Journal of Hypertension最新文献

Background: Defined clinically by elevated blood pressure along with either proteinuria and/or maternal organ dysfunction, representing a major cause of morbidity and mortality pregnant women and newborns. Metformin (MET), an oral antidiabetic medication, has been shown to prevent preeclampsia (PE) through various mechanisms, including reducing inflammation, improving endothelial dysfunction, improving mitochondrial function, and altering cellular homeostasis and energy metabolism. Herein, we explored the role of MET in PE and its underlying molecular mechanisms using in in vivo experiments.

Methods: RT-qPCR, Western blot (WB), and immunohistochemistry (IHC) were conducted to assess the mRNA or protein expression of genes related to mitochondrial apoptosis. Additionally, ELISA was conducted to quantify the expression of mitochondrial apoptosis and inflammation-related genes, as well as PE biomarkers.

Results: Treatment with MET in PE rats ameliorated hypertension and proteinuria, altered the expression of PE biomarkers, and significantly inhibited L-NAME-induced inflammation and cell apoptosis. MET modulated the levels of inflammatory cytokines tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, and IL-10, mitigating inflammation in PE rats. Furthermore, MET regulated mitochondrial outer membrane permeability (MOMP), thereby reducing cell apoptosis occurring in the mitochondrial pathway of PE rats.

Conclusions: This study demonstrates that MET alleviates inflammation and cell apoptosis in PE rats by modulating the expression of inflammatory factors and MOMP. Our results indicate that MET has huge therapeutic potential against PE.

Bartter's and Gitelman's syndromes (BS/GS) are genetically determined kidney tubulopathies leading to electrolyte and neurohormonal abnormalities. Although considered benign entities, major adverse cardiovascular events may complicate both syndromes, in form of ventricular arrhythmias leading to palpitations, syncope or sudden cardiac death, microvascular cardiac dysfunction and exercise-induced myocardial contractile deficit. The mechanisms leading to cardiovascular complications are not only driven by chronic electrolyte abnormalities, i.e. chronic hypokalemia and hypomagnesemia, but also by neurohormonal alterations that can impair vascular tone and myocardial contractility. In presence of triggering factors, BS/GS patients may experience a spectrum of cardiac arrhythmias necessitating prompt diagnosis and treatment. The aim of this review is to explore the pathophysiological mechanisms of BS and GS, highlighting those responsible for cardiovascular involvement, and to analyze the spectrum of associated cardiovascular complications. This highlights the importance of an integrated shared management of GS/BS patients between Nephrologist and Cardiologist.

Background: Hypertension is the most prevalent cardiovascular risk factor, with several detrimental effects on the cardiovascular system. Contrasting results have been reported so far on its prognostic role in patients admitted for ST-segment elevation myocardial infarction (STEMI). Therefore, we investigated the impact of hypertension on short-term mortality in a large multicenter contemporary registry of STEMI patients, including patients treated during COVID-19 pandemic.

Methods: The ISACS-STEMI COVID-19 was a retrospective registry that included STEMI patients treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 in 109 high-volume primary PCI centers from 4 continents. We collected data on baseline, clinical and procedural characteristics, in-hospital outcome and 30-day mortality. For this analysis patients were grouped according to history of hypertension at admission.

Results: A total of 16083 patients were assessed, including 8813 (54.8%) with history of hypertension. These patients were more often elderly, with a worse cardiovascular risk profile, but were less frequently active smoker. Some procedural differences were observed between the two groups, including lower rate of thrombectomy and use of glycoprotein IIb/IIIa inhibitors or cangrelor but more extensive coronary disease in patients with hypertension. Between patients with and without hypertension, there was no significant difference in SARS-CoV-2 positivity. Hypertensive patients had a significantly higher in-hospital and 30-day mortality, similarly observed in both pre-COVID-19 and COVID-19 era, and confirmed after adjustment for main baseline differences and propensity score (in-hospital mortality: adjusted odds ratio (OR) [95% confidence interval (CI)] =1.673 [1.389-2.014], P  < 0.001; 30-day mortality: adjusted hazard ratio (HR) [95% CI] = 1.418 [1.230-1.636], P  < 0.001).

Conclusion: This is one of the largest and contemporary study assessing the impact of hypertension in STEMI patients undergoing primary angioplasty, including also the COVID-19 pandemic period. Hypertension was independently associated with significantly higher rates of in-hospital and 30-day mortality.

Background: Medication nonadherence is a major risk factor for suboptimal or failed hypertension pharmacologic therapy.

Objective: To determine the nonadherence rate to antihypertensive medications using high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) and the self-reported Morisky Medication Adherence Scale (MMAS).

Methods: This study used a prospective cross-sectional cohort design. Patients with hypertension aged ≥18 years and prescribed at least one antihypertensive medication were recruited from an outpatient hypertensive clinic at a tertiary healthcare institution in Oman. Adherence was assessed using LC-MS/MS urine analysis and the MMAS.

Results: In total, 162 patients completed the MMAS questionnaire and provided urine samples for LC-MS/MS analysis. The overall mean age of the cohort was 55 ± 13 years, and 57% of the patients were men. The mean systolic and diastolic blood pressures were 146 ± 18 mmHg and 79 ± 10 mmHg, respectively. Using the MMAS method, 65% of the patients reported nonadherence. However, LC-MS/MS analysis revealed that only 27% of the patients were nonadherent. The adherent group by LC-MS/MS had significantly lower systolic ( P  = 0.026) and diastolic blood pressures ( P  < 0.001) than the nonadherent group, whereas no differences were observed using the MMAS method. There was weak or no agreement between the MMAS and LC-MS/MS results ( P  = 0.142).

Conclusion: Almost one-fourth of our patients with hypertension were nonadherent to their medications. There was a weak concordance between the MMAS and LC-MS/MS methods in detecting medication nonadherence. Further research into noninvasive convenient adherence scales or methods and their correlations with LC-MS/MS analysis is warranted.

Background and aims: Exploring the effect of different isometric resistance training (IRT) on improving blood pressure, so as to provide important reference for the design of aerobic exercise prescription for IRT to improve blood pressure.

Methods: Forty eight overweight or obese college students with irregular exercise habits were randomly divided into four groups and underwent exercise intervention three times a week for a total of 6 weeks. Cardiovascular changes were evaluated before the first and 18th exercise sessions, as well as 0, 30, and 60 min after exercise.

Results: Heart rate (HR) of equal distance wall squat group (ISG) and whole body equal length exercise group (WIG) increased significantly immediately after exercise, but long-term IRT intervention significantly decreased systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) of WIG and ISG, SBP, and MAP of equal grip strength group (IHG), and DBP and MAP of equal curl up group (ICG); In the first exercise, ICG, ISG, and WIG significantly increased SBP and DBP immediately after exercise, ISG significantly increased MAP immediately after exercise, while in the 18th exercise, IHG, ISG, and WIG significantly increased SBP immediately after exercise, ISG significantly increased DBP and MAP immediately after exercise.

Conclusion: IRT is a safe and easy to implement exercise mode. Long-term intervention can effectively control blood pressure, and will not cause excessive cardiovascular pressure response after a single exercise.

Aim: Arterial stiffness hallmarks age-related cardiovascular diseases, precedes their onset and strongly links to accelerated disease progression. However, whether carotid-to-femoral pulse wave velocity (PWV), a proxy of arterial stiffness, predicts cardiovascular risk over and above SCORE2, a newly introduced risk score remains to be investigated.

Methods: We measured PWV among 747 individuals without established atheromatosis. Study participants were followed up over a 6-year period for the incidence of cardiovascular events [[MACE)-cardiovascular mortality, stroke and myocardial infarction].

Results: PWV emerged as an independent and additive predictor of first cardiovascular events when added in a model encompassing SCORE2 (hazard ratio = 1.10; 95% confidence interval (95% CI) = 1.07-1.14; P  < 0.001, Brier score changed from 0.073 (0.060-0.086) to 0.067 (0.055-0.081); P  < 0.001, c-statistic increased from 0.71 to 0.75; P  = 0.017; likelihood ratio: 20.22; P  < 0.001; the overall net reclassification improvement (NRI): 0.577; P  < 0.001, AICc changed from 697.81 to 679.60; BIC changed from 702.42 to 688.82]. An increase in PWV predicted a greater risk of future MACEs additively to conventional risk factors ( P  < 0.05). We performed Kaplan-Meier survival analysis for the tertiles of PWV [first tertile < 8.04 m/s; the second tertile: (8.04-10 m/s); the third tertile: (10-17.10 m/s); ( P  < 0.05 for all comparisons between the tertiles). PWV tertiles also predicted MACE when added to SCORE2 [for the second tertile: hazard ratio: 5.87 (95% CI: 1.73-19.92); P  = 0.004 and for the third tertile: hazard ratio: 9.69 (95% CI: 2.97-31.55); P  < 0.001 with the respective change of c-statistic from 0.739 to 0.772; P  = 0.012 and continuous NRI = 0.598].

Conclusion: PWV confers additive prognostic value to the newly introduced SCORE2 for adverse outcome in primary prevention.