Journal of Hypertension最新文献

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.

Proteinuria is a key marker of renal damage and is often associated with hypertension and increased cardiovascular risk. This study reviews and brings the potential involvement of renal nerves in the pathophysiology of proteinuria and renal impairment in clinical and experimental studies. Studies have highlighted that increased activation of renal sympathetic and sensory nerves activity either alone or in combination with the renin-angiotensin-aldosterone system (RAAS) contributes to the development of proteinuria and the decline in renal function. This phenomenon may occur through mechanisms that alter glomerular and/or tubular function. Additionally, interventions aimed at disrupting renal nerve activity, including pharmacological agents and surgical denervation, or RAAS blockade demonstrated a significant reduction in proteinuria and improved renal and cardiovascular outcomes. Here, we highlight the potential roles of renal nerves beyond their traditional effects on renal function, such as albumin reabsorption, glomerular function, and renal damage, in the onset and maintenance of cardiovascular disease and hypertensive nephropathy.

Objectives: Isometric exercise is an accessible, time efficient intervention for reducing blood pressure (BP). However, guideline recommendations for its use remain sparse due to safety concerns. This study aimed to determine the proportion of participants whose BP exceeded predefined limits during isometric exercise. Secondary aims were to examine differences in BP responses between sexes and across exercises.

Methods: Participants attended the laboratory for two sessions: screening and familiarisation, and exercise testing. In session two, participants performed the plank and wall sit in a randomised order while their BP was continuously monitored noninvasively using the Finapres NOVA. Each exercise was performed until volitional fatigue or until reaching the American College of Sports Medicine limits of SBP (>250 mmHg) or DBP (>115 mmHg).

Results: Sixty-two apparently healthy participants completed the study (age 26.7 ± 8.2 years, 52% women, resting BP 121 ± 8/77 ± 6 mmHg). Almost all participants were stopped [plank: 97% (95% confidence interval, 95% CI 89-99); wall sit: 98% (95% CI 91-100)] due to DBP more than 115 mmHg after an average of approximately 50 s of exercise. All women exceeded the DBP limit [plank: 100% (95% CI 89-100); wall sit: 100% (95% CI 89-100)] compared to most males [plank: 93% (95% CI 78-99); wall sit: 97% (95% CI 83-99)]. No participants reached the SBP limit. No adverse events were reported.

Conclusion: Common isometric exercises cause a marked increase in BP, particularly DBP. Despite this, no adverse events occurred. Future studies should examine the dose-response of different isometric exercises in higher risk populations to better inform its clinical suitability.

Objective: Diagnostic criteria for an exaggerated BP increase in response to standing (ERTS) are still debated making it difficult to interpret data regarding the cardiovascular risk associated with ERTS. The aim of the present study was to identify the ERTS definition that was most strongly associated with cardiovascular disease.

Design and methods: The study was conducted within the frame of the PARTAGE study, in 920 individuals aged 80 years or older. BP was measured 1 min and 3 min after standing up. Participants were classified into three groups according to whether they had normal response to standing (reference group), orthostatic hypotension, or ERTS defined using 16 different definitions. The risk of adverse cardiovascular outcomes was explored by means of multivariable survival Cox analyses.

Results: ERTS was associated with both cardiovascular events and mortality when it was identified according to three definitions: SBP ≥20 mmHg in either orthostatic measurement [hazard ratios (HRs) (95% confidence interval, CI), 1.45 (1.03-2.03; P  = 0.031)] and 1.71 (1.05-2.77; P  = 0.030), respectively; SBP ≥15 mmHg in either orthostatic measurement ((1.43 (1.03-1.99; P  = 0.032) and 1.82 (1.12-2.94; P  = 0.015)), respectively; and SBP ≥20 mmHg and/or DBP ≥15 mmHg in either orthostatic measurement ((1.42 (1.03-1.98; P  = 0.035) and 1.94 (1.19-3.17; P  = 0.008)), respectively. The best model fit was found for SBP and DBP combined. No independent association with both outcomes was found for other ERTS definitions.

Conclusions: The present results show that an SBP increase of >15-20 mmHg is a more important prognostic indicator than less pronounced increases of SBP. However, associating also an increase in DBP of ≥15 mmHg slightly increased the predictive value of ERTS.

Upon hypoosmotic stimulation, cardiomyocytes undergo a transient positive inotropic effect (Pie) associated with an increase in the amplitude of intracellular Ca2+ transients. However, the underlying mechanisms remain elusive. The Transient Receptor Vanilloid 4 channel (TRPV4) promotes Ca2+ entry and, thus, could contribute to hypotonic swelling-induced Pie. TRPV4 have not been studied in spontaneously hypertensive rats (SHRs). We aimed to determine if TRPV4 contributes to swelling-induced Pie in Wistar rats and if this response is altered in SHR. Cardiomyocytes were isolated from 8 to 12-month-old Wistar and SHR rats. Contractility was assessed by video-edge-detection in myocytes superfused with isotonic (309 mOsm) or hypotonic solution (217 mOsm). TRPV4 expression was assessed by western blot. The slow force response (SFR) was examined in papillary muscles from SHR stretched from 92 to 98% of their maximal length. While TRPV4 inhibition with GSK2193874 (GSK; 300 nmol/l) or HC067047 (1 μmol/l) did not affect the hypotonic solution induced Pie in Wistar myocytes, it was significantly reduced in SHR. Consistently, TRPV4 expression was enhanced in SHR hearts and myocytes. Disruption of caveolae with 5 mmol/l methyl-β-cyclodextrin and inhibition of microtubule polymerization with 10 μmol/l Colchicine, reduced the GSK-sensible component of the hypotonic solution induced Pie. GSK also blunted the SFR in SHR papillary muscles. We conclude that TRPV4 do not contribute to the hypotonic solution induced Pie in Wistar rats but provide Ca2+ entry that amplifies this response in SHR. Intact caveolae and microtubule integrity are required for TRPV4 activation in SHR myocytes. In SHR hearts, TRPV4 can be activated by cardiac stretch contributing to the SFR.

Background: The magnitude of the association between fibromuscular dysplasia (FMD) and spontaneous cervical artery dissection (sCeAD) remains uncertain, since data available derive from uncompleted vascular screening. This study aims to assess the frequency and types of cervical and extra-cervical arterial lesions, particularly of the FMD type, in patients with sCeAD.

Methods: We recruited all patients with a diagnosis of sCeAD from January 2016 to December 2023. All patients underwent full-body vascular imaging to assess the presence of cervical and extra-cervical multifocal and focal stenosis, aneurysms, dissections, tortuosity, ectasia/dilatation or parietal irregularities.

Results: Of the 94 patients included (65.7% male; 48.8 ± 8.7 years old), 31.9% had evidence of cerebrovascular FMD. After a whole-body vascular screening, all-type of extra-cervical vascular abnormalities were identified in 47.5% of patients. Twenty-one percent of patients (21.3%) had evidence of extra-cervical FMD, affecting renal (11.5%), visceral (13.1%), and limb (6.7%) arteries. Prevalence of extra-cervical dissections and aneurysms was 14.8% and 9.8%, respectively. After a whole-body screening, overall prevalence of FMD raised from 32.8% to 39.3%. Patients with FMD were mainly female ( P  < 0.0001), had a history of migraine ( P  = 0.023) and recurrent sCeADs ( P  = 0.025). After a multivariate analysis, female sex ( P  < 0.0001) and, almost, a positive history of recurrent sCeADs ( P  = 0.053) were identified as predictors of FMD in patients with sCeADs.

Conclusions: The study reveals a high prevalence of FMD and other vascular abnormalities outside the cervical arteries in patients with sCeAD, highlighting the importance of a comprehensive vascular screening, especially in women and in patients with a positive history of recurrent sCeAD.