Journal of Human Hypertension最新文献

Serum placenta growth factor (PIGF), adiponectin, and endothelin-1 (ET-1) were associated with hypertension. However, it remains unclear whether these factors could predict the occurrence and prognosis of hypertensive disorders complicating pregnancy (HDCP). The enrolled pregnant women were classified into different groups according to diagnosis criteria. The demographic and clinical characteristics were compared among different groups. The levels of serum PIGF, adiponectin and ET-1 were determined. The predictive values of serum PIGF, adiponectin, and ET-1 for the occurrence and prognosis of HDCP were assessed using the receiver operating characteristic curve (ROC) analysis. There was a significant difference in systolic blood pressure, diastolic blood pressure, and proteinuria between the HDCP group and the normal pregnancy group. The level of serum PIGF and adiponectin decreased while ET-1 increased in the HDCP group compared to the normal pregnancy group. Furthermore, they had a similar change pattern with the progression of HDCP. The ROC analysis demonstrated that PIGF, adiponectin and ET-1 could effectively predict the occurrence and prognosis of HDCP. Compared to normal pregnant women, serum PIGF and adiponectin gradually decreased while ET-1 gradually increased with the progression of HDCP. Thus, they could effectively predict the occurrence and prognosis of HDCP.

Cardiometabolic diseases (CMDs) arise from shared pathophysiological pathways characterized by insulin resistance, dysglycemia, inflammation, adipokine dysregulation, and endothelial dysfunction. Pregnancy represents a natural cardiovascular stress test, involving hemodynamic adaptations such as increased blood volume, reduced vascular resistance, and elevated cardiac output. Adverse pregnancy outcomes (APOs) reflect maladaptive responses to this stress and are strongly associated with future CMDs. These outcomes are linked to an increased incidence of hypertension, ischemic heart disease, and stroke in later life. Proposed underlying mechanisms include impaired cardiac remodeling, chronic inflammation, and persistent dyslipidemia. Despite robust evidence linking APOs to future cardiometabolic risk, current cardiovascular disease (CVD) and diabetes prediction tools systematically overlook pregnancy history, leading to significant underestimation of risk in women. This problem is compounded by suboptimal postpartum screening. This review summarizes evidence supporting the role of APOs as early markers of CMDs. We propose a risk-stratification framework that incorporates APOs into CMDs risk assessment, supported by biomarker profiling, and promotes multidisciplinary postpartum care pathways along with individualized interventions such as dietary and physical activity programs. Future research should focus on developing risk prediction models that include APOs and on evaluating early preventive strategies to mitigate the long-term burden of CMDs in this high-risk population.

The association between remnant cholesterol (RC) and the risk of developing hypertension remains poorly elucidated. We analyzed China Health and Retirement Longitudinal Study data (CHARLS, 2011-2020). RC was categorized into baseline RC, cumulative RC, and RC change. In Cohort 1 (n = 7474), baseline RC was measured at Wave 1, with incident hypertension identified during Waves 2-5. In Cohort 2 (n = 3956), cumulative RC was calculated using Waves 1 and 3 data, with hypertension assessed during Waves 4-5. Participants were divided into quartiles. Logistic regression was used to assess the association between RC and hypertension. Restricted cubic splines explored non-linear relationships. During follow-up, 2366 (31.7%) and 805 (20.3%) hypertension cases occurred in Cohorts 1 and 2, respectively. A non-linear association was found between baseline RC and hypertension, with an inflection point at 1.16 mmol/L. The highest RC quartile showed increased hypertension risk, with adjusted odds ratios (OR) of 1.52 (p < 0.001) for baseline RC and 1.39 (p = 0.004) for cumulative RC. RC change suggested potential increased risk, though not statistically significant. BMI and HbA1c partially mediated the RC-hypertension relationship, accounting for 36.94 and 7.2% of the total effect, respectively. These findings indicate that elevated baseline and cumulative RC levels are associated with an increased risk of new-onset hypertension in middle-aged and older adults, and that baseline RC levels and hypertension are non-linearly related, with an inflection point of 1.16 mmol/L. Additionally, this study found that BMI and HbA1c mediated the association between RC and incident hypertension.

Cardiovascular diseases, the leading global cause of mortality, are frequently driven by hypertension, which contributes to left ventricular hypertrophy (LVH) and heart failure. Although ejection fraction (EF) remains the standard metric for assessing left ventricular function, it often fails to detect early dysfunction. Speckle-tracking echocardiography (STE) provides a more sensitive approach to identifying subclinical myocardial strain changes before EF declines. This cross-sectional, case-control study evaluated 90 participants divided into three groups: 30 healthy controls (Group I), 40 hypertensive patients without LVH (Group II), and 20 hypertensive patients with LVH (Group III). All underwent clinical evaluation, conventional echocardiography, and 2D-STE. Results showed that Group III had significantly greater septal and posterior wall diastolic thickness (p = 0.001) and higher LV mass index (p = 0.001) compared to Groups I and II. 2D-STE revealed reduced apical (AP2Ls, AP3Ls) and global longitudinal strain (GLS) in Groups II and III versus controls. Basal and mid-segment strains were also lower in disease groups, with mid-inferolateral segments showing more pronounced impairment in Group III. These findings highlight that Group III exhibited the most severe structural and functional cardiac alterations. The study demonstrates the superiority of 2D-STE over conventional echocardiography in detecting subclinical LV dysfunction in hypertensive patients, particularly those with LVH, through impaired longitudinal strain measurements. Early integration of 2D-STE into clinical practice could facilitate timely interventions to mitigate myocardial remodeling and heart failure progression.

The Simplified Cardiovascular Management Program (SimCard), a cluster-randomized controlled trial conducted in Tibet, China, demonstrated significant reduction in systolic blood pressure (SBP) compared to usual care among people with or at high risk of developing cardiovascular diseases (CVD). This study conducted a comprehensive economic evaluation for within-trial incremental cost per mmHg reduction in SBP at 12 months and per Quality-Adjusted Life Year (QALY) gained over the 10-year timeframe through a Markov-based CVD model. We reported expenses in 2023 CNY, using China's 2023 per-capita gross domestic product of CNY 89,358 as the cost-effectiveness threshold. We performed both one-way and probabilistic sensitivity analyses. During the trial period, the intervention group experienced a greater reduction in SBP, with a mean difference of 4.37 mmHg (95% CI: 1.32-7.42) compared to the usual care group. The Incremental Cost-Effectiveness Ratio (ICER) was CNY 101 (95% CI: 85-137) per mmHg reduction in SBP. In the 10-year modeled cost-effectiveness analysis, QALYs were higher in the intervention group by 0.11 (95% CI: 0.02-0.22) compared to the control group. The intervention had superior outcomes at similar costs (¥19,439 for the intervention group compared to ¥19,622 for the control group). This outcome remained robust across all sensitivity analyses The SimCard intervention was cost saving in preventing CVD among individuals at high risk in resource-constrained settings in China. Our findings highlight significant economic and health benefits of the intervention in Tibet, China, potentially generalizable to similar settings in other low- and middle-income countries.

We aimed to assess trends in elevated blood pressure (EBP) and hypertension among US children and adolescents before and after the COVID-19 pandemic using data from 25,916 participants aged 8-19 years in NHANES 1999-2023. Survey-weighted multinomial logistic regression was used to examine associations of sociodemographic, nutritional and other factors with EBP and hypertension overall and across subgroups during the pre-pandemic cycles (2015-2020) and post-pandemic cycles (2021-2023). Among children (n = 10,616), EBP prevalence decreased from 4.3% in 1999-2002 to 3.5% in 2021-2023 (P = 0.36), and hypertension declined from 3.3% to 2.3% (P = 0.025). Among adolescents (n = 15,300), EBP declined from 10.0% to 9.4% (P = 0.46), and hypertension prevalence fell from 8.3% to 5.1% (P < 0.001). From 2015-2023, obesity was strongly associated with both EBP and hypertension in children (odds ratio [OR] 1.78, 95% CI 1.02-3.10) and adolescents (OR 1.89, 95% CI 1.30-2.74). In children, higher dietary fat intake was associated with greater odds of EBP, and higher sodium intake with greater odds of hypertension. In adolescents, older age, male sex and non-Hispanic Black race were additional risk factors. Comparing pre-pandemic (2015-2020) with post-pandemic (2021-2023) cycles, EBP prevalence in adolescents decreased (11.6% vs 9.42%, P = 0.46) and hypertension prevalence in children changed modestly (2.53% vs 2.26%, P = 0.025). Despite concerns about pandemic-related increases in obesity, pediatric EBP and hypertension prevalence remained stable or declined from 2015 to 2023, with adiposity remaining the dominant modifiable correlate.

Apparent treatment-resistant hypertension (aTRH) is linked to significantly elevated cardiovascular risk and unfavorable long-term outcomes. Despite guideline recommendations to screen for primary aldosteronism (PA) in patients with aTRH, the prevalence of screening in Asian ambulatory care settings remains unknown. This cross-sectional study evaluated hypertensive adults who were managed in the ambulatory clinics of a tertiary hospital in Thailand between January 2020 and May 2023. aTRH was defined by: (1)uncontrolled office blood pressure (BP ≥ 140/90 mmHg) despite maximally tolerated doses of three antihypertensive drug classes, including a diuretic, or (2)use of four or more antihypertensive classes regardless of BP control. PA screening was performed using plasma aldosterone concentration and plasma renin activity measurements. Among 3207 hypertensive patients identified via ICD-10 (I10) coding, 2047 met inclusion criteria after excluding 1160 based on the exclusion criteria; the prevalence of aTRH was 9.4%. The mean age of the aTRH group was 74 ± 10 years, 59% were female, and the average number of antihypertensive agents was 3.8 ± 0.7. PA screening was conducted in only 3.1% of patients with aTRH and 17.9% of hypokalemia, with a median delay of 9.5 (21.25) months from the detection of hypokalemia to PA testing. Among 20 screened patients, five were diagnosed with PA, leading to improved BP control with targeted therapy. This study represents the first real-world analysis of PA screening practices in an Asian ambulatory care population. Strategies to enhance PA screening and address barriers to its implementation are warranted to improve clinical outcomes.

Dietary interventions are recommended as part of hypertension (HTN) treatment. Sodium reduction has proven effective, however supplements of potassium and/or nitrate are likely also of importance. We aimed to test how these three dietary components affect blood pressure (BP) individually and in combination in patients with HTN. A double-blind randomized controlled trial of 90 participants with HTN was conducted. Participants were randomized to eight groups receiving a hand-out diet and different combinations of supplementation of sodium chloride (130 mmol/day), potassium chloride (40 mmol/day) and beetroot juice (BRJ) with nitrate (13 mmol/day) or for each a matching placebo. The intervention lasted one week. 24 h BP, blood samples and 24 h urine collection were conducted before and after. We found a strong association between change in BP and sodium reduction (p < 0.0001). The change in systolic BP in the low-sodium groups was -7 mmHg (95% CI -9;-5) and no change was found in the high-sodium groups. We found a BP reduction in the low-potassium vs. the high-potassium groups (p = 0.03). Nitrate supplementation was not related to change in BP (p = 0.31). Plasma aldosterone and aldosterone-to-renin ratio (ARR) were associated to the change in BP in the low-sodium groups. In conclusion, in this one week intervention we found sodium reduction to be the important dietary alteration in matters of lowering BP. BRJ with nitrate and potassium chloride supplements did not assist in decreasing BP during this short-time intervention. Measuring ARR might be relevant in a clinical setting to predict the BP effect of sodium reduction. URL: https://www.clinicaltrialsregister.eu . Unique identifier: 2021-003407-17.