Journal of Hypertension最新文献

Background: While emerging evidence suggests guideline-defined nonhypertensive blood pressure (BP) may encompass heterogeneous risk, the relationship between BP variations within nonhypertensive ranges and mortality risk remains inadequately characterized among individuals without traditional cardiovascular risk factors. This study investigated whether nonhypertensive range of SBP, DBP, and pulse pressure (PP) are associated with long-term mortality in a healthy population.

Methods: This study included 80 730 UK Biobank participants without traditional cardiovascular risk factors and with nonhypertensive BP (SBP <140 mmHg, DBP <90 mmHg, and PP <60 mmHg). Participants were followed up for all-cause, cardiovascular, and noncardiovascular mortality. Associations were assessed using multivariable Cox proportional hazards models with restricted cubic splines.

Results: Over a median follow-up of 13.7 years, 2553 deaths occurred. SBP and PP showed significant nonlinear associations with all-cause mortality (P-overall <0.01), while DBP showed a linear inverse association (P-overall = 0.049). Compared to the third quintile, the lowest PP quintile (<40 mmHg) was associated with 26% higher mortality risk (hazard ratio 1.26, 95% confidence interval [95% CI] 1.10-1.44), and the highest quintile (53-60 mmHg) with 14% higher risk (hazard ratio 1.14, 95% CI 1.01-1.28). The lowest SBP quintile (<114 mmHg) was associated with 16% higher risk (hazard ratio 1.16, 95% CI 1.02-1.32) compared to the third quintile (120-126 mmHg).

Conclusion: Even within nonhypertensive ranges, the lowest and highest quintiles of PP level, as well as low-normal SBP and DBP levels, were associated with increased mortality risk in a healthy population.

Introduction: Given Croatia's high and rising prevalence of arterial hypertension, we aimed to investigate the population-level determinants of hypertension.

Materials: Out of 2049 individuals recruited in the EHUH 2 study (random sample), in this analysis, we included 864 individuals (men 34.5%) who provided valid 24-h urine samples. Data on demographics, lifestyle, clinical and laboratory parameters were collected. Hypertension was defined as blood pressure at least 140/90 mm Hg or antihypertensive use.

Results: Key determinants of hypertension included male sex [odds ratio (OR) 2.27], salt intake more than 5 g/day (OR 2.46), presence of diabetes (OR 1.95), residence in rural areas (OR 1.63) and a high sodium-to-potassium ratio (OR 1.24). Current smokers had fewer odds than nonsmokers (OR 0.55). When estimated pulse wave velocity (ePWV) was added, model 2 became stronger (R2 = 0.455), and each increase of 1 m/s of ePWV increased odd for hypertension by 3.73. The higher prevalence of hypertension observed in rural areas was linked to low socioeconomic status, obesity and high sodium/potassium ratio. Ex-smokers had a higher risk obviously because they replaced one poor habit with another one.

Conclusion: Based on our results, we can recommend in low-medium-income countries like Croatia tailor screening programs for hypertension not only for individuals with chronic kidney disease, diabetes, or obesity but also for those with low socioeconomic status and rural residents. We can suggest that two low-cost methods, sodium-to-potassium ratio and ePWV, become a regular routine part of these screening programs. In smoking cessation programs, smokers should be educated how to quit smoking, but also how to live healthier.

Objectives: Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are linked to later-life cardiovascular disease, but their impact on midlife cardiac health is unestablished. Therefore, we examined their associations with midlife left ventricular remodeling.

Methods: This study included 408 and 451 women from the Bogalusa Heart Study cohort with information on HDP and GDM, respectively. Of these, 34 had HDP and 41 had GDM. Mean echocardiographic follow-up was approximately 15 years after pregnancy. Outcomes included left ventricular mass index (LVMi), ejection fraction (LVEF), and left ventricular geometry (concentric remodeling, concentric or eccentric hypertrophy). Multivariable regression was adjusted for demographic and prepregnancy cardiometabolic factors. Effect modification by age and race and mediation by postpregnancy cardiometabolic factors were evaluated.

Results: Median age at first pregnancy was 22.0 years and 33.0% were Black. HDP was associated with greater LVMi in midlife (standardized β = 0.37, 95% confidence interval [CI]: 0.01-0.72, P = 0.04), but not with LVEF. HDP was also associated with greater odds of concentric remodeling (odds ratio = 2.48, 95% CI: 1.03-6.00, P = 0.04). Postpregnancy BMI mediated 19.47% of the association between HDP and LVMi (P = 0.01). GDM was not associated with left ventricular structure or function after adjustment. Interaction terms by age and race were not significant.

Conclusion: HDP is associated with adverse left ventricular remodeling, partly mediated by postpregnancy BMI. These findings underscore the need for early echocardiographic monitoring and postpartum weight management in women with HDP to reduce long-term cardiovascular risk.

Objective: Hypertension and diabetes frequently coexist and may interact to induce organ damage. Herein, we evaluated whether persons with prediabetes already have impaired retinal and glomerular autoregulatory responses to higher blood pressure.

Methods: We used cross-sectional, population-based data of 6594 participants [4206 with normal glucose metabolism (NGM), 1023 with prediabetes, and 1365 with type 2 diabetes (oversampled); mean age 59.8 ± 8.6 years; 50.2% men] of the Maastricht Study. Using multiple linear regression models, we tested if glucose metabolism status modified the associations of 24 h systolic and diastolic blood pressure (SBP/DBP) with retinal arteriolar and venular diameters (CRAE/CRVE) and urinary albumin excretion (uAE).

Results: The total modification for CRAE was significant for diabetes but not for prediabetes. The association of SBP with CRAE was attenuated by prediabetes (Pinteraction = 0.098) and diabetes (Pinteraction < 0.001) in females (but not males), with a beta of -0.21 SD per 10 mmHg (95% CI: -0.25; -0.16), -0.14 (-0.24; -0.05) and -0.04 (-0.14; 0.07) for NGM, prediabetes, and diabetes, respectively. The association of SBP with uAE was stronger in prediabetes (Pinteraction = 0.002) and diabetes (Pinteraction < 0.001) than in NGM, for the whole study population (no sex difference). The corresponding beta was 0.13 (0.11; 0.16), 0.20 (0.15; 0.26), and 0.24 (0.18; 0.29) for NGM, prediabetes and diabetes, respectively. No substantial changes were observed when replacing SBP by DBP.

Conclusions: Our findings suggest that retinal and glomerular autoregulatory responses to higher blood pressure are impaired in persons with prediabetes and with diabetes. This emphasizes the importance of both blood pressure and glycemic control already in those with prediabetes.

Objectives: The association between blood pressure (BP) and the mortality risk may vary depending on the comorbidities. This study was conducted to investigate the subgroup-specific correlation between systolic BP (SBP) and mortality in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI).

Methods: The Clinical Deep Data Accumulation System for PCI (CLIDAS-PCI), a nation-wide multicenter database with seven tertiary medical hospitals in Japan, retrospectively collected data on patients undergoing PCI for acute coronary syndrome or stable coronary artery disease. Cubic spline curves modeled the relationship between SBP and all-cause death in the entire cohort and subgroups stratified by age, sex, diabetes, left ventricular (LV) hypertrophy, renal function and LV systolic function. We assessed the SBP, which minimizes mortality risk.

Results: A total of 8384 patients [71 [IQR 64, 78] years, 6494 (77%) male] with SBP at hospital discharge were analyzed. During 2.7 years of median follow-up, 695 deaths occurred. In the overall population, spline analysis demonstrated a nadir range of mortality risk around an SBP of 110-130 mmHg. Subgroup analyses revealed that elderly (age ≥ 80 years), those with renal dysfunction, and those with preserved LV systolic function had higher SBP levels associated with lowest risk. Conversely, patients <80 years, those with better renal function, and those with LV systolic dysfunction exhibited lower SBP levels at lowest risk.

Conclusion: This study demonstrated differential association between SBP and mortality risk in various subgroups, highlighting the need for personalized BP management in multimorbid patients with coronary artery disease.

Background: Increased activity of the sympathetic nervous system (SNS) is a critical factor in the pathophysiology of hypertension. Centrally acting sympatholytic agents (CASA) and renal denervation (RDN) represent two distinct therapeutic strategies targeting the SNS.

Aims: This study explored whether the blood pressure (BP)-lowering effect of RDN is influenced by the presence of CASAs.

Methods: Patients from the Global Symplicity Registry (GSR) were categorized into two groups based on whether or not their antihypertensive medication regimen prior to RDN included CASAs. Changes in systolic and diastolic 24-h ambulatory BP from baseline to 3-, 6, 12 and 24-month follow-up were compared between groups with crude and adjusted ANCOVAs.

Results: A total of 2712 patients had medication data available at baseline, of whom 1036 (38.2%) were on CASAs, and 1676 (61.8%) were not. Systolic 24-h ambulatory BP lowering at all time points after RDN was consistently more pronounced in the non-CASA compared to the CASA group (P < 0.001). DBP lowering was greater in the non-CASA group at 3- and 6-month follow-up, but not at later time points.

Conclusion: Patients not treated with CASAs prior to RDN demonstrated a more pronounced ambulatory SBP reduction over 24 months compared to those on CASA treatment. These findings corroborate the notion that the RDN-induced BP reduction is at least in part mediated via modulation of central sympathetic outflow. Even in the presence of CASAs, RDN still results in significant BP lowering, yet to a lesser degree. These findings have implications for managing patient expectations prior to RDN.

Objective: To investigate the effects of combined exercise training associated with enalapril maleate on blood pressure variability (BPV) and renal morphofunctional, inflammatory and oxidative stress parameters in an experimental model of arterial hypertension.

Methods: Male spontaneously hypertensive rats (SHR) were randomly allocated into sedentary placebo (SP), trained placebo (TP), sedentary enalapril (SE) or trained enalapril (TE). Both enalapril treatment (3 mg/kg) and combined exercise training (3 days/week) were performed for 8 weeks. Blood pressure (BP) was recorded intra-arterially for BPV analysis. Renal function, morphology, inflammation and oxidative stress were assessed.

Results: Combined exercise training alone (TP group) did not alter systolic BP. However, TP group showed lower media/lumen ratio of interlobular arteries and NAPDH oxidase activity, as well as higher interleukin (IL)-10 and superoxide dismutase activity in renal tissue compared to the SP group. In addition to similar benefits induced by exercise training alone, the combination of approaches (TE group) resulted in lower vascular sympathetic modulation (TE: 10.6 ± 1.7 vs. SP: 22.0 ± 3.1 mmHg2), higher creatinine clearance, lower NADPH oxidase activity, lower areas with severe tubulointerstitial fibrosis (injury range 51-100%, TE: 10.0 ± 0.2 vs. SP: 27.5 ± 0.1, TP: 22.5 ± 0.1 and SE: 22.5 ± 0.1%), as well as a lower media/lumen ratio. Positive correlations were obtained between vascular sympathetic modulation with SBP (r = 0.61), media/lumen ratio (r = 0.74) and renal tubulointerstitial fibrosis (r = 0.69).

Conclusions: The combination of exercise training with enalapril provided additional renal morphofunctional benefits, which may result from interactions involving BPV, inflammation, and oxidative stress, and could contribute to the observed renal improvements. Our findings also suggest that BPV may play a role in hypertension-related renal changes and that combining pharmacological and nonpharmacological therapies might offer effective strategies to reduce residual cardiovascular risk in arterial hypertension.

Introduction: Fibromuscular dysplasia (FMD) is a rare disease with diverse clinical presentations. The need for a bespoke clinic providing individualized care was deemed a patient priority at the United Kingdom's (UK) first patient information day on FMD. In response, a multidisciplinary clinic was established at Salford Royal Hospital in November 2019, integrating renal, neurology, interventional radiology, and neuro-radiology expertise. It has since evolved into the UK's first national FMD clinic. This study aimed to describe baseline patient characteristics and identify contributing factors in disease progression.

Methods and results: This prospective observational study included 215 patients reviewed over 5 years. All underwent brain-to-pelvis imaging at least once to radiologically confirm FMD. FMD mimics were identified more often than expected (n = 87, 40.4%), predominantly due to sub-optimal imaging artefacts. Of 128 confirmed FMD patients, median age was 49 years; focal FMD patients were younger than multifocal FMD patients [median (interquartile range or IQR): 44 (27-58) vs. 45 (36-49) years; P = 0.038]. Sixty-seven percent were Caucasian and 85.3% female, and 66.7% had multivessel disease, 29.3 and 19.6% had aneurysms or dissections at presentation. Multifocal disease, aneurysms and dissections were more common in multivessel disease. Follow-up data defined risk factors for clinical or radiological disease progression: younger age at FMD onset [odds ratio (OR) 0.97, P = 0.042], current smoking (OR 3.78, P = 0.006), baseline history of hypertension (OR 6.2, P = 0.017).

Conclusion: This study emphasizes the importance of a dedicated multidisciplinary FMD service for confirming diagnosis and identifying FMD mimics to facilitate personalized care. Early diagnosis, smoking cessation and blood pressure management are key to preventing disease progression.

Objective: Blood pressure (BP) typically decreases during sleep, known as the "dipping" pattern. A "nondipper", characterized by <10% BP reduction during sleep, has an elevated cardiovascular risk. Intermittent hypoxia (IH) is used to model hypertension with sleep apnea, but its relation with BP dipping and its effect on the kidney remains unclear.

Methods: Male C57BL/6J (WT) mice were exposed to either normoxia (NX) or IH (O2 concentration reduced to 5% in 90 s every 3 min during 8 h within the light period, for >1 week). BP was measured by radiotelemetry, and the dipping state was assessed by comparing mean BP (MBP) between light and dark periods. High- or low-salt diet (8% or 0.05% NaCl) and Slc12a3-/- mice (NCC-KO) were used to clarify the role of renal mechanism in the IH model mice.

Results: WT mice exhibited a dipping BP pattern under NX, but showed a nondipping pattern under chronic IH. Low-salt diet restored the dipping pattern and high-salt diet reinduced the nondipping one in the IH-model mice. Chronic IH increased the phosphorylation of Na-Cl cotransporter (NCC) and Na-K-Cl cotransporter (NKCC2) in the kidney, without affecting ENaCα cleavage. Even NCC-KO mice showed a dipping pattern of BP under NX, which shifted to a nondipping pattern under chronic IH. As expected, treatment with furosemide restored the dipping pattern in NCC-KO mice under chronic IH.

Conclusions: Chronic IH disrupts the physiological dipping pattern of BP through NCC and NKCC2 activation. This study underscores the kidney's role in the pathophysiology of nondippers with sleep apnea.

The regulation of blood pressure is closely linked to sympathetic activity. This retrospective study analyzed 142 hypertensive patients undergoing computed tomography (CT)-guided O 2 -O 3 neurolysis targeting intervertebral foramina or lumbar paravertebral ganglia for pain management. Results demonstrated significant reductions in both postoperative in-hospital blood pressure and office blood pressure during follow-up alongside decreased antihypertensive medication use. Notably, blood pressure reduction showed independence from pain relief but exhibited strong anatomical correlation with renal sympathetic innervation, specifically with the lower thoracic vertebral level (T9-T12) and the upper lumbar vertebral level (L1-L2). The findings suggest that modulation of thoracolumbar sympathetic pathways through minimally invasive gas neurolysis may represent a novel therapeutic strategy for hypertension management, potentially offering a targeted approach for renal sympathetic denervation. Further prospective studies are warranted to validate these observations.