Journal of Hypertension最新文献

Objective: Baroreflex activation therapy (BAT) is a treatment option for resistant hypertension. However, data from randomized trials are scarce, especially regarding long-term efficacy.

Methods: This exploratory, prospective, randomized, two-center study investigated the impact of BAT deactivation and reactivation on office and home blood pressure (BP) in patients with resistant hypertension scheduled for BAT device replacement after multiannual treatment. Patients were randomized 8 weeks before device replacement: group one was deactivated from week -8 to -4 and reactivated from week -4 until surgery, group two remained activated from week -8 to -4 and was deactivated from week -4 until surgery. Patients were not aware of assignment. BP values were monitored during outpatient visits by a blinded physician and by telemetric home measurements. Statistical analysis using paired, two-tailed t-tests was considered significant at a P value less than 0.05.

Results: Sixteen patients with BAT for 50 months in median (IQR: 38-77 months) were included in the study. Office BP was significantly lower under active BAT compared to preimplantation values (146 ± 27 vs. 172 ± 21 mmHg systolic, P < 0.01). Home BP with deactivated device was 5 ± 7 mmHg higher than during active BAT (P < 0.05), office BP after 4 weeks of deactivation was 8 ± 14 mmHg higher (P = 0.06) than at baseline. Two patients met the predefined termination criteria and were reactivated immediately. In total, nine patients (60%) were classified as BAT responders based on at least 5 mmHg BP increase or early reactivation.

Conclusion: Deactivation of BAT increased home BP significantly, even after multiannual therapy, supporting a moderate BP-lowering effect of BAT in the long-term.

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.

Hypertension in children and adolescents is an increasingly prevalent global health concern and a strong predictor of adult cardiovascular and kidney disease. Variability in existing guidelines and limited applicability in low-resource settings hinder effective identification and management. This International Society of Hypertension (ISH) position paper provides practical, harmonized guidance for clinicians globally. To develop evidence-based, clinically relevant recommendations for the evaluation, diagnosis, and management of hypertension in youth, informed by multidisciplinary expertise from 12 countries. An expert panel undertook an iterative, consensus-driven synthesis of current evidence covering epidemiology, risk factors, blood pressure measurement, diagnostic evaluation, target organ injury, lifestyle therapy, pharmacological treatment, and long-term monitoring. Youth hypertension is driven by obesity, adverse childhood experiences, unhealthy lifestyle behaviors, and socioecological factors, with a disproportionately higher burden in low and middle-income countries. Accurate diagnosis requires standardized measurement using validated devices, proper cuff sizing, and out-of-office monitoring, particularly ambulatory blood pressure monitoring. Targeted investigations help distinguish primary from secondary hypertension and identify early organ injury. Lifestyle modification forms the foundation of treatment, while pharmacotherapy is indicated for persistent stage 2 hypertension, comorbid conditions, or evidence of organ damage. Structured transition to adult care is essential to improve long-term adherence and outcomes. Timely recognition and individualized management of youth hypertension are critical for reducing lifelong cardiovascular risk. This ISH position paper offers pragmatic, globally adaptable recommendations to enhance early detection, treatment, and continuity of care for children and adolescents with elevated blood pressure.

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.

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.