Journal of Hypertension最新文献

Background: Although the invasive measurement of intra-arterial pressure is considered the gold standard, it is not feasible for routine clinical practice. This study aimed to investigate the prognostic value of invasively measured aortic pulse pressure (aPP) in patients undergoing invasive coronary angiography (ICA).

Methods: A total of 1110 patients who underwent ICA (mean age 65 years, 35.5% female) were prospectively enrolled. Just before ICA, aortic pressures were measured using a pigtail catheter positioned 3 cm above the aortic valve. Major adverse cardiovascular events (MACE), a composite of cardiac death, nonfatal acute myocardial infarction, coronary revascularization, and ischemic stroke, were assessed during clinical follow-up after ICA.

Results: During a median follow-up of 6.3 years (interquartile range, 2.8-8.9 years), there were 153 cases of MACE (13.8%). Patients with MACE had a higher aPP compared to those without MACE (83.0 ± 25.3 vs. 62.9 ± 18.1 mmHg; P < 0.001). Kaplan-Meier survival analysis demonstrated that a higher aPP (≥78 mmHg) was associated with an increased risk of MACE (log-rank P < 0.001). Multiple Cox regression analysis revealed that an increase in aPP by 10 mmHg was significantly associated with a higher risk of MACE, even after adjusting for potential confounders (hazard ratio, 1.68; 95% confidence interval, 1.49-1.82; P < 0.001).

Conclusion: Invasively measured aPP is a strong and independent predictor of long-term cardiovascular outcomes in patients undergoing ICA. aPP could be a valuable addition to current risk assessment tools in this high-risk population.

Introduction: Treatment-resistant hypertension (TRH) is defined as uncontrolled blood pressure despite the use of ≥3 antihypertensive medications at maximum tolerated doses. It is associated with increased risks of cardiovascular events, kidney disease, and mortality. White-coat hypertension, nonadherence, and inappropriate drug combinations overestimate its prevalence. The exact cause of TRH remains unclear, though obesity, obstructive sleep apnoea, and sympathetic overactivity may contribute. This study aimed to better understand the factors associated with true TRH.

Methods: Adult patients with treated hypertension without confirmed secondary causes from the West Midlands Hypertension Centre, UK were recruited for comprehensive evaluation. Patients underwent thorough clinical assessment, including tests for endothelial function, body composition, arterial stiffness, sleep study, and inflammation and endothelial biomarkers; comparing true TRH with non-TRH patients.

Results: Of 141 patients, 60 (43%) had true TRH after excluding whitecoat effect, secondary hypertension and medication nonadherence. The TRH patients were significantly older, had a longer duration of hypertension, and more frequently had diabetes. They had higher rates of left ventricular hypertrophy, higher extracellular water, lower eGFR, and higher urine albumin. They also had higher cardiac biomarkers, (serum NT-proBNP and hs-troponin), inflammatory markers (serum free light chains), aldosterone:renin ratio, and serum Endothelin-1. There was no difference between the groups in adjusted arterial stiffness, reactive hyperaemia or overnight pulse oximetry. Multivariate analysis identified only NT-proBNP as a significant factor associated with TRH (P = 0.027).

Conclusion: The FACT-RHY study provides valuable insights into the possible pathophysiological mechanisms of TRH. These results emphasize the need for further research into the mechanisms underlying TRH and potential management strategies.

Objective: The relation between classical orthostatic hypotension (cOH) and supine hypertension is largely unknown. We investigated the relative contributions of heart rate (HR), stroke volume (SV) and total peripheral resistance (TPR) to supine and upright blood pressure (BP).

Methods: In this retrospective study, tilt tests were divided in four groups: 19 normotensive and 61 hypertensive controls, 50 cOH patients with SH (cOH/SH+) and 30 without (cOH/SH-). Hypertension was defined as supine SBP at least 140 mmHg. We used linear regression to relate cOH severity to supine SBP, and the logratio method to analyse relative contributions of HR, SV and TPR. P values less than 0.003 were considered significant.

Results: High supine SBP was associated with high TPR in patients and controls. Orthostatic SBP decrease in cOH was larger in those with higher supine SBP. The main parameter explaining this effect was a high supine TPR that did not increase after tilt in cOH/SH+ compared to cOH/SH- (logratio difference, P  < 0.002). SV logratio decreased more in cOH/SH- than in cOH/SH+ ( P  < 0.003), and HR logratio contributed similarly to orthostatic SBP in both cOH groups ( P  = 0.028).

Conclusion: While high supine TPR explained SH, a failure to further increase upright TPR explained the orthostatic SBP fall in patients. Autonomic failure can explain the SBP fall but not directly the high supine TPR that causes SH. We assume that slow-acting humoral vasoconstrictors are triggered in the upright position and continue to act after tilting back, causing high TPR and SH.

Background: Gut microbiota is essential in hypertension pathogenesis, and dietary patterns modulate microbial diversity and metabolic function. Specific associations between dietary index for gut microbiota (DI-GM) and hypertension remains unclear.

Objective: To explore associations between DI-GM and hypertension risk.

Methods: We analyzed data from 11 429 participants in National Health and Nutrition Examination Survey (NHANES) 2005-2016. Weighted multivariate logistic regression and restricted cubic spline (RCS) models assessed DI-GM-hypertension relationship and nonlinearity. Subgroup analyses evaluated heterogeneity across populations.

Results: After full covariate adjustment, DI-GM showed a significant inverse association with hypertension [odds ratio (OR) = 0.95, 95% CI: 0.91-0.99]. Compared to the lowest quartile of DI-GM, the highest quartile was associated with a significant 21% reduction in the risk of hypertension (OR = 0.79, 95% CI: 0.66-0.96). No nonlinear relationship was detected ( P -nonlinear = 0.593). Subgroup analyses revealed stronger inverse associations in women, younger adults (20-44 years), college-educated individuals, unmarried/married/cohabiting participants, and never-smokers. Significant interactions were seen for marital status and smoking.

Conclusion: Higher DI-GM scores were significantly associated with a reduced risk of hypertension, with the most robust relationships observed among nonsmokers and individuals with partners. This suggests that future dietary interventions must fully account for population heterogeneity to achieve more precise hypertension prevention and management.

Inter-arm blood pressure differences (IABPDs) can be caused by atherosclerosis. We investigated 29 921 men and women aged 50-64 years from the nationwide population-based Swedish CArdio Pulmonary bioImage Study (SCAPIS) to evaluate if IABPD is related to risk factors for atherosclerosis and can be used as a marker of atherosclerosis as evaluated by coronary artery calcium score, arterial segment involvement score on computed tomography, carotid ultrasound, and ankle-brachial index (ABI). The overall prevalence of systolic IABPD at least 10 mmHg was 2110/29 921 (7.1%). Individuals with IABPD at least 10 mmHg were significantly ( P  < 0.001) older, more often women, had higher BMI, nonhigh-density lipoprotein cholesterol, triglycerides, SBP and DBPs, and were more likely to have diabetes. In unadjusted analyses, IABPD at least 10 mmHg was associated with presence of coronary atherosclerosis, with more carotid arteries with plaque, and with pathological ABI. These associations were largely attenuated after adjustment for cardiovascular risk factors (age, sex, nonhigh-density lipoprotein cholesterol, systolic BP, smoking, diabetes, and the use of BP lowering drugs). Only ABI retained significance after these adjustments. In conclusion, a systolic IABPD of at least 10 mmHg in middle aged men and women is common in the general population, and can be used as a screening tool for subclinical atherosclerotic changes in coronary, carotid, and lower extremity arteries. However, these relationships were largely explained by correlations between IABPD and traditional cardiovascular risk factors.

Objectives: This study aimed to investigate the association between the triglyceride-glucose (TyG) index and emotional states, including depression, anxiety, and stress, in adult men and women, considering their blood pressure (BP) status.

Methods: This cross-sectional study was conducted within the framework of the Tehran Lipid and Glucose Study, including 5379 adults (53.43% female). Participants were categorized into three groups based on their BP status: normotensive, suspected, and diagnosed hypertension. The TyG index was calculated, and emotional states were assessed using the Depression Anxiety Stress Scale-21 (DASS-21). Linear regression models were used to evaluate the mentioned association.

Results: Our findings showed a significant positive association between the TyG index and emotional states, including depression, anxiety, and stress, only in women with diagnosed hypertension. Specifically, a one-unit increase in the TyG index was associated with an approximately 3-point increase in the scores of depression ( β  = 3.09, P  = 0.007), anxiety ( β  = 3.09, P  = 0.009), and stress ( β  = 3.09, P  = 0.007). No significant associations were observed between the TyG index and emotional states in men or across other BP groups.

Conclusion: The study highlights a stronger association between women's emotional well being and their metabolic health compared to men. Additionally, it underscores the critical importance of addressing emotional health in women with high TyG and diagnosed hypertension.

Arterial hypertension is a complex disorder influenced by extensive genetic variability, which contributes to interindividual differences in drug response by altering metabolism, transport, and receptor interaction. Current antihypertensive therapies effectively control arterial hypertension in only about half of patients, emphasizing the need for precise strategies. Genetic variation plays a crucial role in modulating drug response, and integrating this knowledge into clinical practice could significantly transform the management of hypertension through personalized medicine. This review examines the impact of genetic factors on the efficacy of antihypertensive drug classes, including angiotensin converting enzyme inhibitors and calcium channel blockers. It also examines advances in pharmacogenomic research that can aid in tailoring drug selection and dose adjustment based on genetic profiles. Beyond genomics, this review also highlights the impact of multiomics approaches, such as proteomics, metabolomics, and microbiomics, in advancing precision medicine and enabling a comprehensive, personalized approach to hypertension management. Pharmacogenomics can help refine hypertension care, improve patient outcomes, and reduce the burden of the disease. The future of hypertension treatment lies in precision medicine, where therapy is tailored to individual needs for effective and personalized management.