Journal of Hypertension最新文献

Objective: Preeclampsia imposes significant cardiovascular stress and frequently diastolic dysfunction. New recommendations advise multimodal assessments of cardiac function. The Heart Failure Association - Pretest assessment, Echocardiography and Functional testing, and Final etiology (HFA-PEFF) scoring system integrates echocardiographic indices and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and provides a structured way to characterize cardiac function. This study applied the HFA-PEFF algorithm to assess cardiac function in preeclampsia and its association with maternal and fetal outcomes.

Methods: This prospective observational study was conducted between 2019 and 2022. Ninety women with preeclampsia and 46 normotensive controls were assessed using echocardiography and NT-proBNP levels according to the HFA-PEFF scoring system. Patients were categorized into high (≥5 points), intermediate (2-4 points), or low (0-1 points) score groups. Maternal and fetal outcomes were recorded.

Results: Women with preeclampsia were more frequent in the high (27 vs. 0%) and intermediate (56 vs. 28%) score groups and less frequent in the low-score group (18 vs. 72%, P  < 0.001) compared to controls. The median HFA-PEFF score was 3 points [interquartile range (IQR) 2-5] in women with preeclampsia and 1 point (IQR 0-2) in controls ( P  < 0.001). The HFA-PEFF score groups did not relate to core outcomes overall but small-for-gestational age neonates and higher soluble fms-like tyrosine kinase-1/placental growth factor ratio (sFLT/PlGF) ratios were more common in the HFA-PEFF high-score group ( P  = 0.011, P  = 0.036).

Conclusion: The HFA-PEFF algorithm effectively detected cardiac dysfunction - reflected in structural changes, functional impairment, and elevated heart failure biomarkers - in women with preeclampsia. NT-proBNP may serve as potential screening tool for HFA-PEFF score.

Objectives: The association between blood pressure (BP) and the mortality risk may vary depending on the comorbidities. This study was conducted to investigate the subgroup-specific correlation between systolic BP (SBP) and mortality in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI).

Methods: The Clinical Deep Data Accumulation System for PCI (CLIDAS-PCI), a nation-wide multicenter database with seven tertiary medical hospitals in Japan, retrospectively collected data on patients undergoing PCI for acute coronary syndrome or stable coronary artery disease. Cubic spline curves modeled the relationship between SBP and all-cause death in the entire cohort and subgroups stratified by age, sex, diabetes, left ventricular (LV) hypertrophy, renal function and LV systolic function. We assessed the SBP, which minimizes mortality risk.

Results: A total of 8384 patients [71 [IQR 64, 78] years, 6494 (77%) male] with SBP at hospital discharge were analyzed. During 2.7 years of median follow-up, 695 deaths occurred. In the overall population, spline analysis demonstrated a nadir range of mortality risk around an SBP of 110-130 mmHg. Subgroup analyses revealed that elderly (age ≥ 80 years), those with renal dysfunction, and those with preserved LV systolic function had higher SBP levels associated with lowest risk. Conversely, patients <80 years, those with better renal function, and those with LV systolic dysfunction exhibited lower SBP levels at lowest risk.

Conclusion: This study demonstrated differential association between SBP and mortality risk in various subgroups, highlighting the need for personalized BP management in multimorbid patients with coronary artery disease.

Introduction: Given Croatia's high and rising prevalence of arterial hypertension, we aimed to investigate the population-level determinants of hypertension.

Materials: Out of 2049 individuals recruited in the EHUH 2 study (random sample), in this analysis, we included 864 individuals (men 34.5%) who provided valid 24-h urine samples. Data on demographics, lifestyle, clinical and laboratory parameters were collected. Hypertension was defined as blood pressure at least 140/90 mm Hg or antihypertensive use.

Results: Key determinants of hypertension included male sex [odds ratio (OR) 2.27], salt intake more than 5 g/day (OR 2.46), presence of diabetes (OR 1.95), residence in rural areas (OR 1.63) and a high sodium-to-potassium ratio (OR 1.24). Current smokers had fewer odds than nonsmokers (OR 0.55). When estimated pulse wave velocity (ePWV) was added, model 2 became stronger ( R2  = 0.455), and each increase of 1 m/s of ePWV increased odd for hypertension by 3.73. The higher prevalence of hypertension observed in rural areas was linked to low socioeconomic status, obesity and high sodium/potassium ratio. Ex-smokers had a higher risk obviously because they replaced one poor habit with another one.

Conclusion: Based on our results, we can recommend in low-medium-income countries like Croatia tailor screening programs for hypertension not only for individuals with chronic kidney disease, diabetes, or obesity but also for those with low socioeconomic status and rural residents. We can suggest that two low-cost methods, sodium-to-potassium ratio and ePWV, become a regular routine part of these screening programs. In smoking cessation programs, smokers should be educated how to quit smoking, but also how to live healthier.

Introduction: Fibromuscular dysplasia (FMD) is a rare disease with diverse clinical presentations. The need for a bespoke clinic providing individualized care was deemed a patient priority at the United Kingdom's (UK) first patient information day on FMD. In response, a multidisciplinary clinic was established at Salford Royal Hospital in November 2019, integrating renal, neurology, interventional radiology, and neuro-radiology expertise. It has since evolved into the UK's first national FMD clinic. This study aimed to describe baseline patient characteristics and identify contributing factors in disease progression.

Methods and results: This prospective observational study included 215 patients reviewed over 5 years. All underwent brain-to-pelvis imaging at least once to radiologically confirm FMD. FMD mimics were identified more often than expected ( n  = 87, 40.4%), predominantly due to sub-optimal imaging artefacts. Of 128 confirmed FMD patients, median age was 49 years; focal FMD patients were younger than multifocal FMD patients [median (interquartile range or IQR): 44 (27-58) vs. 45 (36-49) years; P  = 0.038]. Sixty-seven percent were Caucasian and 85.3% female, and 66.7% had multivessel disease, 29.3 and 19.6% had aneurysms or dissections at presentation. Multifocal disease, aneurysms and dissections were more common in multivessel disease. Follow-up data defined risk factors for clinical or radiological disease progression: younger age at FMD onset [odds ratio (OR) 0.97, P  = 0.042], current smoking (OR 3.78, P  = 0.006), baseline history of hypertension (OR 6.2, P  = 0.017).

Conclusion: This study emphasizes the importance of a dedicated multidisciplinary FMD service for confirming diagnosis and identifying FMD mimics to facilitate personalized care. Early diagnosis, smoking cessation and blood pressure management are key to preventing disease progression.

Objectives: Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are linked to later-life cardiovascular disease, but their impact on midlife cardiac health is unestablished. Therefore, we examined their associations with midlife left ventricular remodeling.

Methods: This study included 408 and 451 women from the Bogalusa Heart Study cohort with information on HDP and GDM, respectively. Of these, 34 had HDP and 41 had GDM. Mean echocardiographic follow-up was approximately 15 years after pregnancy. Outcomes included left ventricular mass index (LVMi), ejection fraction (LVEF), and left ventricular geometry (concentric remodeling, concentric or eccentric hypertrophy). Multivariable regression was adjusted for demographic and prepregnancy cardiometabolic factors. Effect modification by age and race and mediation by postpregnancy cardiometabolic factors were evaluated.

Results: Median age at first pregnancy was 22.0 years and 33.0% were Black. HDP was associated with greater LVMi in midlife (standardized β  = 0.37, 95% confidence interval [CI]: 0.01-0.72, P  = 0.04), but not with LVEF. HDP was also associated with greater odds of concentric remodeling (odds ratio = 2.48, 95% CI: 1.03-6.00, P  = 0.04). Postpregnancy BMI mediated 19.47% of the association between HDP and LVMi ( P  = 0.01). GDM was not associated with left ventricular structure or function after adjustment. Interaction terms by age and race were not significant.

Conclusion: HDP is associated with adverse left ventricular remodeling, partly mediated by postpregnancy BMI. These findings underscore the need for early echocardiographic monitoring and postpartum weight management in women with HDP to reduce long-term cardiovascular risk.

Introduction: Hypertensive urgency (HU) is a clinical condition characterized by rapid office blood pressure (BP) elevation in the absence of hypertension-mediated organ damage (HMOD).

Aim: To evaluate out-of-office BP levels and predictors of HU in adult outpatients with stage 3 hypertension.

Methods: We included patients who were consecutively referred for office and out-of-office BP assessment. All patients underwent BP measurements using a validated, oscillometric device (Mobil-O-Graph PWA Monitor, I.E.M. GmbH, Stolberg, Germany). Patients were stratified into two groups: grade 3 hypertension (either systolic BP ≥180 mmHg or diastolic BP ≥110 mmHg); HU (both systolic BP ≥180 and diastolic BP ≥110 mmHg).

Results: We identified 828 adult outpatients (42.6% women, age 56.5 ± 13.6 years, BMI 27.5 ± 5.2 kg/m 2 , 55.2% on therapy), among whom 655 (79.1%) had grade 3 hypertension and 173 (20.9%) had HU. HU patients consistently showed significantly higher home (157.0 ± 25.3 vs. 146.9 ± 20.4 mmHg), 24-h (155.6 ± 18.3 vs. 143.2 ± 13.7 mmHg), daytime (160.5 ± 18.2 vs. 147.7 ± 13.9 mmHg), and night-time (143.2 ± 20.1 vs. 131.0 ± 16.1 mmHg) systolic BP values than those with stage 3 hypertension, even when treated. Diastolic BP levels were also higher at all BP measurements. Female sex [odds ratio (OR) 0.53 (95% confidence interval (CI) 0.32-0.86); P  = 0.010], age >50 years [OR 2.57 (95% CI 1.48-4.69); P  = 0.001], smoking [2.03 (1.21-3.37); P  = 0.006], home diastolic [OR 1.02 (95% CI 1.00-1.04); P  = 0.013] and daytime systolic [OR 1.04 (95% CI 1.03-1.06); P  < 0.001] BP were independent predictors of having HU at multivariate analysis.

Conclusions: HU outpatients showed persistently higher out-of-office BP levels than those with stage 3 hypertension, even when treated.

Background: Hypertension is the leading modifiable risk factor for cardiovascular disease in the UK and Ireland, yet significant implementation gaps and health inequalities in hypertension management persist. The British and Irish Hypertension Society (BIHS), in collaboration with the British Heart Foundation Clinical Research Collaborative (BHF-CRC), undertook the first national initiative to identify priority areas for future hypertension research.

Methods: A modified Delphi approach, informed by James Lind Alliance methodology, was used to gather and rank research questions. The process involved clinicians, allied health professionals, researchers, and patients, supported by a multidisciplinary steering group. Questions were refined through iterative surveys and a final consensus workshop.

Results: From an initial list of 66 research questions, 38 were shortlisted for the prioritisation exercise, which resulted in a Top 10 list of national hypertension research priorities.Key themes included digital and remote monitoring, reducing health inequalities, supporting treatment adherence, and determining the role of blood pressure management in preventing dementia, frailty-related outcomes, and kidney disease. Priorities also addressed optimal treatment targets, home versus clinic monitoring, and the impact of new obesity therapies on cardiovascular health.

Conclusion: This is the first structured, consensus-driven national initiative to recommend hypertension research priorities in the UK and Ireland. The resulting Top 10 reflect a shift towards person-centred research that emphasises implementation, digital innovation, and equity, alongside pharmacological and mechanistic studies. These priorities provide a roadmap for funders, policymakers, and researchers to address unmet clinical needs and improve outcomes for people living with hypertension.

Objective: We evaluated Australian adults' knowledge on the risk factors and complications of hypertension to identify areas of poor understanding.

Methods: In 2024, an adapted validated hypertension-knowledge survey was distributed to participants who had used kiosk BP stations in retail stores across metropolitan and remote Australia. Kiosk stations collected measured and self-reported data.

Results: A total of 826 participants (51% male; mean age 52 ± 16 years; 36% with a history of hypertension) completed the survey. Participants generally demonstrated a good understanding of hypertension risk factors, with 90% recognizing that being overweight increases risk, and that exercise helps lower BP. Twenty-seven percent were unaware that hypertension is usually asymptomatic; 41% did not know that stress is not its main cause; and 42% were unaware of the importance of medication adherence. Seventy-three percent and 77% were unaware of the increased risk of dementia and kidney disease, respectively.People with a history of hypertension (vs. no hypertension; P  = 0.01) and those in outer regional areas (vs. major cities, inner regional, or remote; P  = 0.011) had better knowledge. Individuals who were unemployed or had lower educational backgrounds (both P  < 0.001) had poorer knowledge. Kiosk BP readings and the use of antihypertensive medications were not associated with knowledge scores.

Conclusions: Public misconceptions regarding hypertension persist. With three in four participants unaware that hypertension increases the risk of dementia and kidney disease, and with limited understanding of the importance of medication adherence, educational efforts are essential, particularly among people who are unemployed or have lower educational backgrounds.

Objective: Blood pressure (BP) typically decreases during sleep, known as the "dipping" pattern. A "nondipper", characterized by <10% BP reduction during sleep, has an elevated cardiovascular risk. Intermittent hypoxia (IH) is used to model hypertension with sleep apnea, but its relation with BP dipping and its effect on the kidney remains unclear.

Methods: Male C57BL/6J (WT) mice were exposed to either normoxia (NX) or IH (O 2 concentration reduced to 5% in 90 s every 3 min during 8 h within the light period, for >1 week). BP was measured by radiotelemetry, and the dipping state was assessed by comparing mean BP (MBP) between light and dark periods. High- or low-salt diet (8% or 0.05% NaCl) and Slc12a3-/- mice (NCC-KO) were used to clarify the role of renal mechanism in the IH model mice.

Results: WT mice exhibited a dipping BP pattern under NX, but showed a nondipping pattern under chronic IH. Low-salt diet restored the dipping pattern and high-salt diet reinduced the nondipping one in the IH-model mice. Chronic IH increased the phosphorylation of Na-Cl cotransporter (NCC) and Na-K-Cl cotransporter (NKCC2) in the kidney, without affecting ENaCα cleavage. Even NCC-KO mice showed a dipping pattern of BP under NX, which shifted to a nondipping pattern under chronic IH. As expected, treatment with furosemide restored the dipping pattern in NCC-KO mice under chronic IH.

Conclusions: Chronic IH disrupts the physiological dipping pattern of BP through NCC and NKCC2 activation. This study underscores the kidney's role in the pathophysiology of nondippers with sleep apnea.

Background: Blood pressure variability (BPV) is an independent predictor of cardiovascular events, yet its relationship with daily sleep remains unclear. This study examined whether objective and subjective sleep measures are associated with short-term BPV among adults with elevated clinic blood pressure.

Methods: In a cross-sectional baseline analysis from a behavioral sleep-extension trial, adults aged 18-65 years with self-reported short sleep (<7 h/night) and clinic blood pressure 120-150/80-90 mmHg completed seven days of wrist actigraphy and 24-h ambulatory blood pressure monitoring. Objective sleep measures were actigraphy-derived sleep efficiency and total sleep time (TST). Subjective measures included the Insomnia Severity Index and PROMIS Sleep Disturbance and Sleep-Related Impairment scales. BPV was quantified as the average real variability of systolic and diastolic pressures. Linear regression models adjusted for age, sex, and race; additional adjustment for BMI left the diastolic association significant ( P  = 0.003) and the systolic association marginal ( P  = 0.056).

Results: Among 200 participants (mean age 42 ± 11 years), higher sleep efficiency was associated with lower systolic and diastolic BPV ( P  < 0.05). TST and subjective sleep measures were not independently related to BPV. Hourly BPV profiles showed peak variability in early morning and late afternoon periods.

Conclusions: Among adults with elevated blood pressure, better sleep efficiency, but no longer sleep duration or perceived sleep quality, was linked to lower short-term BPV. Interventions improving sleep efficiency may offer cardiovascular benefits beyond extending sleep duration.