Journal of Hypertension最新文献

Resistant hypertension is a challenging condition and linked with considerable morbidity. We aimed to evaluate the efficacy and safety of aldosterone synthase inhibitors (ASIs) in patients with resistant hypertension. Four electronic databases were searched to identify randomized clinical trials (RCTs) evaluating ASIs compared with placebo for resistant hypertension. A frequentist network meta-analysis was conducted. Continuous outcomes were reported as mean differences and dichotomous outcomes as risk ratio, each with 95% confidence interval (95% CI), using a random-effect model. The primary outcomes were changes in SBP and DBP. A total of 2725 patients from six RCTs were included. Baxdrostat and Lorundrostat significantly reduced SBP (Baxdrostat: MD -8.81 mmHg, 95% CI -10.94 to -6.67; Lorundrostat: MD -8.42 mmHg, 95% CI -11.05 to -5.78) and DBP (Baxdrostat: MD -3.28 mmHg, 95% CI -4.68 to -1.87; Lorundrostat: MD -3.13 mmHg, 95% CI -4.27 to -1.98). In contrast, Osilodrostat did not show a significant difference in SBP or DBP compared with placebo. Baxdrostat and Lorundrostat were associated with significant increases in serum potassium levels and hyperkaliemia. None of the three drugs significantly increased the risk of serious adverse events. Highly selective ASIs (Baxdrostat and Lorundrostat) significantly lowered BP in patients with resistant hypertension without increasing the risk of serious adverse events, whereas the nonselective agent Osilodrostat did not reach the significant difference. These findings suggest that selective aldosterone synthase inhibition represents a promising therapeutic option for resistant hypertension.

Introduction: Blood pressure variability (BPV) is a prognostic marker in hypertension and coronary artery disease (CAD), but its role in acute myocardial infarction (AMI) remains unknown. This study assessed the association of short-term (24-h ambulatory BP monitoring, ABPM) and mid-term BPV with adverse in-hospital and long-term outcomes in AMI patients.

Methods: Mid-term BPV was calculated as the standard deviation (SD) of daily in-hospital BP readings; short-term BPV was measured by average real variability (ARV) from ABPM. Patients were evaluated as continuous variables and by quartiles (Q1-Q4). Logistic regression and Cox models assessed in-hospital and 3-year outcomes.

Results: In this prospective, single-center cohort, 441 of 677 AMI patients were included. Each 1 mmHg rise in day-to-day systolic BPV (SBP-SD) increased in-hospital MACE risk by 24% [odds ratio (OR): 1.24, 95% confidence interval (CI): 1.17-1.31], with Q4 showing the highest risk (OR: 28.89, 95% CI: 8.58-97.28). ABPM-derived SBP-ARV predicted in-hospital mortality (OR: 1.58, 95% CI: 1.21-2.07) and MACE (OR: 1.35, 95% CI: 1.23-1.48). Diastolic ARV was linked to in-hospital myocardial infarction (MI), arrhythmias, and shock. At 3-year follow up, Q4 of SBP-SD showed higher risk of composite outcomes (hazard ratio: 29.88, 95% CI: 10.93-81.66) and all-cause mortality (hazard ratio: 11.85, 95% CI: 2.81-49.91). SBP-ARV independently predicted both all-cause mortality (hazard ratio: 1.37, 95% CI: 1.25-1.51) and adverse events (hazard ratio: 1.29, 95% CI: 1.22-1.36), while diastolic BPV was primarily associated with arrhythmias and heart failure hospitalization.

Conclusion: Systolic BPV independently predicts in-hospital and long-term outcomes in AMI. BPV assessment may aid post-MI risk stratification and guide novel therapeutic strategies in this high-risk population.

Introduction: Sleep duration is associated with blood pressure (BP), the leading risk factor for cardiovascular disease. Yet, limited data exists on the relationship between objectively measured sleep duration and BP in a large population. We sought to examine this relationship using data from the 2011-2014 National Health and Nutrition Examination Survey cycles.

Methods: Average nighttime sleep duration was estimated from actigraphy using a validated algorithm among 6963 individuals [median age 47 (27) years, 52% women]. SBP and DBP were calculated as the average of up to three measures. Hypertension was defined as SBP at least 130 mmHg, DBP at least 80 mmHg, self-reported use of antihypertensive medication, or a self-reported physician diagnosis of hypertension. Linear and logistic regression assessed sleep duration's association with BP and hypertension.

Results: We observed a U-shaped association between sleep duration and SBP [B2 = 0.29, 95% confidence interval (95% CI) = 0.10-0.49, P = 0.0031], with higher SBP values observed at shorter and longer sleep durations. Optimal sleep duration was estimated at 7.5 h, corresponding to SBP of 122 mmHg for men and 115 mmHg for women. The association of sleep duration with DBP was nonsignificant (B2 = 0.13, P = 0.067). Sleep durations greater or less than 7 h were not associated with increased odds of hypertension (B = -0.30, 95% CI = -0.73 to 0.12, P = 0.16).

Conclusion: An objectively measured sleep duration of 7.5 h was associated with optimal SBP in both men and women. Yet, neither short nor long sleep durations were associated with hypertension incidence.

Background and aims: The magnesium depletion score (MDS) estimates magnesium deficiency risk by integrating dietary intake and physiological losses. This study evaluated the association between MDS and arterial stiffness in a rural Mediterranean population.

Methods: We analyzed data from 2048 participants (49.2% men, 50.8% women) in the Brisighella Heart Study. MDS and arterial stiffness parameters - augmentation index (AIx) and carotid-femoral pulse wave velocity (cfPWV) - were assessed using validated methods. Multiple regression models adjusted for age and mean arterial pressure included sex, smoking, physical activity, BMI, heart rate, fasting glucose, low-density lipoprotein cholesterol (LDL-C), triglycerides, serum uric acid, estimated glomerular filtration rate (eGFR), and MDS.

Results: An MDS at least 2 was observed in 51.6% of participants, more often in men (P < 0.001). Higher MDS was significantly associated with increased AIx and cfPWV in both sexes (P < 0.001). MDS remained an independent predictor of AIx (β = 0.087, P = 0.011) and cfPWV (β = 0.131, P = 0.013) after adjustment.

Conclusion: Higher MDS values correlate with greater arterial stiffness, suggesting that magnesium imbalance may negatively affect vascular health.

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.

Objectives: This study investigated whether lowering the home blood pressure (BP) threshold for the diagnosis of hypertension from 135/85 to 130/80 mmHg enhances diagnostic accuracy when assessed against ambulatory BP monitoring (ABPM).

Methods: A total of 646 untreated participants (mean age 52 ± 10  years; 310 men) with valid 3-day office BP, 7-day home BP, and 24-h ABPM data and preserved renal function were included. Hypertension phenotypes were classified as normotension, white-coat, masked, and sustained hypertension according to office BP and ABPM criteria.

Results: Lowering the home BP threshold increased sensitivity from 72.3 to 89.5% but reduced specificity from 81.8 to 69.1%, thereby improving overall diagnostic accuracy from 73.1 to 87.8% and the kappa coefficient from 0.238 to 0.247. At the conventional threshold of 135/85 mmHg, 63.2% of masked and 15.1% of sustained hypertension were misclassified as normotension, whereas these rates declined to 30.3 and 3.4%, respectively, at the 130/80 mmHg threshold. Individuals with home BP between 130/80 and 134/84 mmHg showed intermediate office and ambulatory BP values, with a high prevalence of masked (32.9%) and sustained hypertension (11.7%). Within this subgroup, isolated nighttime and daytime-nighttime hypertension were identified in 35.7 and 13.5% of participants, respectively.

Conclusion: The conventional home BP threshold of 135/85 mmHg may fail to identify a considerable proportion of masked, sustained, and nighttime hypertension. Lowering the threshold to 130/80 mmHg, or designating 130/80-134/84 mmHg as a diagnostic 'gray zone' warranting ABPM confirmation, may improve diagnostic precision and facilitate earlier detection of hypertension in clinical practice.

Obstructive sleep apnea (OSA) is a common disorder in the general population and individuals with hypertension. We reviewed the literature on the prevalence of OSA in hypertension and hypertension subgroups. The current literature shows a high prevalence of OSA in patients with nocturnal and resistant hypertension, up to more than 90% in patients with refractory hypertension. The prevalence of OSA in patients with primary aldosteronism is greater than 45%. We also conducted an Italian national survey to assess the diagnostic approach to OSA in centers associated with European and Italian Societies of Hypertension. The median rate of OSA diagnosis was 10 patients/year, with a higher rate in Excellence Centers. The most common criterion for OSA screening was the combination of hypertension, snoring, and daytime somnolence (90%), followed by hypertension and a nondipping profile (55%). Resistant hypertension was considered a criterion by only 23% of the specialists.

Background: Renal denervation (RDN) has been approved in Europe and the United States and is recommended by the ESH and ESC hypertension guidelines as a therapeutic option for patients with resistant or uncontrolled hypertension. The aim of this study was to evaluate the long-term outcomes of radiofrequency (RF) RDN in a cohort of patients treated at an ESH center of excellence, with a mean follow-up of 8  years, and to review current evidence on the durability and safety of the procedure.

Methods: From a pool of patients with uncontrolled hypertension who had previously undergone RF RDN, we included those with a follow-up longer than 3  years ( n  = 97). Baseline and follow-up data were collected for each patient, including office blood pressure (OBP), ambulatory blood pressure (ABP), use of antihypertensive medication, and markers of renal function. A propensity-matched control group of patients with resistant hypertension managed conservatively (without RDN) was selected for comparison. All-cause mortality and nonfatal cardiovascular events were recorded. Additionally, we conducted a systematic review and meta-analysis of studies reporting RDN outcomes with follow-up periods exceeding 3 years.

Results: A total of 76 patients (mean age 61.4 ± 10.5 years, 25% female) had follow-up data over a mean of 8.3 ± 3.4 years. OBP decreased significantly from baseline by 21.8 ± 16.9 mmHg systolic and 13.1 ± 9.6 mmHg diastolic ( P  < 0.001 for both). In 41 patients with ABP data, systolic ABP decreased by 19.4 ± 13.1 mmHg and diastolic ABP by 12.7 ± 10.0 mmHg ( P  < 0.001 for both). The number of prescribed antihypertensive medications was reduced by 0.54 ± 1.2 ( P  < 0.01). By the end of follow-up, 9 of the 97 RDN patients (9.3%) had died, compared with 5 of 44 control patients (11.4%) over a mean follow-up of 8.1 ± 2.3 years. Twelve patients were lost to follow-up. Estimated glomerular filtration rate declined significantly in the RDN group from 83.0 ± 14.4 to 75.5 ± 19.2 mL/min/1.73 m 2 ( P  < 0.001). A meta-analysis of eight studies, including ours, with a mean follow-up of 8.7 years, showed a reduction in 24-h systolic ABP of -15.7 mmHg [95% confidence interval (CI): -18.4 to -13.0] and diastolic ABP of -9.2 mmHg (95% CI: -10.5 to -7.9), consistent with our findings. No major adverse events were reported.

Conclusion: RDN is a safe procedure that provides durable antihypertensive effects lasting for at least 8 years.

Background: Fibromuscular dysplasia (FMD) is a nonatherosclerotic, multiarterial disease with unknown aetiology. The aim of this study was to comprehensively evaluate arterial stiffness, wave reflections and local arterial wall remodelling in patients with FMD and blood pressure-matched essential hypertensives (HTN).

Methods: Carotid and aortic wave separation and wave intensity analysis was performed in patients with FMD [n = 16, (14 women)], age and blood-pressure matched HTN [n = 21, (18 women)] and age-matched healthy individuals [n = 22, (19 women)]. Carotid and aortic pressure waveforms were acquired using tonometry. Carotid blood flow and diameter were measured using B-mode and doppler respectively and aortic flow using the ARCSolver algorithm.

Results: Carotid backward wave amplitude was comparable between HTN and FMD 14.82 ± 4.71 vs. 13.45 ± 5.36 mmHg, P = 0.13) but higher in HTN compared to healthy individuals (11.69 ± 3.78 mmHg, P = 0.03). Carotid backward compression wave intensity [FMD -5.68 (-9.32 to 3.23), HS -6.43 (-8.58 to 3.59), HTN -8.38 (-11.46 to 5.37) mmHg*m/s3*10-2) and energy (FMD 0.33 (0.21-0.46), healthy individuals 0.35 (0.24-0.52), HTN 0.43 (0.29-0.66) mmHg*m/s2*10-2] was also higher in HTN compared to healthy individuals (P = 0.04 and 0.02) and FMD (P = 0.006 and <0.001), respectively. Aortic backward wave amplitude and wave intensity energy were higher in patients with FMD compared to healthy individuals but comparable to HTN.

Conclusion: The results indicate that, despite similar blood pressure, wave reflections at carotid are higher in patients with essential HTN compared to FMD indicating greater flow transmission to the cerebral circulation in FMD. Second, wave reflections at aortic level are higher, potentially increasing risk of cardiovascular disease in these patients.