire captured sociodemographic, morbidity, and medication details from records. BP measurements were taken following standard guidelines with OMRON-X7 BP monitors. Multivariate logistic regression was used to identify significant associations ( P  < 0.05).

Results: Among 600 patients (mean age 64 ± 9 years, 43% men), 55% had uncontrolled hypertension. Most (62%) were on 1 or 2 antihypertensives, primarily renin-angiotensin blockers (91%), with minimal (<10%) thiazide use. Uncontrolled hypertension was less common among furosemide (10.5%) and spironolactone (21.5%) users but frequent among those on alpha-blockers (16.3%). Coronary artery disease (58%), heart failure (9%), and stroke (17%) were more common in men and those with longstanding hypertension. Beta-blockers were favoured in those with cardiac comorbidities, and dihydropyridines in those with stroke. Potential treatment resistance, seen in 11%, was associated with increased cardiac morbidity, while sociodemographic factors and family history had no significant impact on BP control or cardiovascular morbidity.

Conclusion: Uncontrolled hypertension and cardiovascular morbidity were highly prevalent. The data suggest the need for optimized antihypertensive regimens, with reduced use of alpha-blockers and early and prioritized incorporation of diuretics.

Objective: Anemia, obstructive sleep apnea (OSA), and hypertension are common social health problems. They are interconnected. This study assessed the independent association of anemia and OSA with hypertension and the interaction between anemia and OSA on hypertension in the US population.

Methods: Data used by this retrospective study were obtained from the National Health and Nutrition Examination Survey (NHANES) 2015-2018. The relative excess risk due to interaction (RERI), weighted logistic regression, and the attributable proportion due to interaction (AP) were used to investigate the interaction above. Its impact was also assessed via subgroup analysis by gender, age, race, diabetes, smoking, alcohol use, education, and marital status.

Results: After covariate adjustment in 6949 eligible observers, it was found that compared with non-OSA patients, OSA patients were at higher risk of hypertension [odds ratio (OR) = 1.254, 95% confidence interval (CI) 1.099-1.432, P  < 0.001). Meanwhile, OSA and anemia had a potential synergistic effect on the incidence of the disease (OR = 1.705, 95% CI: 1.390-2.091, P  < 0.01): the RERI was 0.371, and the AP was 0.218. In addition, such effect was observed in the subgroup of other race (AP = 0.48), the nondrinking subgroup (AP = 2.50), the subgroup graduating from high school or above (AP = 0.28), the unmarried subgroup (AP = 0.4), the subgroup without diabetes (AP = 0.24), and the drinking subgroup (AP = 0.41).

Conclusion: Anemia and OSA had a potential synergistic effect on hypertension. Their relationship needs to be further elucidated by a further study.

Kiosk devices for unsupervised self-measurement of blood pressure (BP) are being used in public spaces and healthcare settings in several countries. This statement by the European Society of Hypertension (ESH) Working Group on BP Monitoring and Cardiovascular Variability provides a review of the published evidence on kiosk BP devices and consensus recommendations for their requirements and clinical use. A systematic literature search identified 54 relevant studies. Kiosk BP measurements appeared to be close to office BP [mean difference systolic 0.2 mmHg (95% confidence intervals -1.3 to 1.8); diastolic -0.4 mmHg (-3.5 to 2.7)], and higher than daytime ambulatory and home BP [mean difference 6.0 mmHg (1.6-10.4)/5.0 (2-8) and 8.1 mmHg (-2.6 to 18.9)/0.2 (-9.6 to 10.0), respectively]. Randomized or observational studies using kiosk BP measurements for hypertension screening or for assessing hypertension control were also included, as well as studies investigating users' and healthcare professionals' opinions, acceptability, and perspectives regarding kiosk BP measurements, and validation studies of kiosk BP devices. These studies had considerable heterogeneity in design, setting, methodology, measurement protocol, and sample size. Thus, at present, the clinical utility of kiosk BP measurements is uncertain. This ESH consensus statement acknowledges the potential of kiosk BP measurement as an emerging method for unsupervised self-measurement in the context of opportunistic screening for hypertension in apparently healthy people and the long-term monitoring of people with diagnosed hypertension. Requirements for the design, validation, function, and use of kiosk BP monitors are provided, together with the pending research questions on their optimal implementation in clinical practice.

Introduction: Abnormal blood pressure response to exercise (ABPR) in athletes is considered a risk for incident hypertension, conferring a higher cardiovascular risk profile. We sought to describe the clinical cardiovascular features of athletes with ABPR and, moreover, the relationship of ABPR with occurrence of exercise-induced ventricular ectopic beats (VEBs).

Methods and results: We enrolled 1460 elite athletes (56.1% male; mean age 25.8 ± 5.1 years old), engaged in skills, power, mixed and endurance sport, who underwent clinical examination, transthoracic echocardiogram (TTE) and exercise stress testing. ABPR was defined as >220/85 mmHg in males and >200/80 mmHg in females. ABPR was found in 8% ( n  = 117) of athletes, being older ( P  = 0.049) and presenting higher cardiovascular risk profile (obesity, P  = 0.007; glucose intolerance, P  = 0.043 and familiarity for cardiovascular disease, P  = 0.026). Athletes with ABPR had higher prevalence of exercise-induced VEBs (19.6% vs. 11.9% in normotensive athletes, P  = 0.015). Uncommon VEBs morphology was more frequent in athletes with ABPR (64.7% vs. 19% in the normotensive, P  = 0.0002). Finally, in those with ABPR and VEBs, TTE revealed greater left ventricular end-diastolic diameter indexed ( P  = 0-006), LVEDVi ( P  = 0.017) and LVMi ( P  = 0.04) compared to those without VEBs.

Conclusion: A not small group of elite athletes (8%) presented an exaggerated blood pressure response to exercise and exhibited higher cardiovascular risk profile compared to their normotensive counterparts. Moreover, athletes with ABPR showed higher prevalence of ventricular arrhythmias on effort and the combination of ABPR and ventricular arrhythmias was associated with more pronounced cardiac remodelling.

Purpose: We studied the relative contributions of total peripheral resistance (TPR), stroke volume (SV) and heart rate (HR) to low blood pressure in classical orthostatic hypotension (cOH) on group and individual levels.

Methods: We retrospectively analyzed tilt test records from cOH patients and age/sex-matched controls. We quantified relative effects of HR, SV and TPR on mean arterial pressure (MAP) with the log-ratio method. We studied relations of changes of HR, SV or TPR with the change of MAP across patients and variability of contributions of HR, SV and TPR to MAP. We also explored neurogenic vs. nonneurogenic causes.

Results: MAP responded to tilt with a decrease in patients ( n  = 80) and an increase in controls ( n  = 80). A too small TPR-increase contributed most to cOH, followed by a too large SV-decrease; both effects were partially corrected by a larger increase of HR. Only TPR changes consistently affected MAP change in patients and controls. TPR decreased almost exclusively in patients, most in those with severe cOH. Contributions of HR, SV and TPR to MAP did not differ between probable neurogenic and nonneurogenic causes.

Conclusion: HR, SV and TPR all contributed to cOH, with a key role for TPR; a decrease of TPR was almost unique to patients and may be due to hyperventilation. The lack of differences between neurogenic and nonneurogenic causes needs further study.

Aim: Autotaxin is an adipokine involved in metabolic disorders. The aim of the current study was to evaluate serum autotaxin levels in hypertensive postmenopausal women and establish a relationship between autotaxin and other comorbidities in this special group.

Methods: This single-center study included postmenopausal women who received annual health examinations at the First Affiliated Hospital, College of Medicine, Zhejiang University in Zhejiang, China. The metabolic and demographic characteristics of the subjects, including age, sex, height, weight, blood pressure, and biochemical indices, were collected. The serum autotaxin level was measured via ELISA. The Kolmogorov-Smirnov test, Student's t test, Mann-Whitney U test, χ2 test, receiver operating characteristic (ROC) curve analysis, Spearman correlation analysis and multivariate logistic regression analysis were adopted for statistical analysis.

Results: This pilot observational study included 25 hypertensive postmenopausal women and 25 age-matched normotensive controls. Hypertensive patients presented significant metabolic disturbances with greater comorbidities such as nonalcoholic fatty liver disease, obesity, overweight, diabetes, hypertriglyceridemia and hyperuricemia ( P  < 0.05), impaired renal health with higher uric acid levels ( P  < 0.001), and slightly elevated creatinine levels ( P  = 0.156) with lower estimated glomerular filtration rates (eGFRs) ( P  = 0.195). The serum autotaxin level was markedly greater in the hypertensive group (239.0±59.6 ng/ml vs. 192.7 ± 49.0 ng/ml; P  < 0.01) and was positively associated with systolic blood pressure; diastolic blood pressure; and alanine transaminase, triglycerides (TG), creatinine, and uric acid levels and inversely associated with the eGFR ( P  < 0.05) among postmenopausal women. Serum autotaxin levels positively predicted hypertension, with an AU-ROC of 0.750 [95% confidence interval (CI): 0.613-0.888] and a Youden index of 0.480 at a cutoff of 225 ng/ml. In the multivariate logistic regression analysis, after adjustment for demographic and metabolic parameters (including age, BMI, ALT, TB, uric acid, FBG, TG, LDL and creatinine), autotaxin (ATX) remained independently positively correlated with the risk of hypertension [odds ratio: 1.016, 95% CI 1.001-1.031; P  < 0.05).

Conclusions: Among postmenopausal women, the serum autotaxin level is significantly elevated in the hypertensive group compared with age-matched normotensive controls. ATX is related to multiple metabolic disorders and renal health, suggesting that autotaxin has potential as a multiorgan therapeutic target for cardiovascular-metabolic-renal disorders.

Objective: There are noticeable sex differences in the treatment response to antihypertensives, with limited data on the response to single pill combinations. The aim of the PRECIOUS trial was to assess the treatment response to perindopril/amlodipine and perindopril/amlodipine/indapamide dual and triple single-pill combination in men and women.

Methods: Four hundred and forty adults with essential hypertension were assessed in the 16-week interventional, open-label, prospective, international, multicentre trial. Based on the previous antihypertensive therapy, patients were assigned to either perindopril/amlodipine 4/5 mg or perindopril/amlodipine/indapamide 4/5/1.25 mg, with the initial dose up-titrated in 4-week intervals in case of uncontrolled blood pressure. An additional analysis was performed for sex- and age-related differences on the blood pressure response and arterial stiffness in men and women aged 35-74 years.

Results: Women achieved better overall blood pressure control in all age groups, except for the 35-44 age group. Women presented higher average 24 h aortic augmentation indexes than men, but had more pronounced decreasing trends. The pulse wave velocity was only age-dependent, with reductions slightly greater in women. Both the aortic augmentation index and pulse wave velocity were significantly decreased in all groups compared to baseline.

Conclusions: The results of the PRECIOUS trial contribute significant data to the expanding body of evidence on sex differences in hypertension, including the aspect of age-related changes during the life course of women. The differences between same-aged men and women tend to be smaller with advancing age, but with a greater treatment response in women in all age groups for all observed blood pressure parameters and arterial stiffness.

Trial registration: ClinicalTrials.gov identifier NCT03738761.