Pub Date : 2025-10-15DOI: 10.1038/s41371-025-01080-y
José Lucas Porto Aguiar, Ozeas de Lima Lins-Filho, José Ricardo Vieira de Almeida, Elton Carlos Felinto dos Santos, Christopher E. Kline, Rodrigo Pinto Pedrosa, Breno Quintella Farah
This study aimed to analyze the effect of acute aerobic exercise at different times of the day on respiratory sleep parameters, blood pressure (BP), and cardiac autonomic modulation in patients with obstructive sleep apnea (OSA). In this randomized cross-over trial, 22 patients with OSA were recruited and completed four experimental sessions in random order: aerobic exercise and control in the morning (8:00–11:00 AM) and in the afternoon (3:30–6:30 PM). Each exercise session consisted of 40 min of aerobic exercise on a treadmill at 54–59% heart rate reserve; each control session consisted of seated rest for 40 min. Measurements were taken in the supine position before and after each session for clinic and central BP and cardiac autonomic modulation (by heart rate variability). After each session, all patients underwent at-home polysomnography using a portable polygraph. Clinic and central systolic BP decreased following both morning (Clinic: −16.1 mmHg; 95%CI = −22.5–−9.7 mmHg; p < 0.001; Central: −13.3 mmHg −21.6–−5.0 mmHg, p = 0.002) and afternoon (Clinic: −11.4 mmHg; 95%CI = −16.8–−5.9 mmHg; p = 0.03; Central: −13.9 mmHg; 95%CI = −20.1–−7.7 mmHg; p < 0.001) exercise sessions; however, no significant difference was observed between sessions. No significant changes were observed regarding diastolic BP, respiratory, or heart rate variability parameters (p > 0.05 for all). In conclusion, a single session of aerobic exercise has no effect on respiratory sleep parameters but led to a similar reduction in systolic blood pressure following both morning and afternoon sessions.
{"title":"Effects of acute exercise performed at different times of day on respiratory, blood pressure, and cardiac autonomic modulation outcomes in patients with obstructive sleep apnea: a randomized crossover trial","authors":"José Lucas Porto Aguiar, Ozeas de Lima Lins-Filho, José Ricardo Vieira de Almeida, Elton Carlos Felinto dos Santos, Christopher E. Kline, Rodrigo Pinto Pedrosa, Breno Quintella Farah","doi":"10.1038/s41371-025-01080-y","DOIUrl":"10.1038/s41371-025-01080-y","url":null,"abstract":"This study aimed to analyze the effect of acute aerobic exercise at different times of the day on respiratory sleep parameters, blood pressure (BP), and cardiac autonomic modulation in patients with obstructive sleep apnea (OSA). In this randomized cross-over trial, 22 patients with OSA were recruited and completed four experimental sessions in random order: aerobic exercise and control in the morning (8:00–11:00 AM) and in the afternoon (3:30–6:30 PM). Each exercise session consisted of 40 min of aerobic exercise on a treadmill at 54–59% heart rate reserve; each control session consisted of seated rest for 40 min. Measurements were taken in the supine position before and after each session for clinic and central BP and cardiac autonomic modulation (by heart rate variability). After each session, all patients underwent at-home polysomnography using a portable polygraph. Clinic and central systolic BP decreased following both morning (Clinic: −16.1 mmHg; 95%CI = −22.5–−9.7 mmHg; p < 0.001; Central: −13.3 mmHg −21.6–−5.0 mmHg, p = 0.002) and afternoon (Clinic: −11.4 mmHg; 95%CI = −16.8–−5.9 mmHg; p = 0.03; Central: −13.9 mmHg; 95%CI = −20.1–−7.7 mmHg; p < 0.001) exercise sessions; however, no significant difference was observed between sessions. No significant changes were observed regarding diastolic BP, respiratory, or heart rate variability parameters (p > 0.05 for all). In conclusion, a single session of aerobic exercise has no effect on respiratory sleep parameters but led to a similar reduction in systolic blood pressure following both morning and afternoon sessions.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 12","pages":"841-848"},"PeriodicalIF":3.4,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145301554","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 : 2025-10-15DOI: 10.1038/s41371-025-01079-5
Jowita Zachwyc, James E. Sharman, Wojciech Kosowski, Anna K. Woznicka, Tomasz Kotwica, Grzegorz Kubielas, Monika Przewlocka-Kosmala, Wojciech Kosmala
Exaggerated systolic blood pressure (SBP) during submaximal exercise is associated with increased cardiovascular (CV) risk. However, findings are mixed and new evidence indicates that cardiorespiratory fitness should be considered for proper clinical interpretation of exercise SBP responses. This study aimed to determine the relationship between exercise SBP during submaximal effort corrected and uncorrected for fitness, as well as at peak effort and abnormalities of cardiac structure and function. Each of 231 participants with controlled BP (with or without previously diagnosed hypertension), no evidence for ischemic or valvular heart disease, or heart failure underwent cardiopulmonary exercise testing and resting and exercise echocardiography. Submaximal exercise SBP (measured at the 2nd stage of Bruce protocol) and peak exercise SBP was corrected for peak VO2. Associations with TOD – target organ damage (left ventricular [LV] mass, relative wall thickness, diastolic function, LV exercise reserve) were stronger for fitness-corrected than uncorrected exercise SBP. There was a progressive deterioration of cardiac function and structure parameters across the submaximal exercise SBP/peak VO2 tertiles. Multivariable models demonstrated that fitness-corrected SBP was more closely associated with LV hypertrophy and diastolic dysfunction than uncorrected SBP, and ROC analysis revealed better performance of fitness-corrected SBP than uncorrected SBP (AUC 0.792 vs. 0.627, and 0.808 vs. 0.662, both p < 0.001, for LV hypertrophy and diastolic dysfunction, respectively). Fitness-corrected SBP responses to submaximal exercise can identify more profound target organ damage with respect to cardiac function and structure even among patients with controlled clinic BP. Exaggerated BP response to exercise must be considered relative to fitness for proper clinical interpretation of BP responses to exercise testing.
亚极限运动时收缩压（SBP）升高与心血管（CV）风险增加有关。然而，研究结果是混合的，新的证据表明，在正确的临床解释运动收缩压反应时应考虑心肺健康。本研究旨在确定运动收缩压在亚最大努力纠正和未纠正适应度，以及在最高努力与心脏结构和功能异常之间的关系。231名血压控制的参与者（有或没有先前诊断的高血压），没有缺血性或瓣膜性心脏病或心力衰竭的证据，每个参与者都接受了心肺运动试验和静息和运动超声心动图。亚极限运动收缩压（在布鲁斯方案第二阶段测量）和峰值运动收缩压根据峰值VO2进行校正。与TOD -靶器官损伤（左室质量、相对壁厚、舒张功能、左室运动储备）的相关性，健身校正比未校正的运动收缩压更强。在亚最大运动收缩压/峰值VO2三分位数，心功能和结构参数渐进式恶化。多变量模型显示，与未校正的收缩压相比，适应度校正的收缩压与左室肥厚和舒张功能障碍的关系更为密切，ROC分析显示，适应度校正的收缩压比未校正的收缩压表现更好(AUC 0.792 vs. 0.627, 0.808 vs. 0.662，均为p
{"title":"Exaggerated blood pressure response to submaximal exercise and cardiac target organ damage: importance of fitness","authors":"Jowita Zachwyc, James E. Sharman, Wojciech Kosowski, Anna K. Woznicka, Tomasz Kotwica, Grzegorz Kubielas, Monika Przewlocka-Kosmala, Wojciech Kosmala","doi":"10.1038/s41371-025-01079-5","DOIUrl":"10.1038/s41371-025-01079-5","url":null,"abstract":"Exaggerated systolic blood pressure (SBP) during submaximal exercise is associated with increased cardiovascular (CV) risk. However, findings are mixed and new evidence indicates that cardiorespiratory fitness should be considered for proper clinical interpretation of exercise SBP responses. This study aimed to determine the relationship between exercise SBP during submaximal effort corrected and uncorrected for fitness, as well as at peak effort and abnormalities of cardiac structure and function. Each of 231 participants with controlled BP (with or without previously diagnosed hypertension), no evidence for ischemic or valvular heart disease, or heart failure underwent cardiopulmonary exercise testing and resting and exercise echocardiography. Submaximal exercise SBP (measured at the 2nd stage of Bruce protocol) and peak exercise SBP was corrected for peak VO2. Associations with TOD – target organ damage (left ventricular [LV] mass, relative wall thickness, diastolic function, LV exercise reserve) were stronger for fitness-corrected than uncorrected exercise SBP. There was a progressive deterioration of cardiac function and structure parameters across the submaximal exercise SBP/peak VO2 tertiles. Multivariable models demonstrated that fitness-corrected SBP was more closely associated with LV hypertrophy and diastolic dysfunction than uncorrected SBP, and ROC analysis revealed better performance of fitness-corrected SBP than uncorrected SBP (AUC 0.792 vs. 0.627, and 0.808 vs. 0.662, both p < 0.001, for LV hypertrophy and diastolic dysfunction, respectively). Fitness-corrected SBP responses to submaximal exercise can identify more profound target organ damage with respect to cardiac function and structure even among patients with controlled clinic BP. Exaggerated BP response to exercise must be considered relative to fitness for proper clinical interpretation of BP responses to exercise testing.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 12","pages":"1-10"},"PeriodicalIF":3.4,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145301492","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 : 2025-10-14DOI: 10.1038/s41371-025-01075-9
Francesco P. Cappuccio
Sodium reduction is a well-established strategy for the prevention of cardiovascular disease (CVD), yet effective implementation requires context-specific approaches. Low-sodium salt substitutes (LSSS), in which sodium chloride is partially replaced with potassium chloride, have been investigated as an adjunct intervention. Evidence from randomized controlled trials in Peru and China demonstrates substantial increases in potassium intake and corresponding improvements in blood pressure and CVD outcomes. However, reductions in sodium intake were modest or absent, suggesting that the observed benefits are mediated primarily by potassium rather than sodium reduction. Additional concerns include compensatory sodium consumption from alternative sources, limited evaluation beyond high-risk cohorts, and uncertain safety in populations excluded from trials, such as individuals with kidney disease, children, and pregnant women. Current World Health Organization guidance remains ‘conditional’, reflecting these uncertainties. While LSSS may contribute to CVD prevention strategies, the central objective of global policy continues to be the sustained reduction of population sodium intake.
{"title":"World Hypertension League perspective on public health initiatives to reduce global sodium consumption: are we not seeing the elephant in the room?","authors":"Francesco P. Cappuccio","doi":"10.1038/s41371-025-01075-9","DOIUrl":"10.1038/s41371-025-01075-9","url":null,"abstract":"Sodium reduction is a well-established strategy for the prevention of cardiovascular disease (CVD), yet effective implementation requires context-specific approaches. Low-sodium salt substitutes (LSSS), in which sodium chloride is partially replaced with potassium chloride, have been investigated as an adjunct intervention. Evidence from randomized controlled trials in Peru and China demonstrates substantial increases in potassium intake and corresponding improvements in blood pressure and CVD outcomes. However, reductions in sodium intake were modest or absent, suggesting that the observed benefits are mediated primarily by potassium rather than sodium reduction. Additional concerns include compensatory sodium consumption from alternative sources, limited evaluation beyond high-risk cohorts, and uncertain safety in populations excluded from trials, such as individuals with kidney disease, children, and pregnant women. Current World Health Organization guidance remains ‘conditional’, reflecting these uncertainties. While LSSS may contribute to CVD prevention strategies, the central objective of global policy continues to be the sustained reduction of population sodium intake.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 11","pages":"739-740"},"PeriodicalIF":3.4,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01075-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292436","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}
This study aims to investigate the associations between the trajectories of menstrual symptoms over 18 years and measured blood pressure in midlife. Data were sourced from the Australian Longitudinal Study on Women’s Health. Participants provided self-reported data on their health and wellbeing, including menstrual symptoms, through regular surveys conducted from ages 18–23 (in 1996) to ages 40–45 (in 2018). Between 2019 and 2021, a subset participated in the Menarche-to-PreMenopause study, which collected physical measurements, including blood pressure and anthropometric data. Distinct trajectories of heavy menstrual bleeding, irregular periods, and dysmenorrhea were identified among 458 women by group-based trajectory modelling. Associations between menstrual symptom trajectories and blood pressure were examined by linear regression models. After adjusting for covariates, women in the increasing heavy menstrual bleeding group had higher diastolic blood pressure (DBP) (mean difference = 3.3 mmHg, 95% CI:1.1–5.6) compared to those in the reference group. Women in chronic irregular periods group also had higher DBP (mean difference = 2.5 mmHg, 95% CI:−0.1–5.0) than those in the reference group. No differences in blood pressure were observed across the different trajectories of dysmenorrhea. In conclusion, women who experienced an increasing heavy menstrual bleeding pattern over time and chronic irregular periods during their reproductive lifespan had higher DBP in their mid-40s. This suggests that attention should be paid to the cardiovascular health of women who report menstrual symptoms.
{"title":"Trajectories of menstrual symptoms and blood pressure in midlife: a prospective cohort study on Australian women","authors":"Gita D. Mishra, Chuyao Jin, Hsiu-Wen Chan, Jenny Doust, Annette Dobson","doi":"10.1038/s41371-025-01070-0","DOIUrl":"10.1038/s41371-025-01070-0","url":null,"abstract":"This study aims to investigate the associations between the trajectories of menstrual symptoms over 18 years and measured blood pressure in midlife. Data were sourced from the Australian Longitudinal Study on Women’s Health. Participants provided self-reported data on their health and wellbeing, including menstrual symptoms, through regular surveys conducted from ages 18–23 (in 1996) to ages 40–45 (in 2018). Between 2019 and 2021, a subset participated in the Menarche-to-PreMenopause study, which collected physical measurements, including blood pressure and anthropometric data. Distinct trajectories of heavy menstrual bleeding, irregular periods, and dysmenorrhea were identified among 458 women by group-based trajectory modelling. Associations between menstrual symptom trajectories and blood pressure were examined by linear regression models. After adjusting for covariates, women in the increasing heavy menstrual bleeding group had higher diastolic blood pressure (DBP) (mean difference = 3.3 mmHg, 95% CI:1.1–5.6) compared to those in the reference group. Women in chronic irregular periods group also had higher DBP (mean difference = 2.5 mmHg, 95% CI:−0.1–5.0) than those in the reference group. No differences in blood pressure were observed across the different trajectories of dysmenorrhea. In conclusion, women who experienced an increasing heavy menstrual bleeding pattern over time and chronic irregular periods during their reproductive lifespan had higher DBP in their mid-40s. This suggests that attention should be paid to the cardiovascular health of women who report menstrual symptoms.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 12","pages":"874-880"},"PeriodicalIF":3.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01070-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238553","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 : 2025-10-04DOI: 10.1038/s41371-025-01078-6
Lama Ghazi, Medha Dubal, Alain Bertoni, April Carson, Bessie A. Young, Cora E. Lewis, Chibuike J. Alanaeme, Dayna A. Johnson, Daichi Shimbo, Kathryn Foti, Lisandro D. Colantonio, Milla Arabadjian, Rikki Tanner, Paul Muntner
The cardiovascular-kidney-metabolic (CKM) syndrome consists of four progressive stages and is characterized by the interaction of metabolic risk factors, chronic kidney disease (CKD), and cardiovascular disease (CVD). We assessed the prevalence of hypertension in CKM and its role in progression to more advanced stages. We included 2118 Black adults from the Jackson Heart Study without a history of coronary heart disease, heart failure, stroke or stage 0 CKM (normal weight, no metabolic risk factors or CVD) at baseline. Participants were categorized into CKD stage: Stage 1: overweight/obesity, abdominal obesity or dysfunctional adipose tissue without metabolic risk factors or subclinical CVD; Stage 2: metabolic risk factors (hypertension, diabetes, hypertriglyceridemia, metabolic syndrome or CKD); or Stage 3: subclinical CVD. We used Cox proportional hazards regression to estimate the hazard ratio (HR) of developing stage 4 CKM, defined by a CVD event, in participants with hypertension and stages 2 and 3 CKM. At baseline, 20.2, 69.1 and 10.6% of participants had stage 1, 2 and 3 CKM, respectively. Hypertension was the most common metabolic risk factor in participants with stage 2 and 3 CKM with a prevalence of 80 and 95%, respectively. Incidence rates (95%CI) of stage 4 CKM per 1000 person-years were 1.4 (0.4, 2.4) for stage 1 CKM, 7.5 (6.1, 8.9) for stage 2 CKM with hypertension, and 26.6 (19.8, 33.3) for stage 3 CKM with hypertension. The HRs (95% CI) for developing stage 4 CKM were 3.25 (1.56, 6.80) and 5.11 (2.05,12.78) among participants with hypertension and stage 2 and 3 CKM versus stage 1 CKM, respectively. Hypertension was associated with an increased risk for progression to stage 4 CKM among Black adults.
{"title":"Role of hypertension in the cardiovascular-kidney-metabolic syndrome among black adults: The Jackson Heart Study","authors":"Lama Ghazi, Medha Dubal, Alain Bertoni, April Carson, Bessie A. Young, Cora E. Lewis, Chibuike J. Alanaeme, Dayna A. Johnson, Daichi Shimbo, Kathryn Foti, Lisandro D. Colantonio, Milla Arabadjian, Rikki Tanner, Paul Muntner","doi":"10.1038/s41371-025-01078-6","DOIUrl":"10.1038/s41371-025-01078-6","url":null,"abstract":"The cardiovascular-kidney-metabolic (CKM) syndrome consists of four progressive stages and is characterized by the interaction of metabolic risk factors, chronic kidney disease (CKD), and cardiovascular disease (CVD). We assessed the prevalence of hypertension in CKM and its role in progression to more advanced stages. We included 2118 Black adults from the Jackson Heart Study without a history of coronary heart disease, heart failure, stroke or stage 0 CKM (normal weight, no metabolic risk factors or CVD) at baseline. Participants were categorized into CKD stage: Stage 1: overweight/obesity, abdominal obesity or dysfunctional adipose tissue without metabolic risk factors or subclinical CVD; Stage 2: metabolic risk factors (hypertension, diabetes, hypertriglyceridemia, metabolic syndrome or CKD); or Stage 3: subclinical CVD. We used Cox proportional hazards regression to estimate the hazard ratio (HR) of developing stage 4 CKM, defined by a CVD event, in participants with hypertension and stages 2 and 3 CKM. At baseline, 20.2, 69.1 and 10.6% of participants had stage 1, 2 and 3 CKM, respectively. Hypertension was the most common metabolic risk factor in participants with stage 2 and 3 CKM with a prevalence of 80 and 95%, respectively. Incidence rates (95%CI) of stage 4 CKM per 1000 person-years were 1.4 (0.4, 2.4) for stage 1 CKM, 7.5 (6.1, 8.9) for stage 2 CKM with hypertension, and 26.6 (19.8, 33.3) for stage 3 CKM with hypertension. The HRs (95% CI) for developing stage 4 CKM were 3.25 (1.56, 6.80) and 5.11 (2.05,12.78) among participants with hypertension and stage 2 and 3 CKM versus stage 1 CKM, respectively. Hypertension was associated with an increased risk for progression to stage 4 CKM among Black adults.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 12","pages":"822-830"},"PeriodicalIF":3.4,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01078-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228270","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}
This study aimed to compare measurements of the renin-angiotensin-aldosterone system (RAAS) components by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and chemiluminescent immunoassay (CLIA) in hypertensive patients with different gender, position and renal function. EDTA plasma from 100 hypertensive patients who completed postural test were included. Aldosterone (PAC), renin (PRC, using Autobio CLIA microparticles kit; DRC, using LIAISON Direct Renin CLIA kit), angiotensin I and II (AngI and AngII), 18-hydroxycorticosterone (18-OHB) and 18-hydroxycortisol (18-OHF) were measured. Median PACCLIA was 46.0% higher (P < 0.01) than PACLC-MS/MS. Median PACCLIA, 18-OHBLC-MS/MS and 18-OHFLC-MS/MS were higher (P < 0.01) in patients with renal dysfunction compared with patients with normal renal function, whereas median PACLC-MS/MS did not show a significant difference between the two groups. Both median PRCCLIA and DRCCLIA were higher (P < 0.01) in male patients compared with female patients. PACLC-MS/MS, PACCLIA, PRCCLIA and DRCCLIA all showed good consistency in response to an assumption of upright posture. Close (P < 0.01) correlations were observed between PACCLIA and PACLC-MS/MS, between PRCCLIA and DRCCLIA, between AngIILC-MS/MS and PRCCLIA, and between AngIILC-MS/MS and DRCCLIA. LC-MS/MS is a reliable assay for measurement of the RAAS components in hypertensive patients under different pathophysiological conditions.
{"title":"Comparisons of renin-angiotensin-aldosterone levels measured by chemical luminescence immunoassay and liquid chromatography-tandem mass spectrometry in hypertensive patients under different pathophysiological conditions","authors":"Ting-Ting Xu, Yi-Gui Tang, En-Jun Xu, Xuan-Xuan Wang, Yu-Ping Yang, Zeng Guo","doi":"10.1038/s41371-025-01071-z","DOIUrl":"10.1038/s41371-025-01071-z","url":null,"abstract":"This study aimed to compare measurements of the renin-angiotensin-aldosterone system (RAAS) components by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and chemiluminescent immunoassay (CLIA) in hypertensive patients with different gender, position and renal function. EDTA plasma from 100 hypertensive patients who completed postural test were included. Aldosterone (PAC), renin (PRC, using Autobio CLIA microparticles kit; DRC, using LIAISON Direct Renin CLIA kit), angiotensin I and II (AngI and AngII), 18-hydroxycorticosterone (18-OHB) and 18-hydroxycortisol (18-OHF) were measured. Median PACCLIA was 46.0% higher (P < 0.01) than PACLC-MS/MS. Median PACCLIA, 18-OHBLC-MS/MS and 18-OHFLC-MS/MS were higher (P < 0.01) in patients with renal dysfunction compared with patients with normal renal function, whereas median PACLC-MS/MS did not show a significant difference between the two groups. Both median PRCCLIA and DRCCLIA were higher (P < 0.01) in male patients compared with female patients. PACLC-MS/MS, PACCLIA, PRCCLIA and DRCCLIA all showed good consistency in response to an assumption of upright posture. Close (P < 0.01) correlations were observed between PACCLIA and PACLC-MS/MS, between PRCCLIA and DRCCLIA, between AngIILC-MS/MS and PRCCLIA, and between AngIILC-MS/MS and DRCCLIA. LC-MS/MS is a reliable assay for measurement of the RAAS components in hypertensive patients under different pathophysiological conditions.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 11","pages":"741-747"},"PeriodicalIF":3.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01071-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225423","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 : 2025-10-02DOI: 10.1038/s41371-025-01074-w
Jonathan Nsamba, Danielle Swanepoel, Leandi Lammertyn, Wayne Smith, Ruan Kruger
Risk factor exposure during childhood contributes to the early onset of cardiovascular disease and clusters with incident hypertension. We investigated cardiovascular risk factor patterns in preadolescent children, stratified by BP status, and their associations with macro- and microvasculature measures. We included children (n = 1043, ages 5–9 years) from the ExAMIN Youth SA study. Measurements included anthropometry, cardiorespiratory fitness, dietary intake, office BP, central pulse wave velocity (PWV), central retinal artery (CRAE), vein equivalent (CRVE), and their ratio (AVR), to identify factor patterns with exploratory factor analysis. We identified three factor pattern scores (FPS). FPS1 (chips, sweets, fast foods, and cookies/cake) and FPS2 (fruits, meat, milk, and socioeconomic status) were identified in both the normotensive blood pressure (BP) and incident hypertension groups, with the exceptions of fruits being absent in the incident hypertension group and fast foods absent in the normotensive group. FPS3, characterised by BMI, diastolic BP, and systolic BP, was observed only in the normotensive group. PWV associated with FPS3 (β = 0.372, p < 0.001) in the normotensive but with FPS2 (β = 0.197, p = 0.045) in the incident hypertension group. CRAE (β = −0.224, p = 0.001) and AVR (β = −0.26, p < 0.001) inversely associated with FPS3 in normotensive but with FPS1 in the incident hypertension (CRAE: β = −0.343, p < 0.001; AVR: β = −0.274, p < 0.001). CRVE was positively associated with FPS3 (β = 0.194, p = 0.002) in the normotensive group. Exposure to unhealthy dietary patterns in childhood compromises vascular health in the context of incident hypertension, beginning as early as five years of age.
儿童时期的危险因素暴露有助于心血管疾病的早期发病和突发高血压的聚集性。我们调查了青春期前儿童的心血管危险因素模式，按血压水平分层，以及它们与宏观和微血管测量的关系。我们纳入了来自ExAMIN Youth SA研究的儿童（n = 1043，年龄5-9岁）。测量包括人体测量、心肺适能、饮食摄入、办公室血压、中央脉搏波速度（PWV）、视网膜中央动脉（CRAE）、静脉当量（CRVE）及其比值（AVR），通过探索性因素分析确定因素模式。我们确定了三个因素模式得分（FPS）。FPS1（薯片、糖果、快餐和饼干/蛋糕）和FPS2（水果、肉类、牛奶和社会经济地位）在血压正常组和偶发性高血压组中都被发现，但在偶发性高血压组中没有水果，在正常血压组中没有快餐。FPS3以BMI、舒张压和收缩压为特征，仅在正常血压组观察到。PWV与FPS3相关(β = 0.372, p
{"title":"Risk factor patterns and vascular health in children with incident hypertension: The ExAMIN Youth SA study","authors":"Jonathan Nsamba, Danielle Swanepoel, Leandi Lammertyn, Wayne Smith, Ruan Kruger","doi":"10.1038/s41371-025-01074-w","DOIUrl":"10.1038/s41371-025-01074-w","url":null,"abstract":"Risk factor exposure during childhood contributes to the early onset of cardiovascular disease and clusters with incident hypertension. We investigated cardiovascular risk factor patterns in preadolescent children, stratified by BP status, and their associations with macro- and microvasculature measures. We included children (n = 1043, ages 5–9 years) from the ExAMIN Youth SA study. Measurements included anthropometry, cardiorespiratory fitness, dietary intake, office BP, central pulse wave velocity (PWV), central retinal artery (CRAE), vein equivalent (CRVE), and their ratio (AVR), to identify factor patterns with exploratory factor analysis. We identified three factor pattern scores (FPS). FPS1 (chips, sweets, fast foods, and cookies/cake) and FPS2 (fruits, meat, milk, and socioeconomic status) were identified in both the normotensive blood pressure (BP) and incident hypertension groups, with the exceptions of fruits being absent in the incident hypertension group and fast foods absent in the normotensive group. FPS3, characterised by BMI, diastolic BP, and systolic BP, was observed only in the normotensive group. PWV associated with FPS3 (β = 0.372, p < 0.001) in the normotensive but with FPS2 (β = 0.197, p = 0.045) in the incident hypertension group. CRAE (β = −0.224, p = 0.001) and AVR (β = −0.26, p < 0.001) inversely associated with FPS3 in normotensive but with FPS1 in the incident hypertension (CRAE: β = −0.343, p < 0.001; AVR: β = −0.274, p < 0.001). CRVE was positively associated with FPS3 (β = 0.194, p = 0.002) in the normotensive group. Exposure to unhealthy dietary patterns in childhood compromises vascular health in the context of incident hypertension, beginning as early as five years of age.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 12","pages":"859-866"},"PeriodicalIF":3.4,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01074-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206385","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 : 2025-10-02DOI: 10.1038/s41371-025-01077-7
Ayça Demir Yildirim, Şerife Kelle Dikbaş, Tuğba Yilmaz Esencan, Ruken Merve Avşar
This study examines the impact of blood pressure measurement in different postures on diastolic and systolic blood pressure values, as well as anxiety levels, in pregnant women diagnosed with preeclampsia. The study was conducted between March and June 2024 as a quasi-experimental pretest-posttest study with 96 pregnant women diagnosed with preeclampsia who were hospitalized in the perinatology unit of a training and research hospital. Data were collected using a descriptive information form and the State Anxiety Scale. Among the participants in the study, a statistically significant difference was found between systolic blood pressure measured in the fully seated posture and that measured in the left and right lateral postures (p < 0.001). Regarding diastolic blood pressure, a significant difference was observed among the values measured in the left lateral, right lateral, and semi-Fowler postures (p < 0.001). The left and right lateral postures were found to have a lowering effect on systolic blood pressure. Additionally, a statistically significant difference was detected in the State Anxiety Scale scores of participants before and after blood pressure measurement in the left lateral posture (p < 0.05). In pregnant women with preeclampsia, the left and right lateral postures were found to lower both systolic and diastolic blood pressure compared to the sitting posture. Additionally, the left lateral posture was effective in reducing anxiety levels. Therefore, conducting blood pressure measurements in the left lateral posture in clinical practice may yield more optimal results for pregnant women with preeclampsia.
{"title":"The effect of blood pressure measurement in different postures on blood pressure values and anxiety levels in 3rd trimester pregnant women with preeclampsia","authors":"Ayça Demir Yildirim, Şerife Kelle Dikbaş, Tuğba Yilmaz Esencan, Ruken Merve Avşar","doi":"10.1038/s41371-025-01077-7","DOIUrl":"10.1038/s41371-025-01077-7","url":null,"abstract":"This study examines the impact of blood pressure measurement in different postures on diastolic and systolic blood pressure values, as well as anxiety levels, in pregnant women diagnosed with preeclampsia. The study was conducted between March and June 2024 as a quasi-experimental pretest-posttest study with 96 pregnant women diagnosed with preeclampsia who were hospitalized in the perinatology unit of a training and research hospital. Data were collected using a descriptive information form and the State Anxiety Scale. Among the participants in the study, a statistically significant difference was found between systolic blood pressure measured in the fully seated posture and that measured in the left and right lateral postures (p < 0.001). Regarding diastolic blood pressure, a significant difference was observed among the values measured in the left lateral, right lateral, and semi-Fowler postures (p < 0.001). The left and right lateral postures were found to have a lowering effect on systolic blood pressure. Additionally, a statistically significant difference was detected in the State Anxiety Scale scores of participants before and after blood pressure measurement in the left lateral posture (p < 0.05). In pregnant women with preeclampsia, the left and right lateral postures were found to lower both systolic and diastolic blood pressure compared to the sitting posture. Additionally, the left lateral posture was effective in reducing anxiety levels. Therefore, conducting blood pressure measurements in the left lateral posture in clinical practice may yield more optimal results for pregnant women with preeclampsia.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 12","pages":"881-887"},"PeriodicalIF":3.4,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212927","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 : 2025-09-27DOI: 10.1038/s41371-025-01076-8
Abdullah Sarıhan, Macit Kalçık, Mucahit Yetim
This letter comments on the recent article by Fernandes et al. evaluating the long-term effects of continuous positive airway pressure (CPAP) in patients with resistant hypertension and obstructive sleep apnea. While the study provides valuable insights into prolonged CPAP use, its non-randomized design and reliance on per-protocol analyses limit the generalizability of the findings. Evidence from previous randomized and multicenter studies suggests that the benefits of CPAP are modest and often diminish over time. Moreover, the exclusive focus on blood pressure outcomes overlooks broader cardiovascular effects, and the role of psychosocial and socioeconomic determinants of adherence remains underexplored. Future large-scale, randomized studies that integrate clinical and behavioral factors are needed to better define the long-term role of CPAP in resistant hypertension management.
{"title":"Impact of adherence and study design on CPAP effectiveness in resistant hypertension","authors":"Abdullah Sarıhan, Macit Kalçık, Mucahit Yetim","doi":"10.1038/s41371-025-01076-8","DOIUrl":"10.1038/s41371-025-01076-8","url":null,"abstract":"This letter comments on the recent article by Fernandes et al. evaluating the long-term effects of continuous positive airway pressure (CPAP) in patients with resistant hypertension and obstructive sleep apnea. While the study provides valuable insights into prolonged CPAP use, its non-randomized design and reliance on per-protocol analyses limit the generalizability of the findings. Evidence from previous randomized and multicenter studies suggests that the benefits of CPAP are modest and often diminish over time. Moreover, the exclusive focus on blood pressure outcomes overlooks broader cardiovascular effects, and the role of psychosocial and socioeconomic determinants of adherence remains underexplored. Future large-scale, randomized studies that integrate clinical and behavioral factors are needed to better define the long-term role of CPAP in resistant hypertension management.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 11","pages":"804-805"},"PeriodicalIF":3.4,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181913","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 : 2025-09-25DOI: 10.1038/s41371-025-01072-y
Antonios A. Argyris, David Baker, Paul Charnley, Liam Howe, Steven H. M. Lam, Gregory Y. H. Lip, Eduard Shantsila, Alena Shantsila
Home blood pressure (BP) monitoring (HBPM) is an established method for improved diagnosis and control of high BP. The BP@Home programme was launched in 2021 to support the use of HBPM. BP tele-messaging systems allow the digital transmission of HBPM readings back to healthcare providers, offering the potential to improve hypertension management. Aim of our study was to examine the enabling effect that implementing a new BP tele-messaging service had on hypertension metrics of an urban area. Through a new integrated BP text messaging system within GP platforms, practices from Wirral region, UK were able for the first time to contact their patients digitally to transmit their HBPM readings back to the practice. These readings were reviewed by the practice clinicians and patients received appropriate therapeutic recommendations. A total number of 10,010 patients were included in a 20-month period. The rate of HBPM per 1000 hypertensives ranged from 14.4–26.8 between different Primary Care Networks. BP control had been achieved in 64.3%. In linear regression analysis, use of HBPM was significantly associated with higher rates of new hypertension diagnosis [Beta coefficient (95% Confidence Interval (CI)): 0.11 (0.02–0.20), p = 0.021] and BP control [Beta coefficient (95% CI): 0.48 (0.40–0.56), p < 0.001]. In this community study using a BP tele-messaging implemented approach, system wide BP messaging was associated with an increase in new hypertension diagnoses and better control of hypertension. Future studies should focus on the role of digital BP messaging in reducing cardiovascular disease and improving clinical outcomes.
家庭血压监测（HBPM）是提高高血压诊断和控制的一种行之有效的方法。BP@Home计划于2021年启动，以支持HBPM的使用。血压远程信息系统允许将HBPM读数数字传输回医疗保健提供者，提供改善高血压管理的潜力。我们研究的目的是检查实施新的血压电话信息服务对城市地区高血压指标的有利影响。通过GP平台内的一个新的综合BP短信系统，来自英国Wirral地区的诊所第一次能够以数字方式联系他们的病人，将他们的HBPM读数传回诊所。这些读数由临床医生审查，患者得到适当的治疗建议。在20个月的时间里，总共有10010名患者被纳入研究。在不同的初级保健网络中，每1000名高血压患者的HBPM率在14.4-26.8之间。64.3%的患者血压得到控制。在线性回归分析中，HBPM的使用与更高的高血压新诊断率显著相关[β系数（95%置信区间（CI））： 0.11 (0.02-0.20), p = 0.021]和血压控制[β系数（95% CI）： 0.48 (0.40-0.56), p
{"title":"Effect of digital messaging on blood pressure control in general practice: observations from the BP@Home programme in wirral area","authors":"Antonios A. Argyris, David Baker, Paul Charnley, Liam Howe, Steven H. M. Lam, Gregory Y. H. Lip, Eduard Shantsila, Alena Shantsila","doi":"10.1038/s41371-025-01072-y","DOIUrl":"10.1038/s41371-025-01072-y","url":null,"abstract":"Home blood pressure (BP) monitoring (HBPM) is an established method for improved diagnosis and control of high BP. The BP@Home programme was launched in 2021 to support the use of HBPM. BP tele-messaging systems allow the digital transmission of HBPM readings back to healthcare providers, offering the potential to improve hypertension management. Aim of our study was to examine the enabling effect that implementing a new BP tele-messaging service had on hypertension metrics of an urban area. Through a new integrated BP text messaging system within GP platforms, practices from Wirral region, UK were able for the first time to contact their patients digitally to transmit their HBPM readings back to the practice. These readings were reviewed by the practice clinicians and patients received appropriate therapeutic recommendations. A total number of 10,010 patients were included in a 20-month period. The rate of HBPM per 1000 hypertensives ranged from 14.4–26.8 between different Primary Care Networks. BP control had been achieved in 64.3%. In linear regression analysis, use of HBPM was significantly associated with higher rates of new hypertension diagnosis [Beta coefficient (95% Confidence Interval (CI)): 0.11 (0.02–0.20), p = 0.021] and BP control [Beta coefficient (95% CI): 0.48 (0.40–0.56), p < 0.001]. In this community study using a BP tele-messaging implemented approach, system wide BP messaging was associated with an increase in new hypertension diagnoses and better control of hypertension. Future studies should focus on the role of digital BP messaging in reducing cardiovascular disease and improving clinical outcomes.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 11","pages":"770-776"},"PeriodicalIF":3.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01072-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149605","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}
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