Journal of Hypertension最新文献

Objective: To compare blood pressure (BP) and cardiovascular function between individuals with and without a family history of hypertension in a first-degree relative.

Methods: The haemodynamics of participants with ( n  = 437) and without ( n  = 274) a family history of hypertension were recorded using continuous tonometric pulse wave analysis and whole-body impedance cardiography during passive head-up tilt.

Results: The group with a family history of hypertension had a higher percentage of antihypertensive medication users (15.6 vs. 8%, P  = 0.003) and higher office BP (143/91 vs. 140/87 mmHg, P  < 0.05) than the group without hypertensive first-degree relatives. The proportion of men (51.9 vs. 55.1%) and the mean age (48.2 vs. 48.1 years) were similar in both groups. During head-up tilt, participants with a family history of hypertension consistently had 5/4 mmHg (systolic/diastolic) higher radial and aortic BP ( P  < 0.001 for all comparisons), a shorter aortic reflection time (-2.4 ms, P  = 0.017), and a higher systemic vascular resistance (SVR) index (180 dyn s/cm 5  m 2 , P  < 0.001) than participants without hypertensive first-degree relatives. Central forward wave amplitude, pulse pressure, augmentation pressure, augmentation index, heart rate, cardiac output, and pulse wave velocity did not differ between the study groups. All haemodynamic variables changed significantly in response to head-up tilt with no differences between the two study groups.

Conclusion: Participants with a family history of hypertension were characterized by elevated central and peripheral BP probably due to higher SVR, whereas the stiffness of large arteries was not higher. These findings highlight the role of SVR in the pathogenesis of primary hypertension.

Aerobic exercise is a well-recognized nonpharmacological intervention for lowering blood pressure (BP) in obese adults, yet its efficacy has not been thoroughly evaluated through meta-analysis. This study analyzed 15 randomized controlled trials (796 participants) comparing aerobic exercise with sedentary controls. Results showed that aerobic exercise significantly reduced systolic blood pressure (SBP) by 3.39 mmHg [95% confidence interval (CI): 0.36-6.42; P  = 0.03] and diastolic blood pressure (DBP) by 2.75 mmHg (95% CI: 1.14-4.35; P  = 0.0008). High-intensity aerobic exercise reduced DBP by 3.09 mmHg ( P  < 0.05) but had an insignificant effect on SBP. Short-term interventions (≤12 weeks) were effective (SBP: 4.26 mmHg; diastolic blood pressure (DBP): 2.77 mmHg, P  = 0.01), whereas longer interventions (>12 weeks) showed no statistically significant effects. Low-to-moderate intensity exercises showed negligible effects. Substantial heterogeneity ( I2   >  50%) indicates variability across studies. These findings suggest that high-intensity, short-term aerobic excerise programs are effective for reducing BP in obese adults, although further research is needed to clarify long-term outcomes and identify optimal exercise protocols.

Objectives: Flow-mediated slowing (FMS) reflects macrovascular reactivity by quantifying the decline in brachial-radial pulse wave velocity (PWV) during reactive hyperaemia. We identified abnormal FMS response using normal values and integrative algorithms.

Methods: In this cross-sectional, observational study, 408 community-dwelling individuals underwent FMS testing with 5 min of upper arm occlusion. FMS was assessed at 30 s intervals for 4 min postocclusion. From 76 healthy individuals, we extracted limits of normality for peak FMS, defining an abnormal peak response if PWV slowed by less than 9.4% (if <60 years) or 4.6% (if ≥60 years). Group-based trajectory modelling (GBTM) assigned participants to distinct FMS response groups. Multivariable regression identified clinical correlates of the FMS response groups.

Results: Higher age correlated independently with less decline in PWV in the early phase ( P  ≤ 0.0076 for 0-30 s), whereas higher SBP and no beta blocker use were linked to less decline overall (SBP: P  ≤ 0.048 for 0-210 s; beta blockers: P  ≤ 0.014 for 0-180 s). Abnormal peak FMS was associated with higher SBP [adjusted odds ratio (OR): 1.31, P  = 0.0017) and less use of beta blockers (adjusted OR: 0.44, P  = 0.041). A three-group GBTM model identified a low, moderate and high FMS response group. The risk for a low FMS response increased with age, SBP and no use of beta blockers ( P  ≤ 0.038 for all).

Conclusion: Abnormal FMS response was linked to cardiovascular risk factors such as ageing, hypertension and beta blocker use. The FMS response patterns may enable qualitative interpretation of FMS tests, though validation against hard clinical outcomes is warranted.

Apparent mineralocorticoid excess is an extraordinarily rare autosomal recessive disorder, with less than 100 cases reported to date. This monogenic disorder, due to dysfunction of the 11-beta-hydroxysteroid type 2 enzyme, is characterized by severe hypertension and hydroelectrolytic disorders. The initial suspicion and diagnosis of this disease are crucial for targeted treatment, thereby improving the prognosis of these patients and minimizing complications.

Objective: We investigated the morning-to-evening changes in home blood pressure (BP) in relation to the risk of fatal and nonfatal cardiovascular events.

Method: The study participants (≥18 years of age) were outpatients enrolled in the China Nationwide Ambulatory and Home Blood Pressure Registry. Home BP was measured at baseline for 7 consecutive days in the morning and evening five times consecutively, of which the first three readings were averaged for analysis. The morning-to-evening changes in home BP were calculated by subtracting the BP values in the morning from that in the evening.

Result: During a mean (±SD) follow-up of 4.9 (±2.6) years, 184 cardiovascular events occurred among the 5057 study participants. The mean morning-to-evening change in home SBP/DBP was -2.2 ± 8.1/-2.5 ± 4.5 mmHg. The age and sex-standardized incident rate was highest in quartile 1 of the changes in both SBP and DBP for fatal and nonfatal cardiovascular events, stroke (log-rank test, P  < 0.001). After adjustment for confounding factors, including the mean of morning and evening BP, the hazard ratios for patients in quartile 1 of the morning-to-evening change relative to the overall study participants reached statistical significance for SBP [1.39, 95% confidence interval (95% CI) 1.03-1.88] and DBP (1.59, 95% CI: 1.17-2.15) in relation to fatal and nonfatal stroke, and for diastolic BP in relation to fatal and nonfatal cardiovascular events (1.42, 95% CI: 1.13-1.77).

Conclusion: In outpatients, a mild to moderate BP drop from morning to evening was associated with a significantly higher risk of all cardiovascular events, especially stroke.

Objective: We aimed to assess risk reclassification and cost-effectiveness of echocardiography for cardiovascular primary prevention in hypertension.

Methods and results: Community hypertensive patients without cardiovascular disease (CVD) were included from the 2016-2020 China PEACE Project (n = 3243). Discriminative performance of adding echocardiographic measures to conventional clinical model was assessed. Based on mean incidence rate of major adverse cardiovascular events (MACE), participants were classified into low-risk, intermediate-risk, and high-risk categories. Number needed to test (NNT) and cost of echocardiography for screening one intermediate-risk and one high-risk individual were calculated. After a median follow-up of 4.5-year, 368 participants (11.3% of the cohort) had MACE. Adding subclinical cardiac changes on echocardiography improved discriminative performance of conventional clinical model, with C-statistic increased by 0.028 (P-value = 0.003). Presence of subclinical cardiac changes led to reclassification of 18% of low-risk individuals into intermediate-risk and 4% into high-risk categories. Based on the differences in the rate of MACE between low-risk and intermediate-risk and high-risk groups, 77 (USD 3080) and 11 (USD 440) echocardiographic examinations were needed to identify one intermediate-risk and one high-risk individual respectively at the first-year follow-up. These numbers decreased to 27 (USD 1080) and 7 (USD 280) at the second-year follow-up; and further declined to 20 (USD 800) and 6 (USD 240) at the third-year follow-up. Echocardiography is cost-effective based on the monetary value of a quality-adjusted life year (USD 14 952).

Conclusion: The results demonstrate the potential of echocardiography for risk reclassification and cost-effectiveness in the context of cardiovascular primary prevention among hypertensive individuals in China.