Journal of Human Hypertension最新文献

Hypertension is the second leading cause of heart failure (HF), yet strategies for identifying hypertensive individuals at increased HF risk remain limited. Cardiac biomarkers, particularly natriuretic peptides and cardiac troponins, reflect subclinical myocardial stress and injury, and have emerged as promising tools for refining HF risk stratification in hypertensive populations. Experimental, epidemiological, and post-hoc analyses of interventional studies have consistently demonstrated that elevated concentrations of these biomarkers are independently associated with blood pressure elevation and variability, abnormal circadian patterns, progression to hypertension, and increased risk of HF and other major cardiovascular events. Both biomarker classes correlate with left ventricular hypertrophy, diastolic dysfunction, and myocardial fibrosis, and their concentrations decline with effective antihypertensive therapy, supporting their use in monitoring treatment response. Incorporating these biomarkers into conventional risk prediction models improves discrimination, and post-hoc analyses of large trials such as the SPRINT suggest greater absolute benefit of intensive blood pressure lowering among biomarker-positive individuals. Despite this robust evidence base, major hypertension guidelines have not explicitly integrated biomarker testing into routine care. This narrative review aims to summarize current evidence on the mechanistic, prognostic, and therapeutic value of natriuretic peptides and cardiac troponins in hypertension and outlines key research priorities, including pragmatic randomized trials of biomarker-guided prevention strategies, cost-effectiveness analyses, integration with multi-omics and artificial intelligence for precision phenotyping, and development of simplified screening approaches for resource-limited settings. Embedding cardiac biomarker assessment into hypertension care pathways could enable earlier detection, more personalized blood pressure management, and ultimately reduce the burden of HF worldwide. This figure illustrates the key roles of natriuretic peptides and cardiac troponins in hypertension, including their associations with BP dynamics (elevation, variability, circadian pattern, and incident hypertension), cardiac remodeling reflecting underlying pathophysiological processes, cardiovascular risk stratification, and their potential to guide personalized BP management. BP blood pressure; LVH left ventricular hypertrophy; LA left atrial; HF heart failure; CVD cardiovascular disease.

Cardiovascular events occur 20 years earlier in Sub-Saharan Africa compared to Europe. The risk factors for atherosclerosis differ between population groups and according to age. We compared the main correlates of carotid intima-media thickness (IMT, an index of atherosclerosis) in young and older adults of African ancestry. Hemodynamic (central and peripheral arterial pressures) and metabolic factors (lipids, glucose, glycated haemoglobin), smoking status and carotid IMT were determined in 573 adult Africans. In young (age<35years, n = 181) and middle-aged (35-59years, n = 231) adults, carotid IMT was associated with hemodynamic and metabolic cardiovascular risk factors on bivariate analyses. In older (age≥60years, n = 161) adults only hemodynamic factors were associated with carotid IMT. After adjustments for confounders, lipids were not associated with carotid IMT at any adult age. Carotid IMT was independently associated with backward wave pressure (Pb, p = 0.001) and age (p = 0.006) in young adults; with hemodynamics (central systolic blood pressure, p = 0.003; Pb, p = 0.02), age (p = 0.0002), body mass index (BMI, p = 0.005) and heart rate (p = 0.007) in middle-aged adults; and with Pb (p < 0.0001), male sex (p = 0.03), and HR (p = 0.04) in older adults. Increased carotid IMT was related to Pb in young (odds ratio [OR] = 1.233, p = 0.0003) and older (OR = 1.086, p = 0.0059) adults, and BMI (OR = 1.089, p = 0.0005) in middle-aged adults. Improvements in predictive performance for detecting increased carotid IMT were shown with Pb in young (p = 0.0032) and older (p = 0.0031) adults, and with BMI (p = 0.0004) in middle-aged adults. In conclusion, in African adults in Sub-Saharan Africa, carotid IMT is associated with hemodynamic factors, but not lipids. Moreover, in young adults, carotid IMT is primarily associated with hemodynamic factors.

While non-pharmacological interventions are fundamental to hypertension management, real-world evidence regarding their effectiveness and the specific populations most likely to benefit remains limited in China. This study investigates the demographic and lifestyle factors associated with self-reported blood pressure improvement among untreated middle-aged and elderly hypertensive patients, utilizing longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2015-2020. Among 502 eligible participants not receiving pharmacological treatment, 41.6% reported blood pressure improvement by the 2018 follow-up. Generalized Estimating Equations (GEE) analysis revealed that residential and lifestyle factors were significantly associated with hypertension management outcomes. Specifically, rural residents had significantly lower odds of improvement compared to their urban counterparts (OR = 0.63, 95% CI: 0.40-0.99, p = 0.047). In contrast, lifestyle modifications showed a clear protective effect: never smokers (OR = 1.82, 95% CI: 1.05-3.13, p = 0.032) and non-drinkers (OR = 1.66, 95% CI: 1.09-2.53, p = 0.017) demonstrated significantly higher odds of blood pressure improvement compared to current smokers and heavy drinkers, respectively. While the 2020 follow-up indicated a lower mortality rate in the improved group (1.9%) compared to the ineffective group (4.1%), this difference did not reach statistical significance. These findings highlight that abstaining from smoking and alcohol remains a cornerstone of non-pharmacological blood pressure management. Furthermore, the observed urban-rural disparity suggests a critical need for targeted public health interventions and enhanced resource allocation to support hypertension control in China's rural communities.