Journal of Hypertension最新文献

Background: Carotid-femoral pulse wave velocity (PWV), a marker of arterial stiffness, is a recognized cardiovascular disease risk factor. As measuring PWV is time-consuming, reliable estimation methods have been developed, but their ability to inform cardiovascular risk prediction beyond what is achievable with current clinical risk tools is uncertain.

Methods: This study includes participants aged between 40 and 69 years from the population-based CARTaGENE cohort. PWV estimations (ePWV) were obtained using published formulas (ePWV f ) or algorithmic transformation of pulse waveforms (ePWV algo ) and 10-year cardiovascular risk for each participant was computed using the ASCVD and the SCORE-2 risk equations. Participants were followed during 10 years for major adverse cardiovascular events occurrence (MACE: cardiovascular death, myocardial infarction, stroke). Associations of ePWV f and ePWV algo with MACE were obtained using Cox models adjusted for ASCVD or SCORE-2 in the overall population and in a subpopulation representative of the ePWV f derivation cohort.

Results: Of 17 548 eligible participants, 2263 (12.9%) experienced a MACE during follow-up. Both ePWVf and ePWV algo were associated with MACE in unadjusted analyses, but only ePWV algo remained significant after adjustments for ASCVD [hazard ratio (HR) = 1.16 [1.09-1.22]] and SCORE-2 (HR = 1.07 [1.00-1.13]). In contrast, ePWV f was not associated with MACE after adjustment for either risk score, and only after adjustment with ASCVD when it was tested in the subpopulation representative of its derivation cohort.

Conclusions: Algorithm-based PWV improved cardiovascular risk prediction beyond what is achievable from recognized risk equations, whereas the predictive ability of ePWV f may not be generalizable outside of its reference population.

Background: Cold ambient temperatures are known to increase blood pressure (BP), but the influence of room temperature remains understudied. This study examined the impact of room temperature in morning, evening, and sleep BP measured at home.

Methods: The study included 779 adults (mean age: 70.7 years) from a community-based longitudinal study. Home BP was measured for 1 week using a conventional cuff-oscillometric device, whereas sleep BP was automatically recorded at 00 : 00, 02 : 00, and 04 : 00 using a timer-equipped BP monitor. Room temperature was measured concurrently using a thermometer in the BP monitor.

Results: A 1°C decrease in room temperature increased morning systolic and diastolic BPs by 0.863 and 0.342 mmHg, respectively ( P  < 0.001). The evening systolic and diastolic BPs increased by 0.721 and 0.320 mmHg, respectively ( P  < 0.001). However, sleep systolic (0.076 mmHg, P = 0.181) and diastolic (0.078 mmHg, P  = 0.039) BPs showed weaker associations. The association between morning systolic and diastolic BPs remained significant after adjusting for ambient temperature (0.809 and 0.304 mmHg, respectively; P  < 0.001). Age was the only factor associated with room temperature-related BP changes. Among 433 normotensive individuals (based on 1-week average morning BP), 93 were hypertensive on the coldest day. These participants had higher average morning BPs within the normal range and were more likely to use antihypertensive medication.

Conclusion: Room temperature significantly influenced home morning and evening BPs but not sleep BP, independent of ambient temperature. Maintaining appropriate room temperatures may aid in BP management at home.

Objective: Hypertension is a major risk factor for cardiovascular diseases. Insulin resistance is one of the main risk factor for hypertension. A simple index (triglyceride-glucose index - TyG) has been considered as a surrogate marker of insulin resistance. Although several studies have explored TyG and cardiovascular risk, few longitudinal data on the relationship between new-onset hypertension and this novel index are available so far, especially in European countries. Therefore, we aimed to estimate the predictive role of TyG, in comparison to that of the HOmeostatic Model Assessment of Insulin Resistance (HOMA-IR) index (a widely used tool to assess insulin resistance), on the development of hypertension, in an 8-year follow-up observation of a sample of adult men.

Methods: The analysis included 482 men (The Olivetti Heart Study), without hypertension at baseline. The optimal cut-off point of the association of continuous TyG or HOMA-IR index with new-onset hypertension was identified by receiver-operating characteristic (ROC) analysis.

Results: TyG was linearly associated with the occurrence of new-onset hypertension, whereas HOMA-IR was nonlinearly related to the risk of developing hypertension. After stratification by the optimal cut-off point, TyG greater than 4.91 were significantly associated with new-onset hypertension, also after adjustment for main confounders. In contrast, the HOMA-IR index greater than 1.82 was not associated with the risk of new-onset hypertension in the adjusted models.

Conclusion: The principal findings of this study suggest that the TyG index exhibits a significant predictive capacity for the development of new-onset hypertension. Although its limited sensitivity, the results support the potential utility of TyG as a simple, cost-effective, and noninvasive adjunctive tool for the early assessment of cardiovascular risk.

Objectives: Comprehensive and updated assessments of arterial hypertension (HTN)-attributable mortality trends across Europe are limited. We evaluated the HTN-attributed mortality trends in Europe between 2012 and 2021, examining variations by age, sex, and European region.

Methods: We extracted heart failure-attributed mortality data from the WHO mortality dataset for 2012-2021. Age-adjusted mortality rates (AAMRs) were analyzed using joinpoint regression modeling, expressed as average annual percentage change (AAPC) with 95% confidence intervals (CIs). A parallelism test compared trend differences across groups.

Results: From 2012 to 2021, 1 658 592 individuals (773 129 men and 885 463 women) died due to HTN, equating to 3932.3 deaths per 100 000 population. Overall, the AAMR increased (AAPC: +1.6%; 95% CI: 1.2-2.1; P  < 0.001), without significant differences between sexes ( P for parallelism 0.38). HTN-attributable mortality trend had a higher increase among patients aged 70 or older compared to those aged less than 70 years ( P for parallelism 0.007). Regionally, AAMRs increase in Northern (AAPC: +0.7%; 95% CI: 0.1-1.3; P  = 0.002) and Eastern (AAPC: +2.79%; 95% CI: 1.8-3.6; P  < 0.001) while plateaued in Western and Southern Europe (AAPC: -0.5%; 95% CI: -1.2 to 10.2; P  = 0.09). Disparities in hypertension-attributable mortality were observed among countries.

Conclusion: HTN-attributed mortality in Europe increased between 2012 and 2021. Substantial disparities persist across European regions and countries.

Background: Hypertension is closely associated with autonomic dysfunction. The role of the structural integrity of the central autonomic network (CAN) of the brain is insufficiently explored. Large-scale imaging data were used to investigate the relationship between the microstructural properties of the CAN with blood pressure (BP) and hypertension.

Methods: We analysed MRI data from 43 994 individuals to investigate whether BP levels were linked to the microstructural integrity of white matter tracts involved in autonomic control (CAN tracts). To test the specificity of these associations, we compared them to randomly selected white matter regions not specifically tied to the autonomic network, aiming to identify whether CAN tracts had a stronger connection to BP and which subsystems were particularly affected.

Results: Our findings showed that BP was more strongly linked to the microstructural integrity of CAN tracts than to other white matter regions. Further analysis revealed that specific CAN subsystems had distinct associations with BP, with higher levels of free water in these regions being associated with increased BP and hypertension. Additionally, the severity of hypertension was associated with the level of microstructural integrity in CAN tracts.

Conclusion: This study provides evidence of a specific relationship between BP levels and the microstructural integrity of the CAN. We found that, particularly in cortical parts of the CAN, higher levels of free water - indicating tissue not actively involved in neural signalling - were associated with elevated BP levels and a greater risk of hypertension. This evidence supports a close link between the central autonomic system and BP from a population-imaging perspective.

Objective: Arterial stiffening can promote the development of systolic hypertension, affecting the characteristics of arterial blood flow. Estimated pulse wave velocity (ePWV) can provide information regarding the progression of arterial stiffness. The aim of the present study was to explore the utility of ePWV to predict masked hypertension (MH) in untreated patients or masked uncontrolled hypertension (MUCH) in treated patients with optimal, normal or high-normal office blood pressure (oBP).

Methods: Data of the Hungarian ABPM Registry between September 2020 and November 2023 were used in our analysis. ePWV was calculated based on previously published formulas in different age categories as ≤40, 40-49, 50-59, 60-69 and ≥70 years. Optimal ePWV values to predict MH or MUCH were defined with classification and regression tree analysis.

Results: Out of 38 720 uploaded ABPM curves with clinical data, 7386 participants had optimal, normal or high-normal oBP. MH or MUCH were diagnosed in 981 (56.3%) or 3367 (59.6%) cases, respectively. Optimal ePWV values to predict MH or MUCH in age categories ≤40, 40-49, 50-59, 60-69 and ≥70 years were 6.84, 7.88, 8.24, 9.98 and 11.44 m/s, respectively. For the prediction of MUCH the identified thresholds were significant predictors in all age categories, while for the prediction of MH from the age above 50 years the associations became nonsignificant.

Conclusion: Despite normal oBP categories, ePWV can be a marker of MH and MUCH, thus it can help in patient selection for ABPM.

Background: Clevidipine emulsion injection is an ultra-short-acting, intravenous calcium-channel blocker that produces a rapid and transient antihypertensive effect.

Methods: This is a multicenter, randomized, single-blind, parallel, positive-controlled, noninferiority phase III clinical trial comparing the efficacy and safety of clevidipine and nicardipine in hypertensive emergencies. Participants were randomly assigned in a 1 : 1 ratio to the experimental group (clevidipine emulsion injection) or the positive-control group (nicardipine), and standard safety data were collected.

Results: In the per-protocol set (PPS), the primary endpoint showed that 100.0% of patients in the clevidipine group achieved a 15-25% reduction in systolic blood pressure from baseline within 30 min after dosing, compared with 95.9% in the nicardipine group. The absolute difference between the two proportions was 4.1% [95% confidence interval (CI): 0.58, 7.62], with the lower bound exceeding the noninferiority margin of -10%. Secondary endpoints revealed that the median time to reach the target systolic blood pressure (defined as a 15-25% reduction from baseline) was 9.0 (9.0, 12.0) minutes for clevidipine versus 12.0 (12.0, 15.0) minutes for nicardipine, and the between-group difference was statistically significant ( P  < 0.0001). The proportions of patients who successfully transitioned to oral antihypertensive therapy within 6 h after study drug discontinuation were 96.83% for clevidipine and 95.90% for nicardipine, with no statistically significant difference ( P  = 0.7459). In the safety set (SS), the safety endpoint showed that the proportion of patients whose systolic blood pressure fell by >25% from baseline within 3 min after dosing was 0.00% for clevidipine and 0.79% for nicardipine, with no statistically significant difference ( P  = 0.4980). The overall incidence of adverse events was similar between clevidipine and nicardipine.

Conclusions: Clevidipine has similar therapeutic effects and safety compared with the nicardipine.

Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04670809.

Obstructive sleep apnea (OSA) is associated with structural heart disease, with continuous positive airway pressure (CPAP) potentially improving cardiac remodeling. This meta-analysis provides an updated assessment of CPAP's effects on myocardial strain and remodeling in patients with OSA. A systematic review and meta-analysis of clinical studies evaluating CPAP's effects on speckle-tracking echocardiographic parameters in OSA patients was conducted. PubMed, Embase and Cochrane Central were searched. A random-effects model analyzed pooled data. Studies assessing right ventricular global longitudinal strain (RV-GLS) or left ventricular global longitudinal strain (LV-GLS) were included. Ten studies [one randomized controlled trial (RCT), nine observational] involving 385 patients treated with CPAP were analyzed. CPAP significantly improved left ventricular GLS -1.92% [-2.63 to -1.21] (MD [95% confidence interval]), P  < 0.01; and right ventricular GLS -1.88% [-2.77 to -0.99], P  < 0.01. No significant changes were observed in LVEF 0.77% [-0.65 to 2.18] P  = 0.29; TAPSE 0.07 mm [-0.53 to 0.68] P  = 0.81, I2  = 0%; LV mass [SMD -0.22; -0.56 to 0.12] P  = 0.54, I2  = 0%; PVR -0.59 [-1.25 to 0.04] P  = 0.08; or E/e' ratio -0.95 [-2.42 to 0.53], P  = 0.21. CPAP significantly reduced PASP -5.23 mmHg [-8.54 to -1.92], P  = 0.002, I2  = 64%; and right atrial volume index -3.96 ml/m 2 [-5.43 to -2.50], P  < 0.001, with no significant change in left atrial volume [SMD -0.01; -0.35 to 0.32], P  = 0.93. CPAP therapy improves both left and right ventricular function and reduces right atrial volume in patients with OSA. Further trials are needed to assess CPAP's long-term impact on myocardial strain and cardiac mechanics beyond conventional echocardiography.