Pub Date : 2025-08-20DOI: 10.1038/s41371-025-01063-z
Jesse E. Passman, Amanda Bader, Nadim Mahmud, Kristoffel R. Dumon, Heather Wachtel, Feibi Zheng, Jordana B. Cohen
Metabolic and bariatric surgery (MBS) is an effective treatment for obesity and metabolic syndrome. Evidence regarding the impact of MBS on hypertension outcomes is limited by short-term follow-up. Thus, this retrospective cohort study was designed to compare blood pressure (BP) control, number of antihypertensive medications (AHMs), development of apparent treatment resistant hypertension (ATRH), and remission of hypertension between patients treated with and without MBS. Adults with BMI ≥ 35 kg/m2 and a new diagnosis of hypertension receiving care within the Veterans Health Administration system from 2000–2019 were included. Generalized estimating equations and time-updated Cox models with inverse probability of treatment weighting to address time-updated confounding were used. Over a median follow-up of 5.1 years, 183702 patients with BMI ≥ 35 kg/m2 and hypertension were managed medically and 3965 were managed surgically. At baseline, those who underwent MBS were more likely to be women than men (22 vs. 10%). Patients treated surgically demonstrated significantly better BP control over time, with an average 5.4 mm Hg (95% CI 4.9–5.9) lower systolic BP and 1.8 mm Hg (95% CI 1.5–2.1) lower diastolic BP. Compared to patients treated medically, those who received MBS had 32% higher likelihood of complete AHM discontinuation (95% CI 1.23–1.42). Patients treated with MBS were 14% less likely to develop ATRH (95% CI 0.78–0.95). Overall, among patients with obesity and hypertension, treatment with MBS was associated with durably improved BP control compared to medical management, including lower systolic and diastolic BPs, higher AHM cessation, and lower rates of ATRH.
代谢和减肥手术（MBS）是治疗肥胖和代谢综合征的有效方法。关于MBS对高血压预后影响的证据受到短期随访的限制。因此，本回顾性队列研究旨在比较接受和不接受MBS治疗的患者之间的血压（BP）控制、抗高血压药物（AHMs）数量、明显难治性高血压（ATRH）的发展以及高血压缓解情况。纳入了2000-2019年在退伍军人健康管理系统内接受治疗的BMI≥35 kg/m2和新诊断为高血压的成年人。使用广义估计方程和时间更新的Cox模型与逆概率处理权重来处理时间更新的混淆。在中位5.1年的随访中，183702例BMI≥35 kg/m2的高血压患者接受了医学治疗，3965例接受了手术治疗。基线时，接受MBS的患者中女性多于男性（22%对10%）。随着时间的推移，手术治疗的患者表现出明显更好的血压控制，平均收缩压降低5.4 mm Hg (95% CI 4.9-5.9)，舒张压降低1.8 mm Hg （95% CI 1.5-2.1）。与接受药物治疗的患者相比，接受MBS的患者完全停止AHM的可能性高出32% （95% CI 1.23-1.42）。接受MBS治疗的患者发生ATRH的可能性降低14% （95% CI 0.78-0.95）。总体而言，在肥胖和高血压患者中，与医疗管理相比，MBS治疗与持续改善的血压控制相关，包括更低的收缩压和舒张压，更高的AHM终止率和更低的ATRH率。
{"title":"The Effect of Bariatric Surgery on Hypertension Outcomes: A Retrospective Cohort Study","authors":"Jesse E. Passman, Amanda Bader, Nadim Mahmud, Kristoffel R. Dumon, Heather Wachtel, Feibi Zheng, Jordana B. Cohen","doi":"10.1038/s41371-025-01063-z","DOIUrl":"10.1038/s41371-025-01063-z","url":null,"abstract":"Metabolic and bariatric surgery (MBS) is an effective treatment for obesity and metabolic syndrome. Evidence regarding the impact of MBS on hypertension outcomes is limited by short-term follow-up. Thus, this retrospective cohort study was designed to compare blood pressure (BP) control, number of antihypertensive medications (AHMs), development of apparent treatment resistant hypertension (ATRH), and remission of hypertension between patients treated with and without MBS. Adults with BMI ≥ 35 kg/m2 and a new diagnosis of hypertension receiving care within the Veterans Health Administration system from 2000–2019 were included. Generalized estimating equations and time-updated Cox models with inverse probability of treatment weighting to address time-updated confounding were used. Over a median follow-up of 5.1 years, 183702 patients with BMI ≥ 35 kg/m2 and hypertension were managed medically and 3965 were managed surgically. At baseline, those who underwent MBS were more likely to be women than men (22 vs. 10%). Patients treated surgically demonstrated significantly better BP control over time, with an average 5.4 mm Hg (95% CI 4.9–5.9) lower systolic BP and 1.8 mm Hg (95% CI 1.5–2.1) lower diastolic BP. Compared to patients treated medically, those who received MBS had 32% higher likelihood of complete AHM discontinuation (95% CI 1.23–1.42). Patients treated with MBS were 14% less likely to develop ATRH (95% CI 0.78–0.95). Overall, among patients with obesity and hypertension, treatment with MBS was associated with durably improved BP control compared to medical management, including lower systolic and diastolic BPs, higher AHM cessation, and lower rates of ATRH.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 10","pages":"683-689"},"PeriodicalIF":3.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01063-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957177","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 : 2025-08-19DOI: 10.1038/s41371-025-01048-y
Yongho Jee, Wes Spiller, Eleanor Sanderson, Kate Tilling, Tom Palmer, Eunhee Ha, YoungJu Kim
This study explores the causal role of multiple correlated risk factors in coronary heart disease (CHD) and ischemic stroke, using Mendelian randomization (MR) analyses with GWAS summary data from both prevalent and incident stroke cases. Thirteen candidate risk factors were considered, including age at menarche, adiposity, lipid fractions, blood pressure, and smoking. Univariable MR identified seven exposures significantly associated with CHD risk, including BMI, blood pressure, LDL, triglycerides, type-II diabetes, and smoking. Notably, HDL showed a protective effect (OR = 0.77, 95% CI: 0.72–0.83), while type-II diabetes was positively associated with CHD (OR = 1.10, 95% CI: 1.05–1.16). For ischemic stroke subtypes, diastolic and systolic blood pressure showed consistent effects across both small vessel and large artery stroke (e.g., DBP OR = 2.27, 95% CI: 1.77–2.89 for small vessel stroke), and HDL again demonstrated protective effects. Multivariable MR (MVMR) further confirmed these associations, though estimates were attenuated. In summary, both univariable and MVMR analyses identified robust associations of lipid fractions and blood pressure with cardiovascular outcomes, highlighting their importance in CHD and ischemic stroke risk across multiple stroke subtypes.
{"title":"Elucidating the causal role of age of menarche, adiposity, lipid fractions, and blood pressure upon cardiovascular disease: a multivariable Mendelian randomization study","authors":"Yongho Jee, Wes Spiller, Eleanor Sanderson, Kate Tilling, Tom Palmer, Eunhee Ha, YoungJu Kim","doi":"10.1038/s41371-025-01048-y","DOIUrl":"10.1038/s41371-025-01048-y","url":null,"abstract":"This study explores the causal role of multiple correlated risk factors in coronary heart disease (CHD) and ischemic stroke, using Mendelian randomization (MR) analyses with GWAS summary data from both prevalent and incident stroke cases. Thirteen candidate risk factors were considered, including age at menarche, adiposity, lipid fractions, blood pressure, and smoking. Univariable MR identified seven exposures significantly associated with CHD risk, including BMI, blood pressure, LDL, triglycerides, type-II diabetes, and smoking. Notably, HDL showed a protective effect (OR = 0.77, 95% CI: 0.72–0.83), while type-II diabetes was positively associated with CHD (OR = 1.10, 95% CI: 1.05–1.16). For ischemic stroke subtypes, diastolic and systolic blood pressure showed consistent effects across both small vessel and large artery stroke (e.g., DBP OR = 2.27, 95% CI: 1.77–2.89 for small vessel stroke), and HDL again demonstrated protective effects. Multivariable MR (MVMR) further confirmed these associations, though estimates were attenuated. In summary, both univariable and MVMR analyses identified robust associations of lipid fractions and blood pressure with cardiovascular outcomes, highlighting their importance in CHD and ischemic stroke risk across multiple stroke subtypes.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 10","pages":"723-734"},"PeriodicalIF":3.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01048-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882917","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 : 2025-08-11DOI: 10.1038/s41371-025-01060-2
Muhammad Yousaf, Ali Hassan
{"title":"Critical appraisal of machine learning-based hypertension detection via single-lead electrocardiograms","authors":"Muhammad Yousaf, Ali Hassan","doi":"10.1038/s41371-025-01060-2","DOIUrl":"10.1038/s41371-025-01060-2","url":null,"abstract":"","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 10","pages":"735-736"},"PeriodicalIF":3.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144821560","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 : 2025-08-07DOI: 10.1038/s41371-025-01049-x
Son Bao Nguyen, Thomas Bastholm Olesen, Sidsel Louise Domazet, Sofie Frigaard Kristoffersen, Jens Steen Nielsen, Michael Hecht Olsen, Jacob Volmer Stidsen
Strenuous physical activity alleviates the risk of elevated blood pressure (BP) presumably through a reduction in systemic vascular resistance (SVR). Using logistic multivariate regression models, we investigated whether moderate to vigorous physical activity (MVPA) was negatively associated with high SVR among adults with Type 2 Diabetes (T2DM). Additionally, we assessed associations between other cardiometabolic risk factors and SVR. SVR was assessed using thoracic electrical bioimpedance; high SVR was defined as ≥20% above normal. Time spent on MVPA was calculated using accelerometer data and age-specific cut points. In fasting blood samples, we measured plasma glucose and c-peptide and used the Homeostasis Model Assessment 2-Insulin Resistance (HOMA2-IR) to estimate Insulin resistance. Results are adjusted for age, sex, BP, body mass index (BMI), HOMA2-IR, medication, and smoking. We included 824 adults (mean age = 61.6 years) with recently diagnosed T2DM (interquartile range for diabetes duration = 4.9 years). 41% were females. Median MVPA was 10.7 min/day, and 50.5% had high SVR. Increments of 14.4 min/day in MVPA were independently associated with a lower risk of high SVR (OR = 0.69, [0.57;0.83]). Other risk determinants of high SVR were female sex (OR = 2.06, [1.49;2.86]), each increase in BMI of 6.16 kg/m2 (OR = 2.20, [1.76;2.73]), and HOMA2-IR of 1.79 (OR = 2.33, [1.09;4.96]). BMI had a notably greater impact on explained variability of SVR than MVPA when comparing the coefficient of determination (pseudo-R2, 35.0% vs. 7.9%). Although increased levels of MVPA are associated with a reduced risk of high SVR, BMI appears to have a more pronounced effect on SVR.
{"title":"Impact of moderate to vigorous physical activity on systemic vascular resistance in Danish adults with recently diagnosed type 2 diabetes: a cross-sectional study","authors":"Son Bao Nguyen, Thomas Bastholm Olesen, Sidsel Louise Domazet, Sofie Frigaard Kristoffersen, Jens Steen Nielsen, Michael Hecht Olsen, Jacob Volmer Stidsen","doi":"10.1038/s41371-025-01049-x","DOIUrl":"10.1038/s41371-025-01049-x","url":null,"abstract":"Strenuous physical activity alleviates the risk of elevated blood pressure (BP) presumably through a reduction in systemic vascular resistance (SVR). Using logistic multivariate regression models, we investigated whether moderate to vigorous physical activity (MVPA) was negatively associated with high SVR among adults with Type 2 Diabetes (T2DM). Additionally, we assessed associations between other cardiometabolic risk factors and SVR. SVR was assessed using thoracic electrical bioimpedance; high SVR was defined as ≥20% above normal. Time spent on MVPA was calculated using accelerometer data and age-specific cut points. In fasting blood samples, we measured plasma glucose and c-peptide and used the Homeostasis Model Assessment 2-Insulin Resistance (HOMA2-IR) to estimate Insulin resistance. Results are adjusted for age, sex, BP, body mass index (BMI), HOMA2-IR, medication, and smoking. We included 824 adults (mean age = 61.6 years) with recently diagnosed T2DM (interquartile range for diabetes duration = 4.9 years). 41% were females. Median MVPA was 10.7 min/day, and 50.5% had high SVR. Increments of 14.4 min/day in MVPA were independently associated with a lower risk of high SVR (OR = 0.69, [0.57;0.83]). Other risk determinants of high SVR were female sex (OR = 2.06, [1.49;2.86]), each increase in BMI of 6.16 kg/m2 (OR = 2.20, [1.76;2.73]), and HOMA2-IR of 1.79 (OR = 2.33, [1.09;4.96]). BMI had a notably greater impact on explained variability of SVR than MVPA when comparing the coefficient of determination (pseudo-R2, 35.0% vs. 7.9%). Although increased levels of MVPA are associated with a reduced risk of high SVR, BMI appears to have a more pronounced effect on SVR.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 10","pages":"701-708"},"PeriodicalIF":3.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799353","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 : 2025-08-05DOI: 10.1038/s41371-025-01059-9
Kumi Sagara, Kenichi Goto, Megumi Maeda, Haruhisa Fukuda
The American Heart Association’s Life’s Essential 8 is a set of modifiable lifestyle habits and risk factors used to assess cardiovascular health (CVH). However, little is known about the potential impact of non-ideal statuses in these metrics on hypertension risk. This study aimed to clarify the associations between the total number of non-ideal CVH metrics and incident hypertension in a Japanese population. This retrospective cohort study was conducted using data from 10 Japanese municipalities participating in the LIFE Study. We identified National Health Insurance enrollees who had undergone health checkups between April 2017 and March 2018. Participants were categorized into 7 groups (0, 1, 2, 3, 4, 5, and 6–7 metrics) based on their total number of non-ideal CVH metrics (excluding blood pressure). The hazard ratio of each group (reference: 0 metrics) for new-onset hypertension was estimated using Cox proportional hazards models. During a mean follow-up period of 1405 days, 22 826 (24.5%) participants developed hypertension. Hypertension risk significantly increased with higher numbers of non-ideal CVH metrics (hazard ratios ranged from 1.067 for 1 metric to 1.609 for 6–7 metrics). Additionally, all non-ideal CVH metrics except for blood lipids were found to be significant predictors of hypertension. Higher numbers of non-ideal CVH metrics in Life’s Essential 8 were consistently associated with a higher incidence of hypertension. Multicomponent lifestyle modification strategies that improve overall CVH status may help to prevent hypertension.
{"title":"Associations between cardiovascular health metrics in life’s essential 8 and incident hypertension: The LIFE Study","authors":"Kumi Sagara, Kenichi Goto, Megumi Maeda, Haruhisa Fukuda","doi":"10.1038/s41371-025-01059-9","DOIUrl":"10.1038/s41371-025-01059-9","url":null,"abstract":"The American Heart Association’s Life’s Essential 8 is a set of modifiable lifestyle habits and risk factors used to assess cardiovascular health (CVH). However, little is known about the potential impact of non-ideal statuses in these metrics on hypertension risk. This study aimed to clarify the associations between the total number of non-ideal CVH metrics and incident hypertension in a Japanese population. This retrospective cohort study was conducted using data from 10 Japanese municipalities participating in the LIFE Study. We identified National Health Insurance enrollees who had undergone health checkups between April 2017 and March 2018. Participants were categorized into 7 groups (0, 1, 2, 3, 4, 5, and 6–7 metrics) based on their total number of non-ideal CVH metrics (excluding blood pressure). The hazard ratio of each group (reference: 0 metrics) for new-onset hypertension was estimated using Cox proportional hazards models. During a mean follow-up period of 1405 days, 22 826 (24.5%) participants developed hypertension. Hypertension risk significantly increased with higher numbers of non-ideal CVH metrics (hazard ratios ranged from 1.067 for 1 metric to 1.609 for 6–7 metrics). Additionally, all non-ideal CVH metrics except for blood lipids were found to be significant predictors of hypertension. Higher numbers of non-ideal CVH metrics in Life’s Essential 8 were consistently associated with a higher incidence of hypertension. Multicomponent lifestyle modification strategies that improve overall CVH status may help to prevent hypertension.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 10","pages":"716-722"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789318","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 : 2025-08-05DOI: 10.1038/s41371-025-01051-3
Alexandra Lindsay-Perez, Rebecca Jurdon, Thomas King, Lydia Koffman, Nia Roberts, Richard J. McManus, David McCartney
Hypertension is a major risk factor for cardiovascular disease, for which the management involves both lifestyle modification (diet, exercise etc) and medication. Digital interventions (mobile applications, websites, and SMS messages) are being developed to facilitate lifestyle change, but their effectiveness remains uncertain. This review aimed to establish whether digital interventions targeting lifestyle factors are effective in reducing blood pressure in individuals with hypertension. A systematic search was run through MEDLINE, EMBASE and the Cochrane Library. 5302 records were screened for eligibility and data on the primary outcome (systolic blood pressure (SBP)) and secondary outcomes (diastolic blood pressure (DBP) and change in lifestyle factors) were extracted from eligible papers. Where sufficient data were available, meta-analysis was undertaken using a random effects model. 17 randomised controlled trials were eligible for inclusion (3040 patients). 12 studies were suitable for meta-analysis. Lifestyle change mediated by digital interventions were associated with a larger SBP reduction than controls (mean difference (MD) −2.91 mmHg; 95% confidence interval (CI) −4.11, −1.71; p value (p) <0.0001). A significant difference was also seen in DBP reduction between groups (MD −1.13 mmHg; CI −1.91, −0.35; p = 0.005). Reporting of other secondary outcomes relating to lifestyle change was too heterogenous for meta-analysis. Digital interventions targeting lifestyle factors were associated with an improvement in blood pressure in patients with hypertension, but interpretation of the results is limited by significant heterogeneity between studies. Further research is required to understand which lifestyle factors, when targeted with digital interventions, result in maximal blood pressure reduction.
{"title":"A systematic review and meta-analysis of digital interventions targeting lifestyle factors in patients with hypertension","authors":"Alexandra Lindsay-Perez, Rebecca Jurdon, Thomas King, Lydia Koffman, Nia Roberts, Richard J. McManus, David McCartney","doi":"10.1038/s41371-025-01051-3","DOIUrl":"10.1038/s41371-025-01051-3","url":null,"abstract":"Hypertension is a major risk factor for cardiovascular disease, for which the management involves both lifestyle modification (diet, exercise etc) and medication. Digital interventions (mobile applications, websites, and SMS messages) are being developed to facilitate lifestyle change, but their effectiveness remains uncertain. This review aimed to establish whether digital interventions targeting lifestyle factors are effective in reducing blood pressure in individuals with hypertension. A systematic search was run through MEDLINE, EMBASE and the Cochrane Library. 5302 records were screened for eligibility and data on the primary outcome (systolic blood pressure (SBP)) and secondary outcomes (diastolic blood pressure (DBP) and change in lifestyle factors) were extracted from eligible papers. Where sufficient data were available, meta-analysis was undertaken using a random effects model. 17 randomised controlled trials were eligible for inclusion (3040 patients). 12 studies were suitable for meta-analysis. Lifestyle change mediated by digital interventions were associated with a larger SBP reduction than controls (mean difference (MD) −2.91 mmHg; 95% confidence interval (CI) −4.11, −1.71; p value (p) <0.0001). A significant difference was also seen in DBP reduction between groups (MD −1.13 mmHg; CI −1.91, −0.35; p = 0.005). Reporting of other secondary outcomes relating to lifestyle change was too heterogenous for meta-analysis. Digital interventions targeting lifestyle factors were associated with an improvement in blood pressure in patients with hypertension, but interpretation of the results is limited by significant heterogeneity between studies. Further research is required to understand which lifestyle factors, when targeted with digital interventions, result in maximal blood pressure reduction.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 10","pages":"690-700"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01051-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789317","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 : 2025-08-02DOI: 10.1038/s41371-025-01058-w
G. Miceli, M. Velardo, A. Casuccio, M. Daidone, M. G. Basso, A. Tuttolomondo
Resistant hypertension (RH) is defined as office systolic blood pressure (BP) that remains uncontrolled despite the concurrent use of three or more antihypertensive drug classes and may be associated with altered vasomotor responses to physiological stimuli. However, the effect of RH on cerebrovascular reactivity (CVR) remains poorly understood. Furthermore, the potential contribution of autonomic nervous system dysfunction to these alterations has not yet been fully clarified. Understanding these mechanisms may offer insights into the pathophysiology of resistant hypertension and could have important prognostic implications. This study aims to analyze CVR in a cohort of patients with RH, compared with patients with non-resistant hypertension (NRH), taking into account the differences in sympathovagal balance between the two groups. Forty consecutive hypertension patients, 20 with NRH and 20 with RH, underwent heart rate variability analysis and transcranial color-coded Doppler at rest and during a breath-holding maneuver to evaluate CVR. Hypertensive individuals presented a significant reduction of the Breath Holding Index (BHI) and time-domain parameters (SDNN and SDANN) in comparison to the control group (BHI control 1.32 ± 0.41 vs hypertensive 0.92 ± 0.65; p = 0.018; SDANN control 125.76 ± 24.96 vs hypertensive 87.65 ± 20.63; p < 0.0001). RH patients presented a significant reduction in BHI (NRH BHI 1.15 ± 0.65 vs RH BHI 0.70 ± 0.58; p = 0.027) and HRV parameters (SDANN in NRH 95.09 ± 22.12 vs RH 80.21 ± 16.36; p = 0.021). Our results show that RH is associated with impaired HRV and CRV. Autonomic dysfunction could be a concurrent cause of cerebral vasomotor reactivity impairment.
{"title":"Cerebrovascular reactivity impairment in resistant hypertension","authors":"G. Miceli, M. Velardo, A. Casuccio, M. Daidone, M. G. Basso, A. Tuttolomondo","doi":"10.1038/s41371-025-01058-w","DOIUrl":"10.1038/s41371-025-01058-w","url":null,"abstract":"Resistant hypertension (RH) is defined as office systolic blood pressure (BP) that remains uncontrolled despite the concurrent use of three or more antihypertensive drug classes and may be associated with altered vasomotor responses to physiological stimuli. However, the effect of RH on cerebrovascular reactivity (CVR) remains poorly understood. Furthermore, the potential contribution of autonomic nervous system dysfunction to these alterations has not yet been fully clarified. Understanding these mechanisms may offer insights into the pathophysiology of resistant hypertension and could have important prognostic implications. This study aims to analyze CVR in a cohort of patients with RH, compared with patients with non-resistant hypertension (NRH), taking into account the differences in sympathovagal balance between the two groups. Forty consecutive hypertension patients, 20 with NRH and 20 with RH, underwent heart rate variability analysis and transcranial color-coded Doppler at rest and during a breath-holding maneuver to evaluate CVR. Hypertensive individuals presented a significant reduction of the Breath Holding Index (BHI) and time-domain parameters (SDNN and SDANN) in comparison to the control group (BHI control 1.32 ± 0.41 vs hypertensive 0.92 ± 0.65; p = 0.018; SDANN control 125.76 ± 24.96 vs hypertensive 87.65 ± 20.63; p < 0.0001). RH patients presented a significant reduction in BHI (NRH BHI 1.15 ± 0.65 vs RH BHI 0.70 ± 0.58; p = 0.027) and HRV parameters (SDANN in NRH 95.09 ± 22.12 vs RH 80.21 ± 16.36; p = 0.021). Our results show that RH is associated with impaired HRV and CRV. Autonomic dysfunction could be a concurrent cause of cerebral vasomotor reactivity impairment.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 9","pages":"626-633"},"PeriodicalIF":3.4,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41371-025-01058-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768666","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}
Studies have indicated a relationship between bullous pemphigoid (BP) and hypertension, but the findings remain controversial. To examine this association, we conducted a systematic review using studies from PubMed, EMBASE, Web of Science, and the Cochrane Library, applying a random-effects model while performing subgroup and sensitivity analyses to explore potential sources of heterogeneity. Subgroup analyses were performed by country, data source, and sample size. The quality of evidence was evaluated using the Newcastle-Ottawa Scale. The review protocol was registered in PROSPERO (ID: CRD42024573911). The analysis included 20 studies, primarily consisting of case-control studies from Europe and Asia, encompassing 72,981,822 participants, of whom 29,199 had BP. The mean ages of the BP group and the non-BP group were 74.62 and 74.25 years, respectively. Random-effects meta-analysis demonstrated a significant association between BP and hypertension (odds ratio [OR] = 1.13, 95% confidence interval [CI]: 1.07–1.20). Subgroup analyses revealed stronger associations in database studies (OR = 1.24, 95% CI: 1.17–1.31) and in studies with over 1000 BP cases (OR = 1.30, 95% CI: 1.23–1.37). No significant association was observed in studies conducted in Asia (OR = 1.05) or Europe (OR = 1.07). However, a significant relationship was found in studies from the United States (OR = 1.29, 95% CI: 1.12–1.48). This study found a significant correlation between BP and hypertension, particularly in the United States. However, as most included studies were observational in nature, causality cannot be inferred. Further research is needed to elucidate the underlying mechanisms and causal relationship between BP and hypertension.
{"title":"Association between bullous pemphigoid and hypertension: a systematic review and meta-analysis of observational studies","authors":"XiaoLi Yang, XiaoRan Tao, PanLing Wei, Chen Xu, JinPing Gao, FuSheng Zhou, ZaiXing Wang","doi":"10.1038/s41371-025-01056-y","DOIUrl":"10.1038/s41371-025-01056-y","url":null,"abstract":"Studies have indicated a relationship between bullous pemphigoid (BP) and hypertension, but the findings remain controversial. To examine this association, we conducted a systematic review using studies from PubMed, EMBASE, Web of Science, and the Cochrane Library, applying a random-effects model while performing subgroup and sensitivity analyses to explore potential sources of heterogeneity. Subgroup analyses were performed by country, data source, and sample size. The quality of evidence was evaluated using the Newcastle-Ottawa Scale. The review protocol was registered in PROSPERO (ID: CRD42024573911). The analysis included 20 studies, primarily consisting of case-control studies from Europe and Asia, encompassing 72,981,822 participants, of whom 29,199 had BP. The mean ages of the BP group and the non-BP group were 74.62 and 74.25 years, respectively. Random-effects meta-analysis demonstrated a significant association between BP and hypertension (odds ratio [OR] = 1.13, 95% confidence interval [CI]: 1.07–1.20). Subgroup analyses revealed stronger associations in database studies (OR = 1.24, 95% CI: 1.17–1.31) and in studies with over 1000 BP cases (OR = 1.30, 95% CI: 1.23–1.37). No significant association was observed in studies conducted in Asia (OR = 1.05) or Europe (OR = 1.07). However, a significant relationship was found in studies from the United States (OR = 1.29, 95% CI: 1.12–1.48). This study found a significant correlation between BP and hypertension, particularly in the United States. However, as most included studies were observational in nature, causality cannot be inferred. Further research is needed to elucidate the underlying mechanisms and causal relationship between BP and hypertension.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 9","pages":"666-674"},"PeriodicalIF":3.4,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742273","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 : 2025-07-25DOI: 10.1038/s41371-025-01053-1
Guido Grassi
{"title":"Vagal dysfuction in resistant hypertension: no longer the “cinderella” of the autonomic cardiovascular profile","authors":"Guido Grassi","doi":"10.1038/s41371-025-01053-1","DOIUrl":"10.1038/s41371-025-01053-1","url":null,"abstract":"","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 7","pages":"465-466"},"PeriodicalIF":3.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717956","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}
Preeclampsia (PE) is a prevalent and severe pregnancy-related complication, for which effective intervention targets remain limited, posing significant risks to maternal and fetal health. This study aimed to identify potential therapeutic target genes through genetic analyses. Specifically, we utilized cis-expression quantitative trait loci (cis-eQTL) of druggable genes derived from blood samples obtained from the eQTLGen consortium as exposure data. Subsequently, Mendelian randomization (MR) analysis was conducted to explore causal associations between these druggable genes and PE. Functional enrichment analysis, Summary-data-based MR (SMR), and colocalization analysis were employed to validate the identified genes. MR results revealed 17 druggable genes significantly associated with PE after multiple testing correction (FDR < 0.05). Functional enrichment analysis indicated that these genes are involved in key biological processes such as leukocyte proliferation and activation, immune response regulation, and the metabolism of water-soluble vitamins. Additionally, they were found to participate in several critical signaling pathways, including the complement and coagulation cascades, the renin-angiotensin system, and folate biosynthesis. SMR and colocalization analyses further confirmed the causal relationships between PE and five genes—TESK2, LNPEP, CD320, NELL2, and SF3B3. Moreover, single-cell RNA sequencing data supported the association between the expression levels of TESK2, CD320, and SF3B3 and the development of PE. This study provides preliminary evidence identifying several potential genetic targets that may help reduce the risk of PE from a genomic perspective. These findings offer novel scientific insights and research directions for future drug development and the optimization of therapeutic strategies aimed at managing and preventing PE.
{"title":"Exploration of potential therapeutic target genes for preeclampsia through genetic analysis","authors":"Huihui Wang, Meihong Shen, Guangtong She, Huiyan Wang, Wenbo Zhou","doi":"10.1038/s41371-025-01054-0","DOIUrl":"10.1038/s41371-025-01054-0","url":null,"abstract":"Preeclampsia (PE) is a prevalent and severe pregnancy-related complication, for which effective intervention targets remain limited, posing significant risks to maternal and fetal health. This study aimed to identify potential therapeutic target genes through genetic analyses. Specifically, we utilized cis-expression quantitative trait loci (cis-eQTL) of druggable genes derived from blood samples obtained from the eQTLGen consortium as exposure data. Subsequently, Mendelian randomization (MR) analysis was conducted to explore causal associations between these druggable genes and PE. Functional enrichment analysis, Summary-data-based MR (SMR), and colocalization analysis were employed to validate the identified genes. MR results revealed 17 druggable genes significantly associated with PE after multiple testing correction (FDR < 0.05). Functional enrichment analysis indicated that these genes are involved in key biological processes such as leukocyte proliferation and activation, immune response regulation, and the metabolism of water-soluble vitamins. Additionally, they were found to participate in several critical signaling pathways, including the complement and coagulation cascades, the renin-angiotensin system, and folate biosynthesis. SMR and colocalization analyses further confirmed the causal relationships between PE and five genes—TESK2, LNPEP, CD320, NELL2, and SF3B3. Moreover, single-cell RNA sequencing data supported the association between the expression levels of TESK2, CD320, and SF3B3 and the development of PE. This study provides preliminary evidence identifying several potential genetic targets that may help reduce the risk of PE from a genomic perspective. These findings offer novel scientific insights and research directions for future drug development and the optimization of therapeutic strategies aimed at managing and preventing PE.","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":"39 9","pages":"643-651"},"PeriodicalIF":3.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717955","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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