Journal of Hypertension最新文献

Background: Premature birth disrupts the intra-uterine structural and functional maturation of the left ventricle (LV) and arteries. The study investigated the impact of premature birth on ventricular-arterial coupling (VAC), a potential precursor of cardiovascular disease in adulthood.

Methods: This case-control study in Northern Belgium (2011-2016) included 93 extremely-low-birth-weight (ELBW) cases and 87 sex and age-matched term-born controls. Main outcomes included SBP and DBP, central arterial properties, echocardiographic structure and function, and VAC.

Results: Compared with controls, cases were shorter by 4.1 cm [95% confidence interval (95% CI): 1.3-7.0] and lighter by 4.1 kg (95% CI: 1.3-6.9). Cases had higher central SBP/DBP (+7.3/3.0 mmHg; 95% CI: 4.7-9.9/1.1-4.8), lower left ventricular end-diastolic and end-systolic dimensions, and 9.2 g (95% CI: 3.7-14.6) lower left ventricular mass. Left ventricular volumes and mass correlated with body size without significant between-group differences ( P  ≥ 0.12). Cardiac output was 0.38 l/min lower in cases, who also had higher arterial resistance (29.5 vs. 24.4 mmHg × min/l) and augmentation ratio (1.10 vs. 1.05). The tension-time index was 231 mmHg × ms (95% CI: 128-335) higher in cases. Ea and Ees were higher in cases (0.40 and 0.65 mmHg/ml, respectively), but VAC did not differ between groups ( P  = 0.48).

Conclusion: Compensatory mechanisms maintain the anatomical and functional integrity of the cardiovascular system in ELBW youth, but mask their vulnerability to cardiovascular disease in adulthood and necessitate careful follow-up during adolescence.

Objectives: Immunity, particularly T lymphocytes, plays an important role in the development of arterial hypertension. Moreover, the so-called neuro-immune axis has been identified as a crucial crossroads, occurring in the spleen and involving placental growth factor as the principal mediator. However, no studies in humans have yet investigated the role of the spleen in hypertension and vascular damage.

Methods: In this retrospective, case-control, single-blind study, we enrolled patients who had previously undergone elective splenectomy (cases) and subjects who had undergone elective cholecystectomy (controls). All subjects underwent 24-h ambulatory blood pressure monitoring, evaluation of retinal arteriole morphology by adaptive optics, capillary density assessment by video-capillaroscopy, arterial stiffness measurements, and analysis of T lymphocyte subpopulations by flow cytometry.

Results: Fifty patients were included: 25 (50%) cases and 25 (50%) controls. No difference in hypertension prevalence ( P  = 0.39) or cumulative incidence ( P  = 0.79) of new diagnoses was detected. Splenectomized patients displayed lower 24-h ( P  = 0.024) and daytime ( P  = 0.011) diastolic blood pressure compared to cholecystectomized patients. Similar results were obtained for retinal structural parameters, capillary density, and arterial stiffness between the groups. A significant impact of splenectomy on the relationship between 24-h diastolic BP and wall cross-sectional area ( P -interaction = 0.019) and forearm capillary density recruitment ( P -interaction = 0.020) was found. A higher number and percentage of CD3 + CD8 + T cells were observed in splenectomized patients compared to cholecystectomized patients ( P  = 0.009 and P  = 0.001, respectively), although no differences in cytokine production patterns were detected.

Conclusions: For the first time, our results support the role of the spleen in blood pressure control in humans. Further and larger studies are required to appropriately translate our findings into clinical practice.

Hypertension is a significant risk factor for cerebrovascular diseases, affecting cerebral blood flow (CBF) and brain health. Reduced CBF in hypertensive individuals is linked to cognitive decline and neurodegenerative diseases. Arterial spin labeling (ASL) MRI offers a noninvasive method to assess these changes. This systematic review consolidates evidence on the impact of hypertension on CBF using ASL-MRI. A comprehensive search across PubMed, Scopus, Embase, and Web of Science, following PRISMA 2020 guidelines, included studies on adults with hypertension reporting CBF measurements. Findings indicate that hypertension reduces CBF in various brain regions, with improvements seen after antihypertensive treatment. ASL-MRI may be a valuable tool for monitoring treatment effectiveness and brain health. However, most studies were conducted in high-income countries and elderly populations, emphasizing the need for further research in younger and low-income settings. Early CBF assessment using ASL-MRI could aid in timely interventions.

Objectives: Estimated pulse wave velocity (ePWV) is a useful indicator for arterial stiffness assessment. However, traditional ePWV calculation only utilizes resting blood pressure (BP) values, and the association between ePWV based on exercise BP readings and clinical outcomes remains unclear. This study aims to explore whether ePWV calculated by BP derived from cardiopulmonary exercise test (CPET) is superior to traditional ePWV in the relationship with all-cause mortality.

Methods: A total of 2272 young and middle-aged adults without cardiovascular disease in the National Health and Nutrition Examination Survey (1999-2002) were included. Traditional ePWV was calculated using resting BP. Moreover, using CPET as protocol, exercise BP and recovery BP were used for ePWV calculation as well. Cox proportional hazards models were applied to assess the association between different types of ePWV and all-cause mortality, with hazard ratio with 95% confidence intervals (95% CIs) estimated. Restricted cubic spline analysis was performed to examine the nonlinear correlation between ePWV and outcomes, and subgroup analyses were conducted.

Results: After adjustment for potential confounders, a linear relationship was observed between all types of ePWV and outcomes, and only recovery ePWV showed a significant association with all-cause mortality (hazard ratio: 1.67, 95% CI: 1.26-2.21). Subgroup analysis showed that recovery ePWV was significantly associated with all-cause mortality in certain groups, including different age ranges, moderate cardiopulmonary health status, absence of hypertension, lower education levels, and current smokers. However, no significant interactions were found across subgroups.

Conclusion: Recovery ePWV, derived from postexercise BP measurements, demonstrated superior prognostic value for all-cause mortality compared to traditional resting or exercise ePWV in young and middle-aged adults. This finding suggests that incorporating dynamic BP assessments may provide additional prognostic information.

Background: Ambulatory blood pressure measurement (ABPM) data from the PRECISION study have shown that in patients with confirmed resistant hypertension (RHT), aprocitentan leads to substantial lowering of BP, particularly at night-time. Here, the ABPM data were used to define subgroups with substantial prognostic value (dipping pattern, BP load, heart rate, arterial stiffness, and salt sensitivity) and to evaluate the BP-lowering effect of aprocitentan on these subgroups.

Methods: The effects of aprocitentan on ABPM derivatives including dipping pattern, BP load, and heart rate were evaluated. The BP lowering effect of aprocitentan was assessed based on the subject's baseline arterial stiffness and salt sensitivity.

Results: At week 4, the placebo-corrected and dose-dependent decrease of ambulatory systolic BP was more marked for baseline non-dippers than dippers. The proportion of non-dippers at baseline whose dipping pattern normalized at week 4 was higher for the aprocitentan group compared to placebo. The decrease in BP load during daytime/nighttime was also more pronounced with aprocitentan compared to placebo. Despite the BP lowering effect of aprocitentan, heart rate remained unchanged at week 36. The BP lowering effect of aprocitentan was not diminished by increased arterial stiffness index or salt sensitivity risk at baseline.

Conclusion: In addition to a significant and sustained day and night-time ambulatory BP reduction, aprocitentan was associated with a higher proportion of patients experiencing dipping pattern normalization and more pronounced BP load reduction, indicating prognostic relevance. Increased arterial stiffness or salt sensitivity did not alter the BP response to aprocitentan, suggesting additional clinical benefit.

Background: Carotid-to-femoral pulse wave velocity (c-f PWV) is commonly used to assess large artery stiffness, particularly as a surrogate of aortic stiffness. Given that c-f PWV represents the average stiffness of all main arteries along the carotid-to-femoral arterial pathway, without specifically accounting for the stiffness of the proximal aorta, we hypothesized that c-f PWV may not represent stricto sensu the stiffness of the ascending aorta (AAO), which is the main contributor to total arterial compliance ( CT ).

Methods: To test our hypothesis, we recruited 45 healthy volunteers from different age groups. We evaluated the relation between c-f PWV and different indices of proximal aorta stiffness calculated from distensibility (AAO dist PWV) and characteristic impedance (Zc) in frequency (AAO Z c(f) PWV) and time domain (AAO Zc(t) PWV) and compared their relationships with age and CT . 2D phase contrast MRI was performed to measure AAO flow and cross-sectional area. Tonometry was used to obtain c-f PWV and pressure waveforms.

Results: In healthy individuals, AAO PWV indices demonstrated a strong relationship with each other ( R  ≥ 0.86), but c-f PWV did not show high correlations with AAO PWV indices ( R  ≤ 0.50). All AAO PWV indices increased with age ( P  ≤ 0.05); however, c-f PWV did not increase from young to middle-aged ( P  = 0.13) and middle-aged to old age groups ( P  = 0.28). AAO PWV indices correlated well with C T ( R2  ≥ 0.60), whereas c-f PWV did not ( R2  = 0.23).

Conclusion: The present study reveals that a complete understanding of large artery stiffness requires the direct assessment of proximal aortic stiffness rather than surrogate indices such as c-f PWV.

Background: Although 24-h ambulatory blood-pressure monitoring (ABPM) is widely available, its diagnostic potential beyond confirming different types of hypertension remains under-utilized.

Objective: To derive and externally validate against echocardiographic hemodynamic indices a purely ABPM-based classification of circulatory phenotypes that extends conventional blood-pressure staging.

Methods: We retrospectively analyzed 29 743 consecutive adults who underwent 24-h ABPM. After excluding anyone previously treated for hypertension, 12 876 de-novo participants (50.2 ± 13.6 years; 51.4% men; 24.7% obese) were included, 9195 of whom were hypertensive. Pearson correlation matrices identified diastolic blood pressure (DBP), pulse pressure (PP) and heart rate (HR) as the least-collinear variables. These were z -standardized and submitted to K-means clustering.

Results: Four reproducible phenotypes were yielded: cardiogenic - elevated HR and cardiac output (CO) without arterial dysfunction (ΔHR = +10.5 bpm vs. normotensives, 95% CI 10.0-10.9); vaso-resistive - raised DBP with reduced HR, resulting in a higher DBP/HR index (ΔDBP/HR = +0.23 mmHg bpm -1 , 95% CI 0.22-0.24); mixed - simultaneously increased HR and DBP, giving the highest DBP/HR index ( P < 0.001 vs. normotensives); arterial-stiffness - widened PP with lower DBP, reflected in an elevated PP/DBP index (ΔPP/DBP = +0.16, 95% CI 0.15-0.17). Cluster-derived proxies of CO, systemic vascular resistance, and arterial stiffness showed good agreement with echocardiographic measurements, confirming their physiological validity.

Conclusions: A simple, unsupervised cluster analysis of routine ABPM data uncovers four reproducible circulatory phenotypes that enrich traditional blood pressure staging. Incorporating these phenotypes into clinical practice could refine risk stratification and enable mechanism-targeted antihypertensive therapy.

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.