Journal of Hypertension最新文献

Objectives: Home blood pressure monitoring (HBPM) is valuable for the detection and monitoring of hypertension. Despite logistical advantages, HBPM has not yet been used in national blood pressure (BP) surveys. We investigated randomly selected adults' willingness to participate in an HBPM study (attitude survey) and piloted this approach (feasibility study).

Methods: The attitude survey, part of the 2020 population representative cross-sectional telephone interview survey, German Health Update (GEDA), assessed willingness to self-measure BP on three days in the morning and evening in 6517 participants. Descriptive analyses and weighted log-binomial regression were used to examine associations between willingness to participate in HBPM and sociodemographic and health factors. The feasibility study piloted self-measurements with mailed devices, video instructions, and before and after online interviews with 258 commercial panel volunteers.

Results: In the attitude survey, 38% of randomly selected adults expressed willingness to participate in the HBPM study. Willingness to participate was associated with higher education [risk ratio (RR) 1.63, 95% confidence interval (CI) 1.37-1.94] and medium education (RR 1.30, 95% CI 1.09-1.56) compared to low education, ages 18-39 (RR 1.69, 95% CI 1.45-1.97) and 40-59 (RR 1.37, 95% CI 1.20-1.58) compared to participants from age 60s, and self-reported hypertension (RR 1.19, 95% CI 1.04-1.36). In the feasibility study, 43% ( n  = 110) of those receiving a device completed the study.

Conclusion: Our findings suggest that national BP studies cannot rely solely on HBPM because selective participation would yield biased results. However, HBPM may be used in other epidemiological studies, such as longitudinal studies.

Objectives: Greater vulnerability of Black vs. White individuals to cardiovascular disease (CVD) and chronic kidney disease (CKD) is well charted in the United States, but studies involving sub-Saharan blacks are scarce.

Methods: Baseline data (2021-2024) were collected in 168 sub-Saharan Blacks and 93 European Whites in an ongoing clinical trial (NCT04299529), using standardized patient selection criteria. Data included clinical and biochemical risk factors, ECG and echocardiographic traits, Framingham CVD risk, CKD grades (KDIGO 2024), self-assessed symptoms (WHO questionnaire), and urinary proteomic profiles predictive of left ventricular dysfunction (LVD) and CKD, HF1, and CKD273, respectively. Racial comparisons rested on unadjusted and multivariable-adjusted analyses.

Results: Despite being younger (60.4 vs. 68.3 years), blacks had a worse risk profile, as evidenced by higher diabetes prevalence, higher BMI, faster heart rate, unfavourable serum cholesterol fractions, lower estimated glomerular filtration rate, microalbuminuria, and sedentary lifestyle. This resulted in blacks having higher 10-year CVD risk, higher heart age (index of vascular ageing with chronological age as reference), and a worse CKD grades. In both races, CKD273 increased with CKD grade, but CKD273 and HF1 were not different by race. These observations were robust in subgroup and adjusted analyses.

Conclusion: This study did not differentiate host (genetic, molecular, and pathogenic) from environmental drivers of disease. Nonetheless, the findings call for a multipronged and comprehensive implementation of innovative health policies in sub-Saharan countries. Education, research, empowerment of stakeholders, and international learned societies connecting experts from a wide array of disciplines should vigorously sustain this effort.

Objective: The objective of this study was to examine the relationship between systemic inflammation and long-term mortality in patients with hypertension.

Methods: The study employed a retrospective cohort design. The study population was derived from the National Health and Nutrition Examination Survey (NHANES), and the mortality data for this population was acquired from the National Death Index (NDI) database. Systemic inflammation was quantified by the Systemic Immune Inflammation Index (SII) and the Systemic Inflammatory Response Index (SIRI), which were then categorized into four groups (Q1-Q4, with Q4 representing the highest level of SII or SIRI). Weighted Cox regression models were constructed to investigate the association between mortality and SII and SIRI, with hazard ratios (HRs) subsequently calculated.

Results: A total of 7431 participants were included in the analysis. The highest quantile (Q4) of SII was associated with a higher risk of all-cause mortality (hazard ratio 1.36, 95% CI 1.1-1.69, P  < 0.001). After adjustment for important covariates, the association remained significant (hazard ratio 1.70, 95% CI 1.27-2.30, P  < 0.001). The highest quantile (Q4) of SIRI was also associated with the highest risk of mortality (hazard ratio 2.11, 95% CI 1.64-2.70, P  < 0.001), and this association remained significant after adjustment for important covariates (hazard ratio 1.64, 95% CI 0.61-1.22, P  = 0.001).

Conclusion: Both SII and SIRI scores were found to be associated with mortality rates in patients with hypertension. The findings suggest that these scores may serve as complementary biomarkers to the neutrophil-to-lymphocyte ratio (NLR) for assessing mortality risk in patients with hypertension. Further investigation is warranted to elucidate the underlying mechanisms that underpin this association.

Objective: Ibrutinib has been the first Bruton tyrosine kinase inhibitor (BTKi) authorized for the treatment of B-cell lymphoproliferative disorders (B-LPDs). Numerous publications have confirmed the efficacy of this orally administrated drug in chemo-free regimens for B-LPDs. They also reported several adverse events (AE) associated with ibrutinib treatment. Whether these AEs depended on ibrutinib exposure has however been seldom explored.

Methods: In the study reported here, the incidence of AE was recorded in 92 patients with B-LPD (mostly chronic lymphocytic leukemia n  = 79) for whom ibrutinib alone was proposed as fist line therapy. Moreover, a pharmacokinetics (PK) exploration was planned over one day after 1 month treatment. PK assays included drug and metabolite (DHD-ibrutinib) mean/median and maximal plasmatic concentrations as well as areas under the curve (AUE) data.

Results: This PK evaluation was analyzed regarding AEs recorded over the first year of therapy, which were similar as in published reports. PK data disclosed a significant impact of ibrutinib exposure on infections but mostly on the occurrence of hypertension. The latter was mostly related to dihydrodiol-ibrutinib (DHD-ibrutinib) exposure.

Conclusions: These data suggest that a DHD-ibrutinib assay after one month of treatment could be interesting to consider a lower dosage for patients above maximal concentration thresholds for the drug, its metabolite or the sum of both. Whether this can be applied to newer BTKi remains to be explored but it could be important for patients to whom ibrutinib is proposed.

Objectives: Hypertension guidelines recommend the use of single-pill combinations (SPCs) of antihypertensive drugs to improve treatment persistence and blood pressure control. This study aimed to investigate the long-term effects of ramipril/amlodipine (R/A) SPC versus free equivalent dose combinations (FEC) on cardiovascular outcomes and treatment persistence.

Methods: This retrospective, observational study analysed the database of the Hungarian National Health Insurance Fund. The study included patients with hypertension aged at least 18 years who were initiated on R/A SPC or FEC of different dose combinations (R/A 5/5, 5/10, 10/5 and 10/10 mg) between 2012 and 2018, with follow-up for up to 60 months. Imbalances in baseline characteristics were reduced with propensity score-based sub-classification. All analyses were performed with Cox proportional hazard model and propensity score sub-classification to adjust the imbalances in baseline characteristics. Drug persistence and MACEs were the primary and secondary endpoints, respectively.

Results: Overall, 104 882 patients with SPC and 68 324 patients with FEC-treated hypertension were included. The R/A 5/5 mg combination represented the largest proportion (62%). The nonpersistence rate was significantly lower with SPC than with FEC from month 1 to month 24 in the R/A 5/5 mg combination ( P  < 0.001) and during the entire observation period in the remaining combinations. The MACE rate was significantly reduced with all R/A SPCs versus FECs. No effects on age and sex on both endpoints were noted.

Conclusion: This study further supports the beneficial effects of the use of SPC on 60-month persistence and MACEs in hypertension.

Objectives: The effects of acute physical exercise in patients with resistant hypertension remain largely unexplored compared with hypertensive patients in general. We assessed the short-term effects of acute moderate-intensity (MICE) and high-intensity interval exercise (HIIE) on the clinic (BP) and 24-h ambulatory blood pressure (ABP) of patients with resistant hypertension.

Methods: Using a crossover randomized controlled design, 10 participants (56 ± 7 years) with resistant hypertension performed three experimental sessions: MICE, HIIE, and control. MICE consisted of continuous treadmill exercise at an intensity of 3-4 metabolic equivalents of energy (METs) until completing 3 kcal/kg and was energy-matched to HIIE (which included six to eight intervals of 3 min duration at 6-7 METs interspersed with 1.5-min rests at 3 METs). In the control session, participants remained seated for 50 min. Flow-mediated vasodilation, autonomic nervous system balance (heart rate variability), exerkines [interleukin (IL)-6, IL-8, IL-15, vascular endothelial growth factor A, irisin, adiponectin, and angiopoietin] and 71 inflammatory-related proteins were also measured.

Results: Compared with baseline, HIIE and MICE reduced clinic SBP immediately ( P  < 0.001 for both) and 90 min ( P  = 0.001 and P  = 0.041, respectively) postexercise. HIIE and MICE also reduced clinic DBP immediately postexercise ( P  = 0.003 and P  = 0.025). By contrast, no changes were found in the control session. On the other hand, no significant effects were noted for 24 h ABP measures or for the rest of variables.

Conclusion: Although in patients with resistant hypertension, acute aerobic exercise induces short-term reductions in clinic BP, this stimulus does not suffice to reduce 24 h ABP or to impact on potential biological mechanisms.

Objective: Hypertension (HTN) increases cardiovascular risk and is a frequent finding across all solid organ transplant recipients. We describe the prevalence of HTN and uncontrolled HTN, as well as details on pharmacologic treatment of HTN across solid organs transplant recipients up to five years after transplantation.

Methods: This retrospective study is nested in the prospective Swiss Transplant Cohort Study ( www.stcs.ch ) that includes kidney, heart, lung, and liver transplantation. Data extraction from 2008 to 2019 was used for this study and follow-up data at 6, 12 and 60 months was analyzed.

Results: A total of 3865 transplant recipients were included for analysis. The prevalence of HTN at 6 and 60 months was 88.9% and 90.4% in kidney ( P  = 0.21), 61.8% and 76.1% in liver ( P  < 0.01), 72.6% and 84.9% in lung ( P  < 0.01), and 89.3% and 85.8% in heart ( P  = 0.33) transplant recipients, respectively. The prevalence of uncontrolled HTN at 6 and 60 months was 40.3% and 38.9% in kidney ( P  = 0.48), 21.2% and 30.5% in liver ( P  = 0.05), 26.0% and 36.8% in lung ( P  = 0.03) and 38.9% and 18.5% in heart ( P  < 0.01) transplant recipients, respectively. At 12 months, compared to heart transplant recipients, kidney [odds ratio (OR) = 1.6, 95% confidence interval (CI) 1.1-2.1], liver (OR = 1.7, 95% CI 1.1-2.6) and lung (OR = 2.6, 95% CI 1.6-4.0) transplant recipients had a higher likelihood of presenting with uncontrolled HTN.

Conclusion: HTN prevalence after solid organ transplantation is high. Uncontrolled and untreated HTN remain a major issue post transplantation, particularly in organ recipients not necessarily suffering from cardiovascular diseases such as liver or lung transplant recipients.

Objective: Home blood pressure (BP) variability (BPV) and BP phenotypes such as white-coat hypertension (WCH), white-coat uncontrolled hypertension (WUCH), masked hypertension (MH) and masked uncontrolled hypertension (MUCH) are predictors of adverse cardiovascular events. This study compared home BPV across BP phenotypes built from abnormal office BP (OBP) and home BP monitoring (HBPM) thresholds defined by three distinct societies [European Society of Hypertension (ESH): OBP ≥ 140/90 mmHg and HBPM ≥ 135/85 mmHg; American College of Cardiology/American Heart Association (ACC/AHA): OBP and HBPM ≥ 130/80 mmHg and Brazilian Society of Cardiology (BSC): OBP ≥ 140/90 mmHg and HBPM ≥ 130/80 mmHg].

Methods: This cross-sectional study evaluated 51 194 treated (37% men, age = 61 ± 15 years) and 56 100 untreated (41% men, age = 54 ± 16 years) individuals from 1045 Brazilian centers who underwent OBP and HBPM measurements. Systolic and diastolic home BPV were estimated as the: standard deviation, coefficient of variation, and the variability independent of the mean of HBPM.

Results: Results of adjusted analysis showed that home BPV parameters were significantly greater in individuals with WCH/WUCH according to the BSC criteria, in those with MH/MUCH defined by the ACC/AHA criteria, and tended to be greater in individuals with either MH/MUCH or WCH/WUCH defined by the ESH criteria.Furthermore, restricted cubic spline analysis showed a U-shaped association between BPV and the difference between OBP and HBPM in treated and untreated individuals.

Conclusion: Home BPV was greater in WCH/WUCH and/or MH/MUCH depending on the criteria used to define abnormal OBP and HBPM thresholds. These findings underscore the need to standardize abnormal BP criteria in clinical practice.

Hypertension (HTN) is recognized as a major modifiable risk factor for cardiovascular deaths in South Asia. Our aim was to furnish a comprehensive analysis of HTN prevalence, trends, control efforts, awareness, barriers in care delivery and associated factors, based on nationally derived evidence in Sri Lanka. A systematic search of online databases ( PubMed, Web of Science, Scopus ), local journals and repositories yielded 6704 results, of which 106 were included. Prevalence of HTN steadily increased from 23.7% (2005-2006) to 34.8% (2021). Associated factors identified were hyperhomocysteinaemia [odds ratio (OR) 2.80], overweight/obesity (OR 2.02), perceived job stress (OR 2.20-3.02), physical inactivity (OR 2.08-2.80), salt intake more than 5 g/day (OR 2.50), smoking (OR 2.31) and waist-to-height ratio more than or equal to 0.5 (OR 2.23). Cohort studies revealed poor blood pressure control and treatment adherence among patients. Pharmacological ( n  = 4) and nonpharmacological ( n  = 6) interventional studies were few. Studies on knowledge, attitudes and practices demonstrated a lack of public awareness. Despite the high prevalence of HTN in Sri Lanka, many cases remain undiagnosed, underscoring importance of targeted screening programmes and culture-specific public health education programmes.