Journal of Hypertension最新文献

Background: The increasing accessibility of high altitudes due to modern lifts has led to rise in individuals reaching high elevations without acclimatization or medical screening. Acute exposure to hypobaric hypoxia induces hemodynamic and metabolic stress, increasing blood pressure (BP) and heart rate while reducing oxygen saturation. These effects are particularly concerning for individuals with preexisting cardiovascular diseases.

Methods: We conducted an observational cross-sectional study at the base station (1300 m) of the Skyway Monte Bianco cable car, evaluating the demographic and clinical characteristics of unselected participants before ascent. Data were collected via a biometric multiparametric recording system (Keito K9), measuring SpO 2 , heart rate, BP, body composition, and medical history.

Results: A total of 1930 individuals (56% men) participated but anamnestic data were available in 1174 volunteers. Among them, 18% had history of cardiovascular disease, predominantly hypertension (16%). SBP at least 135 mmHg was found in 11.1% of participants, with 4.3% presenting values at least 150 mmHg. The prevalence of individuals with hypertension above the reference limits was higher in cardiac patients. Cardiovascular patients were older, heavier, and had higher BP compared to healthy individuals. Interestingly, no differences in altitude exposure frequency were observed between groups.

Conclusion: Our findings indicate that a significant proportion of individuals, including those with cardiovascular disease, reach low altitudes with BP above the reference limits. Given the potential risks associated with hypoxia-induced sympathetic activation, improved screening and preventive strategies should be considered for high-altitude tourism. Further research is needed to assess acute BP variations at different altitudes and their implications for cardiovascular risk.

Introduction: High blood pressure remains the leading risk factor for cardiovascular and all-cause deaths in Australia. Higher sodium and lower potassium intake are well established risk factors for elevated blood pressure and increased cardiovascular disease risk. Despite decades of global public health efforts, progress in reducing sodium and increasing potassium intake has been limited. The WHO recommends potassium-enriched salt as an effective, affordable, and scalable strategy to lower blood pressure by simultaneously reducing sodium and increasing potassium intake. This position statement was developed to support implementation and address this public health priority.

Main recommendations: For patients with hypertension, core dietary recommendations should include reducing sodium by limiting the regular salt added when cooking and at the table, choosing low-salt foods and increasing potassium intake through fruit and vegetable intake. When these changes are challenging, switching regular salt with potassium-enriched salt offers a practical alternative. We recommend including this switch as an additional dietary recommendation in clinical hypertension guidelines. Suggested wording: 'If patients add salt to their food, they should make a 1 : 1 switch from regular salt to potassium-enriched salt with a composition of approximately 75% sodium chloride and 25% potassium chloride, unless they are at risk of hyperkalaemia because of kidney disease, use of a potassium supplement, use of a potassium sparing diuretic or for another reason." Routine kidney health checks are recommended to support safe implementation.

Changes in management: We advocate for the inclusion of this recommendation in future hypertension management guidelines. Systematic, nation-wide implementation of potassium-enriched salt as a replacement for regular salt should be prioritized as a scalable public health intervention. We call for further research into the impact of potassium-enriched salt in patients with kidney disease, the general population unscreened for hyperkalaemia risk, and patients using different antihypertensive regimens.

Background: Finerenone, a novel nonsteroidal mineralocorticoid receptor (MR) antagonist, has shown antihypertensive activity and improved cardiac function in clinical studies, but the role and target of finerenone in the prevention and treatment of ventricular remodeling in hypertension remains unclear. In the present study, hypertensive rats were employed to evaluate the beneficial effects of finerenone on ventricular remodeling and cardiac function in hypertension and to identify the related targets.

Method: Hypertensive two-kidney, one-clip (2K1C) Sprague-Dawley rats were randomly divided into three groups: sham-operated, 2K1C model, and finerenone-treated groups (2 mg/kg/day, Bayer Pharmaceuticals, HJ20220057). All groups were treated for 8 weeks. Blood pressure, echocardiographic measurements, biochemical parameters related to cardiovascular remodeling and endoplasmic reticulum (ER) stress markers were evaluated. Cultured H9C2 cells were used to determine the effect of finerenone on cardiomyocytes administered Ang-II.

Result: Compared with the model group, finerenone significantly reduced SBP, DBP, cardiac index, left ventricular mass index, NT-proBNP, and sST2 levels. Left ventricular remodeling and cardiac function were significantly improved after treatment with finerenone for 8 weeks. Finerenone effectively decreased the protein expression of the ER stress marker GRP78 and reduced the protein levels of p-IRE1, XBP1, and TRAF2 in myocardial tissue samples from hypertensive rats, thus decreasing ER stress in the myocardial tissue, as well as the production of the inflammatory factors IL-6 and TNF-α. In addition, finerenone significantly decreased apoptosis in H9C2 cells induced by Ang-II. Furthermore, the modulatory effects of finerenone on ER stress factors in cardiomyocytes were identified.

Conclusion: Finerenone effectively lowers blood pressure and improves ventricular remodeling and cardiac function in hypertensive rats. These effects may be mediated via IRE1-dependent regulation of XBP1 and TRAF2, leading to reduced ER stress, inflammation, and cardiomyocyte apoptosis. Comparisons among the sham, model, and treatment groups confirm the cardioprotective role of finerenone in hypertensive heart disease.

Objective: Guidelines from ACC/AHA, ESC/ESH, and JNC 8 recommend ACE inhibitors (ACEi), ARBs, calcium channel blockers (CCBs), and diuretics for hypertension in patients with cardiometabolic multimorbidity (CMM). Their effectiveness in Asians is underexplored. This study evaluates their association with mortality in Taiwanese patients with hypertension and CMM.

Methods: A population-based cohort study was conducted using Taiwan's administrative health databases (2004-2014). Patients aged ≥20 years with hypertension and ≥8 outpatient blood pressure measurements were included. All-cause mortality was assessed using inverse probability weighted Cox models, evaluating medication classes, adherence, and systolic blood pressure (SBP) control.

Results: Of 80 748 patients (mean age 60 years, 56.3% male), 41.7% had one CMM, and 9.4% had multiple CMMs. ARBs reduced mortality in multimorbid patients [hazard ratio (HR) = 0.80, 95% confidence interval (CI) 0.67-0.95], while diuretics (HR = 1.63, 95% CI 1.33-1.99) and vasodilators (HR = 1.22, 95% CI 1.03-1.45) increased risk. ACEi and CCBs were neutral. Optimal SBP control (120-139 mmHg) benefited multimorbid patients, but intensive control (<120 mmHg) increased risk in those with ≤1 CMM (HR = 1.37, 95% CI 1.20-1.55). High SBP variability (SD >18 mmHg) raised mortality risk (HR = 1.62, 95% CI 1.07-2.44).

Conclusions: Antihypertensive effectiveness varies by CMM burden. ARBs reduce mortality in multimorbid patients, while diuretics and vasodilators may increase risk. Optimal SBP control (120-139 mmHg) benefits multimorbid patients, but intensive control may harm less complex cases. Further research is needed.

Objectives: Diabetic lower extremity arterial disease (LEAD) is a manifestation of diabetic lower extremity vascular complications. This study aimed to screen the key single nucleotide polymorphism (SNP) gene signature in patients with type 2 diabetes mellitus (T2DM) and LEAD.

Methods: A total of 147 patients with T2DM complicated by LEAD and 144 patients with T2DM without LEAD were enrolled for transcriptome sequencing. The Plink software was used to preprocess the data. Five machine learning methods were adopted to build the SNP diagnosis models. The receiver operating characteristic (ROC) curve was used to quantify the predicted probabilities of the model. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed using the cluster Profiler package. Finally, regression statistical analysis was used to correlate the key SNPs with clinical information and biochemical indicators.

Results: A total of 24 SNPs were retained and 10 SNPs were risk allele genes. Nine SNPs (rs7412, rs1800629, rs699947, rs3918242, rs668, rs1800470, rs1800449, rs1800469, and rs1024611) were identified as the key SNPs sites. GO and KEGG pathway analyses revealed that these genes are mainly enriched in fluid shear stress and atherosclerosis. Finally, rs1800449 was associated with low-density lipoprotein cholesterol (LDL-C). With high density lipoprotein cholesterol (HDL-C), related site was rs1024611. The sites associated with total cholesterol (CHOL) were rs1800449 and rs7412.The site associated with apolipoprotein B (APOB) and apolipoprotein A1 (APOA1) were rs1800470 and rs1800469.

Conclusion: This study authenticated nine SNPs for the diagnosis of T2DM patients with LEAD, which will be of great significance in the development of diagnostic molecular biomarkers for T2DM patients.

Background: GLP-1 receptor agonists (GLP-1RA) and dual GLP-1/GIP agonists reduce cardiovascular events in patients with type 2 diabetes and obesity. The extent to which these benefits are mediated by blood pressure (BP) reduction vs. weight loss, especially in hypertensive patients, remains unclear.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials published from January 2015 to April 2025 evaluating GLP-1RA or dual agonists. Eligible trials reported major adverse cardiovascular events (MACE) and changes in SBP and/or weight. Random-effects meta-analyses and meta-regressions were used to assess associations between MACE and reductions in BP or weight. Subgroup analyses were performed according to BP measurement method (clinical vs. ambulatory).

Results: Twenty-one trials including 145 322 participants were analyzed. GLP-1RA significantly reduced MACE (pooled hazard ratio 0.86; 95% confidence interval 0.81-0.91). Meta-regression revealed that both SBP and weight reductions were independently associated with MACE risk reduction, with BP reduction showing a stronger relationship in trials using ambulatory BP monitoring.

Conclusion: The cardiovascular benefits of GLP-1RA are likely influenced by both BP and weight reductions. Ambulatory BP monitoring strengthens the observed association between BP control and cardiovascular outcomes, although causality cannot be definitively established. These findings support the use of GLP-1RA in individuals with hypertension, including those with resistant phenotypes.

Objectives: Accurate blood pressure measurement is essential for cardiovascular risk management, but conventional oscillometric devices are unreliable for atrial fibrillation and arterial stiffness. We evaluated the accuracy of a novel automated Korotkoff sound-based monitor (Ksens-BP), integrating a semiconductor strain-gauge sensor and artificial intelligence waveform classification, compared to oscillometric (Oscillo-BP) and manual auscultatory (Auscl-BP) methods.

Methods: This single-center prospective observational study enrolled adults with cardiovascular disease at National Cheng Kung University Hospital, Douliu Branch (October 2023-January 2024). Eligible conditions included hypertension, diabetes, atrial fibrillation, myocardial infarction, coronary artery disease, peripheral artery disease, stroke, or heart failure. Participants underwent three paired blood pressure (BP) measurements with Ksens-BP, Oscillo-BP, and Auscl-BP using a unified cuff system. Agreement was assessed with Auscl-BP assessed by concordance correlation coefficient (CCC). Hierarchical linear models (HLMs) examined the effects of comorbidities on measurement differences.

Results: A total of 178 patients (mean age 67.4 years; 80% men) contributed 686 valid paired measurements. Ksens-BP demonstrated excellent agreement with Auscl-BP (SBP CCC = 0.952; DBP CCC = 0.945) compared with Oscillo-BP (SBP CCC = 0.903; DBP CCC = 0.851). Mean absolute differences were smaller with Ksens-BP than Oscillo-BP (SBP: 2 vs. 4.4 mmHg; DBP: 2.3 vs. 5.4 mmHg). Oscillo-BP accuracy was negatively affected by PAD and atrial fibrillation, whereas Ksens-BP performance was unaffected by comorbidities.

Conclusion: The Ksens-BP system demonstrated superior accuracy and robustness, providing reliable BP measurement across complex cardiovascular populations.

Objectives: Vascular aging (VA) is a prognostically relevant aspect of biological aging. We investigated its prevalence and determinants in Austria.

Methods: The LEAD (Lung, Heart, Social, Body) study is an ongoing, longitudinal, population-based observational study, which started in 2011 in Vienna and six villages from Lower Austria. Within the study, carotid-femoral pulse wave velocity (cfPWV) was measured using applanation tonometry. Based on a reference population (no history of overt cardiovascular disease, no diabetes, no pharmacological treatment for hypertension or dyslipidemia), sex-, and age-specific Z-scores for cfPWV were calculated. Healthy (HVA), normal (NVA), and early (EVA) vascular aging were defined as cfPWV Z-score <10th, 10th-90th, and >90th percentile, respectively.

Results: In the overall population (n = 7926, 54.2% women, age 18-82 years), the prevalence of HVA/NVA/EVA was 9.1/78.6/12.2%, respectively, with EVA prevalence increasing in older age. The risk of EVA, as compared to HVA, was independently and directly associated with female sex (odds ratio, OR 2.8), systolic (OR 1.04) and diastolic (OR 1.02) blood pressure, heart rate (OR 1.06), body height (OR 1.03), and diabetes mellitus (OR 3.0), and inversely related to appendicular lean mass index (OR 0.82), postbronchodilation FEV1 (OR 0.81), and healthy nutrition (OR 0.69). The results were similar for the comparison of EVA and NVA, adding an independently increased risk for EVA with regular alcohol intake (OR 1.37) and low income (OR 1.21).

Conclusions: We observed a high percentage of EVA in Austria, determined by classical and nonclassical risk factors. The latter may offer novel targets for prevention.

Objective: Arterial stiffness, a well established cardiovascular risk factor, is accelerated in metabolic conditions such as diabetes and chronic kidney disease. It is typically assessed by measuring pulse transit time along an arterial path in the supine position. We hypothesized that introducing a hydrostatic pressure gradient by changing body position could reveal additional vascular biomechanical properties. This study aimed to quantify the increase in finger-to-toe pulse wave velocity (Δft-PWV) from supine to sitting and identify its determinants across varying cardiovascular risk profiles.

Methods: In this cross-sectional study, 248 adults were recruited, and 210 had reliable ft-PWV measurements in both positions. Ft-PWV was determined from pulse transit time between the finger and toe using two photoplethysmographic sensors.

Results: The mean age of participants was 55 ± 19 years; 112 (53%) were male, 104 (50%) had hypertension, 76 (36%) had diabetes, and 75 (36%) were on hemodialysis. Mean SBP and DBPs were 127 ± 17 and 77 ± 12 mmHg (mean ± standard deviation). Ft-PWV increased significantly from 8.5 ± 3.3 m/s (supine) to 14.3 ± 9.1 m/s (sitting; P < 0.001). In univariable analyses, Δft-PWV was significantly associated with supine ft-PWV (r = 0.405, P < 0.001), age (r = 0.337, P < 0.001), diabetes (r = 0.219, P < 0.001), and cardiovascular disease (r = 0.188, P = 0.006). Sex, dialysis status, weight, height, and mean BP changes were not significantly associated with Δft-PWV. In stepwise multivariable regression, Δft-PWV was independently associated with supine ft-PWV (β = 0.379, P < 0.001) and diabetes (β = 0.154, P = 0.016).

Conclusion: Ft-PWV increased significantly from supine to sitting. The magnitude of change was independently associated with supine ft-PWV and diabetes, highlighting biomechanical insights from postural change.

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.