Journal of Hypertension最新文献

Objectives: Isometric exercise is an accessible, time efficient intervention for reducing blood pressure (BP). However, guideline recommendations for its use remain sparse due to safety concerns. This study aimed to determine the proportion of participants whose BP exceeded predefined limits during isometric exercise. Secondary aims were to examine differences in BP responses between sexes and across exercises.

Methods: Participants attended the laboratory for two sessions: screening and familiarisation, and exercise testing. In session two, participants performed the plank and wall sit in a randomised order while their BP was continuously monitored noninvasively using the Finapres NOVA. Each exercise was performed until volitional fatigue or until reaching the American College of Sports Medicine limits of SBP (>250 mmHg) or DBP (>115 mmHg).

Results: Sixty-two apparently healthy participants completed the study (age 26.7 ± 8.2 years, 52% women, resting BP 121 ± 8/77 ± 6 mmHg). Almost all participants were stopped [plank: 97% (95% confidence interval, 95% CI 89-99); wall sit: 98% (95% CI 91-100)] due to DBP more than 115 mmHg after an average of approximately 50 s of exercise. All women exceeded the DBP limit [plank: 100% (95% CI 89-100); wall sit: 100% (95% CI 89-100)] compared to most males [plank: 93% (95% CI 78-99); wall sit: 97% (95% CI 83-99)]. No participants reached the SBP limit. No adverse events were reported.

Conclusion: Common isometric exercises cause a marked increase in BP, particularly DBP. Despite this, no adverse events occurred. Future studies should examine the dose-response of different isometric exercises in higher risk populations to better inform its clinical suitability.

Objective: Diagnostic criteria for an exaggerated BP increase in response to standing (ERTS) are still debated making it difficult to interpret data regarding the cardiovascular risk associated with ERTS. The aim of the present study was to identify the ERTS definition that was most strongly associated with cardiovascular disease.

Design and methods: The study was conducted within the frame of the PARTAGE study, in 920 individuals aged 80 years or older. BP was measured 1 min and 3 min after standing up. Participants were classified into three groups according to whether they had normal response to standing (reference group), orthostatic hypotension, or ERTS defined using 16 different definitions. The risk of adverse cardiovascular outcomes was explored by means of multivariable survival Cox analyses.

Results: ERTS was associated with both cardiovascular events and mortality when it was identified according to three definitions: SBP ≥20 mmHg in either orthostatic measurement [hazard ratios (HRs) (95% confidence interval, CI), 1.45 (1.03-2.03; P  = 0.031)] and 1.71 (1.05-2.77; P  = 0.030), respectively; SBP ≥15 mmHg in either orthostatic measurement ((1.43 (1.03-1.99; P  = 0.032) and 1.82 (1.12-2.94; P  = 0.015)), respectively; and SBP ≥20 mmHg and/or DBP ≥15 mmHg in either orthostatic measurement ((1.42 (1.03-1.98; P  = 0.035) and 1.94 (1.19-3.17; P  = 0.008)), respectively. The best model fit was found for SBP and DBP combined. No independent association with both outcomes was found for other ERTS definitions.

Conclusions: The present results show that an SBP increase of >15-20 mmHg is a more important prognostic indicator than less pronounced increases of SBP. However, associating also an increase in DBP of ≥15 mmHg slightly increased the predictive value of ERTS.

Proteinuria is a key marker of renal damage and is often associated with hypertension and increased cardiovascular risk. This study reviews and brings the potential involvement of renal nerves in the pathophysiology of proteinuria and renal impairment in clinical and experimental studies. Studies have highlighted that increased activation of renal sympathetic and sensory nerves activity either alone or in combination with the renin-angiotensin-aldosterone system (RAAS) contributes to the development of proteinuria and the decline in renal function. This phenomenon may occur through mechanisms that alter glomerular and/or tubular function. Additionally, interventions aimed at disrupting renal nerve activity, including pharmacological agents and surgical denervation, or RAAS blockade demonstrated a significant reduction in proteinuria and improved renal and cardiovascular outcomes. Here, we highlight the potential roles of renal nerves beyond their traditional effects on renal function, such as albumin reabsorption, glomerular function, and renal damage, in the onset and maintenance of cardiovascular disease and hypertensive nephropathy.

Upon hypoosmotic stimulation, cardiomyocytes undergo a transient positive inotropic effect (Pie) associated with an increase in the amplitude of intracellular Ca2+ transients. However, the underlying mechanisms remain elusive. The Transient Receptor Vanilloid 4 channel (TRPV4) promotes Ca2+ entry and, thus, could contribute to hypotonic swelling-induced Pie. TRPV4 have not been studied in spontaneously hypertensive rats (SHRs). We aimed to determine if TRPV4 contributes to swelling-induced Pie in Wistar rats and if this response is altered in SHR. Cardiomyocytes were isolated from 8 to 12-month-old Wistar and SHR rats. Contractility was assessed by video-edge-detection in myocytes superfused with isotonic (309 mOsm) or hypotonic solution (217 mOsm). TRPV4 expression was assessed by western blot. The slow force response (SFR) was examined in papillary muscles from SHR stretched from 92 to 98% of their maximal length. While TRPV4 inhibition with GSK2193874 (GSK; 300 nmol/l) or HC067047 (1 μmol/l) did not affect the hypotonic solution induced Pie in Wistar myocytes, it was significantly reduced in SHR. Consistently, TRPV4 expression was enhanced in SHR hearts and myocytes. Disruption of caveolae with 5 mmol/l methyl-β-cyclodextrin and inhibition of microtubule polymerization with 10 μmol/l Colchicine, reduced the GSK-sensible component of the hypotonic solution induced Pie. GSK also blunted the SFR in SHR papillary muscles. We conclude that TRPV4 do not contribute to the hypotonic solution induced Pie in Wistar rats but provide Ca2+ entry that amplifies this response in SHR. Intact caveolae and microtubule integrity are required for TRPV4 activation in SHR myocytes. In SHR hearts, TRPV4 can be activated by cardiac stretch contributing to the SFR.

Background: The magnitude of the association between fibromuscular dysplasia (FMD) and spontaneous cervical artery dissection (sCeAD) remains uncertain, since data available derive from uncompleted vascular screening. This study aims to assess the frequency and types of cervical and extra-cervical arterial lesions, particularly of the FMD type, in patients with sCeAD.

Methods: We recruited all patients with a diagnosis of sCeAD from January 2016 to December 2023. All patients underwent full-body vascular imaging to assess the presence of cervical and extra-cervical multifocal and focal stenosis, aneurysms, dissections, tortuosity, ectasia/dilatation or parietal irregularities.

Results: Of the 94 patients included (65.7% male; 48.8 ± 8.7 years old), 31.9% had evidence of cerebrovascular FMD. After a whole-body vascular screening, all-type of extra-cervical vascular abnormalities were identified in 47.5% of patients. Twenty-one percent of patients (21.3%) had evidence of extra-cervical FMD, affecting renal (11.5%), visceral (13.1%), and limb (6.7%) arteries. Prevalence of extra-cervical dissections and aneurysms was 14.8% and 9.8%, respectively. After a whole-body screening, overall prevalence of FMD raised from 32.8% to 39.3%. Patients with FMD were mainly female ( P  < 0.0001), had a history of migraine ( P  = 0.023) and recurrent sCeADs ( P  = 0.025). After a multivariate analysis, female sex ( P  < 0.0001) and, almost, a positive history of recurrent sCeADs ( P  = 0.053) were identified as predictors of FMD in patients with sCeADs.

Conclusions: The study reveals a high prevalence of FMD and other vascular abnormalities outside the cervical arteries in patients with sCeAD, highlighting the importance of a comprehensive vascular screening, especially in women and in patients with a positive history of recurrent sCeAD.

Background and objectives: Preeclampsia (PE) is a leading cause of maternal and perinatal morbidity and mortality, yet effective targeted therapies remain limited. This study aimed to investigate the therapeutic potential of annexin A5 (ANX A5) in PE and to elucidate the underlying mechanisms based on metabolomic profiling.

Methods: A PE-like mouse model was established by intraperitoneal injection of lipopolysaccharide (LPS, 20 μg/kg/day) from gestational day (GD) 7.5 to 17.5, followed by intravenous administration of ANX A5 (50 μg/kg/day) in the treatment group. In vitro, LPS-stimulated HTR-8/Svneo trophoblast cells were treated with either ANX A5 or NLRP3 inhibitor. Placental metabolite profiling was performed using liquid chromatography-tandem mass spectrometry. Placental morphology and NF-κB/NLRP3 inflammasome markers were evaluated by western blotting and enzyme-linked immunosorbent assay.

Results: ANX A5 administration markedly attenuated high blood pressure, proteinuria, and adverse pregnancy outcomes in PE-like mice. Metabolic alterations associated with ANX A5 were predominantly enriched in the NF-κB/NLRP3 inflammasome pathway. Correspondingly, ANX A5 treatment downregulated the elevated placental expression of NLRP3, caspase-1, and interleukin-1β in PE-like mice. Furthermore, in HTR-8/Svneo cells, ANX A5 effectively suppressed the inflammatory responses by inhibiting the NF-κB/NLRP3 inflammasome signaling pathway, thereby restoring trophoblast migratory capacity.

Conclusion: These findings demonstrate that ANX A5 confers significant protection in a PE mouse model, which is mediated through inhibition of the NF-κB/NLRP3 inflammasome pathway and modulation of placental metabolism. This study highlights the potential of ANX A5 as a novel therapeutic strategy for PE.

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.