Current Hypertension Reviews最新文献

Introduction: Hypertension has become a salient public health issue on a global scale, affecting more than one billion people worldwide. In Vietnam, and specifically in Kon Tum prov-ince, many studies on hypertension have been conducted, mainly focusing on Kinh people, the majority ethnic group in Vietnam. Very few hypertension studies have focused on ethnic minority groups. This study aims to determine the prevalence of hypertension and identify related factors in mem-bers of the Ba Na ethnic group, aged 25 years and older, in Kon Tum City, Kon Tum province, Vietnam, in 2019.

Methods: A descriptive cross-sectional analysis design was carried out among 450 Ba Na ethnic people aged 25 years and older living in Kon Tum province.

Results: The study results indicated that the rate of hypertension in the study population was 30.89%. Increasing age was associated with increasing hypertension, with the highest rate found in the ≥ 65 age group at 66.67%. The lowest rate of hypertension in the group was found among participants aged 25-34 years at 9.66%. In addition to age (>65 years), factors associated with hypertension included BMI (obesity), a family history of hypertension, smoking cigarettes, number of cigarettes smoked per day (>10 cigarettes/day), and having diabetes.

Conclusion: This is one of the very few studies conducted to measure the prevalence of hyperten-sion in ethnic minority populations in Vietnam. It is necessary to implement community interven-tions to reduce the exposure to the risk factors of hypertension for the Ba Na ethnic people in Kon Tum, Vietnam.

Arterial stiffness, a hallmark of cardiovascular aging and disease, is characterized by the reduced elasticity of the arterial walls, which increases cardiovascular risk. Effective treatment aims not only to manage symptoms but also to address underlying causes and reduce associated risks. Thus, the present study aims to provide an understanding of lifestyle modifications and pharmaco-logical treatments for arterial stiffness, as well as the associated cardiovascular risk. The cornerstone of arterial stiffness treatment involves lifestyle changes. Regular aerobic physical activity, com-bined with a healthy diet, can help reduce weight, lower blood pressure, and improve arterial func-tion. Moreover, since tobacco use directly damages arterial walls and promotes stiffness, smoking cessation is necessary. Several classes of medication, such as renin-angiotensin-aldosterone system inhibitors and calcium channel blockers, not only help control blood pressure but also improve arterial compliance. New antidiabetic agents, such as SGLT2 inhibitors and GLP-1 receptor agonists, have been shown to have beneficial effects on arterial stiffness. Statins, which are commonly prescribed for cholesterol management, also have favorable effects on arterial health, beyond their lipid-lowering properties. In conclusion, treating arterial stiffness is a multifaceted process that involves lifestyle modifica-tions, medication, and emerging therapies, all of which are best achieved through consistent moni-toring. This holistic approach aims to enhance arterial elasticity, reduce cardiovascular risk, and improve overall quality of life.

Introduction: Hypertension represents a major public health challenge, contributing to the global health burden. Lifestyle modifications and pharmacotherapeutic interventions are the cornerstones in the management of hypertension. However, suboptimal adherence remains a criti-cal impediment to achieving desired clinical outcomes, stemming from a complex interplay of socioeconomic factors, access to care, and affordability of medications. Therefore, the objective of this study was to assess adherence to lifestyle modifications and drug therapy and their associated factors.

Methods: A monocentric cross-sectional study was conducted on 200 hypertensive patients from July 1st to October 30, 2022. Participants were selected using a consecutive sampling technique. Adherence to lifestyle modifications was assessed through questions filled in a data sheet, with consumption of salt and the DASH diet evaluated using a Food Frequency Questionnaire and the Hill-Bone Compliance to High Blood Pressure Therapy Scale, while medication adherence was assessed using the Morisky Medication Adherence Scale with 4 items (MMAS-4).

Results: The overall adherence to lifestyle modifications was 39.8%, with good adherence to fruit and vegetable consumption at 59.5%, adherence to a low-salt diet at 43%, and physical activity at 24.5%. According to the MMAS-4, poor medication adherence was observed in 58.3% of our patients and was associated with advanced age (>60 years; p = 0.014), low socio-economic level (p = 0.012), and use of free-dose combination therapy (p = 0.001).

Discussion: Our study demonstrates that poor adherence critically undermines hypertension control, while patient education and fixed-dose combination therapies improve outcomes. However, variability across populations and healthcare contexts limits generalizability and warrants further multicenter research.

Conclusion: The findings of this study indicate that therapeutic adherence among individuals with hypertension remains suboptimal, highlighting the need for a comprehensive, multifactorial strategy to address the diverse and intersecting determinants of nonadherence.

Introduction: High blood pressure (BP) damages various structures. The damaged structures are named hypertension-mediated organ damages (HMODs). Some of HMODs are acute (i.e., intracranial haemorrhage), while the others are chronic (e.g., left ventricular hypertrophy (LVH)). The aim of the paper was to investigate how HMODs compare to each other, and to answer the question of whether HMODs are divided into acute and chronic forms in the major medical publications - guidelines.

Methods: A search for 'acute hypertension-mediated organ damage' and 'acute target organ damage' was performed in the whole papers in SCOPUS. Moreover, the available guidelines on hypertension are analysed.

Results: Our results show that the mentioned chronic HMODs differ a lot, both in number and qualitatively, i.e. which HMODs are specified. The difference regarding the number of HMODs listed reflects partially the different approach; some guidelines state organ damage in general, and the other guidelines provide extensive lists.

Discussion: A Substantial number of arterial hypertension (HTN) guidelines do not list both acute and chronic HMODs; several guidelines refer to acute HMODs, and some others to chronic HMODs. In a number of HTN guidelines, acute (e.g., intracranial haemorrhage) and chronic HMODs (such as LVH) were mixed. In the vast majority of guidelines, the acute and chronic HMODs are not directly divided.

Conclusion: Consensus is clearly missing about the definition and classification of HMODs. Multiple reasons suggest that HMODs should be divided into acute and chronic subgroups. We presented some of the arguments and examples to start with.

Introduction: The arterial stiffness index (ASI) is a widely recognized metric used to assess arterial endothelial function and predict cardiovascular issues. This study has validated ASI as a non-invasive clinical assessment tool for atherosclerotic coronary artery disease (CAD).

Methods: We conducted a retrospective, observational study involving 396 patients undergoing coronary angiography. ASI was measured using the CardioVision MS-2000 system, and the SYN-TAX scores (SXscore) were computed to evaluate CAD severity. Patients were divided into two groups according to the SXscore: low SXscore (<22) and intermediate-high SXscore (≥ 22).

Results: In total, 257 (64.9 %) patients had CAD, of whom 166 (64.6%) had low (<22), 75(29.2%) had intermediate (23-32), and 16 (6.2%) had high (≥ 33) SXscore. ASI was significantly higher in CAD patients (120.82 ± 76.26 mmHg×10) compared to non-CAD patients (56.60 ± 35.89 mmHg×10; p < 0.01). In the multivariate regression model, a significant association was observed between ASI and CAD, with an odds ratio (OR) of 1.031 [95% confidence interval (CI): 1.022-1.040; p < 0.0001]. Additionally, ASI demonstrated an independent association with both intermediate and high SXscore (adjusted OR: 1.027; 95% CI: 1.020-1.034; p < 0.0001). The levels of ASI differed significantly in groups of patients with control, low SXScore, and intermediate-high SXScore as follows: 56.60±35.89 mmHg×10, 92.67±51.79 mmHg×10, and 172.2±86.6 mmHg×10, respectively (p < 0.01). ASI exhibited 59% sensitivity and 90% specificity for recognizing CAD.

Conclusion: Our findings suggested ASI to accurately evaluate arterial elastic function and provide information on CAD severity.

Obstructive sleep apnea (OSA) is a breathing disorder characterized by repeated, com-plete, and partial upper airway blockage, which results in disturbances in sleep patterns, neurocog-nitive functions, and hypoxemia. It is strongly linked to obesity and metabolic dysfunction, con-tributing to cardiovascular and neurocognitive complications. Tirzepatide, a dual GIP/GLP-1 re-ceptor agonist, has shown significant potential for weight loss with metabolic benefits, making it a potential therapeutic strategy for OSA by reducing fat deposition around the upper airway, im-proving insulin sensitivity, and lowering systemic inflammation. Emerging clinical studies have shown potential improvement in apnea-hypopnea index (AHI) and oxygenation. In this review, we have explored the role of tirzepatide in managing OSA by targeting obesity, metabolic dysfunction, and airway stability. Here, we have also examined tirzepatide mechanisms by highlighting clinical trials to find its efficacy in reducing OSA severity and improving patient outcomes.

Hypertension is a major challenge in patients with end-stage kidney disease (ESKD) undergoing dialysis, contributing to increased cardiovascular morbidity and mortality. Both hemo-dialysis (HD) and peritoneal dialysis (PD) serve as renal replacement therapies, yet their effective-ness in blood pressure (BP) control remains a subject of ongoing debate. Emerging evidence sug-gests that PD may offer better BP regulation than HD due to continuous ultrafiltration, superior sodium removal, and the preservation of residual kidney function. In contrast, HD is often associ-ated with interdialytic fluid retention, leading to BP fluctuations and a higher risk of cardiovascular complications. However, BP control in PD patients is not without challenges, as ultrafiltration fail-ure, peritoneal membrane dysfunction, and inflammation can contribute to resistant hypertension. Despite these limitations, PD may provide a more stable hemodynamic profile compared to HD, making it a promising option for patients with difficult-to-manage hypertension. Individualized dialysis selection remains crucial, as it balances the benefits of fluid control with the risks of PD-related complications. Further research, particularly randomized controlled trials, is needed to de-termine the long-term impact of PD and HD on BP control and cardiovascular outcomes in dialysis patients.

Hypertension and intracranial hypertension are associated with distinct clinical contexts, encompassing both neurological and cardiovascular implications. Hypertension induces significant structural and functional alterations in cerebral arteries, such as vascular wall thickening, increased arterial stiffness, reduced vascular compliance, and endothelial dysfunction, all of which can contribute to elevated intracranial pressure. These vascular changes may impair the integrity of the blood-brain barrier and disrupt cerebral autoregulation, thereby diminishing the brain's ability to effectively regulate cerebral blood flow in response to physiological demands. The persistence of these dysfunctions over time may increase the risk of neurological outcomes, including stroke, cerebral edema, and cognitive impairment. Intracranial hypertension in turn may remain subclinical in patients with chronic hypertension, particularly when there is a gradual loss of intracranial compliance. This potential link highlights the need for further studies on the topic. Emerging evidence points to advances in noninvasive techniques for intracranial hypertension assessment, which may enable the early identification of altered intracranial dynamics and promote broader clinical application. Although the association between hypertension and intracranial hypertension has not yet been fully elucidated, the literature suggests overlapping mechanisms that may be clinically relevant. Combined assessment of blood pressure and intracranial parameters could represent a complementary strategy for better understanding cerebrovascular risk in selected populations. In this narrative review, we discuss the potential association between hypertension and intracranial hypertension, emphasizing their pathophysiological connections, contributing risk factors, and potential consequences for brain structure and function. Further research is needed to clarify these associations and their implications in clinical practice.

Introduction: Orthostatic hypotension (OH) is a prevalent disorder among the elderly, characterized by a marked decrease in blood pressure upon standing. It impacts 10-30% of elderly individuals and is linked to falls, cognitive deterioration, and cardiovascular issues. The primary factors include aging, autonomic dysfunction, and pharmaceutical usage.

Methods: This narrative review consolidates and examines contemporary research regarding the etiology, pharmacological effects, diagnosis, and treatment of orthostatic hypotension in elderly adults. A systematic technique was not employed; rather, expert analysis of the existing literature was utilized to distill essential ideas.

Results: OH in the elderly is frequently complex. Frequently involved drugs encompass diuretics, β-blockers, calcium channel blockers, ACE inhibitors, antidepressants, and antiparkinsonian ther-apies. These medications, within the framework of age-associated physiological alterations, elevate the risk of orthostatic hypotension. The diagnosis relies on monitoring blood pressure during changes in posture. Non-pharmacological interventions, including water, sodium consumption, compression garments, and physical movements, constitute first-line therapies. In chronic in-stances, pharmacological treatments such as midodrine, droxidopa, and fludrocortisone may be employed, albeit with vigilant monitoring due to potential deleterious effects.

Discussion: OH significantly affects the autonomy and quality of life of elderly individuals. Med-ication-induced orthostatic hypotension is frequently disregarded, particularly in the context of polypharmacy. Customized management, encompassing drug evaluation and integrated therapy approaches, is crucial. Clinical monitoring and regular orthostatic evaluations are essential for prompt diagnosis and management.

Conclusion: Effective OH management requires a personalized, multidisciplinary approach. Fu-ture research should focus on identifying reliable diagnostic biomarkers and developing individu-alized treatment algorithms to improve patient outcomes and support healthy aging.

Introduction: Sleep problems are increasingly recognized as a factor that may contribute to high blood pressure. Evidence in Asian populations, however, remains limited. This study explored the link between sleep quality and hypertension in middle-aged adults through a mixed-methods design.

Methods: A sequential approach was used, beginning with a cross-sectional survey of 492 adults aged 35-60 years who attended the outpatient clinic at Phramongkutklao Hospital. Sleep quality was assessed with the Pittsburgh Sleep Quality Index, while blood pressure was measured by standard procedures. Logistic regression identified predictors of hypertension. In the second phase, 15 participants with poor sleep and/or hypertension were interviewed, and transcripts were analyzed thematically.

Results: Poor sleep quality (PSQI >5) was strongly associated with hypertension (adjusted OR 7.54; 95% CI: 3.33-17.06; p < 0.001). Older age, alcohol use, and a family history of hypertension also emerged as independent risk factors. The qualitative findings highlighted three recurring issues: lifestyle and psychological obstacles to adequate sleep, low awareness of the connection between sleep and blood pressure, and limited counseling on sleep health in routine care.

Discussion: These results emphasize the importance of sleep as a modifiable risk factor for hypertension. The lack of awareness among patients and insufficient advice from healthcare providers point to gaps in current practice.

Conclusion: Poor sleep quality is a strong predictor of hypertension among middle-aged adults. Incorporating sleep assessment and education into outpatient services may help improve the prevention and management of hypertension.