Journal of Hypertension最新文献

Introduction: Hypertension remains the leading modifiable risk factor attributable to 10.8 million premature deaths. Hence the study of hypertension and gut microbiome as a therapeutic target is very important. Yet the links between the gut microbiome and long-term incidence of hypertension are unknown.

Aim: This study assessed the association between gut microbiome and incident hypertension.

Method: The study sample consisted of 3311 nonhypertensive individuals (60.7% women) aged 25-74  years who were drawn from the general population in Finland. In the baseline examination performed in the year 2002, the participants underwent a health examination and provided a stool sample. The gut microbiome was assessed using shallow shotgun metagenomic sequencing. Microbiome analyses were performed with Cox proportional hazards model.

Results: In total, 675 participants developed hypertension over a follow-up period of nearly 20 years. In multivariable-adjusted models, overall gut microbiome composition was not related to risk of future hypertension. Eight genera, including Agathobaculum, Blautia_A_141780, Blautia_A_141781, Mediterraneibacter_A_155590, Enterocloster, Bariatricus, CAG-317-146760, and CAG-628 were significantly associated with incident hypertension in the age-adjusted and sex-adjusted models, but none remained significant in the multivariable-adjusted models. No functional pathways were associated with hypertension risk.

Conclusion: Our results do not provide strong evidence for an association between the gut microbiome and risk of future hypertension, especially after adjusting for covariates that are known to influence the gut microbiome.

Background: Peripheral artery disease (PAD), assessed via the ankle-brachial index (ABI), is a recognized form of hypertension-mediated organ damage (HMOD). While alternative ABI calculations have shown improved sensitivity for PAD detection, their prognostic utility in hypertensive populations remains unclear.

Methods: In this prospective cohort study of 21 875 hypertensive individuals (ÉRV Study), we compared the prognostic performance of three ABI-based approaches: standard ABI using the higher ankle pressure (ABI-HIGH), ABI using the lower ankle pressure (ABI-LOW), and multivessel ABI scoring (number of vessels with ABI ≤0.90). The primary endpoint was all-cause mortality, assessed over a median follow-up of 5 years using interval-censored Cox regression.

Results: PAD prevalence was 14.4% using ABI-HIGH and 28.3% using ABI-LOW, with 13.9% of patients identified only by the latter. All PAD definitions were independently associated with mortality. ABI-LOW as a continuous variable demonstrated the strongest association (hazard ratio 1.87; 95% CI, 1.63-2.16). Multivessel ABI showed a dose-response relationship with mortality. However, overall discrimination was modest: time-dependent AUCs ranged from 0.608 to 0.635 for ABI-based models alone. When added to clinical predictors, ABI metrics improved the AUC to a range from 0.763 to 0.780, with added predictive value between 6 and 11%.

Conclusion: In hypertensive individuals, ABI-LOW and multivessel scoring identify more PAD cases and are independently associated with mortality. However, their incremental value in mortality risk prediction is limited. Alternative ABI methods may assist in identifying higher risk subgroups warranting further vascular assessment.

Background and objective: Blood pressure (BP) varies seasonally in inverse relation to temperature, although its impact on heart failure is poorly understood. The main objective was to compare BP readings between summer and winter using different measurement methods and to assess the clinical impact of these variations.

Materials and methods: This was an observational, prospective, cross-sectional study of 50 patients with reduced or improved heart failure and optimised treatment, conducted at a single centre in southern Spain. Each patient was evaluated in summer (June--August) and winter (December--February) using BP measurements in the clinic, 3 days of home self-measurement (HBPM), and 24-h ambulatory monitoring (ABPM), completing 1 year of follow-up.

Results: The mean age was 64 ± 12 years, 76% were men, with a mean ejection fraction of 43%. HBPM showed decreases in summer compared to winter in SBP (-7.6 mmHg; P < 0.001), DBP (-3.2 mmHg; P < 0.001) and mean BP (-4.6 mmHg; P < 0.001). ABPM detected slight daytime reductions in systolic (Δ -1.5 mmHg; P = 0.004), diastolic (Δ -2.2 mmHg; P = 0.001) and heart rate (Δ -3 bpm; P < 0.001), with no nocturnal changes. Nonsignificant concordant differences were observed in the clinic. Thirty-five per cent required therapeutic reduction in summer compared to 16% in winter (P = 0.006), with a greater tendency to dizziness. Fourteen per cent experienced events: two renal deteriorations and one syncope in summer-autumn, compared to three decompensations and one noncardiovascular death in winter-spring.

Conclusion: In patients with heart failure, summer is associated with a significant decrease in BP, best detected by HBPM, which requires therapeutic adjustments and clinical monitoring to prevent adverse events.

Introduction: Altered autonomic control has been proposed as a mechanism underlying postexercise hypotension (PEH). This meta-analysis examined the effects of acute aerobic exercise on blood pressure (BP) and autonomic outflow in adults with normal or elevated BP.

Methods: A systematic search identified trials involving adults who performed aerobic exercise, with BP and autonomic measures taken before and at least 30 min after exercise. Random-effects models were used to calculate Hedge's g effect sizes.

Results: Sixty-five trials (118 interventions; 1248 participants) were analyzed. Individuals were relatively young (mean age 37.5 ± 5.5 years) with average BP of 122.5 ± 8.8/75.2 ± 6.6 mmHg. Aerobic exercise significantly reduced systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) (g = -0.373 to -0.813, P < 0.05). These reductions were accompanied by increased sympathetic (g = 0.279 to 0.436, P < 0.01) and decreased parasympathetic (g = -0.535 to -0.414, P < 0.003) activity. In individuals with normal BP, pressoric reductions were inversely related to sympathetic activity (overall BP: n = 153, slope = -0.199, P = 0.016) and positively related to parasympathetic activity (overall BP: n = 147, slope = 0.134; P = 0.046), though not all associations reached statistical significance. In those with elevated BP, the opposite pattern emerged from meta-regression: BP reductions were positively associated with sympathetic activity (SBP: n = 43, slope = 0.402, P = 0.002; overall BP: n = 153, slope = -0.199, P = 0.016) and negatively with parasympathetic activity (SBP: n = 38, slope = -0.230, P = 0.011; overall BP: n = 73, slope = -0.140, P = 0.018).

Conclusion: These findings support autonomic control as a mechanism of prolonged PEH in individuals with elevated, but not normal BP. Aerobic exercise induced BP reductions appear linked to differing autonomic responses depending on baseline BP status.

Background: Hypertension is considered a significant modifiable risk factor for cardiovascular disease among hemodialysis patients. Aside from blood pressure (BP) levels, blood pressure variability (BPV) has been independently associated with all-cause and cardiovascular mortality in hemodialysis patients. Sodium load is associated with thirst, fluid retention, interdialytic weight gain (IDWG), and hypertension. This study investigated the effect of lowering dialysate sodium concentration on visit-to-visit BPV in hemodialysis patients.

Methods: Among 110 hemodialysis patients assessed for eligibility, 89 were randomized to receive hemodialysis either with standard dialysate sodium (143 mmol/l) or reduced dialysate sodium (140 mmol/l) for 3 months. Eighty-three patients completed the study. Predialysis BP readings were recorded with an automated device 2 weeks before and after the intervention. The visit-to-visit BPV was quantified at baseline and after 3 months by three metrics: the standard deviation (SD) of the BP, the coefficient of variation (CV), and the average real variability (ARV).

Results: SD (P = 0.02), CV (P = 0.034), and ARV (P < 0.001) of SBP were significantly decreased in the lower sodium dialysate group. No significant difference was observed between both groups in terms of diastolic BPV measures. Furthermore, IDWG was significantly decreased in the lowered sodium dialysate group after 3 months (P = 0.02). Intradialytic adverse events were comparable for both groups.

Conclusion: Lowering dialysate sodium concentration decreases visit-to-visit systolic BPV parameters and IDWG. Long-term studies are required to confirm postulated cardiovascular benefits.

Trial registration: The trial was registered with ClinicalTrials.gov (trial registration number NCT05169125, trial registration date 23/12/2021).

This review examines current evidence on the effects of physical exercise in individuals with resistant hypertension, a population for whom the effects of exercise are less well understood compared to those with general hypertension. Emerging evidence indicates that aerobic exercise promotes clinically meaningful reductions in blood pressure in individuals with resistant hypertension, with potential to reduce medication reliance and improve cardiovascular health. Combined aerobic and dynamic resistance exercise, particularly in heated-water environments, may offer additional benefits. However, important research gaps remain, including limited data on resistance training (dynamic or isometric), and mind-body exercises such as Tai Chi or Yoga. While aerobic exercise is well established as an effective strategy for lowering blood pressure, further studies are needed to evaluate other exercise modalities and digital or remote interventions to enhance adherence. Expanding the evidence base will allow for more personalized and flexible exercise prescriptions, ultimately improving long-term blood pressure control and cardiovascular outcomes in this population.

Background and objectives: Preeclampsia (PE) is a leading cause of maternal and perinatal morbidity and mortality, yet effective targeted therapies remain limited. This study aimed to investigate the therapeutic potential of annexin A5 (ANX A5) in PE and to elucidate the underlying mechanisms based on metabolomic profiling.

Methods: A PE-like mouse model was established by intraperitoneal injection of lipopolysaccharide (LPS, 20 μg/kg/day) from gestational day (GD) 7.5 to 17.5, followed by intravenous administration of ANX A5 (50 μg/kg/day) in the treatment group. In vitro, LPS-stimulated HTR-8/Svneo trophoblast cells were treated with either ANX A5 or NLRP3 inhibitor. Placental metabolite profiling was performed using liquid chromatography-tandem mass spectrometry. Placental morphology and NF-κB/NLRP3 inflammasome markers were evaluated by western blotting and enzyme-linked immunosorbent assay.

Results: ANX A5 administration markedly attenuated high blood pressure, proteinuria, and adverse pregnancy outcomes in PE-like mice. Metabolic alterations associated with ANX A5 were predominantly enriched in the NF-κB/NLRP3 inflammasome pathway. Correspondingly, ANX A5 treatment downregulated the elevated placental expression of NLRP3, caspase-1, and interleukin-1β in PE-like mice. Furthermore, in HTR-8/Svneo cells, ANX A5 effectively suppressed the inflammatory responses by inhibiting the NF-κB/NLRP3 inflammasome signaling pathway, thereby restoring trophoblast migratory capacity.

Conclusion: These findings demonstrate that ANX A5 confers significant protection in a PE mouse model, which is mediated through inhibition of the NF-κB/NLRP3 inflammasome pathway and modulation of placental metabolism. This study highlights the potential of ANX A5 as a novel therapeutic strategy for PE.

Objectives: Humans born preterm have low nephron endowment and an increased risk for hypertension and chronic kidney disease (CKD) later in life. The risks of these sequelae are augmented by a higher incidence of postnatal kidney injury from ischemic, hypoxic and/or nephrotoxic insults.

Methods: To test the hypothesis that congenital nephron deficits in the absence of other renal insults are a risk factor for hypertension, and that salt intake modifies this response, we performed continuous ambulatory blood pressure (BP) monitoring before and after high salt diet in a novel mouse model of low nephron endowment (named RetUB del).

Results: We discovered that adult RetUB del mice and controls have similar systolic and diastolic BP. After high salt diet, RetUB del males and females had a greater rise in systolic BP, and RetUB del females had a greater rise in diastolic BP than controls. In contrast, RetUB del males had less of a rise in diastolic BP, revealing possible sex dimorphisms in mice with low nephron endowment. In females, salt loading was accompanied by less suppression of juxtaglomerular renin and a blunted rise in fractional excretion of urinary sodium, although sample stratification reduced the power to detect significant male-female differences. RetUB del males had more of a CKD phenotype, suggesting that CKD did not contribute to salt-sensitivity.

Conclusions: This study shows the impact of a modifiable dietary factor on the development of hypertension in mice with low nephron endowment.

Aim: To investigate sex differences in the use of antihypertensive therapy and achievement of blood pressure targets among patients with hypertension in a real-world clinical setting.

Methods: Data were used from the PHARMO Data Network between 2010 and 2020. New users of antihypertensive medications with a diagnosis for hypertension were included. We assessed sex differences in antihypertensive intensity at initiation, time to first intensification, and achievement of blood pressure targets within 6 months after initiation.

Results: In total, 24 851 individuals (48% women) were included. Women were 34% [95% confidence interval (CI): 27-42] more likely than men to be dispensed low intensity antihypertensives at initiation and to start with a beta-blocker or diuretic. Women were less likely than men to be uptitrated (adjusted hazard ratio: 0.93 (95% CI: 0.90-0.96)), yet 16% (95% CI: 11-20) more likely to reach blood pressure target levels.

Conclusion: Among individuals with hypertension, women initiated antihypertensive therapy at lower intensities and were less likely to be uptitrated than men. Nonetheless, attainment of blood pressure targets within 6 months after initiation was higher in women than men.

Objectives: This study aims to estimate the current prevalence of suspected and diagnosed untreated hypertension in middle-aged Lithuanian men. In addition, it seeks to examine the cardiometabolic risk profile associated with these conditions.

Methods: This was a cross-sectional study of data collected from 2009 to 2019. The dataset included 52 012 male participants aged 40-54 years who participated in the Lithuanian High Cardiovascular Risk (LitHiR) Primary Prevention Programme. We compared the prevalence of dyslipidaemia, diabetes mellitus, smoking, family history of cardiovascular disease (CVD), overweight, obesity based on BMI and waist circumference, metabolic syndrome and cardiometabolic parameters between the normotensive, suspected hypertensive and diagnosed untreated hypertensive groups.

Results: All risk factors were more prevalent in suspected and diagnosed untreated hypertensive groups compared to normotensive individuals, with dyslipidaemia being the most prevalent risk factor (91.20 and 93.40%, respectively). The cardiometabolic parameters were also markedly elevated in these groups. Increased waist circumference, elevated total cholesterol, smoking and a family history of CVD were independently associated with both suspected and untreated hypertension. The prevalence of suspected hypertension and diagnosed untreated hypertension in Lithuania slightly increased between 2009 and 2019. Overall, 26.84% of middle-aged men with hypertensive blood pressure readings have no prior diagnosis, while 18.57% of diagnosed individuals are not receiving antihypertensive treatment.

Conclusion: A considerable number of hypertensive middle-aged men in Lithuania experience prolonged delays in initiating pharmacological interventions.