Current Hypertension Reviews最新文献

Background: Dihydropyridine-calcium channel blockers (DHP-CCBs) are effective first-line blood pressure-lowering agents for primary hypertension. However, data comparing the variations in efficacy and safety between different types of DHP-CCBs are scarce.

Aims and objectives: This study aimed to summarize the latest evidence on the benefits and harms of seven DHP-CCBs (amlodipine, levamlodipine, felodipine, lacidipine, nitrendipine, nifedipine, and benidipine).

Methods: A meta-analysis of DHP-CCBs was carried out to explore differences in efficacy and safety. We searched PubMed, Embase, the Cochrane Library, CNKI, Wanfang Data, and VIP databases from inception to September, 2023, for randomized controlled trials (RCTs) comparing DHP-CCBs. The main outcomes were blood pressure lowering and adverse events (AEs) during treatment.

Results: We included 181 RCTs (21,383 patients) in this analysis. In terms of efficacy, levamlodipine ranked highest in reducing office blood pressure (surface under the cumulative ranking systolic blood pressure = 80.81%, diastolic blood pressure [DBP] = 82.42%) and 24-h ambulatory DBP (98.07%). Felodipine had the highest probability of reducing 24-h ambulatory blood pressure (80.65%). Regarding safety, levamlodipine had the least impact on heart rate (85.71%). In terms of AEs, benidipine had the highest rate for cardiovascular (86.58%) and digestive system (93.57%) AEs. Nifedipine and amlodipine had the highest rates of central (80.65%) and peripheral nervous system (83.28%) AEs, respectively. Levamlodipine exhibited significantly lower rates of total AEs (1.24%), central nervous system AEs (1.28%), and cardiovascular system AEs (3.62%) than the other interventions.

Conclusion: In the office setting, levamlodipine may be the best treatment for primary hypertension, and lacidipine shows good safety.

Background: According to current clinical practice guidelines, ambulatory blood pressure measurement (ABPM) is recommended to confirm diagnoses of hypertension. It remains unclear as to which method is superior in predicting mortality outcomes.

Methods: Prospective observational studies, comparing ABPM with clinical blood pressure measurements (CBPM), were included with outcomes of the study being all-cause and cardiovascular mortality.

Results: Nine studies with a total of 23,140 participants were included. Each 10-mmHg increase in 24-hour mean systolic blood pressure (SBP) was linked to a higher risk of all-cause mortality (HR: 1.13, 95% CI: 1.09-1.18), while clinic blood pressure measurement (CBPM) was not a significant predictor (HR: 1.02, 95% CI: 0.90-1.13). Nighttime SBP increases of 10 mmHg were associated with a higher all-cause mortality risk than daytime SBP (HR: 1.16, 95% CI: 1.11-1.21 versus HR: 1.08, 95% CI: 1.05-1.12). For cardiovascular mortality, a 10 mmHg increase in SBP yielded an HR of 1.21 (95% CI: 1.16-1.27) for 24-hour ABPM compared to 1.08 (95% CI: 1.04-1.11) for CBPM. Similarly, for a 5 mmHg increase in diastolic blood pressure (DBP), the HR was 1.14 (95% CI: 1.07-1.20) for 24-hour ABPM versus 1.04 (95% CI: 1.01-1.07) for clinical DBP, highlighting 24-hour monitoring as a stronger predictor for cardiovascular mortality.

Conclusion: The findings of this study support the superiority of ABPM measurements in predicting both all-cause and cardiovascular mortality.

A significant proportion of hypertensive patients are both smokers and obese. Several pathophysiological mechanisms are involved in the combined effect of smoking and obesity on hypertension onset and maintenance. These include increased sympathetic nervous system activity, endothelial dysfunction, inflammation, oxidative stress, and insulin resistance. The presence of these major cardiovascular risk factors may lead to difficult-to-control hypertension as well as substantially increase the risk for an adverse cardiovascular outcome. It is, therefore, imperative that healthcare providers embrace a comprehensive, multifaceted approach in the management of obese hypertensive patients with smoking habits. This review delves into the complex interplay of these risk factors, providing a comprehensive overview of the current literature to aid the deployment of effective clinical management strategies toward reducing the risk profile of affected individuals.

Introduction: Hypertension is a chronic medical state and a major determining factor for cardiovascular and renal diseases. Both genetic and non-genetic factors contribute to hypertensive conditions among individuals. The renin-angiotensin-aldosterone system (RAAS) is a major genetic target for the anti-hypertension approach.

Purpose of the study: The majority of classical antihypertensive drugs were mainly focused on the RAAS signaling pathways. Though these antihypertensive drugs control blood pressure (BP), they have mild to severe life-threatening effects. Unrevealing effective hypertensive targets for BP management is essential. The effective targets could emerge either from RAAS-dependent or RAAS-independent pathways and/or through the cross-talks among them.

Results: Analyzing the physiopathological mechanisms of hypertension has the benefit of understanding the interactions between these systems which helps in better understanding of drug targets and the importance of emergence of novel therapeutics.

Conclusion: This review is about the signaling pathways involved in hypertension pathogenesis and their cross-talks and it contributes to a better understanding of the etiology of hypertension.

Background: Chronic Kidney Disease (CKD) is a known risk factor for End-Stage Renal Disease (ESRD) and Cardiovascular Diseases (CVD). Renal Doppler Ultrasound (RDU) can detect early renal involvement in CKD using the Renal Resistive Index (RRI).

Aims: This study aimed to investigate the effects of risk factors and clinical complications associated with CKD on RRI among patients with different stages of CKD.

Methods: In this analytical cross-sectional study, 186 patients referred to Poursina Hospital for RDU were categorized into six groups (normal and five stages of CKD). We analyzed the impact of demographic factors and clinical complications on RRI across all groups.

Results: Our findings indicated that CKD prevalence was particularly high among older patients and those with CVD, type 2 diabetes mellitus (DM), and hypertension (HTN). Elevated RRI in CKD patients was significantly associated with age, CKD stage, CVD, and HTN (p < 0.05). Furthermore, RRI was higher in CKD patients with elevated serum phosphorus (P) levels, higher low-density lipoproteins (LDL), and lower calcium (Ca) and hemoglobin (Hb) levels. Based on a multivariate regression model, CVD, lower Ca, high LDL, and proteinuria were identified as independent predictors of elevated RRI (p < 0.05).

Conclusion: This study concludes that elevated RRI is associated with the severity of CKD and its clinical complications, suggesting that RRI can serve as a reliable indicator for assessing CKD patients, managing treatment, and preventing early death complications.

Hypertension, a prevalent global health issue, poses significant risks for morbidity and mortality. The interplay between hypertension and comorbidities like diabetes and chronic kidney disease (CKD) underscores the urgency for effective management strategies. Chronotherapy, aligning medication administration with circadian rhythms, emerges as a promising approach to optimize treatment outcomes. The objective of this study is to assess the safety and efficacy of the use of ACEIs and ARBs in the chronotherapeutic treatment of hypertension. We aim to clarify the influence of circadian blood pressure patterns on the efficacy of medications and investigate the potential of chronotherapy in the management of hypertension by conducting a thorough examination of the existing literature. A literature search spanning from January 1980 to 2023 was conducted using PubMed, Scopus and Google Scholar databases. Search terms included ACE inhibitors, ARBs, chronotherapy, hypertension, and circadian rhythm of blood pressure. Studies investigating the effects of chronotherapy with ACEIs and ARBs in hypertensive patients were analyzed. Chronotherapy offers a personalized approach to hypertension management, leveraging the dynamic nature of circadian rhythms. By administering ACEIs or ARBs at night, the risk of morning blood pressure surges, associated with adverse cardiovascular events, can be mitigated. However, the optimal timing and combination of medications remain areas of ongoing research. Our review highlights the potential of chronotherapy with ACEIs and ARBs as a promising avenue for hypertension treatment. Further research is warranted to elucidate the mechanisms underlying circadian blood pressure regulation and optimize chronotherapeutic strategies. This comprehensive evaluation underscores the need for personalized treatment approaches tailored to individual circadian rhythms for improved hypertension management and reduced cardiovascular risk.

Introduction: Hypertension is a worldwide problem that affects people of all ethnicities and social groups. Its mortality rate has been steadily increasing. However, several pharmacological compounds have been used to manage hypertension and related issues. Calcium Channel Blockers (CCBs) based on Dihydropyridine (DHP) are used as first-line therapy. It is well established that simple adjustments to an existing medicine's fundamental structure can considerably improve its efficacy.

Materials and methods: The purpose of this research study was to create potential antihypertensive drugs utilizing a 1,4-DHP scaffold and analyze their binding processes with different calcium channel proteins for comparative analysis, with PDB IDs 3LV3, 1T0J, and 6DAF. This study used molecular docking and ADMET (Absorption, Distribution, Metabolism, Excretion, Toxicity) profiling to predict the binding efficacy of newly produced potential drugs, such as CCBs.

Results: The binding energy of the protein with the newly created compounds ranged between -2.6 and -7.26 kcal/mol (3LV3), -7.42 to -10.36 kcal/mol (1T0J), and -6.63 to -11.98 kcal/mol (6DAF).

Discussion: The predicted ADMET profiling yielded significant results, indicating that among the virtually prepared ligands, apart from the standard drugs amlodipine and nifedipine, ligand numbers 60 and 13 showed a favorable ADMET profile.

Conclusion: In this study, drug development efforts focused on modifying existing hypertension medications through in silico analysis. From hundreds of synthesized ligands, 19 showed optimal docking scores. ADMET profiling of these 19 ligands revealed ligands 60 and 13 to have favorable profiles. The Swiss ADME and ADMET lab 2.0 tools confirmed these findings, highlighting their potential for further development.

Hypertension remains the primary driver of Cardiovascular Diseases (CVDs) and mortality. Dyslipidaemia is a common risk factor for CVDs in hypertensive patients, and their coexistence significantly increases the risk of CVDs. Furthermore, epidemiologic studies indicate that there are U-shaped curves between cholesterol levels of HDL-C and CVDs-related mortality in patients with hypertension, in which CVDs are paradoxically increased in those with elevated HDLC levels. On the one hand, HDL-C levels and HDL particle function are associated with the pathogenesis and prognosis of hypertension. On the other hand, hypertension leads to lower HDL-C levels and worse HDL function through various changes in HDL granule proteome and liposome. In view of these findings, the relationship between hypertension and HDL-C necessitates a renewed analysis. This study summarizes the findings from clinical trials and basic research to determine the relationship between HDL-C and hypertension.

Background: Declined kidney function associated with hypertension is a danger for cognitive deficits, dementia, and brain injury. Cognitive decline and vascular dementia (VaD) are serious public health concerns, which highlights the urgent need for study on the risk factors for cognitive decline. Cysteinyl leukotriene (CysLT₁) receptors are concerned with regulating cognition, motivation, inflammatory processes, and neurogenesis.

Objective: This research aims to examine the consequence of montelukast (specific CysLT₁ antagonist) in renovascular hypertension 2-kidney-1-clip-2K1C model-triggered VaD in experimental animals.

Methods: 2K1C tactics were made to prompt renovascular hypertension in mature male rats. Morris water maze was employed to measure cognition. Mean arterial pressure (MAP), serum nitrite levels, aortic superoxide content, vascular endothelial activity, brain's oxidative stress (diminished glutathione, raised lipid peroxides), inflammatory markers (IL-10, IL-6, TNF-α), cholinergic activity (raised acetylcholinesterase), and cerebral injury (staining of 2, 3, 5- triphenylterazolium chloride) were also examined.

Results: Montelukast in doses of 5.0 and 10.0 mg kg^-1 was used intraperitoneally as the treatment drug. Along with cognitive deficits, 2K1C-operated rats showed elevated MAP, endothelial dysfunction, brain oxidative stress, inflammation, and cerebral damage with diminished serum nitrite/nitrate. Montelukast therapy significantly and dose-dependently mitigated the 2K1Chypertension- provoked impaired behaviors, biochemistry, endothelial functions, and cerebral infarction.

Conclusion: The 2K1C tactic caused renovascular hypertension and associated VaD, which was mitigated via targeted regulation of CysLT₁ receptors by montelukast administration. Therefore, montelukast may be taken into consideration for the evaluation of its complete potential in renovascular-hypertension-induced VaD.

Background: The representatives of mathematical concepts and indices allied to the Golden Ratio (GR) have been shown in the human body in superimposed human hands, phalangeal lengths of the digits, human ears, and the cardiovascular system. Recently, it has been demonstrated that the systolic blood pressure (SBP) to diastolic blood pressure (DBP) ratio measured by ambulatory blood pressure monitoring (ABPM) is close to GR. Accordingly, we aimed to evaluate the ratios between the SBP, DBP, and PP in normotensive and hypertensive patients who were on medical treatment or not, to assess the existence of golden proportions in 24-hour ambulatory blood pressure monitoring results.

Material and method: Five hundred and twenty-nine patients who underwent ABPM were retrospectively enrolled in the study population. The ABPM was programmed to measure blood pressure every 30 min during the daytime and 60 min night time. Based on the ABPM results, patients were classified as hypertensive (SBP/DBP≥130/80 mmHg) and normotensive (SBP/DBP<130/80 mmHg), depending on ESC/ESH 2018 guidelines. They were also divided into two subgroups: medicated and nonmedicated. Systolic to diastolic blood pressure ratio (SBP/DBP) and diastolic blood pressure to pulse pressure (DBP/PP) were calculated in the usual fashion in all study populations and subgroups.

Results: After the exclusion of 133 patients who did not fulfill the inclusion criteria, 396 patients were included in the statistical analysis. Mean SBP/DBP ratios were 1.66±0.15 in all the study population, 1.63±0.11 in normotensive without medication, 1.66±0.13 in normotensive with medications, 1.62±0.15 in hypertensive without medication, and 1.76±0.20 with medications.

Conclusion: We have documented that SBP to DBP ratios of untreated patients, irrespective of having normal or high blood pressure, run close around the GR. However, SBP to DBP ratios of patients having antihypertensive treatment are far from the GR.