Pub Date : 2024-10-01DOI: 10.1038/s41371-024-00963-w
S. E. Sherman, E. Stoutenburg, D. L. Long, S. P. Juraschek, M. Cushman, V. J. Howard, R. P. Tracy, S. E. Judd, D. Kamin Mukaz, N. A. Zakai, T. B. Plante
Leptin is an adipokine associated with obesity and with hypertension in animal models. Whether leptin is associated with hypertension independent of obesity is unclear. Relative to White adults, Black adults have higher circulating leptin concentration. As such, leptin may mediate some of the excess burden of incident hypertension among Black adults. REGARDS enrolled 30,239 adults aged ≥45 years from 48 US states in 2003–07. Baseline leptin was measured in a sex- and race-stratified sample of 4400 participants. Modified Poisson regression estimated relative risk (RR) of incident hypertension (new ≥140/≥90 mmHg threshold or use of antihypertensives) per SD of log-transformed leptin, stratified by obesity (BMI of 30 kg/m2). Inverse odds ratio weighting estimated the % mediation by leptin of the excess hypertension RR among Black relative to White participants. Among the 1821 participants without prevalent hypertension, 35% developed incident hypertension. Obesity modified the relationship between leptin and incident hypertension (P-interaction 0.006) such that higher leptin was associated with greater hypertension risk in the crude model among those with BMI < 30 kg/m2, but not those with BMI ≥ 30 kg/m2. This was fully attenuated when adjusting for anthropometric measures. In the crude model, Black adults had a 52% greater risk of incident hypertension. Leptin did not significantly mediate this disparity. In this national U.S. sample, leptin was associated with incident hypertension among non-obese but not obese adults. Future investigations should focus on the effect of weight modification on incident hypertension among non-obese adults with elevated leptin.
{"title":"The association of leptin and incident hypertension in the reasons for geographic and racial differences in stroke (REGARDS) cohort","authors":"S. E. Sherman, E. Stoutenburg, D. L. Long, S. P. Juraschek, M. Cushman, V. J. Howard, R. P. Tracy, S. E. Judd, D. Kamin Mukaz, N. A. Zakai, T. B. Plante","doi":"10.1038/s41371-024-00963-w","DOIUrl":"10.1038/s41371-024-00963-w","url":null,"abstract":"Leptin is an adipokine associated with obesity and with hypertension in animal models. Whether leptin is associated with hypertension independent of obesity is unclear. Relative to White adults, Black adults have higher circulating leptin concentration. As such, leptin may mediate some of the excess burden of incident hypertension among Black adults. REGARDS enrolled 30,239 adults aged ≥45 years from 48 US states in 2003–07. Baseline leptin was measured in a sex- and race-stratified sample of 4400 participants. Modified Poisson regression estimated relative risk (RR) of incident hypertension (new ≥140/≥90 mmHg threshold or use of antihypertensives) per SD of log-transformed leptin, stratified by obesity (BMI of 30 kg/m2). Inverse odds ratio weighting estimated the % mediation by leptin of the excess hypertension RR among Black relative to White participants. Among the 1821 participants without prevalent hypertension, 35% developed incident hypertension. Obesity modified the relationship between leptin and incident hypertension (P-interaction 0.006) such that higher leptin was associated with greater hypertension risk in the crude model among those with BMI < 30 kg/m2, but not those with BMI ≥ 30 kg/m2. This was fully attenuated when adjusting for anthropometric measures. In the crude model, Black adults had a 52% greater risk of incident hypertension. Leptin did not significantly mediate this disparity. In this national U.S. sample, leptin was associated with incident hypertension among non-obese but not obese adults. Future investigations should focus on the effect of weight modification on incident hypertension among non-obese adults with elevated leptin.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"836-843"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-29DOI: 10.1038/s41371-024-00962-x
Takeshi Fujiwara, Constantinos Koshiaris, Claire L. Schwartz, James P. Sheppard, Naoko Tomitani, Satoshi Hoshide, Kazuomi Kario, Richard J. McManus
This study tested the hypothesis that differences in ethnicity impact the level of agreement between ambulatory blood pressure (ABP) and home BP (HBP) levels. A retrospective analysis of cross-sectional data from the UK and Japan was performed. Participants underwent office BP, daytime ABP, and HBP measurements. The ABP–HBP difference was compared between ethnic groups by multiple linear regression analysis. Diagnostic disagreement was defined as a disparity between the hypertension diagnoses obtained using ABP and HBP, since both measures share common thresholds of 135/85 mmHg for hypertension. Definite diagnostic disagreement was assigned where such a difference exceeded ±5 mmHg for either systolic BP (SBP) or diastolic BP (DBP). A total of 1 408 participants (age 62.1 ± 11.1 years, 48.6% males, 78.9% known hypertensive, White British 18.9%, South Asian 11.2%, African Caribbean 12.0%, Japanese 58.0%) were eligible. More Japanese participants showed higher ABP than HBP compared to White British: SBP + 3.09 mmHg, 95% confidence interval (CI) + 1.14, +5.04 mmHg; DBP + 5.67 mmHg, 95%CI + 4.51, +6.84 mmHg. More Japanese participants than African Caribbean participants exhibited diagnostic disagreement in SBP (33.2% vs. 20.7%, p = 0.006). Furthermore, Japanese participants had a higher percentage of definite diagnostic disagreement in SBP compared to White British (9.3% vs. 4.5%, p = 0.040) and African Caribbean participants (9.3% vs. 3.0%, p = 0.018). In conclusion, Japanese participants showed greater disparity between ABP and HBP compared to White British participants. Complementary use of ABP and HBP monitoring may be more beneficial for assessing cardiovascular disease risk in Japanese participants compared to other ethnic groups.
{"title":"Differences in ambulatory versus home blood pressure levels by ethnicity: data from the United Kingdom and Japan","authors":"Takeshi Fujiwara, Constantinos Koshiaris, Claire L. Schwartz, James P. Sheppard, Naoko Tomitani, Satoshi Hoshide, Kazuomi Kario, Richard J. McManus","doi":"10.1038/s41371-024-00962-x","DOIUrl":"10.1038/s41371-024-00962-x","url":null,"abstract":"This study tested the hypothesis that differences in ethnicity impact the level of agreement between ambulatory blood pressure (ABP) and home BP (HBP) levels. A retrospective analysis of cross-sectional data from the UK and Japan was performed. Participants underwent office BP, daytime ABP, and HBP measurements. The ABP–HBP difference was compared between ethnic groups by multiple linear regression analysis. Diagnostic disagreement was defined as a disparity between the hypertension diagnoses obtained using ABP and HBP, since both measures share common thresholds of 135/85 mmHg for hypertension. Definite diagnostic disagreement was assigned where such a difference exceeded ±5 mmHg for either systolic BP (SBP) or diastolic BP (DBP). A total of 1 408 participants (age 62.1 ± 11.1 years, 48.6% males, 78.9% known hypertensive, White British 18.9%, South Asian 11.2%, African Caribbean 12.0%, Japanese 58.0%) were eligible. More Japanese participants showed higher ABP than HBP compared to White British: SBP + 3.09 mmHg, 95% confidence interval (CI) + 1.14, +5.04 mmHg; DBP + 5.67 mmHg, 95%CI + 4.51, +6.84 mmHg. More Japanese participants than African Caribbean participants exhibited diagnostic disagreement in SBP (33.2% vs. 20.7%, p = 0.006). Furthermore, Japanese participants had a higher percentage of definite diagnostic disagreement in SBP compared to White British (9.3% vs. 4.5%, p = 0.040) and African Caribbean participants (9.3% vs. 3.0%, p = 0.018). In conclusion, Japanese participants showed greater disparity between ABP and HBP compared to White British participants. Complementary use of ABP and HBP monitoring may be more beneficial for assessing cardiovascular disease risk in Japanese participants compared to other ethnic groups.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"828-835"},"PeriodicalIF":2.7,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-24DOI: 10.1038/s41371-024-00961-y
Nikolaos Kakaletsis, Athanase D. Protogerou, Vasilios Kotsis, Konstantinos Vemmos, Eleni Korompoki, Anastasios Kollias, Haralampos Milionis, George Ntaios, Christos Savopoulos
Pulse wave velocity (PWV) is as a reliable marker of arterial stiffness and vascular aging, surpassing traditional risk factors in predicting detrimental cardiovascular events. The present meta-analysis aims to investigate PWV thresholds and assess its prognostic value in outcomes of acute ischemic stroke (AIS). A search was conducted in PubMed, Cochrane, Web of Science, and Scopus for studies published up to January 2024, focusing on patients admitted with AIS, wherein arterial stiffness was assessed through PWV measurements during hospitalization. Identified studies reported PWV values in individuals with both favorable and unfavorable outcomes at the end of follow-up. Initially, 35 eligible studies provided data for weighted mean baPWV (11,953 AIS patients) and cfPWV (2,197 AIS patients) calculations. The average age was 67 years, with approximately 60% male, 67% hypertensive, 30% diabetic and 30% smoker participants. The weighted mean systolic blood pressure was approximately 150 mmHg. In AIS patients, the mean PWV was 10 m/s for standard cfPWV and 20 m/s for baPWV. Nine cohort studies (6,006 AIS patients) were included in the quantitative analysis of clinical outcomes. Higher PWV levels were associated with poorer functional outcomes (2.3 m/s higher, 95%CI:1.2–3.4, p < 0.001; I2 = 87.4%). AIS patients with arterial stiffness/vascular aging (higher PWV) had approximately 46.2% increased risk of poor functional outcome, 12.7% higher risk of mortality, 13.9% greater risk of major adverse cardiovascular events, and 13.9% greater risk of stroke recurrence over the long term compared to those without arterial stiffness. Advanced vascular aging, as indicated by PWV, significantly predicts adverse outcomes in AIS patients. Integrating the assessment of vascular aging into clinical practice can improve risk perception in these patients.
{"title":"Advanced vascular aging and outcomes after acute ischemic stroke: a systematic review and meta-analysis","authors":"Nikolaos Kakaletsis, Athanase D. Protogerou, Vasilios Kotsis, Konstantinos Vemmos, Eleni Korompoki, Anastasios Kollias, Haralampos Milionis, George Ntaios, Christos Savopoulos","doi":"10.1038/s41371-024-00961-y","DOIUrl":"10.1038/s41371-024-00961-y","url":null,"abstract":"Pulse wave velocity (PWV) is as a reliable marker of arterial stiffness and vascular aging, surpassing traditional risk factors in predicting detrimental cardiovascular events. The present meta-analysis aims to investigate PWV thresholds and assess its prognostic value in outcomes of acute ischemic stroke (AIS). A search was conducted in PubMed, Cochrane, Web of Science, and Scopus for studies published up to January 2024, focusing on patients admitted with AIS, wherein arterial stiffness was assessed through PWV measurements during hospitalization. Identified studies reported PWV values in individuals with both favorable and unfavorable outcomes at the end of follow-up. Initially, 35 eligible studies provided data for weighted mean baPWV (11,953 AIS patients) and cfPWV (2,197 AIS patients) calculations. The average age was 67 years, with approximately 60% male, 67% hypertensive, 30% diabetic and 30% smoker participants. The weighted mean systolic blood pressure was approximately 150 mmHg. In AIS patients, the mean PWV was 10 m/s for standard cfPWV and 20 m/s for baPWV. Nine cohort studies (6,006 AIS patients) were included in the quantitative analysis of clinical outcomes. Higher PWV levels were associated with poorer functional outcomes (2.3 m/s higher, 95%CI:1.2–3.4, p < 0.001; I2 = 87.4%). AIS patients with arterial stiffness/vascular aging (higher PWV) had approximately 46.2% increased risk of poor functional outcome, 12.7% higher risk of mortality, 13.9% greater risk of major adverse cardiovascular events, and 13.9% greater risk of stroke recurrence over the long term compared to those without arterial stiffness. Advanced vascular aging, as indicated by PWV, significantly predicts adverse outcomes in AIS patients. Integrating the assessment of vascular aging into clinical practice can improve risk perception in these patients.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 10","pages":"676-686"},"PeriodicalIF":2.7,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00961-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1038/s41371-024-00954-x
Julio Cesar Silva de Sousa, Rafael Yokoyama Fecchio, Laura Oliveira-Silva, Andrea Pio-Abreu, Giovânio Vieira da Silva, Luciano F. Drager, David A. Low, Cláudia Lúcia de Moraes Forjaz
Ambulatory blood pressure (ABP) monitoring is a widespread recommendation for the diagnosis and management of hypertension. Dynamic resistance training (DRT) and isometric handgrip training (IHT) have been recommended for hypertension treatment, but their effects on ABP have been poorly studied. Additionally, combined dynamic and isometric handgrip resistance training (CRT) could produce an additive effect that has yet to be tested. Thus, this randomized controlled trial was designed to evaluate the effects of DRT, IHT and CRT on mean ABP and ABP variability. Fifty-nine treated men with hypertension were randomly allocated to 1 of four groups: DRT (8 dynamic resistance exercises, 50% of 1RM, 3 sets until moderate fatigue), IHT (4 sets of 2 min of isometric handgrip at 30% of MVC), CRT (DRT + IHT) and control (CON – 30 min of stretching). Interventions occurred 3 times/week for 10 weeks, and ABP was assessed before and after the interventions. ANOVAs and ANCOVAs adjusted for pre-intervention values were employed for analysis. Mean 24-h, awake and asleep BPs did not change in either group throughout the study (all, P > 0.05). Nocturnal BP fall as well as the standard deviation, coefficient of variation and the average real variability of ABP also did not change significantly in either group (all, P < 0.05). Changes in all these parameters adjusted to the pre-intervention values were also similar among the four groups (all, p > 0.05). In treated men with hypertension, 10 weeks of DRT, IHT or CRT does not decrease ABP levels nor change ABP variability.
{"title":"Effects of dynamic, isometric, and combined resistance training on ambulatory blood pressure in treated men with hypertension: a randomized controlled trial","authors":"Julio Cesar Silva de Sousa, Rafael Yokoyama Fecchio, Laura Oliveira-Silva, Andrea Pio-Abreu, Giovânio Vieira da Silva, Luciano F. Drager, David A. Low, Cláudia Lúcia de Moraes Forjaz","doi":"10.1038/s41371-024-00954-x","DOIUrl":"10.1038/s41371-024-00954-x","url":null,"abstract":"Ambulatory blood pressure (ABP) monitoring is a widespread recommendation for the diagnosis and management of hypertension. Dynamic resistance training (DRT) and isometric handgrip training (IHT) have been recommended for hypertension treatment, but their effects on ABP have been poorly studied. Additionally, combined dynamic and isometric handgrip resistance training (CRT) could produce an additive effect that has yet to be tested. Thus, this randomized controlled trial was designed to evaluate the effects of DRT, IHT and CRT on mean ABP and ABP variability. Fifty-nine treated men with hypertension were randomly allocated to 1 of four groups: DRT (8 dynamic resistance exercises, 50% of 1RM, 3 sets until moderate fatigue), IHT (4 sets of 2 min of isometric handgrip at 30% of MVC), CRT (DRT + IHT) and control (CON – 30 min of stretching). Interventions occurred 3 times/week for 10 weeks, and ABP was assessed before and after the interventions. ANOVAs and ANCOVAs adjusted for pre-intervention values were employed for analysis. Mean 24-h, awake and asleep BPs did not change in either group throughout the study (all, P > 0.05). Nocturnal BP fall as well as the standard deviation, coefficient of variation and the average real variability of ABP also did not change significantly in either group (all, P < 0.05). Changes in all these parameters adjusted to the pre-intervention values were also similar among the four groups (all, p > 0.05). In treated men with hypertension, 10 weeks of DRT, IHT or CRT does not decrease ABP levels nor change ABP variability.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"796-805"},"PeriodicalIF":2.7,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00954-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There has been steady progress in documenting the psychosocial risk factors of hypertension. However, most of the extant evidence is based on population from the developed countries. Using nationally representative data from India, this cross-sectional study explores whether spousal age gap is associated with risk of hypertension in married women aged 20 to 49 years. Based on the age difference with their husbands, women were grouped into four categories: husband was – i) of similar age, ii) 3–5 years older, iii) 6–9 years older, and iv) 10+ years older. Compared to women whose husbands were of similar age, the odds of having hypertension for the other categories were assessed by estimating multivariable logistic regression models. While the hypertension prevalence in our sample was 18.9%, it was 2.2%-points lower among women whose husbands were of similar age, and 3.3%-points higher among women whose husbands were 10+ years older. The adjusted odds of having hypertension for women with 10+ years of spousal age difference were 1.18 (95% CI: 1.13–1.24) times that of their counterparts who were of similar age to their husbands. These results were persistent in both younger (age 20–34) and older (age 35–49) women and robust across age at marriage, years in marriage, and various socioeconomic sub-groups including women’s educational attainment, husband’s educational level, household wealth, urban/rural residence, and geographic regions. The relationship also persisted after adjusting for husband’s hypertension status. Our findings thus highlight spousal age difference as a biopsychosocial factor influencing the risk of hypertension in women.
{"title":"Spousal age difference and risk of hypertension in women: evidence from India","authors":"Biplab Kumar Datta, Ashwini Tiwari, Murshed Jahan, Natalia Torres, Sara Attari","doi":"10.1038/s41371-024-00959-6","DOIUrl":"10.1038/s41371-024-00959-6","url":null,"abstract":"There has been steady progress in documenting the psychosocial risk factors of hypertension. However, most of the extant evidence is based on population from the developed countries. Using nationally representative data from India, this cross-sectional study explores whether spousal age gap is associated with risk of hypertension in married women aged 20 to 49 years. Based on the age difference with their husbands, women were grouped into four categories: husband was – i) of similar age, ii) 3–5 years older, iii) 6–9 years older, and iv) 10+ years older. Compared to women whose husbands were of similar age, the odds of having hypertension for the other categories were assessed by estimating multivariable logistic regression models. While the hypertension prevalence in our sample was 18.9%, it was 2.2%-points lower among women whose husbands were of similar age, and 3.3%-points higher among women whose husbands were 10+ years older. The adjusted odds of having hypertension for women with 10+ years of spousal age difference were 1.18 (95% CI: 1.13–1.24) times that of their counterparts who were of similar age to their husbands. These results were persistent in both younger (age 20–34) and older (age 35–49) women and robust across age at marriage, years in marriage, and various socioeconomic sub-groups including women’s educational attainment, husband’s educational level, household wealth, urban/rural residence, and geographic regions. The relationship also persisted after adjusting for husband’s hypertension status. Our findings thus highlight spousal age difference as a biopsychosocial factor influencing the risk of hypertension in women.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"851-859"},"PeriodicalIF":2.7,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-17DOI: 10.1038/s41371-024-00958-7
Vinicius Crahim, Valéria Verri, Andrea De Lorenzo, Eduardo Tibirica
Resistant hypertension (RH) may be associated with microalbuminuria (MAU), a marker of cardiovascular risk and target organ damage, and both may be related to microvascular damage. Laser speckle contrast imaging (LSCI) is an innovative approach for noninvasively evaluating systemic microvascular endothelial function useful in the context of RH with or without MAU. Microalbuminuria was defined as a urine albumin-to-creatinine ratio between 30 and 300 mg/g. Microvascular reactivity was evaluated using LSCI to perform noninvasive measurements of cutaneous microvascular perfusion changes. Pharmacological (acetylcholine [ACh], or sodium nitroprusside [SNP]) and physiological (postocclusive reactive hyperemia [PORH]) stimuli were used to evaluate vasodilatory responses. Thirty-two patients with RH and a normal urine albumin-to-creatinine ratio (RH group) and 32 patients with RH and microalbuminuria (RH + MAU) were evaluated. Compared with patients without MAU, patients with RH + MAU showed reduced endothelial-dependent systemic microvascular reactivity, as demonstrated by an attenuation of microvascular vasodilation induced by PORH. On the other hand, ACh-induced vasodilation did not differ between groups. The results also revealed reduced endothelial-independent (SNP-induced) microvascular reactivity in hypertensive patients with MAU compared with patients without MAU. In this study, there was evidence of endothelial dysfunction associated with impaired microvascular smooth muscle function in patients with RH + MAU. This may suggest that patients with RH need more intensive therapeutic strategies for the control of blood pressure to avoid further vascular damage and the resulting consequences. The study was registered at ClinicalTrials.gov ( https://register.clinicaltrials.gov ) under protocol # NCT05464849, initial release 12/07/2022.
耐药性高血压（RH）可能与微量白蛋白尿（MAU）有关，后者是心血管风险和靶器官损伤的标志物，两者都可能与微血管损伤有关。激光斑点对比成像（LSCI）是一种无创评估全身微血管内皮功能的创新方法，对伴有或不伴有MAU的RH非常有用。微量白蛋白尿的定义是尿白蛋白与肌酐的比率在 30 至 300 毫克/克之间。使用 LSCI 对微血管反应性进行评估，以对皮肤微血管灌注变化进行无创测量。药理（乙酰胆碱[ACh]或硝普钠[SNP]）和生理（闭塞后反应性充血[PORH]）刺激用于评估血管扩张反应。对 32 名患有 RH 且尿白蛋白与肌酐比值正常的患者（RH 组）和 32 名患有 RH 且有微量白蛋白尿的患者（RH + MAU）进行了评估。与无微量白蛋白尿的患者相比，RH + MAU 患者的内皮依赖性全身微血管反应性降低，表现为 PORH 诱导的微血管扩张减弱。另一方面，ACh 诱导的血管舒张在各组之间没有差异。研究结果还显示，与非 MAU 患者相比，患有 MAU 的高血压患者的内皮依赖性（SNP 诱导的）微血管反应性降低。在这项研究中，有证据表明，RH + MAU 患者的内皮功能障碍与微血管平滑肌功能受损有关。这可能表明，RH 患者需要更强化的治疗策略来控制血压，以避免进一步的血管损伤和由此导致的后果。该研究已在临床试验网（https://register.clinicaltrials.gov）注册，协议号为 NCT05464849，初始发布日期为 2022 年 7 月 12 日。
{"title":"Reduced systemic microvascular function in patients with resistant hypertension and microalbuminuria: an observational study","authors":"Vinicius Crahim, Valéria Verri, Andrea De Lorenzo, Eduardo Tibirica","doi":"10.1038/s41371-024-00958-7","DOIUrl":"10.1038/s41371-024-00958-7","url":null,"abstract":"Resistant hypertension (RH) may be associated with microalbuminuria (MAU), a marker of cardiovascular risk and target organ damage, and both may be related to microvascular damage. Laser speckle contrast imaging (LSCI) is an innovative approach for noninvasively evaluating systemic microvascular endothelial function useful in the context of RH with or without MAU. Microalbuminuria was defined as a urine albumin-to-creatinine ratio between 30 and 300 mg/g. Microvascular reactivity was evaluated using LSCI to perform noninvasive measurements of cutaneous microvascular perfusion changes. Pharmacological (acetylcholine [ACh], or sodium nitroprusside [SNP]) and physiological (postocclusive reactive hyperemia [PORH]) stimuli were used to evaluate vasodilatory responses. Thirty-two patients with RH and a normal urine albumin-to-creatinine ratio (RH group) and 32 patients with RH and microalbuminuria (RH + MAU) were evaluated. Compared with patients without MAU, patients with RH + MAU showed reduced endothelial-dependent systemic microvascular reactivity, as demonstrated by an attenuation of microvascular vasodilation induced by PORH. On the other hand, ACh-induced vasodilation did not differ between groups. The results also revealed reduced endothelial-independent (SNP-induced) microvascular reactivity in hypertensive patients with MAU compared with patients without MAU. In this study, there was evidence of endothelial dysfunction associated with impaired microvascular smooth muscle function in patients with RH + MAU. This may suggest that patients with RH need more intensive therapeutic strategies for the control of blood pressure to avoid further vascular damage and the resulting consequences. The study was registered at ClinicalTrials.gov ( https://register.clinicaltrials.gov ) under protocol # NCT05464849, initial release 12/07/2022.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"806-813"},"PeriodicalIF":2.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00958-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13DOI: 10.1038/s41371-024-00956-9
Jonathan P. Glenning, Kieran Sandhu, Hilary A. Harrington, Lucas Eastaugh, Geoffrey K. Lane, Joseph J. Smolich, Jonathan P. Mynard
High blood pressure (BP) in childhood is a recognised precursor of elevated cardiovascular risk in adulthood. Brachial BP is normally used for clinical decision making, but central BP may be a better marker of pressure load on the heart. There is a paucity of validated non-invasive, automated devices for estimating central BP in children and adolescents. In this study, we compared the WatchBP Office Central (a Type 2 central pressure estimation device) against a high-fidelity micromanometer in the ascending aorta of anaesthetised patients undergoing clinically-indicated catheterisation (n = 15, age 4–16 years). As a secondary aim, central systolic BP (cSBP) was also compared to two non-invasive estimation methods in 34 awake patients undergoing routine cardiac MRI (age 10–18 years). WatchBP substantially overestimated cSBP compared to the intra-arterial gold-standard reference (26.1 ± 7.4 mmHg), and recruitment was terminated at n = 11 (included in the analysis) due to high statistical certainty that the device would not pass the validation criteria of 5±8 mmHg. WatchBP cSBP was also substantially higher than values obtained from a phase contrast MRI method (11.8 ± 7.9 mmHg) and the SphygmoCor XCEL (13.5 ± 8.9 mmHg) in the awake patient group, which translate to 21–23 mmHg on average after accounting for known/estimated biases in these non-invasive comparators. Compared with invasive central diastolic and systolic BPs, the brachial measures from WatchBP yielded errors of 0.1 ± 5.6 and 12.5 ± 6.0 mmHg respectively. We conclude that the WatchBP substantially overestimates cSBP in children and adolescents. These findings reinforce the need for central BP-measuring devices to be further developed and validated in this population.
{"title":"Accuracy of the WatchBP Office Central as a Type 2 device for non-invasive estimation of central aortic blood pressure in children and adolescents","authors":"Jonathan P. Glenning, Kieran Sandhu, Hilary A. Harrington, Lucas Eastaugh, Geoffrey K. Lane, Joseph J. Smolich, Jonathan P. Mynard","doi":"10.1038/s41371-024-00956-9","DOIUrl":"10.1038/s41371-024-00956-9","url":null,"abstract":"High blood pressure (BP) in childhood is a recognised precursor of elevated cardiovascular risk in adulthood. Brachial BP is normally used for clinical decision making, but central BP may be a better marker of pressure load on the heart. There is a paucity of validated non-invasive, automated devices for estimating central BP in children and adolescents. In this study, we compared the WatchBP Office Central (a Type 2 central pressure estimation device) against a high-fidelity micromanometer in the ascending aorta of anaesthetised patients undergoing clinically-indicated catheterisation (n = 15, age 4–16 years). As a secondary aim, central systolic BP (cSBP) was also compared to two non-invasive estimation methods in 34 awake patients undergoing routine cardiac MRI (age 10–18 years). WatchBP substantially overestimated cSBP compared to the intra-arterial gold-standard reference (26.1 ± 7.4 mmHg), and recruitment was terminated at n = 11 (included in the analysis) due to high statistical certainty that the device would not pass the validation criteria of 5±8 mmHg. WatchBP cSBP was also substantially higher than values obtained from a phase contrast MRI method (11.8 ± 7.9 mmHg) and the SphygmoCor XCEL (13.5 ± 8.9 mmHg) in the awake patient group, which translate to 21–23 mmHg on average after accounting for known/estimated biases in these non-invasive comparators. Compared with invasive central diastolic and systolic BPs, the brachial measures from WatchBP yielded errors of 0.1 ± 5.6 and 12.5 ± 6.0 mmHg respectively. We conclude that the WatchBP substantially overestimates cSBP in children and adolescents. These findings reinforce the need for central BP-measuring devices to be further developed and validated in this population.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"814-820"},"PeriodicalIF":2.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00956-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1038/s41371-024-00951-0
Johanna Seiffert, Niklas Ortelbach, Anja Hummel, Grace O’Malley, Thomas Stamm, Karl Haller
Blood pressure remains in the hypertensive range in nearly half of those affected by arterial hypertension despite it being an extremely modifiable risk factor, whereby morbidity decreases significantly upon implementation of lifestyle-based therapeutic approaches. There are significant discrepancies between the S3 guideline’s recommendations and its implementation. In this cross-sectional study sampling 160 inpatients with arterial hypertension, we assessed patients’ perceptions of secondary prevention therapeutic approaches recommended to them within treatment guidelines. Additionally, we used psychometric questionnaires to assess prevention factors. We conducted a latent class analysis to identify patterns in patients’ views, and tested for group differences regarding gender, age, education years, body mass index, psychopathology, and blood pressure. Two latent classes could be identified: Class 1 tended to perceive all recommended therapeutic approaches as helpful and reflected individuals with high-normal blood pressure. Class 2 tended to view recommendations regarding weight reduction, and cessation of nicotine and alcohol use, as less effective and included those with mild hypertension. There were no statistically significant class differences regarding the socio-demographic parameters. We further examined the evaluation of therapeutic approaches independent of classes, with social support reported to be the most effective approach. In conclusion, persistently-elevated blood pressure may be linked to poorer perceptions of therapeutic approaches which are then not implemented. Furthermore, patient-centered treatment planning and concepts such as shared decision-making appear to be central in treating this population regarding secondary prevention.
{"title":"How do the guideline recommendations work for you? Patients’ perceived effectiveness of therapeutic approaches in arterial hypertension","authors":"Johanna Seiffert, Niklas Ortelbach, Anja Hummel, Grace O’Malley, Thomas Stamm, Karl Haller","doi":"10.1038/s41371-024-00951-0","DOIUrl":"10.1038/s41371-024-00951-0","url":null,"abstract":"Blood pressure remains in the hypertensive range in nearly half of those affected by arterial hypertension despite it being an extremely modifiable risk factor, whereby morbidity decreases significantly upon implementation of lifestyle-based therapeutic approaches. There are significant discrepancies between the S3 guideline’s recommendations and its implementation. In this cross-sectional study sampling 160 inpatients with arterial hypertension, we assessed patients’ perceptions of secondary prevention therapeutic approaches recommended to them within treatment guidelines. Additionally, we used psychometric questionnaires to assess prevention factors. We conducted a latent class analysis to identify patterns in patients’ views, and tested for group differences regarding gender, age, education years, body mass index, psychopathology, and blood pressure. Two latent classes could be identified: Class 1 tended to perceive all recommended therapeutic approaches as helpful and reflected individuals with high-normal blood pressure. Class 2 tended to view recommendations regarding weight reduction, and cessation of nicotine and alcohol use, as less effective and included those with mild hypertension. There were no statistically significant class differences regarding the socio-demographic parameters. We further examined the evaluation of therapeutic approaches independent of classes, with social support reported to be the most effective approach. In conclusion, persistently-elevated blood pressure may be linked to poorer perceptions of therapeutic approaches which are then not implemented. Furthermore, patient-centered treatment planning and concepts such as shared decision-making appear to be central in treating this population regarding secondary prevention.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"821-827"},"PeriodicalIF":2.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1038/s41371-024-00955-w
Xiaohua Liang, Daochao Huang, Yang Bi, Yun He, Taoyu Mao, Qin Liu, Guomin Hu, Jishuang Tong, Lan Chen, Yuwei Wang, Xizou An, Xiaoping Jiang, Muhammad Fahad Tahir
To explore the relationship between serum folic acid (FA) or Vitamin B12 (VB12) and elevated BP in children and adolescents. Both a nested case control and a cohort study were designed to explore the relationship between serum folic acid (FA) or Vitamin B12 (VB12) and elevated blood pressure (BP). All the included participants were from primary school. A total of 326 subjects (116:210) in nested case control were from an established cohort. And 270 participants without hypertension at baseline and followed in 2019 in cohort. FA and VB12 levels were lower in the elevated BP group than in the control group, and homocysteine level was higher than that in the control group. In the elevated BP group, overweight/obese children had lower FA than overweight/obese children in the normal BP group. FA was positively correlated with high-density lipoprotein (HDL) and Apo lipoprotein A (APOA), but negatively correlated with triglyceride (TG). FA was significantly correlated with elevated BP in children and adolescents (β = –0.353, P = 0.032), after adjusting VB12, and homocysteine (HCY), and the interaction effect of FA*HCY was significant. Both systolic and diastolic BP levels were statistically lower in the FA high exposure group than in the FA low exposure group in the cohort study. This study found that FA and vitamin B12 deficiency in childhood was correlated with elevated BP levels, which may affect BP by regulating lipid levels, and confirmed the importance of maintaining high levels of FA and vitamin B12 in childhood either by diet or supplementation.
探讨儿童和青少年血清叶酸（FA）或维生素 B12（VB12）与血压升高之间的关系。为了探讨血清叶酸（FA）或维生素 B12（VB12）与血压（BP）升高之间的关系，我们设计了一项巢式病例对照和一项队列研究。所有研究对象均来自小学。在嵌套病例对照中，共有 326 名受试者（116:210）来自已建立的队列。队列中有 270 人基线时没有高血压，但在 2019 年接受了跟踪调查。血压升高组的 FA 和 VB12 水平低于对照组，同型半胱氨酸水平高于对照组。在血压升高组中，超重/肥胖儿童的 FA 值低于血压正常组中的超重/肥胖儿童。FA与高密度脂蛋白（HDL）和载脂蛋白A（APOA）呈正相关，但与甘油三酯（TG）呈负相关。在调整 VB12 和同型半胱氨酸（HCY）后，FA 与儿童和青少年的血压升高明显相关（β = -0.353，P = 0.032），FA*HCY 的交互效应也很明显。据统计，在队列研究中，高 FA 暴露组的收缩压和舒张压水平均低于低 FA 暴露组。这项研究发现，儿童期缺乏足量脂肪酸和维生素 B12 与血压升高有关，这可能会通过调节血脂水平来影响血压，并证实了在儿童期通过饮食或补充剂维持高水平足量脂肪酸和维生素 B12 的重要性。
{"title":"The impact of folic acid/VB12 deficiency on essential hypertension in children and adolescents: from a nested case-control and a cohort study","authors":"Xiaohua Liang, Daochao Huang, Yang Bi, Yun He, Taoyu Mao, Qin Liu, Guomin Hu, Jishuang Tong, Lan Chen, Yuwei Wang, Xizou An, Xiaoping Jiang, Muhammad Fahad Tahir","doi":"10.1038/s41371-024-00955-w","DOIUrl":"10.1038/s41371-024-00955-w","url":null,"abstract":"To explore the relationship between serum folic acid (FA) or Vitamin B12 (VB12) and elevated BP in children and adolescents. Both a nested case control and a cohort study were designed to explore the relationship between serum folic acid (FA) or Vitamin B12 (VB12) and elevated blood pressure (BP). All the included participants were from primary school. A total of 326 subjects (116:210) in nested case control were from an established cohort. And 270 participants without hypertension at baseline and followed in 2019 in cohort. FA and VB12 levels were lower in the elevated BP group than in the control group, and homocysteine level was higher than that in the control group. In the elevated BP group, overweight/obese children had lower FA than overweight/obese children in the normal BP group. FA was positively correlated with high-density lipoprotein (HDL) and Apo lipoprotein A (APOA), but negatively correlated with triglyceride (TG). FA was significantly correlated with elevated BP in children and adolescents (β = –0.353, P = 0.032), after adjusting VB12, and homocysteine (HCY), and the interaction effect of FA*HCY was significant. Both systolic and diastolic BP levels were statistically lower in the FA high exposure group than in the FA low exposure group in the cohort study. This study found that FA and vitamin B12 deficiency in childhood was correlated with elevated BP levels, which may affect BP by regulating lipid levels, and confirmed the importance of maintaining high levels of FA and vitamin B12 in childhood either by diet or supplementation.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 12","pages":"844-850"},"PeriodicalIF":2.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-09DOI: 10.1038/s41371-024-00953-y
Nazar Mohd Azahar, Mohamad Rodi Isa, Mizuki Ohashi, Yuichiro Yano
{"title":"Navigating the waves: understanding blood pressure amplitude and rhythm changes from childhood to adulthood","authors":"Nazar Mohd Azahar, Mohamad Rodi Isa, Mizuki Ohashi, Yuichiro Yano","doi":"10.1038/s41371-024-00953-y","DOIUrl":"10.1038/s41371-024-00953-y","url":null,"abstract":"","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 10","pages":"673-675"},"PeriodicalIF":2.7,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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