Journal of Human Hypertension最新文献

Age-related arterial stiffness increases pulsatility that reaches the cerebral microcirculation, compromises cerebrovascular health and lead to cognitive decline. The presence of cardiovascular risk factors (CVRFs) such as high blood pressure can exacerbate this effect. Despite extensive research on the impact of antihypertensive treatments on reducing arterial stiffness, little is known about the impact of antihypertensive treatments on pulsatility in cerebral microcirculation. This study investigated the impact of antihypertensive treatments on cerebral pulsatility and cognition in older adults with CVRFs. Participants were 42 older adults with diverse CVRFs in two groups of untreated (n = 21, mean 67.2 ± 5.9 years old, 57.1% female) and treated with antihypertensive medications (n = 21, mean 67.2 ± 5.5 years old, 61.1% female). Cognitive scores of processing speed and executive functions were evaluated behaviorally using the four subsets of the Stroop test. A near-infrared spectroscopy (NIRS) device recorded hemodynamics data from the frontal and motor cortex subregions. The data were then used to extract an optical index of cerebral pulsatility. Results indicated that after controlling for CVRFs, the antihypertensive treatment was associated with lower cerebral pulsatility (untreated 33.99 ± 6.68 vs. treated 28.88 ± 5.39 beats/min, p = 0.009). In both groups cerebral pulsatility was associated with pulse pressure (p < 0.05). Also, treated group had significantly higher cognitive scores in executive functions compared with the untreated group (p < 0.05). These results suggest that beyond its known effect on blood pressure, antihypertensive treatments might also favor cerebrovascular health by reducing pulsatility in the cerebral microcirculation.

Red cell distribution width (RDW) quantifies the degree of variation in erythrocyte size, is identified as a potential marker of adverse cardiovascular events, and may be a surrogate marker for assessing cardiovascular disease (CVD) risk in low-resource settings. We evaluated RDW as a predictor of CVD risk compared to the World Health Organization (WHO) CVD risk score among adults with hypertension attending primary healthcare centers (PHCs) in Ghana and Nigeria. Adults with hypertension attending selected PHCs in Ghana and Nigeria participated in a cross-sectional study. Each participant underwent blood pressure (BP) measurement and laboratory evaluation (RDW, total cholesterol, and fasting blood sugar) following standard methods. We recruited 319 adults aged 40-74 years from the study sites. The mean (standard deviation) RDW was 13.96 (1.1%). The median CVD risk score was 8.11% [interquartile range (IQR) 4.00 to 11.00]. For participants with hemoglobin (Hb) levels ≥ 12 g/dL, RDW showed positive correlations with age (r = 0.136; p = 0.042); systolic BP (r = 0.183; p = 0.006), diastolic BP (r = 0.206, p = 0.002) and WHO CVD risk scores (r = 0.166, p = 0.013). Multiple linear regression showed an independent association between RDW and WHO CVD risk scores with an upward gradient, and was most significant at 3rd quartiles. Using receiver operating characteristic curve, the C-statistic was 0.673 (95% confidence interval: 0.618 to 0.724), p = 0.031. With a cut-off of >14, the RDW demonstrated a sensitivity of 81.82% and specificity of 55.84%. This study shows that at Hb levels ≥ 12 g/dL, RDW modestly predicted CVD risk in adults with hypertension in sub-Saharan Africa.

Previous studies suggest that ferroptosis is involved in cardiovascular diseases. The aim of the present study is to investigate the causal relationship between angiotensin II type 1 and type 2 receptors (AT_1/2R) activities and mitochondrial dysfunction in induction of cardiomyocyte ferroptosis. Human AC16 cardiomyocytes were first pre-treated with an AT_1/2R blockers, before stimulated with angiotensin II (Ang II) for 24 h. The redox status of the cardiomyocytes were assessed by measuring the cellular malondialdehyde (MDA), superoxide dismutase (SOD), and Nicotinamide-adenine dinucleotide phosphate, (NADPH) levels using biochemical methods. Mitochondrial reactive oxygen specifics (mitROS), mitochondrial memebrane potential, and Fe²⁺ levels were determined using flow cytometry. The signaling pathways, including the glutathione peroxidase 4 (GPX4), heme oxygenase-1 (HO-1), sirtuin1, and ferroptosis suppressor protein 1 (FSP1)-coenzyme Q10 (CoQ10) pathways, were evaluated using western blotting. Our results demonstrated that Ang II significantly elevated the levels of MDA, Fe²⁺, mitoROS, and FtMt and markedly reduced SOD, NADPH, mitochondrial membrane potential, GPX4, HO-1, Sirt1, SFXN1, Nrf2, and FSP1 levels in cardiomyocyte, which were reversed by blockade of AT_1/2R. Our results suggest that AT_1/2R signaling can induce myocardial ferroptosis by impairing mitochondrial function via multiple signaling pathways, including the cyst (e)ine /GSH/GPX4 axis and FSP1/coenzyme Q10 (CoQ10) axis.

Coronary collateral flow (CCF) is crucial for myocardial viability in patients with obstructive coronary artery disease, specifically ST-elevation myocardial infarction (STEMI). However, hypertension can contribute to vascular dysfunction and hinder the formation of CCF. Wide pulse pressure (WPP), defined as ≥65 mmHg, may better reflect impaired cardiovascular health compared to classic blood pressure indices. The effect of WPP on CCF remains unclear. Therefore, we aimed to evaluate the impact of WPP on CCF. This retrospective study included 1180 STEMI patients that underwent primary percutaneous coronary intervention (PCI) between 2021 and 2023 at a tertiary healthcare center. Patients were classified into good and poor CCF groups based on the Rentrop classification. Out of these patients, 272 (23.1%) had good CCF, while 908 (76.9%) had poor CCF. Two distinct models were constructed using multivariable logistic regression analysis to identify independent predictors of good CCF, including pulse pressure (Model 1) and WPP (Model 2). Covariates such as age, gender, diabetes mellitus, smoking, pre-infarction angina, Killip Class 3/4, multivessel disease, peak troponin, pre-thrombolysis in myocardial infarction (TIMI) flow 0, and previous PCI were added to both models. WPP was identified as an independent predictor that negatively influences good CCF (OR: 0.511, 95% CI: 0.334-0.783, p = 0.002). Moreover, diabetes, pre-infarction angina, Killip class III/IV, multivessel disease, and pre-TIMI flow 0 were also found to be independent predictors of CCF. WPP, derived from blood pressure measurements, has been associated with poor CCF in STEMI patients undergoing primary PCI and may serve as a predictor of poor CCF.

Blood pressure (BP) measurement is a common procedure conducted in various disciplines and is widely available on clinical reports. The diagnosis and management of hypertension require reliable measurement of BP in outpatient clinics. Published studies suggest the standardised method for BP measurement is difficult to apply in routine clinical practice. This study aimed to assess the current practice of BP measurement in outpatient clinics in relevant secondary care clinical specialties across the 15 separate hospital sites of the NHS Greater Glasgow and Clyde region (population 1.2 million) compared to the recommended standardised method. An online questionnaire was developed and disseminated to the supervising clinician of each of 268 regular outpatient clinics. The questionnaire focused on the standardised BP method (patient preparation, environment, and BP measurement technique). The questionnaire was returned for 110 clinics. 73 (66.4%) of the participating clinics measure BP routinely and these formed the basis for further analysis. 3 clinics (4.1%) apply all components of the standardised BP method. 5 (6.9%) clinics deliver advice to patients prior to clinic attendance on how to prepare for BP measurement. 61 (83.6%) of participating clinics have a dedicated quiet environment for BP measurement. 50 (68.5%) clinics always place the cuff on bare upper arm and 63.0% use a cuff size appropriate to upper arm circumference. In a wide range of secondary care out-patient clinic settings, we found that BP measurement rarely adheres to the recommended standards. This has important implications for the quality of treatment decisions that are based on BP measurement.

The conventional assessment of the relationship between arterial hypertension (AH) and cardiovascular damage has predominantly relied on office measurements. However, the diagnostic significance of ambulatory and home measurements has gained prominence, particularly in identifying distinct AH phenotypes like masked hypertension (MH), characterized by normal office values but elevated readings outside the clinical setting, carrying comparable risks to sustained AH. Current guidelines advocate for Ambulatory Blood Pressure Monitoring (ABPM) in individuals with office values exceeding 130/85 mmHg. This study aims to develop a clinical prediction model to identify masked hypertension in individuals with normal office blood pressure and to create a clinical score.A cross-sectional study was conducted in a secondary level hospital, including patients aged 18-85 years with average office blood pressure <140/90 mmHg who underwent a valid ABPM on the same day. Pregnant and postpartum women were excluded. A multivariable logistic regression model with calibration, discrimination, and stability parameters was applied to predict masked hypertension. 506 individuals with valid ABPM were analysed. The prevalence of masked hypertension was 30.8%. The selected variables were: diastolic blood pressure, pulse pressure, waist diameter and sex. The model calibrated adequately (Hosmer-Lemeshow test p = 0.35), with an AUC of 0.72 (95% CI, 0.67-0.77). Significant differences existed between the traditional and the new models (p < 0.001). A user-friendly clinical model was developed, with a clinical score achieving 90% specificity using an estimated probability of 0.4 with a 10-point score.A novel model, performed with easily collectable clinical variables, showed robust calibration, stability, and discrimination. It outperforms sole reliance on office blood pressure, exhibiting high specificity (~90%) for masked hypertension detection. Its internal validity suggests a potential for enhanced masked hypertension identification.