Journal of Hypertension最新文献

Objective: It is unclear whether central SBP (cSBP) is an independent predictor of stroke above and beyond brachial SBP (bSBP). This study aimed to investigate the difference between cSBP and bSBP in predicting first stroke and the joint effect of cSBP and bSBP on the risk of first stroke in hypertensive adults.

Methods: A total of 8122 hypertensive adults without stroke history were included in this study. cSBP was measured noninvasively using A-Pulse CASPro device. The outcome was first stroke. During a median follow-up of 4.4 years, 579 first strokes were identified.

Results: A total of 8122 hypertensive adults without stroke history were included in this study. cSBP was measured noninvasively using A-Pulse CASPro device. The outcome was first stroke. During a median follow-up of 4.4 years, 579 first strokes were identified. The risk of first stroke increased by the same 16% [hazard ratio: 1.16, 95% confidence interval (95% CI): 1.07-1.26] for per SD increment in both cSBP and bSBP. The differences in areas under the curves, continuous net reclassification indices, and integrated discrimination indices of bSBP and cSBP models for predicting first stroke were 0.003 (95% CI: -0.003, 0.008), 0.007 (95% CI: -0.058, 0.071), and -0.0002 (95% CI: -0.0028, 0.0013), respectively. When cSBP and bSBP were evaluated jointly, participants in the highest tertiles of both cSBP and bSBP had the highest risk of first stroke compared with their counterparts (hazard ratio: 1.59, 95% CI: 1.29-1.96; P -interaction = 0.034). Similar results were found for ischemic stroke and hemorrhagic stroke.

Conclusion: Although cSBP was not found to be superior to bSBP in predicting first stroke, cSBP and bSBP were jointly associated with the risk of first stroke among hypertensive adults.

Recently, a two-hit model for the development of aldosterone-producing adenoma (APA) was proposed but until now, only two cases supporting the model have been reported. Here, we present two new cases of primary aldosteronism (PA), both of which had large functional adenomas with somatic mutations in aldosterone-driving genes. Furthermore, the first patient, who had a history of colorectal cancer, was found to have a germline and an additional somatic mutation in APC , and APC inactivation was confirmed by immunohistochemistry. The other patient had pathogenic somatic mutation in CTNNB1 . These pro-proliferation mutations resulted in abnormal activation of the Wnt/β-catenin pathway. Two consecutive events apparent in these patients, namely, the first event leading to cell proliferation and the second driving hormonal hypersecretion, supported the two-hit model of APA development. The two-hit model usually occurs in the larger adenomas, and the driving factors of the first hit that promote cell proliferation still require further research and exploration.

We report on a case of a 67-year-old male who was referred to our care with persistent aldosteronism post adrenalectomy. Biochemical failure after surgery is rare after surgery for primary aldosteronism (PA). Persistent hypokalaemia and raised aldosteronism is an indication of treatment failure after surgery. Causes of failure may be multiple aldosterone producing nodules or diffuse hyperplasia, inappropriate or incomplete lateralization studies, presence of CACNA1D -mutated aldosterone producing adenomas (APAs) and incomplete or partial adrenalectomy. In our case the persistent disease was imaged with METOMIDATE PET as the patient had a previous history of adrenal vein clipping during index surgery. The patient underwent reoperative adrenalectomy and was cured of hypokalaemia and hypertension, despite a long duration of his disease. This case highlights some of the reasons for biochemical failure and work up of the patient for reoperative surgery.

Objective: The pathogenic mechanism of depression involves chronic inflammation, which can be affected by sedentary behavior. This study aimed to determine whether sedentary behavior modified the association between depression and risk of death in the hypertensive population.

Methods: Data from the National Health and Nutrition Examination Survey (2007-2018) was analyzed. Depression was assessed through the Health Questionnaire-9, and sedentary behavior was evaluated using self-reported sitting hours in a day. Deaths were ascertained through the National Death Index until 31 December 2019. The interaction effect was evaluated through multivariable Cox regression analysis.

Results: Eight thousand one hundred and twenty-four patients with hypertension were involved in the study. During a median follow-up of 7.3 years, we confirmed 1384 all-cause and 373 cardiovascular deaths. Separate analyses revealed that both depression and sitting for 6 h per day or more were correlated with increased risks of all-cause and cardiovascular deaths. Of note, we found that sitting time modified the link between depression and the risk of all-cause death (P for interaction: 0.02). Compared with the nondepression group, the depression group was correlated with an elevated risk of all-cause death among participants with sitting time of more than 6 h/day [hazard ratio 1.52, 95% confidence interval (CI) 1.22-1.91, P < 0.001], but not among participants with sitting time of less than 6 h/day (hazard ratio 0.95, 95% CI 0.65-1.39, P = 0.76).

Conclusion: Sedentary behavior modified the link between depression and the risk of all-cause death. Reducing sedentary time might attenuate the detrimental effects of depression on survival in the hypertensive population.

Objective: Diastolic blood pressure (DBP) is associated with atherosclerosis and cardiovascular disease, independent of systolic blood pressure (SBP). However, prior evaluation of the association of DBP with coronary artery calcium (CAC) has not included South Asian adults, a population that is at excess risk of atherosclerotic cardiovascular disease.

Methods: In the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, we evaluated the association of sex-specific DBP tertiles and CAC score > = 100 with robust Poisson regression adjusted for age, sex, SBP, BP medication use, and other cardiovascular risk factors. We examined these associations stratified by antihypertensive medication use, and secondarily the association of baseline DBP tertile with incident CAC over median 4.7 years of follow-up.

Results: Among 1155 participants (48% women, mean age 57 years), mean (standard deviation) DBP was 74 (10) mmHg, 33% were on antihypertensive medications, and 22% had CAC > = 100. Relative to DBP in tertile 1, DBP in tertiles 2 and 3 was associated with a significantly higher prevalence of CAC > = 100 [adjusted prevalence ratio 1.30 [95% confidence interval (CI) 1.03-1.65] and 1.47 (1.12-1.93), respectively]. These significant associations were primarily observed in participants who were not on antihypertensive medications. Baseline DBP tertile was not associated with incident CAC.

Conclusion: Among South Asian adults in MASALA, DBP in the second or third tertiles vs. tertile 1 were associated with a higher prevalence of CAC > = 100 after adjustment for covariates, including SBP. DBP may be an important clinical ASCVD risk factor among South Asian adults.

Background: Identifying predictors of blood pressure (BP) response to renal denervation (RDN) is crucial for patient selection. According to Wilder's principle, baseline BP predicts BP change after any antihypertensive intervention. Thus, any observed BP change after RDN is the sum of the BP change depending on the baseline BP and the specific BP reduction due to RDN. Based on this concept, we propose a new definition of BP responders.

Methods: In our center, 148 patients with uncontrolled hypertension underwent RDN, and 24-h ambulatory BP (ABP) was measured at baseline, and 6 months after the procedure. The decrease in 24-h systolic BP (SBP) correlated with baseline SBP ( P  = <0.001, r  = -0.374). We determined the RDN-specific effect by subtracting the predicted SBP decrease from the observed SBP decrease. The cohort was divided into RDN responders, neutral responders, and nonresponders.

Results: Our study population had a mean age of 59 ± 10.4 years and was 74% male. The RDN-specific (residual) 24-h ABP decreased by -14.9 ± 6.3/-8.2 ± 3.8 mmHg (responder group), 1.0 ± 3.2/0.2 ± 1.9 mmHg (neutral group), and 14.2 ± 10.4/8.3 ± 3.9 mmHg (nonresponder group) 6 months after RDN. Responders had fewer antihypertensive medications ( P  = 0.018), higher baseline office heart rate (HR) ( P  = 0.019), higher 24-h ambulatory HR ( P  = 0.003), lower BMI ( P  < 0.038), and absence of type 2 diabetes (T2D) ( P  = 0.020).

Conclusion: Our definition of BP responders to RDN separates baseline BP-related changes from RDN-specific changes. Positive predictors for BP response to RDN include low BMI, fewer antihypertensive medications, high baseline office HR, high 24-h ambulatory HR, and absence of T2D.

Objectives: Patients with advanced chronic kidney disease suffer from hypertension, and kidney transplantation (KT) has potential to induce hypertension resolution. We hypothesized that hypertension resolution after KT is associated with better KT outcomes.

Methods: We identified KT recipients (2006-2015) who had pretransplant hypertension. They were categorized into two groups based on their hypertension status after KT: persistent vs. resolved hypertension, using data from the Korea National Health Insurance System. Cox proportional hazard analyses were performed to assess the risk of graft failure and mortality, adjusting for various clinical factors.

Results: Among 11 317 KT recipients with pretransplant hypertension, 7269 (64%) remained hypertensive, while 4048 (36%) experienced hypertension resolution. Recipients with resolved hypertension exhibited a lower prevalence of delayed graft function and major comorbidities, including diabetes, ischemic heart disease, and stroke. Graft failure and mortality rates were significantly lower in resolved hypertension group. After adjusting for multiple covariates, hazard ratios of resolved hypertension were 0.61 (95% confidence interval 0.52-0.72) for graft failure and 0.68 (0.56-0.81) for all-cause mortality.

Conclusions: A significant proportion of patients experienced hypertension resolution after KT, which is associated with improved graft and overall survival. The post-KT hypertension resolution can be used as a prognostic indicator for predicting better KT outcomes.

Objective: The oxidative balance score (OBS) has emerged as a novel marker for assessing oxidative stress status. This study aimed to investigate the association of OBS with systolic blood pressure (SBP), diastolic blood pressure (DBP), all-cause, and cardiovascular disease mortality in hypertensive patients.

Methods: We conducted an analysis of data from 7602 hypertensive patients from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. Multiple linear regression, Cox proportional hazards models, Kaplan-Meier survival curves, restricted cubic spline, and subgroup analysis were used to examine the association between OBS and SBP, DBP, estimated pulse wave velocity (ePWV), and mortality risk.

Results: The results showed that individuals in the highest OBS quartile (27 ≤ OBS ≤ 40) had a significant 2.41 mmHg reduction in SBP compared to the lowest quartile (5 ≤ OBS ≤ 15) ( Ptrend  < 0.001). Compared to the lowest quartile, individuals in the highest OBS quartile had a 29% lower risk of all-cause mortality and a 44% lower risk of cardiovascular disease mortality ( Ptrend  < 0.001). This inverse association persisted irrespective of antihypertensive medication use. OBS is inversely associated with SBP, all-cause, and cardiovascular disease mortality in hypertensive patients.

Conclusion: This finding provides new evidence and suggestions for those with poor blood pressure control and low OBS (<15) to adjust their diet and lifestyle reasonably.