Journal of Hypertension最新文献

Introduction: Estimating hypertension incidence and improving screening in general population could enhance blood pressure control and decrease cardiometabolic risks. Identifying those likely to develop hypertension is essential. Our study focused on predicting onset hypertension and its incidence based on initial characteristics.

Methods: We utilized data from the French prospective CONSTANCES cohort, including volunteers assessed twice over 5 years up to 31 December 2019, who were initially free from hypertension. Hypertension was defined as having a SBP at least 140 mmHg or DBP at least 90 mmHg during the second checkup or if antihypertensive medication was prescribed. We calculated annual incidence rates among subgroups and used machine learning models to identify predictors of hypertension. The impact of changes in BMI was analyzed using logistic regression.

Results: Of the 11 112 participants (average age 47.5 ± 12 years), 1929 (17.4%) developed hypertension within an average of 5.2 years, with 383 on medication. The incidence rate was 3.4 new cases per 100 person-years, rising with age and consistently higher in men (4.3 vs. 2.8). A blood pressure (BP) threshold of 130 mmHg predicted 70% of new cases. One-point BMI reduction significantly reduced hypertension risk by 16%, regardless of initial BMI and SBP levels.

Conclusion: The study reports a notable hypertension incidence of 3.4 new cases per 100 person-years, particularly among those with SBP over 130 mmHg, highlighting the need for regular screening. Early diagnosis and control can mitigate hypertension's adverse effects, emphasizing the crucial role of preventive measures like BMI reduction.

Background: Higher blood pressure variability (BPV) is associated with adverse clinical outcomes but lack of standardized methodology hampers clinical translation. Day-to-day BPV seems most promising for an older population, especially those with cognitive impairment. This study aimed to determine the optimal number of measurements for obtaining day-to-day BPV in this population.

Methods: We included 127 patients attending the geriatric outpatient memory clinic, who measured blood pressure for seven days, morning and evening. Blood pressure measurements of day one were discarded and the coefficient of variation was calculated to assess BPV. Concordance between 7-day BPV (CV7days) and a reduced number of measurement days (CV6days - CV3days) was analysed with Bland-Altman plots, intraclass correlation coefficient (ICC), and an a priori determined threshold of a 95% confidence interval (CI) with a lower bound of 0.75.

Results: The mean age was 74.6 ± 8.6 years, 49% were female, and had dementia or mild cognitive impairment in 37% and 33% respectively. Reducing the number of measurement days resulted in wider limits of agreement. Concordance decreased when reducing measurement days and reached our predefined threshold with four measurement days (ICC = 0.91, 95% CI = 0.87 - 0.93). BPV derived from five measurement days showed a similar relationship with diagnosis as our reference BPV value obtained with seven days.

Conclusion: Our results suggest that systolic home blood pressure should be measured in the morning and evening for at least five consecutive days in duplicate to obtain reliable day-to-day BPV values in older adults with cognitive complaints.

Objective: Over the last decade, the European Society of Hypertension (ESH) published several guidelines (GLs) for the Management of Arterial Hypertension (2013, 2018, and 2023). We hypothesized that the GL has been improved because of the publications of new evidence. Thus, we aimed to examine the development of ESH guidelines (ESH GLs) by comparing their helpfulness regarding the diagnosis and treatment of hypertension.

Methods: A novel mathematical analysis was used to compare ESH GLs. Not only the frequency of Classes of Recommendations (CLASS) and the Levels of Evidence (LEVEL) were examined but a newly developed certainty index (CI) was calculated. This CI allows the CLASS and LEVEL to be assessed together, providing a less biased assessment of GLs, than examining the CLASS and LEVEL independently or related to each other.

Results: The number of recommendations showed continuous and significant increases from 2013 (N = 110) to 2018 (N = 169), and 2023 (N = 269). Examining the frequency of CLASS and/or LEVEL led to biased results, showing both improvements and/or worsening comparing years. However, based on the new analysis, a continuous improvement was shown in the percentage of certainty from 2013 to 2023 (2013: 60.5%, 2018: 72.1%, 2023: 75.3%). Accordingly, the CI was also significantly increased from 2013 (CI: 0.21), to 2018 (CI: 0.44), and to 2023 (CI: 0.51).

Conclusion: The analysis shows that compared to previous GLs, the structure of the ESH 2023 GL has been rearranged and simplified. The higher number of Recommendations indicates a continuously accumulating knowledge regarding the mechanisms, clinical findings, and epidemiology of hypertension. Moreover, the ESH 2023 GL shows a higher degree of certainty and CI, corresponding to a higher level of helpfulness of the ESH 2023 GL for healthcare professionals to diagnose, prevent, and treat hypertension.

Objective: Vascular pathology, characterized by impaired vasoreactivity and mitochondrial respiration, differs between the sexes. Housing rats under thermoneutral (TN) conditions causes vascular dysfunction and perturbed metabolism. We hypothesized that thoracic perivascular adipose tissue (tPVAT), a vasoregulatory adipose depot known to have a brown adipose tissue (BAT) phenotype, remodels to a mainly white adipose (WAT) phenotype in rats housed at TN, driving diminished vasoreactivity in a sex-dependent manner.

Methods: Male and female Wistar rats were housed at either room temperature (RT) or TN. We measured changes in tPVAT morphology, vasoreactivity in vessels with intact tPVAT or transferred to tPVAT of the oppositely-housed animal, vessel stiffness, vessel mitochondrial respiration and cellular signaling.

Results: Remodeling of tPVAT was observed in rats housed at TN; animals in this environment showed tPVAT whitening and displayed diminished aortae vasodilation (P < 0.05), different between the sexes. Juxtaposing tPVAT from RT rats onto aortae from TN rats in females corrected vasodilation (P < 0.05); this did not occur in males. In aortae of all animals housed at TN, mitochondrial respiration was significantly diminished in lipid substrate experiments (P < 0.05), and there was significantly less expression of phosphorylated endothelial nitric oxide synthase (peNOS) (P < 0.001).

Conclusions: These data are consistent with TN-induced remodeling of tPVAT, notably associated with sex-specific blunting of vasoreactivity, diminished mitochondrial respiration, and altered cellular signaling.

There are inconsistencies in the effect of raising or lowering body salt on blood pressure (BP). We hypothesize that they are caused in part by differences in plasma renin activity (PRA). PRA changes reciprocally with body salt. PRA is the rate limiting step in the formation of the vasoconstrictor peptide angiotensin II (Ang II) in the circulation where it cleaves Ang I from plasma angiotensinogen, and then Ang I is rapidly converted to Ang II by angiotensin-converting enzyme in plasma and vascular endothelial cells. We hypothesize that PRA levels above 0.65 ng/ml/h lead to sufficient Ang II production to cause vasoconstriction, whereas lower levels do not. PRA is usually more than 0.65 in normotensives who are not on a high-salt diet; in them, the increase in PRA/Ang II vasoconstriction caused by reduction in body salt (low-salt diet, diuretic use) is large enough to prevent BP from falling. By contrast, a similar reduction in body salt lowers BP in the 30% of hypertensive patients with low baseline PRA (<0.65 ng/ml/h), because vasoconstriction does not increase in that range. A similar reduction in body salt also lowers BP in the 60% of hypertensive patients with baseline PRA between 0.65 and 4.5 ng/ml/h, but for a different reason; the rise in PRA and the increase in vasoconstriction is too small to prevent BP from falling. However, after body salt has been reduced enough to raise PRA above 4.5 ng/ml/h, further salt depletion increases PRA to a greater extent, and BP does not fall. Renin-angiotensin system (RAS) inhibitors leave a small amount of renin unblocked. In salt-depleted hypertensive patients, they also raise PRA enough to prevent BP from falling significantly. We propose that this PRA/Ang II vasoconstrictor effect related to reactive increases in PRA can prevent or attenuate the decrease in BP caused by excessive salt depletion, even during concurrent RAS inhibition. This phenomenon, if confirmed, could inform new strategies to optimize the treatment of hypertension, cardiovascular disease (CVD) and chronic kidney disease (CKD).

Backgroundaims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is an independent risk factor for cardiovascular morbidity and mortality. Another critical risk factor in these patients is arterial hypertension (AH). Although it is estimated that 50% of MASLD patients are suffering from AH, 24-h ambulatory blood pressure monitoring (24-h-ABPM), the gold standard for diagnosing hypertension, is often neglected. However, only 24-h-ABPM can identify hypertension subtypes, particularly nocturnal hypertension (NH), which is a stronger predictor of cardiovascular mortality than daytime or 24-h blood pressure. The aim of this study was to investigate the prevalence of NH in MASLD patients and to identify associated risk factors.

Methods: To this end, 226 MASLD patients with or without known AH were prospectively recruited in an outpatient liver department and underwent 24-h-ABPM together with repeated office-blood-pressure measurements.

Results: 24-h-ABPM datasets from 218 patients were included in the final analysis. NH was observed in 112 patients (51.3%), of whom 54 (48.2%) were receiving antihypertensive treatment (uncontrolled hypertension). Univariable regression analysis showed that age, increased waist-to-hip ratio, a waist-to-height ratio ≥0.5, type 2 diabetes mellitus (T2DM), dyslipidemia, a lower estimated glomerular filtration rate and increased liver stiffness were significantly associated with a higher risk of NH. In multivariable regression analysis, T2DM [odds ratio (OR) 2.56; 95% confidence interval (CI) 1.09-6.23; P = 0.033], dyslipidemia (OR 3.30; 95% CI, 1.67-6.73; P = 0.001) and liver stiffness (OR 1.09; 95% CI, 1.02-1.18; P = 0.021) were identified as independent risk factors.

Conclusions: In conclusion, particularly MASLD patients with accompanying T2DM, dyslipidemia, and increased liver stiffness should undergo 24-h-ABPM to detect and treat NH, as they are at the highest risk of adverse cardiovascular events.

Clinical trial: NCT-04543721.

Objective: The aim of this study was to characterize individuals with nondipping heart rate (HR) and to assess the association between that pattern and sleep quality during the night of an ambulatory blood pressure monitoring (ABPM).

Methods: Individuals who attended our Unit to perform an ABPM, from February 2022 to May 2024, were asked about clinical and epidemiological antecedents and responded two validated surveys, about sleep quality during the night of the ABPM and in the prior 30 days. Then, they were categorized according to the presence of a dipping in nocturnal HR (defined as a decline in average HR at night equal or higher than 10% compared with daytime values) as HR dippers or HR nondippers (drop in mean nighttime HR lower than 10% of diurnal mean) in order to compare the mentioned variables.

Results: One thousand two hundred and nine individuals were included. They were predominantly female (61.8%), middle-aged (median 50 years, IQR 36-60), overweight (median BMI 29, IQR 25.3-33.5) and had median ABPM estimates within normal ranges. In individuals without beta-blockers (n = 1107), HR nondippers had an adverse cardiovascular disease (CVD) risk profile, and no differences were found between HR dippers and HR nondippers concerning perceived good rest during the ABPM night (63.5 vs. 59.7%, P = 0.211) and usual sleep quality. The sensitivity analysis including beta-blockers' users (n = 102) was consistent.

Conclusion: A blunted dipping in mean nighttime HR identifies individuals with a high CVD risk profile and is not associated with bad sleep quality during the night of an ABPM.

Background: Sympathetic hyperactivity contributes to the pathogenesis of hypertension. However, it is unclear whether the excessive sympathetic activity is an independent and crucial factor for vascular remodeling in hypertension. This study focused on the effect of local sympathetic denervation with superior cervical ganglionectomy (SCGx) on vascular remodeling.

Methods: Surgical bilateral SCGx was performed in 9-week-old male Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR). Control rats received sham-operation without SCGx. All measurements were made 4 weeks after the surgery.

Results: The effectiveness of SCGx was confirmed by the eye features of Horner syndrome, greatly reduced tyrosine hydroxylase (TH) contents in the superior cervical ganglion (SCG)-innervated arteries in the head. Although SCGx had no significant effects on blood pressure and heart rate in WKY and SHR, it attenuated vascular remodeling of facial artery and superficial temporal artery in SHR, two representative SCG-innervated extracranial arteries, without significant effects on non-SCG-innervated thoracic aorta and mesenteric artery. SCGx-treated SHR had more auricular blood flow and retina microvasculature than sham-operated SHR. However, SCGx had only a mild effect in attenuating the vascular remodeling of basilar artery and middle cerebral artery, two representative SCG-innervated intracranial arteries, in SHR. SCGx-treated SHR exhibited upregulation of α-smooth muscle actin, downregulation of proliferating cell nuclear antigen, and attenuation of oxidative stress and inflammation in facial artery and superficial temporal artery.

Conclusions: Sympathetic denervation by SCGx in SHR attenuated local vascular remodeling, suggesting that sympathetic overactivity is a crucial pathogenic factor of vascular remodeling in SHR.

Introduction: Glucagon-like peptide-1 receptor agonists are novel medications with proven efficacy in treating type 2 diabetes mellitus, and are increasingly being used for weight loss. They may potentially have benefit in treating metabolic disorders; however, evidence is sparse with regards to treating high blood pressure (BP). We performed a systematic review, meta-analysis and meta-regression investigating the efficacy of GLP-1 RAs in lowering BP in obese or overweight patients.

Methods: Three electronic databases (PubMed, EMBASE, and CENTRAL) were systematically searched for randomized controlled trials (RCTs) published from inception to 13 February 2024. Pair-wise meta-analysis and random effects meta-regression models were utilized. Fixed effects meta-analysis was used to unify treatment effects across different GLP-1 RA doses.

Results: We included a total of 30 RCTs with a combined population of 37 072 patients. GLP-1 RAs demonstrated a mean systolic BP (SBP) reduction of -3.37 mmHg [95% confidence interval (CI) -3.95 to -2.80] and a mean diastolic BP (DBP) reduction of -1.05 mmHg (95% CI -1.46 to -0.65) compared with placebo. This effect was consistent across subgroups for diabetic status, formulation of GLP-1 RA, follow-up duration and route of administration for both SBP and DBP, with the exception of subgroups investigating exenatide. Meta-regression suggested no significant correlation between BP reduction and baseline characteristics such as age, percentage of male patients, HbA1c, weight, BMI, and percentage of patients with hypertension.

Conclusion: Our meta-analysis suggests significant BP reduction benefits from GLP-1 RA use in obese or overweight patients, consistent across diabetic status, duration of treatment, and across route of administration.

Background: We have previously demonstrated that electrical stimulation of the carotid sinus nerve (CSN) protects the development of periodontitis. In the current study, we evaluated whether periodontitis accelerates the onset of hypertension in spontaneously hypertensive rats (SHR); and whether electrical stimulation of the CSN would delay the onset of hypertension.

Methods: Three-week old SHR were implanted with electrodes around the CSN for electrical stimulation for 13 days. Bilateral ligation of the first molar and oral administration of Porphyromonas gingivalis induced periodontitis. The femoral artery of the SHR was cannulated, and 24 h later, in a conscious state, the blood pressure was recorded.

Results: Five-week old sham SHR (subjects without electrical stimulation of the CSN) did not demonstrate hypertension. However, when the SHR were submitted to periodontitis they exhibited hypertension at 5 weeks of age. Nevertheless, the stimulation of the CSN prevented the onset of hypertension. Periodontitis promoted alveolar bone loss in SHR; but, electrical stimulation of the CSN prevented this undesirable outcome following the exposure to periodontitis.

Conclusion: Periodontitis accelerated the onset of hypertension in SHR; while the electrical stimulation of the CSN delayed the onset of hypertension.