Journal of Human Hypertension最新文献

Nocturnal blood pressure (BP) is associated with cardiovascular events independently of daytime BP. Isolated nocturnal hypertension (INH), defined by elevated nocturnal BP with normal daytime BP, increases cardiovascular risk. However, its underlying; mechanisms remain unclear. This study aims to assess the association between nocturnal BP and INH with sleep quality and duration. This cross-sectional study analyzed 2297 individuals (57% women, 49.5 ± 15 years) using ambulatory blood pressure monitoring (ABPM) to evaluate the relationship between INH and sleep quality. Individuals with secondary hypertension and sleep disorders were excluded. Sleep quality and duration were primarily assessed using the Pittsburgh Sleep Quality Index (PSQI) and the STOP-BANG score. Results showed that 64% had poor sleep quality (PSQI > 5), and 18.7% slept less than 6 h. No significant differences in sleep quality were found among hypertensive phenotypes. INH was associated with older age, diabetes, and waist circumference; however, sleep quality and duration were not independent factors in its development. Nonetheless, nocturnal BP exhibited a slight association with sleep quality and disturbances of mild clinical significance.

Elevated blood pressure (BP) ≥ 180/110 mmHg is a frequent cause of attendance to the Emergency Department (ED). Current hypertension guidelines clearly define a diagnostic and management approach for hypertensive urgencies (HUs) and emergencies (HEs). The aim of this study was to report on physicians' routine clinical practice regarding diagnosis and treatment of HUs and HEs. This observational cross-sectional study was conducted in tertiary hospitals of Thessaloniki, Greece. A specifically designed questionnaire was distributed to physicians working in the ED, who were actively implicated in the management of patients with HUs/HEs. Among 146 responders, only 54.1% correctly reported that HUs and HEs are characterized by an increase in BP ≥ 180/110 mmHg. Less than half (48.6%) stated that they routinely check for compliance with antihypertensive treatment. The vast majority routinely order an electrocardiogram (91.8%) and laboratory tests (79.5%) in patients attending the ED with BP ≥ 180/110 mmHg, but this percentage dropped to 61.0% for urinalysis. Only 21.2% routinely order a fundoscopic examination. Calcium channel blockers would be the first drug to administer by 63.0% of study participants to HUs, whereas only 40.4% would choose intravenous labetalol as the first-line antihypertensive medication for malignant hypertension. Subgroup analysis revealed significant differences according to the most prevalent ED specialties of Internal Medicine, General Practice and Cardiology. The diagnostic approach and therapeutic management of HUs or HEs may deviate significantly in real-life clinical practice compared to current recommendations by international hypertension guidelines. More efforts are warranted to educate physicians on this important clinical issue.

Accurately estimating childhood hypertension prevalence is challenging due to blood pressure variability and the need for confirmation across multiple measurements. This study assessed prevalence of hypertension status, stages, and phenotypes among Chinese children on three visits and explored their associations with healthy lifestyles. A school-based cross-sectional survey conducted in Pinghu, Zhejiang province, in September 2022 included 2538 children aged 8-14 years. Elevated blood pressure was defined as blood pressure ≥95th percentile for age, sex, and height in a single measurement, while hypertension required confirmation across three occasions. A healthy lifestyle score was developed based on normal weight, ≥60 min/day of moderate-to-vigorous physical activity, <2 h/day of screen time, adequate sleep, dietary diversity. Multivariable logistic regression assessed associations between healthy lifestyles and hypertension status, stages (stage 1 and stage 2) and phenotypes (isolated systolic hypertension [ISH], isolated diastolic hypertension [IDH], systolic diastolic hypertension [SDH]). Elevated blood pressure prevalence decreased from 16.9% to 4.4% across visits. Prevalence rates were 3.2% for stage 1 hypertension, 1.2% for stage 2 hypertension, 2.5% for ISH, 0.4% for IDH, and 1.4% for SDH. Each 1-point increase in healthy lifestyle score, the odds of children being hypertension, stage1 hypertension, stage 2 hypertension, ISH, IDH and SDH decreased by 43% (odds ratio 0.57, 95% confidence interval 0.46-0.70), 44% (0.56, 0.44-0.71), 40% (0.60, 0.41-0.86), 39% (0.61, 0.47-0.80), 49% (0.51, 0.27-0.98) and 48% (0.52, 0.36-0.74), respectively. Prevalence of childhood hypertension among those aged 8-14 years in Pinghu was 4.4%. Adherence to multiple healthy lifestyles was associated with hypertension status, stages, and phenotypes.

We conducted a prospective study in consecutive high-risk pregnant women with 8 to 34 weeks of gestation to evaluate the relationship between PWV and the subsequent development of early- and late- onset preeclampsia (PE). The cohort was divided in high PWV (defined by the top tertile) and normal PWV (the remaining two tertiles). PE were classified as late-onset PE and early- onset PE using a cut-point of 34 weeks of gestation. The risk of women with high PWV for early- and late-onset PE was compared with women with normal PWV using multinomial regression. Two hundred and sixty-three high-risk pregnant women (mean age 30 ± 7 years, with 26 ± 7 weeks of gestation at the evaluation) were included in the study; 7.4%, 22.6%, 1.2%, 3.1% and 0.8% had antecedents of diabetes, chronic hypertension, chronic renal disease, collagen diseases and antiphospholipid syndrome, respectively. In previous pregnancies, 11.3% had had gestational diabetes and 22,6% hypertensive disorders of pregnancy. Forty-six pregnant women (17.9%) developed PE, of which 31 (12.1%) were late-onset and 15 (5.8%) early-onset. Women with high PWV more frequently developed early-onset than late-onset PE (14.0% vs 11.8% p = 0.509). Unadjusted and adjusted OR for early-onset PE were 9.61 (95%CI 2.62-35.25) and 7.13 (1.89-26.71), respectively. In conclusion, in high-risk pregnant women, a high PWV value was related with ~7 times more risk for development of early-onset PE.