Pub Date : 2024-08-13DOI: 10.1038/s41371-024-00943-0
Tomoyuki Kawada
{"title":"Smoking cessation as a recommended action for incident hypertension","authors":"Tomoyuki Kawada","doi":"10.1038/s41371-024-00943-0","DOIUrl":"10.1038/s41371-024-00943-0","url":null,"abstract":"","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 8","pages":"624-624"},"PeriodicalIF":2.7,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975858","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 : 2024-08-06DOI: 10.1038/s41371-024-00941-2
Xin Zhong, Xiaowei Liu, Zhi Zhang, Lijiang Tang
In prior research related to physical activity, researchers have often centered their focus on only a limited number of activities, with little regard for mortality-related outcomes and insufficient focus on outcomes among diabetes patients with hypertension. The National Health and Nutrition Examination Survey was evaluated from 1999-2018 to identify individual with both diabetes and hypertension. These individuals were classified as being physically active or inactive. Comparisons among groups were performed with appropriate statistical tests. In total, this study evaluated data from 6,163 patients with a mean age of 63.18 ± 12.80 years. A total of 50.30% of the participants were male, with 39.86% being non-Hispanic white, 57.17% with a normal body mass index, and 89.20% were insured. Physical activity was significantly negatively correlated with systolic blood pressure in the overall population (p = 0.01) and when specifically focusing on individuals undergoing antihypertensive drug treatment (p = 0.0035). This negative relationship remained intact even following adjustment for age, sex, and ethnicity (p = 0.03). Physical activity was positively correlated with diastolic blood pressure in the overall population of participants (p = 0.002) and when specifically evaluating participants undergoing antihypertensive drug treatment (p = 0.02). All-cause and hypertensive mortality risk levels were significantly higher among individuals classified as being physically inactive (p < 0.0001), and this relationship remained true even with adjustment for age, sex, and ethnicity (p < 0.0001). In conclusion, physical activity is capable of lowering systolic blood pressure and decreasing the incidence of mortality among diabetes patients with hypertension.
{"title":"Physical activity lower blood pressure and mortality in hypertensive patients with diabetes: data from National Health and Nutrition Examination Survey (NHANES) 1999–2018","authors":"Xin Zhong, Xiaowei Liu, Zhi Zhang, Lijiang Tang","doi":"10.1038/s41371-024-00941-2","DOIUrl":"10.1038/s41371-024-00941-2","url":null,"abstract":"In prior research related to physical activity, researchers have often centered their focus on only a limited number of activities, with little regard for mortality-related outcomes and insufficient focus on outcomes among diabetes patients with hypertension. The National Health and Nutrition Examination Survey was evaluated from 1999-2018 to identify individual with both diabetes and hypertension. These individuals were classified as being physically active or inactive. Comparisons among groups were performed with appropriate statistical tests. In total, this study evaluated data from 6,163 patients with a mean age of 63.18 ± 12.80 years. A total of 50.30% of the participants were male, with 39.86% being non-Hispanic white, 57.17% with a normal body mass index, and 89.20% were insured. Physical activity was significantly negatively correlated with systolic blood pressure in the overall population (p = 0.01) and when specifically focusing on individuals undergoing antihypertensive drug treatment (p = 0.0035). This negative relationship remained intact even following adjustment for age, sex, and ethnicity (p = 0.03). Physical activity was positively correlated with diastolic blood pressure in the overall population of participants (p = 0.002) and when specifically evaluating participants undergoing antihypertensive drug treatment (p = 0.02). All-cause and hypertensive mortality risk levels were significantly higher among individuals classified as being physically inactive (p < 0.0001), and this relationship remained true even with adjustment for age, sex, and ethnicity (p < 0.0001). In conclusion, physical activity is capable of lowering systolic blood pressure and decreasing the incidence of mortality among diabetes patients with hypertension.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 10","pages":"694-702"},"PeriodicalIF":2.7,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897623","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 : 2024-07-31DOI: 10.1038/s41371-024-00940-3
Shubhanjali Roy, Mansi Malik, Saurav Basu
Adolescent hypertension in India is an emergent public health concern with lack of programmatic focus on regular screening amongst both individuals and healthcare providers. This study was conducted to assess the hypertension care cascade (prevalence, awareness, treatment and control status of hypertension) from nationally representative data. We used data from the demographic and health surveillance (DHS) comprising India’s National Family Health Survey Fifth Round (2019–2021). The prevalence of hypertension among 204,054 older adolescents (15–19 years) was 5.08% (95% CI: 4.94–5.23%) wherein 42.26% (95% CI: 40.69–43.64%) were aware of their condition, 43.70% (95% CI: 41.73–45.70%) of those aware were receiving treatment, and 85.88% (95% CI: 83.83–87.71%) of those on treatment achieved blood pressure control. Overall, there were nearly 60% newly diagnosed hypertension cases detected on screening. Females had significantly lower odds, while those with diabetes and higher waist-hip ratio had significantly higher odds of having hypertension. The awareness of their hypertensive status was higher among females and rural residents, while it was lower among adolescents that were obese and tobacco smokers. Improved blood pressure control was associated with a lower waist-to-hip ratio. In conclusion, nearly five in every hundred older adolescents in India are clinically hypertensive with significantly higher odds linked with obesity and male gender. Awareness and utilization of antihypertensive treatment was lower than the classical rule of halves signifying deficiencies in hypertension screening and management strategies for older adolescents within the existing public health policy framework.
{"title":"Hypertension care cascade and their determinants among older adolescents in India: evidence from a nationally representative cross-sectional survey","authors":"Shubhanjali Roy, Mansi Malik, Saurav Basu","doi":"10.1038/s41371-024-00940-3","DOIUrl":"10.1038/s41371-024-00940-3","url":null,"abstract":"Adolescent hypertension in India is an emergent public health concern with lack of programmatic focus on regular screening amongst both individuals and healthcare providers. This study was conducted to assess the hypertension care cascade (prevalence, awareness, treatment and control status of hypertension) from nationally representative data. We used data from the demographic and health surveillance (DHS) comprising India’s National Family Health Survey Fifth Round (2019–2021). The prevalence of hypertension among 204,054 older adolescents (15–19 years) was 5.08% (95% CI: 4.94–5.23%) wherein 42.26% (95% CI: 40.69–43.64%) were aware of their condition, 43.70% (95% CI: 41.73–45.70%) of those aware were receiving treatment, and 85.88% (95% CI: 83.83–87.71%) of those on treatment achieved blood pressure control. Overall, there were nearly 60% newly diagnosed hypertension cases detected on screening. Females had significantly lower odds, while those with diabetes and higher waist-hip ratio had significantly higher odds of having hypertension. The awareness of their hypertensive status was higher among females and rural residents, while it was lower among adolescents that were obese and tobacco smokers. Improved blood pressure control was associated with a lower waist-to-hip ratio. In conclusion, nearly five in every hundred older adolescents in India are clinically hypertensive with significantly higher odds linked with obesity and male gender. Awareness and utilization of antihypertensive treatment was lower than the classical rule of halves signifying deficiencies in hypertension screening and management strategies for older adolescents within the existing public health policy framework.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 10","pages":"703-718"},"PeriodicalIF":2.7,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860048","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 : 2024-07-24DOI: 10.1038/s41371-024-00927-0
Yavana Suriya Venkatesh, Venkatesh Raju, Koustav Pal, Anish Keepanasseril
Preeclampsia is a multisystem disorder associated with defective trophoblast invasion, maternal syndrome, and capillary endothelial leak. The presence of ascites/third space fluid accumulation increases the risk of maternal morbidity and mortality. The current criteria/guidelines of preeclampsia do not establish the presence of ascites as a marker of severity or recognize the timing and need for early delivery despite associated complications. Medline and Embase databases were searched to identify relevant literature, reported up to December 2023, regarding the pathophysiology, pregnancy outcome, and management of preeclampsia complicated with ascites. A total of 5 studies on pathophysiology and eight on pregnancy outcomes met the inclusion criteria, with 41 case reports on ascites in preeclampsia. The etiopathogenesis for the development of ascites in preeclampsia includes endothelial damage, capillary hyperpermeability, release of vasoconstrictive agents, reduced intravascular oncotic pressure, and raised intraabdominal pressure. The presence of ascites represents the extreme form of microvascular damage, which also correlates with the raised sFlt-1 levels in this condition. The adverse pregnancy outcomes include increased risk of congestive heart failure, eclampsia, renal failure, disseminated intravascular coagulation, acute respiratory distress syndrome, and maternal death. The presence of ascites in preeclampsia is associated with the deterioration of the maternal condition. Hence, it is indicative of preeclampsia with severe features and requires vigilant monitoring, and prompt delivery may be considered.
{"title":"Pathophysiology and pregnancy outcomes of ascites in preeclampsia—a scoping review","authors":"Yavana Suriya Venkatesh, Venkatesh Raju, Koustav Pal, Anish Keepanasseril","doi":"10.1038/s41371-024-00927-0","DOIUrl":"10.1038/s41371-024-00927-0","url":null,"abstract":"Preeclampsia is a multisystem disorder associated with defective trophoblast invasion, maternal syndrome, and capillary endothelial leak. The presence of ascites/third space fluid accumulation increases the risk of maternal morbidity and mortality. The current criteria/guidelines of preeclampsia do not establish the presence of ascites as a marker of severity or recognize the timing and need for early delivery despite associated complications. Medline and Embase databases were searched to identify relevant literature, reported up to December 2023, regarding the pathophysiology, pregnancy outcome, and management of preeclampsia complicated with ascites. A total of 5 studies on pathophysiology and eight on pregnancy outcomes met the inclusion criteria, with 41 case reports on ascites in preeclampsia. The etiopathogenesis for the development of ascites in preeclampsia includes endothelial damage, capillary hyperpermeability, release of vasoconstrictive agents, reduced intravascular oncotic pressure, and raised intraabdominal pressure. The presence of ascites represents the extreme form of microvascular damage, which also correlates with the raised sFlt-1 levels in this condition. The adverse pregnancy outcomes include increased risk of congestive heart failure, eclampsia, renal failure, disseminated intravascular coagulation, acute respiratory distress syndrome, and maternal death. The presence of ascites in preeclampsia is associated with the deterioration of the maternal condition. Hence, it is indicative of preeclampsia with severe features and requires vigilant monitoring, and prompt delivery may be considered.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 9","pages":"631-641"},"PeriodicalIF":2.7,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00927-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759151","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 : 2024-07-23DOI: 10.1038/s41371-024-00939-w
Walter G. Espeche, Martin R. Salazar, Julián Minetto, Gustavo Cerri, Patricia Carrera Ramos, Adelaida Soria, Claudia Santillan, Florencia Grassi, Soledad Torres, Horacio A. Carbajal
To analyze the possible association between serum uric acid (SUA) and nocturnal hypertension and to evaluate the ability of these variables (alone or in combination) to predict preeclampsia (PE) we conducted a historical cohort study in 532 high-risk pregnancies. Women were divided according to SUA values and nocturnal blood pressure (BP) into four groups: 1- normal SUA and nocturnal normotension; 2- high SUA and nocturnal normotension; 3- normal SUA and nocturnal hypertension and 4- high SUA and nocturnal hypertension. High SUA was defined by the top quartile values and nocturnal hypertension as BP ≥ 120/70 mmHg, using ambulatory blood pressure monitoring (ABPM), during nocturnal rest. Risks for PE were compared using logistic regression. SUA had a weak but significant correlation with daytime systolic ABPM (r = 0.11, p = 0.014), daytime diastolic ABPM (r = 0.13, p = 0.004), nighttime systolic ABPM (r = 0.16, p < 0.001) and nighttime diastolic ABPM (r = 0.18, p < 0.001). Also, all ABPM values were higher in women with high SUA. The absolute risk of PE increased through groups: 6.5%, 13.1%, 31.2%, and 47.9% for groups 1, 2, 3, and 4, respectively, p < 0.001. Compared with Group 1, Group 3 (OR 6.29 95%CI 3.41–11.60), but not Group 2 (OR 2.15 95%CI 0.88–5.24), had statistically significant higher risk for PE. Group 4 (women with both, high SUA and nocturnal hypertension) had the highest risk (OR 13.11 95%CI 6.69–25.70). Risks remained statistically significant after the adjustment for relevant variables. In conclusion, the combination of SUA > 4 mg/dL and nocturnal BP > 120/70 mmHg implies a very high risk to developed PE.
为了分析血清尿酸（SUA）和夜间高血压之间可能存在的关联，并评估这些变量（单独或组合）预测子痫前期（PE）的能力，我们对 532 名高危孕妇进行了历史队列研究。根据 SUA 值和夜间血压（BP）将妇女分为四组：1- SUA 正常和夜间血压正常；2- SUA 偏高和夜间血压正常；3- SUA 正常和夜间高血压；4- SUA 偏高和夜间高血压。高 SUA 的定义是前四分位值，夜间高血压是指夜间休息时使用动态血压监测（ABPM）测得的血压≥ 120/70 mmHg。采用逻辑回归法比较了发生 PE 的风险。SUA与日间收缩压ABPM（r = 0.11，p = 0.014）、日间舒张压ABPM（r = 0.13，p = 0.004）、夜间收缩压ABPM（r = 0.16，p 4 mg/dL）有微弱但显著的相关性，夜间血压> 120/70 mmHg意味着发生PE的风险非常高。
{"title":"Relationship between serum uric acid, nocturnal hypertension and risk for preeclampsia in high-risk pregnancies","authors":"Walter G. Espeche, Martin R. Salazar, Julián Minetto, Gustavo Cerri, Patricia Carrera Ramos, Adelaida Soria, Claudia Santillan, Florencia Grassi, Soledad Torres, Horacio A. Carbajal","doi":"10.1038/s41371-024-00939-w","DOIUrl":"10.1038/s41371-024-00939-w","url":null,"abstract":"To analyze the possible association between serum uric acid (SUA) and nocturnal hypertension and to evaluate the ability of these variables (alone or in combination) to predict preeclampsia (PE) we conducted a historical cohort study in 532 high-risk pregnancies. Women were divided according to SUA values and nocturnal blood pressure (BP) into four groups: 1- normal SUA and nocturnal normotension; 2- high SUA and nocturnal normotension; 3- normal SUA and nocturnal hypertension and 4- high SUA and nocturnal hypertension. High SUA was defined by the top quartile values and nocturnal hypertension as BP ≥ 120/70 mmHg, using ambulatory blood pressure monitoring (ABPM), during nocturnal rest. Risks for PE were compared using logistic regression. SUA had a weak but significant correlation with daytime systolic ABPM (r = 0.11, p = 0.014), daytime diastolic ABPM (r = 0.13, p = 0.004), nighttime systolic ABPM (r = 0.16, p < 0.001) and nighttime diastolic ABPM (r = 0.18, p < 0.001). Also, all ABPM values were higher in women with high SUA. The absolute risk of PE increased through groups: 6.5%, 13.1%, 31.2%, and 47.9% for groups 1, 2, 3, and 4, respectively, p < 0.001. Compared with Group 1, Group 3 (OR 6.29 95%CI 3.41–11.60), but not Group 2 (OR 2.15 95%CI 0.88–5.24), had statistically significant higher risk for PE. Group 4 (women with both, high SUA and nocturnal hypertension) had the highest risk (OR 13.11 95%CI 6.69–25.70). Risks remained statistically significant after the adjustment for relevant variables. In conclusion, the combination of SUA > 4 mg/dL and nocturnal BP > 120/70 mmHg implies a very high risk to developed PE.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 9","pages":"642-648"},"PeriodicalIF":2.7,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00939-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751869","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 : 2024-07-20DOI: 10.1038/s41371-024-00935-0
Bernadette Jenner
The Sir Stanley Peart Essay Competition is an annual event run by the British and Irish Hypertension Society to encourage Early Career Researchers to continue the ethos of Sir Stanley Peart. Sir Stanley Peart was a clinician and clinical researcher who made a major contribution to our understanding of blood pressure regulation. He was the first to demonstrate the release of noradrenaline in response to sympathetic nerve stimulation. He was also the first to purify, and determine the structure of, angiotensin and he later isolated the enzyme, renin, and carried out many important investigations of the factors controlling its release in the body. This year, the essay topic was “Do we need new classes of antihypertensive drugs?”. In her prize-winning essay, “Deeds not words”: the forgotten class, Dr Jenner proposes that there is a need to address the unmet needs of hypertensive women, to increase their involvement in clinical trials and develop antihypertensives that are fit for purpose. Dr Jenner proposes that women are therefore the perfect class for new antihypertensives.
{"title":"“Deeds not words”: the forgotten class","authors":"Bernadette Jenner","doi":"10.1038/s41371-024-00935-0","DOIUrl":"10.1038/s41371-024-00935-0","url":null,"abstract":"The Sir Stanley Peart Essay Competition is an annual event run by the British and Irish Hypertension Society to encourage Early Career Researchers to continue the ethos of Sir Stanley Peart. Sir Stanley Peart was a clinician and clinical researcher who made a major contribution to our understanding of blood pressure regulation. He was the first to demonstrate the release of noradrenaline in response to sympathetic nerve stimulation. He was also the first to purify, and determine the structure of, angiotensin and he later isolated the enzyme, renin, and carried out many important investigations of the factors controlling its release in the body. This year, the essay topic was “Do we need new classes of antihypertensive drugs?”. In her prize-winning essay, “Deeds not words”: the forgotten class, Dr Jenner proposes that there is a need to address the unmet needs of hypertensive women, to increase their involvement in clinical trials and develop antihypertensives that are fit for purpose. Dr Jenner proposes that women are therefore the perfect class for new antihypertensives.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 10","pages":"728-730"},"PeriodicalIF":2.7,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00935-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734288","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}
Atrial fibrillation (AF) is the most common heart rhythm disorder, especially in people over the age of 50, which affects more than 40 million people worldwide. Many studies have highlighted the association between hypertension with the development of AF. Blood pressure variability (BPV) is a dynamic size obtained by recording blood pressure oscillations using specific readings and at specific time intervals. A multitude of internal and external factors shape BPV while at the same time constituting a common pathogenetic pathway with the development of AF. Until recently, BPV has been applied exclusively in preclinical and clinical studies, without significant implications in clinical practice. Indeed, even from the research side, the determination of BPV is limited to patients without AF due to doubts about the accuracy of its measurement methods in patients with AF. In this review, we present the current evidence on common pathogenic pathways between BPV and AF, the reliability of quantification of BPV in patients with AF, the prognostic role of BPV in these patients, and discuss the future clinical implications of BPV in patients with AF.
{"title":"Exploring the link between blood pressure variability and atrial fibrillation: current insights and future directions","authors":"Konstantinos Konstantinou, Anastasios Apostolos, Dimitrios Tsiachris, Kyriakos Dimitriadis, Panteleimon E. Papakonstantinou, Konstantinos Pappelis, Vasileios Panoulas, Konstantinos Tsioufis","doi":"10.1038/s41371-024-00936-z","DOIUrl":"10.1038/s41371-024-00936-z","url":null,"abstract":"Atrial fibrillation (AF) is the most common heart rhythm disorder, especially in people over the age of 50, which affects more than 40 million people worldwide. Many studies have highlighted the association between hypertension with the development of AF. Blood pressure variability (BPV) is a dynamic size obtained by recording blood pressure oscillations using specific readings and at specific time intervals. A multitude of internal and external factors shape BPV while at the same time constituting a common pathogenetic pathway with the development of AF. Until recently, BPV has been applied exclusively in preclinical and clinical studies, without significant implications in clinical practice. Indeed, even from the research side, the determination of BPV is limited to patients without AF due to doubts about the accuracy of its measurement methods in patients with AF. In this review, we present the current evidence on common pathogenic pathways between BPV and AF, the reliability of quantification of BPV in patients with AF, the prognostic role of BPV in these patients, and discuss the future clinical implications of BPV in patients with AF.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 8","pages":"583-594"},"PeriodicalIF":2.7,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00936-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723774","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 : 2024-07-18DOI: 10.1038/s41371-024-00931-4
Sonali S. Shah, Stella May Gwini, Michael Stowasser, Christopher M. Reid, Morag J. Young, Peter J. Fuller, Jun Yang
Low-renin hypertension affects 1 in 4 people with hypertension, but the optimal management of this condition is not known. We hypothesize that a large proportion of people with low-renin hypertension is mediated by excess mineralocorticoid receptor (MR) activation and that targeted treatment with an MR antagonist (MRA) will be beneficial. This randomized, single-blinded, titration-to-effect aims to investigate whether targeted treatment in low-renin hypertension with MRA is better compared to standard antihypertensives in terms of blood pressure control and end-organ protection. Adults with hypertension, who are treatment naïve or are receiving up to two antihypertensive agents and have a low direct renin concentration <10 mU/L will be included. Participants with severe hypertension, a secondary cause of hypertension, pregnant, breastfeeding, with moderate-severe cardiovascular and chronic kidney disease, or on medications that confound interpretation of the plasma direct renin or aldosterone concentrations will be excluded. Eligible participants will be randomized 1:1 to either MRA therapy (spironolactone) or standard anti-hypertensive therapy (perindopril+/− amlodipine) for 48 weeks. Anti-hypertensives will be up-titrated every 12 weeks until target blood pressure is achieved. The primary objective will be to determine the total defined daily dose of antihypertensives required to achieve the target blood pressure and change in mean clinic systolic blood pressure at week 48. Current hypertension guidelines do not have specific recommendations for the choice of anti-hypertensive medications for people with low-renin hypertension. The results of this trial could guide future hypertension guidelines.
{"title":"A Randomized trial assessing Efficacy and safety of Mineralocorticoid receptor Antagonist therapy compared to Standard antihypertensive Therapy in hypErtension with low Renin (REMASTER): rationale and study design","authors":"Sonali S. Shah, Stella May Gwini, Michael Stowasser, Christopher M. Reid, Morag J. Young, Peter J. Fuller, Jun Yang","doi":"10.1038/s41371-024-00931-4","DOIUrl":"10.1038/s41371-024-00931-4","url":null,"abstract":"Low-renin hypertension affects 1 in 4 people with hypertension, but the optimal management of this condition is not known. We hypothesize that a large proportion of people with low-renin hypertension is mediated by excess mineralocorticoid receptor (MR) activation and that targeted treatment with an MR antagonist (MRA) will be beneficial. This randomized, single-blinded, titration-to-effect aims to investigate whether targeted treatment in low-renin hypertension with MRA is better compared to standard antihypertensives in terms of blood pressure control and end-organ protection. Adults with hypertension, who are treatment naïve or are receiving up to two antihypertensive agents and have a low direct renin concentration <10 mU/L will be included. Participants with severe hypertension, a secondary cause of hypertension, pregnant, breastfeeding, with moderate-severe cardiovascular and chronic kidney disease, or on medications that confound interpretation of the plasma direct renin or aldosterone concentrations will be excluded. Eligible participants will be randomized 1:1 to either MRA therapy (spironolactone) or standard anti-hypertensive therapy (perindopril+/− amlodipine) for 48 weeks. Anti-hypertensives will be up-titrated every 12 weeks until target blood pressure is achieved. The primary objective will be to determine the total defined daily dose of antihypertensives required to achieve the target blood pressure and change in mean clinic systolic blood pressure at week 48. Current hypertension guidelines do not have specific recommendations for the choice of anti-hypertensive medications for people with low-renin hypertension. The results of this trial could guide future hypertension guidelines.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 9","pages":"663-668"},"PeriodicalIF":2.7,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00931-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723773","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 : 2024-07-17DOI: 10.1038/s41371-024-00938-x
Jon Stavres, Anabelle Vallecillo-Bustos, Ta’Quoris A. Newsome, Ryan S. Aultman, Caleb F. Brandner, Austin J. Graybeal
Previous research shows that exercise pressor and metaboreflex responses are significantly exaggerated in individuals with metabolic syndrome, but it is unclear if these exaggerated responses extend to the cold pressor test (CPT). This study tested the hypothesis that, contrary to previously reported exaggerated responses during exercise, CPT responses would not be significantly exaggerated in individuals with MetS compared to matched controls. Eleven individuals with MetS and eleven control participants matched by age, race, sex, and ethnicity completed a cardiometabolic prescreening and a CPT. Each CPT required participants to immerse their hand in ice water for two minutes while beat-by-beat blood pressure, heart rate (HR), and leg blood flow (LBF) were continuously measured. Leg vascular conductance (LVC) was calculated as LBF divided by mean arterial pressure (MAP). The precent changes in MAP, systolic blood pressure (SBP), diastolic blood pressure (DBP), HR, LBF, and LVC were compared across time (BL vs. Minutes 1 and 2 of CPT) and between groups (MetS vs. Control) using repeated measures analyses of variance. As expected, MAP (f = 32.11, p < 0.001), SBP (f = 23.18, p < 0.001), DBP (f = 40.39, p < 0.001), and HR (f = 31.81, p < 0.001) increased during the CPT, and LBF (f = 4.75, p = 0.014) and LVC (f = 13.88, p < 0.001) decreased. However, no significant main effects of group or group by time interactions were observed (f ≤ 0.391, p ≥ 0.539). These findings indicate that the hemodynamic responses to the CPT are not significantly exaggerated in MetS, and therefore, previous reports of exaggerated exercise pressor and metaboreflex responses in MetS cannot be attributed to generalized sympathetic overexcitability.
{"title":"Hemodynamic responses to the cold pressor test in individuals with metabolic syndrome: a case-control study in a multiracial sample of adults","authors":"Jon Stavres, Anabelle Vallecillo-Bustos, Ta’Quoris A. Newsome, Ryan S. Aultman, Caleb F. Brandner, Austin J. Graybeal","doi":"10.1038/s41371-024-00938-x","DOIUrl":"10.1038/s41371-024-00938-x","url":null,"abstract":"Previous research shows that exercise pressor and metaboreflex responses are significantly exaggerated in individuals with metabolic syndrome, but it is unclear if these exaggerated responses extend to the cold pressor test (CPT). This study tested the hypothesis that, contrary to previously reported exaggerated responses during exercise, CPT responses would not be significantly exaggerated in individuals with MetS compared to matched controls. Eleven individuals with MetS and eleven control participants matched by age, race, sex, and ethnicity completed a cardiometabolic prescreening and a CPT. Each CPT required participants to immerse their hand in ice water for two minutes while beat-by-beat blood pressure, heart rate (HR), and leg blood flow (LBF) were continuously measured. Leg vascular conductance (LVC) was calculated as LBF divided by mean arterial pressure (MAP). The precent changes in MAP, systolic blood pressure (SBP), diastolic blood pressure (DBP), HR, LBF, and LVC were compared across time (BL vs. Minutes 1 and 2 of CPT) and between groups (MetS vs. Control) using repeated measures analyses of variance. As expected, MAP (f = 32.11, p < 0.001), SBP (f = 23.18, p < 0.001), DBP (f = 40.39, p < 0.001), and HR (f = 31.81, p < 0.001) increased during the CPT, and LBF (f = 4.75, p = 0.014) and LVC (f = 13.88, p < 0.001) decreased. However, no significant main effects of group or group by time interactions were observed (f ≤ 0.391, p ≥ 0.539). These findings indicate that the hemodynamic responses to the CPT are not significantly exaggerated in MetS, and therefore, previous reports of exaggerated exercise pressor and metaboreflex responses in MetS cannot be attributed to generalized sympathetic overexcitability.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 9","pages":"655-662"},"PeriodicalIF":2.7,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633746","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 : 2024-07-16DOI: 10.1038/s41371-024-00934-1
Amy E. Boettcher, Hannah E. Penfold, Katharine D. Currie
{"title":"Correction: Exercise systolic blood pressures are unaffected by time of day in healthy young adults","authors":"Amy E. Boettcher, Hannah E. Penfold, Katharine D. Currie","doi":"10.1038/s41371-024-00934-1","DOIUrl":"10.1038/s41371-024-00934-1","url":null,"abstract":"","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"38 8","pages":"1-3"},"PeriodicalIF":2.7,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41371-024-00934-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626917","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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